V-shaped Incision Research Articles

Anovulvar cleft and vaginal prolapse‐hyperplasia in a bitch

This report presents the case of a nine-month-old bitch with incomplete occlusion of the skin and mucosa between the anus and dorsal commissure of the vulva. This anomaly, known as anovulvar cleft, was associated with a vaginal prolapse-hyperplasia. Anovulvar cleft is a rare condition in bitches and is caused by incomplete closure of the dorsal urogenital folds. Anovulvar cleft can lead to clitoritis, abrasion, dryness and devitalisation of the smooth exposed mucosa. Surgery can correct the condition. In the present study, surgical resection of the hyperplasic vaginal tissue associated with perineoplasty using an inverted V-shaped incision showed excellent results. An ovariohysterectomy was also performed to prevent recurrence of the vaginal prolapse-hyperplasia.

Description and biogeographical implications of a new species of the genus Podisma Berthold 1827 from Mont Ventoux in South France (Orthoptera: Acrididae)

Summary The status of the genus Podisma Berthold 1827 is discussed and all its taxa are listed. Endemic taxa within montane orthopteroid insects in southern Europe are considered and new genera recently revised are recorded. In this context Podisma amedegnatoae n. sp. from Mount Ventoux in the South Alps (France) is defined and described. The main distinctive characters of the new species are the relative length of prozona and metazona, the presence of the dotted dorsal pattern (FDDP) in almost 100% of the females, the broadly incised male furcula, the subquadrate dorsal valvae of the penis and the peculiar v-shaped middle incision diving them. The presence of a distinct species on Mount Ventoux allows to suppose the presence of a refuge area in this region during the ice ages. The analysis of the distribution of the FDDP character, distributed from southern France to southeastern Italy, shows a clear interruption in the genetic flow between the western and eastern slopes (French and Italian slopes) in the western Alps. This interruption fits well with the presence of a hybrid zone, recorded in literature for the genus Podisma on the basis of the distribution in this area of two male sex-chromosome forms. On the other hand data concerning the distribution of FDDP suggest a genetic flow coming from Nortwest to South-east. After that the description of P. amedegnatoae is not only a new contribution to the knowledge of the biodiversity in the southern Europeanmountains but adds new data to the study of the colonisation of Europe after the ice ages, by species which have survived in refuge areas.

Laparoscopic en bloc partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma

Introduction Surgical options for treating urachal adenocarcinoma include radical cystectomy and en bloc partial cystectomy with excision of the urachus and umbilectomy. Recently, laparoscopy has been increasingly used to treat bladder and urachal pathologic findings efficaciously. We describe two techniques for performing laparoscopic en bloc partial cystectomy with bilateral extended pelvic lymphadenectomy. Technical Considerations We performed the procedure in 3 patients with established urachal adenocarcinoma. The anatomic boundaries of resection were similar to those described for open surgery. We used an inverted V-shaped, five-port configuration, with the camera port placed 3 cm supraumbilically. An antegrade approach was performed for tumors less than 5 cm in 2 cases. The steps of the procedure included an inverted V-shaped incision along the peritoneum lateral to the medial umbilical ligament on either side; urachal disconnection, dissection of the urachus using the “twist and roll technique”; anterior cystotomy, circumferential resection of the tumor-bearing bladder dome, under vision; tumor placement in a “lap-bag”; bladder reconstruction using intracorporeal suturing; bilateral extended pelvic lymphadenectomy; placement of catheter and drain; and specimen retrieval. We evolved a retrograde technique for larger size tumors (larger than 5 cm). The procedure was successfully completed in all patients, with a mean operative time of 180 minutes (range 150 to 210). No significant intraoperative or postoperative complications occurred, except for a left inferior epigastric artery injury in 1 case. The resected nodes (range 8 to 11) were free of tumor. No local or distant recurrences were observed at a mean follow-up of 6.5 months (range 4.5 to 9). Conclusions Laparoscopic en bloc partial cystectomy and bilateral extended pelvic lymphadenectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for urachal tumors.

