Aesthetic Reconstruction Research Articles

Extended Total Temporomandibular Joint Replacement - A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint.

Study design: Retrospective case series. Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods: Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded. Results: The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months. Conclusions: The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.

Aesthetic Reconstruction of Auricular Keloids with a Novel Hemi-keystone Flap.

Surgical management of helical and retroauricular keloids has been rarely discussed. This study aims to introduce our successful reconstruction of helical and retroauricular keloids using a novel hemi-keystone flap. The current study is a retrospective review of patients with pathologically confirmed helical and retroauricular keloids. All keloid cases were completely excised. We covered the defect with a hemi-keystone flap followed by a single fraction of 10 Gy radiation therapy at postoperative day 0 or postoperative pressure therapy using magnets for four months. Treatment outcome was recorded as recurrence or nonrecurrence. A follow-up period of a minimum of 12 months was required in all patients. Of 45 keloids in 33 patients, none of the cases had a recurrence of their auricular keloids and the postoperative course was uneventful. We successfully reconstructed helical and retroauricular keloids using our modified hemi-keystone flaps without any keloid recurrence in one-year follow-ups. This is especially useful during the COVID-19 pandemic when facial mask wearing is mandatory.Level of Evidence IVThis 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.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00266-022-02909-4.

Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle

Objective: The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome. Methods: A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded. Results: Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision. Conclusions: Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

Digitalized analysis of the gingival and bone morphology in the maxillary anterior teeth in patient with posterior dental implant

Objective: To explore and analyze the correlation between labial gingival morphology and alveolar bone morphology of maxillary anterior teeth in patients with posterior dental implant, so as to provide reference basis for restoration design and esthetic reconstruction of anterior teeth. Methods: Sixty-four patients [24 males, 40 females (25.6±3.3) years old] who planned to receive posterior dental implant restoration were recruited randomly with the inclusion and exclusion criteria in Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University from May 2020 to May 2021. According to the visibility of periodontal probe through gingival margin, the subjects were divided into thin and thick gingival biotypes, including 29 cases of thin biotype and 35 cases of thick biotype. The 3Shape software was used to perform oral scanning, and cone beam CT (CBCT) was taken for each patient. Geomagic and Mimics software were used to measure and record the labial crown width and length, gingival papilla height, gingival angle, bone papilla height and bone margin angle of maxillary anterior teeth. Results: The crown width length ratios of maxillary central incisors, lateral incisors and canines were 0.85±0.08, 0.80±0.08 and 0.86±0.09 (F=10.71, P<0.01). The height of gingival papilla between maxillary central incisors, between central incisors and lateral incisors, between lateral incisors and canines were (3.93±0.86), (3.47±0.84) and (3.38±0.91) mm respectively (F=7.44, P<0.01), and the height of corresponding bone papilla were (3.44±0.88), (3.12±0.75) and (2.72±0.63) mm respectively (F=14.26, P<0.01). The gingival margin angles of maxillary central incisors, lateral incisors and canines were 88.3°±7.7°, 84.7°±8.9° and 81.2°±6.6° (F=13.15, P<0.01), and the bone margin angles were 103.2°±13.1°, 99.5°±11.2° and 110.6°±13.0° (F=13.25, P<0.01). The crown width length ratio (0.81±0.08), gingival margin angle (82.2°±7.4°) and bone margin angle (99.4°±12.9°) of thin gingival subjects were significantly lower than those of thick gingival subjects (0.85±0.09, 86.5°±8.6°, 108.5°±11.4°) (t=-2.79, 3.63, 5.20, P<0.01). The height of gingival papilla [(3.93±0.81) mm] and bone papilla [(3.43±0.80) mm] in thin gingival subjects were significantly lower than those in thick gingival subjects [(3.34±0.84) and (2.85±0.71) mm, respectively] (t=-4.89, -5.36, P<0.01). The height of labial gingival papilla of upper anterior teeth was positively correlated with that of bone papilla in all patients (r=0.66, P<0.01); the ratio of crown width to length of upper anterior teeth was positively correlated with the angle of bone margin (r=0.42, P<0.01); the height of anterior gingival papilla was negatively correlated with the angle of bone margin (r=-0.58, P<0.01), and the height of bone papilla was negatively correlated with the angle of bone margin (r=-0.82, P<0.01). Conclusions: The crown shape, gingival shape and alveolar bone shape of maxillary anterior teeth were different in different tooth positions. Patients with different periodontal phenotypes had different crown width length ratio, gingival papilla height, bone papilla height, gingival margin angle, and bone margin angle.

