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Demke JC, Nagy KK. Pediatric Facial Soft Tissue Repair and Reconstruction. Facial Plast Surg Clin North Am 2024; 32:85-94. [PMID: 37981419 DOI: 10.1016/j.fsc.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
There are unique considerations for the management, repair, and reconstruction of pediatric facial soft tissue injuries. Conventional methods for the repair and reconstruction of facial soft tissue injuries can be successfully applied in children with considerations for anatomic and physiologic differences and the growth potential of a child. Attention to correct form, framework, and esthetics guides the proper reconstruction of individual regions on the face. Choice of approach ultimately depends on and the size, severity, location of injury, and surgeon's preferences.
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Affiliation(s)
- Joshua C Demke
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, TTUHSC, Lubbock, TX, USA.
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2
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Sheehan E, Workman L, Qadir D, Simman R. Nasolabial Flap for Nasal Reconstruction and Beyond. EPLASTY 2024; 24:QA2. [PMID: 38501141 PMCID: PMC10948196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Erin Sheehan
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio
| | - Lauren Workman
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio
| | - Daniyal Qadir
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio
| | - Richard Simman
- University of Toledo, College of Medicine and Life Sciences, Division of Plastic and Reconstructive Surgery, Toledo, Ohio
- Jobst Vascular Institute: ProMedica Health Network, Wound Care Program, Toledo, Ohio
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Kim DNW, Kibbi N, Christensen SR, Leffell DJ, Suozzi KC. Factors affecting outcomes of second intent healing of nasal defects after Mohs micrographic surgery. Arch Dermatol Res 2023; 315:67-73. [PMID: 35112163 DOI: 10.1007/s00403-021-02306-y] [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: 12/08/2020] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 01/07/2023]
Abstract
Reconstruction of nasal defects secondary to Mohs micrographic surgery (MMS) presents particular challenges related to the complex topography, skin quality, tissue laxity, and functional and aesthetic concerns of the region. Factors affecting outcomes resulting from second intent healing (SIH) on the nose have not been well described. The purpose of the study was to identify factors impacting outcomes of SIH for nasal tumors following MMS. Retrospective analysis was performed of all nasal lesions treated with MMS followed by SIH from a single surgical center over a 1.5-year period. Ninety-six cases were included. Chart review was performed, and data were collected including age, gender, nasal site, tumor type, defect size, depth, and number of MMS stages. Pre- and post-operative follow-up photographs were available for all cases. All five authors evaluated the photographs using the modified Manchester scar scale. Analysis was then conducted to identify features associated with good outcomes. Of the 96 tumors, 39 lesions (40.6%) were located on the nasal tip (including supratip), 32 (33.3%) on the ala/alar groove, 17 (17.7%) on the sidewall, and 8 (8.3%) on the dorsum. The average defect size was 0.83 cm2 (diameter of 1.06 cm ± 0.4). Defect diameter and defect depth were the factors that significantly impacted scar outcome (p < 0.001) in multivariate analysis. No significant functional deficits were reported. This retrospective study suggests that nasal defects with area less than 0.83 cm2 (or 1.06 cm diameter) and depth of defect not extending beyond the superficial fat healed well by SIH regardless of location on the nose.
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Affiliation(s)
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Sean R Christensen
- Department of Dermatologic Surgery, Yale University, 333 Cedar Street, New Haven, CT, USA
| | - David J Leffell
- Department of Dermatologic Surgery, Yale University, 333 Cedar Street, New Haven, CT, USA
| | - Kathleen C Suozzi
- Department of Dermatologic Surgery, Yale University, 333 Cedar Street, New Haven, CT, USA. .,Yale Surgical Dermatology, 40 Temple Street Suite 5A, New Haven, CT, 06510, USA.
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Cason RW, Shammas RL, Pyfer BJ, Glener AD, Marcus JR, Cook JL. Cutaneous Reconstruction of the Nasal Distal Third: Alternative Local Flaps for a Complex Region. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3444. [PMID: 34881138 PMCID: PMC8647876 DOI: 10.1097/gox.0000000000003444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022]
Abstract
Small-to-medium cutaneous defects of the distal nose pose a significant challenge to reconstructive surgeons, and commonly described reconstructive techniques have their limitations. As the skin of this region is characteristically rigid and sebaceous, care must be taken to avoid introducing unfavorable tension vectors that can result in functional or anatomic distortion of the nasal free margins. With this in mind, the authors discuss 3 alternative reconstructive options, the East-West, nasalis sling, and trilobed flaps, which have wide utility in the repair of distal nasal cutaneous defects and can result in excellent cosmesis. The indications, surgical technique, and limitations of each are discussed in detail, and are compared with several of the more commonly described options in the context of distal nasal reconstruction.
