Cartilage Resection Research Articles

Updated Dynamics of Rhinoplasty: A Review of the Literature and Comprehensive List of the Findings

The cardinal reason accounting for the complexity of rhinoplasty is that each maneuver during this operation has both intended and unintended effects. The purpose of this report is to review the literature and update the dynamics of rhinoplasty. PubMed searches were conducted for "rhinoplasty dynamics" as well for keywords associated with each specific rhinoplasty maneuver. Titles were evaluated for relevance, and duplicates were consolidated with years of publication 1991 to 2019. Article types include case series (retrospective and prospective), cohort studies, and review articles. Beginning with the radix, its reduction apparently elongates the nose and widens the intercanthal space, while radix augmentation creates the opposite illusions. In a similar manner, dorsal hump reduction widens both the nose and intercanthal space. Nasal tip dynamics focus on the aftermath of changes to tip projection, width, and rotational position. Resection of the upper lateral cartilages can cephalically rotate the tip and reduce tip width. Manipulation of the footplates of the medial crura primarily influences the columella but can also affect tip projection. Placement of a columellar strut firmly establishes tip position. Placement of alar rim grafts advances the ala caudally, widens the nostrils, and elongates the short nostril. Alar base reduction can create the illusion of increased tip projection. Augmentation and reduction in the anterior nasal spine influence tip projection, upper lip length, and the nasolabial angle. As rhinoplasty techniques continue to evolve, surgeons undertaking this operation must continue to reassess the dynamics of various maneuvers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

ПРОБЛЕМЫ ВТОРИЧНОЙ РИНОПЛАСТИКИ

Every year, there has been a steady increase in the number of rhinoplasty. At the same time, the patient’s demands for these surgery are also increasing. Therefore, unsatisfactory functional and aesthetic results after rhinoplasty require repeated (revision) operations. The secondary rhinoplasty itself is more complex than the primary operation. Incorrectly performed rhinoplasty and iatrogenic tissue damage lead to deformities that require repeated reconstructive interventions. The reasons for the unsatisfactory results of rhinoplasty can be different. In assessing the results of rhinoplasty, the surgeon’s opinion may not be ambiguous with the patient. Often, when the surgeon considers the rhinoplasty result to be acceptable, the patient may be unhappy. In the postoperative period, deformities of the tissues of the nose may be due to the rough scars, and an infectious process. Еxcessive cartilage resection, insufficient or excessive osteotomy lead to deformities that require repeated reconstructive interventions. For secondary rhinoplasty, it is necessary to take into account all tissue deformations to eliminate them in one stage. Sometimes after the second, third or more operations performed, the result of revision rhinoplasty is difficult to predict, so the surgeon must predict the expected outcome result. Keywords: Secondary rhinoplasty, nasal meatus, nasal septum deviation, septoplasty.

Хондросаркома гортани

The chondrosarcoma of the larynx is a poorly understood and rare malignant tumour. It accounts for only 1% of malignant neoplastic pathology of the larynx, but at the same time it is the most common non-epithelial neoplasm of the larynx. More often occurs in the area of the cricoid cartilage, namely the inner plate, less often in the area of the vocal folds and the epiglottis. There are no clinical guidelines for the treatment of chondrosarcoma of the larynx, therefore each clinical case describing clinical observations of this rare tumour is of interest. A clinical case of chondrosarcoma of the larynx is presented in a 55-year-old man who complained of hoarseness for 3 months. The patient underwent a complete clinical and instrumental examination, but computed tomography (CT) is of the greatest value. According to CT data, a calcified mass is visualized in the cricoid cartilage. At the first stage, the patient underwent resection of the cricoid cartilage in order to verify the diagnosis. Histological examination: low-grade chondrosarcoma. At the second stage, a radical surgical treatment was performed - laryngectomy. 8 months after the operation, the patient has no data on the relapse and progression of the disease according to the survey data. Currently, total laryngectomy is preferred for patients with recurrent low-grade chondrosarcoma. However, a literature review and our case show that the inability to restore the cricoid cartilage of the larynx, which is affected in most cases, often leads to laryngectomy

