Morselized Bone Graft: A Tool for Nasal Dorsum Refinement and Camouflaging

Goals/Purpose The nasal dorsum is a cornerstone of rhinoplasty aesthetics, playing a vital role in achieving facial harmony and balance. Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, acellular dermal matrices, and silicone implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum after dorsal reduction. Methods/Technique The senior surgeon exclusively utilizes an open approach to rhinoplasty, and all cases are performed under general anesthesia. After performing a dorsal hump reduction with a bone rasp, the MBG is stored on the back table for later use in the same case. After addressing other components of the rhinoplasty procedure, attention is turned back to the nasal dorsum, wherein any contour irregularities are filled with the MBG paste. A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases in which autologous MBG was used for dorsum refinement and contouring with a minimum of 12 months of follow-up. 953 patients met the inclusion criteria and were included in the study. Outcomes of interest included the rate of postoperative infection, defined as patients with signs of infection requiring antibiotics after completing their standard course of prophylactic antibiotics, and the rate of operative revisions. Results/Complications The mean age of our study group was 31.6 years old, with 869 female patients. 640 cases were primary rhinoplasties. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision, among whom 4 (23.5%) patients were revision cases. There were no patients who sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique in camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, as there is no additional equipment required and minimal operative time added when performing this technique, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction. Future steps will involve performing a five-year follow-up on this cohort of patients to assess for long-term dorsal aesthetics following MBG use.

Goals/Purpose Smoking negatively impacts tissue perfusion and wound healing, raising concerns about infection and delayed recovery in surgical patients. While smoking remains a strict contraindication in some procedures with extensive dissection, such as abdominoplasty and facelift surgery, the risks of smoking in rhinoplasty patients are not well known. Given the nasal region's robust vascular supply, the risk of smoking complications may be less in rhinoplasty. This study explores whether smoking should be considered a contraindication for rhinoplasty by comparing postoperative infection rates and the need for revision surgery between smokers and nonsmokers. Using a decade of patient data, we aim to assess whether there is an increased risk of infection or revision surgery in smokers. The findings will provide valuable insights to guide plastic surgeons in making informed decisions and ensuring safe, successful outcomes for both smokers and nonsmokers. Methods/Technique A retrospective review was conducted on the senior author’s (R.G.R.) rhinoplasty cases from July 2014 to June 2022, including all patients treated in this period. The study was approved by the BRANY Institutional Review Board. All patients underwent open rhinoplasty under general anesthesia, prioritizing septal cartilage for reconstruction. If septal cartilage was inadequate, fresh frozen cartilage (FFCC) from MTF Biologics was used; no alloplastic materials were utilized. Patients were categorized as active smokers, former smokers, and non-smokers. Active smokers used any inhaled tobacco products (e.g., cigarettes, cigars, vaping) within 4 weeks before and/or after surgery. Former smokers had quit over 4 weeks prior to surgery with no intent to resume, and non-smokers had no history of tobacco use. Patients with less than one-year follow-up were excluded. After reviewing 2003 cases of rhinoplasty, 1884 patients were found to match both the inclusion and exclusion criteria. Patient demographics and surgical outcomes were collected through manual chart review. Primary outcomes included infection and revision rates, with infections identified by clinical signs requiring antibiotics or further intervention post-prophylactic antibiotics. Revision rhinoplasty was defined as any subsequent open procedure. Infection and revision rates were compared across active smokers, former smokers, and non-smokers, with subgroups for primary and revision rhinoplasty patients. Results/Complications A total of 1884 patients consisting of 1673 (88.80%) females and 211 (11.20%) males met inclusion criteria with an average age of 30.7 years and BMI of 22.47 kg/m2. Among these patients, 1421 (75.42%) were primary rhinoplasty cases and 463 (41.5%) were revisions. The average length of follow-up was 23.8 months. This study’s rhinoplasty patient population consists of 81 (4.30%) active smokers, 38 (2.02%) former smokers, and 1765 (93.68%) non-smokers (Table 1). In our patient population, we included patients who underwent both primary and revision rhinoplasty. In the overall population, there were 62 (3.29%) patients that underwent subsequent revision. 36 of 1421 (2.53%) of these patients belonged to the primary rhinoplasty group and 26 of 463 (5.62%) to the revision rhinoplasty population. In comparison, revisions were performed on 3 of 80 (3.75%) active smokers, 1 of 39 (2.56%) former smokers, and 58 of 1,765 (3.29%) non-smokers. Among these groups, all 3 of 71 (4.23%) revision patients were among primary rhinoplasty patients in the active smoker population, whereas in the non-smoker population, the distribution was 32 (2.42%) for primary and 26 (5.83%) for revision cases. No statistically significant difference was observed between groups (Table 2). Overall, 32 of 1884 (1.70%) of patients required 5-7 days of additional postoperative antibiotics for cellulitis. This was in addition to the standard postoperative antibiotic prophylaxis. 21 of 1421 (1.48%) of these patients belonged to the primary rhinoplasty group and 11 of 463 (2.38%) to the revision rhinoplasty patient population. 3 of 80 (3.75%) of patients requiring additional postoperative antibiotics were active smokers and 29 of 1765 (1.64%) were non-smokers. There was no incidence of use of additional postoperative antibiotics in the former smoker rhinoplasty population. Again, no statistically significant differences were found among the groups (Table 3). Conclusion The results of this study indicate that active smoking should not be considered a contraindication for rhinoplasty, as there is no significant increase in the need for revision surgeries in actively smoking patients compared to nonsmokers. While smoking is commonly associated with impaired wound healing and increased risk of infection due to its negative effects on tissue perfusion and immune response, our data demonstrate that these concerns can be managed effectively in the context of rhinoplasty. Among the 1884 patients included in this study, the revision rates for smokers (3.75%) and nonsmokers (3.29%) were comparable. This finding is particularly notable as it challenges the assumption that smokers are inherently at higher risk for suboptimal surgical outcomes. Despite the known systemic effects of smoking on vascular health and tissue healing, rhinoplasty in smokers appears to result in satisfactory outcomes when proper postoperative care is implemented.