Whither Theatricality? Toward Traditional Chinese Drama and Theater (Xiqu 戲曲) as World Theater

Abstract The essay provides a brief review of how certain approaches to theatricality evolved in response to particular theatrical archives or repertoires in non-Chinese contexts. It then considers a number of recent studies of Chinese drama and theater in light of the following issues: the nature of theatrical language, the emergence and uses of fictionality, and the reconstruction of performance aesthetics. In focusing on these particular areas, the essay seeks to show how such research can contribute toward countering entrenched characterizations of xiqu as “non-drama,” “spectacle,” or “pure heritage.” The final section of the article proposes some future avenues of inquiry in order to deepen the dialogue between Sinology and theater studies while providing tools for sustaining the practice of xiqu and fostering broader appreciation of traditional Chinese theater in Anglophone, Chinese-speaking, and other contexts.

Plastic Surgeon Familiarity with Female Genital Mutilation and Cutting in the United States.

Plastic Surgeon Familiarity with Female Genital Mutilation and Cutting in the United States.

Esthetic Assessment following Ridge Augmentation, Late Implant Placement and Immediate Esthetic Reconstruction of the Atrophic Anterior Maxilla.

Purpose: Evaluate the esthetic outcome of ridge augmentation using cancellous bone-block allografts, late implant placement, and immediate loading in the atrophic anterior maxilla, by PES (pink esthetic score) and WES (white esthetic score) indexes. Materials and Methods: Retrospective cohort study. Inclusion criteria were bone loss of at least 3 mm horizontally and 3 mm vertically according to preliminary CBCT; ridge augmentation using cancellous bone-block allografts; six months later the implant insertion and immediately loaded. PES-WES index was used for esthetic assessment of soft tissues surrounding the final implant-supported prosthesis (ISP). Results: All twenty-five successive individuals were included. The mean follow-up was 12.1 ± 56 months (range, 42–90 months). The mean PES index and WES index were 7 ± 1.74 (range: 5–10) and 8.4 ± 2.12 (range: 5–10), respectively. The mean total combination of PES index and WES index (PES/WES) was 15.3 ± 2.85 (range: 12–20). All ISPs had an overall score >12 (the defined threshold of clinical acceptability). Conclusions: Ridge augmentation in the atrophic anterior maxilla using cancellous bone-block allografts and immediate loading allows a stable esthetic result of the soft and hard tissues over the years (follow-up of 42–90 months).

The "Frogger Flap": A Novel Quadruple Rhomboid Flap for Complex Central Upper Lip Reconstruction.

Summary:Upper lip reconstruction represents a unique challenge for the reconstructive plastic surgeon. Given its prominent aesthetic role in addition to its functional role in facial expression, speech, and oral intake, preservation of this region’s natural form and function is paramount. In this report, we present a novel technique for the reconstruction of a complex central upper lip defect, restoring the natural aesthetic of this essential structure. We describe the case of a 51-year-old woman who presented with recurrence of a previously resected basal cell carcinoma center on the upper lip at the level of the white roll and philtral depression. Following surgical resection via Mohs micrographic surgery, a 1.8 × 1.6 cm partial-thickness defect centered around the Cupid bow involving both cutaneous and vermillion tissues remained. Reconstruction was achieved through a novel quadruple rhomboid flap primarily based on the preservation of the aesthetic subunits of the upper lip. A functional and aesthetic reconstruction was achieved through local tissue rearrangement, restoring the appearance of the white roll and red line. Native perfusion and innervation were preserved during the reconstruction of the Cupid bow, recreating this region’s natural appearance. The design of the flap resembles a jumping frog, which is the etiology of the “Frogger flap” moniker. The Frogger flap recreates the natural aesthetic of the central upper lip through the geometric transposition of tissue commensurate with native anatomy. Through the application of aesthetic subunit principles, it reliably reconstructs central upper lip defects while preserving function and providing an aesthetically pleasing outcome.

