Aesthetic Reconstruction Research Articles

Reconstruction of lower lip defects with free super-thin anterolateral thigh flap.

Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full-thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32-85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension. Overall flap survival was 100%. The flap size ranged from 8 × 6 cm to 14 × 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speaking and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance. Super-thin ALT flaps seem to be a useful option for functional and aesthetic reconstruction of extensive lip defects.

A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures.

The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO2 laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients' satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P < 0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.

Functional and aesthetic reconstruction of digital flexion contractures with full-thickness plantar skin grafts in children.

Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.

Art Music and Transterritoriality: Reflections on Cuban Migrations to Europe during the 1990s

AbstractThe fall of Communist rule in Eastern Europe (1989–91) had a profound impact on economic, socio-political, and cultural conditions in Cuba during the 1990s. It was the beginning of the so-called ‘Special Period in Times of Peace’. Increasing dire economic conditions on the island led to many changes that impoverished cultural life, including the relocation of composers in Europe, the United States, and other countries in the Americas. The situations encountered by composers who migrated to Europe varied, depending on generational differences and on the dynamics of the socio-political and cultural powers to which each of them were exposed in their new reception contexts. Whether adopting an uncontested identification with the new cultural milieu or resorting to discursive strategies of appropriation and de/re-territorialized negotiation, this text centres on the compositional journeys of four Cuban composers who settled in different European cities: Leo Brouwer (Córdoba, Spain); Eduardo Morales-Caso (Madrid); Keyla Orozco (Amsterdam); and Louis Aguirre (Aalborg, Denmark). Each case represents an invaluable experience of aesthetic reconstruction in a new creative territory that, by its own transterritoriality, has in turn enriched the sonic map of the Caribbean island.

Towards 3D Multi-Layer Scaffolds for Periodontal Tissue Engineering Applications: Addressing Manufacturing and Architectural Challenges.

Reduced periodontal support, deriving from chronic inflammatory conditions, such as periodontitis, is one of the main causes of tooth loss. The use of dental implants for the replacement of missing teeth has attracted growing interest as a standard procedure in clinical practice. However, adequate bone volume and soft tissue augmentation at the site of the implant are important prerequisites for successful implant positioning as well as proper functional and aesthetic reconstruction of patients. Three-dimensional (3D) scaffolds have greatly contributed to solve most of the challenges that traditional solutions (i.e., autografts, allografts and xenografts) posed. Nevertheless, mimicking the complex architecture and functionality of the periodontal tissue represents still a great challenge. In this study, a porous poly(ε-caprolactone) (PCL) and Sr-doped nano hydroxyapatite (Sr-nHA) with a multi-layer structure was produced via a single-step additive manufacturing (AM) process, as a potential strategy for hard periodontal tissue regeneration. Physicochemical characterization was conducted in order to evaluate the overall scaffold architecture, topography, as well as porosity with respect to the original CAD model. Furthermore, compressive tests were performed to assess the mechanical properties of the resulting multi-layer structure. Finally, in vitro biological performance, in terms of biocompatibility and osteogenic potential, was evaluated by using human osteosarcoma cells. The manufacturing route used in this work revealed a highly versatile method to fabricate 3D multi-layer scaffolds with porosity levels as well as mechanical properties within the range of dentoalveolar bone tissue. Moreover, the single step process allowed the achievement of an excellent integrity among the different layers of the scaffold. In vitro tests suggested the promising role of the ceramic phase within the polymeric matrix towards bone mineralization processes. Overall, the results of this study demonstrate that the approach undertaken may serve as a platform for future advances in 3D multi-layer and patient-specific strategies that may better address complex periodontal tissue defects.

Implant-Based Breast Reconstruction Cutting Edge and Controversies

In recent years, the field of breast reconstruction has undergone dramatic changes that have given reconstructive plastic surgeons tools to rebuild more natural breasts Improved outcomes are in part attributable to improved mastectomy techniques with nipple preservation and efforts to preserve well-perfused mastectomy skin flaps. There have also been tremendous advancements in technology and supplemental fat grafting which have greatly enhanced cosmetic results. The present review provides data from the authors’ experience and outlines important components of successful implant-based breast reconstruction and highlight the evolution of this process. Many novel, innovative techniques and advancements in implant design aim to refine patient outcomes and experience. Reconstructive plastic surgeons must be aware of the unique benefits and risks inherent in each technique, device, companion tools, and cancer treatment strategies to help guide their patients toward a successful, aesthetic reconstruction that meets their expectations and wishes.

