Cheek Flap Research Articles

Reconstructive Techniques Following Malignant Eyelid Tumour Excision-Our Experience.

Background: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. Method: This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient. The most commonly used techniques included regional flaps, local flaps, and skin grafts. The most frequently employed reconstruction techniques were forehead flaps (59 cases), simple excisions (38 cases), and Mustarde cheek flaps (16 cases). Result: The postoperative complications, including ectropion, epiphora, and flap necrosis, were recorded. However, no significant correlation was found between the risk of complications and either the location of the tumour or the reconstruction method employed. Despite the complexity of medial canthal and lower eyelid reconstruction, satisfactory aesthetic and functional outcomes were generally achieved. Conclusions: This study emphasises the importance of individualised surgical planning, highlighting the advantages and limitations of various techniques to optimise both the functional and aesthetic results.

Modified Mustardé rotation cheek flap with full-thickness skin graft for reconstruction of large cheek defects.

Modified Mustardé rotation cheek flap with full-thickness skin graft for reconstruction of large cheek defects.

Lower Eyelid Reconstruction with Mustardé Flap

Restoring defects in the lower eyelids, particularly those that extend beyond two-thirds, can be challenging, especially after tumor resection. Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting the lower eyelid and inner canthus. Grafts are often combined with flaps for replacing the posterior lamella or anterior lamella. The Mustardé rotational cheek flap is a popular choice for reconstructing the anterior lamella of the lower eyelid, as it meets the basic requirements of an ideal cutaneous flap. This wide-based pedicle flap can support free grafts needed to line the inside of the flap. Other autogenous grafts, such as labial mucosa, hard palate mucoperiosteum, auricular cartilage, and nasoseptal cartilage, have also been used in eyelid reconstruction. However, hard palate mucosa transplants provide uniformity and can be expensive. Hughes procedures are not suitable for individuals with amblyogenic age or one-seeking eyes. Combining a vascular flap with a superior graft like pericranium may provide a viable surgical option for enduring functional and aesthetic outcomes.

The Trans-facial Approach for Simultaneous Resection and Reconstruction of Retromolar Trigone Tumors: A Pilot Study

IntroductionEarly retromolar trigone (RMT) lesions are difficult to access and free tissue transfer is often an overkill for such small lesions. The aim was to devise a novel surgical approach that would aid the resection without raising a cheek flap and simultaneously provide a local reconstructive option for small lesions in the RMT.MethodologyThis study was to demonstrate the outcomes of the “trans-facial” approach used to simultaneously access and reconstruct small RMT tumors through an islanded nasolabial flap. Patients with histologically proven squamous cell carcinoma of RMT requiring surgery were included from January 2021 to September 2022. Case selection was done based on the location of the disease and its size (cT1/T2). All needed bone and soft tissue resection via per oral trans-facial approach, along with an ipsilateral neck dissection. The technique is described along with their post-operative and pathologic outcomes.ResultsOut of the eight patients included in this study, six underwent a bi-alveolar marginal resection and reconstructed using the trans-facial approach. No major complications were noted in the post-operative period. 50% were pT1 tumors and 75% were pN0 status. One patient had a close margin; while, the others had adequate resection margins. All patients were followed up for a median of 18 months with a locoregionally controlled status.ConclusionThe trans-facial approach can be a suitable option with a reasonable oncologic outcome to address small RMT lesions.

Modified island pedicle advancement cheek flap for optimal reconstruction of cutaneous defects after excisional biopsy of basal cell carcinoma right lower eyelid

A 64-year male came for treatment of a lesion on his eyelid. Approximately 10 years earlier, he had developed a small blackish mass on his right lower eyelid, which was gradually increasing in size along the infra-orbital crease. It is associated with blackish discharge. Laboratory tests were normal; medical history and family history were unremarkable. Incisional biopsy shows strings of stratified squamous epithelium, proliferative basal cells, and scattered melanin pigmentation. The tumor was completely excised, and the defect is reconstructed with modified island pedicle advancement cheek flap and sent for HPE examination. It is a powerful technique for reconstruction with minimal complication.

