Dog Ear Research Articles

Microdot vasovasostomy improves patency and reduces time for return of sperm to the ejaculate

In previously published series, the mean time for sperm to return to the ejaculate following vasovasostomy (VV) was 63 days. Long obstructive intervals between vasectomy and VV results in luminal discrepancies typically up to 5:1; leading to “dog ear” at the completion of the anastomosis. Evidently, sperm leak, granuloma, stricture, or obstruction. To address this problem, the microdot suture placement was introduced in 1995. The impact of this technique on patency rates and timing of return of sperm to the ejaculate has not been previously reported.

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.

Reading Man Flap: Application to Plantar Defects

The plantar surface of the foot has highly specialized, densely adherent, glabrous skin, making functional replacement difficult. Glabrous skin defects should be replaced with similar skin to restore function and aesthetics. An innovative technique, the “reading man flap,” was developed for closure of circular skin defects. At locations such as the face, trunk, thigh, and calf, the “reading man” procedure provides tension-free closure with minimal additional healthy skin excision, and it does not cause “dog ear” formation. The potential exists for replacement of plantar defects with skin of the same quality using this procedure. In the present study, we report on 2 clinical cases in which intermediate-size plantar defects were reconstructed using the reading man flap. This method can provide tissue as durable, yet as sensitive, as skin that matches the unique characteristics of the plantar skin.

Double microcatheter technique for coiling intracranial aneurysms with unfavorable configurations

Background Although stent⁃assisted technique has been widely used clinically, it is still hard to perform coiling treatment for complicated intracranial aneurysms, including relatively wide-necked tiny aneurysms and lobulated wide-necked aneurysms with important branch vessels arising from the neck. This study aims to investigate the feasibility and clinical results of endovascular treatment for intracranial aneurysms with unfavorable configurations by using double microcatheter technique. Methods Thirty-three cases with complicated aneurysms were treated by using double microcatheter technique from April 2008 to November 2012. The locations of these aneurysms were anterior communicating artery (7 cases), posterior communicating artery (14 cases), ophthalmic artery (3 cases), anterior choroidal artery (3 cases), origin of posterior inferior cerebellar artery (3 cases), bifurcation of middle cerebral artery (2 cases) and top of basilar artery (1 case). The mean neck-to-body (width) ratio was 0.80 ± 0.21 (0.53-1.33). The mean body (width)-to-dome (height) ratio was 1.12 ± 0.37 (0.55-2.12). The mean dome (height)⁃to⁃neck ratio was 1.26 ± 0.41 (0.65-2.96). The diameter of neck ≥ 4 mm was seen in 7 aneurysms, neck ≥ height in 9 and neck ≥ width in 8. Besides, there were 9 very small aneurysms (the maximum diameter ≤ 3 mm) and 13 aneurysms with important branch vessels arising from the neck. All of these aneurysms were treated with coiling by using double microcatheter technique. Results All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in 19 aneurysms, and residual filling in 14. There were some small loops protruding from the neck without influencing the blood flow in 12 cases. At discharge, according to modified Rankin Scale (mRS), 30 patients with 0-1 scores presented excellent clinical outcomes and 3 patients with 2 scores had cognitive dysfunction and moderate disability due to vasospasm. Among the 33 cases, only 1 case receiving follow-up angiography 1 year after operation showed the coils near the neck were slightly compressed and presented a dog ear like recanalization. Conclusion According to the clinical experience with complicated aneurysms, double microcatheter technique is feasible, safe and effective for coil embolization of aneurysms with unfavorable configurations.

