scholarly journals Tunneled Interpolated Flaps in the Reconstruction of Nasal Defects

2021 ◽  
Vol 79 (1) ◽  
pp. 47-52
Author(s):  
Frederico Bonito ◽  
André Pinho ◽  
Ana Brinca ◽  
João Goulão ◽  
Ricardo Vieira
Keyword(s):  
Surgical Procedure ◽  
Good Option ◽  
Nasal Reconstruction ◽  
Advantages And Disadvantages ◽  
Skin Defects ◽  
Nasal Defects

The reconstruction of nasal skin defects is a challenge even for an experienced dermatological surgeon. When the defect is too large or complex to be corrected with simpler flaps, interpolated flaps are a good option, but they usually require two surgeries. Tunneled interpolated flaps were developed to allow the reconstruction of complex defects in only one surgical procedure. In nasal reconstruction, the main tunneled flaps are the paramedian forehead and the melolabial flaps. This review will focus on these two flaps: description of the technique, applications, advantages and disadvantages.

The use of paquette blade handle in harvesting free gingival graft from the palate – a report of three cases with its method of use, advantages and disadvantages.

2018 ◽  
Vol 10 (2) ◽  
pp. 32-38
Author(s):  
Abhilash Neelakanti ◽  
Abdul Hakeem ◽  
Sunil Sathyanarayana
Keyword(s):  
Surgical Procedure ◽  
Hard Palate ◽  
Root Coverage ◽  
Razor Blade ◽  
Ridge Augmentation ◽  
Advantages And Disadvantages ◽  
Free Gingival Graft ◽  
Gingival Graft

Free gingival grafting is a well-known periodontal plastic surgical procedure used for gingival augmentation, for root coverage procedures and in some cases of pre-prosthetic ridge augmentation. Several instruments have been used to harvest the graft from hard palate, ranging from scalpel to mucotome, each of which has its own advantages and disadvantages. One such instrument is Paquette blade handle, which incorporates a regular razor blade for graft harvesting. This article intends to describe in detail the handling of this instrument, its usefulness as well as limitations, as explained in the following three cases.

PS01.026: CHANGES IN SURGICAL PROCEDURES AND SHORT-TERM OUTCOMES FOR ACHALASIA SINCE THE INTRODUCTION OF POEM

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 57-57
Author(s):  
Fumiaki Yano ◽  
Nobuo Omura ◽  
Kazuto Tsuboi ◽  
Masato Hoshino ◽  
Se-Ryung Yamamoto ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Reflux Esophagitis ◽  
Surgical Procedure ◽  
Conflicts Of Interest ◽  
Treatment Options ◽  
Balloon Dilation ◽  
Short Term ◽  
Reduced Port Surgery ◽  
Advantages And Disadvantages ◽  
Postoperative Reflux

Abstract Background In our institution, laparoscopic Heller-Dor procedure (LHD) has been the first-line surgical procedure for achalasia since the introduction in August 1994, and 578 patients underwent LHD until January 2018. In January 2016, per-oral endoscopic myotomy (POEM) was started, taking into patients’ needs into consideration. Since then, treatment options have expanded to include balloon dilation, conventional LHD, LHD by reduced port surgery (RPS), LHD by needlescopic surgery (NS), and POEM. Here, we report changes we have observed in surgical procedures and short-term outcomes since the introduction of POEM. Methods The subjects were 82 patients (mean age 47.4 ± 14.7 years, 39 women) who underwent surgery for achalasia from January 2016 to January 2018. After explaining the advantages and disadvantages, the choice of surgical procedure was decided by the patient. Results The surgical procedures consisted of LHD in 57 (including 1 RPS and 33 NS) and POEM in 25 patients. A total of 7 peri-operative complications (POEM = 1) were observed in 7 patients (9%), consisting of gastroesophageal mucosal injury (7%, LHD) and injuring of esophageal longitudinal muscles (2%, POEM), while dysphagia improved in all patients. Postoperative reflux esophagitis was observed in 9 patients with POEM (36%), which was significantly higher than 6 patients (11%) in LHD (P = 0.0173). Conclusion While 30% of patients underwent POEM, reflux esophagitis occurred at a higher rate in POEM as compared to LHD. Disclosure All authors have declared no conflicts of interest.

