Buccal Mucosal Flap Research Articles

MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY Ahmed Tawakol, Mohammed Abdel-Rassoul, Mohamed Abdelwahab, Mohamed Elghoneimy, Ahmed Y. Abdelaziz, Ahmed Rammah, Mohamed Elgammal, and Amr Elkady Ahmed TawakolAhmed Tawakol More articles by this author , Mohammed Abdel-RassoulMohammed Abdel-Rassoul More articles by this author , Mohamed AbdelwahabMohamed Abdelwahab More articles by this author , Mohamed ElghoneimyMohamed Elghoneimy More articles by this author , Ahmed Y. AbdelazizAhmed Y. Abdelaziz More articles by this author , Ahmed RammahAhmed Rammah More articles by this author , Mohamed ElgammalMohamed Elgammal More articles by this author , and Amr ElkadyAmr Elkady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Our aim is to compare the use of buccal mucosal grafts (BG) versus local penile skin flaps (PF) in patients with complex anterior urethral strictures regarding success rates and complications. METHODS: A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of>2 cm and/or previous failed procedures, including urethral dilatation, internal optical urethrotomy and urethroplasty. We randomized patients to undergo either buccal mucosa dorsal/ dorso-lateral onlay graft or ventral onlay local penile skin flap urethroplasty. We compared operative time, estimated blood loss, complications, and succcess rates in both groups. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate>15 ml/s. RESULTS: Mean follow up was 22.3 months in BG group vs 18.9 months in PF group. The site of the stricture, the median stricture length (40 mm in BG group Vs. 50 mm in PF group) and mean operative time were not statistically different between the two groups. Estimated blood loss was higher in PF group (median 400 ml and 300 ml in PF and BG group respectively, p=0.003); statistically significant but clinically insignificant.Two patients (11.8%) in each group developed wound infection. In PF group, one patient (5.9%) had urinary fistula, and one patient (5.9%) presented by mild ventral chordee post operatively. The success rates in the buccal mucosal and penile flap groups were similar (88.2%). CONCLUSIONS: Dorsal/ dorso-lateral onlay buccal mucosal graft and ventral onlay penile skin flap urethroplasty provided similar success rates. Complications were higher in the penile skin flap group. Both techniques can be used for the treatment of complex anterior urethral strictures with good outcome based on the surgeon's expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Tawakol More articles by this author Mohammed Abdel-Rassoul More articles by this author Mohamed Abdelwahab More articles by this author Mohamed Elghoneimy More articles by this author Ahmed Y. Abdelaziz More articles by this author Ahmed Rammah More articles by this author Mohamed Elgammal More articles by this author Amr Elkady More articles by this author Expand All Advertisement PDF downloadLoading ...

The successful surgical removal of a massive maxillary palatine osteoma in a dog

AbstractA 1.5‐year‐old, spayed, female labrador x kelpie presented with a massive solitary palatine osteoma. En bloc excision required excision of palatine, maxillary and ventral vomer bone. The subsequent defect was closed with a combination of a left angularis oris buccal mucosal interpolation flap, right buccal mucosal rotational flap and rostral advancement of the remaining soft palate. The procedure was tolerated by the patient, with no major complications from the surgery. Histopathological examination of the excised tissue indicated complete excision of the osteoma. At the time of the publication, no recurrence had occurred, and the owners considered the procedure to provide excellent post‐operative results. The use of these soft tissue techniques allowed complete excision of the neoplasia from this difficult anatomic location in a single procedure without the need for revision surgery.

Use of a folded lip‐to‐nose flap for unilateral reconstruction of the nasal planum in a dog

AbstractA 12‐year‐old female neutered Labrador retriever was referred for treatment of a right nasal carcinoma. Surgical excision was performed and included a right unilateral planectomy with partial right rostral upper lip resection. The medial mucosa of the nasal vestibule was preserved as well as the mucocutaneous junction of the right rostral upper lip. The preserved right rostral upper lip was folded to reconstruct the entire circumference of a new nasal orifice. A dorsomedial hinged buccal mucosal flap was used to replace the lateral mucosa of the new nasal vestibule. Two weeks postoperatively, wound healing was uneventful and no stertor was observed. Nasal endoscopy confirmed patency of the nasal stoma and good mucosal healing in the new nasal vestibule. Three months postoperatively, the dog was reported bright with very mild stertor, but tumour recurrence was suspected on the nasal philtrum. This folded lip‐to‐nose flap healed successfully, providing a good cosmetic appearance.