Isolated Neck-Lifting Procedure: Isolated Stork Lift

Many patients desire cosmetic improvement of neck laxity when consulting with a plastic surgeon about their face. Neck laxity and loss of the cervicomental angle can be due to multiple components of aging such as skin quality/elasticity, loss of platysma muscle tone, and submental fat accumulation. Traditionally, the procedure of choice for patients with an aging lower face and neck is a cervicofacial rhytidectomy. However, occasionally, a patient wishes to have no other facial surgery than an improvement of their excessive skin of the anterior, lateral, and/or posterior neck. In other instances, a patient may present with having had a face/neck-lifting procedure that left objectionable vertical/diagonal lines at the lateral neck. In both these instances, a surgeon should consider an isolated stork lift (ISL) procedure. An ISL procedure avoids and/or corrects problematic vertical/diagonal lateral neck folds by "walking" the excess skin flaps around the posterior inferior occipital hairline bilaterally, bringing the flaps together at the lateral and posterior neck, which sometimes involves a midline posterior dart excision of the dog ear. A patient presenting with excessive skin of the neck (anterior, lateral, and/or posterior) and/or residual vertical/diagonal skin folds is an excellent candidate for the ISL. The ISL procedure was performed on 273 patients over a 2-year period at The Morrow Institute. Patients were included if they had excessive skin of the anterior, lateral, and/or posterior neck and/or diagonal/vertical lateral bands and did not desire a full face-lifting procedure. Patients were excluded from this study if they would not accept having longer hair in order to cover the scar along the posterior inferior occipital hairline or a midline T-flap skin closure scar at the base of the posterior midline neck. Under a combination of local anesthesia and IV sedation, a postauricular face-lift incision was made that was extended in a circumoccipital fashion along the mastoid and posterior hairline to the midline nape of the neck. Long skin flaps were developed by dissecting the anterior neck from the mentum to the anterior clavicles, the lateral neck from the mastoid to the lateral clavicles, and the posterior neck from the hairline to the base of the nape of the neck, all with a combination of sharp and blunt dissection. Suspension sutures of the SMAS were placed at various strategic locations along the lateral neck in a superior posterior vector. The dog ears were walked posteriorly around the hairline, with final trimming at the midline nape using an A-to-T flap closure. The skin closure was affected by a combination of deep and superficial sutures as well as staples. No drains were used on any of the cases. Of the 273 patients (59 males and 214 females) who had the ISL, 240 rated their satisfaction with the results as very high, 21 rated it as high, and 12 rated it as some what satisfied. The average age of the patients was 58.7 years (range=45-79 years). There were two patients who needed a minimal amount of submental liposuction after the procedure. No patients had vertical/diagonal skin folds after this procedure. Five patients reported being slightly bothered by the appearance of the midline posterior scar for the first 6 months. Three of these cases involved hypertrophic scarring and were treated with intralesional triamcinolone suspension 40 mg per cc dilution; doses ranged from 20 to 40 mg per session and no more than two sessions were required. All five cases rated their scar appearance after 6 months to be acceptable. All of the remaining 268 patients reported that the final posterior scar was virtually undetectable. Ten patients needed scar revision for secondary widening of the scar at various locations of the lateral, posterior, and or nape of the neck. There were no other significant complications. Most patients were satisfied with their cosmetic result 2 years after their operation. An ISL procedure provides excellent lifting of the anterior, lateral, and posterior neck without the resulting postoperative sequelae of vertical/diagonal lines, and it is especially indicated for the patient who has markedly excessive skin in those areas and does not want to undergo a lower face-lift procedure at the same time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Paradigm of Surgical Ellipse Dimensions: Are the Length-to-Width Ratio of 3 to 4 and a Vertex Angle of 30º Correct?

Background: It has been postulated that elliptical cutaneous excisions must possess a length-to-width ratio of 3 to 4 and a vertex angle of 30o or less in order to be closed primarily without creating a “dog ear”. These dimensions became axiomatic in cutaneous surgery and have been taught in the apprenticeship model for years. The present article examines the validity of that paradigm. Methods: We collected data from two sources: ellipses described in the literature (57 cases); and elliptical excisions performed at the authors’ outpatient clinic (83 cases). The surgical ellipse lengths, widths, and vertex angles were analyzed, and the data were compared to a mathematical formula used to generate a fusiform ellipse. Results: The length-to-width ratio of 3 - 4 was found to be inconsistent with the recommended vertex angle of 30o. In fact, a length-to-width ratio of 3 - 4 determines a vertex angle of 48o - 63o. A 30o vertex angle is only feasible with long length-to-width ration of about 7.5. Conclusions: The paradigm that surgical ellipses should have a vertex angle of 30o with length-to-width ratio of 3 - 4 is incorrect. Evidence from actual surgical practice and from mathematical formulation shows that either the length-to-width ratio must be larger than 3 - 4 or the vertex angle must be larger than 30 degrees.

In this issue – January/February 2013

In this issue – <scp>J</scp>anuary/<scp>F</scp>ebruary 2013

Use of Magnetic Resonance Imaging in the diagnosis of spinal empyema caused by a migrating grass awn in a dog

