Dog-ear Correction Research Articles

Triangular Flap Insertion: An Option for Correction of Dog-Ears Deformity in High-Tension Areas.

Dog-ear deformity is a common protrusion defect of skin tissue after the closure of a surgical wound, affecting patients' appearance and quality of life. The common methods for correcting dog ears involve the removal of excess tissue in different directions or shapes after extending the incision along the long axis of the original wound. However, the literature regarding tissue preservation techniques for dog-ear correction is poor, especially for areas with insufficient skin tissue or high tension. The authors modified the original design of direct excisions, which transferred excess tissue from the horizontal axis of the wound to the longitudinal axis, thereby absorbing longitudinal tension and relieving linear scar contracture. This technique provides a way to correct dog ears without removing excess healthy tissue, especially as an option for dog-ear correction in high-tension areas.

Triangular Resection Epicanthoplasty: A Novel Method of Minimizing Hypertrophic Scar After Medial Epicanthoplasty.

Medial epicanthoplasty is a crucial component in Asian cosmetic eyelid surgery. Conventional surgical methods have mandated wide undermining for the purpose of sufficient release. However, excessive undermining may result in hypertrophic scar or webbing deformities. To minimize undesirable results, the authors are proposing a novel approach. From March 2010 to December 2017, a triangular resection epicanthoplasty was performed in 421 Asian patients. The authors' procedure consists of triangular skin resection, the release of orbicularis oculi muscle and upper half medial epicanthal tendon, and dog ear correction. No complication regarding scarring or webbing was reported. The revision was performed in 18 cases where the patients wanted additional correction. The triangular resection epicanthoplasty offers both optimal results and minimal scar with relative simplicity.

Surgical Results and Patient Satisfaction After A New Surgical Technique for Asian Medial Epicanthoplasty: A Modified Skin Redraping Method Using a Horizontal Point Incision and Staged 'Y-Shaped' Dog Ear Correction.

The double eyelid operation is the most common cosmetic procedure conducted in Asians. However, the epicanthal fold presents a conundrum that limits the cosmetic results of double eyelid surgery. Despite not being a pathologic condition, numerous procedures have been developed and introduced to address this issue, but these techniques have potential disadvantages that include an unnatural ciliary position of the lower lids and prominent scarring. A total of 156 patients who underwent a double eyelid operation with medial epicanthoplasty using the modified skin redraping method using a horizontal point incision and staged dog ear correction between 2015 and 2019 at our medical center were enrolled in the study. A single senior plastic surgeon performed all surgical procedures. The Patient-Reported Outcome Measures (PROM) questionnaire was used to obtain objective satisfaction scores, and patient satisfaction scores were obtained using some criteria. Of 147 patients, 8 (0.05) complained of visible scarring at the medial epicanthal and upper fold line region; there were only 2 (0.01%) epicanthal fold recurrences and 1.36% wound-related complications. The PROM scores and patient satisfaction scores showed a strong positive linear correlation according to linear regression analysis (P < 0.001). We performed double eyelidplasty with epicanthoplasty by using "a modified skin redraping method using a horizontal point incision and a staged 'Y-shaped' dog ear correction." Few complications were encountered, and almost all patients were satisfied with their surgical outcome as determined by the PROM questionnaire.

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

BackgroundBreast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation.MethodsTo date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study.ResultsWe applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site.ConclusionsIn our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

Counterweight method for dog ear correction.

Counterweight method for dog ear correction.

Lymphoepithelioma-like Carcinoma of the Skin in the Cheek with a Malignant Metastatic Cervical Lymph Node.

Lymphoepithelioma-like Carcinoma of the Skin in the Cheek with a Malignant Metastatic Cervical Lymph Node.

The three-bite technique: a novel method of dog ear correction.

The closure of any circular or asymmetric wound can result in puckering or an excess of tissue known as a 'dog ear'. Understanding the mechanism of dog ear formation is a fundamental requirement necessary to facilitate an appropriate treatment. Many solutions have been reported in the literature, but in all cases, the correction entails the extension of the scar and the sacrifice of the dermal plexus. Here, we propose a novel technique of dog ear correction by using a three-bite suture that sequentially pierces the deep fascial plane and each dog ear's margin, thus allowing for flattening the dog ear by anchoring the over-projecting tissue to the deep plane. The three-bite technique proved to be a fast, easy, and versatile method of immediate dog ear correction without extending the scar, while maintaining a full and complete local skin blood supply.