Effect of cutting parameters on cutting force and surface quality in cutting of articular cartilage

In this paper, we studied the influence of cutting parameters on cutting force and surface quality during resection of articular cartilage, which has not previously been investigated to any great extent. Triangular tooth shaver and porcine articular cartilage were used in this paper. The results showed that cutting parameters had similar influence on cutting force and surface quality. Compared with feed rate, spindle speed and axial depth of cut, radial depth of cut played a main role. Empirical formula of cutting force is established. In order to obtain low cutting force and good surface quality, the preferred combination of process parameters was radial depth of cut of 0.2 mm, axial depth of cut of 0.5 mm, spindle speed of 4000 rpm and feed rate of 400 mm/min.

Minimally Invasive Sacroiliac Joint Fusion

Background:Minimally invasive sacroiliac (SI) joint fusion is indicated for low back pain from the SI joint that is due to degenerative sacroiliitis and/or sacroiliac joint disruption. This technique is safe and effective in relieving pain uncontrolled by nonoperative management1-4. There is some controversy, but there continues to be increasing evidence of effectiveness.Description:This procedure is performed, with the patient under general anesthesia and in the prone position, using fluoroscopy or 3-dimensional (3D) navigation such as cone-beam computed tomographic (CT) imaging. After navigation setup, a navigated probe is used to approximate the desired location of each implant and trajectory. These positions are marked on the skin, and the skin is incised. A 3 to 5-cm lateral incision is made. The gluteal fascia is bluntly dissected to the outer table of the ilium. A guide pin is passed across the SI joint and into the center of the sacrum lateral to the neural foramina, which is confirmed with imaging. This is then drilled and broached. Triangular titanium rods are placed. Typically, 3 implants are placed, 2 in S1 and 1 in S2. Multiplanar postplacement imaging of the pelvis is obtained. The wound is irrigated and closed in layers.Alternatives:Nonsurgical alternatives have been reported to include pharmacological therapies, such as nonsteroidal anti-inflammatory drugs, therapeutic SI joint blocks5, and physical therapy, such as core stabilization, orthotics (SI belts), and radiofrequency ablation1,2,6-8. The surgical alternative is an open anterior or posterior approach with SI joint arthrodesis. The anterior approach differs by the resection of the SI joint cartilage, the use of a plate or screws across the joint for stabilization, and the packing of bone graft to facilitate fusion9. These are more morbid and have a much longer recovery.Rationale:Conservative management for SI joint pain is inadequate for all patients. Having 3 of 5 positive physical examination maneuvers7, having confirmatory diagnostic block(s)10, and ruling out the hip or spine as the pain generator provide a success rate of >80%. These patients have early and sustained clinically important and significantly improved outcomes across varying measures compared with conservative treatment1-4,11,12.Expected Outcomes:Patients can expect to experience decreased pain, reduced disability, increased daily function, and improved quality of life soon after the procedure is performed. These patients typically have an improvement of ≥50% in the Oswestry Disability Index score and a clinically significant decrease in visual analog pain scores13. The procedure appears durable through at least 5 years14. Complete pain relief is rare, but clinically important improvement is typical.Important Tips:Proper setup of the navigation system or fluoroscopy is needed to ensure accurate starting points.For 3D navigation, use a reference pin in the contralateral posterior superior iliac spine.Although navigation is used, radiographic images are made periodically to confirm proper placement of guide pins and implants. Images provide the greatest benefit when establishing navigation, after guide-pin placement when an outlet view allows for evaluation of pin depth, and after implant placement to confirm proper placement.Blood loss is generally low, but care should be taken to avoid vascular injury. Although rare, improper placement has led to injury of the superior gluteal artery15 and iliac artery16. This can be avoided by staying in bone.Proper placement of the implant is imperative in this procedure. There is the potential for nerve injury with improper placement of the implant: an L5 nerve injury if the implant is too ventral or an S1 or S2 nerve injury if the implant is too deep and into the foramen. Revision surgery is commonly due to nerve root impingement and/or malpositioning.Preoperative 3D imaging is indicated when it is necessary to rule out differential diagnoses that mimic SI joint pain. This enables the surgeon to rule out intrapelvic pathology, assess sacral bone density17, and identify dysmorphic sacra or transitional vertebrae.