Resection of cervical vagal schwannoma via a post-auricular approach

Cervical vagal schwannomas are extremely rare and gross total resection is the standard treatment modality. However, because the conventional cervical approach leaves an incision scar in a visible area, other approaches need to be developed for young women who want the postoperative scar to be invisible. A 28-year-old female underwent complete resection of a 4×4 cm tumor in her right upper neck via a post-auricular approach using an inverted V-shaped incision along the post-auricular sulcus and hairline. The tumor was a schwannoma originating from the right cervical vagus nerve. Postoperatively, right vocal cord paralysis developed despite careful dissection but completely recovered within 6 months after surgery. The patient was satisfied with an invisible external scar which was hidden by her auricle and hair. A cervical vagal schwannoma can be successfully removed by making an incision in a potentially invisible area.

Avoidance of leakage and strictures when creating an invisible conduit for antegrade colonic enemas

Background: Antegrade enemas have been proven to minimize problems with stool control for many incontinent patients; however, foreign bodies are unsightly, and native tissues have been shown to leak or stricture. Methods: Using a limited laparotomy incision, the appendix or a rolled cecal tube was sutured to the apex of the everted umbilical skin using a V-shaped incision. The skin then was inverted to hide the mucosa. The cecum was plicated around the base of the appendix or cecal tube and then tested by filling the cecum with saline to a pressure of 30 cm H2O. Results: Twenty patients (aged 4.8 to 41 years) with fecal incontinence caused by imperforate anus (17 cases) and other causes underwent this procedure. Two patients had minor strictures that resolved with home dilatations, and one cecal tube necrosed, and the patient has refused reoperation. One patient had minor prolapse and underwent revision. None of the conduits leak. Two patients achieved continence and stopped cannulating their stomas. With adjustment and customization of each enema regimen, stool accidents are infrequent. Follow-up is 22 ± 14 (mean ± SD) months. Conclusion: A catheterizeable colocutaneous conduit has been developed that allows for an invisible, leak-proof, and relatively stricture-free means through which antegrade enemas can be given. J Pediatr Surg 37:1768-1771. Copyright 2002, Elsevier Science (USA). All rights reserved.

A standardized measurement of ulnar carpal translocation

45 seconds without severe pain recurring and pinch strength falling again to 10 pounds (Fig. 1). Diagnosis of a chronic, exercise-induced, compartment syndrome in the first dorsal interosseous muscle was made. The patient had a release of the fascia of the first dorsal interosseous muscle and of the adductor pollicis through a 1% cm, V-shaped incision made in the first dorsal web space under local anesthesia. By 2 weeks after surgery, he could pinch repetitively without the aching discomfort (Fig. 1). He was placed on gentle pinching exercises in the immediate postoperative period to permit stretching of the fascial compartments. By 1 month after surgery, he was able to work without problems. Two months later, the opposite hand had a similar procedure.

口がい垂先端に発生した多形性せんしゅの１例

A case of pleomorphic adenoma at the top of the uvula. Tumors originating from the uvula are relatively rare. We experienced a very rare case of pleomorphic adenoma arising from and localized at the top of the uvula.The patient, 43-year-old man, visited our clinic complaining of swelling of the uvula and pain in right molar region. Although he noticed swelling of the uvula about ten years ago and visited some clinics, he did not recieve any surgical treatment.At the first examination, there was a thumb's head sized globlar tumor at the top of the uvula and it was positioned in the middle pharynx. But functonal disorders such as respiration, deglution and speech were not found.Under general anesthesia, after CL V-shaped incision was made at the uvula over 5 mm above its margin, the tumor was excised and the uvula was reconstructed.The excised tumor measured 1.5×2×2cm and was elastic hard and solid. Its histological diagnosis was pleomorphic adenoma.The Recurrence of the tumor and functional disorders were not noticed two years after the opeation.

