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The authors report the experience in facial reanimation using free innervated split and segmental latissimus dorsi muscle flap onestage transfer in 86 patients with longstanding facial palsy. The segmental latissimus dorsi was taken from the distal part of the muscle so that the muscle flap had an ultralong neurovascular pedicle of 13 to 17.5 cm in length. The muscle flap was made thinner by splitting the segmental muscle. The split segmental muscle flap was transferred to the paralyzed side of the face with its ultralong neurovascular pedicle passing through a tunnel in the upper lip to the normal side of the face. The neurovascular pedicle of the muscle flap was anastomosed with the facial nerve, artery, and veins, respectively, on the normal side of the face. The operation was designed without the crossfacial nerve graft stage. From 1986 to October of 1997, 86 patients with longstanding facial paralysis were treated in our department. The duration of facial palsy in this series ranged from 1.5 to 51 years. A satisfactory result was obtained in 80 cases, evaluated at 8 months to 2 years postoperatively. The expression movement of the soft tissues of the face can be seen not only over transferred muscle but also on the paralyzed muscle covered by the splitting muscle flap. It is supposed that this is the result of musclemuscle neurolization. Study of 66 specimens of latissimus dorsi muscle in the cadavers is discussed. Plast. Reconstr. Surg.103 473, 1999.

Onehundred and thirty patients 85 female, 45 male with portwine stains were treated with photodynamic therapy, also called photochemotherapy,which recently has become acknowledged as effective for a variety of malignant tumors. Probably based on the photochemical reaction with the generation of toxic species, photochemotherapy results in endothelial cell injury and death of abnormal capillaries under overlying epidermis. A retrospective review of 118 available patients with portwine stains reveals that 98.3 percent responded to photochemotherapy with varying degrees of success after onetime treatment. Results were reported under a simple classification system ranging from ordinary to dilated to posttreatment type. In the ordinary group, the results evaluated as excellent, good, fair, and poor were 37.8, 53.7, 8.5, and 0 percent, respectively, before a second treatment the treated area was an average of 9.8 range 7 to 13 cm in diameter. In addition, hypertrophic scars, permanent hyperpigmentation, and hypopigmentation were not seen based on proper parameters. Photochemotherapy offers a potentially efficient and promising choice based on a completely different mechanism from that of selected photothermal therapy with the pulseddye laser. Plast. Reconstr. Surg.99 1826, 1997.