Costal cartilage resection for the treatment of slipping rib syndrome (Cyriax syndrome) in adults.

Slipping rib syndrome is an overlooked cause of low chest or upper abdominal pain. Costal cartilage excision has been described as an effective treatment of this disorder. We review our experience with surgically treated slipping rib syndrome in the adult patient. This is a single institution retrospective analysis from January 2000 to March 2019 of adult patients operated on for treatment of a slipping rib syndrome. Nineteen patients were diagnosed with slipping rib syndrome and underwent costal cartilage excision. All patients presented with unilateral and life disturbing chest pain (8 left sided). In all cases, point tenderness was observed with palpation and hooking maneuver was positive. Each patient underwent imaging and ultrasonography suggested slipping rib syndrome in one case. A mean of 1±0.2 cartilages was excised. Early postoperative course was uneventful in all the cases. Follow-up was complete for all patients over a median of 18.7±12 [3-132] months. At postoperative month 2 follow-up, 15 on 19 patients had complete resolution of their symptoms. At late interviews, 6 out of 19 patients described recurrent pain, whose intensity was significantly lower. We observed significant differences about pre-operative and post-operative visual analog pain (EVA) (8.07±0.75 vs. 2±2.3, P<0.005), weekly pain crises (6.25±2.7 vs. 1.6±2.1, P<0.005) and morphinics consomption (9/19 vs. 2/19, P=0.029). Fourteen patients out of 19 nineteen strongly recommended surgical intervention. Slipping rib syndrome of the adult is an overlooked cause of chest or abdominal pain which diagnosis and treatment are often delayed. Costal cartilage excision allows short to mid-terms effective and reliable treatment to reduce symptoms and life disturbance but does not exclude late pain recurrence.

Long-term results after the modified Ravitch procedure performed in children and adolescents - a one-time procedure without the need to use additional support of the sternum. A retrospective study.

IntroductionPectus excavatum is a depression of the sternum. Pectus carinatum, in contrast, is the convexity of the sternum. The mixed form is an intermediate condition. Surgical intervention is the treatment of choice. The techniques most commonly used include the Ravitch and the Nuss procedures.AimTo assess the immediate and long-term results of the original modification of the surgical treatment for anterior chest wall deformation.Material and methodsThe modification is based on the Ravitch procedure. The difference is that the ends of the resected cartilages are shaped like a blade in order to be inserted into the previously prepared wedge-shaped hollows located on both edges of the sternum. The result is long lasting without the need to use additional brackets.ResultsThe follow-up examinations performed in 72 patients, including 57 boys and 15 girls, were the basis to produce long-term results. As for the type of deformity, out of 57 patients operated on due to pectus excavatum, 43 expressed satisfaction with the very good result. Similar satisfaction was reported in 7 out of 11 patients operated on due to pectus carinatum. There were 4 cases with the mixed form who had very good long-term results. Wound dehiscence was observed in 13 subjects, with one documented recurrence.ConclusionsThe alternative treatment we propose is a one-time procedure without the need to use additional support of the sternum. Good long-term results make the procedure suitable to be used more frequently in all types of deformities.

Partial Resection Versus Complete Resection of Costal Cartilage in Breast Reconstruction by DIEP Flap

Background: Breast reconstruction is a vital component of the overall treatment plan of breast cancer patients. Surgical breast reconstruction is not only desired by most patients, but is recommended by law in many countries. Aim of the Work is to compare between partial resection and complete resection of costal cartilage in breast reconstruction by DIEP flap as regard postoperative pain mainly and other factors as operative time, blood loss, blood transfusion, and hospital stay. Patient and Methods: Forty patients were recruited in this study and were divided into 2 groups, 20 patients underwent breast reconstruction by DIEP flap with partial resection of costal cartilage and 20 patients underwent breast reconstruction by DIEP flap with complete resection of costal cartilage. Results: DIEP flap with partial resection of costal cartilage does in fact cause less postoperative pain than DIEP flap with complete resection of costal cartilage. Conclusion: The DIEP flap is an excellent choice for breast reconstruction, and is usually the first choice of flap for breast reconstruction in our practice. Over the past 3 years in our practice it has shown to be safe and reliable and provide a breast reconstruction with a superior long-term result with minimal donor site morbidity.