A cephalometric appraisal of changes in the maxillofacial complex resulting from palatal suture expansion utilizing fixed appliance therapy

This retrospective study evaluated the nasolabial changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different approaches. Nineteen patients were included in the study, divided into two groups according to the kind of surgical approach performed: group 1 (n = 9), SARME performed through the standard Le Fort I circumvestibular approach followed by the alar base cinch, and group 2 (n = 10), SARME performed through a subtotal vestibular approach associated to a V-shaped incision at the maxillary midline in the labial frenulum region, without alar base cinch. Measurements of width, length, and nasal projection as well as upper lip length were taken from cone beam tomographic images obtained before surgery (T1) and 6 months postoperatively (T2). Both groups presented an increase in the alar base width postoperatively (P < 0.05). The approach used in group 2 resulted in smaller changes in the alar base width as measured at the superior alar curvature (P < 0.05). Nasal length and projection and upper lip length were not altered by SARME. The type of surgical approach influenced nasolabial changes, but did not eliminate increase in width of the alar base.

Simplified method of rotating skin and mucous membrane flaps for complete reconstruction of the lower lip

D EFECTS of the lower lip result from inflammatory or degenerative processes, as advanced carcinoma’, 2 and extensive ulcerations (noma) ; or traumatisms from burnss or other accidents.4g 5 That’ reconstruction of these defects has been a surgical problem for many years is evidenced by the fact that according to Pierce and O’Conno~,~ over sixty-five methods and modifications of repairing complete or partial defects of the lower lip have been described in the literature. According to Martin6 von Bruns,7 as early as 1859, had found thirty-two methods described by fifty-two authors. That there have been so many different methods for the correction of this defect is indicative of the inexpedience of any one method. This fact should decry, on the one hand, the advancement of a new technique which may be only as good as others previously advocated, and yet, on the other hand, should be a stimulant to the development of a technique which fulfills satisfactorily all surgical requirements. Cheiloplasty for carcinoma of the lower lip, one of the oldest operations known, has been practiced since the days of Celsus (born about A.D. 25).B He is generally considered the originator of a method, the principle of which is still adhered to today-V-shaped incision and modifications including horizontal incisions from the angles of the mouth and along the lower edge of the mandible forming two lateral flaps of the cheek. Sccording to Fornan,’ the Hindus utilized rotating flaps from the adjacent tissues to rebuild a defect of the lip; this later became known as the lndian method. Tagliacozzi is accredited with the first description of a technique using flaps from the arm (1597).9 Chopart,‘o in 1785, reported the use of advancing flaps from the neck and chin for this purpose. Most of the operations advocated today are modifications of procedures, the basic principles of which were recognized in the early nineteenth century. BernardI and Burow and Saemann,l* in 1853, devised an operation in which full-thickness triangles were removed from the upper lip and discarded. The lower lip was then built by loosenin g and pulling the sides of the cheeks to the midline over the mandible. This procedure was modified by Steward,‘” in 1910, and Martin6 in 1932. In 1877, Estlander14 proposed a procedure which is one of the recognized methods of lip reconstruction today. A V-shaped incision is made. A similar defect only one-half the size is outlined at the outer border of the corresponding upper lip and excised completely, excepting the tissue where the coronary artery of the lip is located. The upper triangle is then turned down into the lower lip and sutured. In 1936, Padgett15 modified this operation by bringing

Simplified method of rotating skin and mucous membrane flaps for complete reconstruction of the lower lip

D EFECTS of the lower lip result from inflammatory or degenerative processes, as advanced carcinoma’, 2 and extensive ulcerations (noma) ; or traumatisms from burnss or other accidents.4g 5 That’ reconstruction of these defects has been a surgical problem for many years is evidenced by the fact that according to Pierce and O’Conno~,~ over sixty-five methods and modifications of repairing complete or partial defects of the lower lip have been described in the literature. According to Martin6 von Bruns,7 as early as 1859, had found thirty-two methods described by fifty-two authors. That there have been so many different methods for the correction of this defect is indicative of the inexpedience of any one method. This fact should decry, on the one hand, the advancement of a new technique which may be only as good as others previously advocated, and yet, on the other hand, should be a stimulant to the development of a technique which fulfills satisfactorily all surgical requirements. Cheiloplasty for carcinoma of the lower lip, one of the oldest operations known, has been practiced since the days of Celsus (born about A.D. 25).B He is generally considered the originator of a method, the principle of which is still adhered to today-V-shaped incision and modifications including horizontal incisions from the angles of the mouth and along the lower edge of the mandible forming two lateral flaps of the cheek. Sccording to Fornan,’ the Hindus utilized rotating flaps from the adjacent tissues to rebuild a defect of the lip; this later became known as the lndian method. Tagliacozzi is accredited with the first description of a technique using flaps from the arm (1597).9 Chopart,‘o in 1785, reported the use of advancing flaps from the neck and chin for this purpose. Most of the operations advocated today are modifications of procedures, the basic principles of which were recognized in the early nineteenth century. BernardI and Burow and Saemann,l* in 1853, devised an operation in which full-thickness triangles were removed from the upper lip and discarded. The lower lip was then built by loosenin g and pulling the sides of the cheeks to the midline over the mandible. This procedure was modified by Steward,‘” in 1910, and Martin6 in 1932. In 1877, Estlander14 proposed a procedure which is one of the recognized methods of lip reconstruction today. A V-shaped incision is made. A similar defect only one-half the size is outlined at the outer border of the corresponding upper lip and excised completely, excepting the tissue where the coronary artery of the lip is located. The upper triangle is then turned down into the lower lip and sutured. In 1936, Padgett15 modified this operation by bringing