English

BACKGROUND: The reconstruction of the lower extremity poses a great challenge because of the complexity of the injuries. Road traffic accidents are the most common cause of mortality and morbidity in patients. High speed traffic accidents result in a variety of associated life- threatening injuries. Lower extremity poses problems of wound healing and also the lack of suitable donor local flaps. The development of Microsurgical techniques in the past 25 years has changed the whole spectrum of reconstruction of the lower limbs. AIMS AND OBJECTIVES: The aim of this study is to evaluate the use of various flaps in the lower extremity reconstruction in a tertiary care center. The main objective is to study the process of rehabilitation with main focus on early return to normal activities following the reconstructive procedures. SETTINGS AND DESIGN: Seventy three patients between the ages 17 to 65 years (mean age-36.43) with an injury period of up to 4 weeks were included in the study. For the 73 patients, 74 flaps were used. Patients with collagen disorder, liver disease. HIV positive patients and patients with history peripheral vascular diseases were excluded from the study. METHODS AND MATERIAL: This study was conducted in a tertiary teaching hospital over a period of two years from July 2012 to July 2014.Flap surgery was done in 73 patients with a total of 74 flaps. Defects of various regions of the lower extremity were selected for the study. A variety of reconstructive options are available for the lower extremity. This study includes patients from my private practice also. OBSERVATION AND RESULT: The flap surgery was successful in a variety of indications like trauma, infected chronic wounds, tumor excision and bone infections. There was a total failure of reverse sural artery flap in one patient. There was a partial necrosis of small area of the tip of the flaps in two patients with transposition fasciocutaneous flaps which healed by secondary intention in two weeks period. Venous congestion in two patients subsided on its own in 3 days. Three patients had minor infection problems which were treated with appropriate antibiotics. Two patients had partial skin loss in the donor areas which required secondary skin grafting procedures. CONCLUSION: Despite the fact free flaps are used more in the recent times, other flaps are still effective in the treatment of lower limb defects. Cross leg flap, a staged procedure was also used in our series for very large defects with good results. Muscle flaps and free flap were associated with fast recovery of patients and with minimal infection and non- union complications. Early skin cover gives the best results and the patients returned to normal activities earlier. Patients with fractures in whom flaps were done early along with bone graft procedures were ambulant early without problems of non-union. Patients who had muscle flaps for fractures and infective problems showed early wound healing. Most of the patients accepted the appearance of the flaps and a. very little percentage of patients returned back for secondary procedures of dog ear correction and thinning of the flaps.

Aesthetic Refinement of the Dog Ear Correction: The 90° Incision Technique and Review of the Literature

The closure of any circular or asymmetric wound results in puckering or excess of tissue known as dog ears. Tissue dynamics, wound geometry, surface contour, and surgical technique affect dog ear formation [1,2]. Despite good preoperative planning for skin management techniques including Burow's triangle, V-Y advancement flap, M-plasty [3], and S-plasty [4], and despite following intraoperative procedures including proper undermining of a shallow wound, proper 90° angle of the scalpel blade, precise suture placement, and removal of excess underlying fat, sometimes a dog ear occurs anyhow. Methods for correcting dog ears include excision of the excess tissue in the shape of a triangle, crescent or ellipse; excision of conical folds of tissue at the end of the wound in the same direction as the long axis of the original wound; and excision of the dog ear at a 120° angle to the long axis of the existing excision line in a shape resembling a hockey stick [5]. They are extensively described in the literature, but they all lead to wound extension. Only M-plasty allows for reduction in the scar's length but produces a double-tailed scar, so if the total length with the two tails is considered, the new scar is still longer than the original one. We have developed a new and easy technique for dog ear correction without extending the length of the original wound.