Surgical correction of bilateral soft palate hypoplasia using soft palate hinged-flap and bilateral buccal mucosal rotation flaps in a dog

Surgical correction of bilateral soft palate hypoplasia using soft palate hinged-flap and bilateral buccal mucosal rotation flaps in a dog

АНАЛИЗ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ДВУХ ОПЕРАТИВНЫХ МЕТОДИК ПРИ ЛЕЧЕНИИ ПОСЛЕДСТВИЙ ТРАВМ УРЕТРЫ

Objective: To analyze the results of application of the two surgical techniques in the treatment of the consequences of urethral injuries (CUI). Methods: 38 patients aged 16.4±1.9 years with CUI were examined. CUI were localized in the area of the scaphoid fossa (n=3), the penile part (n=9), the bulbous region (n=6). Multi-site and panurethral lesions were noted in 8 and 12 cases, respectively. Additional research methods included ultrasound examination of the bladder, uroflowmetry, residual urine measurement, and, if necessary, retrograde and voiding urethrography. The patients underwent two types of surgical intervention: one-stage (16 patients, 1st group) and two-stage (22 patients, 2nd group) urethroplasty using a buccal mucosal flap. The results of surgery were assessed by ascending urethrography and uroflowmetry. The follow-up period ranged from 6 to 24 months. Results: The immediate and long-term results between the two groups showed significant difference. According to uroflowmetry data, the main indicator of the effectiveness of surgical intervention was a stable retention of maximum urine flow rate at least 15 ml/sec. In the 1st group, there was one case of early wound dehiscence with the formation of a fistula. In the 2nd group, early divergence was observed in 8 cases, it was also accompanied by formation of fistulas. These complications required additional surgical intervention; their correction was deferred. Conclusion: One-stage urethroplasty using a buccal mucosal flap for CUI proved to be safer and more effective compared to the two-stage technique Keywords: Consequences of urethral injury, urethrography, uroflowmetry, buccal flap.

Reconstruction of a Gunshot-Caused Mouth Floor Defect Using a Nasolabial Flap and a De-Epithelialized V-Y Advancement Flap

We present reconstruction of a gunshot-caused mouth floor defect using a nasolabial flap and a de-epithelialized V-Y advancement flap.A 58-year-old man presented 14 days after bullet injury passed from anterior chin to the right postauricular area. Upon examination, the central incisors, alveolar bones, and soft tissues of the mouth floor were lost. Bone fragments and failed miniplates were exposed. Pus discharge filled the defect.On the 23rd post-trauma day, right unilateral nasolabial flap was used to cover the oral side of the mouth floor. This flap was centered on the nasolabial fold and its base was situated on the commissure of the lips. The flap was raised in the soft tissue, just superficial to the facial muscles, transferred into the oral cavity through an incision made in the cheek mucosa, and sutured to the margin of the defect. A de-epithelialized dermal and subcutaneous flap was used to reconstruct the deep portion of the mouth floor through the V-Y advancement method. At the lower border of the mandible, a 3-cm-wide V-Y advancement flap was designed. The de-epithelized portion was inserted into the mouth floor and sutured to the defect margin. On 30th post-trauma day, left commissure-based buccal mucosal flap was used for the gingivobuccal sulcus defect. The apex was near the retromolar trigone. The elevated flap was transferred to the lower gingivobuccal sulcus defect. On POD 28, the nasolabial flap and commissure-based buccal myomucosal flap was divided and inset respectively.These flaps can be used for moderate-sized mouth floor defects.

Turbinate stitch: modification of Ahmed’s three-layered flap for oroantral fistulas. A technical note

Oroantral fistula is a communication between the maxillary sinus and the oral cavity. According to the literature, dental extraction is the most common cause, followed by maxillary cysts, benign or malignant lesions, and trauma. 1 Güven O. A clinical study on oroantral fistulae. J Craniomaxillofac Surg. 1998; 26: 267-271 Crossref PubMed Scopus (75) Google Scholar , 2 Yilmaz T. Suslu A.E. Gursel B. Treatment of oroantral fistula: experience with 27 cases. Am J Otolaryngol. 2003; 24: 221-223 Crossref PubMed Scopus (30) Google Scholar , 3 Abuabara A. Cortez A.L. Passeri L.A. et al. Evaluation of different treatments for oroantral/oronasal communications: experience of 112 cases. Int J Oral Maxillofac Surg. 2006; 35: 155-158 Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar Various techniques have been described for repair of the fistula, using buccal fat, palatal rotational flaps, and serratus anterior flaps. 4 Môczair L. A new surgical method of closure of oroantral fistula of odontogenic origin. Ann Stomatol (Roma). 1930; 28: 1087-1088 Google Scholar A new and extremely effective method for addressing larger defects is a vascularised three-layered technique recently described by Darr et al. 5 Darr A. Jolly K. Martin T. et al. Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap. Br J Oral Maxillofac Surg. 2018; 56: 638-639 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Recurrence and chronicity is a major issue, which is mainly due to trauma, sinus disease, or edentulousness. We describe a modification of the three-layered flap for better outcomes for recurrent oroantral fistula.

