Masters Degrees (Plastic and Reconstructive Surgery)

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Browsing Masters Degrees (Plastic and Reconstructive Surgery) by browse.metadata.advisor "Graewe, F. R."

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    Modified total cranial vault remodeling technique for scaphocephaly repair
    (Stellenbosch : Stellenbosch University, 2015-12) Altaib, Mohamed Giuma; Graewe, F. R.; Zuhlke, Alexander; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Surgical Sciences: Plastic and Reconstructive Surgery.
    ENGLSIH ABSTRACT: Introduction: Sagittal synostosis or scaphocephaly is the most common isolated single-suture synostosis that accounts for 40% to 60% of all craniosynostosis cases which affects 1 out of 2000 live births. The craniofacial unit at Tygerberg Academic Hospital modified the technique of total vault remodeling by lag screw fixation of onlay bone segments in the temperoparietal region to: a) improve the stability of the reconstruction; b) to increase the biparietal distance; c) to reduce operation time; and lastly d) to avoid secondary procedures for the removal of titanium plates. The aim of this study was to evaluate the surgical outcomes of the modified total cranial vault remodeling procedure for the management of sagittal synostosis. Method: A retrospective study was employed to investigate the surgical outcomes of the modified total cranial vault remodeling technique for non-syndromic scaphocephaly repair by use of medical records of eight pediatric patients operated over thirty-two months from October 2011 to May 2014. The sample comprised three boys and five girls with an age range of 4 months to 5 years and 7 months. The head circumference was measured pre- and post-operatively and the parents’ satisfaction recorded. The surgical duration of the modified procedure and the patients’ blood transfusion volume was compared to the unit’s traditional approach. Results: The head circumference of all patients increased on the percentiles of the head circumference-for-age growth chart. Pre-operatively a mean of 47 cm and post-operatively a mean of 50.94 cm were measured. Parents were generally satisfied with the aesthetic outcomes of the surgery. The average volume for intraoperative blood transfusion was 230 ml compared to 763 ml for the conventional method. The average surgical time decreased from 5.5 hours with the conventional method to 3.4 hours with the modified technique. Conclusion: The modification of the cranial vault remodeling increased the head circumference, yielded good parental satisfaction, decreased the surgery time and intraoperative blood transfusion volume with complications comparable to the traditional method.
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    Reconstruction of the lower eye lid with a rotation-advancement tarso-conjunctival cheek flap
    (Stellenbosch : University of Stellenbosch, 2010-12) Wessels, William Louis Fick; Graewe, F. R.; Van Deventer, P. V.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Surgical Sciences. Plastic and Reconstructive Surgery.
    The repair of full-thickness defects of the lower eyelids poses a challenge because a graft in combination with a flap is typically used to replace either the posterior or anterior lamella. This often results in aesthetically and functional unsatisfactory outcomes. A rotation-advancement tarso-conjunctival cheek flap, which reconstructs both posterior and anterior lamella with vascularized tissue similar to the native eyelid, is described. Nine patients underwent reconstruction with a rotation-advancement tarso-conjunctival cheek flap. The indications, complications and outcomes were evaluated. The follow-up time ranged from 6 to 60 months with an average of twenty three months. The main indication for use of this flap is full-thickness defects of the lower eyelid between 25 – 75 %, typically after tumour ablation. All the patients had a functional and aesthetically satisfactory outcome. One patient underwent a revision canthoplasty. The rotation-advancement tarso-conjunctival cheek flap adheres to basic plastic surgery principles resulting in a satisfactory outcome; (a) Vascularized tissue is used to reconstruct the defect. (b)The flap composition is similar to the native eyelid i.e. replace like with like. (c) The flap makes use of tissue that is excess and therefore limits donor morbidity.