Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

AbstractA thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

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Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

Aesthetic Surgery Journal ◽

10.1093/asj/sjz107 ◽

2019 ◽

Vol 40 (1) ◽

pp. 34-48 ◽

Cited By ~ 25

Author(s):

Aaron M Kosins ◽

Rollin K Daniel

Keyword(s):

Soft Tissue ◽

Case Series ◽

Open Rhinoplasty ◽

Level Of Evidence ◽

Soft Tissue Envelope ◽

Primary Rhinoplasty ◽

Proper Patient Selection ◽

Total Preservation ◽

One Year

Abstract Background Preservation rhinoplasty (PR) is a new chapter in rhinoplasty history. The term was coined by Daniel in 2018 and represents a fundamental change in philosophy. Objectives The aim of this study is to discuss a single-surgeon case series utilizing PR techniques. Methods One hundred fifty-three primary rhinoplasty cases were studied retrospectively between December 2016 and August 2017. One hundred cases had at least 1 year of follow-up. Technical details were recorded, including dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and preservation of the dorsum vs traditional reduction. These 100 cases can be categorized as either complete preservation rhinoplasty (PR-C) or partial preservation rhinoplasty (PR-P). Results All patients had open rhinoplasty and the average follow-up time was 13 months. All patients had preservation of the dorsal soft tissue envelope, and in 36 the entire soft tissue envelope and ligaments were preserved. Fifty-four had preservation of the alar cartilages. Thirty-one had dorsal preservation. The combinations include: PR-C (skin, dorsum, and alars): 24; PR-P (skin and dorsum): 2; PR-P (alars and dorsum): 2; and PR-P (skin and alars): 7. Conclusions In most patients, the dorsal soft tissue envelope and nasal ligaments can be preserved. When possible, the lateral crura should be preserved and tensioning chosen over excision. Dorsal preservation is a versatile technique when proper patient selection is undertaken, and long-term issues with the middle vault and keystone area can be avoided. Some patients will benefit from total preservation where nothing is removed/disrupted and underlying structures are reshaped. Level of Evidence: 4

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A 3-Level Impaction Technique for Dorsal Reshaping and Reduction Without Dorsal Soft Tissue Envelope Dissection

Aesthetic Surgery Journal ◽

10.1093/asj/sjab261 ◽

2021 ◽

Author(s):

Valerio Finocchi ◽

Valentino Vellone ◽

Mattioli Rubens Giorgio ◽

Rollin K Daniel

Keyword(s):

Soft Tissue ◽

Fast Recovery ◽

Surgical Time ◽

Soft Tissue Envelope ◽

Profile Correction ◽

Profile Height ◽

Versatile Technique ◽

Technical Details ◽

Push Down

Abstract Background Preservation Rhinoplasty (PR) techniques are continuously evolving in the last two years. Many variations of old-fashioned techniques have been proposed since Daniel coined this term in 2018. Objectives Authors want to describe indications for a new “three level impactions” technique allowing, in selected cases, a complete profile correction and dorsal reduction without the dorsal soft tissue envelope (STE) dissection. Methods Three hundred fifty primary closed rhinoplasty cases were retrospectively studied from January 2018 and October 2019. Age, sex, race and technical details, surgical time and complications have been registered. Ninety-five dorsums were reduced and shaped without dissecting the dorsal soft tissue envelope, combining a 1) swinging door septoplasty with low septal strip resection, 2) endonasal bony cap mosaic osteotomies, and 3) Let down or Push down operation (LDO/PDO). Results All patients showed a dramatic change in profile height and shape without neither dorsal STE dissection nor bony cartilage dorsal tissue resection. The average follow-up time was 14 months (range, 12-16 months). Conclusions In selected patients, dorsum can be preserved without soft tissue envelope dissection. By combining multiple endonasal maneuvers is possible to obtain a dramatic change without dissecting the soft tissue envelope and at the same time avoiding any dorsal tissue resection: mosaic osteotomies for DKA conversion from S to V shaped dorsum, LDO and low septal strip resection for impaction and quadrangular cartilage flap rotation for profile setting. It is a versatile technique in selected patients, which leads to fast recovery and natural results.