Sir: Dorsal nasal irregularities are common aesthetic deformities following primary and secondary rhinoplasty, especially in patients with thin nasal dorsal skin. The authors present a simple technique of obtaining autologous graft material, by collecting the remnants of rasped osseocartilaginous dorsum, which is used as a routine in their rhinoplasty practice. The authors prefer open rhinoplasty in all patients. After transcolumellar and infracartilaginous incisions, a distally subperichondrial and proximally subperiosteal pocket is developed over the osseocartilaginous dorsum. A nasal dorsum rasp is introduced into this space and the dorsal hump is removed by rasping alone. During rasping, tiny fragments of bone and cartilage are produced from the breakdown of osseocartilaginous dorsum (Fig. 1). These particles are collected meticulously from the surface of the rasp by drying the rasp on a piece of gauze or from the pocket with an atraumatic forceps. Aspiration of blood by the assistant is not allowed at this stage. Hemostasis is achieved by sponges, and these sponges are also preserved for collecting any particles attached on them. When all particles are gathered and dried over a piece of gauze, a solid "meatball" of osseocartilaginous graft material is obtained (Fig. 2). This graft material is placed on the osseocartilaginous dorsum just before closure of incisions, and the nose is taped and splinted.Fig. 1.: Tiny fragments of bone and cartilage are formed by rasping the nasal dorsum.Fig. 2.: These particles are gathered into a "meatball" composite graft.This technique, which was used as a routine in 562 primary open rhinoplasties between 2002 and 2008, simply eliminated postoperative dorsal nasal irregularities in our rhinoplasty practice. Prevention of dorsal irregularities that may occur even in the most experienced hands is much easier than treating them. The authors believe that in primary rhinoplasty of patients with thin dorsal nasal skin, a maneuver that adjusts the smoothness and softness of nasal dorsum should be a part of the routine. Many techniques have been suggested in attempts to prevent visible sharp edges of dorsal nasal structures, most of which involve placement of soft, smooth, pliable grafts of autologous or alloplastic origin such as fat, diced cartilage, fascia, bone chips, AlloDerm (LifeCell Corp., Branchburg, N.J.), polytetrafluoroethylene patches, silicone sheets, and Vicryl (Ethicon, Inc., Somerville, N.J.) mesh.1–4 Our technique is simply about returning the rasped osseocartilaginous hump to where it belongs. Absence of additional donor-site morbidity is a major advantage over most autologous graft options. Lower cost and avoidance of infectious complications are advantages over alloplastic materials. Prolonged edema, which is common after contouring with dermis grafts or AlloDerm, is not seen with this technique. No envelope or wrapping is necessary. The adequacy of graft material obtained with this technique may be a subject of curiosity. In our opinion, the higher level of control that is provided by rasp removal of dorsum diminishes the amount of material that is necessary to camouflage subtle irregularities in primary rhinoplasty. In cases where additional volume is desired, especially in secondary rhinoplasties, remnants of septal, conchal, or costal cartilages that are left on the table after placement of grafts can be rasped on the table and added to the meatball. DISCLOSURE Neither of the authors has a financial conflict of interest to disclose with regard to the content of this article. Aycan Kayikçioğlu, M.D. Ozan Bitik, M.D. Hacettepe University Faculty of Medicine Department of Plastic, Reconstructive, and Esthetic Surgery Ankara, Turkey

