Reconstruction Of Defects Research Articles

Histodynamics of calcium phosphate coating on the osseointegration of medical-grade polycaprolactone β-tricalcium phosphate scaffolds

Bone formation on implant surfaces occurs via distance and contact osteogenesis, with osseointegration influenced by the implant’s surface topography and coating. However, the traditional mechanisms of osseointegration around metal implant surfaces may not fully encompass the ultimate outcomes of using medical-grade polycaprolactone β-tricalcium phosphate calcium phosphate coated (mPCL-TCP-CaP) scaffolds for the reconstruction of large bone defects. Using histology, immunohistochemical (IHC) and scanning electron microscopy (SEM) analyses our studies on large bone defects using mPCL-TCP-CaP scaffolds show osteogenic cells forming a fibrous connective matrix around these scaffolds. Despite extensive research, the in vivo mechanisms of osseointegration of CaP-coated mPCL-TCP-CaP scaffolds remain unclear. This study investigates the structural details and spatial organization of the mPCL-TCP-CaP scaffold’s interface, providing insights into the histodynamic processes involved in their osseointegration with CaP coatings.

Cost-Effectiveness Analysis of Operating Room and In-Office Reconstruction of Skin Cancer Defects.

Reconstruction of skin cancer and Mohs micrographic surgery (MMS) defects of the head and neck is performed in both in-office and operating room (OR). This study intends to understand cost differences between reconstructive surgery for skin cancer defects in the OR and clinic to perform a cost-effectiveness analysis with single-institution patient satisfaction data. Population-based retrospective analysis of cost data and an institutional, prospective survey of patient satisfaction. National insurance database and institutional survey. The Merative® MarketScan database was queried to identify claims involving the reconstruction of skin cancer defects of the head/neck between 2013 and 2020 for cost-analysis by setting (OR vs clinic). Patients undergoing operative and clinic-based reconstruction of MMS defects by 3 different surgeons at a single institution in 2023 were surveyed for satisfaction using a 5-point Likert scale. Data was coupled for cost-benefit analysis. Analysis was performed using propensity-matched samples. Using Marketscan, 1206 patients were analyzed for cost data. OR cases had a higher median baseline cost of $2308 (interquartile range [IQR]: 1484-3889) compared to procedures in the office (median $987, IQR: 784-1454, P < .001). Survey data from 116 patients revealed no significant difference in scores between OR and clinic cases (clinic: 4.57 vs OR: 4.60, P = .8752). Using propensity-matched subsets, providers incur an additional $4744 for a reduction in satisfaction of 0.083 when performing cases in the OR. Lower cost is associated with reconstructive procedures performed in the office. This study is the first cost analysis of head and neck skin cancer reconstruction based on procedural settings and will be valuable to surgeons in considering practice patterns and resource utilization.

Reconstruction of Complex Oral and Maxillofacial Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Multiple Paddle Flaps.

This study aimed to use reconstructive methods for complex oral and maxillofacial defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) multiple paddle flaps. The authors performed a retrospective case series of 33 patients who underwent oral and maxillofacial defect reconstruction using the ALT multiple paddle flaps. The design and harvest of the flaps, methods for defects reconstruction, and reconstructive efficacy are described. All 33 patients were men, with a mean age of 49.5 years. Of the flaps, triple skin paddles plus muscle paddles were included in 3 cases, triple skin paddles were included in 1 case, 2 skin paddles plus muscle paddles were included in 29 cases. The skin paddles measured 3×5cm to 10×16cm. Postoperatively, all flaps survived completely. Parotid salivary fistula and orocutaneous fistula occurred in 1 patient of each, thigh wound infection and effusion occurred in 1 and 2 patients, respectively. All patients were followed up for ~2 to 93 months; most patients' oral functions and appearance were acceptable, and thigh motor dysfunction was not observed. With separate skin paddles for defects of different positions, individualized muscle flap for dead spaces, combination of different skin paddles for larger defects, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT multiple paddle flaps are an ideal candidate for complex oral and maxillofacial defects reconstruction.

