Aesthetics and Function in Lip Reconstruction

Reconstruction of the lip following excision of malignant tumors is a frequent task of the plastic surgeon. Adequate oncological treatment must be followed by a satisfactory aesthetic and functional result. A simple and successful technique of lip reconstruction is revisited. It consists in using the remaining lip, which is released by way of a horizontal mucomyocutaneous flap(s) and stretched to fill the gap. Twenty-six consecutive cases of T2–T3 squamous cell carcinoma of the lip were treated using this technique, with excellent aesthetic and functional results.     

Reconstruction of the Helical Rim with the Rubber Band-Conditioned Postauricular Tubed Flap: A Case Report

Objective: A case with posttraumatic tissue loss of the auricle is presented, where successful reconstruction with the aid of a tubed flap is achieved by gradual lysis within three stages. Background: Helical rim losses may be reconstructed with a tubed flap created from postauricular tissue. Method: The vascularity of the tubed flap was increased with the intermittent application of a rubber band tourniquet. Conclusion: The use of a tourniquet before completing the third stage of the helical rim reconstruction may enhance the reliability of this procedure.     

Aesthetic Reconstruction for Large Upper Lip Defects in Men

Although many techniques use hair-bearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function. Available techniques can also result in an unnatural appearance, because the entire upper lip is covered by a dense region of hair. We have developed a new technique and successfully repaired a large defect in the upper lip of three men. This technique uses flaps pedicled by angular vessels and includes the orbicularis oris muscle. A good outcome can be obtained both functionally and cosmetically when used in men with defects involving more than one-half of the upper lip.     

Lip Reconstruction of Comparatively Large Defect Including the Commissure Using Remaining Lip Tissue: A Modification of Reconstructed Method

We present two reconstructed cases after malignant skin tumor of comparatively large defects of lip including the commissure using remaining lip tissue alone. After resecting a tumor including wedge-shaped full-thickness lip tissue, a full thickness oblique incision is made at the site 5 mm distant from the contralateral commissure. The rhomboid-shaped lower lip flap is created, transposed to the defect, and sutured with the defect margin, including the upper lip, to reconstruct the commissure. The cross lip flap is created at the contralateral side of the lower lip, 5 mm from the commissure, and the defect is closed with the crosslip flap. Although our method is applicable only to selected cases, we believe that it is useful in terms of maintaining symmetry of the lip and function of the commissure in the reconstruction of comparatively large defects including the commissure.     

Helical Advancement with a Posterior Auricular Pull-Through Flap: A Technique for Reconstruction of Combined Helical and Scaphal Defects

Ear reconstruction after skin cancer resection has traditionally challenged the reconstructive surgeon and many techniques of reconstruction have been published as a testiment to this. With the widespread use of Moh's technique for resection, more tissues are now available after resection, and this has created a new challenge for the reconstructive surgeon—to use creatively all the remaining tissues and maximize the aesthetics of the ear reconstruction. This paper demonstrates a one-stage technique for reconstruction of a combined helical and scaphal Moh's defect which utilizes helical advancement with a posterior auricular skin flap.     

Breast Reconstruction by Expansion and Advancement of the Upper Abdominal Flap

Inspired by successful reconstruction obtained using the Lewis–Ryan lower thoracic advancement flap to rebuild missing breast, we have adapted that extremely simple technique to prior serial expansions, in order to create more natural mounds, better defined submammary folds, and when possible, some grade of ptosis, without additional, new scarring. The procedure is introduced and compared to other such flaps as the TRAM and the latissimus dorsii. In our series, 30 patients were evaluated according to the quality of the final results, and the most frequent complications are pointed out and discussed.     

Nummular Nipple Hypertrophy and Repair as Part of an Aesthetic Nipple-Areola Unit

The author suggests that an aesthetically pleasing ratio between nipple and areola diameter exists which should always be taken in consideration during nipple and areola reconstruction. In a study of 40 nipple–areola complexes of 20 healthy, nulliparous, Caucasian female volunteers with a mean age of 25.5 years, the average nipple diameter measured 28% of the areola diameter, that is, a ratio of 1:3.6. A hitherto undescribed form of macrothelia is presented in which the nipple width rather than the projection (length) is increased. A successful technique for reconstruction is described, based on the new method of assessing the aesthetic relations within the nipple–areola complex and known anatomy.     

