Good Cosmetic Appearance Research Articles

Clitoroplasty: A variant of the technique by Acimi

ObjectivesTo evaluate the mid-term results of clitoroplasty through the reduction of the length and diameter of the corpus cavernosum, as well as the volume of the glans. Patients and methodsFrom October 2003 to July 2015, we performed 29 clitoroplasties using the described procedure. The median (range) age of the patients was 18 (3–47) months. After surgery we evaluated the volume of the clitoris, the appearance of glans, and its sensitivity to light touch, pressure, and pain. ResultsThe length of the apparent part of the glans remained large (>10 mm) in four patients (14%), was an average size (between 5 and 10 mm) in 11 (39%), and small (<5 mm) in 13 (46%). The length of the corpus cavernosum was <20 mm and its diameter <5 mm in all cases. The sensitivity of the reduced clitoris to touch, pressure and pain seemed normal in all patients. In addition, we never found the circumflex arteries and nerves of the penis (on histological examination of excised pieces of corpus cavernosum) in all children operated on during the first 3 years of life. The circumflex arteries of the penis begin to develop, only after the fourth year. This anatomical finding is an argument for performing clitoroplasty at an early age to avoid any risk of intraoperative and postoperative bleeding. ConclusionsThe sensitivity of the clitoral glans appeared to be normal in all cases, with a good cosmetic appearance of the external genitalia in most patients.

Minimally Invasive Pericranial Flap for Reconstruction after Endonasal Endoscopic Surgery of 30 Consecutive Patients

Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not always available because of nasal septum invasion. Minimally invasive pericranial flaps (PCF) are associated with minimal adverse effects and good cosmetic appearance. In spite of that, there are only a few reports of this reconstructive technic limited to short surgical series and radio-anatomical analysis. Clinical results of a surgical cohort are presented. Study Design: Cohort prospective study. Methods: Clinical data, including age, gender, stage, histopathological findings, rate of complications and appearance of PCF at fifth day and two months postoperative were recorded. Postoperative morbidities were recorded as wound abnormalities, nasosinusal, orbital and central nervous system complications. Chi-squared test was used to correlate qualitative variables and Student-t-test to correlated qualitative and quantitative variables. Items were considered statistically significant with a p value of less than 0.05 (confidence Interval of 95%). Results: Thirty patients (18 males and 12 females) were registered. Mean age was 51.5 years ± 23.0 and range between 20 and 71 years. Most common histologic subtypes were adenocarcinoma, epidermoid carcinoma and squamous cell carcinoma. Complete resection of the tumor was achieved in all patients including surgical margins. Length of the PCF varies between 9.9 cm and 13.9 cm with a mean of 11.8 cm. There was an association between length of the flaps and the covering structure with the nose apex relation. None patient experienced postoperative cerebrospinal fluid (CSF) leak, frontal sinusitis or other complications. Conclusions: Minimally invasive PCF constitute a good and inexpensive reconstructive option in patients with malignant anterior cranial base tumors in whose nasoseptal flap was not a feasible option.

Prospective randomized comparative study of skin adhesive glue (2- methyl -2- cyanopropionate or cyanoacrylate) versus conventional skin suturing by suture material/skin stapler in clean surgical cases

Background: To compare cosmetic appearance of skin closure wound by three methods -sutures, staples and skin adhesive glue. Traditional skin closure using sutures causes more pain, infection, needs its removal, time consuming and leaves behind bad scar. Nowadays, good cosmetic appearance of operated site is appealing among patients. Surgeons are looking for faster, comfortable and cosmetically best technique for skin closure. Newer techniques need to be evaluated which are better than suture and staples. 2-octylcyanoacrylate is easier to use, flexible, water resistant, pain free sealed skin closure without its need for removal and has better cosmesis.Methods: This study is conducted from July 2010 to April 2013 in 90 patients at LTMG Hospital. Wounds of clean surgeries closed with suture material, skin staples and skin adhesive glue were studied in 30 patients each. Patients were randomized using standardized methods. Patients followed up over period of 28 days and their scars were assessed according to the modified Hollander cosmesis scale(MHCS) and cosmetic visual analogue scale(VAS). Patient allotment was done using random number table.Results: Mean MHCS score for skin adhesive group on day 7 was 4.83 which was significantly more than 3.90for suture and 3.97 for stapler. Mean VAS score for skin adhesive group on day 7 was 67.67 which was significantly more than 61.67 for suture and stapler each. Mean MHCS and VAS score for skin adhesive group on day 7, 14 and 28 were significantly more than suture and stapler groups.Conclusions: Octylcyanoacrylate can be used for skin closure in clean elective surgeries with better cosmetic outcome as compared to staples and sutures.

