1
|
Sharma RK, DeSisto NG, Longino ES, Stephan SJ, Patel PN, Yang SF. Postoperative Cosmetic Scores and Revision Rates After Nasal Mohs Reconstructive Surgery. Otolaryngol Head Neck Surg 2024. [PMID: 38738913 DOI: 10.1002/ohn.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Few studies have examined the impact of preoperative and surgical factors on the change in cosmetic survey scores after nasal Mohs reconstruction using a subset of the 10-item Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C). We aim to determine preoperative and surgical factors that impact cosmetic outcomes following Mohs nasal reconstruction. STUDY DESIGN Retrospective analysis. SETTING Nasal Mohs reconstruction patients at a tertiary medical center. METHODS All patients receiving Mohs reconstruction of any nasal subunit at a tertiary medical center were analyzed. Variables collected included demographic and Mohs defect/reconstruction characteristics. Primary outcomes were changes in cosmetic (SCHNOS-C) scores and revision rates. Multivariable analysis was used to identify independent predictors of cosmetic scores/revision. RESULTS We included 296 patients for analysis. On multivariable logistic regression, factors contributing to better final cosmetic scores were receiving a skin/composite graft (odds ratio [OR]: 0.22, 95% confidence interval: 0.06-0.68, P = .014) compared to a local flaps. Women were more likely to have worsening cosmetic scores (OR: 2.27, 1.06-4.99, P = .037). Only initial cosmetic scores independently predicted receiving any revision (OR: 1.11, 1.03-1.20, P = .006). CONCLUSION Average SCHNOS-C scores after nasal reconstruction of Mohs defects are low. Only worse patient reported SCHNOS-C scores predicted revision. It is important to understand preoperative and surgical factors that affect cosmetic outcomes to optimize patient counseling and reconstructive planning. Patient perception is a key factor in predicting revisions.
Collapse
Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole G DeSisto
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott J Stephan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Priyesh N Patel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
2
|
Grande DP, Auger SR, Bolotin D, Meleca JB. Recurrent Postoperative Hemorrhage After Mohs Reconstruction in a Patient on Ruxolitinib. OTO Open 2024; 8:e133. [PMID: 38618287 PMCID: PMC11009940 DOI: 10.1002/oto2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- David P. Grande
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Samuel R. Auger
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Diana Bolotin
- Section of Dermatology, Department of MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Joseph B. Meleca
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Chicago MedicineChicagoIllinoisUSA
| |
Collapse
|
3
|
Steckler D, Fernstrum C. Upper Lip Lift Excision Used as Full-Thickness Skin Graft for Mohs Reconstruction of the Philtrum: A Case Report. Eplasty 2022; 22:e57. [PMID: 36545642 PMCID: PMC9748822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Upper lip defects pose a significant challenge for the reconstructive surgeon to produce an aesthetically pleasing result. Case Presentation This article reviews 2 cases of middle-aged women who underwent upper lip lift excisions that were used as full-thickness skin grafts for reconstruction of philtral defects after Mohs excision of cutaneous carcinomas. Conclusions Using the upper lip lift as a full-thickness skin graft donor site can result in superior results to other donor sites for reconstruction of philtral defects.
Collapse
Affiliation(s)
- David Steckler
- Mississippi Center for Plastic Surgery, Ridgeland, MS,Correspondence: David Steckler, MD;
| | - Colin Fernstrum
- University of Mississippi Medical Center Division of Plastic and Reconstructive Surgery, Jackson, MS
| |
Collapse
|
4
|
Yang SF, Powell A, Srinivasan S, Kim JC, Baker SR, Green GE, Zopf DA. Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction. Laryngoscope 2021; 131:E2444-E2448. [PMID: 33656188 PMCID: PMC8013962 DOI: 10.1002/lary.29490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS To assess the use of a three-dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction. STUDY DESIGN Cohort study. METHODS A 3D printed facial flap simulator was designed from a computed tomography scan and manufactured out of silicone for low-cost, high-fidelity simulation. This simulator was tested by a group of Otolaryngology-Head and Neck Surgery trainees at a single institution. The simulator group was compared to a control group who completed an exercise on a traditional paper facial flap exercise. Both groups underwent didactic lectures prior to completing their respective exercises. Pre- and post-exercise Likert scale surveys measuring experience, understanding, effectiveness, and realism were completed by both groups. Central tendency, variability, and confidence intervals were measured to evaluate the outcomes. RESULTS Trainees completing the facial flap simulator reported a statistically significant (p < 0.05) improvement in overall expertise in facial flap procedures, design of facial flaps, and excision of standing cutaneous deformities. No statistically significant improvement was seen in the control group. CONCLUSIONS Trainees found the facial flap simulator to be an effective and useful training tool with a high level of realism in surgical education of facial reconstruction. Surgical simulators can serve as an adjunct to trainee education, especially during extraordinary times such as the novel coronavirus disease 2019 pandemic, which significantly impacted surgical training. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2444-E2448, 2021.