Auricular Sandwich Graft for Caudal Septal Augmentation

1986 ◽  
Vol 3 (4) ◽  
pp. 27-31
Author(s):  
Julius Newman ◽  
Abram Nguyen ◽  
Roger Anderson
Keyword(s):  
Surgical Procedure ◽  
Donor Site ◽  
Obtuse Angle ◽  
Nasal Reconstruction ◽  
Nasal Dorsum ◽  
Cartilage Graft ◽  
Nasal Tip ◽  
Aesthetic Results ◽  
Conchal Cartilage Graft ◽  
Primary Phenomenon

Retraction of columella and collapse of nasal tip may be a primary phenomenon or secondary to poor results of rhinoplasty. This may be due to excessive resection of dorsocaudal septum or inappropriate removal of the nasal spine. Reconstruction of the columella is a difficult surgical procedure and many techniques have been described. This report describes a technique of interposition of a composite skin-conchal cartilage graft between the caudal septum and columella. The graft will restore the projection of the nasal tip and correct a retracted columella by increasing its base. The newly positioned columella forms an aesthetically acceptable obtuse angle with the lip and is 2–3 mm lower than the alar rims. The cartilage from the concha of the ear is an excellent grafting material for nasal reconstruction. It has been used for augmentation of the nasal dorsum, tip grafting, and correction of vestibular atresia. The graft is harvested utilizing a technique that allows for minimal postoperative auricular deformity at the donor site. Aesthetic results have been satisfactory, with very low morbidity following this method.

Nasal Anatomy and Function

2017 ◽  
Vol 33 (01) ◽  
pp. 003-008 ◽  
Author(s):  
Ruchin Patel
Keyword(s):  
Complex Structure ◽  
Respiratory Physiology ◽  
Nasal Reconstruction ◽  
Facial Aesthetics ◽  
Basic Understanding ◽  
Nasal Anatomy ◽  
And Function ◽  
Nasal Function ◽  
Nasal Defects

AbstractThe nose is a complex structure important in facial aesthetics and in respiratory physiology. Nasal defects can pose a challenge to reconstructive surgeons who must re-create nasal symmetry while maintaining nasal function. A basic understanding of the underlying nasal anatomy is thus necessary for successful nasal reconstruction.

scholarly journals Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

2014 ◽  
Vol 47 (03) ◽  
pp. 333-339 ◽  
Author(s):  
Rajeev B. Ahuja ◽  
Rajat Gupta ◽  
Pallab Chatterjee ◽  
Prabhat Shrivastava
Keyword(s):  
Informed Choice ◽  
Composite Graft ◽  
Nasal Reconstruction ◽  
Composite Grafts ◽  
Alar Base ◽  
Split Skin ◽  
Nasal Defects ◽  
Long Term Experience

ABSTRACT Introduction: Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patients and Methods: Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm × 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. Results: All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. Conclusion: In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of ‘warm ischemia time’ for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an informed choice.

The Bilobe Flap for Nasal Reconstruction

2020 ◽  
Vol 36 (03) ◽  
pp. 276-280
Author(s):  
Tyler S. Okland ◽  
Yu Jin Lee ◽  
Akshay Sanan ◽  
Sam P. Most
Keyword(s):  
Surgical Technique ◽  
Subcutaneous Tissue ◽  
Retrospective Chart Review ◽  
Nasal Reconstruction ◽  
Flap Reconstruction ◽  
Transposition Flap ◽  
Scar Revision ◽  
Facial Plastic ◽  
Ear Cartilage ◽  
Nasal Defects

AbstractRepair of nasal defects is technically challenging due to inelastic nasal skin and unforgiving nasal geometry. The bilobe flap is a double transposition flap that can transpose skin from cephalad to caudad to repair defects of the lower third of the nose. However, pincushioning may complicate this flap, yielding untoward aesthetic outcomes. We review our single surgeon series of patients who underwent bilobe flap reconstruction of nasal defects, and describe our surgical technique to minimize pincushioning and poor aesthetic outcomes. This was a retrospective chart review of patients who underwent bilobe flap reconstruction of nasal defects at a tertiary referral facial plastic and reconstructive surgery clinic between January 1, 2010 and February 12, 2019. All postoperative clinic notes were analyzed for complications, reports of unfavorable cosmetic outcome, and rates of revision procedures. Surgical technique is described. In the analysis, 125 patients were included, of whom 84 (67%) patients were women, and the mean (standard deviation) age was 60.7 (12.5) years. Complications were reported in 20 (16%) patients, including scars, pincushioning, and nasal obstruction. Five patients underwent revision surgery (4%), including scar revision and z-plasty. Pincushioning was reported in four patients (3.2%), of whom three underwent scar revision procedures. One patient had alar notching requiring correction. There was no statistically significant association between ear cartilage graft and complications (p = 0.84) or requirement of intervention (p = 1.0). Univariate and multivariate logistic regression did not show statistically significant association between size of the defect and the presence of complications (p > 0.05). The bilobe flap is an excellent transposition flap for the repair of small nasal tip defects. By adequately thinning the transposition flap of excess subcutaneous tissue prior to inset, rates of poor aesthetic outcomes, revision procedures, and pincushioning are minimized.