不同耳再造术式在复杂耳缺损病例中的运用

目的 根据耳郭缺损患者乳突区组织生理特性的差异,运用不同的耳再造术式完成耳郭再造,探讨个性化耳郭再造的可行性。方法 2012年6月至2016年10月,针对乳突区组织生理特性的不同,分别运用耳后皮肤扩张法完成耳郭再造6例,耳后筋膜皮瓣扩张法完成耳郭再造1例,Nagata二期法完成耳郭再造4例,所有患者均以自体肋软骨作为耳支架制作材料。结果 术后随访10～24个月(平均15个月)。11例患者及家属对再造耳郭形态满意。全部患者均无胸廓畸形及耳支架软骨局部外露、感染等并发症。结论 根据乳突区组织生理特性的差别,个性化选择不同的手术方法,有利于获得理想的再造耳外形。     

Reconstruction of the Eye Socket

Ten cases of irradiated and exenterated orbits in retinoblastoma patients were treated for reconstruction of the eye socket. The follow-up was from 1 to 5 years, with no retraction of the treated area and without sequels of the donor site. The author finds that this pathology is a new and precise indication for the grafted temporofascial island flap described by Dr. O. Erol.     

Repair of Full Thickness Defect of the Nose Using an Expanded Forehead Flap and a Glabellar Flap

We describe a method to repair full thickness defects of the nose using a glabellar flap as the lining of the nasal cavity and an expanded forehead flap for external closure. We consider our method useful in the reconstruction of a nose with a full thickness defect for which the flap donor site is limited. The patient was a 45-year-old man who underwent resection of a basal cell carcinoma located over the dorsum of the nose which was associated with a hemangioma simplex on the face. As a result, about two-thirds of the nose, from the dorsum to the tip, as well as a part of the right cheek became deficient and the right nasal cavity became exposed. The nose was reconstructed using the above-mentioned method. The result was satisfactory both cosmetically and functionally.     

Breast Implantation and the Incidence of Upper Extremity Somatic Complaints

Attention has been drawn to elevated laboratory tests of inflammation as indicators of a possible reaction to silicone breast implants. These patients have complaints of joint pain, pain, and myalgia that were possibly caused by a reaction to silicone. This study is a retrospective review of 100 consecutive patients (79 female, 21 male) who were evaluated because of a purported industrial injury to the upper extremity. Patients were examined by a single examiner and all had laboratory screening for indicators of inflammation (sedimentation rate, anti-nuclear antibody levels, C-reactive protein, anti-streptolysin, rheumatic factor), endocrine abnormalities (thyroid panel), and serum glucose. None of the patients had any history of breast augmentation with any implant. Of the 79 female patients, 50 had an identifiable clinical diagnosis and 18 of them had elevation of at least one of the indicators of inflammation. The remaining 29 did not have an identifiable diagnosis and 21 of them had elevation of at least one indicator of inflammation (P < 0.01). There were 74 out of 79 females with subjective complaints of upper extremity pain, joint pain, and aching. Forty-five of these patients had an identifiable diagnosis and 17 of them had elevation of at least one inflammatory indicator. Of the 74 female patients, 29 had no identifiable diagnosis and 21 of them had elevation of at least one inflammatory indicator (P < 0.01). In summary, there were a high number of female patients with complaints of upper extremity symptoms with no prior exposure to silicone from breast implantation. There was a statistically significant correlation in these patients who had no identifiable diagnosis and elevated indicators in inflammation. This study suggests these markers of inflammation should not be used as indicators of a reaction to silicone from breast implantation in patients with upper extremity subjective complaints.     

Orbital Septorhaphy for the Correction of Baggy Upper and Lower Eyelids

Eyelid bags are the result of relaxation of lid structures like the skin, the orbicularis muscle, and mainly the septum, with subsequent protrusion or pseudo herniation of intraorbital fat contents. The logical treatment of baggy upper and lower eyelids should therefore include repositioning the herniated fat into the orbit and strengthening the attenuated septum in the form of a septorhaphy as a hernia repair. The preservation of orbital fat results in a more youthful appearance. The operative technique of the orbital septorhaphy is demonstrated for the upper and lower eyelid. A prospective series of 60 patients (50 upper and 90 lower blepharoplasties) with a maximum follow-up of 17 months were analyzed. Pleasing results were achieved in 56 patients. A partial recurrence was noted in 3 patients and widening of the palpebral fissure in 1 patient. Orbital septorhaphy for baggy eyelids is a rational, reliable procedure to correct the herniation of orbital fat in the upper and lower eyelids. Tightening of the orbicularis muscle and skin may be added as usual. The procedure is technically simple and without trauma to the orbital contents. The morbidity is minimal, the rate of complications is low, and the results are pleasing and reliable.     

Primary Reconstruction of the Ala Nasi in Cleft Lip

Displacement of the lateral crus of the alar cartilage of the nose in cleft lip is demonstrable in diagrams showing the pathological anatomy of this deformity. An account is given of our method used for several years, whereby the lateral limb is returned to a more natural position, alar convexity is restored, and the angle between the limbs is corrected. Two flaps taken from the inside surface of the nostril are alternated. The caudal one is a full-thickness flap composed of vestibular skin, while the cranial flap comprises the cartilage and the vestibular mucosa; the lateral limb is left attached to the mucosa. Alternation does not require any interruption of cartilage continuity, so there is no risk of surgical damage to the perichondrium and cartilage in young subjects. The two limbs (particularly the lateral one) are positioned in such a way that their normal growth can be expected, as shown by the aesthetic results on follow-up after a period of many years. This method is a primary reconstruction technique of the ala nasi, applied at the same time as the lip repair and compatible with current methods.     

