Cleft Palatal Fistula: Perspectives on Management With Review of Literature

The goals of cleft palate surgery are an effective barrier between the nasal and oral air passages leading to functional outcomes in terms of speech, feeding and hearing for the affected child. But unfortunately, these goals are sometimes not easily attained and complicated by Cleft Palate Fistulas (CPFs), which adversely affects not only the child but also the parents. The principles of cleft palate surgery include a two-layer, tension-free, watertight closure with preservation of the greater palatine neurovascular pedicle. This article aims to give a broad review of the current perspectives in the management of this distressing complication.

Treatment of children with skin and soft tissue defects of distal phalanges of the fingers

Introduction. This article discusses the relevance of performing organ-preserving operations for traumatic skin and soft tissue defects in children. The author analyzes the traditional types of skin grafting procedures and their application in children. From the authors' point of view, the most acceptable skin grafting method is a displaced island flap on a neurovascular pedicle with direct blood flow. Materials and methods. The operating technique of lifting a displaced island flap on a neurovascular pedicle with direct blood flow is shown. The features of its implementation, the number of children, and their distribution by groups are shown. From 2016 to 2019, 15 children with traumatic defects of the distal phalanges of the fingers were operated on in the microsurgical Department of the Khabarovsk KKB No. 2 using a displaced neurovascular island flap on the leg with direct blood flow. The children ranged in age from four to 14 years. The number of children and the frequency of damage to the right and left hands was approximately the same. Results. Positive results of using this technique in the Department of Microsurgery of KKB No. 2 are presented. In all cases, it was possible to close the existing defects with the primary closure of the donor defect simultaneously; Sensitivity was preserved in all operated children, and movements in the finger joints were almost complete. Discussion. This flap method has undeniable advantages, although it is quite time-consuming and requires microsurgical skills, techniques, and appropriate equipment. The proposed skin grafting results are encouraging and satisfying for both doctors and children with parents. Conclusions. The authors recommend this skin grafting method for traumatic defects of the distal phalanges of the fingers in children.

The pulp switch flap: An option for the treatment of loss of the dominant half of the digital pulp

The fingertip has an important role in bi-digital pinch quality, and pulp loss is common and difficult to solve. The pulp switch consists of a pulp island flap with a homodigital neurovascular pedicle, vascularized by the palmar digital artery of the non-dominant pulp transposed to the dominant pulp side. We report the results in 16 patients treated for loss of the dominant half of a digital pulp from January 2000 to December 2008. On review after a minimum of 6 (range 6–18) months, the Weber’s test demonstrated an average of 8 mm in static 2 point discrimination test for all digits, except the ring finger. In the monofilament Semmes–Weinstein test, we obtained a score of 3.61 for the thumb and little fingers, and 4.31 for the other fingers. We did not find partial or total necrosis of the flap. The pulp switch flap gave satisfactory functional results for viability, sensitivity, and digital mobility providing a sensate bi-digital pinch with acceptable aesthetic results in a single surgical procedure.

Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap

Eighteen finger pulp defects were reconstructed using a homodigital dorsal middle phalangeal neurovascular island flap procedure based on a single neurovascular pedicle preserving the length of the finger. All flaps survived and achieved adequate functional and cosmetic results. The mean follow-up time was 22 months. The mean value of static two-point discrimination test of the healed flaps was 7 mm and the mean value of moving two-point discrimination test was 5 mm. Range of motion was considered satisfactory in all reconstructed fingers except one, in which a 20° extension deficit at the proximal interphalangeal joint was observed. This flap represents a useful alternative for reconstruction of the fingers with large pulp defects.