scholarly journals Reconstruction of congenital microtia after ear canaloplasty using V-Y advancement of a temporal triangular flap

2021 ◽  
Vol 48 (6) ◽  
pp. 614-621
Author(s):  
Hae Yeon Park ◽  
Kyeong-Tae Lee ◽  
Eun-Ji Kim ◽  
Kap Sung Oh
Keyword(s):  
Soft Tissue ◽  
Costal Cartilage ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Median Number ◽  
Auricular Reconstruction ◽  
Second Stage ◽  
Triangular Flap ◽  
History Of ◽  
Bilateral Lesions

Background Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity. Herein, we present a method using V-Y advancement of a temporal triangular flap to gain additional soft tissue in these challenging cases.Methods Congenital microtia patients with a history of ear canaloplasty who underwent auricular reconstruction using the Nagata technique between 2016 and 2020 were reviewed. To obtain additional soft tissue, V-Y advancement of a temporal triangular flap was performed concurrently with implantation of the costal cartilage framework, without prior insertion of a tissue expander. The outcomes of these patients with respect to postoperative complications and esthetics were evaluated.Results Eight patients with bilateral lesions were included. No specific complications developed after the first-stage surgery. However, one patient experienced complications after the second stage (auricular elevation). An analysis of the esthetic results showed most patients had excellent outcomes, achieving a satisfactory convolution. The median number of operations needed to complete reconstruction was 2, which was fewer than required using the conventional method with prior insertion of a tissue expander.Conclusions In patients with a history of previous canaloplasty, V-Y advancement of a temporal triangular flap could serve as an alternative to tissue expansion for microtia reconstruction. This technique provided reliable and satisfactory results with a reduced number of surgical stages.

scholarly journals Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

2021 ◽  
pp. 014556132110079
Author(s):  
Tongyu Cao ◽  
Qingguo Zhang
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Ear Reconstruction ◽  
Lower Pole ◽  
Tension Free ◽  
Subsequent Exposure ◽  
Free Closure ◽  
Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

Staged Scalp Soft Tissue Expansion Before Delayed Allograft Cranioplasty

2011 ◽  
Vol 71 (suppl_1) ◽  
pp. ons15-ons21 ◽  
Author(s):  
Ekkehard M. Kasper ◽  
Emily B. Ridgway ◽  
Amr Rabie ◽  
Bernard T. Lee ◽  
Clark Chen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Successful Outcome ◽  
Skull Defect ◽  
Neurosurgical Procedure ◽  
Decompressive Hemicraniectomy ◽  
Second Stage ◽  
Cranial Defect ◽  
Complex Cases

Abstract BACKGROUND: Hemicraniectomy is an established neurosurgical procedure. However, before cranial vault reconstruction, it is imperative that sufficient scalp soft tissue is available for coverage of the reconstructed skull. OBJECTIVE: To present 2 complex cases of posttraumatic patients requiring soft tissue expansion of the scalp before definite cranioplasty with use of a synthetic polyethylene graft. METHODS: Two patients underwent decompressive hemicraniectomy for trauma and required delayed cranioplasty. Both patients had developed significant scalp contraction and presented with a paucity of soft tissue. These patients underwent a staged cranioplasty in which we first achieved scalp-tissue expansion adjacent to the craniectomy site over a prolonged interval. In a second stage, the patient underwent definite reconstructive surgery in which the subgaleal expanders were removed and polyethylene allograft cranioplasty was performed. RESULTS: Cutaneous coverage of the underlying defect could be achieved in this setting without causing tension on the incision line secondary to the now available excess scalp tissue. CONCLUSION: Repair of a cranial defect requires detailed attention to the available scalp and its size relationship to the skull defect to achieve a successful outcome with an aesthetically pleasing, reliable, and lasting result. Preoperative scalp tissue expansion is a valuable step in taking care of patients presenting with scalp soft tissue defect. This technique reduces the morbidity associated with conventional rotational and free-flap techniques.

scholarly journals Microtia reconstruction: our experiences of first 10 cases in Bangladesh

1970 ◽  
Vol 1 (2) ◽  
pp. 14-19
Author(s):  
MS Khondoker ◽  
R Awwal ◽  
MM Sarker ◽  
SH Khundkar
Keyword(s):  
Plastic Surgery ◽  
Costal Cartilage ◽  
Three Dimensional ◽  
Ear Reconstruction ◽  
Two Stage ◽  
College Hospital ◽  
Auricular Reconstruction ◽  
Medical College ◽  
Second Stage ◽  
One Year