The advantages of transumbilical single-site laparoscopic percutaneous extraperitoneal closure for inguinal hernia in 1583 children.

There have been numerous surgical procedures for inguinal hernia in children, and recently the novel technique of single-site laparoscopic procedure was introduced. This study aimed to analyze the safety and efficacy of single-site laparoscopic hernia repair in a large number of children, while compared with the traditional open surgery. From January 2012 to June 2015, we performed transumbilical single-site laparoscopic percutaneous extraperitoneal closure (TSLPEC) in 1583 patients, including bilateral hernia in 135 cases, and unilateral hernia in 1448 cases (left side in 582, right side in 866). From January 2007 to January 2010, we performed open inguinal hernia repair in 355 patients, including bilateral hernia in 52 cases, and unilateral hernia in 303 cases. Operating time, recurrence rate, incidence of contralateral hernia, and prevalence of contralateral patent processus vaginalis (cPPV) were recorded and compared. A total of 1583 patients underwent TSLPEC, without conversion to open surgery. For unilateral repair, the average operating time in TSLPEC group was shorter than open repair group (19.3 ± 6.1 vs. 28.0 ± 8.9, p < 0.05), and it was much shorter than open repair group for bilateral repair (26.2 ± 9.5 vs. 49.8 ± 12.9, P p < 0). The left hernia had higher prevalence of cPPV than right hernia (48.1% vs. 38.5%, p < 0.05). The wound recovered well with good cosmetic appearance in TSLPEC group. Hernia recurrence occurred in seven cases (0.4%) of TSLPEC group, and six cases (1.7%) of open repair group ( p < 00.05). No contralateral hernia developed in TSLPEC group, while 17 cased (5.6%) had contralateral hernia in open repair group ( p < 00.05). TSLPEC is an effective and safe procedure for inguinal hernias with lots of advantages, including short operating time, simultaneous management of cPPV, excellent cosmetic appearance, low incidence of contralateral hernia, and low recurrence rate. This procedure could be recommended as a routine treatment for inguinal hernias in children.

Pedicled preputial island flap for double functions in hypospadias surgery.

To use the prepuce for double functions one as a second layer for the neourethra to decrease the incidence of urethrocutaneous fistula and the second as a skin covering for the ventral aspect of the penis. From January 2013 to December 2016, 37 cases of hypospadias with mild to moderate chordee were included in this study. The cases with ventral penile skin defect were managed by tubularized incised plate urethroplasty (TIPU) using pedicled preputial flap. Recurrent cases, cases with severe chordee which necessitated division of the urethral plate, and cases with penoscrotal hypospadias were excluded from this study. Thirty-seven cases of hypospadias aged 9-60 months with a mean age of 24.8 months were included in this study. Coronal (n= 9 cases; 24.3%), distal penile (n=11; 29.9%), and midpenile hypospadias (n= 17; 45.9%) were detected in respective number of patients. Postoperative complications consisted of external meatal stenosis (n=2; 8.1%), and one case with urethrocutaneous fistula. Skin necrosis was not reported in this study. Follow-up visits were performed at 1, 3 and 6 months which showed good cosmetic appearance that was accepted by their parents. This technique was beneficial in decreasing the rate of skin necrosis, as it keeps the blood supply to the preputial skin intact, and decreases the incidence of urethrocutaneous fistula.