Objective To evaluate the postoperative related aesthetic parameters and satisfactory degree between CT 3D reconstruction augmentation rhinoplasty with silicone and augmentation rhinoplasty with silicone in adult Han women. Methods Totally 60 adult healthy Han women voluntarily subjected to augmentation rhinoplasty with silicone were randomly divided into groups A and B, 30 people each group; Row CT 3D reconstruction augmentation rhinoplasty with silicone was performed in group A, and the augmentation rhinoplasty with silicone in group B; 6 months after surgery related data measurement and questionnaire collected, we compared the objective and subjective indicators for the nasal root, dorsum and ministry, respectively. Results There was a difference between group A and group B in the nasorostral angle, the nasal facial angle, the asofrontal angle and the height of the nasal root (89.50±1.40)°, (28.85±2.20)°, (136.26±1.92)°, (6.45±0.27) mm in group A, and (85.40±3.70)°, (26.43±4.39)°, (138.88±4.78)°, (5.28±0.34) mm in group B (all P<0.05). There was a difference between group A and group B in operation time (51.77±5.35) min vs (29.83±5.76) min (P<0.05). Conclusions Owing to its preoperative prosthesis design purpose and avoiding local swelling, CT 3D reconstruction augmentation rhinoplasty with silicone has better effects than that of augmentation rhinoplasty with silicone, especially on the nasal dorsum and the nasal root), which can obviously shorten the operation time, and therefore it is more suitable for the defects of the nasal root and dorsum. Key words: Three-dimensional reconstruction; Rhinoplasty; Han nationality

Background: Nasal dorsal irregularities after rhinoplasty are troublesome for both patient and surgeon, especially in patients with thin dorsal skin, which may be seen after improper hump reduction and multiple surgeries. Many types of grafts have been used for nasal contouring, augmentation and cam-ouflage as diced cartilage, fascia, dermal grafts, alloderm and banked allograft.Methods: We report the use of Fascia Lata (FL) graft for dorsalcontouring and camouflage in 20 patients who underwent rhinoplasty between May 2015 to September 2016. There were 12 male and 8 female patients, with ages ranging from 18 to 43 years (mean age: 30.35). Of the 20 patients, 12 underwent primary rhinoplasty, while 8 were secondary cases. An informed consent was obtained from all patients for the use of FL graft. The graft was harvested from the right lateral thigh. A simple method was used to placethe graft over the nasal dorsum. Post-operative follow-up period was 16 months. Clinical evaluation was made by inspection, palpation and photographic documentation.In addition, a questionnaire related to patient satisfaction and donor-site morbidity.Results: All patients had satisfactory aesthetic results, andno apparent irregularities were observed over the nasal dorsum. The questionnaire resultsshowed that all patients, but one, were satisfied with surgery, and were not concerned aboutdonor-site scar; however, one patient had donor-site morbidity.Conclusions: This study conclusively shows that it is a reliable, simple method for camouflaging any post-operative dorsalirregularities, particularly in patients with thin nasal skin.