Hierarchical Integration of Curcumin-Loaded CaCO3 Nanoparticles and Black Phosphorus Nanosheets in Core/Shell Nanofiber for Cranial Defect Repair.

Reconstruction and healing of large craniofacial bone defects are major clinical challenges due to high risk of chronic inflammation and reduced cell mineralization levels. Herein, a core-shell nanofiber-based implant with significant pro-osteogenesis capability for treating skull defects is reported, which is hierarchically integrated with curcumin-loaded calcium carbonate nanoparticles (CaCO3@Cur NPs) in the outer layers and black phosphorus nanosheets (BPNSs) in the core compartments. The radical alignment of the integrated nanocomponents allows the sequential in situ release of the therapeutic agents in a controlled manner after implantation. Curcumin can repolarize M1 macrophages into M2 phenotypes for anti-inflammation purposes. Meanwhile, the released calcium and phosphate ions can promote the biomineralization of hydroxyapatite at the defect site and facilitate bone regeneration. Evaluations on cranial defect-bearing rat models demonstrated that the electrospun fibers in the present study substantially promoted restoration of the damaged skulls and inhibited inflammation in the wound bed. This strategy provides a new idea for the treatment of skull defects in the clinic.

Nicorandil-based Hydrogel Promotes Bone Defect Reconstruction by Targeting Hmox1

BackgroundThe local use of drugs to promote bone healing is still difficult to apply clinically. We aimed to construct a nicorandil-based hydrogel to promote local bone healing by promoting angiogenesis and inhibiting osteoclastogenesis. ResultsIn this study, we constructed a nicorandil-based hydrogel and used it to intervene in bone repair during bone defect reconstruction. The results showed that the nicorandil-based hydrogel significantly inhibited osteoclast differentiation and promoted angiogenesis in vitro. Furthermore, bone formation was significantly promoted by the use of a nicorandil-based hydrogel. Mechanistically, Hmox1 was directly targeted by nicorandil, and overexpression of Hmox1 was found to promote bone defect reconstruction. ConclusionOur study provides a fresh perspective and a potential therapeutic approach for the use of local nicorandil-based hydrogels to improve bone defect reconstruction.

Phrenoplasty Techniques for the Reconstruction of Basal Chest Wall Defects

Background: Primary and secondary tumors of the abdominal lower third of the bony thorax are relatively rare. Therefore, indications and techniques for chest wall reconstructions in this area are not well defined. Methods: The techniques for reconstructing basal chest wall defects using the diaphragm are described. Indications for phrenoplasty are limited to reconstruction after full-thickness resection of at least two of the last four ribs in the midaxillary line. The diaphragm can be used for reconstructive purposes both if it is intact and if it is partially involved in the resection of the chest wall. Results: At our institution, the abovementioned reconstructive technique was successfully performed in five patients with an uneventful post-operative course. Conclusions: The main advantages of these methods are the use of promptly available, high-quality autologous tissue and the exclusion of the pleural space from the defect area, thus transforming a thoracic defect into an abdominal one. The disadvantage is a variable reduction in the volume of the hemithorax. These techniques could be compared with other reconstruction techniques using pre-/post-operative respiratory functional tests.

One-stage scalp reconstruction using single-layer dermal regeneration template and split-thickness skin graft: a case series.

