One-stage reconstruction of full-thickness alar defects with a folded nasolabial island flap

Background: The reconstruction of large full-thickness alar defects requires complex surgical procedures that are usually performed in two stages, with concomitant disadvantages in terms of patient trauma, surgical risk, and cost. This study presents a functional folded nasolabial island flap (FNIF) that can be used to repair large-sized full-thickness alar defects in a straightforward manner.Methods: This retrospective study included seven patients who received a FNIF for a full-thickness alar defect between January 2007 and December 2020. The FNIF is different from the conventional nasolabial flap in that it is folded and twisted to achieve nostril reconstruction with a satisfactory three-dimensional mucosal lining in a single stage. The cosmetic and functional results of FNIF were evaluated by both patients and physicians.Results: The age ranged from 51 to 82 years (mean, 65.6 years). The causes of the defects were squamous cell carcinoma, basal cell carcinoma, and trigeminal trophic syndrome. The nostril lining did not collapse, there was no hypertrophic scarring, and air movement through the nostrils on the flap side was normal. Overall, FNIF produced excellent aesthetic and functional outcomes, with minimal patient discomfort. There were no postoperative complications.Conclusion: Compared with existing reconstruction methods for large full-thickness alar defects, FNIF can easily achieve aesthetic and functional success in a single-stage procedure. It provides satisfactory results for both the patient and the surgeon.

Autologous dura mater grafts in reconstructive surgeries for breast cancer patients

Reconstructive surgeries have long been considered as an essential part of rehabilitation of breast cancer patients. The majority of patients tend to choose one-stage reconstruction, because this type of surgery ensures rapid emotional and physical recovery. Due to the lack of subcutaneous fat in a substantial proportion of cases, which leads to postoperative complications, the most common surgical tactics now is simultaneous reconstruction after subcutaneous mastectomy with subpectoral implant location and strengthening of the lower breast slope using different materials. So far, there has been no gold standard material for secure covering of the lower pole of the implant. Autologous acellular dura mater grafts are a promising material for breast reconstruction. Studies evaluating biointegration, compatibility, inertness, reactivity, and cost effectiveness of autologous acellular dura mater grafts have determined feasibility of using these grafts in reconstructive surgeries.

One-stage reconstruction of bone defects with fibula perforator flap

At the current stage of reconstructive surgery development, perforator flaps have confidently taken a priority place when choosing a method for wound defects cover. However, wounds with significant volume defects of both soft tissues and the bone skeleton remain especially difficult challenges for the surgeon. The desired result of such defects repair could be a technique that allows surgeons to carry out an effective reconstruction in one step.The paper describes in detail the surgical and vascular anatomy, design, preoperative preparation and surgical technique for the mobilization of the free vascularized fibula perforator flap containing a fragment of the bone di-aphysis. Clinical examples of orthoplastic reconstruction in different locations are presented.The authors conclude that free fibula flap allows effective one-stage reconstruction of extensive wounds after trauma or oncological resections, including extensive defects of the skeleton, without significant loss of support function in the donor area. A chimera-style composite flap, which contains soft tissues and a fragment of the fibula, can already be called as a “workhorse" for orthoplastic reconstruction on the lower extremities and in the field of maxillofacial surgery.

Lateral Plantar Arch Reconstruction Using Vascularized Fibula Osteocutaneous Flap

A Sixteen-year-old male had a road traffic accident resulting in crush and loss of lateral two metatarsals of the left foot. The Lateral plantar arch was reconstructed with a vascularized fibula osteocutaneous flap. Flap survived and partial weight-bearing was started by 3 months and full weight-bearing was started 6-months post-surgery. At a 16-month follow-up patient had a normal gait and integrity of the lateral plantar arch was maintained. Vascularized fibula osteocutaneous flap is an excellent option for one-stage reconstruction of the lateral arch of the foot and gives satisfactory results in terms of functions of foot and in avoiding long-term morbidity.

Reconstructive surgery in the complex treatment of breast cancer (10 years of experience)

The aim of the study is to improve the quality of life of women with breast cancer (BC) and a high risk of its development by performing one-stage or delayed reconstruction of the lost breast.The objectives of the study were: to clarify the criteria for selecting patients for prophylactic mastectomy; development of surgical tactics in the treatment of breast cancer and a high risk of its development; assessment of oncological safety of LME; clarification of the methods of reconstruction of the breast; analysis of postoperative complications, including the effect of neoadjuvant PCT during simultaneous breast reconstruction on their frequency, and determination of possible ways to prevent them.Material and methods. The prospective controlled study included 258 patients who underwent surgical treatment in our department between 2007 and 2016. The criteria for the inclusion of patients in the study were: carrying out radical surgical treatment for breast cancer, both in isolation and in combination with the reconstruction of the lost breast; carriage of germline mutations in the tumor suppressor genes BRCA1 and BRCA2, the presence of first-degree relatives suffering from breast cancer, previous BRCA-associated breast cancer; the desire of patients with multiple recurrent proliferative benign breast diseases that are not amenable to conservative and surgical treatment to use the surgical method of breast cancer prophylaxis with immediate restoration of the breast.Results. According to the Beck Depression Questionnaire, 72 % of patients in the first group of patients had a critical and high level of depression, while patients who underwent CME with one-stage reconstruction did not have such levels of depression. At the same time, a relatively favorable psychological state of patients with a low level of depression was observed in 17 of 21 patients in the RME + delayed reconstruction group (which amounted to 81% of the group), in 21 of 22 patients in the RME + simultaneous reconstruction group (95% of the group), and only in 5 of 43 patients in the RME group (12% of the group) (χ2 = 51.6; critical value 9.2 at p ≤ 0.01).Conclusions. When analyzing the results obtained, we once again became convinced of the oncological safety of LME with a one-stage reconstruction of the breast, subject to certain requirements. In the presence of appropriate conditions, it is possible to preserve the SAC during the LME. Preventive LME with simultaneous breast reconstruction is the method of choice in patients with a high risk of developing breast cancer, subject to the appropriate selection criteria and the patient's desire.