Angular Effects of Z-Plasty Technique on Extent of Relaxation of Contracted Scar, Cosmetic Appearance and Tip Necrosis in Dogs

Z-plasty is a plastic surgery technique which is used to improve the functional and cosmetic appearance of a scar by redirecting it into better alignment and allowing the closure of a large wound by increasing circumference of its orifices. This experimental study was executed to evaluate the extent of relaxation of contracted scar, cosmetic appearance and tip necrosis in dogs by using Z-plasty technique at different angles, i.e. 45°, 60° and 75°, respectively. 18 mongrel dogs were randomly selected and divided in three groups (A, B and C) comprising six dogs each; after induction of scar tissue, Z-plasty was applied at 45° in Group A, 60° in Group B and 75° in Group C, respectively. % Gain in length was superior for the 60° group (P<0.05), as compared with the 45° and 75° Z-plasty, respectively. Tip Necrosis Status and cosmetic appearance for the 60° group were also found superior (P<0.05) than at 45° and 75°, respectively. The results of the experimental trial showed that the parameters of extent of relaxation of the contracted scar, cosmetic appearance and tip necrosis, were mainly governed by two factors, (1) length of contracted scar and (2) angle of Z-plasty technique. Conclusively, 60° Z-plasty serves a better option for correction of burn scar contractures since it provides average gain in length, good cosmetic appearance and causes no tip necrosis.

Application of ultrasound-guided vacuum-assisted percutaneous excision technique in non-palpable breast lesions

Objective: To determine the efficacy of ultrasound-guided vacuum-assisted percutaneous excision technique in treating non-palpable breast lesions. Materials and Methods: Between January 2012 and November 2014, a total of 452 non-palpable breast lesions diagnosed by ultrasonography in 400 patients were treated by ultrasound-guided vacuum-assisted percutaneous excision. All patients received pressure dressings, which were removed after 48 hours, then rechecked after three months. Results: Ultrasonography clearly displayed all 452 breast lesions during the mammotome biopsy. The operative process was successfully guided. All patients were free from infections or pneumothoraces, as well as skin lesions; four patients developed postoperative local hematomas and five patients had local bruising. The incidence of local hematomas was 6.0% (27/452). One mass residue was detected during the ultrasonographic follow up after three months. Conclusion: Ultrasound-guided vacuum-assisted percutaneous excision for non-palpable breast lesions has advantages, including simple operation, accurate positioning, safety, minimal invasion, fewer complications, rapid recovery, and good cosmetic appearance. It can substitute the traditional surgical approach and is thus recommended as an alternative minimally invasive technique.

Superficial Automated Keratopigmentation for Iris and Pupil Simulation Using Micronized Mineral Pigments and a New Puncturing Device: Experimental Study.

To study the outcomes and tolerance of micronized mineral pigments for corneal tattooing, using a superficial automated keratopigmentation (SAK) technique in an experimental animal model and a new puncture device to inject the pigments into the corneal stroma. Forty eyes of 40 New Zealand rabbits were included in this study. The animals were divided into groups A and B. Both groups underwent SAK using a new automated keratopigmentation device. Micronized mineral pigments were injected through the epithelium into the corneal stroma to replicate the iris color in 25 eyes (group A), and black color was used to replicate the pupil in 15 eyes (group B). Slit-lamp examination was performed to evaluate the outcome. Histopathological examination was also performed to ascertain the presence of pigment dispersion, inflammation, and/or neovascularization. All 40 eyes showed good cosmetic appearance after keratopigmentation. No intraoperative complications were detected. At the first week, mild or moderated conjunctival injection was observed in 13 eyes and transitory corneal epithelial defects were also detected in 27 eyes. Examination was unremarkable 2, 4, and 6 months after surgery. No neovascularization was detected in any case in the histopathology study. SAK using a new automated puncture device and micronized mineral pigments achieved good cosmetic outcomes for iris and pupil simulation. This method could be a valid alternative to treat serious cosmetic eye problems that affect the superficial cornea or functional problems, such as photophobia or diplopia secondary to iris defects or trauma.