Varying degrees of congenital ear deformity (microtia) occurs 1 in about 8000 to 10,000 live births. One of the greatest challenges in plastic surgery is total auricular reconstruction as it demands precise technique as well as artistic creativity. In Bangladesh, recent advancement in the technique of carving and sculpting rib cartilage  and better training for achieving finer anatomic details has given a break through in the surgical management of  deformed ear. Between January 2009 and January 2010, total ear reconstruction was done with a two-stage method using  autogenous costal cartilage in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka. In the first stage, lobule rotation, fabrication of the cartilage framework and its implantation were performed. In  the second stage, elevation of the auricle and formation of the tragus were done. A total of 10 cases with microtia comprising different age group have been operated. All of them underwent stage I operation; among them 8 patients went through stage II procedure while the other 2 are waiting for the same. Results: 10 patients, ranging in age between 8 and 25 years, were operated on using autogenous costal cartilage between 2009 and 2010. Six patients were males and four were females. Unilateral microtia was present in all of these patients (7 right, 3 left). Eight cases were with Grade III microtia; the remaining 2 cases presented with Grade II microtia. The follow-up period was one month to one year. Seven among 8 cases presented acceptable ear contour after second stage ear reconstruction. The cranioauricular angle of the reconstructed ears was also similar to that of the opposite ears. Unfavourable result was deformation of the constructed helix which occurred in one case. Though it is impossible to reconstruct an ear that appears exactly as the opposite one, the new ears which were  made were of correct size and in normal position with impressive finer three dimensional details that achieved patient’s satisfaction as well as surgeon’s professional gratification.Key words: Microtia; Two stage auricular reconstruction; Autologous costochondral cartilageBDJPS 2010; 1(2): 14-19

scholarly journals Palatal Mucoperiosteal Expansion as an Adjunct to Palatal Fistula Repair: Case Report and Review of the Literature

1996 ◽  
Vol 33 (3) ◽  
pp. 255-257 ◽  
Author(s):  
Philip A. Van Damme ◽  
Hans Peter M. Freihofer
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Cleft Palate ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Review Of The Literature ◽  
Fistula Closure ◽  
Fistula Repair ◽  
Palatal Fistula ◽  
Oronasal Fistula

Case report of conventional palatal soft-tissue expansion in an attempt at cleft palate fistula closure with a standard tissue expander. This technique may be an alternative to a tongue flap to promote closure of persistent oronasal fistula.

scholarly journals Tissue Expansion Improves the Outcome and Predictability for Alveolar Bone Augmentation: Prospective, Multicenter, Randomized Controlled Trial

2020 ◽  
Vol 9 (4) ◽  
pp. 1143
Author(s):  
Soo-Hwan Byun ◽  
Sun-Hyun Kim ◽  
Sura Cho ◽  
Ho Lee ◽  
Ho-Kyung Lim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Graft ◽  
Alveolar Bone ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Control Group ◽  
Bone Augmentation ◽  
Hard Tissue ◽  
Multicenter Randomized Controlled Trial ◽  
Bone Gain

Objectives: The purpose of this study was to evaluate the effectiveness of the intraoral use of subperiosteally placed self-inflating tissue expanders for subsequent bone augmentation and implant integrity. Material and methods: A prospective, multicenter, randomized controlled trial was performed on patients requiring alveolar bone graft for dental implant insertion. Patients were assigned to three groups: tissue expansion and tunneling graft (TET group), tissue expansion and conventional bone graft (TEG), and control group without tissue expansion. Dimensional changes of soft tissue and radiographic vertical bone gain, retention, and peri-implant marginal bone changes were evaluated and secondary outcomes; clinical complications and thickness changes of expanded overlying tissue were assessed. Results: Among 75 patients screened, a total of 57 patients were included in the final analysis. Most patients showed uneventful soft tissue expansion without any inflammatory sign or symptoms. Ultrasonographic measurements of overlying gingiva revealed no thinning after tissue expansion (p > 0.05). Mean soft vertical and horizontal tissue measurements at the end of its expansion were 5.62 and 6.03 mm, respectively. Significantly higher vertical bone gain was shown in the TEG (5.71 ± 1.99 mm) compared with that in the control patients (4.32 ± 0.97 mm; p < 0.05). Hard tissue retention— measured by bone resorption after 6 months—showed that control group showed higher amount of vertical (2.06 ± 1.00 mm) and horizontal bone resorption (1.69 ± 0.81 mm) compared to that of the TEG group (p < 0.05). Conclusion: The self-inflating tissue expander effectively augmented soft tissue volume and both conventional bone graft and tunneling techniques confirmed their effectiveness in bone augmentation. With greater amount of bone gain and better 6 month hard tissue integrity, the TEG group compared to the control group—without tissue expansion—showed that the combined modality of tissue expander use and guided bone regeneration (GBR) technique may improve the outcome and predictability of hard tissue augmentation.

