New Posterior Auricular Perichondrial Cutaneous Graft for Stable Reconstruction of Nasal Defects

The perichondrial cutaneous graft (PCCG), a reliable composite graft that provides stability, is routinely harvested from the anterior conchal bowl. This established PCCG was simplified by using the less conspicuous posterior auricular donor site, which can be closed without the need of cartilage resection for reconstruction with a postauricular interpolated skin island. Patients with basal cell carcinoma of the nose underwent reconstruction of the nose with a PCCG if parts of the tip cartilage or the fibrofatty tissue were resected. The defect surface area was assessed with a template. Follow-up evaluation included assessment of graft survival, donor-site morbidity, nostril stability, and aesthetic outcome. Of the 14 patients included in the study, whose average defect sizes were 2 cm² (ala) and 2.5 cm² (tip), 79% showed primary complete healing. Nostril stability was symmetrical 6 months postoperatively, and no contractions or depressed contour had occurred. In one case, a hyperpigmented area resulted in a slightly imperfect color match. All the donor sites healed without deformity or destabilization of the ear. With the use of this new posterior auricular donor site for graft harvest, functional, stable, and aesthetic reconstruction of the nose can be achieved. The graft- and donor-site morbidity rates are very low, and the results are fully satisfying.     

Eyebrow Reconstruction With the Subcutaneous Island Pedicle Flap

BACKGROUND: Surgical defects of the eyebrow region routinely present a cosmetic challenge to the reconstructive surgeon. OBJECTIVE: To present the use of a commonly employed reconstructive technique for an uncommon location. METHODS: Defects and repairs are demonstrated to illustrate techniques and document outcomes. The biomechanical influences on flap choice are explored. RESULTS: The subcutaneous island pedicle flap yielded excellent functional and cosmetic results when medium or larger defects were confronted in the eyebrow region. A centrally based pedicle enhanced cosmetic outcome, while rendering an uncompromised vascular supply. CONCLUSION: The subcutaneous island pedicle flap provides a competitive repair alternative when reconstructing substantial defects of the eyebrow region.     

毛发移植在修复眉缺损中的临床效果

目的 探讨实施自体毛发移植术对眉缺损的修复效果。方法 选取我院2021年1月-2022年12月收 治接受修复手术的150例眉缺损患者为研究对象。150例患者均接纳自体毛发移植术治疗,记录毛囊数量、 手术时间并发症发生率、成活率、毛发脱落率以及再植次数以及患者满意度。结果 150例患者中,所钻取 毛囊数量50~600个毛囊;35~180 min完成修复术;二次眉毛接种者有14人;受区眉毛成活率70%~90%;全 部病例的供区组织恢复效果良好,术区无并发症发生;满意度为99.33%。结论 对眉缺损患者实施自体毛 发移植术的整体修复效果良好,且具有较强的安全性,成活率较高,值得临床应用。     

可调控眉毛密度的眉再造术同期治疗瘢痕性秃发的临床护理

目的:探索专项护理在眉再造同期治疗瘢痕性秃发术中的应用效果。方法:根据手术过程分两期进行专项临床护理。扩张器一期置入术后进行扩张器相关专项护理,严密监测扩张注水情况,密切观察扩张部位,防止扩张皮瓣坏死或感染;眉再造和瘢痕性秃发修复二期术后密切观察再造眉毛头皮条的颜色,避免静脉回流不畅发生。结果:本组12例患者进行了眉再造的全方位密切护理,岛状头皮瓣全部存活,头皮瘢痕全部修复,无一例皮瓣坏死。随访6~24个月,再造眉毛毛发密度与健侧非常接近,眉形自然逼真,手术效果满意。结论:在可调控眉毛密度的眉再造同期治疗瘢痕性秃发术中进行全方位护理是手术成功的重要保障。     

Two-Lobed Advancement Flap for Cutaneous Helical Rim Defects

BACKGROUND: Bilobed flaps, transposition repairs used primarily on the nose, recruit tissue from an area of laxity via rotational motion. A variant of the bilobe, the two-lobed flap based on the W-plasty, is a transposition flap that shifts tissue predominantly via advancement. OBJECTIVE: To apply the two-lobed advancement flap to the problem of reconstructing cutaneous helical rim defects of the ear. METHODS: Helical two-lobed advancement flaps were designed and implemented to correct small- to medium-sized defects. RESULTS: The ear helix was successfully repaired with two-lobed advancement flaps. There was minimal distortion of the ear architecture or cartilage, and blood supply was sufficient to ensure flap viability. CONCLUSIONS: In selected cases, cutaneous helical rim defects of the ear can be aesthetically repaired with a two-lobed advancement flap derived from the posterior auricular surface.     

The use of the ALT Flap and Lateral Femoral Cutaneous Nerve for the Reconstruction of Carpal Soft Tissue and Ulnar Nerve Defects: a Case Report

The anterolateral thigh (ALT) flap has become one of the workhorse flaps, with indications including diverse reconstructive problems. The lateral thigh area is also a useful donor site for nerve grafts. The lateral femoral cutaneous (LFC) nerve can be dissected along with the ALT flap for a substantial length, depending on the requirements of the recipient site. The LFC nerve can be used as a vascularized or non-vascularized nerve graft. The technique offers advantages and it can find clinical applications, satisfying the functional and aesthetic reconstructive requirements of a complex defect. We report the case of a patient who presented with traumatic soft tissue defect of the volar aspect of the wrist and ulnar nerve defect as a complication of a fracture of distal radius. An ALT flap was used to reconstruct the soft tissue defect. The ulnar nerve was resected due to necrosis and the gap was repaired with non-vascularized grafts of the anterior branch of the LFC nerve. The soft tissues were resurfaced successfully without complications. Functional recovery was good for the superficial branch of the ulnar nerve, whereas it was variable for the deep branch of the ulnar nerve. The anterolateral thigh area offers significant advantages as donor site in the reconstruction of complex soft tissue defects being a large source of vascularized skin, fat, fascia, muscle and nerve. This availability allows for single donor site dissection, minimizing the operating time and the associated morbidity.     