Modified Brisson technique for concealed penis in children

Objective To investigate the corrective effect of modified Brisson technique to treat concealed penis in children. Methods From July 2014 to July 2016, selected 12 patients (3-10 years old, mean 7.2 years old) with concealed penis were surgically treated with the modified Brisson technique in the Second Affiliated Hospital of Nanjing Medical University.Their clinical manifestations included the penis buried below the surface of prepubic skin which can be palpated and visualized through pushing the skin around the penis to the pubis and the short foreskin which was not attached to the penile corpus cavernosum.Patients with other conditions such as obesity and penial agenesis that caused buried penis were excluded from the study.The modified Brisson technique consisted of 4 steps.Ventral incision was used to gradually slit the narrow ring of the prepuce and to expose the glans followed by circumfe-rential inner foreskin incision made below the coronary sulcus of penis then the foreskin stripping released the corpus cavernosum.Finally the skin coverage was accomplished by posthioplasty.The operation time, blood loss, complications, postoperative treatments and followed-ups were retrospectively analyzed. Results For all the 12 patients, the operations were successful, lasting 40 to 60 minutes.The bleeding was about 5 to 10 mL and there was no operation-related complications like bleeding and infection of incision.Satisfactory cosmetic outcomes were obtained without retraction and the scars were similar to those of circumcision.All patients had penile lymphedema postoperatively which disappeared within 6 months after operation.Follow-up ranged from 6 months to 1 year, and there were no complications like skin necrosis and contracture or voiding difficulty. Conclusions The modified Brisson technique for concealed penis repair is technically easy and safe.In addition, it provides a good cosmetic appearance, functional outcomes and excellent postoperative satisfaction grades. Key words: Brisson technique; Concealed penis; Child

Single-stage socket reconstruction with vascularised temporalis muscle flap following total orbital exenteration: Description of 3 surgical approaches

ABSTRACTWe describe the techniques and outcome of three different approaches to transfer the posterior 2/3rd temporalis muscle pedicle flap for orbital socket reconstruction following total orbital exenteration. A retrospective interventional series of 9 patients operated between February of 2000 and 2006. We describe three different techniques, namely supraorbital, transorbital and transorbitectomy approach. All patients were followed for minimum of 3 years and muscle trophism with periorbital contour was clinically studied for outcome. There were 6 males and 3 females with a mean age of 42 years. Three patients each underwent the three mentioned approaches of socket reconstruction following total orbital exenteration performed mainly for oculo-adenexal malignancies with orbital extension (77.78%). Intraoperative, tumor-free histopathological margins were ensured. Postoperatively, bulky lateral orbital rim was noticed in all 3 patients of supraorbital approach, while progressive temporalis flap atrophy was noticed in all with transorbital approach over a period of 6 months. No such complications were observed in transorbitectomy approach and reasonably good periorbital cosmetic appearance with optimum preservation of muscle trophism was obtained. The mean follow-up period was 7 years. Temporalis muscle flap provides adequate orbital volume restoration in an exenterated socket. It also helps in better skin graft uptake, socket health and appearance. The transorbitectomy approach appeared as a reliable one stage surgical technique with reasonably acceptable anatomical and cosmetic outcome over a long-term follow-up. The choice of posterior portion of temporalis muscle as a flap offers satisfactory temporal fossa appearance.

Quick fabricated none modified prosthetic socket for transtibial (below knee) amputee: An alternative, cost-effective approach of prosthetic management

Background: The population of amputees in India is increasing day by day, but the existing technology does not permit to provide artificial limb to all in the right time and remote place. Although different types of fabrication procedures are available, still amputee spends significant time and effort to get prosthesis for regaining their lost walking proficiency. To overcome these problems, we have devised a new technique through which quick fabrication of desired prosthesis can be made with low cost, that too in remote areas and could be fabricated and delivered same day. Materials and Methods: The quick fabrication socket is a nonmodified prosthetic socket which can be made directly on the amputee stump using a composite material (fiberglass bandage) without taking a negative plaster cast. Quick fabrication socket, after fitted with modular TTP component has been evaluated by subjective (patient's satisfaction) and objective (kinematic gait analysis) method and also by economical and other factors. Results: We have taken 15 transtibial amputees to study the clinical effect of quick fabricated socket and compared with previous patellar tendon bearing socket. In subjective (patient's satisfaction) observation, the overall satisfaction level was found to be almost same in the majority of the subjects (12 subjects). In objective observation of kinematic gait analysis, all the gait parameters were found to be almost similar except the gait symmetry, which was found to be better in nonmodified socket. The quick fabricated nonmodified (QFNM) prosthesis was found to be prepared in less time, less delivery time (the same day) less costly and good cosmetic appearance. Conclusion: The QFNM socket prosthesis was found to be an alternative cost-effective method to provide prosthesis in less time, less tools, less manpower that too in a remote area without electricity. However its efficacy, durability and cosmetic aspects need further improvement.