Reconstruction of microstomia considering their functional status.

Background Microstomia is defined as a condition with a small sized-mouth that results in functional impairment such as difficulty with food intake, pronunciation, and poor oral hygiene and cosmetic problems. Several treatment methods for microstomia have been proposed. None of them are universally applicable. This study aims at analyzing the cases treated at our institution critically reviewing the pertinent literature.Methods The medical records of all microstomia patients treated in our hospital from November 2015 to April 2018 were reviewed retrospectively. Of these, all patients who received surgical treatment for microstomia were included in the study and analyzed for etiology, chief complaint, surgical method, and outcomes. The functional outcomes of mouth opening and intercommissure distance before and after the surgery were evaluated. The cosmetic results were assessed according to the patients’ satisfaction.Results Five patients with microstomia were corrected. Two cases were due to scar contracture after chemical burn, two cases derived from repeated excision of skin cancer, and one patient suffered sequela of Stevens-Johnson syndrome. The following surgical methods were applied: one full-thickness skin graft on the buccal mucosa, three buccal mucosal advancement flaps after triangular excision of the mouth corner, and one local buccal mucosal flap. Mouth opening was increased by 6.0 mm, and the intercommissure distance improved by 7.2 mm on average. Follow-up was 9.6 months (range, 5–14 months). Cosmetic assessment was as follows: two patients found the results excellent, three judged it as good.Conclusion Microstomia has several causes. In order to achieve optimal functional recovery and aesthetic improvement it is important to precisely evaluate the etiologic factors and the severity of the impairment and to carefully choose the appropriate surgical method.

NON-STANDARD APPROACHES TO UPPER URINARY TRACT RECONSTRUCTION

The main alternatives to a standard ureteral reconstruction at the expense of urothelial−containing tissues are an autotransplantation of the kidney, replacement of the ureter, and interposition of autologous tissues that do not contain urothelium. This compares the tissues that have a similar histological structure, system of blood supply and innervation. Although the general trend in the assessment of the role of renal autological transplantation in the correction of ureteral defects is quite optimistic, there is a likelihood of severe complications, including severe transplant infection and its loss, complications from vascular anastomoses. At the same time the tissues having similar histological structure, system of blood supply and innervation have been compared. However, in some clinical situations it is not possible to replace the upper urinary tract with such a surgical approach, which forces the surgeon to use alternative and non−standard methods of ureteral reconstruction. Among the various types of ureteral reconstruction with enteral tissues, the leading role is the interposition of segments of the small intestine. Most authors point to the favorable results of this technique in terms of minimal lethality, low incidence of complications and stabilization of renal function after surgery. However, the problem of intestinal interposition is complications associated with enterotomy, electrolyte balance disorders, reabsorption into the blood of metabolism products and active secretion of mucus into the lumen of the urinary tract. The published reports have mostly described the positive results after ureteral plasticity of the buccal mucosa flap, but the length of the stricture in the implementation of such a treatment method should not exceed 5−6 cm ureter. Key words: ureteral reconstruction, kidney autotransplantation, intestinal ureteroplasty, ureteral reconstruction with buccal mucosa flap.

Management of palatal fistulas and a simple surgical algorithm proposal

Objectives: Despite improved techniques in repair of cleft palate, failure of healing of palatal structures resulting in a palatal fistula is one of the major challenges in the practice of reconstructive surgery. The aim of this study is to evaluate treatment success and failure in patients with palatal fistulas following cleft palate repair. 
 Patients and Methods: Totally 44 patients with a history of cleft palate who underwent surgery for palatal fistula were included in this study undertaken between January 1999 and August 2014. Fistulas were classified as anterior and posterior according to the repair technique and were repaired using one of the following techniques: buccal mucosal flap, tongue flap or mucoperiosteal flap. 
 Results: Success rate for anterior fistulas was 71.42% with tongue flap and 76.92% with mucoperiosteal flap. Success rate for posterior fistulas was 84.62% with mucoperiosteal flap and 75% with buccal mucosal flap. Difference in success rates between the anterior and posterior fistulas was not statistically significant. Conclusion: Our study results suggest the use of mucoperiosteal flaps for both anterior and posterior fistulas smaller than 5mm as the first choice, guided by the principle of replacing absent tissue with similar tissue.