Commissuroplasty using the triangular cheek flap in patients with free flap reconstruction of through and through buccal defects.

Extensive resections of advanced stage oral cavity cancers can sometimes lead to significant through and through buccal defects with compromise of the oral commissure/lips. Post free flap reconstruction, such patients often require a secondary delayed commissuroplasty to assist with improved oral function and quality of life. In current literature, limited methods exist for free flap commissuroplasty with some key limitations, particularly their negative impact on buccal sulcus or oral vestibule. Our technique of the triangular cheek flap commissuroplasty allows the surgeon to reconstruct a neo-commissure without compromising the oral vestibular depth or decreasing mouth opening. Through this pictorial essay we describe a detailed surgical technique for secondary reconstruction of the oral commissure.

Paragnatida kacige tipa Baldeinheim sa Gradine u Biogracima kod Širokog Brijega

Systematic archeological excavations of Gradina in Biograci near Lištica, which were carried out during 1969 and 1971 under the leadership of Irma Čremošnik, put a very valuable archeological site on the archeological map of Bosnia and Herzegovina. According to the research of that time, Biograci was primarily interpreted as a Roman fortification and a high-altitude settlement with an Avar-Slavic phase. Only a recent revision of the material in the Classical Antiquity collection of the National Museum of Bosnia and Herzegovina noticed material that was redefined and dated to the early Byzantine period and the Migration period. From the extremely diverse material from this site with a very wide dating, and thus a long continuity of settlement, the finding of a fragmented cheek flaps- paragnatids from the Baldeinheim type helmet stands out.2 The paper is exclusively dedicated to the professional and scientific processing of the bronze sheet metal plate with traces of gilding, which, in comparison with the complete findings of helmets of this type, was identified as part of the paragnatide helmet of the Baldeinheim type. Geographically, the closest sites to Biograci with complete or almost complete helmets of this type are Vid-Bedemi in Narona near Metković, Batajnica in Srijem, Heraclea Lyncestis near Bitola, Zidani Gaber nad Mihovim i Rifnik pri Šetjurju. The appearance of the so-called western group of helmets known as Baldeinheim-type helmets during the Migration period is an extremely rare find at archeological sites, while no helmet of this type has been found at archeological sites in Bosnia and Herzegovina so far.

Anchored Suture Technique for the Reconstruction of Paranasal Skin Defects Secondary to Melanocytic Nevus Excision.

To describe a modified anchored suture technique combined with varied flaps for the repair of paranasal skin defect secondary to melanocytic nevus excision. The feasibility and effectiveness of the technique were discussed. A total of 26 patients (10 male and 16 female) with an average age of 11.1 years were included in this retrospective study. All patients underwent the anchored suture technique. The subcutaneous tissue of the free margin of the cheek flap was sutured to the deep pyriform ligament. The local flaps were designed according to the size and shape of the defect. The diameter of the nevi ranged from 2.8 to 7.5 cm, with most being 3 to 5 cm (50%). Among the 26 patients, 17 patients underwent the anchored suture technique and nonadvancement flap, whereas the other 9 patients underwent the anchored suture technology and advancement flap with auxiliary incisions. Twenty-five patients had a symmetric nasal alar and unapparent scar and were satisfied with postoperative aesthetic outcomes. Thus, the anchored suture method combined with different flaps to repair paranasal defect is an effective and affordable technique to reconstruct paranasal tissue connections.

Functional outcomes in tongue reconstruction with myomucosal buccinator flaps

Buccal myomucosal local flaps in oral cavity reconstruction are a valid option for small-to-moderate defects. Nevertheless, few articles report about functional recovery. The purpose of the present analysis is to evaluate the impact of these flaps on function and quality of life. The study, retrospectively conducted on 36 patients who were surgically treated for tongue cancer between 2012 and 2018 at the Unit of Maxillo-Facial Surgery, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Italy), evaluates functional outcomes using the following 4 questionnaires: Performance Status Scale for Head and Neck Cancer Patients, M.D. Anderson Dysphagia Inventory, Speech Handicap Index, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module. All patients are able to eat soft or more solid foods, and most of them eat quietly in public. Although 50% of cases reported a certain degree of dysphagia, it does not impact self-esteem and social relationships. Only 20% of patients have severe problems with speech. However, more than half of the cases (65%) report oral problems. The collected data confirm the suitability of the myomucosal cheek flaps for tongue reconstruction. Most patients report a good functional recovery and satisfactory quality of life even if none of them has a recovery comparable to the presurgical state.