Robotic single-site supracervical hysterectomy with manual morcellation: Preliminary experience.

AIMTo evaluate the feasibility, safety and peri- and postoperative outcomes of robotic single-site supracervical hysterectomy (RSSSH) for benign gynecologic disease.METHODSWe report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016. We evaluated the feasibility, safety and outcomes among these patients.RESULTSThe mean surgical time was 244 min and the estimated blood loss was 216 mL, with no blood transfusion necessitated. The docking time was shortened gradually from 30 to 10 min. We spent 148 min on console operation. Manual morcellation time was also short, ranging from 5 to 10 min. The mean hospital stay was 5 d. Lower VAS pain score was also noted. There is no complication during or after surgery.CONCLUSIONRSSSH is feasible and safe, incurs less postoperative pain and gives good cosmetic appearance. The technique of in-bag, manual morcellation can avoid tumor dissemination.

A 16 Year Experience with Modified Lateral Supraorbital Approach for Ruptured Cerebral Aneurysms

Objectives: Upto now, most authors reported the supraorbital approach for unruptured aneurysm and small and less complex aneurysm. The authors devised the Modified Lateral Supraorbital (MLSO) approach. We present a 16 year experience with MLSO approach for ruptured anterior circulation aneurysms and some parts of posterior circulation aneurysms. Materials and Methods: Aneurysm clipping surgery through the MLSO approach was performed on a total 323 patients. Baseline demographics, operative time, procedural complications, and clinical outcomes at 6 months and 1 year were retrospectively analyzed. Results: For patients treated MLSO approach, 293 had single aneurysms and 30 had multiple aneurysms. The proportion of small, medium, large, and giant aneurysms were 64% (206/323), 31% (101/323), 4.7% (15/323), and 0.3% (1/323). Mean operation time was 219.6 minutes. Procedural complications occurred in 21 cases (6.5%). Five patients died from severe brain swelling and refusal of additional treatment, while 1 patient died from tonsilar herniation due to lumbar catheter drainage. Favorable clinical outcomes, Glasgow Outcome Scale IV or V, were observed in 82.6% (267/293) and 83.6% (270/293) at 6 months and one year follow-up. The MLSO approach has the following advantages: less brain retraction, good surgical field for high positioned A-com or basilar tip aneurysm surgery, short operation time, small skin incision, minimizing temporal muscle manipulation and good cosmetic appearance. Conclusions: The MLSO approach can be considered as a useful approach for neurosurgeons for cases of general ruptured aneurysm, except those with a large amount of intracerebral hemorrhage and severe brain swelling.

Efficacy and Safety of Using N-Butyl Cyanoacrylate in Cranial Fixation Following Trauma and Other Pathologies.

Skull bone fixation following different cranial surgeries is essential and should be rigid, simple and cheap. We describe our technique of cranial fixation using the adhesive cyanoacrylates. At the end of cranial and intracranial surgeries the craniotomy flap and bone pieces are returned, realigned and fixed using HistoacrylŽ (N-Butyl Cyanoacrylate) glue. The glue is applied all around the flap in 360-degree fashion. The adhesive material was used in 24 cases after different surgeries involving the calvaria of the skull. Patient age ranged from 1 month to 55 years. Seven cases presented with depressed fractures, 5 traumatic hematomas, and 2 cases after decompressive craniotomies for malignant middle cerebral artery (MCA) infarctions, and 10 cases operated for brain tumors. No skin or bone flap infections were encountered during the follow up period and fusion of the edges of bone flap was observed on follow-up imaging in most of the cases. Skull bone realignment and fixation using glue is a simple, safe, and inexpensive method. The operative procedure was not prolonged. Good cosmetic appearance and realignment and fusion of the bone flap were achieved. Further neuroimaging methods are not prohibited. Glue is suitable for the growing skull of children. Glue is also suitable in compound depressed fractures of the skull with possibility of infection.