Scalp full-thickness defects reconstruction following the resection of skin carcinoma poses significant challenges due to scalp anatomy complexity and limited vascularity. Despite various techniques available, including tissue expansion and local flaps, no single method stands as the gold standard. Moreover, cases requiring adjuvant radiotherapy further complicate reconstruction, demanding durable solutions. This study explores the efficacy of Integra® Dermal Regeneration Template Single Layer (Integra DRTSL) followed by split-thickness skin grafting (STSG) in one-stage scalp reconstruction post oncologic resection. A retrospective analysis was conducted on patients undergoing this procedure from January 2020 to October 2023. Surgical outcomes, including graft take rates, complications, and adjuvant therapy tolerability, were assessed. Results demonstrated successful reconstruction in the majority of cases, with a complete graft take rate of 77% and minimal complications. Notably, the single-stage approach facilitated timely initiation of adjuvant therapy, crucial for oncologic management. Healing times were notably reduced (< 60 days), enabling early radiotherapy commencement. No local recurrences were observed during the 16-month follow-up. The use of Integra DRTSL with STSG in one-stage reconstruction presents a promising alternative, offering optimal cosmetic and functional outcomes with low complication rates. This approach streamlines the reconstruction process, ensuring timely adjuvant therapy initiation and maximizing patient outcomes, especially in the context of scalp cutaneous tumors requiring radiotherapy. This research was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of University of Campania "Luigi Vanvitelli" (protocol code N. 0013333, 29 April 2021).

Application of modified spiral tracheoplasty in thyroid carcinoma with trachea invasion: a retrospective analysis of 15 cases

BackgroundTo describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy.MethodsThe medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed.ResultsThe duration of tracheal reconstruction was 30–60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%.ConclusionThe modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.

Surgical Reconstruction in Malignant Eyelid Tumors.

To report the histopathological subtypes of malignant eyelid tumors treated surgically in the author's clinic and to present the author's graft and flap preferences in the reconstruction of the eyelid defect after surgical excision. This retrospective study included 33 patients who underwent malignant eyelid tumor excision, followed by eyelid reconstruction. A frozen section was performed during surgery to assess surgical margins in all patients. Demographic characteristics, histological classification, localization, and size of the tumor, postoperative defect size, follow-up period, complications, and recurrence rate were recorded. Of the patients with a mean age of 66.6 ± 15.3 (range: 23-94), 15 (45.5%) were females and 18 (54.5%) were males. The lower eyelid was the most commonly involved site in 27 (81.8%) patients. Basal cell carcinoma was the most frequently diagnosed type of malignant cancer in 81.8% (n = 27) of the cases. Among the tumor subtypes, nodular type basal cell carcinoma was the most frequently observed subtype in 10 (30.3%) patients. Wide excision with different flap and graft techniques was performed in 26 (78.8%) patients with defect sizes of 40% or larger. In the author's study, the most preferred flap technique for anterior lamella reconstruction was the Tenzel semicircular flap (30.3% n = 10). The most frequently preferred flap for posterior lamella reconstruction was the Hughes tarsoconjunctival flap (30.3% n = 10). There were no flap or graft failures in any of the author's cases. In the treatment of malignant eyelid tumors, different local flap and graft techniques selected according to the size of the defect have successful anatomical results in reconstructive surgery after frozen section controlled excision.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part II/III): Biomaterials and keratoprosthesis.

The surgical reconstruction of severe corneal ulcers is a common and crucial component of the clinical practice of veterinary ophthalmology. Numerous surgical techniques are used in dogs for corneal reconstruction, and these techniques may be categorized by the material used to repair the corneal lesion. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues. In this second part of the review, the categories of biomaterials and keratoprosthetics will be summarized. Biomaterials that are reported for use in dogs include amniotic membrane, porcine urinary bladder acellular matrix, porcine small intestinal submucosa, acellular porcine corneal stroma, and other miscellaneous soft tissue and cartilage grafts (e.g., preserved equine renal capsule, autologous omentum, autologous buccal mucosa membrane, bovine pericardium, and homologous peritoneum). Descriptions of keratoprosthesis surgery in dogs are currently limited, but the use of artificial corneal transplants hold promise for dogs with severe, vision-compromising corneal disease that is not amenable to other reconstruction techniques. This review describes the results of experimental studies evaluating these graft materials in dogs, and it will summarize the findings and outcomes of the clinical articles published in each material category. Reporting inconsistencies and areas where additional research is required will be highlighted to help guide future studies in this area. A major aim of this review is to help identify potential subjects that could be evaluated in future investigations and that might lead to refinements in clinical practice.