CASE HISTORY: A 13 kg 3.5-year-old male neutered Cocker Spaniel presented with a 6-day history of deteriorating hindlimb paresis. Approximately 10 weeks previously the owner reported removing a large number of barley grass seeds from the dog's coat and ears. Eight weeks later the dog was treated for pneumonia, based on clinical findings and thoracic radiographs. In the 4 days prior to referral the dog had a decreased appetite, was lethargic and appeared unable to urinate voluntarily. CLINICAL FINDINGS: The dog was bright and alert but unable to walk. Upper motor neuron signs were indicative of T3–L3 spinal lesion. Using magnetic resonance imaging (MRI), an abnormal low signal linear structure within the left T12–T13 neural foramen extending to the left lateral aspects of the thoracic spinal cord was detected, consistent with a foreign body. A left T12–T13 lateral hemilaminectomy was performed and a grass seed removed from a tract extending caudally from the T12–13 space, dorsal to the lumbar transverse processes and the rib head. The dog made a rapid recovery after surgery with full resolution of clinical signs. DIAGNOSIS: Spinal empyema caused by a migrating barley grass awn (Hordeum spp.). CLINICAL RELEVANCE: Advanced imaging using MRI can bea valuable method for localising foreign bodies prior to exploratory surgery. Animals presenting with neurological signs should have foreign body reactions included as a differential diagnosis.

Oncoplastic Technique for the Elimination of the Lateral “Dog Ear” During Mastectomy

Following a mastectomy, both the cosmetic and functional results can be impaired by the presence of a lateral "dog ear." This is a particular problem in women with a large body habitus giving an increased amount of adipose tissue lateral to the breast. The standard approaches to this operation of horizontal or oblique incisions often results in an uncomfortable, unsightly lateral "dog ear". We describe a modification to the standard mastectomy incision that allows extensive excision of the lateral adipose tissue, re-draping the skin over the chest wall, thus eliminating the "dog ear." The mastectomy is performed through two oblique incisions originating in the axillary skin crease encompassing the nipple areolar complex, followed by extensive lateral fat excision. A distance of 2-3 cm is kept between the superior limit of the two incisions. At closure the lateral skin flap is advanced superiomedially on the chest wall without tension. This simple and reproducible technique improves cosmesis and patient satisfaction following modified radical mastectomy by eliminating the lateral "dog ear."

P89. Oncoplastic technique for the elimination of the lateral 'dog ear' during mastectomy

Introduction: Following a mastectomy both the cosmetic and functional results can be impaired by the presence of a lateral “dog ear.” This is a particular problem in women with a large body habitus giving an increased amount of adipose tissue lateral to the breast. The standard approaches to this operation of horizontal or oblique incisions often results in an uncomfortable, unsightly lateral “dog ear”.

Superficial tunica albuginea excision, using geometric principles, for the correction of congenital penile curvature

Study Type--Therapy (practise pattern survey) Level of Evidence 3b. What's known on the subject? and What does the study add? Congenital penile deviation has become a relatively frequent finding due to a greater awareness of the problem among patients and physicians. Since the first surgical correction for congenital penile curvature was performed, many modifications have been implemented to overcome the disadvantages of the standard procedure and to improve functional results. Among the possible side effects of the original technique are postoperative erectile dysfunction, the development of painful nodules at the suture sites ('dog ears'), alteration of cutaneous sensibility and significant penile shortening. This study presents a novel approach for the correction of congenital penile curvature. We modified the conventional Nesbit technique by applying superficial tunica albuginea excisions, according to the geometric principles of the Egydio technique. • To report our experience with a new technique for the correction of congenital penile curvature based on geometric principles. • Between January 2006 and March 2011, 211 men with congenital penile curvature underwent our modified Nesbit technique. • The technique consists of an objectivation of the degree of curvature and distribution of the bending force by multiple, small, superficial, elliptical excisions of the tunica albuginea. • The overall success rate was 99.1%. • A residual curvature of less than 20° was reported in 5% (n = 11) of the cases; none of these patients opted for further surgical correction. • Residual curvature of up to 30° was observed in 0.9% (n = 2); these patients underwent a reoperation. • Acquiring or regaining the ability to perform sexual intercourse brought major relief and high rates of satisfaction and self-esteem. • No recurrence of a ventral curvature occurred. • Our modified Nesbit technique, consisting of superficial tunica albuginea excision according to the geometric principles of the Egydio technique, leads to rapid and excellent results due to an objectivation of the curvature. • It is a safe and valid alternative for the treatment of congenital ventral or ventro-lateral penile deviation.

Aggressive remodelling with pedicled skin flaps of the volar surface for the release of contractures of the fingers

We treated contractures of fingers with one or several pedicled skin flaps on one or both sides of the scar, depending on the site and spread of the scar. The length of the flap was equivalent to half the circumference of the unaffected finger, or the distance between bilateral midlateral lines. The width of the flap was the same as the distance between the scar and the midlateral line. A subcutaneous pedicle including one or several vessels is left at the proximal or distal end of each flap. After the scar has been excised the flaps are rotated about 90° and both ends of the flaps are sutured on the bilateral midlateral line. The skin defect that remains between the flaps is covered with a full-thickness skin graft from the non-weight-bearing area of the sole. In all cases, the flaps and skin grafts survived perfectly. Because of the flexibility of the subcutaneous flaps, the skin defects are effectively divided to avoid recontraction without disadvantages such as excess trimming of normal skin, extensive dog ears, or formation of scars on the dorsal surface. The method seems to be less invasive than the procedures used currently, and to yield a satisfactory aesthetic appearance.