Nasal Reconstruction: Reconstruction of a Nasal Tip, Columella and Middle Crura Defect After Human Bite with a Turn Down Flap Associated With Conchal Graft and Interpolated Melolabial Flap.

Nasal reconstruction is one of the most difficult procedures in plastic surgery due to its complex anatomy and function. A 31-year male was sent to our evaluation after an acquired nasal defect caused by a human bite 2 years before. The defect encompassed the nasal tip, columella, and both middle crura. After a detailed evaluation, the inner lining was reconstructed with a turndown flap of the released scar. In the same operative time, a shaped conchal cartilage graft was anchored to the remnants of both lateral crura and covered with a melolabial interpolated flap. Division, debulking, and final in setting of the flap was done after 5 weeks. Although simple steps were used, a good aesthetic reconstruction was achieved with minimal donor site morbidity.This case proves that a good planning is a cornerstone of a good reconstruction.

Rhinopoièses esthétiques triplan de l’unité de l’aile après ablation de lésions basocellulaires évoluées. À propos de 26 cas

The aesthetic reconstruction of full thickness defects of the entire ala is difficult because of its complex tridimensional anatomy. The triplan reconstruction of this unit which includes: -a lining with a mucosal flap, -a sculptured cartilage framework imitating the anatomy of the opposite ala -and a skin coverage by an immediate defatted forehead flap, gives regularly a very good aesthetic results, superior to the ones obtained by other techniques. From may 2008 to December 2020, 26 patients aged between 49 and 78 years old have benefited from this triplan aesthetic reconstruction after an excision of evolved basal cell carcinomas interesting the ala unit. The defects resulting were located in the entire ala with slight extension to the adjacent units. In all cases, the lining was reconstructed by the BURGET'S homolateral septal mucosal flap. The shape of the ala was obtained by a precise sculpture of conqual cartilage, taking the opposite ala as the model. The cutaneous coverage was provided by a paramedian forehead flap tailored exactly to the defect's size and immediately defatted. With a mean follow up of 8 years, all the reconstructed ala were quasi symmetrical to the opposite ones with a very good shape of the new nostrils. No complications and no tumoral recurrence are reported. This triplan reconstruction of the entire ala's defects is really aesthetic and gives a natural look for the lower third of the nose.

Trio talonovih kvržica na spojenom maksilarnom centralnom sekutiću - jedinstvena prezentacija

Introduction: Odontogenic malformations of teeth can be frequently encountered affecting both the primary and permanent dentition. The co-occurrence of talon cusp in a fused tooth, however, is an uncommon developmental dental aberration that necessitates a variety of prophylactic procedures to minimize potential consequences. Often, the presence of talon's cusp can result in pulpal necrosis due to its deep extension, which increases functional complexity. Methods: The present case describes the fusion of a supplemental tooth to a maxillary permanent tooth in conjunction with multiple talon's cusps on labial and palatal aspects which is an extremely rare entity and first of its kind. Results: Endodontic management followed by esthetic reconstruction of the affected tooth is considered as the standard treatment in cases of pulpal involvement of any odontogenically malformed tooth. Our case also demonstrates the establishment of an accurate diagnosis using a three-dimensional imaging modality by overcoming the challenges of periapical radiographs. Conclusion: In addition to diagnosis, practitioners should also have an in-depth understanding of the origin, prevalence, clinical and radiographic characteristics of odontogenic malformations, which AIDS in an effective treatment strategy.