S7B-14 SESSION 7B: HFM ROBIN - PART II MANAGEMENT OF PERSISTENT BUCCOPHARYNGEAL MEMBRANE WITH DISTRACTION OSTEOGENESIS AND PHARYNGEAL FLAP RECONSTRUCTION

Introduction: Persistent Buccopharyngeal Membrane is a rare craniofacial condition with 27 published reports. We have treated 4 with PBM and Pierre-Robin Sequence using external mandibular distraction osteogenesis and flap reconstruction of the pharynx. The stomodeum (primitive mouth) and the foregut are separated by the buccopharyngeal membrane, between endoderm and ectoderm. By the fourth week the membrane breaks down and establishes communication between the oral cavity and pharynx. If this fails to disintegrate, a persistent buccopharyngeal membrane obstructs the pharynx. These infants suffer from breathing and feeding difficulties, and long-term sequellae include swallowing, speech, and chronic eustachian tube dysfunction. These anomalies are frequently incompatible with life. Management included tracheotomy and nasogastric tubes, placement of stents, to definitive surgical repair where buccal mucosal flaps are typically elevated and rotated posteriorly and interposed between a denuded area over the palatoglossus and palatopharyngeus muscles. Methods: We present case studies of 2 infants who presented with anomalies consistent with hypomandibular faciocranal dysostosis. Both underwent emergency tracheostomy at birth due to inability to instrument the upper airway. They were diagnosed with HFD syndrome, with complete buccopharyngeal membrane, absence of the mandibular component of the orbicularis oris, mentalis, and depressor anguli oris, cleft palate, low set ears, downward sloping palpebral fissures, anteverted nares, and hypoplastic nasal sinuses. Both underwent mandibular distraction, using a navigation approach to assure accurate pin placement in the pharynx. After aggressive mandibular advancement, they returned to the OR for device removal. What had previously seemed to be aglossia proved to be microglossia, demonstrating that mandibular advancement permits lingual hypertrophy over time. Further surgery required ablation of bone across the floor of the mouth and symphyseal widening. They both underwen local flaps reconstruction of the defects left after resecting the buccopharyngeal membrane. Results: Mandibular distraction resulted in over 40 mm of stable sagittal advancement, and resulted in hypertrophy of the hypoplastic tongue. Decannulation is not planned, as there is poor po feeding, but both retain a protective gag reflex. Suck/swallow reflexes appear to be normal, and there is no evidence of oral aversion. Conclusion: Even in syndromes with profound oral and lingual anomalies, aggressive mandibular distraction can reposition the floor of mouth musculature and permit gradual hypertrophy of the tongue. Further refinements in reconstruction may permit some degree of oral feeding in this patient group.

Effective method for reconstruction of remaining lower lip vermilion defect after a mental V-Y advancement flap.

BackgroundThe mental V-Y advancement flap method is useful for reconstruction of lower lip defect because of its many advantages. However, it is not easy to select the optimal reconstructive method for the vermilion defect that remains after application of the mental V-Y advancement flap. In choosing the representative surgical method for vermilion mucosal reconstruction including mucosal V-Y advancement flap, buccal mucosal flap, and buccal mucosal graft. We describe an efficient technique to large lower lip defects combining mental V-Y advancement flap and buccal mucosal graftMethodsThis study included 16 patients who underwent reconstructive surgery for full-thickness and large defect (> half the entire width) of the lower lip from October 2006 to September 2017. The operation was conducted using mental V-Y advancement flap with various vermilion mucosal reconstruction methods considering the location of the defect and the amount of residual tissue of the lip coloboma after excision.ResultsAll patients underwent mental V-Y advancement flap. In vermilion mucosal reconstruction, five patients underwent mucosal V-Y advancement flap, three underwent buccal mucosal flap, and eight underwent buccal mucosal graft. There were good aesthetic and functional results in all patients who underwent buccal mucosal graft. However, two patients who underwent mucosal V-Y advancement flap complained of oral incompetence, and all patients who underwent buccal mucosal flap had oral commissure deformity.ConclusionBuccal mucosal graft combined with mental V-Y advancement flap can produce suitable functional and aesthetic outcomes in near total lower lip reconstruction in patient with large mucosal defect including vermilion portion.