P-015 Novel use of the pipeline embolization device for reperfusion of the middle cerebral artery post aneurysm clipping

IntroductionSurgical clipping of intracranial aneurysm can be complicated by clip encroachment of the parent artery. We present a case where symptomatic MCA stenosis occurring after clipping of a left carotid...

Mastectomy flap design: the ‘waisted teardrop’ and a method to reduce the lateral fold

There are various methods to design mastectomy flaps but few are standardized. Lateral skin folds or 'dog ears' are a common, unsightly and uncomfortable consequence following a surgery in overweight patients. We describe a simple technique for designing mastectomy flaps and a method to eliminate the lateral dog ear. The design is easy to apply and may enable standardization. Heuristics of mastectomy design should be standardized and included in surgical training.

Inverted U-Shaped Purse and Rotation Flaps: Correcting the Inferoposterior Deformity of Reconstructed Ears After Canaloplasty of the External Auditory Meatus

After patients with congenital microtia receive external ear canal plasty, the mastoid area usually has insufficient space for ear reconstruction. Hence, after ear reconstruction, an inferoposterior position deformity of the ear appears to some extent. Using inverted U-shaped purse and rotation flaps can correct this deformity effectively. From May of 2009 to September of 2011, five patients received the described procedures in the authors' department. Inverted U-shaped purse and rotation flaps were used for all the patients. The inverted U-shaped purse flap was used to reduce the area of the canal orifice and to lower the position, and the rotation flap was applied to turn the ear in a more superoposterior position. Two patients also received full-thickness skin grafting to cover the secondary wound. In four patients, V-Y-plasty or Z-plasty was used to adjust the flap transition. For the five patients, the distances between the ear antihelix and canal orifice were shortened, and the areas of the canal orifice were diminished. The retroversion of the auricle was corrected in various degrees, and the angles of the long axis of the auricle and the horizontal line were increased an average of 14.4°. The vertical distance between the top of the helix and the center of the canal orifice was increased an average of 15.2 mm. A slight dog ear deformity in front of the crus of the helix was left after the operation, but it was alleviated in the follow-up period. By using inverted U-shaped purse and rotation flaps, the inferoposterior position deformity of the reconstructed ear after external ear canal plasty in congenital microtia can be resolved effectively. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Role of Molecular Diagnosis for Dog Ear Mite Infestation

Dog ear mite infestation is an important ear parasitosis. This infestation is an important common parasitosis in dog and can also be seen as zoonosis to human beings. The diagnosis of dog ear mite is very important since early diagnosis means success in case management. Here, the author briefly reviews and discussed on the role of molecular diagnosis for dog ear mite infestation.

Complex shaped detachable platinum coil system for the treatment of cerebral aneurysms: The Codman Trufill DCS and Trufill DCS Orbit Detachable Coil System COMPLEX Registry final results

ObjectiveTo report on an electronic database with longitudinal information on the use of bare platinum coils for the endovascular occlusion of cerebral aneurysms. We report here the final analysis of...

Dog ears: change the approach, not just the name

Sir, I read Mashhadi et al.’s [1] communication: ‘Dog Ears— inappropriate terminology used to describe wound edges’ with interest and curiosity. I agree that calling the resultant raised areas following wound closure ‘dog ears’ may cause patient distress and dissatisfaction. In the litigious culture in which we practice, we may be leaving ourselves vulnerable to legal action. Rather than simply changing the way we describe the deformity, I would prefer to seek alternative means of avoiding ‘dog ear’ formation (or ‘topped peak’). I have concentrated on skin lesion excision in this instance. During my old-fashioned basic surgical training and in my plastic surgery training, I was taught to plan excision by first defining the boundary of the lesion and the necessary excision margins and then design an appropriate ellipse to enable direct closure whilst minimising excess tissue (dog ear or topped peak) formation. I performed a literature search and discovered two publications which compared elliptical excision and closure with a round excision with the necessary dog ear excision at the primary surgery. Hudson-Peacock et al. [2] showed that by performing circular excision and direct closure, 28% of lesions could be closed flat without the need for dog ear repair, 38% of excisions required one dog ear repair and 34% required two dog ear repairs at time of surgery to achieve a flat closed wound. More significant were the findings that the overall wound lengths were 21% shorter than if a traditional ellipse was used, and in 45% of cases, the wound was closed in a different orientation to the original planned elliptical excision. Seo et al. [3] reported 14% shorter wounds compared to elliptical excisions and 12% of wounds being closed flat without need for dog ear repair. Twenty-two percent of wounds were closed in a different orientation to the original plan. I propose the following approach to skin lesion excision:

How to live, or, a life of Montaigne in one question and twenty attempts at an answer

How to get on well with people, how to deal with violence, how to adjust to losing someone you love? How to live? This question obsessed Renaissance nobleman Michel Eyquem de Montaigne (1533-92), who wrote free-roaming explorations of his thought and experience, unlike anything written before. Into these essays he put whatever was in his head: his tastes in wine and food, his childhood memories, the way his dog's ears twitched when it was dreaming, events in the appalling civil wars raging around him. The Essays was an instant bestseller, and over four hundred years later, readers still come to him in search of companionship, wisdom and entertainment - and in search of themselves. This first full biography of Montaigne in English for nearly fifty years relates the story of his life by way of the questions he posed and the answers he explored.

At the Rothko Chapel, and: Picasso's Eyes, and: Lovesick

At the Rothko Chapel, and: Picasso's Eyes, and: Lovesick Alice Friman (bio) At the Rothko Chapel What is the portrait of Nothingbut the night sky without a star.An abstraction real as a hit on the heador a hunk of bread bitten off hungrywith the back teeth. But if Nothing means absence,that's another story. Then the portraitmust hint at what beat there, the last thrumbefore dying, the last shadow of the lastrope frayed out. Fourteen black paintingsin a surround with no escape. Fourteenportraits of the face of Nothing orof an absence so unbearable, Nothingsaw fit to pour in. One can't help but want a spitof yellow or a Pollock drip of redto latch on to, to say, this being a chapel,something must eulogize the life's colorsof what mattered. [End Page 48] Outside the entrance, a displayof holy books—your choice to borrow,take in with you. An amulet to ward offthe emptiness by holding on to a bookwhich denies it. Rothko knew what he was doing.Sit here and look. Here where the benchesare hard, the floor stone, blocks of stonetrailing footsteps of fading echounlike the colors you strain to see but can't,being bled out—that Wednesday, rightacross both arms. What he said art is:The simple expression of a complex thought.Simple, straight as a razor. Picasso's Eyes No matter the period or style—rose, blue,Les Demoiselles d'Avignon's geometricsoldierettes in love's cubist army that knockedthe socks off critics, or those gargantuan womenlight as balloons cradling their boulder babies— always those eyes. In all that metamorphosisof mask and circus, in the canvas of bulls,bombs and screaming horses, splayed kneesand collapse that demands a lifetime of looking—that one constant. It is as if Paris and New York [End Page 49] and all the hoopla never mattered, and allthe currency he ever really needed was home,duplicated, dark and heavy lidded, there beingone pair of eyes in this world, and he who couldpaint anything, push imagination anywhere, couldn't go beyond them. And why, except to saythey must have been first eyes, the shadowin the corner of the room eyes—primal patternand mirrored stamp—the way tree branchesand leaf veins repeat in the dog's ear and on the inside of your wrist. Never mind body partsforced into trapezoids, necks stretched to stalks,or the lewd itch of bulls in the drawings we knowto be himself, testicle heavy, hairy and rank with seed.All his eyes, even those of lovers, share the same sad gateway to this world—oculus doloroso—overflowing the curved bank of the lower lid.They say, on the night he died, April 8th of hisninety-second year, he raised a glass to his guests,and right before he fell, Drink to me, he said, Drink to me. And I want to think the last he sawwere those eyes. Drink to me only with thine eyes,and I will pledge with mine. And he did, didn't he?Leaving us gifts brought back from the cliff edgeof beauty, kisses in the cup, just as the song says. [End Page 50] Lovesick Buchenwald means beech wood,Birkenau, copse of birches. How they cherished their trees,those nature lovers. The blind roots twisting down, deepas history, the graceful arms reaching up, and all the birdsdisappearing into them like smoke. Alice Friman Alice Friman's new collection, Vinculum, is available from Louisiana State University Press. Her last two books are The Book of the Rotten Daughter and Zoo, winner of the Ezra Pound Prize for Poetry from Truman State University. Her work appears in the Southern Review, Shenandoah, Gettysburg Review, and Best American Poetry 2009. She is the poet-in-residence at Georgia College & State University in Milledgeville, Georgia. Copyright © 2011 University of Nebraska Press