Eyelid Reconstruction Using a Vascularized Composite Flap

For reconstruction of full-thickness eyelid defects, it is optimal to use the eyelid. As a new surgical technique, we reconstructed these defects using a composite flap with vascular pedicles. A composite flap was prepared using the inferior medial palpebral artery as a nutrient vessel for reconstruction in two cases. After surgery, partial necrosis of the skin in the composite flap occurred, and ciliary loss was observed; however, the tarsoconjunctival layer could be reconstructed, and good results were obtained in terms of function and morphology.     

Aesthetic Refinements in Nose Reconstruction

Reconstruction of the nose must be performed whenever a loss of tissue occurs in the nasal pyramid. Partial and subtotal losses are more frequently encountered and may concern the external covering, the supporting structures, the lining, as well as the possible combination of these layers. Correct examination of the patient, helped by photographs, X-rays, and other aids, is invaluable to the diagnosis. These diagnostic resources are also helpful for planning the surgery.     

Aesthetic Aspects of Neurofibromatosis Reconstruction with the Vacuum-Assisted Closure System

Everyone agrees that any reconstructive procedure should carry with it the maximum of aesthetic considerations in order that the reconstructive procedure presents the minimal deformities. Vacuum-assisted closure-(VAC) has allowed surgeons to achieve this goal by creating the most optimal conditions for proper wound healing and thus the best aesthetic results. We present a tragic case whereby a 28-year-old Hispanic male patient with neurofibromatosis was treated for a soccer ball-sized tumor located on his upper left leg. The treatment plan consisted of partial excision with local flap coverage of the wound; however, due to persistent bleeding and tumor growth within the flap, the flap did not survive and we were left with an open wound measuring 20 × 40 cm extending from the patient's upper knee to his iliac crest. Had we attempted an autograft procedure at this time, there would scarcely have been enough donor skin areas to cover the wound. VAC was implemented in an attempt to control the bleeding and to possibly decrease the size of the wound. With the application of this procedure, the previously uncontrollable bleeding (12 units) stopped immediately, and the wound size shrank to 1/2 of its original dimensions. As a result, the area for skin grafting was decreased and was completed with 100% take. The VAC system turned out to be advantageous in achieving the most optimal conditions for our patient's wound to close and heal properly, allowing for enhancement of the aesthetic considerations for the patient.     

Evaluation of the Median Forehead Flap and the Nasolabial Flap in Nasal Reconstruction

Basal cell carcinoma, which accounts for 70%–80% of all cutaneous malignancies in the United States, has increased recently in Japan. We compared methods for reconstruction after surgery for basal cell carcinoma, which is expected to increase further in the future. Thus patients who underwent reconstruction after surgery for basal cell carcinoma of the nose using medial forehead flaps and nasolabial flaps were selected, and the effectiveness of these flaps was compared by taking the size and location of the tissue defect into consideration. As a result, possibly because of anatomical and histological differences of the face between Caucasians and Asians, better results were obtained with nasolabial flaps than with median forehead flaps.     

Reconstruction of Scalp Defects Using Simple Designed Bilobed Flap

We have devised a novel rational method to design a bilobed flap. In our method, two triangle flaps are designed; the angle of the first flap is three-fourths the angle of a rhombus at the defect site, and the angle of the second flap is also three-fourths that of the first flap. We have successfully performed reconstruction of scalp defects as large as 50 × 45 mm using simple designed bilobed flaps. The location of the defect was the parietal region in 10 cases, the frontal region in 6 cases, the temporal region in 3 cases, and the occipital region in one case. The advantages of this method for use in reconstruction of scalp defects are as follows: (1) the dispersion tension on the flap provides stable circulation and prevents expansion of scar formation; (2) since the suture line is zigzag, alopecia at the suture line can be hidden under the hair; (3) since this flap is a random pattern flap using galea aponeurotica with blood flow to the skin, flap design is possible for any part of the scalp; and (4) design and elevation of this flap are easy and do not take much time.     

Aesthetic Reconstruction of Burn Alopecia by Using Expanded Hair-Bearing Scalp Flaps

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a ``sideburn' scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.     

Technique for Correction of the Retracted Columella, Acute Columellar-Labial Angle, and Long Upper Lip

The excess tissue from upper lip vertical length reduction provides bulk for opening the columella–labial angle and increasing the visibility of the columella and upper lip vermillion. Decorticated centrally based transverse flaps from the lip and nostril floor, when transposed into a columellar pocket, correct commonly combined degenerative or developmental deformities. The technique delivers premaxilla, columella, and columella–labial angle mass, which simultaneously corrects the retracted columella, opens the columella-labial angle, shortens the upper lip length, and enhances vermillion visibility.