Optimizing Surgical Procedures of Auricular Keloids According to Their Anatomic Morphological Features.

Aesthetic surgical reconstruction of auricular keloids is still a conundrum. This study introduces our experiences in analyzing the anatomic morphological features of auricular keloids, and devising optimized surgical procedures accordingly. A total of 129 ears with auricular keloids were classified and operated. All patients were followed up for at least 12 months. According to their anatomic positions, auricular keloids were divided into 3 Groups (A, B, and C). The morphological features of keloids were further interpreted according to Chang-Park classification of earlobe keloids. The authors optimized surgical procedures according to the anatomic morphological features from a range of surgical techniques. The recurrence rate of Group C was statistically higher than Group A and B. There was no significant difference in recurrence rate between keloids treated with "primary suture" and "filleted flaps." According to the anatomic positions and morphological features of auricular keloids, we could conveniently devise optimized surgical strategies to obtain aesthetic reconstruction of auricular keloids.

Pedicled vertical posteromedial thigh (vPMT) flap for the reconstruction of extensive perianal-genital defects

Perianal and genital defects occur because of a vast etiology making the reconstruction of function and esthetics remain challenging. Depending on the extent of the defect, different techniques have been employed for coverage including skin grafts, local skin flaps, musculocutaneous flaps, and pedicled perforator flaps. The pedicled vertical posteromedial thigh (vPMT) flap is a new perforator flap that has rarely been employed for this kind of reconstruction. The purpose of this article is to focus on the vPMT perforator flap, which is mainly used as a propeller flap, for reconstructing the perianal and genital region as a feasible option in this area. From July 2013 to December 2018, we treated twelve patients with extensive perianal and/or genital defects with 21 pedicled vPMT flaps. Three patients needed unilateral reconstruction, while 9 patients bilateral needed bilateral reconstruction. The location of the defects included the scrotal region (3 cases), the perianal region (8 cases), and the vulvar region (5 cases), whereby some cases had combined defects. The flap sizes varied from 5-9 cm in width to 18-35 cm in length and all flaps were harvested as perforator-based island flaps. The flap movements used for defect coverage included V-Y advancement in three cases and rotation in propeller fashion in eighteen cases. All flaps survived without any major complications and all donor sites were closed primarily. Our case series showed an exemplary model for the coverage of the perianal and genital region by using the pedicle vPMT flap and the achievement of a sustainable treatment with a minor morbidity of the donor site. We believe that the vPMT flap could be an alternative option for the reconstruction of the perianal and genital region and could be inserted in the armamentarium of the reconstructive microsurgeon.

Aesthetic Reconstruction After Removal of Huge Epidermal Cyst Involving the Calvarium and Dura on the Scalp

Epidermal or epidermoid cysts are one of the most frequent benign masses at the subepidermal level. They are typically smooth, movable, and fluctuant masses covered with stratified squamous epithelium. They rarely grow to a huge size, and only a few cases have been reported. A 69-year-old woman visited the authors' clinic for treatment of a well-defined huge mass in the right temporoparietal and occipital regions of the scalp that had regrown and spontaneously increased in size after excision 30 years prior. Computed tomography revealed a large lobulated mass with an air-fluid level and calvarial bone erosion invading the inner table in the right parietal region. Dural exposure was suspected based on magnetic resonance imaging, which depicted diffuse dural thickening with enhancement.The authors aesthetically excised the mass in cooperation with the Department of Neurosurgery using an inverted T-shaped excisional flap design for the reduction of the redundant scalp similar to that used in reduction mammoplasty surgery. Two months later there was no evidence of recurrence or complications, and the patient was satisfied with the results of the surgery.The authors report the case of a huge scalp mass with skull defect and propose an aesthetic treatment option for this unusual mass on the scalp.

Fallbericht einer Frontobasisrekonstruktion und Volumenkorrektur durch freie M. gracilis-Lappenplastik und autologe Fett-Transplantation – Die Lappenplastik als Scaffold für eine Fettgewebe-Transplantation

This case report shows the interdisciplinary treatment of a 28-year-old woman suffering from a pronounced frontal volume defect after severe craniocerebral trauma. The combination of cranioplasty using a polymethylmethacrylate (PMMA) implant, free gracilis muscle flap transfer for soft tissue coverage and serial autologous fat grafting into the muscle flap for subsequent contouring enabled both an adequate and aesthetic reconstruction. This example demonstrates the feasibility of treating increasingly complex composite defects in a multidisciplinary setting, when plastic surgeons are involved.