Reconstructive Approaches to Nasal Defects

2018 ◽  
Author(s):  
Michael L. Bentz
Keyword(s):  
Steroid Injection ◽  
Free Tissue Transfer ◽  
Nasal Reconstruction ◽  
Nasal Airway ◽  
Prosthetic Rehabilitation ◽  
Prosthetic Reconstruction ◽  
Skin Cancers ◽  
Laser Treatments ◽  
Nonmelanoma Skin Cancers ◽  
Nasal Defects

Nasal reconstruction is commonly performed for treatment of defects arising from excision of nonmelanoma skin cancers, although other tumors, trauma, or infection may also result in significant nasal deformities necessitating corrective surgery. Patients being evaluated for nasal reconstruction should have a functional assessment of airflow through both the internal and external nasal valves to determine the need for reconstructive maneuvers that will maintain or improve the nasal airway. Aesthetic considerations relate to which nasal subunits are missing and how local, regional, and sometimes free tissue transfer can be used to optimize the final appearance of the nose. Reconstruction must incorporate a plan for reestablishing nasal lining, support, and cover depending on which elements are missing. Postoperative considerations include the need for nasal splints and interventions to optimize nasal scarring and contour such as scar massage, steroid injection, and laser treatments. Patients who are not good candidates for autologous nasal reconstruction may be considered for prosthetic reconstruction. This review contains 13 figures and 67 references Key words: Nasal reconstruction, Nasal airway, Mohs surgery, Skin cancer, Nasal aesthetic subunits, Facial flaps, Skin graft, Forehead flap, Nasal cover, Nasal lining, Nasal support, Prosthetic rehabilitation

Rationale and Argument for Subunit Mohs Excision in Nasal Reconstruction

2016 ◽  
Vol 20 (4) ◽  
pp. 343-345
Author(s):  
Zachary R. Jergensen ◽  
Ronnie A. Pezeshk ◽  
James F. Thornton
Keyword(s):  
Functional Results ◽  
Nasal Reconstruction ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Nasal Ala ◽  
Aesthetic Results ◽  
Nasal Defects

Background: Optimal aesthetic results are achieved when nasal defects after Mohs micrographic surgery (MMS) are reconstructed as entire nasal subunits. Objective: To illustrate the importance of reconstructing the nose in entire subunits and explore the possibilities of expanding the principles of subunit reconstruction to the concept of subunit Mohs excision. Methods: An 83-year-old man presented for MMS to excise 3 lesions on the nasal ala. The surgeons elected to excise and reconstruct the entire subunit. Results: Excellent aesthetic and functional results were obtained. Conclusion: When a defect greater than 50% of a nasal subunit is encountered during MMS, immediate marginal control excision of the entire subunit can be performed with subsequent reconstruction. This technique ultimately has the potential to deliver a more aesthetically pleasing outcome and should be, at the very least, considered by all Mohs surgeons.

scholarly journals Use of Porous Polyethylene Implants in Nasal Reconstruction

2011 ◽  
Vol 4 (2) ◽  
pp. 63-70 ◽  
Author(s):  
Natasha Choudhury ◽  
Joe Marais
Keyword(s):  
Surgical Complication ◽  
Septal Cartilage ◽  
Nasal Reconstruction ◽  
Concomitant Disease ◽  
Porous Polyethylene ◽  
Tissue Microenvironment ◽  
Advantages And Disadvantages ◽  
Previous Trauma ◽  
Graft Extrusion ◽  
Porous Polyethylene Implants

ABSTRACT Introduction Patients undergoing complex rhinoplasty, following previous trauma or cartilage deteriorating disease processes, present a surgical challenge. The availability of septal cartilage maybe limited, and alternative graft materials should be considered. Methods A retrospective study of our experience using the porous polyethylene (Medpor®) implant in nasal reconstruction was conducted. The indications for surgery are reviewed and the surgical outcomes noted. We also review the literature on available nasal implants and discuss their advantages and disadvantages. Results A total of 22 Medpor® nasal implants were used for augmentation rhinoplasty over a 6 and half years period. Three patients experienced a surgical complication, including one slipped dorsal implant, and two patients with graft extrusion. Both of these two patients had concomitant disease processes that would have resulted in a poor tissue microenvironment, which may have contributed to their graft failures. Conclusion In our experience, the Medpor® implant has proved very successful in patients requiring complex rhinoplasty, in a normal host tissue microenvironment.

scholarly journals Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?

2021 ◽  
Vol 7 (5) ◽  
pp. 721
Author(s):  
Viresh Arora ◽  
Faisal Ashfaq ◽  
Atif Rafique
Keyword(s):  
Wound Dehiscence ◽  
Advancement Flap ◽  
Nasal Reconstruction ◽  
Full Thickness ◽  
Lateral Migration ◽  
Forehead Flap ◽  
Nasal Defect ◽  
Alar Retraction ◽  
Simultaneous Reconstruction ◽  
Nasal Defects

<p class="abstract"><strong>Background:</strong> Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?</p><p class="abstract"><strong>Methods:</strong> Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.</p><p class="abstract"><strong>Results:</strong> Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.</p><p class="abstract"><strong>Conclusions:</strong> Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.</p>

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