The influence of simultaneous posterior colporrhaphy and perineoplasty on the efficiency and safety of mesh-augmented sacrospinal fixation (apical sling) in advanced POP repair

BackgroundPelvic organ prolapse (POP) is one of the most common pathologies of the pelvic floor, and it can be found among 40–60% of women who have given birth. Correction of the defect of the DeLancey level II without reconstruction of the apical defect is doomed to failure. Also, in the structure of pelvic floor defects, there is often an incompetency of the perineal body, as a consequence of traumatic delivery. Perineoplasty is considered to be the main method of correction for perineal body incompetency. However, it is worth mentioning that there are no randomized trials, which estimate the influence of simultaneous correction of the perineal body on the effectiveness of transvaginal apical fixation.MethodsIt is planned to include 310 patients in this trial. Patients who met the inclusion/exclusion criteria will be randomized into 2 groups: 1st group—patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy without perineoplasty, 2nd group—patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy and perineoplasty. Patients will be called to an appointment 6, 12, and 24 months after discharge.DiscussionThe aim of this trial is to evaluate the efficiency and safety of simultaneous perineoplasty on the clinical and anatomical efficacy of mesh-augmented sacrospinal fixation in advanced pelvic organ prolapse repair. Based on previous studies, it was difficult to estimate and comprehend whether colpoperinoplasty actually reduces the risk of prolapse recurrence.Trial registrationNCT05422209. Registered on 18 May 2022.

Defect characterization from magnetic field leakage signals in petroleum and natural gas pipelines

Pipelines transport invaluable energy resources such as crude oil and natural gas over long distances. The integrity of the piping system in terms of safety of the process is then of high importance. However, pipes are prone by time to defects that may degrade their properties and lead to failures. In this paper, we study the effect of defect parameters on the magnetic field leakage captured by Hall sensors operating along the pipe. In fact, the obtained results show that the defect parameters influence directly the MFL amplitude and shape. For this reason, the inversion problem allowing us to reconstruct the defect from the MFL signals became fast and easier in comparison to the deterministic and probabilistic algorithm inversion procedure. However, the simplified system cannot describe the real defects and the three-dimensional numerical study became necessary. In tank floor inspection domain, as our recent published work, we have studied the performance of defect shape reconstruction from MFL array sensor imaging and depth estimation while using an iterative inversion method. Indeed, the first stage consists of determining the defect width and length from magnetic flux leakage mapping reconstructed from the recorded signals of the micro-integrated magnetic sensors. Then, after coupling Comsol and Matlab software, the defect depth is obtained by coupling the 3D finite elements method and a fast iterative algorithm recently developed. Consequently, the defect shape and size are obtained after a few iterations with high precision. Furthermore, this method of defect reconstruction and seizing can be extended for irregular defect shapes encountered in pipeline such as cracks and corrosion.

Reconstruction of bone defects around the ankle with retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) for tibiotalocalcaneal arthrodesis: a case series.

The objective of this study was to describe the use of retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) in patients with tibial defects who required a tibiotalocalcaneal arthrodesis (TTC). Consecutive series case review of seven men treated with TTC using retrograde PROtect™ between January 2018 and December 2023. The main outcomes evaluated were fracture union, complications, and the health-related quality of life using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). The mean age was 45.3 8.0years. Six patients had a clinical history of chronic osteomyelitis, and one case underwent TTC for congenital pseudoarthrosis. Fracture union was achieved in 5 of 7 patients between 4 and 11months after surgery. Three patients developed complications; two patients had fistulas, and one had persistent pain. At the end of the follow-up, a median of 70 points (interquartile range: 60 to 90) on the EQ-5D-3L was reported. No complications directly attributed to the use of the PROtect™ were reported. TTC with retrograde PROtect™ is a prophylactic treatment option in patients with tibial defects treated with external fixation requiring a tibiotalar and subtalar arthrodesis. This novel use of PROtect™ allows simultaneous fixation of the tibiotalocalcaneal joint and protection of the regenerated bone, facilitating earlier rehabilitation in patients at high risk for postoperative infections.

