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

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.

Comparison of Wound Healing Using Envelope and Triangular Flap for Impacted Mandibular Third Molar Surgery

Objective: To compare the wound healing with triangular flap versus envelope flap techniques among patients undergoing surgical removal of the impacted mandibular third molar (IMTM). Study Design: An open label randomized controlled trial. Place and Duration of the Study: The Department of Oral & Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan from January 2021 to June 2021. Material and Methods: A total of 70 patients (35 in each group) of both genders aged 20 to 50 years requiring surgical removal of IMTM were included. Patients were asked to follow up on third and seventh day while observations regarding wound healing and pain were noted on 7th day among all cases completing the final follow up. Chi square was applied to compare data between both study groups taking p-value below 0.05 as significant. Results: In a total of 70 patients, there were 42 (60.0%) female and 28 (40.0%) female. Majority of the patients, 36 (51.4%) were above 30 years of age while mean age was noted to be 32.4+9.1 years. Sixty two patients completed the follow up so they were included in the final analysis for the assessment of wound healing and pain. Overall, wound healing was observed to be in 55/62 (88.7%) patients while wound healing was found to be 30/32 (93.8%) patients in envelope flap group in comparison to 25/30 (83.3%) in triangular flap group (p=0.1953). Overall, there was no statistically significant difference in between both study group with regards to evaluation of pain (p=0.3271) Conclusion: Both envelop flap and triangular flap techniques resulted in similar outcomes regarding wound healing among patients undergoing surgical removal of IMTM. Both flap techniques resulted in relatively similar degrees of post-surgery pain. Keywords: Third molar, pain, wound healing.

Modified Volar Oblique Triangular Flap for Coverage of Fingertip Defects

Fingertip includes the portion of the digit which is distal to the insertion of flexor digitorum profundus (FDP) tendon and the extensor tendon. It is the most vulnerable part of the hand to be injured. So, reconstruction of this part requires a good outcome in sensation and function. To meet the goal of the reconstruction principle, "Like with Like" local flap is the most preferable. Such type of flap is a Volar oblique triangular flap based on volar perforator vessels from the Digital artery proper. The aim of the study is to identify its reconstruction outcome in viability, sensation, range of movement of DIPJ, and patients' satisfaction regarding contour. This was a prospective observational study; ten patients were included who were admitted in the Burn and Plastic surgery Department of Rajshahi Medical College Hospital, Rajshahi, from September 2019 to December 2020. Thirteen flaps were harvested to cover for the fingertip defect of ten patients; among them, three were female. The age range of our operated patient was 2- 38 years. None of the flaps was lost except marginal necrosis or epidermal loss. The range of movement of DIPJ and 2SPD were within the normal limit. Patients were satisfied with their contour. So, the modified volar oblique, triangular flap is one of the good options for fingertip defects. TAJ 2021; 34: No-1: 63-69

Tail flap for eyelid reconstruction: An alternative to the Tenzel flap

Purpose: To describe a technique of eyelid reconstruction with the tail flap method and also to evaluate the post-surgical outcome in a group of patients. Methods: This was a prospective case series study on nine patients who had undergone an eyelid reconstruction with the tail flap method. The study had been conducted from July 2014 to July 2019. The follow-up continued for six months to one year. Results: A total of nine patients with ten eyelid defects, 2 (22%) patients had unilateral eyelid coloboma, 1 (11%) had lower lid defect associated with Treacher-Collins syndrome,1 (11%)with bilateral upper eyelid coloboma, only one eyelid undergone lid reconstructive surgery associated with craniofacial anomalies,1 (11%) with Juvenile xanthogranuloma of the left upper eyelid,1(11%) with Basal cell carcinoma in the right upper lid, 3(34%) with Meibomian gland carcinoma 2 in lower eyelid and 1 in upper lid undergone lid reconstructive surgery with triangular flap. Among nine patients, a total of ten eyelid defects were repaired with the triangular flap technique, 5 (50%) in the upper eyelid and 5 (50%) in the lower eyelid. The eyelid defects were completely repaired with tail flap in all patients. All patients were evaluated preoperatively and postoperatively. The cosmetic outcomes of surgical intervention were excellent in 5(50%) cases, good in 3(30%) cases, fair enough in 2(20%) cases. Conclusions: Tail flap is an alternative surgical method to the well-established Tenzel flap in eyelid reconstruction. Keywords: Tail Flap; Tenzel Flap; Eyelid Defect; Lid reconstruction

Use of the Modified Unilateral Cleft Lip Repair Technique to Establish a Cupid’s Bow With a Natural Structure

Introduction: There are several surgical techniques for unilateral cleft lip repair. In most of these techniques, the points where the postoperative scars cross the vermilion border are on the peak of the Cupid’s bow. These scars make the shape of Cupid’s bow indistinct. To maintain the natural shape of the Cupid’s bow, we modified the surgical technique. Methods: We modified the modified Millard’s surgical technique (Onizuka’s surgical technique). The main point of this modification was as follows: we combined a small triangular flap and a vermilion triangular flap (described by Noordhoff). We maintained the projection point on the lateral side of cleft lip which was coordinated to the peak of the Cupid’s bow. Results: We could preserve the shape and symmetry of the peak of the Cupid’s bow. Conclusion: To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.