The Effect of Extended SMAS Face-lift on Earlobe Ptosis and Pseudoptosis

In this study, we explore the changes in the earlobe segments following an extended superficial musculoaponeurotic system (SMAS) face-lift and neck lift. We proposed to delineate the effect of the cheek and neck skin tension vectors on the earlobe based on the amount of excised skin length. A retrospective study identified patients who underwent extended SMAS rhytidectomy performed by the senior author (A.M.) at the Cosmetic Plastic Surgery Institute (CPSI) from 2017 to 2020. A total of 34 North American Caucasians, who had preoperative and postoperative photographs available for comparison, were evaluated. Preoperative and postoperative cephalic (the distance from the intertragal notch to the otobasion inferius, abbreviated as I to O) and caudal earlobe segment (the distance from the otobasion inferius to the subaurale, abbreviated as O to S) heights were collected. The change from the postoperative to preoperative measurements was calculated. The effects of the degree of cheek skin (superior ear [SE]) and neck skin (mastoid peak [MP]) excision lengths were then determined by comparing the change in I to O and O to S. The postoperative attached cephalic segment (15.94 ± 1.02 mm) increased significantly compared with the preoperative attached cephalic segment (12.99 ± 1.03 mm). The postoperative free caudal segment (3.62 ± 0.81 mm) decreased significantly compared with the preoperative free caudal segment (5.44 ± 0.95 mm). The SE median was found to be 3.0 cm and the MP median was found to be 3.5 cm. I to O increased by 3.85 mm for SE ≤3.0 cm compared with only 1.57 mm for SE >3.0 cm. O to S decreased by 2.79 mm for SE ≤3.0 cm compared with only decrease of 0.14 mm for SE >3.0 cm. I to O increased by only 1.67 mm for MP < 3.5 cm. O to S decreased less dramatically by 0.55 mm for MP ≤3.5 cm compared with decrease of 2.39 mm for MP >3.5 cm. These data demonstrate that more aggressive SE >3.0 cm cheek excision lengths resulted in a protective effect on decreasing the free caudal segment of the earlobe. More aggressive excisions of the cheek demonstrate a protective effect on preserving the free earlobe caudal segment, whereas more aggressive neck skin excisions result in higher propensity for loss of the free earlobe caudal segment. In our study, we demonstrate findings observed with clinical observations that a face-lift and neck lift will result in increase in the attached cephalic earlobe segment height (I to O) and a decrease in caudal free earlobe segment height (O to S). These findings may assist plastic surgeons when trying to fine-tune the earlobe aesthetics during face-lift and neck lift. If the patient has a small free hanging earlobe, the more aggressive pull on the cheek flap will result in less reduction in the earlobe hang.

Corneal Invasion by Basal Cell Carcinoma.

