Choice Of Donor Site Research Articles

599 Eyelash Reconstruction Utilizing a Strip Graft for Burn-related Madarosis: A Case Report and Operative Technique

IntroductionFacial burns are a common occurrence with a small percentage causing injury to the periocular region. Although the eye itself is often spared, madarosis may occur from deep burn injury to the eyelid. Reconstruction of the eyelid margin is technically difficult due to the challenging aesthetic region, as well as specific characteristics of eyelashes. Although there are several options for eyelash grafting there is no established gold standard, and there is little to no-literature related to procedures involving burn madarosis.MethodsHere we describe a case of unilateral eyelash grafting utilizing a composite strip graft in a 20-year-old female who sustained a 70% flame injury at the age of two.ResultsThe presented results show the efficacy of this technique at restoring function and providing a good aesthetic result which is maintained at 1 year follow up.ConclusionsUtilization of a composite strip graft to recreate the eyelid margin is a viable choice for reconstruction of burned upper eyelids in the appropriate patient. Further exploration regarding procedure timing and choice of donor site are warranted.

Finger reconstruction with dorsal metacarpal artery perforator flaps and dorsal finger perforator flaps based on the dorsal branches of the palmar digital arteries – 40 consecutive cases

Since the first description many variations of the dorsal metacarpal reverse island flap have been published but there is still uncertainty about which vascular component should be included for an optimal result. Therefore, it was the aim of this study to analyze vascular reliability and ischemic complications of dorsal metacarpal artery perforator (DMAP) flaps and dorsal finger perforator (DFP) flaps in our patient collective. We performed 40 of these flaps from the dorsum of hand and fingers for finger injuries. The choice of donor site was made according to the defect’s location. Patients were analyzed with respect to flap necrosis, ischemic complications and achievement of overall reconstruction goals. In addition, we divided our patients in two groups, one group where we raised the flap from the dorsum of the proximal phalanx and a second one where the flaps were raised from the intermetacarpal space to identify complication rates based on the pedicles location. Of the 40 flaps, 36 survived completely. 4 partial necroses were observed in flaps transferred to more distal defects and in one flap that was used in a wrap-around technique for both dorsal and palmar proximal phalanx. These perforator flaps are a reliable method to cover finger defects and the dorsal metacarpal artery is not necessary for their survival, since the blood supply comes from perforating branches of the palmar vascular system. There is a clear trend for a higher complication rate in flaps raised from the dorsum of the fingers compared to the intermetacarpal space.

Expert consensus statement on reconstruction principle for mandibular defect

Mandibular defect is one of the common defects of maxillofacial region, which can seriously affect the appearance, chew and speech. The ultimate goal of functional reconstruction of mandibular defect is to restore mandibular appearance, denture and occlusal function. Vascularized bone grafting is an effective method for reconstruction of mandibular defect, especially in treatment of large defect. However, functional reconstruction of mandibular defects involves multiple specialties, many technical details and long treatment cycle, resulting in a small proportion of functional reconstruction. To establish standard operating procedures, Society of Oral Maxillofacial Rehabilitation, Chinese Stomatological Association has organized a lot of experts to establish expert consensus statement on reconstruction principle for mandibular defect, referred to standard procedure of indication, preoperative evaluation, choice of donor site, digital technology aided surgery, recommendations of the operation in the process of residual mandibular position fixed, the mandibular body molding denture and common post-operative complications, in order to promote the reconstruction of mandibular defect treatment and improve the quality of reconstruction.

Donor Site Complications in Bone Grafting: Comparison of Iliac Crest, Calvarial, and Mandibular Ramus Bone

To compare the donor site complication rate and length of hospital stay following the harvest of bone from the iliac crest, calvarium, or mandibular ramus. Ninety-nine consecutively treated patients were included in this retrospective observational single-center study. Iliac crest bone was harvested in 55 patients, calvarial bone in 26 patients, and mandibular ramus bone in 18 patients. Harvesting of mandibular ramus bone was associated with the lowest percentages of major complications (5.6%), minor complications (22.2%), and total complications (27.8%). Harvesting of iliac crest bone was related to the highest percentages of minor complications (56.4%) and total complications (63.6%), whereas harvesting of calvarial bone induced the highest percentage of major complications (19.2%). The length of the hospital stay was significantly influenced by the choice of donor site (P = .003) and age (P = .009); young patients with the mandibular ramus as the donor site had the shortest hospital stay. Harvesting of mandibular ramus bone was associated with the lowest percentage of complications and the shortest hospital stay. When the amount of bone to be obtained is deemed sufficient, mandibular ramus bone should be the first choice for the reconstruction of maxillofacial defects.

Phalloplasty in Complete Aphallia and Ambiguous Genitalia

The most common indications for phalloplasty in children include aphallia, micropenis/severe penile inadequacy, ambiguous genitalia, phallic inadequacy associated with epispadias/bladder exstrophy and female to male gender reassignment in adolescents. There are many surgical options for phalloplasty; both local pedicled tissue as well as free tissue transfer. The advantages of local tissue include a more concealed donor site, less complex operation and potentially faster recovery. However, pedicled options are generally less sensate, making placement of a penile prosthesis more risky and many children with bladder exstrophy have been previously operated upon making the blood supply for local pedicled flaps less reliable. This Here the authors discuss free tissue transfer, including the radial forearm, the anterolateral thigh, the scapula and latissimus, and the fibula free flaps, as well as local rotational flaps from the abdomen, groin, and thigh. The goal of reconstruction should be an aesthetic and functional (ability to penetrate) phallus, which provides tactile and erogenous sensation, and the ability to urinate standing. Ideally, the operation should be completed in one to two operations with minimal donor site morbidity. There are advantages and disadvantages of each of flap and thus the choice of donor site should be a combination of the patient's preference and surgeon's ability to produce a consistent result.

Microchirurgie et considérations esthétiques. À propos de deux cas de reconstruction talonnière

With two case reports of heel reconstruction on female patients the authors report the advantages and drawbacks of the two main types of reconstruction: free or regional flaps. Regional flaps are technically easy and reliable but their aesthetic after-effects on the donor site may be disabling, specially on the leg of a female patient. Microsurgery is technically more difficult and presents more complications specially on the lower limb. However, in certain conditions, and with the appropriate choice of donor site, free flaps authorize good quality reconstructions with minimal aesthetic after-effects.

Management of Perioral Burn Scarring in the Child and Adolescent

The experience gained in the treatment of 116 patients with perioral burn scarring is presented. Important considerations are the choice of unit release or simple release, the choice of donor site to match the prevailing skin of the remainder of the face, and the timing of the reconstruction. Delaying the reconstructive procedure with the routine use of pressure appliances until the scar was mature produced a more pleasing final result. In addition, we found that modifying the traditional aesthetic unit excised to include darts when there was severe burning of the surrounding facial cheek skin with loss of natural nasolabial folds improved the final result and reduced the need for secondary revision.