Osteosarcoma of the temporal bone occurring 40 years after radiotherapy: A technical case report presenting en bloc resection of intra- and extracranial lesions followed by a one-stage reconstruction

Background: Osteosarcoma (OS) is a malignant tumor of the bone, which rarely occurs in the head-and-neck regions as a primary or a secondary malignancy. Adequate surgical resection is currently the mainstay of treatment for head-and-neck OS; however, en bloc resection and reconstruction can be difficult because the anatomies of these regions are complex. We present a case of an OS arising from the temporal bone 40 years after radiation therapy, which was successfully treated with en bloc resection and a one-stage reconstruction using intraoperative tissue expansion technique. Case Description: A 62-year-old woman who underwent surgery and radiotherapy for a left temporal lesion 40 years before presentation was hospitalized for aphasia and a right hemiparesis. She had a 4 × 3 cm subcutaneous mass in the left temporal area of the head. Computed tomography imaging showed destruction of the left temporal bone and a partially calcified mass. Magnetic resonance imaging showed an enhancing mass with intracranial and extracranial cystic components (5 cm and 3 cm in diameter, respectively). Due to rapid growth of the lesion, a semi-urgent surgery was performed. In this operation, a continuous narrow craniectomy was performed around the tumor using a ruler. Then, en bloc resection of the tumor, with adjacent skin, temporal muscle, skull, dura mater, and cerebral cortex, was achieved. Subsequently, a one-stage reconstruction of the dura mater, skull, and skin of the head was performed using fascia lata, artificial bone, and a local skin flap combined with intraoperative tissue expansion using a 20-French Foley catheter. Postoperative histological examinations revealed the tumor to be an OS. Conclusion: We have presented a rare case of an OS occurring from the temporal bone 40 years after radiation therapy. We describe our experience and the surgical methods in this case to provide options for surgical strategies in patients with head-and-neck OS.

Complications after simultaneous prepectoral breast reconstruction using polyurethane-coated implants in patients with breast cancer

Background. The development and improvement of reconstructive breast surgery provides medical, psychological and social rehabilitation of cancer patients, allowing them to achieve the best cosmetic and functional results. The trend towards the return of prepectoral reconstruction is associated not only with the improvement of mastectomy techniques, but also with implant coating and the emergence of highly cohesive silicone gel filling of implants. The use of polyurethane-coated endoprostheses in prepectoral reconstruction provides more reliable fixation to the surrounding tissues and allows reconstruction of the mammary glands without additional covering of the endoprosthesis.Objective: to improve the results of surgical treatment when performing a one-stage reconstruction by pre-rectal placement of polyurethanecoated implants in breast cancer. Materials and methods. In the period from April 2017 to September 2020 at the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin of P.A. Herzen Moscow Oncology Research Institute performed 340 prepectoral breast reconstructions (direct-toimplant) using polyurethane-coated implants in breast cancer patients. A group of patients was analyzed (n = 208).Results. We noted the following complications: prolonged seroma (more than 30 days) in 39 (18.6 %) patients, red breast syndrome in 31 (14.8 %) patients, capsular contracture III–IV degree by J.L. Baker in 43 (20.57 %) patients, protrusion/extrusion of the endoprosthesis in 23 (11 %) patients, suture divergence in 8 (3.8 %) patients, necrosis in 8 (3.8 %) patients, infectious complications in 14 (6.7 %) patients, ripping in 10 (4.8 %) patients. Also, 2 (0.95 %) patients had a violation of the integrity of the endoprosthesis, and 2 (0.95 %) patients had rotation of the endoprosthesis. Conclusions. Prepectoral breast reconstruction can be used as an alternative to subpectoral reconstruction in primary operable forms of breast cancer with sufficient thickness of integumentary tissues.

Robotic omental flap harvest for near-total anterior chest wall coverage: a potential application of robotic techniques in plastic and reconstructive surgery

We present the robotic harvest of a pedicled omentum flap for reconstruction of a near-total anterior chest wall defect. The patient was a 68-year-old woman with recurrent secondary chest wall angiosarcoma after previous mastectomy and radiation therapy. She underwent neoadjuvant chemotherapy and radiation, followed by wide radical chest wall resection with a final defect size of 15×35 cm. A one-stage reconstruction was performed with an omentum flap harvested by robotic technique and split-thickness skin grafts from thigh donor sites. The patient healed with minimal complications. Our case supports more widespread application of robotics in plastic and reconstructive surgery.