Collapse
Affiliation(s)
- Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Allison Powell
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | | | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Shan R Baker
- Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Glenn E Green
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, Michigan, U.S.A.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
5
|
Bunnell AM. The Facial Skin Defect: Preop to Postop. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:1-5. [PMID: 32008703 DOI: 10.1016/j.cxom.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Anthony M Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, Jacksonville, FL 32209, USA.
| |
Collapse
|
6
|
Abstract
Skin and composite grafting provide effective resurfacing and reconstruction for cutaneous defects after excision of the malignancy. The goal is to restore a natural appearance and function while preventing distortion of the eyelid, nose, or lips. With careful planning and attention to aesthetic subunits, the surgeon can camouflage incisions and avoid blunting aesthetically sensitive sulci. The surgical plan is also informed by the pathology, as basal or squamous cell carcinomas removed by Mohs micrographic excision have different prognostic and logistical considerations from melanoma. Skin and composite grafting are useful as stand-alone procedures or may complement local flaps and other soft tissue reconstructions.
Collapse
|
7
|
Abstract
Successful reconstruction of the cheek following excision for cutaneous malignancy requires careful consideration of defect location, size, and depth in relation to the anatomic properties of the affected cheek unit. Various reconstructive options are available to the surgeon, ranging from simple excisions to complex cervicofacial advancements to meet the needs for functional and aesthetically pleasing reconstructive outcomes. The surgeon must prevent distortion of mobile structures, such as the eyelid, nose, and lips; respect aesthetic subunits; and avoid blunting natural creases. This discussion covers choice of flap, techniques, and technical considerations for medial/perinasal, perilabial, preauricular, lateral, and zygomatic cheek defects.
Collapse
Affiliation(s)
- John E Hanks
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Michael J Brenner
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA.
| |
Collapse
|
8
|
Abstract
Mohs micrographic surgery has become the standard of care for the treatment of cutaneous malignancies. Reconstructing cutaneous defects of the nose can be challenging, as form and function must be respected to the greatest extent possible. A wide range of reconstructive techniques are used. Secondary intent, primary closure, skin grafts, local flaps, and the interpolated workhorse flaps represent the spectrum of options, each with specific advantages and disadvantages. Vigilant postoperative care, including judicious use of adjunctive procedures, can improve outcomes. A subunit approach to reconstruction aids with surgical planning in order to achieve the best possible results.
Collapse
|
9
|
Abstract
Local flaps are a common reconstructive technique of the head and neck. Consequently, knowledge of fundamental concepts and pitfalls to avoid will reduce surgical complications. These complications result from tension-related, ischemic, hematologic, and infectious causes. This paper seeks to address each of these causes with pearls to accomplish a successful outcome.
Collapse
Affiliation(s)
- Charles R Woodard
- Division of Otolaryngology-Head & Neck Surgery, Facial Plastic and Reconstructive Surgery, Duke University Medical Center, DUMC 3805, Durham, NC 27710, USA.
| |
Collapse
|
10
|
Abstract
Skin grafting in nasal reconstruction, long used by dermatologists, can provide superior results and can well be the "go to" procedure for nasal reconstruction. The upper two-thirds of the nose is composed of both flattened, featureless and often thin skin that is well recreated with defect-only full-thickness grafting. Skin grafting for the lower third of the nose has been practiced for years by dermatologists; over the last 4 to 5 years, it has been embraced by plastic surgeons. The patient and donor site selection is critical. Meticulous attention to graft selection, utilization of a no-touch technique during graft harvest and placement of surgical bolsters with through-and-through tacking sutures are essential to ensure 100% graft take and a successful aesthetic result.
Collapse
Affiliation(s)
| | - Mohin Bhadkamkar
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - James F Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
11
|
Hatef DA, Weathers WM, Wolfswinkel EM, Coleman JE, Thornton JF. Avoidance and management of complications in soft tissue facial reconstruction. Semin Plast Surg 2014; 27:121-5. [PMID: 24872753 DOI: 10.1055/s-0033-1351233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Complications in nasal soft tissue reconstruction are inevitable, and all reconstructive surgeons should be comfortable with their management. Patient and surgical complications can be minimized with appropriate preoperative planning and coordination with the anesthesiologist. When managing undesirable results, it is important to realize that most results will improve over time with appropriate wound care and dermabrasion. Patience and attentiveness to the patient are the most-effective strategies for dealing with poor results.
Collapse
Affiliation(s)
- Daniel A Hatef
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | | | | | - Jayne E Coleman
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James F Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|