Paramedian Forehead Flap Reconstruction for Nasal Defects

Background. The paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Changes in technique have resulted in the evolution of the modern-day forehead flap, which is a streamlined, efficient, reliable flap that can be counted on to provide superior function and cosmesis in the reconstruction of large nasal defects.
Objective. Consistent success in the execution of a forehead flap hinges on a careful stepwise approach to the defect, the patient, and the surgical technique. Characterization of these steps was undertaken to assist the surgeon in achieving consistent post- operative results.
Methods. The process of executing a paramedian forehead flap beginning with preoperative assessment through the intraoperative procedure and culminating in the postoperative care is elucidated and discussed.
Results. Through thoughtful planning and correct execution of technique, very large nasal defects are reconstructed, with excellent functional and esthetic results. Specific examples illustrate the range of approaches that can be used to address a variety of nasal tissue loss.
Conclusion. With careful attention to the reconstruction of all components of a nasal defect, a forehead flap can restore virtually any large nasal defect with excellent functional and cosmetic results. The skill sets that help optimize the process of nasal reconstruction are important to acquire. With careful planning and surgical finesse, forehead flaps can often result in nearly imperceptible restoration of the nose.     

Full-Thickness Grafts Procured from Skin Overlying the Sentinel Lymph Node Basin; Reconstruction of Primary Cutaneous Malignancy Excision Defects

Background Radical excision of a cutaneous malignancy may require skin-graft closure. The skin overlying the sentinel lymph node (SLN) basin may be procured as a full-thickness skin graft (FTSG), eliminating a problematic and painful third wound, the donor site. However, the potential for implantation of malignant cells transferred from the nodal basin to the primary site, resulting in increased perigraft recurrence rates with the FTSG technique, has not been evaluated. Methods We retrospectively reviewed all patients with a cutaneous malignancy who underwent SLN biopsy and skin-graft closure to evaluate the outcomes of full-thickness sentinel node basin procured skin grafts compared with partial-thickness grafts (PTSG). Results Fifty-seven patients underwent FTSG reconstruction, and 39 patients had PTSG placed at the time of wide excision and SLN biopsy. Eighty-five percent of patients had melanoma; median melanoma thickness for FTSG patients (N = 53) was 2.0 vs. 2.8 mm (N = 29) for the PTSG group (P = .0007). Positive sentinel nodes were identified in nine of 57 patients (16%) and 11 of 39 patients (28%) in the FTSG and PTSG groups, respectively. Perigraft recurrence rates were not significantly different (5 vs. 10%) between the two groups. Graft take rate for the FTSG group was slightly higher than the PTSG group (median = 88% vs 80%, P = .008). FTSG cosmetic results were generally excellent. Conclusions This FTSG closure method eliminates a painful third wound and often results in a better cosmetic outcome. Perigraft recurrences do not appear to be increased with FTSG. This technique should be in the armamentarium of surgeons who treat cutaneous malignancy. Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users.     

Composite Tissue Allotransplantation for the Reconstruction of Congenital Craniofacial Defects

Facial disfigurement in children with congenital craniofacial defects can lead to decreased self-esteem and poor self-perception. Traditional methods of reconstruction can fail to achieve a normal appearance in patients with severe disfigurements. Composite tissue allotransplantation (CTA) in children could offer a unique reconstructive opportunity. A discussion of the usage of CTA for congenital craniofacial defects is thus warranted. Treatment of severe craniofacial clefts, Treacher-Collins syndrome, hemifacial microsomia, and some vascular anomalies can yield unsatisfactory results, even after multiple surgeries. CTA provides the advantage of intact vascularized bone that would not need to be reshaped to fit the defect, with the correct donor match. CTA also provides reconstruction with similar tissue type in regions of the central midface such as the nose, lips, and eyelids. With advances in transplant immunology to devise mechanisms to decrease immunosuppression and induce donor antigen-specific tolerance, CTA may be a future reality in the pediatric population.     

Innovations in the Island Pedicle Flap for Cutaneous Facial Reconstruction

BACKGROUND: The island pedicle flap is a useful method of reconstruction in dermatologic surgery. Traditionally, the pedicle has been centrally and inferiorly based, with flap movements by rotation or advancement. With innovations, however, the flap is remarkably applicable to a variety of facial defects. OBJECTIVE: Our purpose is to introduce modifications of the island pedicle flap, including (1) single lateral pedicle, (2) transposition, and (3) interpolation movements. METHODS: Modifications of the island pedicle flap were applied in nine cases of cutaneous repair after Mohs micrographic surgery. Patient records and postoperative photographs were reviewed retrospectively. Both patients and other surgeons were asked to assess outcome variables. RESULTS: Patients and physicians judged overall outcome as "excellent" or "good" in 100% and 90.7% of evaluated cases, respectively. CONCLUSIONS: Variations of the island pedicle flap, including (1) single lateral pedicle, (2) transposition, and (3) interpolation movements, are viable options in the reconstruction of facial defects after Mohs micrographic surgery.