Determinants of surgeon choice in cases of suspected implant rupture following mastectomy or aesthetic breast surgery: Clinical implications.

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.

Aesthetic Reconstruction of Fingers and Thumbs With the Vascularized Half–Big Toenail Flap With Minimum Donor Site Morbidity

PurposeThe vascularized half–big toenail flap is a short-pedicle free vascularized flap approximately 30 mm in size that contains a fibular half-nail with a 5-mm skin edge and the partial distal phalanx bone. The fingertip skin of the amputated finger is reflected to cover the skin deficiency. The sensation and function are maintained at the donor site, and primary wound closure of the donor site is possible. This study aimed to evaluate the clinical outcomes of thumb and finger reconstruction operations performed using this flap.MethodsWe assessed 16 patients (19 digits) with digit amputation who underwent this procedure. We evaluated the following parameters: reconstructed digits, amputation level, survival rate, period until bone union, elongated length, morphologic indices, feeding artery, vein distribution, static 2-point discrimination, and patient occupation. We used the Michigan Hand Outcomes Questionnaire for the evaluation of the function and appearance of the arm.ResultsWe reconstructed 3 thumbs and 16 fingers. No patients with zone I or V or palm amputation underwent surgery. Flap survival was obtained in all cases, including one atrophic case. Elongated length was 14.1 mm (range, 0–30 mm). The width and longitudinal/axial convexity of the transferred nail increased and the length decreased, whereas the width of the donor site nail increased at final follow-up. Reasonable sensation of the flap was obtained. The feeding artery was the plantar digital artery in 15 toes, the branch in 1, and the arterial anonymous vessel in 3. We could harvest the vein in the first web in 16 toes. All patients went back to their former jobs.ConclusionsThe aesthetic and functional outcomes of the reconstructed thumbs and fingers significantly improved. Donor site functional morbidity was minimum. Nevertheless, patients’ expectations regarding the reconstructed digit seemed to be that of an intact digit.Type of study/level of evidenceTherapeutic IV.

Facial aesthetic evaluation of rehabilitation effects in edentulous patients with varying degrees of residual ridge resorption by 3D stereophotogrammetry.

Residual ridge resorption impairs patients' satisfaction with complete denture (CD) treatment, but influence of bone resorption on the aesthetic rehabilitation of edentulous patients still remains unclear due to insufficient quantitative investigations. To quantitatively evaluate the effects of residual ridge resorption on facial aesthetic reconstruction in elderly edentulous patients. According to radiological examination, a total of 19 edentulous subjects were categorised into two groups, atrophic patients (APs) and non-atrophic patients (NAPs). Before CD treatment and 3months after treatment, patients were asked to complete the Orofacial Esthetic Scale (OES). The changes in facial appearance were measured by 3D stereophotogrammetry, and the facial parameters of two groups were compared. The patient's subjective satisfaction of oro-facial aesthetics and 3D objective assessment of facial appearance improved after CD treatment. Subnasale-gnathion (Sn-Gn) significantly increased from 60.13±3.91mm to 62.27±3.82mm. After rehabilitation, glabella-subnasale (G-Sn)/Sn-Gn, nasolabial (Cm-Sn-Ls) and mentolabial (Li-Sm-Pg) significantly decreased and were closer to normal values. Moreover, the subtraction value between G-Sn/Sn-Gn and normal value before treatment of APs and NAPs was 14.47±8.04% and 6.94±3.69%, respectively (P=.026), while after treatment, the values decreased to 10.61±6.33% and 3.86±2.31% (P=.013), respectively. The increased volume of lips and cheeks played an important role in the facial aesthetic reconstruction of edentulous patients. NAPs tended to have more attractive faces after CD treatment, as their facial profile parameters (G-Sn/Sn-Gn and Cm-Sn-Ls) were closer to normal Chinese with well-balanced faces.

Clinical guidelines for total temporomandibular joint replacement.