Anterolateral thigh free flap using modified turbocharging method: a case report

The free flap is a versatile option for reconstruction of soft tissue defects around the ankle. In patients with poor lower leg circulation, arterial insufficiency is one of the complications that can occur immediately after vessel anastomosis during free flap surgery. The authors were able to improve blood circulation in the flap by using modified turbocharging method in which another perforator was anastomosed to the distal end of the main pedicle.

The Role of Fabricated Coral Shell Powder in the Healing of Mandibular Bone Gap in Dogs

Background: The reconstruction of mandibular bone defects poses a real challenge and difficulty for surgeons; biomaterial bone substitutes are the most used material for reconstructing mandibular bone defects. Objectives: This study explored the role of fabricated hydroxyapatite (HAp) powder from the coral shell in healing critical size mandible gaps in dogs. Methods: HAp was prepared using the hydrothermal method from coral shells. Characterization of the fabricated coral shell was done by x-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and energy dispersive x-ray spectroscopy (EDX). The designed research was performed on 18 dogs of both sexes (mean weight: 20±0.5 kg, mean age: 2±0.6 years). The samples were divided into two equal groups. Animals underwent experimental defects at the ventral surface of the lower mandible about 14.5 mm. Results: The results of XRD represented high crystallinity, the EDX results indicated the surface morphology of distributed particles of calcium, phosphorous, carbon, and oxygen, respectively, and the FESEM results suggested that the surface morphology of HAp appears as a spherical particle that regularly distributed within the sample. In the HAp group, at 30 days, the FESEM images show that the defective gap completely closed, and the center of the defect was filled with a thick layer of osteoid matrix. Radiographically, the HAp group at 30 days post-surgery indicated a well-defined circular radiolucent bone gap at the caudal portion of the mandible, with a partially sclerosed margin. Macroscopically, at 30 days, the gap appears very small and is invaded by new bone formation. Conclusion: In conclusion, recycling HAp from coral shells has practical value in the reconstitution of the mandibular gap, and the radiological and critical properties of prepared HAp emphasize this outcome.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part I/III): Autogenous ocular tissues, donor tissues, and corneal clarity scoring.

Corneal reconstruction is a key part of veterinary ophthalmic practice and numerous reconstructive techniques have been described for use in small animals in the peer-reviewed veterinary literature written in English. Despite the evidence accrued over the last six decades in over 40 clinical articles and numerous other publications on ocular surface health, several key areas require further study. The comparison between studies is difficult due to elements that go beyond common factors, such as the indication for surgery, the reconstructive technique preferred by the surgeon or the availability of reconstructive materials. However, the differences in reporting style adopted by different authors between similar studies and the lack of data found in retrospective studies add to this complexity. The present review is divided into three parts. One covers the use of autologous materials for reconstruction and corneal transplants, as well as corneal clarity. A second part focuses on biomaterials and keratoprosthetics, while the third part focuses on the use of corneal sutures and report of ocular discomfort/pain in the veterinary literature. The review focuses on the main findings of each reconstruction technique. It aims to identify areas where key information about common procedures is missing so that general guidelines may be provided for the planning of patient record keeping and future retrospective or prospective studies, while it also aims to highlight the presence of knowledge gaps that deserve further attention.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part III/III): The use of corneal sutures and reporting of ocular discomfort.

The surgical reconstruction of severe corneal disease is a common and crucial component of the clinical practice of veterinary ophthalmology. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues in dogs, while the second part reviewed the use of biomaterials and keratoprosthetics in this species. This third part is dedicated to the review of the use of corneal sutures including suture type and suture pattern in corneal reconstruction of small animals including dogs and cats. The review also focused on the way studies report postoperative ocular discomfort/pain and how this is treated. Lastly, the author briefly presents the simple but effective techniques available to bury corneal knots for corneal reconstructive surgery in small animal patients, such as the "tugging" and "deep-superficial-superficial-deep" methods for simple interrupted sutures, and the adaptation of the latter for simple continuous sutures.

