Novel Use of the Buccal Fat Pad for Sinocutaneous Fistulae Closure and a Review of Reconstructive Options

Background: Sinocutaneous fistulae (SCF) are abnormal communications between the paranasal sinuses and the overlying skin. They may be difficult to manage due to facial geometry, scar contraction, and poor tissue vascularity. We describe a novel use of the buccal flap and review the literature to examine management options for this disease process. Methods: A PubMed/MEDLINE literature search was performed for studies published between January 1, 1950 and April 29, 2020 that describe management strategies for SCF. The clinical record, imaging, and operative reports were reviewed of the case in which the buccal fat flap was used in reconstruction. Results: A total of 359 articles were retrieved. After removing duplicate articles, non-English studies, animal studies, duplicate articles and studies that mentioned SCF without specific mention of management strategies, 51 articles were reviewed. Management paradigms throughout the articles include (1) removal of infection, (2) ensuring patency of sinus outflow tracts, (3) tensionless multilayered closure using well vascularized tissue, and (4) prevention or minimization of future risk factors for fistula formation. Conclusion: This article informs surgeons on reconstructive options for sinocutaneous fistulae including a novel description of the buccal fat flap.

Abstract 279: A Defective Mechanosensing Promotes Impaired Fibroblast-to-myofibroblast Maturation in the Aging Mouse Heart

In the aging heart, fibroblasts have a reduced ability to mature into myofibroblasts (expressing contractile actin a-SMA), which is necessary for scar contraction in wound healing. The mechanosensing pathway bridges the extracellular matrix (ECM) with the actin cytoskeleton and is altered during aging. We emphasize that changes in this pathway may affect myofibroblast activation. Using various methods (mass spectrometry, qPCR, flow, IF staining, and western), we found several abnormalities in the fibroblasts derived from old mouse hearts: 1) ECM deposited was altered with an increased quantity of collagens and the presence of fibronectin variant Anastellin that opposes myofibroblast maturation; 2) there was a 50% reduction of Kindlin-2, a protein that promotes integrin activation; 3) Polymerized (F-) to monomeric (G-) actin ratio was decreased by 65%, possibly due to a 5-fold increase in pERKs1/2 level, a negative regulator of F-actin; and pERKs inhibition (by 2.5μM, PD-0325901) increased by 2-fold F/G actin ratio; 4) we found an increased cytoplasmic retention of MRTF-A (by 44%), an actin-sensitive co-transcription factor (necessary for a-SMA) that shuttles into the nucleus in response to F-actin formation; 5) pERKs inhibition increased a-SMA transcription by 78%. Thus, the disrupted mechanosensing pathway contributes to the impaired myofibroblast maturation in the aging heart. All experiments were performed in young (3-4 month-old) and old (24-30 month-old) hearts or primary cardiac fibroblasts isolated from male C57BL/6J mice. Unpaired Student’s t-test was used for statistical analysis, n=2 for mass spectrometry and n=4-10 for all other biological repeats.

AN UNSUTURED MESENTERY DEFECT AFTER COLON GRAFT FORMATION IN ESOPHAGOPLASTY IN CHILDREN

Purpose. To decrease the number of complications at the intra-abdominal stage of total esophagoplasty in children by leaving a mesentery defect unsutured after the graft formation. Material and methods. 27 children with atresia (4) and scar contraction (23) of the esophagus had esophagoplasty with a colon left-side graft on a vascular pedicle including a. colicamed; a.colicasin and the arcade between the first sigmoid artery were ligated and cut. The graft was placed behind the sternum in the antiperistaltic position. A “window” in the mesentary of the transverse colon was left unsutured after the graft formation. Basic techniques for examination - X-ray and endoscopy. An anastomosis “end of the esophagus to the side of the colon graft” was always formed at the neck level. Results. Due to the unsutured mesentary of the transverse colon, surgeons avoided all intra-abdominal complications which may develop, if the mesentary is sutured. The right side of the colon remained intact ; neck-anastomosis fistulas were seen only in 2 (9%) patients.

Skin substitutes

Skin substitutes are a heterogeneous group of wound coverage materials that aid in would closure and replace the functions of the skin. They were developed as an adjunct or alternative to autografts. They are available in large quantities, they can provide a mechanical barrier to infection and fluid loss, and enable a neo-dermal base that may help minimize scar contraction. However, they can be expensive, difficult to store with a short half-life and there is a learning curve for their clinical application and use. Skin substitutes can provide either temporary wound cover (eg. Biobrane, TansCyte) or permanent wound cover (eg. Intergra, Matriderm, Alloderm). The features, advantages and disadvantages of the main types of skin substitutes currently in common use are described in this chapter.

Secondary Reconstruction of Posttraumatic Enophthalmos with Titanium Mesh and Buccal Fat Pad Graft: Case Report

Secondary enophthalmos caused by an untreated orbital blowout fracture can cause esthetic and functional disturbances. The esthetic defect is manifested by sinking of the superior sulcus and the hypophthalmic globe. Functional impairment of the eye can usually be a common complaint with restriction of eye motion and diplopia. Early diagnosis followed by repair of surgically correctable fractures is the most acceptable procedure. Failure in the primary treatment may cause scar contraction and fat atrophy. The aim of this paper is to report a case of a late treatment of blowout orbital floor fracture with secondary enophthalmos using titanium mesh and buccal fat pad graft.