Tactical modifications in the Skoog reduction mammoplasty

Some modifications of the Skoog reduction mammoplasty are presented, with the aims of greater safety, longer lasting results, and a better shape of the breast. These modifications are lengthening and thickening of the flap that carries the nipple-areolar complex and a dermal flap in the lower part of the breast, to prevent the sliding of the gland in a late follow-up.     

Personal refinements in the single pedicle Skoog technique for reduction mammaplasty

A review of the Skoog technique for reduction mammaplasty is presented. A laterally based single pedicle is used for transposition of the nipple-areola flap, deriving its blood supply from a cutaneous vasculature. From our experience using this procedure in a majority of patients, we have developed specific refinements starting with the preoperative planning and including various modifications in the operative technique. The advantages of these refinements are discussed as well as their contribution to the final aesthetic result.     

Aligning the bony nasal vault in rhinoplasty

The bony nasal vault represents a complex three-dimensional structure, analogous to a truncated pyramid or pyramidal frustrum. By analyzing the nasal bones and determining the length and width of the nasal bones, appropriate surgical measures can be employed. In addition, a review of several different osteotomy techniques is performed.     

Avoiding complications of the middle vault in rhinoplasty

Functional and aesthetic abnormalities of the middle nasal vault are frequent reasons for seeking revision rhinoplasty. Complications in rhinoplasties are inevitable; understanding their etiology can help reduce their occurrence. We will examine the more common sequelae, likely causes, and predisposing factors as well as strategies for prevention.     

An alternative method of middle vault reconstruction

Surgery of the nasal valves is a challenging aspect of rhinoplasty surgery. The middle nasal vault assumes an important role in certain aspects of nasal valve collapse. Techniques that address pathologies of the middle vault include the placement of spreader grafts and the butterfly graft. We present an alternative technique of middle vault reconstruction that allows simultaneous repair of nasal valve collapse and creation of a smooth dorsal profile. The surgical technique is described in detail and representative cases are discussed.     

A grading system for nasal dorsal deformities

There is no uniform grading system for nasal dorsal deformities currently in general use among surgeons who perform rhinoplasty. Given the popularity of this procedure among both the general public and surgeons, it is time that there was a uniform system describing dorsal deformities. Such a system has value in the education of students of rhinology and cosmetic nasal surgery. We have developed one such system, and applied it to 100 cases. In all cases it accurately describes the major pathological conditions of the dorsum, if present, as noted on physical examination. We have found application of this system to be facile.     

鼻背皮瓣修复鼻尖缺损的探讨

目的 探讨应用鼻背皮瓣修复鼻尖区组织缺损的方法和效果.方法 根据患者鼻缺损的部位及范围设计鼻背皮瓣,旋转前徙覆盖创面再造鼻尖,修复过程中注意保护各美学单元的完整性,利用天然皱褶掩盖瘢痕.结果 本组4例患者鼻背皮瓣均完全成活,术后随访1～4年,鼻外形良好,效果满意.结论 鼻背皮瓣对于鼻尖1.5～2.5cm的缺损能够提供色泽、质地匹配的修复.     

Expanded applications of the dorsal nasal flap

OBJECTIVE: To describe new applications for the dorsal nasal flap technique of facial reconstruction. METHODS: Retrospective review of surgical records of patients in whom the dorsal nasal flap technique was used. RESULTS: The dorsal nasal flap technique was used in 61 patients to repair defects ranging in size from 12 x 17 mm to 35 x 40 mm. CONCLUSION: The dorsal nasal flap technique is more versatile than has been traditionally appreciated and can allow single-stage reconstruction of many sizes of defects affecting various areas of the nose.     

Sparing the eye in craniofacial surgery for superior nasal vault malignant neoplasms: analysis of benefit

OBJECTIVE: To evaluate orbital and ophthalmologic function following standardized eye-sparing protocol for treating superior nasal vault malignant neoplasms. DESIGN: A retrospective review of patients with sinonasal malignant neoplasms who underwent preoperative radiation therapy with or without chemotherapy and craniofacial resection (CFR) with eye preservation. Pretreatment and posttreatment ophthalmologic evaluations were performed. RESULTS: A total of 59 patients underwent eye-sparing therapy between 1983 and 2005; 36 had invasion of the lamina with or without periorbital resection (61%). The most common abnormality was esthesioneuroblastoma (37 cases; 63%), most of which were Kadish stage C (n = 26). The most common preoperative ophthalmologic findings were motility disturbances (18 cases; 31%), afferent pupillary dysfunction and change in acuity (17 cases; 29%), and proptosis (17 cases; 29%). A total of 36 patients were available for long-term follow-up (mean follow-up, 61 months); 35 of these retained functional vision (97%); and 1 patient had a nonfunctional eye. CONCLUSIONS: Standardized treatment for superior nasal vault malignant neoplasms using an eye-sparing CFR remains a sound approach both oncologically and ophthalmologically. Most patients with advanced disease present with ophthalmologic findings, and most posttreatment eye findings are notable only on detailed examination and either resolve spontaneously in the acute-care setting or do not require surgical repair.     

保留阴蒂头及其血管神经蒂阴蒂成形术

目的探讨保留阴蒂头及其血管神经蒂阴蒂成形术在治疗阴蒂肥大中的应用效果。方法在阴蒂头近端约0.5cm处,环绕阴蒂切开皮肤及浅筋膜,保留阴蒂头及其背侧血管神经蒂,切除肥大阴蒂体部,重塑阴蒂外形。结果12例女性假两性畸形患者,术后切口均Ⅰ期愈合,再造之阴蒂完全成活,触觉敏感,外阴形态满意。结论保留阴蒂头及其血管神经蒂阴蒂成形术,可在改善阴蒂外观的同时,保留其感觉及勃起功能,形成符合美学和功能要求的新阴蒂。     

Management of the middle nasal third in revision rhinoplasty

The middle nasal third is often the source of both aesthetic and functional problems with primary rhinoplasty. Weakness of the middle nasal vault can occur from overresection of the upper lateral cartilages or cartilaginous nasal septum, malposition of the upper lateral cartilages, or from secondary scarring from the primary rhinoplasty. These functional and aesthetic problems can be avoided by maintaining an adequate infrastructure to the middle nasal vault. If secondary problems occur in the middle nasal third, precise anatomic reconstruction can be performed in the form of cartilage grafting and/or suture reconstitution. This reconstruction requires an in-depth knowledge of the functional nasal anatomy and the ability to re-create the infrastructure so that it withstands the forces of scarring and wound contraction. This article outlines the anatomy of the middle third of the nose, the conditions that cause secondary middle-third problems, and the surgical management of these deformities.     

保留阴蒂头及其血管神经蒂阴蒂成形术

目的 探讨保留阴蒂头及其血管神经蒂阴蒂成形术在治疗阴蒂肥大中的应用效果。方法 在阴蒂头近端约0．5cm处，环绕阴蒂切开皮肤及浅筋膜，保留阴蒂头及其背侧血管神经蒂，切除肥大阴蒂体部，重塑阴蒂外形。结果 12例女性假两性畸形患者，术后切口均Ⅰ期愈合，再造之阴蒂完全成活，触觉敏感，外阴形态满意。结论 保留阴蒂头及其血管神经蒂阴蒂成形术，可在改善阴蒂外观的同时，保留其感觉及勃起功能，形成符合美学和功能要求的新阴蒂。