Peptic Ulcer of the Greater Curvature of the Stomach

Lesions of the greater curvature of the stomach are so commonly neoplastic and benign ulcers are so extremely rare that a diagnosis of a benign ulcer by the roentgenologist, clinician, or surgeon, is never justified. The danger of such a diagnosis is well illustrated by a case presented by Sproull (1). The surgeon, his assistant, and the hospital pathologist all agreed that the lesion appeared to be benign and it was accordingly removed by a simple V-shaped incision. On microscopic examination, however, it was shown to be malignant, and two years later a large annular carcinoma was found at the site of the resection by the roentgenologist and later by the surgeon. It was inoperable at this time and the patient died shortly after the second operation. Matthews (2), in presenting two original cases in 1935, reviewed the literature and collected 4,603 examples of peptic ulcer. Of these, 139 or 3.0 per cent were found on the greater curvature, but as none of them was studied histologically, the real percentag...

Surgery of the Closed Pupil

Emphasis is laid upon the value of the V-shaped incision with the Ziegler knife, and three case reports are given to illustrate the possibility of obtaining useful vision in eyes which have been given up as hopeless. Presidential address presented before the Indiana Academy of Ophthalmology and Otolaryngology, December, 1929. Emphasis is laid upon the value of the V-shaped incision with the Ziegler knife, and three case reports are given to illustrate the possibility of obtaining useful vision in eyes which have been given up as hopeless. Presidential address presented before the Indiana Academy of Ophthalmology and Otolaryngology, December, 1929.

"EXCISION OF A V-SHAPED PIECE OF THE LOWER LIP VERSUS ROENTGEN-RAY OR RADIUM TREATMENT"

To the Editor: —The communication appearing inThe Journal, November 24, by Dr. J. C. Bloodgood, with this title is of more than ordinary interest. Dr. Bloodgood divides his cases of lower lip lesions into five classes. For brevity's sake permit me to divide them into three: Lesions primarily and continuously benign. Borderline lesions. Lesions primarily and continuously malignant. It is, of course, recognized that time and conditions may, in a certain proportion of individuals, transform Class 2 into Class 3. Dr. Bloodgood cites one specific instance in which a patient presented a submental metastatic node following successful healing of the primary lesion on the lower lip by radium seven months previously. He makes no mention of such a possibility after a surgical removal, but broadly states that the proper treatment in such cases is a sectional removal by the V-shaped incision, and then makes the astonishing assertion that there

A CONTRIBUTION TO CHEILOPLASTY.

Of the many deformities of the lower lip none is more distressing or more difficult to remedy than ectropion or eversion of the lower lip following extensive burns of the lower part of face and neck. Burns involving the deeper layers of the skin about the neck are almost always followed by this deformity, together with an extensive amount of scar tissue. This often extends up to the cheeks, but more often involves the skin about the inferior maxillary region and the anterior part of neck. The firm adherence of the scar tissue to the muscles and structures immediately beneath it renders the chelioplastic operations usually described in text-books difficult, uncertain or impossible. The operation usually recommended for this condition consists in making a V-shaped incision corresponding to the margins of the inverted lip, raising the lip and closure of the wound thus made in the form of the letter