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External Fixation versus Primary Open Reduction and Internal Fixation (ORIF) of Intra-articular Calcaneus Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000226 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Rishin Kadakia ◽

Catphuong Vu ◽

Jason Bariteau ◽

Rahul Rege ◽

Mara Schenker

Keyword(s):

Soft Tissue ◽

Postoperative Complications ◽

Internal Fixation ◽

External Fixation ◽

Open Reduction ◽

Wound Dehiscence ◽

Complication Rates ◽

Soft Tissue Envelope ◽

Calcaneus Fractures

Category: Hindfoot, Trauma Introduction/Purpose: Calcaneus fractures are common injuries of the foot and account for approximately sixty percent of all tarsal bone fractures. Anatomic reduction of the articular surface is associated with good long-term outcomes. Unfortunately, there is a high rate of complications following surgical fixation due to the fragile soft tissue envelope surrounding these injuries. External fixation of joint depression calcaneus fractures allows for restoration of morphology and preservation of soft tissues. The purpose of this work is to determine if acute external fixation in the management of joint depression calcaneus fractures leads to decreased postoperative complications and better outcomes. Methods: Patients were identified using the appropriate procedure codes over a ten year span at a level one trauma center. Those under the age of eighteen and underwent nonoperative treatment were excluded. Electronic medical records were reviewed to obtain, basic demographic data, comorbidities, and injury specifics. Calcaneus fractures were classified as open or closed and using the Essex-Lopresti classification system. Operative reports were reviewed to determine which patients initially underwent external fixation versus open reduction internal fixation (ORIF), furthermore any staged operative interventions were also noted. Electronic records were also reviewed to determine the length of follow up and incidence of postoperative complications. Bivariate analysis was used to identify an association between collected variables and postoperative complications (wound dehiscence, hardware failure, infection, nonunion). Multivariate logistic regression analysis was used to determine if patients treated with acute external fixation were associated with lower postoperative complication rates. Results: 152 calcaneus fractures were identified and included for analysis. The average age was thirty-eight and the majority of patients were male (111/152 = 73%). Average follow up was approximately five months. Seventeen percent (26/152) were open fractures. Twenty-six (17%) were treated initially with external fixation and eleven of these were a staged ORIF. The overall complication rate was 11% (17/152) with the most common complication being wound dehiscence. Only one complication occurred in the group initially managed with external fixation. Statistical analysis revealed that open fractures were associated with increased postoperative complication rates in a bivariate and multivariate model. Conclusion: External fixation of joint depression calcaneus fractures restores height and preserves the soft tissue envelope. Although there was only one complication in the external fixation group, the difference in complication rates was not statistically significant based on initial treatment. The low number of patients treated with external fixation initially and the short follow up are limitations of this study. Further work is needed with a larger patient cohort in a prospective setting. Acute external fixation may prove to be a useful tool to help prevent postoperative complications following joint depression calcaneus fractures.

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ON-TOP PLASTY USING A FREE METACARPAL HEAD GRAFT FOR LENGTHENING OF PROXIMAL PHALANX IN SYMBRACHYDACTYLY — A CASE REPORT

Hand Surgery ◽

10.1142/s0218810413720192 ◽

2013 ◽

Vol 18 (02) ◽

pp. 273-275 ◽

Cited By ~ 1

Author(s):

Kousuke Iba ◽

Takuro Wada ◽

Toshihiko Yamashita

Keyword(s):

Case Report ◽

Soft Tissue ◽

Bone Growth ◽

Proximal Phalanx ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Soft Tissue Envelope ◽

Metacarpal Head ◽

Little Finger

A three-year old patient with symbrachydactyly (didactyly type) presented with a little finger that was too short to allow pinching and consisting of a floppy soft-tissue envelope with hypoplastic phalanges, although the thumb was functional. As the proximal phalanx was too small to permit distraction lengthening or conventional bone grafting, on-top plasty using a 4th metacarpal graft with a cartilage head was undertaken for lengthening the proximal phalanx of the little finger for pinch reconstruction. At ten weeks after surgery, the patient achieved satisfactory pinch function due to the lengthened and bone-stabilised postoperative digit and reconstruction of functional proximal interphalangeal joint. In addition, the grafted metacarpal demonstrated satisfactory bone growth throughout the six-year follow-up period.