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material. We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up. There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection. Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future. Level of Evidence: Level IV, therapeutic study

Several grafting materials have been used in revision rhinoplasty to correct overresected dorsum. Autologous materials are generally preferred, but have the drawbacks of additional surgical time and donor site morbidity. Tutoplast-processed fascia lata (TPFL) offers a commercially available alternative to autologous fascia grafts. We reviewed the results of 42 revision rhinoplasty procedures that used TPFL with or without autologous cartilage to correct overresected dorsum. Forty-two patients with overresected dorsum underwent revision rhinoplasty with multilayered TPFL at our institution between 2005 and 2012. Saddle nose deformities were classified into one of three types, according to severity. Surgical results were evaluated as excellent, good, or fair by an otolaryngologist who compared preoperative photographs with pictures taken at final follow-up. Surgical complications were analyzed. Of the 42 patients who underwent rhinoplasty with multilayered TPFL, 36 were treated with TPFL alone, while autologous cartilage was used concurrently in six. Twenty-six (62 %) of the patients showed excellent aesthetic improvement, 11 (26 %) showed good improvement, and five (12 %) showed fair improvement. There were no major complications. Minor complications included edema in six patients, major resorption in three, and minimal resorption in nine. Patients with mild or moderate saddle nose deformity had better surgical results than those with more severe deformity. There are many possible methods to correct overresected dorsum. Multilayer TPFL is safe alternative to autologous rib cartilage grafts. Level of Evidence: Level IV, therapeutic study.

PD25-03 FEAR OF POSTOPERATIVE INFECTION FOLLOWING PLACEMENT OF INFLATABLE PENILE PROSTHESIS AT AN ACADEMIC TRAINING CENTER IS UNWARRANTED: DATA FROM A SINGLE SURGEON SERIES

The use of diced cartilage grafts in rhinoplasty surgery was recently revived by Erol with the publication of his technique for "Turkish delight" grafts (i.e., diced cartilage grafts wrapped in Surgicel). The present study details the authors' experience with 50 consecutive diced cartilage grafts used in three configurations during a prospective study of 50 primary and secondary aesthetic rhinoplasty procedures performed by the senior author (Daniel). Part I consists of 22 diced cartilage grafts wrapped in Surgicel and placed in the radix (n = 14), radix/upper dorsum (n = 4), and full-length dorsum (n = 4). All grafts were performed adhering meticulously to Erol's technique without modification. This portion of the study was halted abruptly at 4 months because of the unexpected absorption and clinical failure of all diced cartilage grafts wrapped in Surgicel. Subsequently, five patients had revision surgery, and biopsy specimens were taken at the prior grafting site and analyzed histologically. After this clinical failure, part II of the study began, consisting of 20 patients who had diced cartilage grafts wrapped in fascia. The range of applications was comparable: radix (n = 12), radix/dorsum (n = 3), and full-length dorsum (n = 5). Because of our prior practice of overcorrecting by 20 percent with diced cartilage grafts wrapped in Surgicel, we had excessive amounts of material in six of our initial diced cartilage wrapped in fascia radix grafts, but no subsequent grafts. The overcorrections were easily reduced at 6 weeks to 11 months postoperatively using a pituitary rongeur under local anesthesia, and the material was sent for histologic analysis. Minimum 1-year follow-up of all 20 cases has shown maintenance of the grafts without evidence of absorption. Part III of this study comprised eight patients who had diced cartilage grafts without a fascial covering placed throughout the nose, including on the sides of osseocartilaginous rib grafts to the dorsum. At 14 months, there was no evidence that any of these grafts had been absorbed. Histologic analysis of the biopsy specimens from the diced cartilage grafts wrapped in Surgicel showed evidence of fibrosis and lymphocytic infiltrates with small amounts of Surgicel visible on birefringent microscopy. Remnants of cartilage were present but were metabolically inactive on the basis of negative glial fibrillary acidic protein staining. Control specimens of fresh septal cartilage and banked septal cartilage were remarkably similar to each other and demonstrated normal cartilage architecture and cellular activity. The diced cartilage grafts wrapped in fascia showed coalescence of the diced cartilage into a single cartilage mass, with viable cartilage cells and normal metabolic activity on the basis of glial fibrillary acidic protein staining. All of the diced cartilage grafts wrapped in Surgicel absorbed and failed to correct the clinical problem for which they were performed. All of the diced cartilage grafts wrapped in fascia and pure diced cartilage grafts did correct the clinical deformities and appear to have survived completely. The diced cartilage grafts wrapped in fascia placed along the dorsum were distinctly palpable throughout the postoperative period, as was one prior case with a 6-year follow-up. The authors' clinical experience confirms the experimental studies of Yilmaz et al. that question the use of Surgicel for wrapping diced cartilage grafts in clinical rhinoplasty surgery.