Cranioplasty Using Titanium Mesh After Skull Tumor Resection in Five Dogs.

To describe the clinical details, surgery, postoperative imaging, and short to mid-term outcome after cranioplasty with titanium mesh in dogs with large skull tumors. Case series. Client-owned dogs with skull tumors (n=5). All tumors were removed via craniectomy and a sheet of titanium mesh was contoured to reconstruct the calvarial defect and sutured to surrounding musculature. Four dogs had multilobular tumors of bone and 1 dog had a soft tissue sarcoma invading the cranial vault. Neurologic examination was unchanged or improved postoperative, a good cosmetic appearance was achieved, and no complications were noted at 2 weeks postoperative. Late postoperative computed tomography (CT) in 2 dogs and magnetic resonance (MR) imaging in 1 dog confirmed the presence of the titanium mesh without migration. There was no interference of the mesh with image interpretation and definitive radiation therapy was pursued in 1 dog without complication. Late follow-up reported 2 dogs euthanatized; at 44 weeks postoperative due to tumor re-growth; at 12 weeks postoperative for hemoabdomen, respectively. One dog drowned at 40 weeks postoperative, 1 dog was lost to follow-up, and 1 dog is alive at 83 weeks postoperative free of clinical signs. Titanium mesh is suitable for cranioplasty based on its strength, biocompatibility, and excellent handling characteristics. It does not interfere with acquisition or interpretation of CT or MR images, thereby allowing postoperative imaging for ongoing assessment.

Résultats et complications des transferts fléchisseurs superficiels-fléchisseurs profonds chez le patient cérébrolésé : une série de 26 patients

The hand of the spastic patient combines motor deficit, abnormal muscle tone causing spasticity, and sensory defect. The purpose of the surgical program could be functional by restoring grasp or nonfunctional by resolving hygienic problems and improving cosmetic appearance due to the clenched fist deformity. The superficialis-to-profundus tendon transfer, first described by Braun et al., allows the opening of nonfunctional hands. The aim of our study was to confirm the efficacy of this technique to correct vicious attitudes, to highlight a possible functional gain and finally to identify any complications. Patients (9 women and 17 men, aged 36–79 years) were evaluated by a team of rehabilitation physicians and orthopedic surgeons. Palliative transfer of the flexor digitorum superficialis tendons to the flexor digitorum profundus tendons has been achieved. Pictures were taken both preoperatively and during follow-up consultations. The hands were classified according to their appearance- the position of the wrist and fingers (Keenan et al.). Surgery complications were sought. Mean follow-up was 47 months. Preoperatively, all hands were classified type 5 (closed hand no distance between palm and pulp). Postoperatively, 38% of patients have type 1 hand (wrist in neutral position, metacarpophalangeal joints (MCP) and proximal interphalangeal (PIP) at 20° of flexion) and 46% type 2 hand (fingers are more flexed [MCP and PIP at 40° of flexion]), with good cosmetic appearance. None of them have hygienic problems. Mean House score increased from 0 to 0.9, with 7 patients improved. Four patients had an attitude of supination of the forearm, 10 had an intrinsic-plus deformity and 6 had swan neck deformity of the finger. Secondary procedures had to be made. This transfer gives satisfactory results on the opening of the hand but with significant complications. Intrinsic spasticity may be unmasked. Accessories pronator muscles release, while the biceps is spastic, can lead to an attitude of supination of the forearm, which causes functional and esthetic problems.

Tolerance of Micronized Mineral Pigments for Intrastromal Keratopigmentation: A Histopathology and Immunopathology Experimental Study.

To study the tolerance and biocompatibility of mineral pigments for corneal pigmentation histopathologically and immunologically in an experimental animal model. Manual intralamellar keratopigmentation was performed in 28 New Zealand white rabbits using micronized mineral pigments. Histopathological examination was performed 3 months after the surgery to determine the level of pigment diffusion, the level of inflammation, and the presence/absence of neovascularization. An immunological analysis was also performed. No pigment diffusion or changes in color, inflammation, or neovascularization were detected in the treated eyes. Histopathological examination corroborated clinical results regarding inflammation. Pigmented corneas showed a good cosmetic appearance without signs of ocular toxicity. From the immunological perspective, the pigments do not generate an inflammatory response in the rabbit cornea or in vitro. Micronized mineral pigments could be a valid alternative treatment for corneal pigmentation. Manual intralamellar keratopigmentation technique presented good cosmetic appearance without adverse effects in the treated eyes.