The Regenerated Tissue at the Donor Site After Costal Cartilage Harvest for Auricular Reconstruction.

To observe and summarize the nature of the regenerative tissue at the donor site after harvesting costal cartilage for auricular reconstruction and to explore the contribution of the perichondrium to the regeneration of costal cartilage in the clinic. From January 2016 to June 2017, 23 patients with microtia who were performed chest computed tomography (CT) after costal cartilage harvest for ear reconstruction were reviewed. And they had the surgery for at least 6 months. Of 23 patients, 17 patients were males and 6 were females; these patients were aged 7 to 43 years (mean age, 15.2 years). The authors divided the patients into 2 groups according to whether the perichondrium was retained or not. Group 1 was patients with intact perichondrium, total 20. Group 2 was patients with damaged perichondrium, total 3. Every patients' regenerative tissue CT value at the donor-site region of costal cartilage was measured and recorded. In addition, 2 regenerated tissue samples for examined histologic evaluation by hematoxylin and eosin stain were collected. Of 23 patients, regenerated tissue with high CT value (above 100 Hounsfield unit [Hu]) was observed in 19 (82.61%) patients from group 1. And the direction of the regenerated tissue is roughly similar to that of the resected cartilage in the early surgery. Of 4 patients (1 from group and 3 from group 2), nothing on the donor site was found. From histologic evaluation, fibrocalcific tissue was seen, and cartilage cells were not seen in 2 patients with high CT value. Clinical observation presented that regenerative tissue at the donor site after harvesting costal cartilage, leaving the subjacent perichondrium completely intact, was mostly fibrocalcific tissue rather than cartilage tissue. The authors suspect that the perichondrium itself may not have regenerative power, but as an envelope for regeneration, perichondrium has a role.

Outcomes Following Transoral Laser Microsurgery With Resection of Cartilage for Laryngeal Cancer.

The ability to treat more advanced laryngeal cancers by transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety. We describe a retrospective review of patients undergoing resection of the thyroid cartilage during transoral laser microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included. Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration. We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.

Pediatric thyroglossal duct cysts: Post-operative complications

IntroductionThyroglossal duct cysts (TGDCs) result from incomplete involution of the thyroglossal duct and are resected with a Sistrunk-procedure. We studied and graded severity of postoperative complications in children who underwent this procedure, with corresponding risk factors. MethodsIn our electronic health record system we reviewed the medical records of all patients aged <18 years, with surgically treated TGDC between 01-01–2005 and 31-12-2015 in two university hospitals. Risk factors (age, gender, recurrence at presentation, treatment hospital, cyst inflammation, cyst rupture, drain placement, antibiotics or postoperative infection) were studied by univariate analysis. The Clavien-Dindo surgical complication classification was used as postoperative surgical grading system. ResultsOf the ninety-one patients, with a mean age of 4.4 years, seven were referred from other hospitals with a recurrent TGDC. 24 patients (26.4%) had a complication. Hemorrhage and resection of thyroid cartilage were the most severe complications. Recurrence and wound infection (both n = 7, 7.7%) were most common. We could not identify risk factors for these complications. ConclusionsThe treatment of children with thyroglossal duct cysts shows a considerable amount of complications. Pre-selected risk factors did not show any significant correlation with these complications.

Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes.

Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Continuous Flow Ventricular Assist Device Implantation in Non Dilated Cardiomyopathy Pediatric Patients Using Complimentary 3D Techniques

Purpose Continuous flow ventricular assist devices (CFVAD) are increasingly being used in pediatric patients. We present our technique using preoperative virtual fit using 3D imaging and intraoperative 3D printed CFVAD model to assess fit in pediatric patients. Methods 3D imaging was used to assess chamber cavity size relative to the CFVAD. Additionally a novel 3D printed CFVAD model designed in SolidWorks (Waltham, MA) was printed with biocompatible material (Figure 1A) was used intraoperatively to assess fit. The model inflow was used to limit inflow projection as desired using Teflon washers (Figure 1B). The washers were telescoped on the model inflow with the sewing ring and fixed with four interrupted 3-0 prolene sutures to avoid malalignment, and ease the use of the coring device and CFVAD implantation. Results 3 patients (2-non compaction cardiomyopathy, 1-transplant graft dysfunction) underwent CFVAD implantation (2 LVAD and 1 BiVAD) using these techniques. Intrathoracic fit was obtained by incising the pleuropericardial folds, release of hemidiaphragm or remodeling of anterior chest wall (for RVAD). As predicted by the model, sternal closure could only be achieved after costal cartilage and rib segment resection in 1 patient who needed BiVAD. Postoperative VAD flows were satisfactory in all patients. Conclusion Combination of preoperative virtual fit assessment using 3D imaging and intraoperative fit using 3D printed model of VAD can be used to accurately determine fit of adult CFDs in pediatric patients. The 3D model is useful in tailoring the maneuvers needed to achieve uncomplicated intracardiac, intrapericardial and intrathoracic fit and sternal closure.

Surgical closure of the larynx with partial resection of the cricoid cartilage (Kano’s method) in a patient who developed tracheal stenosis after tracheotomy

Surgical closure of the larynx with partial resection of the cricoid cartilage (Kano’s method) in a patient who developed tracheal stenosis after tracheotomy

Histopathological effects of septoplasty techniques on nasal septum mucosa: an experimental study.

The aim of this study is to evaluate the histopathological effects of septoplasty techniques on the nasal septal mucosa of rabbits with light and electron microscope. The study was performed on 21 rabbits between August 2016 and February 2017. Rabbits were randomly divided into three groups. In Group-1, while preserving the L-strut structure of the septum, cartilage resection, was performed by open technique septoplasty. In Group-2, the same procedure was done except the resected cartilage was crushed and put back in place. No surgical procedure was performed on the Control group. Postoperative 2nd month; the specimens were histopathologically evaluated by light and electron microscope in terms of changes in the morphology of septum mucosa, perichondrial thickness, cilia and goblet cell deprivation, loss in glands, fibrosis and inflammatory cell infiltration in the lamina propria. The deprivation in cilia, goblet cells, serous gland and increase in the amount of collagen fibers were examined in both Group-1 and 2. The difference in Group-1 and Group-2 were statistically significant in terms of presence of cilia, number of goblet cells and glands and increase in collagen fibers when compared to control (p < 0.001, p = 0.002, p = 0.020, p = 0.002, respectively). In terms of perichondrium thickness, statistically significant difference was found between the Control and Group-2 (p < 0.001). CONCLUSıON: In this study, histopathological findings supported that the presence of cartilage in the septum is necessary to prevent the mucosal changes. Long-term studies are needed to observe whether changes in the morphology of epithelium and gland proceed more than 2 months follow-up.

Effects of articular disc or condylar cartilage resection on mandibular growth in young rats

ObjectiveThis study was aimed to compare the effects of articular disc and condylar cartilage resection on mandibular growth in Sprague Dawley rats. DesignEighty-four male Sprague Dawley rats (age = 4 weeks) were grouped according to the following procedures: group A (n = 21), exclusive surgical exposure of articular disc and condylar cartilage; group B (n = 21), exclusive surgical resection of articular disc; group C (n = 21), exclusive surgical resection of condylar cartilage; group D (n = 21), surgical resection of both articular disc and condylar cartilage. All surgery was performed in unilateral. One rat was killed in each group immediately after the surgery. Hematoxylin and eosin (H&E) staining was used to confirm the completely removal of the disc or cartilage. Five rats in the four groups were sacrificed in 1, 3, 6, and 9 weeks post-operation. The heights and lengths of the mandibles were measured and analyzed statistically. ResultsThe mandibular height of group D (5.01 ± 0.25 mm) was statistically lower than group A (5.59 ± 0.17 mm) at 1 week post-operation. The height of group C (5.62 ± 0.26 mm) was significantly lower than group A (6.27 ± 0.31 mm) 3 weeks after surgery. The height of group B (6.38 ± 0.36 mm) was significantly lower than group A (6.95 ± 0.10 mm) 6 weeks after surgery. At 9 weeks post-operation, the mandibular heights in groups B, C, and D were lower than group A, group D was lower than group C, and group C was lower than group B. The lengths of the mandibles were not significantly decreased until 9 weeks post-operation in group D. ConclusionsThe increase in mandibular height was interfered after either articular disc or condylar cartilage was resected, and mandibular height deficiency likely occurred earlier and more severely when cartilage was resected. However, the increase in mandibular length was barely interfered when either articular disc or condylar cartilage was resected.

