Dog Ear Research Articles

A triangular suture to simplify reduction mammaplasty.

A technique to facilitate correct preoperative marking for an en bloc resection in superiorly based mammaplasty is presented. A temporary triangular suture is placed to control the estimated resection lines for the removal of the medial and lateral tissue block. The described technique helps to avoid the formation of medial and lateral dog ears and the unpleasant and visible scars that result.

The bilobed island flap in nasal ala reconstruction

A bilobed island flap with an extended subcutaneous pedicle including part of the transverse portion of the elevator muscle of the nasal ala is described. This flap was employed for nasal ala reconstruction in 21 patients following excision of malignancy. The series includes 12 females and 9 males ranging in age from 25 to 83 years. In 19 patients, the reconstruction spared the mucosa layer and in two a skin graft was used under the flap to reconstruct the lining. The flap was viable in all cases and the aesthetic outcome satisfactory. The rotation fold dog ear is eliminated. In planning the BIF the length of its lobes (proximal and distal), should be equal to the defect; the width of the proximal lobe, compared to the defect, and the distal lobe compared to the proximal lobe should be progressively narrower.

Abdominoplasty: Pearls and Pitfalls

Advances in anesthesia, including improved sedating and amnestic agents as well as tumescent techniques, allow one to perform traditional abdominoplasty on an outpatient basis with greater safety and efficiency. Techniques for primary elimination of dog ears, periabdominal lipectomy, and repositioning of the umbilicus are discussed. Several cases are presented herein. With strict adherence to protocol and technique as well as good patient motivation and compliance, consistently excellent results are safely achieved.

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.

Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation.

The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

Standard abdominoplasty

The appropriate patient for standard abdominoplasty has excessive, loose, sagging abdominal skin; lax abdominal fascial wall; and/or diastasis recti. Preoperative evaluation allows for appropriate selection of the patient for this procedure. Preoperative skin markings in the upright position facilitate an aesthetic result and symmetrical skin resection. The basic abdominoplasty follows a routine procedure: skin undermining, abdominal wall plication, excess skin resection, lipectomy, umbilicoplasty, and final closure with resection of dog ears. It is, necessary that the skin-flap blood supply is preserved as described to prevent skin flap necrosis. Postoperative care is aimed at preventing seroma accumulation.

Comparison of wound closure by means of dog ear repair and elliptical excision

Background: Elliptical excision is a standard method of skin tumor removal. The technique commits the operator to the direction and length of wound closure before lesion excision and hence before the shape and size of the resulting defect is known. Objective: This study was designed to compare the predicted results of elliptical excision with those achieved after tumor excision and dog ear repair. Methods: Fifty-one patients with benign and malignant skin tumors were prospectively studied. Each lesion was examined and an optimal ellipse designed and marked on the skin. Only the lesion and the required margin of adjacent skin were excised before the defect was closed in an optimal direction. Dog ears were removed if appropriate. Precise measurements were made at each step. Results: Twenty-eight percent of wounds could be closed with a flat sutured wound without the need for dog ear repair, 38% required one dog ear repair, and 34% two. Overall, the sutured wound length was 21% shorter and the wound direction different from the predicted ellipse in 45% of cases. Conclusion: Excision with dog ear repair results in significantly shorter and potentially better oriented wounds than those achieved by elliptical excision. For excision and closure of skin tumors this technique should be considered as the method of choice.

Reconstruction of the nose utilizing a bilobed flap.

Defects of the distal nose are particularly challenging to reconstruct because of this area's unique texture, lack of elasticity, and possible distortion of the alar rim. The bilobed flap has been criticized for having a high incidence of "trapdooring," flap necrosis, dog ears, and prominent suture lines. Patients who underwent bilobed flap repairs of the distal nose (n = 171) were reviewed for complications and cosmetic results. The modifications from the traditional design include minimizing the angle of transposition between lobes, thinning of the flap, basing the pedicle on the lateral aspect of the nose, and creating the lobes of the flap to be of equal diameter to the defect. There was a 3% incidence of infection, 7% incidence of partial flap necrosis, and 5% incidence of "trapdooring" and contour distortion. Color match and contour were excellent for all other patients. The modified bilobed flap is an excellent choice for reconstruction of defects of the lower nose because of the good skin match and low incidence of complications.

Laboratory study of borehole breakouts in Lac du Bonnet granite: a case of extensile failure mechanism

We subjected boreholes drilled vertically in the center of cubical specimens of Lac du Bonnet granite to constant vertical (S v) and least horizontal (S h) farfield stresses, and increased the maximum horizontal stress (S H) until breakouts occurred. A thin section study revealed that extensile cracking behind the borehole in two zones aligned with S h preceded the development of breakouts. Progressive detachment of thin long flakes bounded by these densely spaced subparallel cracks led to ‘dog ear’ shaped breakouts. Breakout mechanism and appearance match those found in the field. Results also suggest the potential for using breakout occurrence to estimate S H if S h is known or vice versa.

