The dorsal middle phalangeal finger (DMF) flap is a (neuro)vascular island flap based on one palmar proper digital artery, its venae comitantes (and/or a separate dorsal vein) and the dorsal branch(es) of the palmar digital nerve. The main nerve supply of the donor finger is left undisturbed. The flap may be raised on a short antegrade, long antegrade or a retrograde pedicle, and used as a free, arterial and/or venous flow-through or neurovascular flap. In a prospective study (mean follow-up of 50 months), the results of 43 DMF flaps were analysed. All flaps survived, retained patency of their vascular pedicles and fulfilled their goals. Neurovascular flaps provided sensate coverage at the S3+ level with static 2-point discrimination values of about 10 mm. Dissection between the proper digital nerve and the rest of the neurovascular bundle induced a 5% incidence of cold intolerance and a 12% occurrence of S3+ hypaesthesia. Advantages, drawbacks and indications of DMF flaps are outlined.

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The growth potential of the craniofacial complex of a child with a congenital cleft is not at variance with that of the normal craniofacial complex. Early surgery including mucoperiosteal undermining and the formation of scar tissue generally results in considerable growth retardation. Primary bone grafting seriously inhibits maxillary growth. 15 years' experience with the treatment of cleft patients applying "growth stimulators" combined with postponing surgical corrections is reported, and the results of this treatment method are compared with those found in literature. As a criterion an accurately measurable and reliable parameter, namely the crossbite relation, was opted for. The frequency of crossbite occurrence is now only 16% for deciduous dentitions and 21% for mixed dentitions. In comparison with the most favourable treatment results found in the literature this constitutes a reduction of more than 50%. This implies that the development of maxillary morphology is normalised, leading to an improvement of the oro-nasal functions including speech development.

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