Murthy Ananth S, McGraw Margeaux
Division of Plastic Surgery, Akron Children's Hospital, One Perkins Square, Akron, OH 44308, USA.
The University of Toledo College of Medicine, Toledo, OH 43606, USA.
Case Rep Med. 2014;2014:682806. doi: 10.1155/2014/682806. Epub 2014 Jan 9.
For the Noonan syndrome patient, the most concerning physical defect is often congenital webbing of the neck or pterygium colli. We present a patient with pterygium colli and a low and laterally displaced nuchal hairline. Since its description, various surgical approaches have been implemented to correct the deformity. Previously reported posterior and lateral approaches have notable disadvantages with regard to hairline displacement and recurrence. In order to address these disadvantages, a new surgical technique was used on this patient. We have termed this technique an M to T rearrangement. Using a lateral approach, the M and T incisions are made and the trapezial fascial web is directly visualized and able to be completely excised. This prevents the recurrence seen with the use of posterior techniques. Inferolateral displacement of hair-bearing skin can be removed with resection of the superior intervening triangle and improves the appearance of the low nuchal hairline. The excision of excess skin along with the zig-zag closure also prevents postoperative scar contraction and recurrence. An important effect of this technique is the prevention of anterior displacement of hair bearing skin. M to T rearrangement is an effective technique for the correction of webbed neck deformities seen in Noonan and Turner syndromes.
对于努南综合征患者而言，最令人担忧的身体缺陷往往是先天性颈部蹼状畸形或颈蹼。我们报告了一名患有颈蹼且颈部发际线低且向外侧移位的患者。自该病症被描述以来，已实施了多种手术方法来矫正这种畸形。先前报道的后路和外侧手术方法在发际线移位和复发方面存在显著缺点。为了解决这些缺点，我们对该患者采用了一种新的手术技术。我们将这种技术称为M至T重排。采用外侧入路，制作M形和T形切口，直接观察到斜方筋膜蹼并能够将其完全切除。这可防止使用后路技术时出现的复发情况。通过切除上方的中间三角形可去除有毛发皮肤的下外侧移位部分，改善低位颈部发际线的外观。切除多余皮肤并进行锯齿状缝合还可防止术后瘢痕收缩和复发。该技术的一个重要作用是防止有毛发皮肤向前移位。M至T重排是矫正努南综合征和特纳综合征中所见蹼颈畸形的有效技术。