To correct saddle nose deformity, diced cartilage grafts have been commonly used over the past decade. However, following the correction of saddle nose deformity with diced cartilage graft, some problems like graft absorption or displacement may occur, which require revision surgery. Here, a new technique is presented for correcting saddle nose deformity when diced cartilage graft fails. Twelve cases were admitted to my clinic with complaints of nasal dorsal irregularity and depressions, asking for tertiary rhinoplasty. Seven (four women and three men) of these patients, who had a gap smaller than 1 cm in the lower 1/3rd of nasal dorsum, were selected for the described technique. After the nasal dorsum is undermined through the supra-perichondrial and subperiosteal plane, the diced cartilage island attached to the nasal dorsal skin is released distally until the island can be transposed to the tip area. This island attached to the nasal dorsal skin proximally, is formed as a flap and moved caudally as an advancement flap and sutured to the posterior of the dome area. The patients were followed for minimum 1 year (12-20 months) with intervals of 3 months. All the patients and also the surgeon were satisfied with the results. No complications such as resorption of the grafts were observed in any of the cases. This is an alternative, new, practical technique for correcting saddle nose deformity in the lower 1/3 of the nasal dorsum, in which the diced cartilage graft technique has failed to correct. In addition, tip projection and upward rotation can be achieved with this technique. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to 46 Authors www.springer.com/00266 .

Revision rhinoplasty in Asian patients is associated with problems related to the use of grafts or implant materials. Moreover, the septal cartilage of Asian individuals is generally weak and small, which makes it particularly vulnerable to injury or secondary deformity during primary surgery. Hence, there is an increased demand for major reconstruction of the septal cartilage framework during revision surgery in Asian patients. In revision rhinoplasty of the nose in Asian patients, appropriate management of the graft or implant is vital. The common problems resulting in the need for revision surgery include displacement, malposition, extrusion, recurrent inflammation, and infection of dorsally implanted alloplastic material. A short-nose deformity following silicone rhinoplasty is also a common problem that is difficult to manage. Furthermore, residual or recurrent deviation of the deviated nose, undercorrection of the convex nasal dorsum, and tip graft-related complications are frequently encountered problems that require revision. In revision rhinoplasty for Asian patients, autologous tissues, such as conchal cartilage and costal cartilage, play a pivotal role for use as a new dorsal implant or building block for major septal reconstruction. Therefore, it is imperative for surgeons to familiarize themselves with the appropriate use of autologous tissues, particularly costal cartilage.

Mader, Konrad MD; Pennig, Dietmar MD; Gausepohl, Thomas MD; Patsalis, Theodor MD Author Information