Bertram M. Bernheim: A southern vascular surgeon

Bertram M. Bernheim: A southern vascular surgeon

Modified Temple Incision for Facial Rhytidectomy

A modified temple incision is discussed. The incision has been used on 286 patients. The incision starts cephalad in the temple hair, continues caudally parallel to the ear axis along the caudal border of the sideburn, turns cephalad close to the helix, and then continues along the anterior border of the ear. The advantages of the incision are numerous. First, it virtually eliminates any possibility for injury to the temporal branches of the facial nerve and preserves the temporal vessels. Second, the temple and sideburn skin flap is not elevated so the chance of hair loss is minimal. Third, the incision significantly increases the distribution length of the excised area; this minimizes any possibility of "dog ear" formation. Midface and upperface rhytidectomies are more effective because the skin is pulled a shorter distance. The drawbacks of the incision are the possibility of a visible scar in the most caudal portion of the sideburns and added surgical time because of the need for meticulous incision repair.

Surgical treatment of macrocheilia

The authors report 27 cases of macrocheilia, discussing each cause individually. They classify macrocheilia according to its etiology, emphasizing the importance of an accurate diagnosis in treating the disease. The operative technique indicated for each cause is discussed. The technique basically consists of a fusiform resection, which may include a larger or smaller amount of lip tissue depending on the disease process. The incision may be interrupted at the mid-lip and W-plasty or lateral Z-plasties may be used to avoid the formation of dog ears.

Suppression of Clonidine-lnduced Vasoconstriction by Cooling

Using the cannula inserting method, we investigated whether vascular responses to norepinephrine, phenylephrine, clonidine, tyramine and KCI were altered by cooling (37°C to 27°C) in isolated canine ear arteries. Vasoconstrictor responses to norepinephrine, phenylephrine and tyramine were slightly depressed or unchanged, whereas those to clonidine and KCI were significantly suppressed by cooling. It is suggested that activation of Ca channels via alpha-2 adrenoceptors may be depressed by cooling in dog ear arteries.

Chemosurgical Report: Indications for a Geometric Approach to Wound Closure following Mohs Surgery

Complex geometrically designed closures of defects following tumor removal by Mohs surgery are often utilized when simpler methods of direct tissue aposition would suffice. There are, however, specific advantages in certain instances of using a preplanned geometric closure. Utilization of the secondary defect created by movement of a rotation flap permits redirection of the forces of tension of wound closure. Preplanning of advancement flaps allows for selective placement of tissue dog ears and thereby allows for maximal camouflaging of excisional scars. The dynamics of these two flaps are discussed and specific examples illustrating the principles are reviewed.

A modification of the Duformentel and Mouly split sliding flap

A modification of the Duformentel and Mouly split sliding flap technique is described. This technique does not create a dog ear compared to the original split sliding flap, and leaves a Z-scar, which runs in a similar direction to the wrinkle lines. Skin tension after suture is dispersed equally in the horizontal and vertical planes, so that an inconspicuous scar will result. This technique is excellent for the repair of skin defects on the face.

The Learning Center

School needs to be fun. If children are to receive lasting learning, this is a basic requirement. Frequently I hear teachers say that they never have time to have fun with their classes any more. It is true. The demands on a teacher's time to teach a certain amount of subject matter are greater now than ever before, but I suggest that children learn faster and remember longer if play-time is extended. Not only is this true for learners of all ages but particularly for the learning disabled. I like to use playing with puppets as a way to reach the troubled child, the child with developmental delays, the child with learning problems or with children in general. To children universally, puppets become immediate friends. When I first began play, I had several problems to overcome with my students. The first one was the l-can't-dothat syndrome. I must admit this took me completely by surprise. Have we programmed our children into thinking that even a puppet must be made perfectly or not at all? How sad! What if the dog's ear looks lopsided and the duck's beak is not distinguishable? So what? I agree with William Purkey, Dean of Education at the University of North Carolina, who says, We need to teach our children that doing things well comes directly from doing things poorly.

Alar Rim Reconstruction by a Dorsal Nasal Flap

A method has been described to repair small to moderate full-thickness alar rim defects with a dorsal nasal flap. The flap is based inferiorly as a tiny axial pattern flap, and the dorsal nasal skin is rotated down and turned in on itself for lining. The donor site is closed with a full-thickness skin graft. The dog ear at the base re-forms the alar base.

The Extended Neck Lift

Although adequate submental lipectomy and procedures to reposition and modify the supportive role of the platysma muscles have added to the quality and duration of neck lifts, the "bottom line" is still excision of as much excess skin as possible. A method of extended neck lift is described. It involves ancillary methods of cervical lipectomy and platysma repositioning but it also permits excision of large amounts of excess skin, by extending the posterior incisions medially and inferiorly and pulling the dog ears toward the midline. The results appear to make the additional effort worthwhile.

Further refinements in the plain radiologic diagnosis of splenic rupture: the air enema.

Plain film radiography, by appraisal of the soft tissues of the descending colon and left paracolonic gutter, comprises a safe, accurate, and quick determination of the presence of free fluid, which, in the proper clinical setting, indicates splenic rupture. The air enema, introduced under fluoroscopic control, is a valuable aid in eliminating false negatives and false positives, and also in distinguishing intraperitoneal clots from subserosal hematoma. The preoperative diagnosis was correct in 27 of 28 cases. The one error occurred in a case in which the interpretation of paravesical fluid (dog ears) was faulty, and in which the air enema had not been used.

"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.