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Use of Tissue Expander for Contracted Scarred Saddle Deformity Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0038-1675632 ◽

2018 ◽

Vol 35 (01) ◽

pp. 068-072

Author(s):

Jared Inman ◽

Farhad Ardeshirpour ◽

Erin Ostby

Keyword(s):

Soft Tissue ◽

Adverse Outcome ◽

Case Series ◽

Tissue Expander ◽

Saddle Nose ◽

Nasal Dorsum ◽

Soft Tissue Envelope ◽

Skin Breakdown ◽

Saddle Nose Deformity ◽

Staged Reconstruction

AbstractThe main purpose of this article is to present an alternative technique for the reconstruction of saddle nose deformity in patients with severely scarred or contracted soft tissue envelopes. In this single surgeon case series, the authors present a two-staged reconstruction performed on four adult patients with saddle nose deformities and contracted soft tissue envelope stemming from a variety of etiologic factors including vasculitis, sarcoidosis, and trauma. Stage one involved placement of a 1 × 4 cm tissue expander along the nasal dorsum through anterior scalp and endonasal incisions. The tissue expander port was positioned under the anterior scalp and injected with saline over 3 weeks in-office. Stage two involved removal of the tissue expander and rhinoplasty using osteocartilaginous rib grafts. All four patients had successful expansion of the contracted soft tissue envelope, creating adequate space for the newly reconstructed nasal framework. One patient developed exposure of the tissue expander through the endonasal incision, which did not lead to any adverse outcome. All patients in this series tolerated expansion well, without complaints of pain or external skin breakdown. The use of soft tissue expanders along the nasal dorsum can successfully expand contracted and scarred soft tissue envelopes prior to reconstructive rhinoplasty. This technique may be an effective alternative to the use of interpolated flaps in treating these patients.

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Thermography as a Component of Telemedicine for Diagnosis, Therapy and Follow-up of Joint Bleeding, Soft-tissue Bleeding and Micro-bleeding

10.1055/s-0039-1680188 ◽

2019 ◽

Author(s):

M. von Depka ◽

B. Nawroth ◽

C. Wermes ◽

A. Henkel-Klene ◽

C. Detering

Keyword(s):

Soft Tissue ◽

Diagnosis Therapy

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Inflammatory Myofibroblastic Tumour in Antimesenteric Border of Descending Colon of Children: A Case Report

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v3i1.23908 ◽

2015 ◽

Vol 3 (1) ◽

pp. 47-50

Author(s):

Shahnoor Islam ◽

AKM Amirul Morshed ◽

Afiqul Islam

Keyword(s):

Soft Tissue ◽

Spindle Cell ◽

Inflammatory Myofibroblastic Tumour ◽

Pathological Findings ◽

Soft Tissue Lesion ◽

Soft Tissue Tumours ◽

Inflammatory Pseudotumour ◽

Erythrocyte Sedimentation ◽

Antimesenteric Border

Inflammatory myofibroblastic tumour (IMT) occurring at intraabdominal sites in children has rarely been described. Inflammatory pseudotumour is a soft tissue lesion that may be confused with a sarcoma. It is abbreviated as IMT. Inflammatory myofibroblastic tumour, also known as soft tissue tumours, atypical fibromyxoid tumours, pseudosarcomatous fibromyxoid tumour, plasma cell granuloma, pseudosarcomatous myofibrotic proliferation, post-operative spindle cell nodules. In this paper, we describe a case of inflammatory myofibroblastic tumour (IMT) with an unusual constellation of clinical, pathological findings. A 10-year-old girl had an 7-cm intraabdominal mass accompanied by severe anemia, fever, constipation, weight loss, thrombocytosis, elevated erythrocyte sedimentation rate. Laparotomy was performed. The final pathologic diagnosis was IMT. At the most recent follow up (12months) after excision of the tumour, the patient was symptom-free and there was no evidence of tumour recurrence.J. Paediatr. Surg. Bangladesh 3(1): 47-50, 2012 (January)

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