SummaryTotal joint replacement (TJR) of the temporomandibular joint (TMJ) is a promising surgical procedure and device for treating end-stage diseases of the TMJ. For the functional and aesthetic reconstruction of the oral and maxillofacial head and neck region, TMJ TJR significantly helps maintain the patient’s quality of life in terms of a better diet, mastication, speech and social interaction. TMJ TJR was approved by regulatory authorities in 2019 in Japan, thus enabling the clinical application of the TJR system. However, the surgery demands particularly difficult and high-risk procedures, necessitating the prudent selection of indicated patients. The joint committee of the Japanese Society of Oral and Maxillofacial Surgeons and Japanese Society for Temporomandibular Joint is working together to develop an appropriate clinical guideline for TMJ TJR.

Aesthetic reconstruction in subtotal nasal defect following excision of basal cell carcinoma with bilateral nasolabial flaps: A case report

The use of nasolabial flap to reconstruct nasal soft tissue defects is one of the ancient methods for reconstruction in the medical literature. Over time different modifications have been introduced to expand its usage. Here, we present a case of basal cell carcinoma of the nose for which wide local excision and reconstruction of the subunit was done using bilateral nasolabial flaps.

Improving Aesthetic Outcome in Managing Acute and Chronic Upper and Midface Deformities Using Computer Assisted Planning

Surgical procedures in the facial region are associated bya variety of difficulties. The anatomy of the maxillofacialregion, the complexity of the bony architecture as well as theesthetic implications.The three dimensional imaging and 3D printing, havebeen applied for the restoration the complex anatomy ofcraniofacial structures. In addition, mirror-imaging techniquesadvocating 3D computed tomographic (CT) scanning and 3Dprinting can maximize the surgical outcome on both thefunctional and esthetic reconstruction levels. A syntheticscaffold can be pre-molded to the individual prototype skullmodel to resemble the anatomic contour before applying it tocover the orbital defects.Our aim is to show the importance and present our experiencewith three-dimensional virtual planning in solving avariety of acute and chronic clinical deformities within thescope of trauma in the cranio maxillofacial region.25 patients were retrospectively recruited. Mean age was33.5 years (range 13-59), male: female ratio = 2.6:1 (18:7).Eleven patients had acute injuries (44%) while the remaining14 patients (56%) had chronic (malunited) fractures performedin 2 different centers treating maxillofacial deformities operatedutilizing 3D planning protocols.The advocation of the virtual planning techniques, threedimension printing and printed custom implant enabled anaccurate reduction and fixation procedure of complex acuteand chronic complex upper and midface fracture, which isreflected in very satisfactory aesthetic outcome.

Augmented facelift flap for aesthetic reconstruction of posttraumatic facial defects

Augmented facelift flap for aesthetic reconstruction of posttraumatic facial defects

Aesthetic reconstruction of localized periurethral cancer defects: a case report

Although several techniques of vulvar reconstruction have been reported, the aesthetic repair of localized periurethral defects has not been investigated yet. A 60-year-old woman presented with a neoplasm located on the right side 1–2 mm from the urethral meatus. A radical wide local excision was performed with the resection of the distal part of the urethra. The urethral meatus was reconstructed by the mobilization of the anterior and lateral vaginal mucosa. The vulvar defect was repaired by the advancement of the two bilateral V-shaped local flaps harvested at the level of labia majora. The present case emphasizes the importance of tailoring reconstructive options for vulvar reconstruction to provide aesthetically appealing results, to prevent or restore organ function and to reduce disease and treatment-related morbidity. Level of evidence: Level V, therapeutic study.

The Treatment of Ingrown Nail: Chemical Matricectomy With Phenol Versus Aesthetic Reconstruction. A Single Blinded Randomized Clinical Trial.

Background: In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. Objective: To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. Methods: A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. Results: The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs. 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). Conclusions: The aesthetic reconstruction presents a shorter healing time, favoring the patients’ recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.

Surgical management of high-grade ear malformations in childhood

Malformations of the ear are the most common dysplasias in childhood. Ear malformations are classified into dysplasias of the auricle, of the ear canal, and of the middle and inner ear. The latter types are fortunately relatively rare. Most common is alow-grade dysplasia of the auricle (otapostasis, cup ear). Higher-grade dysplasia of the auricle (microtiaII-III) is often associated with syndromes and/or malformations of the ear canal and the middle ear (e.g., congenital aural atresia with high-grade microtia and dysplasia of the middle ear). Functional aspects of hearing and acquisition of language as well as aesthetic aspects emphasize the importance of surgical therapy. Due to the importance of correctly scheduling surgical treatment in early childhood, this article gives an overview of the possibilities for aesthetic reconstruction of the auricle and the frequently associated functional rehabilitation of hearing.