Dog-ear Deformity Research Articles

A Modified Suture-Bridge Technique for a Marginal Dog-Ear Deformity Caused During Rotator Cuff Repair

Recently, the suture-bridge technique was found to maximize the utility of a single-row construct by using the suture limbs from the medial mattress sutures to bridge and compress the repaired tendon. However, the formation of marginal dog-ear deformities at a repaired rotator cuff is not uncommon with the suture-bridge technique. If a dog-ear deformity is observed at the margin after completion of the rotator cuff repair, the detached marginal cuff is pierced via a suture hook. One strand of the uncut suture in the lateral row is transported through the deformed cuff. A nonsliding knot is seated on top of the detached cuff and presses this area of soft tissue firmly onto the bone. If necessary, these steps are repeated for the other side of the detached rotator cuff. After completion of the rotator cuff repair, a “zigzag” pattern of compression of the cuff against the bone footprint without detachment of the rotator cuff is observed. After repair of the rotator cuff tear via the suture-bridge technique, the benefit of our simple technique for treating a marginal detached cuff is that the footprint contact area of the rotator cuff is restored completely, without the need for additional suture anchors.

Reconstruction method with a newly-designed bilobed flap after excision of tumours of the skin

We have devised a bilobed skin flap for reconstruction after excision of small skin tumours. The sutured part serves as a zig-zag that leads to only slight postoperative contracture of the scar. The rotation centre of the flap is nearer to the affected area than other conventional bilobed flaps, resulting in less dog-ear deformity and distortion of tissue.

The ???Duck??? Modification of the Tensor Fascia Lata Flap

Various common locations of pressure sores require specific considerations. The most commonly used flap for the treatment of trochanteric ulcers is the tensor fascia lata (TFL) flap. According to our experience with the original flap, excessive tension and eventual suture separation at the confluence of the donor site flaps and the TFL flap is the most common problem. The purpose of this article is to present a new design for the TFL flap for the coverage of trochanteric pressure sores. An anterior triangular extension is designed exactly at a point where the flaps that will cover the donor site unite after transposition. The desepithelialized proximal part of the flap is folded into the pouch and sutured. The duck flap was applied to 31 trochanteric pressure sores in 27 patients with no major complications. This modification has many advantages: (1) the flap is reliable and easily designed, (2) formation of dead space and cone-shaped dog-ear deformity due to rotation is prevented, (3) better esthetic results are achieved, (4) suture separation is prevented via a tension-free closure, (5) the desepithelialized part produces tight attachment of the flap to the recipient bed, (6) as no muscle tissue is included, the flap is more resistant to pressure.

Die autologe Gewebetransplantation (TRAM/DIEP) als Therapieoption bei Kapselfibrose der Brust

Free microvascular abdominal tissue transfer (TRAM/DIEP) has become standard in breast reconstruction after mastectomy. A new indication for abdominal tissue transfer is severe capsular contracture after augmentation by implants. Capsular contracture following aesthetic or reconstructive augmentation mammaplasty occurs in only a small percentage of cases, but warrants adequate therapy. Between 1999 and 2003, six patients with an average age of 35 years with symptomatic capsular contracture after augmentation mammaplasty underwent autologous tissue transfer with the free TRAM/DIEP flap. The flap was harvested either with a perforator of the deep epigastric artery (DIEP) or as muscle sparing flap (TRAM) and was anastomosed to vessels of the subscapular system. Operation time was reduced by operating with two teams. Besides minor dog-ear deformities at the donor sites, no complications were noted. Postoperatively, neither, instability of the abdominal wall nor flap loss was seen. In some cases, a secondary mastopexy was necessary. Aesthetic results concerning natural feeling and breast symmetry were graded as excellent. In our experience, the free microvascular transfer of abdominal tissue (TRAM/DIEP flap) offers a treatment option for patients seeking alternatives other than repeated capsulectomies and implant changes for severe capsular contracture.

Innovations to the vertical reduction mammaplasty: making the transition.

The vertical reduction mammaplasty can be challenging to learn. In addition, first attempts to perform the vertical reduction mammaplasty can lead to inconsistent aesthetic results. The authors describe their transition from a traditional inverted-T reduction mammaplasty to a modified vertical reduction mammaplasty based on a technique described by Elizabeth Hall-Findlay. In their early cases using the Hall-Findlay technique, they noted several aesthetic complications. These problems included a persistent vertical dog-ear deformity at the nadir of the incision, a teardrop deformity of the nipple-areola complex, lateral deviation of the nipple, and lateral axillary fullness. They developed several modifications to the Hall-Findlay technique to correct the aesthetic deficiencies and to simplify further the vertical reduction method. The authors think their innovations facilitate the transition from a traditional inverted-T breast reduction to a successful vertical reduction mammaplasty technique.

Tear-drop incision for mastectomy to avoid dog-ear deformity.

Tear-drop incision for mastectomy to avoid dog-ear deformity.

Dog ear: true and false. A simple surgical management.

The rise of the utilization of tissue expanders and procedures like liposuction have brought us a better understanding of the biomechanical properties of the skin as a living organ. This understanding has helped us to appreciate better the etiopathology of a dog ear deformity and to utilize the same properties for its correction by simple methods and thus avoid complex plasties and additional scars.

A New Treatment for Parrot Beak Deformity of the Toe

Two cases of congenital parrot beak deformity of the toe were treated by pushing back the nail plate, nailbed, matrix, and proximal skin fold in one piece as a flap. The proximal skin portion of this flap was deepithelialized to facilitate this shift, and thus no dog-ear deformity was produced. The distal skin defect of the pulp was covered by a palmar advancement flap. This method does not require augmentation of the fingertip or toetip and is very useful for correcting parrot beak deformities of the toes.

The VY tensor fasciae latae musculocutaneous flap.

When first introduced in 1978, the tensor fasciae latae flap was used both as a free-tissue transfer and as a local rotational flap. Its use as a free flap has diminished as other more appropriate flaps for free-tissue transfer have been described. The tensor fasciae latae flap has remained, however, an instrumental flap in the coverage of anterior and posterior soft-tissue defects around the hip region. The purpose of this paper is to present a new design of the tensor fasciae latae flap in the coverage of trochanteric pressure sores. By essentially creating a VY advancement flap into the trochanteric defect with the tensor fasciae latae, one can cover the trochanteric defect with the best-vascularized portion of the flap and avoid the dog-ear deformity.

Eliminating the dog-ear in modified radical mastectomy

Inadequate attention has been paid to optimal closure of the postmastectomy incision in patients not desirous of breast reconstruction. Herein, we describe the use of a basic plastic surgical technique at the time of mastectomy to eliminate the dog-ear deformity at the axillary end of the incision. The technique is conceptually simple and expedient, and gives an excellent cosmetic result.

"Practical suggestions on facial plastic surgery--how i do it". Management of the dog ear deformity.

The dog ear is a common skin deformity resulting from attempted closure of unfavorably shaped defects or from transfer of many local flaps. Prevention is possible in many instances and surgical correction is usually feasible when the deformity appears.