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Xu Z, Li Y, Li D, Zhang R, Zhang Q, Xu F, Chen X. New Strategies for Remnant Ear Treatment in Microtia Reconstruction Based on Morphometric Studies. Laryngoscope 2024; 134:2741-2747. [PMID: 38131383 DOI: 10.1002/lary.31224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Given the lack of specific evaluation indices, it is difficult to determine whether to transpose or abandon remnant ears in lobule-type microtia reconstruction. The authors illuminate referable parameters beneficial for proper treatment of remnant ear in an efficient manner. METHODS A series of 359 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2016 and 2021. Fourteen measuring points and defined distances as well as six ratios of specific distances based on position, plumpness, similarity and the width-to-length ratio of the remnant ear have been described, and relevant tactics for appropriate treatments are introduced. RESULTS Definite morphometric results contribute to attaining satisfactory contours of reconstructed auricles with harmonious earlobes, which exhibit highly similar dimensions and appearances compared to the contralateral normal ears. CONCLUSION With the help of the proposed locating points and measuring approaches, the procedure of remnant ear treatment is systematically clarified. This technique ensures operation safety and contributes to the aesthetic contour of the auricle. LEVEL OF EVIDENCE IV Laryngoscope, 134:2741-2747, 2024.
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Affiliation(s)
- Zhicheng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yiyuan Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Datao Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ruhong Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Feng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xia Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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DeSisto NG, Arnaud EH, Chowdhury N, Davis SJ, Kimura KS, Stephan SJ, Patel PN, Yang SF. Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons. Facial Plast Surg Aesthet Med 2023. [PMID: 38150510 DOI: 10.1089/fpsam.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.
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Affiliation(s)
- Nicole G DeSisto
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ethan H Arnaud
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed Chowdhury
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Seth J Davis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle S Kimura
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F Yang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Hicks MD, Ovaitt AK, Morrison DR, Fleming JC, Jeyarajan H, Greene B, Sorace AG, Patel J, Kasten BB, Hartman YE, Rosenthal EL, Warram JM, Thomas CM. Determination of Flap Survival Isolated From Wound Bed Vasculature Using a Murine Axial Flap Model. EAR, NOSE & THROAT JOURNAL 2023:1455613231183392. [PMID: 37365848 DOI: 10.1177/01455613231183392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background: Axial pattern flaps are a common reconstructive option following resection of soft tissue malignancies. We determine the early dependence of an axial flap on wound bed vasculature by isolating the underlying wound bed and depriving contact with the overlying flap. Materials and Methods: Mice were divided into 5 groups: No silicone (n = 7), silicone in the proximal 50% of the wound bed (n = 8), silicone in the distal 50% of the wound bed (n = 5), silicone over the full length of the wound bed with pedicle preservation (n = 5), and silicone over the full length of the wound bed with pedicle sacrifice (n = 5). The pedicle was the lateral thoracic artery. Daily photographs were taken, and the percent of viable flap was determined using ImageJ© software (public domain JAVA image processing program, National Institute of Health, Bethesda, MA). Percent flap viability for each group was compared to the no silicone group, which acted as the reference. Results: Mean differences in percent flap necrotic area (with 95% confidence interval) compared to the no silicone group were -0.15% (-15.09 to 14.09), 2.07% (-5.26 to 9.39), 2.98% (-10.98 to 16.94), and 14.21% (0.48 to 27.94) for the full-length silicone with preserved pedicle, proximal silicone, distal silicone, and full-length silicone with sacrificed pedicle groups, respectively. The full-length silicone with sacrificed pedicle group had a significant difference in flap viability (P = .045) compared to the no silicone group. Conclusion: We investigate the role of the wound bed vasculature in a murine axial flap model and demonstrate that the wound bed vasculature is not essential for early distal flap survival.