Biometry of width between labial transitional line angles in anterior teeth: an observational study.

PURPOSEThe maximum width between the mesial and distal labial transitional line angles, described as “esthetic width” herein, could significantly influence the visual perception of the teeth and smile. This study aimed to conduct biometric research on esthetic width and to explore whether regular distribution exists in the esthetic width of human teeth.MATERIALS AND METHODSA total of 4,264 maxillary and mandibular anterior teeth were measured using the Geomagic studio software program. The proportions of maxillary to mandibular homonymous teeth and proportions between the adjacent teeth were calculated. Bilateral symmetry and the correlation between the esthetic and mesiodistal widths were both accounted for during the measurement procedures.RESULTSThe mean esthetic widths were 6.773 ± 0.518 mm and 4.329 ± 0.331 mm for maxillary and mandibular central incisors, respectively, 5.451 ± 0.487 mm and 5.008 ± 0.351 mm for maxillary and mandibular lateral incisors, respectively, and 3.340 ± 0.353 mm and 5.958 ± 0.415 mm for maxillary and mandibular canines, respectively. Except for the mandibular canines, no significant difference in esthetic width was found among homonymous teeth from the same jaw. A high linear correlation was found between the esthetic and mesiodistal widths of the same tooth, except for the maxillary canines. Esthetic width proportions among different tooth categories showed some regular patterns, which were similar to those of the mesiodistal width.CONCLUSIONEsthetic width is regularly distributed among the teeth in the Chinese population. This could provide an important reference for anterior dental restorations and dimension recovery in esthetic reconstruction of anterior teeth.

Jumping Extracorporeal Free Latissimus Dorsi Myocutaneous Flap for Aesthetic Reconstruction After Anterior Skull Base and Orbital Cancer Resection.

The authors introduce successful free latissimus dorsi myocutaneous flap transfer, which was temporarily placed onto the face extracorporeally because the position of orbital defect is far from the submandibular microvascular anastomosis region. The authors then secondarily resected the excess part of the flap after 3 weeks of neovascularization period. Although multistage surgery is needed, jumping extracorporeal flap is a useful option to achieve aesthetic outcomes especially in a challenging situation.

Reconstruction of posttraumatic soft tissue defects of the ankle using free fascial flaps from the anterolateral thigh

HintergrundZur Rekonstruktion von Weichteildefekten nach sprunggelenknahen Frakturen wurden freie Faszienlappen aus dem anterolateralen Oberschenkel (ALT) verwendet. Diese Modifikation wurde mit der herkömmlichen fasziokutanen Methode verglichen.Material und MethodenDefektgröße, Dicke der subkutanen Fettschicht des Oberschenkels und des Weichteilmantels am Sprunggelenk wurden retrospektiv bestimmt. Die Auswertungen wurden zwischen faszialen (Fo) und fasziokutanen Lappen (Fc) verglichen. Der Foot and Ankle Outcome Score (FAOS) wurde verwendet. Umfragen zum ästhetischen Ergebnis wurden durchgeführt.ErgebnisseBei insgesamt 18 Frakturen lag in 94 % ein geschlossener Weichteilschaden vor. Nach Plattenosteosynthese entwickelten sich Weichteildefekte mit einer mittleren Fläche von 40,4 ± 13,1 cm2 (28–76 cm2). Der Weichteilschatten über den betroffenen Malleoli nahm durch die Lappenplastik an Dicke signifikant in beiden Gruppen zu (4,5 ± 0,7 vs. 21,1 ± 6,4 mm, p < 0,05). Es fand sich ein signifikanter Unterschied beim Vergleich des Body-Mass-Index (BMI) zwischen den Gruppen (Fc 26,3 ± 3,4 kg/m2 vs. Fo: 30,1 ± 4,2 kg/m2, p < 0,05). Für beide Gruppen bestand eine positive Korrelation (r = 0,843) zwischen dem BMI und der Dicke des epifaszialen Weichteilmantels am Oberschenkel. Zur „Funktion im täglichen Leben“ und zur „fuß- und knöchelbezogenen Lebensqualität“ ergaben sich in der FOAS-Befragung 75,9 ± 28,9 bzw. 47,9 ± 32,4 Punkte. Rund 55 % haben das ästhetische Rekonstruktionsergebnis als „akzeptabel“ und 45 % als „gut“ bewertet.DiskussionDer modifizierte ALT-Faszien-Lappen kann in Situationen sinnvoll sein, wo eine stark auftragende Fett-Haut-Schicht die Einpassung des Lappens in den Defekt erschwert.

Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up

BackgroundThe reconstructive and rehabilitative management of large mandibular defects with basal continuity is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success.Case presentationThree cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout.ConclusionsFree microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in the discussed indication.

Hair Transplant for Eyebrow Restoration.

Eyebrow restoration can be best done with individual single hair follicles grafts harvested by FUE. Understanding the male and female eyebrow allows us to plan an aesthetic reconstruction, requiring 70 to 120 grafts. Selection of donor hair, angle of placement, alignment and direction within the rows influences the results, as does scarring and perfusion of the skin. Details of planning, technique, anesthesia and postoperative care, as well as drawbacks of older methods, are discussed in the article.

Reconstruction of Large Cervicofacial Defects With Expanded Island Superficial Temporal Artery Flaps and an 810-nm Diode Laser Hair Removal Technique.

Extensive cervicofacial reconstruction is challenging for plastic surgeons. Because of the location of the adjacent scalp flap nourished by the superficial temporal artery (STA), it can be a candidate for cervicofacial reconstruction. This article aims to report a combined treatment of an expanded island STA flap and an 810-nm diode laser hair removal technique for extensive cervicofacial defects. Between January 2015 and December 2018, 10 patients with lower face and neck scar contraction were reconstructed with a bilateral or unilateral expanded STA island flap and an 810-nm diode laser for hair removal in this retrospective study. Hair removal via the 810-nm laser was started when the injected volume reached the volume of the expander, with a fluence of 35 to 40 J/cm2 and a 1 to 2 Hz repetition rate. Before second-stage surgery, the hair reduction rate was assessed. Twelve months after surgery, the degree of epilation efficacy according to the satisfaction scale and Global Aesthetic Improvement Scale was evaluated. This study included 2 single-pedicle flaps and 8 double-pedicle flaps. The average size of the implanted expanders was 600 mL. The average injected volume was 1405 mL. Before second surgery, there was a 67.4% hair reduction rate. Twelve months after surgery, the results of Global Aesthetic Improvement Scale were very good (3), good (6), average (1), and poor (0). The expanded island STA flap and 810-nm diode laser technique may be a novel treatment option for severe face and neck aesthetic reconstruction.

Tips on Raising Reliable Local Perforator Flaps.

Summary:From early on in the development of plastic surgery, it was quickly realized that utilizing locally adjacent tissue, or “matching like with like,” yielded superior aesthetic reconstructions to those in which the tissue was derived from a distant location. In many cases, the use of a local perforator flap is a simpler procedure with less patient morbidity and a quicker recovery from surgery. The difficulty with local perforator flaps has been locating the supplying perforators, ensuring that the flap has a robust and reliable blood supply, and that sufficient tissue is able to be transferred. The recent reappraisal of our understanding of the blood supply of the integument has allowed, for the first time, the capacity to accurately and inexpensively, without the need for “high tech equipment,” locate perforators, as they emerge from the deep fascia into the overlying integument, and through a better understanding of the interconnecting anastomotic vessels between perforators reliably predict how much tissue can be safely raised on a single perforator, before surgery. Further, through the use of strategic “delay,” it is possible to manipulate the interconnecting vessels between the selected perforator and its surrounding neighbors to design a flap of tissue of any dimension, composed of whatever tissue we require, and safely transfer that tissue locally, or if required, distantly, as a free flap. This article will highlight these advances, explain their relevance in raising reliable local perforator flaps, and will, where possible, call attention to any pearls and pitfalls, and how to avoid complications.