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Affiliation(s)
- Roger W Cason
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Ronnie L Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Bryan J Pyfer
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Adam D Glener
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Jeffrey R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Jonathan L Cook
- the Department of Dermatology, Duke University Health System, Durham, N.C
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Single-Stage Reconstruction of Full-Thickness Nasal Alar Defect Using Bilobed and Turnover Flaps. J Craniofac Surg 2020; 31:e169-e171. [PMID: 31895852 DOI: 10.1097/scs.0000000000006127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Skin cancer of the nose remains a common challenge for the reconstructive surgeon with full-thickness defects being particularly problematic. Reconstruction of the internal nasal lining poses the greatest difficulty with local tissue often having unsatisfactory vascularity or surface area. We describe the reconstruction of a full thickness nasal alar defect in a patient after failed full-thickness skin graft using a single stage procedure combining a bilobed flap with a turnover flap. The patient achieved excellent initial and long-term cosmesis and functionality and was very satisfied with the results. We demonstrate that selected full-thickness nasal alar defects may be reconstructed in a single procedure using a carefully placed turnover flap for the internal nasal lining and bilobed flap for outer skin cover.
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Abstract
Congenital and pediatric nasal lesion resection and their reconstructive outcomes are not well studied. A surgeon must consider the site, size, depth, etiology, age, and effect on future function (including growth). As such, it is important to contrast the differences between the adult's and child's nose. The authors propose that more conservative resection and reconstructive methods may better serve congenital and pediatric nasal lesions. An Internal Review Board approved study of congenital and pediatric nasal lesions using a defect only approach from 2005 to 2017 was performed. Lesions, type of surgeries, complications, aesthetic outcome, and additional interventions were reviewed. One hundred twenty-seven patients met the study criteria with a median age at surgery of 5.4 years with follow-up of 1.4 years (1 week-11.3 years). The most common diagnosis was congenital melanocytic nevus (47, 37%). The lesions were located on more than 1 subunit in 34 (27%) patients with an average surface area of 3.7 (0.04-32) cm. The most common primary procedure was excision and primary closure with adjacent tissue undermining/rearrangement (73, 57.4%) followed by full-thickness skin graft (23, 18.1%). The aesthetic outcome was considered acceptable in a high number of patients 117 (92%), while 10 (8%) patients had unacceptable aesthetic outcomes, mostly due to scarring. The authors' data supports the concept of minimal healthy tissue excision or lesion only excision when treating pediatric and congenital nasal lesions.
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Johnson EL, Danilkovitch A. Nonsurgical management of a large necrotic nasal tip wound using a viable cryopreserved placental membrane. Clin Case Rep 2018; 6:2163-2167. [PMID: 30455913 PMCID: PMC6230674 DOI: 10.1002/ccr3.1829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 01/23/2023] Open
Abstract
A large necrotic nasal wound with interdomal subcutaneous tissue loss and the exposed greater alar cartilage was managed conservatively with a placental allograft. This approach is an alternative to the complex staged surgical reconstructive procedures for poor surgical candidates, patients unwilling to undergo facial surgeries, or autologous nasal graft failures.
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Affiliation(s)
- Eric L. Johnson
- Wound and Hyperbaric CenterBozeman Health Deaconess HospitalBozemanMontana
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Update on reconstructive options for nasal Mohs defects 1.5 cm or less. Curr Opin Otolaryngol Head Neck Surg 2018; 24:300-8. [PMID: 27389925 DOI: 10.1097/moo.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The article reviews the current literature to provide an overview on contemporary reconstructive options for closure of Mohs defects of the nose that are 1.5 cm or less. RECENT FINDINGS Although some of the techniques described in the literature are of historical importance only, others have undergone modification and metamorphosis to be broadly used in their contemporary form. Others are implemented in their original design, irrespective of relative age or multiple attempted adaptations. The increase in variable closure options available provides the surgeon with the ability to tailor reconstruction in such a way as to maximize form and function for the patient. SUMMARY Here we will provide an update on the core techniques in terms of subtle modifications, expanded applications, and examination of outcomes as well as newly described closure techniques that may fill a certain niche in nasal reconstruction.
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Nicoli F, Orfaniotis G, Gesakis K, Lazzeri D, Ciudad P, Chilgar RM, Sapountzis S, Sönmez TT, Maruccia M, Constantinides J, Sacak B, Chen HC. Supraclavicular osteocutaneous free flap: clinical application and surgical details for the reconstruction of composite defects of the nose. Microsurgery 2015; 35:328-32. [PMID: 25580712 DOI: 10.1002/micr.22375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022]
Abstract
The supraclavicular fasciocutaneous flap is a well-recognized flap in head and neck reconstruction. In this report, we describe for the first time a variation of this flap, the osteocutaneous supraclavicular (SOC) free flap, which was used to reconstruct a composite nasal defect. The defect arose after resection of a recurrent squamous cell carcinoma and involved dorsal nasal skin, cartilage, and the entire nasal bone. A 6 cm × 4 cm size flap including skin, subcutaneous tissue, and a vascularized cortico-periosteal segment of the clavicle was raised based on the transverse cervical artery. The flap survived with no complications. A satisfactory aesthetic outcome was achieved following two revision procedures. We believe that the incorporation of bone to the supraclavicular flap may expand its applications in reconstruction of composite nasal and facial defects.
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Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Kanellos Gesakis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ram M Chilgar
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Maharashtra University of Health Sciences, Nashik, Maharashtra, India
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tolga Taha Sönmez
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Hung Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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