Endonasal Triangular Technique for nasal valve rhinoplasty: a ten year review

The nasal valve is the main regulator of airflow in the nose. Consequently, the collapse of the nasal valve has a significant impact on nasal obstruction and hence quality-of-life of patients. Several nasal valve rhinoplasty techniques are being used, from cartilage grafts to endonasal resection of the upper lateral cartilage. We describe a new endonasal approach to nasal valve rhinoplasty, the Triangular Technique, and assess its efficacy and complication rate over ten years. A retrospective study of patients who underwent nasal valve rhinoplasty at three regional hospitals from Jan 2004 to May 2014 was conducted. Subjective reports were used to assess the improvement of nasal obstruction. 24 patients were included. 3 months postoperatively, 19 patients reported improvement in nasal obstruction. 4 patients required revision surgery. 2 of these 4 patients had substantial symptom resolution post revision surgery. 10 patients were followed up for more than 5 years (range: 5.8 to 10.3 years), 9 of who reported continued satisfaction and none or minimal nasal obstruction after nasal valve rhinoplasty compared to before surgery. There were no reported complications. The Triangular Technique is a straightforward endonasal technique to address collapsed nasal valves with minimal associated co-morbidities.

Correcting the Cleft Lip Nose Deformity: The Graft Number 1 for the Columella.

The nose deformity associated with cleft lip is difficult to solve in the primary and secondary surgery. In an adult patient, many techniques are used including mobilization, suspension, fixation and trimming the alar cartilages, septoplasty, nasal bones osteotomies, and dorsal bone and cartilage resection. Different types of cartilage grafts are commonly used. A septal cartilage graft was used in 75 adult patients with mild to severe cleft lip deformities. Based on the golden ratio proportions of the columella that can be observed in the lateral view, a septal cartilage graft with a number 1 shape was created and inserted between the medial cruras in 75 patients, with unilateral or bilateral cleft lip, between 2007 and 2014. Complementary surgery was done in the nose of all the patients. A retrospective, observational, and descriptive study was made with presurgical and postsurgical photographs, throughout a 6-month follow-up period. Excellent cosmetic and functional results were seen, especially in the lateral view. There was 1 septal perforation reported. The patients were satisfied with the aesthetic results. The graft number 1 works in the reality; it has proven to be a stable support to the affected cartilage, projects a nice nasal tip, and is a lasting solution for adults.

Distal sternectomy for post-sternotomy chronic osteomyelitis

Sternal chronic osteomyelitis following median sternotomy is a severe complication of open cardiac surgery, presenting as purulent draining sinus tracts in patients with a closed sternal wound. First-line treatments are repeated curettages, conservative debridements, aggressive antibiotic therapy and the application of negative pressure to wound to accelerate the wound-healing process and promote granulation tissue formation, by using the vacuum-assisted closure device. Recalcitrant infections may require sternectomy and resection of all infected costal cartilages for complete eradication of the infection. Here we report a case of recalcitrant post sternotomy osteomyelitis treated by distal sternectomy and reconstruction by absorbable mesh.

Repair of pectus carinatum by a modified Ravitch technique combined with postoperative bracing

Abstract A 13-year-old boy with pectus carinatum was successfully treated by modified Ravitch's techniques combined with short-term orthotic bracing. No sternal osteotomy and less extensive resection of costal cartilage were performed. This minimally invasive surgery is safely and effectively in pubertal patients with pectus carinatum.