Surgical approach to prune-belly syndrome: A review of our series and novel surgical technique

Surgical management of children with Prune-belly syndrome (PBS) can be divided into three categories: urinary tract reconstruction, abdominal wall reconstruction, and orchidopexy. Adequate repair of the abdominal wall by abdominoplasty at an early age, allows an adequate aesthetic appearance, but also allows a correct development of walking, breathing, defecation and urination. To present a novel surgical technique for abdominal wall reconstruction, which combines plication with complete overlap of the fascia and neoumbilicoplasty with an island flap rotated on itself. A retrospective review of the patients with PBS who underwent surgery in our center between 2009 and 2020. A new abdominoplasty technique was performed, which consists of plication with complete overlap of the fascia, as well as a neoumbilicoplasty with an island flap rotated on itself. The skin is then well freed from the rest of planes, and the plication is performed with complete overlapping of the muscle-aponeurotic plane from one side to the other. At this time, the interposition of some type of reinforcement material (mesh) may be required in the event of complete absence or insufficient presence of the fascia and muscle. Abdominoplasty was performed in four patients. In all patients, bilateral orchidopexy was performed in the same surgical procedure for intra-abdominal testicles. The mean age of the patients at the time of surgery was 10,5 years and the average admission time was 4 days. There were no short-term or long-term complications. Average follow-up time was 7 years. All patients and their families are satisfied with the aesthetic result obtained. Abdominoplasty in patients with PBS in addition to aesthetic reconstruction, brings significant improvements to wandering, breathing, urination and defecation, improving the quality of life of the patient. Compared to the techniques described, the abdominoplasty we propose makes it possible to easily improve the abdominal wall support by means of meshes or synthetic devices if necessary and allows the evaluation and correction of cryptorchidism or other associated renal abnormalities in the same surgical act, as it allows full abdominal exposure. Likewise our modified abdominoplasty allows the creation of the new umbilicus in a more anatomical way, rectifying its natural position. In our experience, this modified surgical technique for abdominal wall repair is a novel procedure in the PBS approach, easily reproducible, which provides good aesthetic results in our series of cases.

Organizational and legal basis for aesthetic breast reconstruction in oncological clinic

Introduction. The article reveals the organizational and legal basis for aesthetic reconstruction of the breast in the oncology clinic. The increase of patients' requirements for aesthetic results of the breast cancer treatment is outlined. Judicial practice data from open sources on «medical» cases are presented. Materials of external studies are described, where aesthetic reconstruction is presented as an integral part of rehabilitation, prevention of negative consequences of treatment, including mental disorders. The article defines the place of aesthetic reconstruction after breast cancer surgery, raises the problem of the possibility of symmetrical operations on the healthy contralateral breast, preventive breast and pelvic surgery in women with genetically predisposed forms of oncological diseases, expanding the volume of screening in women with a hereditary anamnesis.The purpose of the study was to compare the requirements for the quality and scope of medical care for breast cancer patients at a state oncology clinic with the professional competencies of the end-doctor oncologist, according to current standards, clinical guidelines, and guidelines for medical care.Materials and methods.The review of current regulations in the field of medical activity in the profile «Oncology» effective in the Russian Federation. Also the data of the judicial practice from open sources for 2012, 2017-2020 are presente. Results. The interpretation of current legal documents of the Russian Federation in the field of medical care in the profile «oncology» gave ambiguous results: probably, there is an intersection of qualification requirements for oncologist and plastic surgeon.Discussion. Possible ways out and suggestions from the current dangerous, from the legal point of view, situation are outlined.