CASE PRESENTATION A 68-year-old man suffered with a basal cell carcinoma of the right lower eyelid, with features of the morpheaform and nodular types, treated by report with clear margins on Mohs resection and primary closure. Nine years later, an invasive recurrence involved the lateral canthus and lacrimal gland, producing restrictive strabismus. There was no radiographic evidence of orbital invasion. A Mohs resection, clearing the skin and conjunctiva, resulted in an 80% upper and 90% lower eyelid defect, exposing the anterior zygoma and the lateral 180° conjunctival defect (Fig. 1A). However, the region of the lacrimal gland was not cleared by Mohs surgery, and at the time of reconstruction, an intraoperative frozen section of the lacrimal gland demonstrated myoepithelial cells concerning for malignancy, prompting complete resection of the gland. The surrounding orbital fat and soft tissue were histologically clear of tumor. The lower eyelid was reconstructed with a hard palate graft and a myocutaneous advancement cheek flap anchored to the orbital rim. The upper eyelid was reconstructed with advancement of the remnant levator aponeurosis, Müller muscle, and conjunctiva, surfaced with a postauricular skin graft. Postoperatively, a PROSE lens (BostonSight, Boston, MA) was employed to maintain corneal integrity. One year later, the patient developed a second recurrence, treated with vismodegib, which produced clinical and radiographic tumor control but drug intolerance prompted its discontinuation. Eight months later, a third recurrence required re-excision of the tumor, which involved the lateral conjunctiva and extended to the anterior orbit. The area was repaired with a buccal mucosal graft. Globe preservation precluded achieving tumor-free margins. Postoperatively, the patient received 6 cycles of cemiplimab, which failed to suspend tumor progression. He was subsequently treated with sonidegib for a total of 11 months, which also failed to control the tumor, producing a palpable mass in the lower lid, cicatricial ectropion, and an adduction deficit (Fig. 1B). Neuroimaging demonstrated soft-tissue hyperintensity indicative of persistent tumor of the eyelid (lateral canthal infiltration indicated by the arrow) also involving the globe (Fig. 1C). The patient ultimately underwent orbital exenteration. Final pathology revealed invasive basal cell carcinoma, with corneal infiltration (Fig. 1D, E).FIG. 1.: Mohs resection of the initial recurrence of basal cell carcinoma resulted in an 80% upper eyelid defect and 90% lower eyelid defect (A). Following subsequent recurrences and prior to exenteration, a palpable mass was evident in the lower eyelid causing a cicatricial ectropion (B). Neuroimaging revealed lateral canthal infiltration of tumor, as indicated by the arrow (C). Histopathology of the exenteration specimen demonstrated basal cell carcinoma invading the corneal surface (hematoxylin and eosin stain 60× and 600×) (D, E).

Surgical management of oral cancer extending to the pterygoid region

The resection of oral cancers extending into the pterygoid region remain a challenge for head and neck surgeons. Few studies have suggested the approach methods and showed that the tumor can be resected with a clear vision. In this case series study, we advocated a surgical method for the tumor ablation surgery over this region. The study was conducted in 11 patients with tumors near or directly invading into the pterygoid regions. A cheek flap combined with ramus removal was used to approach the pterygoid plates and the associated muscles. A reciprocating saw was used subsequently for the pterygoid plate resection. In the collected 11 patients, neither serious complications occurred during the surgery nor immediate complications happened after the surgery. Four patients expired during the postoperative follow-up period. Two of them died of cancer related conditions, one for tumor recurrence and the other for distant metastasis. The reasons for non-cancer specific mortality were myocardial infraction and aspiration pneumonia Only one patient showed positive margins in the final surgical pathology.

The history of nasal reconstruction.

Purpose of reviewTotal nasal reconstruction is a unique plastic surgery challenge of the highest order. The history of nasal reconstruction dates back to ancient times and it remains a fundamental challenge today. This article reviews the historical context of nasal reconstruction, and highlights how the essential tenets of this art have been conserved over millennia.Recent findingsThe disfiguring and brutal practice of nasal amputation created a demand for ‘nosemakers’ in India since 1500 BC. In 600 BC, Sushruta described the use of a leaf to make a template of the wound, and a cheek flap to supply tissue. In the 1400–1500s, the Italians relied on similar flap concepts, but employed a pedicled arm flap for soft tissue coverage. Eventually, the forehead flap, or ‘Indian method’ of nasal reconstruction, made its way to Europe in the 1800s. Its use has been a fundamental component of nasal reconstruction to this day.SummaryKnowledge of the unique history of nasal reconstruction permits appreciation of this surgical integration of art and science. The story of nasal reconstruction has been one of global contribution and creativity that has stood the test of time.

Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?