Reconstruction of the Oral Commissure With the Zisser Flap

The aim of this study was to investigate the role of the Zisser flap in the reconstruction of defects of the oral commissure. We describe our personal experience with this method and present some interesting aspects from the relevant literature. We retrospectively evaluated the records, from the period between 2003 and 2017, of all patients with defects of the oral commissure after resection of malignant tumors, traumas, or burns and reconstruction by means of the Zisser flap. We looked for information on the origin of the commissural defect, method of vermillion reconstruction using the lingual or buccal mucosa, functional result, esthetic outcome, and postoperative complications. The functional result of the reconstruction of the oral commissure was assessed regarding postoperative subjective speech integrity, preservation of competence of the oral sphincter, and lip sensation. The esthetic outcome was evaluated regarding limitations in facial expression and scar formation. The study included 13 patients. The follow-up period in the oncologic cases was 63.2months (range, 10 to 140months). No tumor recurrences were detected. Vermillion reconstruction was achieved by means of a buccal mucosal flap in 11 cases and a lingual mucosal flap in 2. All patients achieved normal oral competence and mouth opening except for 1 case, in which secondary commissuroplasty with restoration of sphincter function was needed. No cases of blunting or microstomia were detected. Reconstruction of the oral commissure with the Zisser flap is associated with an outstanding functional outcome that is cosmetically very acceptable.

Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap

Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap

Total lower lip and chin reconstruction with radial forearm free flap: A novel approach

BackgroundThe management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip. MethodsLiterature review performed. ResultsPresentation of novel, two-stage technique for lower lip and chin reconstruction with a submental flap and a radial forearm free flap, suspension of the lower lip and chin with a tensor fascia lata graft, and vermilion reconstruction with a buccal mucosal flap. ConclusionsThis procedure meets all goals of total lower lip reconstruction with the exception of the introduction of dynamic tissue and represents a novel solution to a challenging reconstructive problem.

Chondro‐keratoprosthesis: an alternative to OOKP?

PurposeTo evaluate the use of cartilage as a potential graft material in order to explore a new approach toward osteo‐odontal tissue replacement in keratoprosthesis surgeryMethodsWe describe a modification of the osteo‐odonto‐keratoprosthesis that involves the use of autogenous auricular conchal cartilage graft (ACCG) in 2 patients. In stage 1, ACCG was harvested via a posterior approach. Then, an optical polymethyl‐methacrylate cylinder was embedded into a double‐layered fragment of the conchal cartilage and secured by cyanoacrylate glue. The optical cylinder and cartilage complex were then implanted into the cheek. The stage 2, performed 2–4 months later, involved retrieval of the complex and implantation into the cornea, after reflection of the buccal mucosal flap, corneal trephination, iris and lens removal, and anterior vitrectomy. Cartilage specimens were then processed for histological evaluation after retrieval.ResultsWe report 2 cases of chondro‐keratoprosthesis (CKPRO) who underwent surgery with a 9 months follow‐up following a bilateral limbal stem cell deficiency associated with severe corneal changes. On patient 1, vision was improved to 20/100 J6 during the follow‐up. On patient 2, postoperative visual acuity stay limited to LP related to preoperative retinal lesions. During the follow‐up, any postoperative complication as extrusion, epithelial downgrowth, retrocorneal membrane or endophtalmia was observed.ConclusionsACCG could be a good alternative to replace osteo‐odontal graft in keratoprosthesis surgery especially in young patients with healthy teeth. ACCG has already been widely used for reconstructive surgery and provides safe and stable support to the optical cylinder. However, further comprehensive studies with larger sample size and longer follow‐up are required.

Oro-Nasal Communication.