scholarly journals Tissue Expansion: Further Attempts to Improve Results in Breast Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Donald A. Hudson ◽  
Kevin G. Adams ◽  
Saleigh Adams
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Simple Method ◽  
Second Stage ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Mean Size ◽  
The Mean ◽  
A Prospective Study

Tissue expansion, is a simple method of breast reconstruction. Method. A prospective study of 27 patients treated over a 43 month period is described. At the first stage the expander is inserted in the dual plane, and the medial pectoral nerve is divided. The tissue expander is over-expanded. Second stage: a de-epithelialized vertical triangle is used to aid anterior projection, an inframammary fold is created and a silicone gel prosthesis inserted. Z-plasties are added to the transverse scar. The contralateral breast can be treated or left alone. Complications were recorded and the results were assessed by 4 plastic surgeons using a visual analogue scale. Results. 19 patients had expanders inserted at mastectomy (2 bilateral) and 8 underwent delayed reconstruction, with a mean age of 47 years (range 30–65 years). A single prosthesis was inserted in 15 patients (mean size 320 mL) and two prosthesis were stacked in 12 patients (mean volume of 400 mL). The mean delay from full expansion to the second stage was 10 weeks (range 3 weeks–11 months). A contralateral augmentation was performed in 5 patients, pexy in 10, a reduction in 2 and in 8 patients no procedure was performed. One patient required explantation. The mean visual analogue assessment was 7. Conclusion. This technique should be considered enhance the cosmetic results in tissue expansion.

scholarly journals Tissue Expander Use for Reconstruction of Scalp Soft Tissue Sarcoma Wide Resection Defects

2020 ◽  
Vol 6 ◽  
pp. 2513826X2090350
Author(s):  
Matthew A. Strode ◽  
Robert F. Lohman ◽  
Kilian E. Salerno ◽  
John M. Kane
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Primary Closure ◽  
Soft Tissues ◽  
Tissue Expander ◽  
Soft Tissue Sarcomas ◽  
Tissue Expansion ◽  
Curative Treatment ◽  
Wide Resection ◽  
Preoperative Radiation

The potentially curative treatment for soft tissue sarcomas is wide resection. When located on the scalp, this can require removal of significant volumes of adjacent soft tissues as well as the skull periosteum. Consequently, reconstruction of the surgical defect is challenging. For patients receiving preoperative radiation or chemotherapy, gradual tissue expansion through the placement of a preoperative tissue expander can allow for primary closure of the wide resection defect, typically with hair-bearing scalp.

Achilles Tenorrhaphy in Five Dogs: A Modified Surgical Technique and Evaluation of a Cranial Half Cast

1998 ◽  
Vol 11 (04) ◽  
pp. 205-210 ◽  
Author(s):  
H. Burbidge ◽  
E. Firth ◽  
S. Fox ◽  
S. Guerin
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Surgical Procedure ◽  
Normal Function ◽  
Surgical Reconstruction ◽  
Bone Apposition ◽  
Cast Material ◽  
Bilateral Lesions ◽  
Bone Tunnels

SummaryAchilles mechanism rupture in four of five dogs was treated with tenorrhaphy using a modified surgical technique designed to optimise accurate apposition of tendon to bone. Two bone tunnels were drilled in the calcaneal tuber from a plantomedial - dorsolateral, and plantolateral – dorsomedial direction respectively. The distal ends of the tendons were sutured to the calcaneal tuber using a Krachow suture pattern. The remaining dog had a mid-tendon Achilles mechanism rupture. A resinous half cast was placed on the cranial aspect of the tarsocrural joint of all five dogs, for a minimum of six weeks, in order to provide limited post operative support. Du e to insufficient cast material two of the support splints failed and one of these cases also required a second surgical procedure. A varying amount of soft tissue irritation was noted in each case. All of the five Achilles mechanisms healed, and all of the dogs returned to normal function.Five dogs with surgical reconstruction of the Achilles mechanism were stabilised postoperatively with a resinous half cast placed on the cranial aspect of the tarsocrural joint for a minimum of six weeks. Two of these casts failed at the tarsocrural joint when six folds of casting material were used; all subsequent cases had eight folds applied. Variable soft tissue irration was observed under the cast in each case. A modified surgical technique using a Krachow suture pattern allowed good tendon-bone apposition. All five Achilles mechanisms healed, and all dogs returned to normal function. Bilateral lesions were identified in 3 of the 4 dogs examined.

Sign in / Sign up

Export Citation Format

Share Document