Objective The aim was to compare clinical outcome and fate of solid cartilage versus diced cartilage in fascia in augmentation rhinoplasty. Back ground Augmentation rhinoplasty can be achieved through many different techniques and materials. There are many different implantable materials available, both autologous and nonautologous. The major limitation of nonautologous material is the limited biocompatibility, which contributes to allergic reaction, excursion, displacement, and infection. Patients and methods This study was conducted in combination of Plastic Surgery and Burn Department of Mansoura University and Plastic Surgery Department of Menoufia University during the period from December 2012 to November 2015. It included 14 patients who underwent augmentation rhinoplasty, aged from 18 to 35 years, with mean ± SD age of 25.7 ± 6 years. In total, five (35.7%) patients were female and nine (64.3%) patients were male. Patients were divided into two groups. Group I underwent augmentation rhinoplasty by solid cartilage graft (septal, conchal, or rib). It included seven patients, with five (71.5%) male and two (28.5%) female patients, with mean ± SD age of 24.5 ± 6 years. Group II underwent augmentation rhinoplasty by diced cartilage graft enveloped in fascia (deep temporal fascia). It included seven patients, with four (57%) male and three (43%) female patients, with mean ± SD age of 27 ± 5 years. Results A total of five (35.7%) patients were female and nine (64.3%) of them were male. Overall, six (42.8%) patients underwent primary rhinoplasty, six (42.8%) patients secondary rhinoplasty, and two (14.2%) tertiary rhinoplasty. In group I, 43% of the patients had satisfactory (excellent) results, 14.25% of patients had intermediate results, and 42.75% of patients had unsatisfactory results. In group II, 71.5% of patients had satisfactory (excellent) results, 14.25% had intermediate results, and 14.25% had unsatisfactory results. Conclusion Diced cartilage graft is becoming a common place in rhinoplasty. The diced cartilage warped in autogenous fascia has good results, with minimal drawbacks, in comparison with solid cartilage.

Importance: The facial artery musculomucosal (FAMM) flap is a well vascularized axial flap which has been described for mucosal reconstructions throughout the oral cavity. There are limited data regarding its efficacy in secondary repair of nasopharyngeal stenosis and velopharyngeal insufficiency due previous surgery and scar tissue formation. Objective: This study seeks to demonstrate the efficacy of FAMM flap procedure in patients with nasopharyngeal stenosis and velopharyngeal insufficiency. Design, Setting, and Participants: A retrospective case series included patients treated for nasopharyngeal stenosis or velopharyngeal insufficiency with a FAMM flap at an academic medical center from January 1, 2012 to November 1, 2017. Patients included in the study were those who underwent a FAMM flap procedure by the senior author during the specified time period. Main Outcomes and Measures: Functional outcomes included nasopharyngeal airway patency, nasal regurgitation, and speech quality. Any postoperative complications were recorded, including flap necrosis, infection, flap failure, dehiscence, trismus and need for revision surgery. Results: A total of 6 FAMM flap procedures were performed by the senior author over the study period for the indications of this case series. Three patients had nasopharyngeal stenosis and three had velopharyngeal insufficiency. All had successful, sustained nasopharyngeal airway patency or restored velopharyngeal function. The only postoperative complication noted was trismus at the cheek donor site. There were no patients who suffered flap failure or need for revision surgery of the FAMM flap. Conclusions: The FAMM flap is useful for secondary reconstruction of nasopharyngeal stenosis and velopharyngeal insufficiency due to previous surgery and scarring. This study demonstrates the efficacy and reliability of FAMM flaps for repair of complete/near complete nasopharyngeal stenosis and cases of velopharyngeal insufficiency due to scarring of the pharynx.

A reliable, soft tissue allograft, AlloDerm® is reported in this preliminary study. Processed from allograft skin obtained from tissue banks, it is an acellular dermal graft whose native framework is maintained. This dermal graft has been used in conjunction with ultrathin autografts to treat burns, as well as an oral graft/implant in periodontal and oral surgery. This report describes the use of AlloDerm® dermal grafts for soft tissue defects and augmentation. It was inserted through dissected subdermal tunnels or applied on an iatrogenic wound bed before closure. Four commonly performed plastic surgery applications are reported: revision rhinoplasty, scar revision, glabellar contouring, and lip augmentation. The only complication encountered was infection, which resolved with antibiotic therapy without graft extrusion. In this study, the implantation of an acellular dermal graft was performed with minimal postoperative swelling and pain. Also notable was the absence of immunogenicity. This acellular dermal graft appears to represent a significant solution for the correction of soft tissue deficits and soft tissue augmentation.