Breach in the palatal vault leading to an abnormal communication between oral and nasal cavity is known as oro-nasal communication. It is an uncommon presentation in day-to-day clinical practice except in some patients of cleft lip and palate.Etiology may be congenital or acquired. Alveolar and palatal cleft defects are the most common etiological factor. The acquired causes may be trauma, periapical pathology, infections, neoplasms, postsurgical complications, and radio and chemo necrosis.Clinical features like nasal regurgitation of food, defective speech, fetid odor, bad taste, and upper respiratory tract and ear infection are associated with oro-nasal communication.Management depends upon the size and site of defect, age of patient, and associated comorbidity. The definitive management is always surgical. Two layered closure provides greater support and stability and reduces the risk of failure. Palatal rotational flaps are suitable for smaller defects. The other local flaps are buccal mucosal flap, tongue flap, and facial artery myomucosal flap. Temporoparietal galeal flap, turbinate flap, free radial forearm flap, and scapular flap have also been successfully used for closure of oronasal communication. Newer procedures like the use of bone morphogenic protein, acellular dermal matrices, human amniotic membrane, and distraction osteogenesis have been tried successfully. The rate of recurrence is high.Unsuccessful surgical attempts and larger defects associated with compromised medical conditions are better managed nonsurgically with obturator incorporating the missing teeth.

An Innovative Technique for Columellar Reconstruction using ‘Flip-Over’ Buccal Mucosa Flap

Loss of columella is a significant deformity and its reconstruction proves to be quite difficult. An 18-year-old lady had loss of columella due to burn while steam inhalation at a young age and required reconstruction for the same. Labial mucosa has been used as a source of tissue for columellar reconstruction since long. We describe a modification of the buccal mucosal flap to manage a difficult case of columellar deficiency. The buccal mucosa flap was used to cover the columellar defect in the usual manner in the first stage and in second stage, along with division of the base, the residual length of the mucosal flap was used to add to the thickness of columella by doubling it on itself.

Refinement and Validation of the Urethral Stricture Score in Categorizing Anterior Urethral Stricture Complexity

To update, simplify, and validate the UREThRAL Stricture Score (now called the U-score) for anterior urethral strictures, with the goal of using this system as a predictor of surgical complexity. This is a retrospective review of 102 patients (test set) who underwent anterior urethroplasty at Barnes-Jewish Hospital from 2009 to 2012 and a validation set of 96 patients from Northwestern University. The U-score was based on length (1-3 points), stricture number (1-2 points), location (1-2 points), and etiology (1-2 points) for a total ranging from 4 to 9. Excision and primary anastomosis, buccal mucosal graft, and augmented anterior urethroplasty were classified as low complexity, and double buccal mucosal graft, flap, or flap-graft combo were classified as high complexity. Operative time and estimated blood loss were used as surrogates of surgical complexity. Mean U-score for low-complexity surgeries was 5.2 and for high complexity surgeries was 7.3. Factors that were associated with high-complexity repairs included stricture etiology (trauma or idiopathic or iatrogenic vs inflammatory or hypospadias; P ≤.0001), number (1 vs. >1; P = .003), location (penile vs. bulbar; P <.001), and length (<2 vs. 2-5 vs. >5 cm; P <.001). Increasing U-score correlated with increasing surgical complexity (P ≤.0001). A linear relationship between U-score and operative time was observed (P = .0018). U-score did not correlate with estimated blood loss (P = .82). Among the validation data set, etiology (P = .0014), location (P ≤.0001), stricture length (P ≤.0001), and overall U-score (P ≤.0001) correlated with surgical complexity. The U-score is a validated scale to describe the complexity of anterior urethral strictures that correlates with surgical time and complexity of procedure.

Palliative Surgery in Two Dogs with Non-Curative Palatal Tumors

Two dogs were presented with a history of anorexia, respiratory distress, or epistaxis. On physical examination, the dogs showed difficulty breathing and open-mouth breathing and large masses were found on the hard palate and soft palate. Cardiac arrest happened in case 2 and the dog was stabilized with cardiopulmonary resuscitation and oxygen therapy. Computed tomography demonstrated that the mass occupied the oropharynx, intrapharyngeal ostium, and laryngopharynx including the hard palate and soft palate in case 1. Palliative surgery was decided to improve swallowing and breathing with owner’s consent in two dogs. Buccal mucosal flaps were performed for reconstruction of defects using rotational and single-pedicle advancement flaps and bilateral 90 degree transposition flaps in cases 1 and 2, respectively. Histopathology results described the oral masses as amelanotic melanoma in two dogs. The owners reported that there was normal swallowing and breathing at 7 days postoperatively in two dogs. In case 1, recurrent tumor was identified caudal to the hard palate 4 weeks after surgery. The owner did not allow further treatment and the dog became lost to follow-up at 2 months postoperatively. In case 2, there was no clinical or radiographic evidence of a local recurrence or distant metastasis at 3 weeks after surgery. The owner informed that the dog died suddenly with no signs of anything particularly wrong at 7 weeks after surgery.