A Study of the Outcome of Primary Excision and Closure Technique in the Management of Lip Leukoderma in 30 Patients.

Context:Lips being one of the graceful cosmetic units of the face, any disfigurement, including depigmentation, can be embarrassing, psychologically distressing, and socially stigmatizing. Even with the evolution of various surgical modalities, none of the techniques ensure 100% pigmentation with a good cosmetic appearance. With this background, this study was undertaken to study the efficacy of the technique—primary excision and closure in treatment of lip leukoderma (LL).Aims:To study the efficacy, cosmetic outcome, and recurrence following primary excision and closure technique in the management of LL.Settings and Design:A prospective single-center open-label uncontrolled study.Materials and Methods:Thirty patients with LL involving inner margin of the lower lip and those who fulfilled inclusion and exclusion criteria were included in the study. After obtaining consent and physician fitness, patients were posted for primary excision and closure of the vitiliginous area of the lip. Patients were followed up at the immediate postoperative period and 6 months later. Patient satisfaction scale was done by asking the patient to grade the response between one and ten.Statistical Analysis Used:Mean and percentiles.Results:Out of 30 patients, 29 patients achieved complete clearance that was cosmetically acceptable. Only one patient showed recurrence at the end of 6 months. Average patient satisfaction scale showed an average of 9.66.Conclusions:Primary excision and closure technique is one of the safe, inexpensive modality in the management of LL involving the inner margin of the lip with immediate result.

感覚性斜視に対する手術成績

The purpose of current study to evaluate the surgical outcomes of sensory strabismus. We retrospectively studied 7 consecutive patients who had undergone strabismus surgery for sensory strabismus. Patient age ranged from 14 to 48 years. Initial diagnoses were exotropia (n = 6) and esotropia (n = 1). In all patients, surgery was performed only on the affected eye. Initial types of operative procedures were muscle recession and muscle resection (n = 5) and muscle recession only (n = 2). Results obtained with initial surgery were good in all cases (85.7%) except one. All patients achieved successful postoperative results by their final visit. Our study results suggest that surgery for sensory strabismus achieves good cosmetic appearance.

Feminizing genitoplasty in congenital adrenal hyperplasia: A new method for clitoral reduction

Background: Congenital adrenal hyperplasia (CAH) is a disorder wherein female babies are born with masculinized external genitalia characterized by hyperpigmented or fused labioscrotal tissue, a urogenital sinus, and clitoromegaly. Feminizing genitoplasty (clitoroplasty, labioplasty, and vaginoplasty) is necessary to make the patient consistent with gender identity and to ensure adequate sexual function in pubertal age. Patients and Method: We performed feminizing genitoplasty in which reduction clitoroplasty was done by a ventral approach in 6 patients of CAH, with a mean age of 3.8 years. Excessive erectile tissue was excised by giving incisions into Buck's fascia at 8 and 4 o'clock position on the clitoral shaft and Byar's flaps created from the degloved clitoral shaft were used for labial and vaginal reconstruction. The glans clitoris was left as such and anchored to proximal 1–1.5 cm clitoral shaft. Results: All patients had good cosmetic female appearance of external genitalia. In 5 patients, the clitoroplasty was done along with labioplasty and vaginal introitus exteriorization. However, in 1 patient, the vaginal confluence into urogenital sinus was high and hence only clitoral reduction as well as labioplasty was done and the urogenital sinus opening was left as such. The maximum follow-up is up to 6 years with good result. Conclusion: The reduction clitoroplasty by present approach of 8 and 4 o'clock incision into the Buck's fascia is a good option for clitoral girth and length reduction as it preserves approximately two-third of Buck's fascia with intact neuromuscular bundle and glans. Postoperatively, patients have good vascularity and sensation of the glans clitoris and acceptable cosmetic outcome. However, the long-term results are difficult to comment as no patient of the present study achieved puberty.