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Affiliation(s)
- Melanie D Hicks
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alyssa K Ovaitt
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel R Morrison
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason C Fleming
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hari Jeyarajan
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benjamin Greene
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna G Sorace
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Juhi Patel
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benjamin B Kasten
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yolanda E Hartman
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, Nashville, TN, USA
| | - Jason M Warram
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carissa M Thomas
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Feng R, Chen J, Wang Y. Application of vertical transposition flap in closure for large facial soft tissue defects in children. Front Pediatr 2023; 11:1171092. [PMID: 37215609 PMCID: PMC10196186 DOI: 10.3389/fped.2023.1171092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/07/2023] [Indexed: 05/24/2023] Open
Abstract
Background While transposition flap is widely used for the repairs of facial defects, few studies has reported its application among children with large defects. In this study, we aimed to investigate the surgical techniques and principles in different locations on face of vertical transposition flap in children. Methods We retrospectively reviewed our hospital database and identified children who were treated with vertical transposition flap for large facial defects between January 2014 and December 2021. Information was collected including patients' demographics, location and dimension of the lesion, surgical procedure, additional surgeries, complications, and outcomes. Results A total of 122 patients (77 boys, 63.1%) were included in this study. The average age for participants was 3.3 years (3 months to 9 years). One hundred and four (85.3%) patients had melanin nevus and 18 (14.8%) had sebaceous nevus. The average size of defects was 5.8 cm2 (ranging from 0.8-16.5 cm2). Ten patients (8.2%) suffered from dermal layer or full-thickness necrosis in the distal part of their flaps, They all recovered after conservative treatment and there were noticeable scars at discharge. Five patients (4.1%) had slight traction of the mouth and eyelid, all recovered about 2 week after surgery. An acceptable cosmetic outcome was achieved for all the patients at last time follow-up. Conclusions Repairing large facial defects with vertical transposition flap is effective in Children, especially on forehead, cheek and mandible. However, this technique is far from perfect. Careful selection of appropriate patients and flap design might be needed.
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Affiliation(s)
- Rui Feng
- Department of Burn and Plastic Surgery, BeijingChildren’s Hospital, Capital Medical University, Beijing, China
| | - Jigang Chen
- Department of Burn and Plastic Surgery, BeijingChildren’s Hospital, Capital Medical University, Beijing, China
- Department of Neonatal Surgery, Beijing Children's Hospital, Beijing, China
| | - Yining Wang
- Department of Burn and Plastic Surgery, BeijingChildren’s Hospital, Capital Medical University, Beijing, China
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Hicks MD, Ovaitt AK, Fleming JC, Sorace AG, Song PN, Mansur A, Hartman YE, Rosenthal EL, Warram JM, Thomas CM. Hyperintensity of integrin-targeted fluorescence agent IntegriSense750 accurately predicts flap necrosis compared to Indocyanine green. Head Neck 2022; 44:134-142. [PMID: 34697855 PMCID: PMC8688316 DOI: 10.1002/hed.26914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Flap necrosis is a feared complication of reconstructive surgery. Current methods of prediction using Indocyanine green (ICG) lack specificity. IntegriSense750 is a fluorescence agent that binds sites of vascular remodeling. We hypothesized that IntegriSense750 better predicts flap compromise compared to ICG. METHODS Fifteen mice underwent lateral thoracic artery axial flap harvest. Mice received an injection of ICG (n = 7) or IntegriSense750 (n = 8) daily from postoperative days (POD) 0-3 and were imaged daily. Mean signal-to-background ratios quantified the change in fluorescence as necrosis progressed. RESULTS Mean signal-to-background ratio was significantly higher for IntegriSense750 compared to ICG on POD0 (1.47 ± 0.17 vs. 0.86 ± 0.21, p = 0.01) and daily through POD3 (2.12 ± 0.70 vs. 0.96 ± 0.29, p < 0.001). CONCLUSIONS IntegriSense750 demonstrates increased signal-to-background ratio at areas of flap distress compared to ICG which may increase identification of flap necrosis and improve patient outcomes.
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Affiliation(s)
- Melanie D Hicks
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Alyssa K Ovaitt
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jason C Fleming
- Liverpool Head and Neck Centre, University of Liverpool & Aintree University Hospital, Liverpool, UK
| | - Anna G Sorace
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Patrick N Song
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Ameer Mansur
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Yolanda E Hartman
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Eben L Rosenthal
- Department of Otolaryngology – Head & Neck Surgery, Stanford University, Stanford, CA
| | - Jason M Warram
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Carissa M Thomas
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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Abstract
The goals of cutaneous malignancy reconstruction are to restore the best functional and aesthetic outcome. Reconstruction should aim to restore all defects layers. While local flaps are the mainstay of head and neck Mohs reconstruction, the range of reconstructive options varies from healing by secondary intention to microvascular free tissue transfer.
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Affiliation(s)
- Issam N Eid
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, 3440 North Broad Street, Suite 300, Philadelphia, PA 19140, USA
| | - Oneida A Arosarena
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, 3440 North Broad Street, Suite 300, Philadelphia, PA 19140, USA; Office of Health Equity, Diversity and Inclusion, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Room 324E, Philadelphia, PA 19140, USA.
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Repair of a Large Glabellar/Nasal Defect. Dermatol Surg 2020; 45:1673-1676. [PMID: 30550516 DOI: 10.1097/dss.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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