Virtual Reality Surgical Planning of a Complex Two-Jaw Defect

Head and neck reconstruction poses challenges requiring stable coverage and optimal appearance and functionality. In complex cases, and beyond the right choice of flap, Virtual Reality (VR) surgical software and preoperative planning, are needed to optimize outcomes. Our patient is a 16-year-old with a history of rhabdomyosarcoma necessitating maxillary-mandibular defect reconstruction. VR-based preoperative planning facilitated the intervention by creating 3D-VR models of facial anatomy and fibula, simulating resection margins, and creating surgical guides for intraoperative use. Our 2-team surgeons opted for a single-staged reconstruction using a vascularized fibula free flap. This case demonstrates successful single-flap reconstruction of a maxillary-mandibular defect, addressing challenges of recipient vessel scarcity, fibrotic scarring, and poor tissue quality. It also underscores the efficacy of a 2-team approach and VR-based preoperative planning in achieving successful outcomes in complex maxillary-mandibular reconstruction. The use of a single fibula flap minimized possible complications and operative time, and the 2-team approach helped by combining the expertise and training of craniofacial and microsurgical trained surgeons. Acknowledging limitations in imaging quality and real-time adaptability, we advocate for continued exploration of VR technologies in enhancing surgical precision in challenging cases.

Identification and characteristic analysis of internal defects in rock-filled concrete based on deep learning method

The distribution characteristics and geometric morphology characteristics of defects within RFC are important factors affecting the strength properties and rupture morphology of RFC. However, the excessive size of commonly used aggregates for RFC leads to difficulties in conducting in-depth experimental studies indoors. Based on the improved U-Net and image processing technology, this research establishes an integrated model for the identification, classification, and extraction of defects inside the RFC, quantitatively counts and analyzes the acquired defect distribution characteristics and geometrical morphology characteristics, and establishes a defect characteristic distribution function that can be used for the numerical reconstruction of defects. In order to realize the acceleration of U-Net training using training weights, use VGG-16 with the fully connected layer removed instead of the Encoder part of the U-Net. The integrated model in this research can realize automatic identification, classification, and extraction of multiple types of defects at the same time, and the established distribution function of defect characteristics provides a data basis and new ideas for the establishment of RFC three-dimensional numerical models containing real defects.

Trapezius Island Myocutaneous Flap for Head, Neck, and Facial Reconstruction in Neurofibromatosis Type 1-Associated Plexiform Neurofibromas.

Reconstruction of significant soft tissue defects in the head and neck region after resection of extensive plexiform neurofibromas, as well as preservation and restoration of cosmetic and functional aspects, presents a considerable challenge. The purpose is to evaluate the feasibility of eTMF in repairing substantial defects after the complete resection of NF1 PN. Patients diagnosed with substantial neurofibromatosis (NP) type 1 (NF1), according to the revised criteria, underwent complete resection and remodeling of the facial aesthetic unit. An extended vertical lower trapezius island myocutaneous flap (eTIMF) was used for the defect reconstruction. Perioperative complications were evaluated using the Clavien-Dindo classification. ECOG PS was assessed. Postoperative follow-up at 6 months and completion of UW-QOL. The questionnaire included swallowing, chewing, speech, and quality of life scores. Two patients had pathogenic missense variants: c.5609G>A (p.Arg1870Gln) in exon 38 of NF1 in the first case, and c.4600C>T (p.Arg1534*) in exon 35 in the second case. Two eTMFs were harvested successfully. Five facial esthetic units were remodeled, and 4 units were remodeled. Two extensive tumors were nearly entirely removed. No severe complications were noted. The ECOG PS improved from grade 3 in the first week postsurgery to grade 0 by the eighth week. The UW-QOL results indicated that swallowing, chewing, and speaking functions returned to their preoperative levels, with a 40% improvement in quality of life, reaching 60% and 80%, respectively. eTMF to repair substantial defects following total resection of NF1 PN and facial esthetic unit remodeling enhances appearance, function, and psychosocial outcomes. This technique is safe, efficient, resource-conserving, and simple to implement.