<p class="abstract"><strong>Background:</strong> Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?</p><p class="abstract"><strong>Methods:</strong> Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.</p><p class="abstract"><strong>Results:</strong> Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.</p><p class="abstract"><strong>Conclusions:</strong> Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.</p>

Reconstruction of a Large Oncologic Defect Involving Lower Eyelid and Infraorbital Cheek Using MSTAFI Flap.

An oncologic defect that includes both the lower eyelid and the infraorbital cheek often results in complex reconstructive problems because its reconstruction involves 2 distinct tissue types and cosmetic subunits. Herein, we first present a novel combination of modified supratrochlear artery forehead island flap and advancement rotation cheek flap enables reconstructing a large oncologic defect of lower eyelid and infraorbital cheek. Although discoid lupus erythematosus affects the skin, the patient had achieved a satisfying color match and an acceptable aesthetic restoration without tumor recurrence. This novel flap has shown to be feasible, reliable, and advantageous alternative to the repair of such defects.

Original Design of the Limberg Flap: An Opposite Triangular Flap.

The aim of this study was to identify the original design of the Limberg flap.Publications by the original author, Limberg, and his original designs of the so-called "Limberg flap" were searched in PubMed. These included his original monograph written in Russian (Mathematical Principles of Local Plastic Procedures on the Surface of the Human Body, 1946), the first English paper ("Design of Local Flaps," 1966), and English translation of his book by Wolfe (1984).Three figures that may be the prototypes of the Limberg flap were found in the 1946 Russian monograph. One figure involved designing unilaterally active opposite triangular flaps, placed on a lateral incision on the edge of the defect. Another was closure of a defect of the nasal dorsum with a cheek flap with opposite triangular flaps with lateral incision angles of 30° and 105°. The third depicted closure of the lateral section of a fusiform defect using adjacent opposite triangular patches. In 1966 English chapter, he described the rotation of a triangular flap for the closure of a rhomboid defect. Two standing cones and a lying cone are still formed and should be sited where the tissues are lax enough to compensate. In 1984 English translation, the "unilaterally active opposite triangular flaps" and "rotation of a triangular flap in the closure of a rhomboid defect," were translated as "convergent triangular flaps" and "convergent triangular flaps" respectively.Limberg first called original design of the flap "opposite triangular flap," and later "local triangular flap" for closing rhomboid skin defects.

Reconstruction of Orbital Exenteration Defect With Cheek or Combined Cheek and Forehead Advancement Flaps.

To review the outcomes of orbital exenteration defect reconstruction using cheek or combined cheek-forehead advancement flap. Charts of 14 patients who underwent reconstruction of the exenterated orbit with cheek advancement flap were reviewed. In surgery, a cheek flap elevated via a nasofacial sulcus incision, and preperiosteal dissection was advanced over the defect. The upper orbital defect, if necessary, was covered with a forehead flap, which was dissected through an incision in the midline or temporal forehead and advanced inferiorly. In all patients (7 women, 7 men; mean age, 65 years), total (n = 7) or extended (n = 7) exenteration was performed for a malignant tumor. In 12 patients (86%), the defect was primarily closed with cheek flap alone (n = 6) or cheek plus forehead (n = 6) advancement flaps. Eight patients received radiotherapy before and after surgery. Four patients (29%) had a total of 6 postoperative complications (skin graft infection, orbital cavitary abscess, osteomyelitis, chronic skin ulcer, and 2 sino-orbital fistulae). The mean follow-up duration was 43 months (range, 11-79 months). Cheek advancement flap can be used alone or together with a forehead advancement flap to cover the orbital defects after total or extended exenteration. This repair may be resistant to radiotherapy-related complications in some cases.

