Pedicled Buccal Flaps as a Back-Up Procedure for Intraoral Reconstruction

BackgroundIntraoral soft tissue deficiency and impaired wound beds are common problems after cleft and tumour surgery or after dental trauma. Frequently, limited defects are overtreated with extensive microvascular reconstruction procedures and pedicled flaps remain useful, as they are simple to harvest and provide a reliable outcome. The buccal flap, first described in the 1970s, has been used for palatine lengthening in cleft patients over decades. In the following we present an expanded indication in cases of palatal fistula, complex vestibulum, exposed bone in orthognathic surgery and osteoradionecrosis. MethodsWe conducted a retrospective chart review and report on all buccal flaps harvested within the last three years. 16 buccal flaps were performed in 10 patients. The median age at the time of surgery was 42 years, reaching from 12 years up to 66 years. Results 14 buccal flaps were used for upper jaw or palatal coverage, two buccal flaps were used in the mandible.In terms of complications (four flaps; 25 %) there were two partial flap failures, one wound dehiscence and one wound dehiscence. There were no failures of the remaining mucosal flap islands after the cut of the pedicles.ConclusionThe buccal flap is a reliable and straight forward approach to challenging intraoral wound beds with soft tissue deficiency. We thoroughly discuss the additional indications for buccal flap surgery, describe the harvest technique and provide strategies to prevent intra- and postoperative complications.

Evaluation of Harvesting and Seed Dormancy Overcoming Techniques in Hymenaea courbaril Germination

Hymenaea courbaril is an endangered Brazilian native species. Recently, this species has been used on reforestation programs. So, production techniques that propitiate faster germination are very important. Although, seed dormancy, which could hamper the seedling production process, is not extensively recognized. Thus, this study focused on evaluating the influence of early harvest technique, scarification and pre-imbibition techniques to overcome H. courbaril seed dormancy in two steps. First, evaluating green fruits harvest could influence the germination process, 137 visually healthy seeds from green fruits and 400 seeds from mature fruits were selected. Seeds from green fruits presented similar results to seeds from mature fruits. Probably due to the natural seed tegument rupture. After, the influence of mechanical scarification, pre-imbibition and the combination of both methods were measured. All studied processing methods did not affect significantly any of the germination measurement parameters. Mechanical scarification exhibits similar responses as previous studies showed when using acid scarification. The technique of harvesting green fruits from the treetop seems to be applicable to commercial seedling production. While none of the studied treatments promoted significantly benefits to germination at any of the indexes.

The Revolving Door Flap: Revisiting an Elegant but Forgotten Flap for Ear Defect Reconstruction

Background The revolving door flap, although well described in the literature, is not widely used in general plastic surgery practice. The flap has been used for anterior auricular and conchal defects and is considered elegant for its unique flap design and peculiarity of flap harvest. However, due to its use for a very specific purpose and unique flap harvest technique that may be difficult to grasp, the flap is not very popular in reconstructive practice. Objectives This study aims to evaluate the understanding and learning curve of the revolving door flap, assess surgical outcome, and reemphasize its utility and elegance in reconstruction of ear defects. Methodology This is a case series of nine surgeries performed between January 2014 and 2018. Three cases were performed by the senior author and six cases by two junior authors. Patients were observed for complications and aesthetic outcomes. Results The mean dimension of the flaps was 27.22 mm × 22.78 mm. The mean operative time was 56.56 minutes (standard deviation 22.50, standard error of the mean 7.5). Flap congestion was noted in three cases postoperatively which resolved completely by the second week. Major “pinning” of the ear was noted in four cases. Conclusion Though infrequently performed, the revolving door flap has an easy learning curve once the proper harvest technique and flap movement has been grasped. The flap harvest is convenient, safe, and yields predictable results. Not only is total or partial flap loss extremely rare, the flap is sensate, color match is good, auricular contour is maintained, and the donor site can be closed primarily and remains well hidden.

Cranial Bone Grafting

This chapter provides a summary of calvarial bone graft utilization and technique. The authors provide a brief review of the anatomy, graft type selection, and procedural steps. The needs of the recipient site dominate decision-making regarding the calvarial graft. These needs include structural integrity, size, shape, and fixation of the graft. Autogenous calvarial grafting is a valuable technique for any surgeon working in craniofacial surgery. With proper consideration of recipient site needs and harvest technique, autogenous calvarial grafting is a useful procedure with benefits outweighing the inherent surgical risks. Also discussed is virtual surgical planning (VSP), which has contributed an additional option for calvarial defect reconstruction by broadening the treatment options to include custom three-dimensional printed polyether ether ketone (PEEK) inlays.