Aesthetic Refinements and Reoperative Procedures Following 370 Consecutive DIEP and SIEA Flap Breast Reconstructions: Important Considerations for Patient Consent

Breast reconstruction often requires multiple operations. In addition to potential complications requiring reoperation, additional procedures are frequently essential in order to complete the reconstructive process, with aesthetic outcome and breast symmetry shown to be the most important factors in patient satisfaction. Despite the importance of these reoperations in decision-making and the consent process, a thorough review of the need for such operations has not been definitively explored. A review of 370 consecutive autologous breast reconstructions (326 patients) was undertaken, comprising 365 deep inferior epigastric artery perforator (DIEP) flaps and 5 superficial inferior epigastric artery (SIEA) flaps. The need for additional procedures for either complications or aesthetic refinement following initial breast reconstruction was assessed. Overall, there was an average of 1.06 additional interventions for every patient carried out after primary reconstructive surgery. Of 326 patients, 46 underwent early postoperative operations for surgical complications (0.17 additional operations per patient as a consequence of complications). Procedures for aesthetic refinement included those performed on the reconstructed breast, contralateral breast, or abdominal donor site. Procedures for aesthetic refinement included nipple reconstruction, nipple-areola complex tattooing, dog-ear correction, liposuction, lipofilling, scar revision, mastopexy, and reduction mammaplasty. While DIEP flap surgery for breast reconstruction provides favorable results, patients frequently require additional procedures to improve aesthetic outcomes. The need for reoperation is an important part of the consent process prior to reconstructive surgery, and patients should recognize the likelihood of at least one additional procedure following initial reconstruction.

Transgender patient satisfaction following reduction mammaplasty

To evaluate the outcome of reduction mammaplasty in female-to-male transgender patients. A 5-year retrospective review was conducted on all female-to-male transgender patients who underwent reduction mammaplasty. A postal questionnaire was devised to assess patient satisfaction, surgical outcome and psychological morbidity. Seventeen patients were identified. The senior author performed bilateral reduction mammaplasties and free nipple grafts in 16 patients and one patient had a Benelli technique reduction. Complications included two haematomas, one wound infection, one wound dehiscence and three patients had hypertrophic scars. Secondary surgery was performed in seven patients and included scar revision, nipple reduction/realignment, dog-ear correction and nipple tattooing. The mean follow-up period after surgery was 10 months (range 2-23 months). Twelve postal questionnaires were completed (response rate 70%). All respondents expressed satisfaction with their result and no regret. Seven patients had nipple sensation and nine patients were satisfied with nipple position. All patients thought their scars were reasonable and felt that surgery had improved their self-confidence and social interactions. Reduction mammaplasty for female-to-male gender reassignment is associated with high patient satisfaction and a positive impact on the lives of these patients.

A new dog ear correction technique

When moving a local flap, a dog ear sometimes appears at the base of the flap. If we try to correct the dog ear primarily, the blood supply to the flap may be disturbed. In such a case, the dog ear is prone to be corrected secondarily. In the present report we show a new technique for correcting a dog ear that enables correction to be done primarily and sufficiently. The principle of the technique is to de-epithelialise the dog ear portion and dig it in to the dermis to preserve the subdermal plexus at the base of the flap intact. This method is useful especially at the base of a transposition flap because the pedicle tends to be narrowed by the conventional correction.

Dog-ears: a review.

The closure of any circular or asymmetric wound results in puckering or excess of tissue known as dog-ears. Facility in managing dog-ears is an invaluable tool in cutaneous surgery due to its common presentation. Methods for correcting dog-ears are extensively detailed in both the plastic and dermatologic surgery literature. This review provides a practical outline of nine methods of dog-ear correction along with pertinent schematic and clinical illustration. A comprehensive approach to dog-ears requires knowledge of tissue dynamics, adherence to proper surgical technique, and strategies for the management of dog-ears. A thorough understanding of dog-ear formation and correction allows the surgeon to choose the most appropriate management for dog-ears in any clinical setting.

The Cervico-Humeral Fasciocutaneous Flap

SummaryCervico-humeral fasciocutaneous flap was raised successfully in five patients for the treatment of post-burn contracture of the neck as a single stage procedure. Post-operative splintage was not required. There was no flap loss. Dog-ear correction and Z-plasty were performed as touch-up procedures.