Double Forehead Expanded Flaps for Reconstruction of Total Nasal Defect: A Case Report

ObjectiveTo introduce a method for total nasal defect reconstruction with a double forehead expanded flap.Case presentationA 55-year-old man underwent three-stage total nasal reconstruction for a complete nasal defect due to electrical injury. The skin expander was implanted during the 1st stage. Total nasal reconstruction was performed with double expanded forehead flap transfer during the 2nd stage. The unilateral forehead flap was used for lining and the contralateral forehead flap, together with the autologous cartilage and titanium mesh framework, were used for skin replacement. The forehead donor defect was covered with a skin graft. Pedicle division and inset were performed in the 3rd stage.ResultsThere was no flap loss, infection, hematoma, rhinostenosis, or implant exposure over the 2-year follow-up, and satisfactory aesthetic results were achieved.ConclusionThe double forehead expanded flap method is useful for the reconstruction of large composite nasal defects in patients who are not suitable for nasolabial flaps and those who may not tolerate free tissue transfer. The operation has fewer complications and is uncomplicated.     

负压引流装置在小耳畸形患者皮肤扩张法耳郭再造二期手术中的应用

目的 探讨一种负压引流装置在皮肤扩张法耳郭再造二期手术中的临床应用效果。 方法 收集420例需要外耳再造的小耳畸形患者,应用皮肤扩张器植入法加自体肋软骨移植行耳郭再造术。按照术后引流方式随机分为两组:实验组(290例)采用专用负压引流装置;对照组(130例)常规放置一根负压引流管。比较两组患者皮下血肿的发生率并作统计学分析。 结果 与对照组相比,应用专用负压引流装置组皮下血肿发生率较低,差异有统计学意义(P<0.05)。 结论 在小耳畸形皮肤扩张法耳郭再造二期手术中,应用此负压引流装置可以有效防止术腔血肿,值得临床推广应用。     

Evaluation of effectiveness of three-dimensional printed ear splint therapy following ear elevation surgery in microtia patients: A randomized controlled trial

AimThis study aimed to compare the effectiveness of a 3D-printed ear splint with that of a conventional thermoplastic ear splint after microtia reconstruction.MethodsPatients who underwent ear elevation surgery with postauricular fascia coverage between October 2017 and October 2018 were included. They were randomly divided into the experimental group (3D-printed ear splint) and the control group (thermoplastic ear splint) and underwent routine postoperative rehabilitation and antiscar therapy. Splint therapy was initiated 4 weeks postoperatively and continued until 24 weeks postoperatively. The evaluated indices were the Vancouver scar scale score (VSS score), cranioauricular distance, patient compliance, complications (dermatitis, skin ulcers, skin necrosis), and patient satisfaction. A two-group t-test was carried out to compare all variables except patient satisfaction, which was compared using the Mann–Whitney U-test; p < 0.05 was considered significant.ResultsTwenty patients were included in each group. At 4 weeks postoperatively, the VSS score (p = 0.748) and cranioauricular distance (p = 0.647) showed no significant differences between the groups. At 24 weeks postoperatively, the mean VSS scores were 4.85 ± 1.46 and 6.25 ± 1.74 (p = 0.009), the mean cranioauricular distances were 15.80 ± 1.82 mm and 13.95 ± 1.93 mm (p = 0.004), and the patient satisfaction scores were 4.5 ± 0.51 and 3.7 ± 0.47 (p < 0.001) in the experimental group and the control group, respectively, all showing significant differences. Two patients in each group exhibited skin irritation or skin ulcers, which resolved after 6 months of follow-up.ConclusionThe application of 3D-printed ear splints provides better inhibition of scar contracture, better maintenance of ear projection and higher patient satisfaction than conventional ear splints following ear elevation surgery in microtia patients. Therefore, 3D-printed ear splints should be preferred over conventional ear splints whenever possible.