ПРИМЕНЕНИЕ СУБЭПИТЕЛИАЛЬНОГО ВАСКУЛЯРИЗИРОВАННОГО НЕБНОГО ЛОСКУТА И PRF В КОМПЛЕКСНОЙ ТЕРАПИИ ОСТРОГО ОДОНТОГЕННОГО ПЕРФОРАТИВНОГО ВЕРХНЕЧЕЛЮСТНОГО СИНУСИТА

Subject. The article presents the results of a comprehensive method for the treatment of acute perforated maxillary sinusitis using the developed surgical method for eliminating perforation with a subepithelial vascular palatal flap with simultaneous use of PRF. The effectiveness of the proposed method of treatment was confirmed by x-ray data characterizing the intensity of the inflammatory reaction caused by surgery, morphological parameters of soft tissues in the alveolar process of the upper jaw in the area of intervention and the state of the maxillary sinus before and 3 months after surgery. The aim of the study was to evaluate the effectiveness of the use of subepithelial vascular palatal flap and PRF in the complex treatment of acute odontogenic perforated maxillary sinusitis. Methodology. An assessment and comparative analysis of the activity of the inflammatory process caused by surgery, as well as the study and comparison of the morphological parameters of the alveolar ridge (the depth of the vestibule of the oral cavity, the width of the keratinized gums, and the thickness of the mucous membrane), the X-ray data evaluating the state of the maxillary sinus, before and after 3 months were carried out. after surgical procedures. The study involved 50 patients with acute perforated maxillary sinusitis (J01.0), who were divided into two groups: the main and comparisons. In the main group (25 people), a new developed method of surgical treatment was used (a method of subepithelial vascularized palatal flap with simultaneous use of PRF), in the comparison group (25 people), the traditional method of complex treatment, including a mobilized mucoperiosteal cheek flap to eliminate perforation of the maxillary sinus . Results. Based on the analysis of the data, pronounced manifestations of the inflammatory process of the postoperative period and negative treatment results using the traditional technique, which were absent in the treatment of patients with the developed surgical method, were revealed. Findings. An analysis of the results obtained during the study revealed the high efficiency of the developed method in comparison with the traditional one.

Can respirator face masks in a developing country reduce exposure to ambient particulate matter?

Respirator face masks (RFMs) as a personal-level intervention is increasingly being utilized to reduce ambient particulate matter (PM) exposure, globally. We tested the effectiveness of 50 commercially available ones in reducing the exposure of ambient particle number concentrations (PNC), PM10, PM2.5, and PM1 (PM ≤ 10, 2.5, and 1 μm in diameter, respectively) in a traffic-affected urban site in Tehran. To examine the efficiency of RFMs, we applied a specific experimental setup including vacuum pumps, dummy heads, connecting tubes, glass chambers, and GRIMM Aerosol Spectrometer to measure all metrics after dummy heads. The average effectiveness of RFMs was in the range of 0.7-83.5%, 3.5-68.1%, 0.8-46.1%, and 0.4-32.2% in reducing ambient PNC, PM10, PM2.5, and PM1, respectively. Considering all metrics, the highest effectiveness was observed always for Biomask, followed by 3 M 9332, due to their well-designed physical characteristics (e.g., adjustable nose clip for any face/nose shape, and size, soft inner material in the nose panel to provide a secure seal against leakage, adjustable or elasticated straps/ear loops to better adjust on any face). Biomask reduced ambient PM10 with a mean value of 94.6 μg m-3 (minimum-maximum: 51.7-100.3 μg m-3), whereas it filtered on average just 29.0 μg m-3 (25.7-43.5 μg m-3) of ambient PM2.5 and 18.2 μg m-3 (14.7-21.8 μg m-3) of PM1. A fuzzy analytical hierarchy process to find the most important design-related factors of RFMs affecting their effectiveness, which showed the exhalation valve and its diaphragm (20.4%), nose clip (19.7%), and cheek flaps (18.6%) are ranked as the main design-related variables. The fuzzy technique for order preference by similarity to ideal solution indicated that Biomask and 3M 9332 had scores of 1 and 0.97, the highest scores compared with other RFMs. This study provides crucial evidence-based results to elucidate the effectiveness and design-related factors of RFMs in real-environmental circumstances.

下眼瞼悪性腫瘍切除後の欠損に対する耳介軟骨移植および頬部皮弁による再建の 6 例

下眼瞼悪性腫瘍切除後の欠損に対する耳介軟骨移植および頬部皮弁による再建の 6 例