Excellent Cosmetic Results Research Articles

Single Axillary Incision Reverse Sequence Endoscopic Nipple-Sparing Mastectomy in the Management of Gynecomastia: Short-Term Cosmetic Outcomes, Surgical Safety, and Learning Curve of the Preliminary 156 Consecutive Procedures from a Prospective Cohort Study.

Currently, a standard, optimal surgical procedure is still lacking for gynecomastia. Despite the development of a variety of surgical interventions, these techniques were often limited to patients with Simon I and II. The present study aimed to introduce a novel technique for all types and gradesof gynecomastia, and reported the preliminary results. Patients who received single axillary incision reverse sequence endoscopic nipple-sparing mastectomy (R-E-NSM) from March 2021 to March 2023 were enrolled at a single institution. The data from 3-month follow-up cut-off were collected prospectively and analyzed to determine the short-term esthetic and safety results of this technique, as well as the learning curve. A total of 159 single axillary incision reverse sequence endoscopic nipple-sparing mastectomy procedures were performed in 81 gynecomastia patients. Among these 81 patients, 7 patients (8.6%) were classified as Simon grade I, 29 patients (35.8%) as grade IIa, 24 patients (29.6%) as grade IIb, and 21 patients (25.9%) as grade III. In the patient-reported cosmetic results, the overall satisfaction score was 8.4 ± 1.4. A total of 74.1% of patients were highly satisfied, and 25.9% were satisfied. The overall complication rate was 10.1%, and only 1 patient had a major complication. According to the cumulative sum plot analysis, approximately 12 cases were needed for surgeon B and 11 cases for surgeon C to decrease their operation time significantly. R-E-NSM is safe and effective for all Simon grade gynecomastia patients, with excellent cosmetic results and a short learning curve. However, a long-term follow-up assessment is still needed. 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 .

Novel Hybrid Technique for Preservation of Frontal Branch of Facial Nerve: Subgaleal Preinterfascial Dissection

The pterional approach is the workhorse of skull-base neurosurgery, which allows virtual access to any intracranial lesion around the circle of Willis. Preserving the frontotemporal branch of the facial nerve and conserving the temporal muscle's symmetry are fundamental objectives besides the access that can be obtained through this versatile neurosurgical technique. This manuscript proposes a subgaleal preinterfascial dissection, a novel hybrid technique that provides advantages of previously described temporal muscle dissection techniques while preserving the integrity of facial nerve branches and the unobstructed broad pterional region. We describe the subgaleal preinterfascial dissection as a safe and simple to technique to achieve preservation of the facial nerve frontal branches during anterolateral approaches. Two cadaveric heads were skillfully dissected and studied to perform a proper subgaleal preinterfascial dissection on both sides of each cadaver. Afterward, the same technique was employed in 108 patients during a pterional approach for different neurosurgical diseases, with a postoperative follow-up of 6 months. None of the 108 patients presented postoperative frontotemporal branch palsy during postoperative follow-up. Likewise, no complications related to the proposed technique were present. The subgaleal preinterfascial dissection is a reliable, safe technique that may be employed during a pterional approach with an unobstructed surgical view and excellent cosmetic and functional results, preserving the frontotemporal branch of the facial nerve.

THU524 Combination Of Mustardé Cheek Advancement Flap And Paramedian Forehead Flap As A Reconstructive Option In Basal Cell Carcinoma Of The Nose: A Functional And Aesthetic Alternative

Abstract Disclosure: A.P. Solis Pazmiño: None. C. Rocha: None. E. Pilatuna: None. R. Godoy: None. C. Garcia: None. Background: Defects resulting from the surgical procedure due to basal cell carcinoma (BCC) may be challenging to reconstruct depending on the size and location. In moderate to large-sized defects, especially in face lesions, a combination of more than one type of flap might be necessary. We present a patient with a large BCC in the nasal region which was successfully closed using a combination of rotation and advancement flaps. The patient showed excellent functional and cosmetic outcomes. Clinical Case: An elderly woman presented to our center with a five-year history of a persistent nasal vestibular lesion. It was treated with multiple cauterizations without a total improvement, until then. There was no associated pain, bleeding, or drainage. She denied family history, risk factors, or systemic diseases associated with this skin pathology. Physical examination revealed a 4 cm x 3 cm desquamated plaque with multiple pustules and a small deep ulcered area on the left nasal vestibule and overlying telangiectasia. A skin biopsy confirmed the clinical suspicion that this patient had nodular basal cell carcinoma (BCC), also known as rodent ulcer. The patient underwent surgery and we sent an intraoperative frozen section (IFS), 6 margins were taken in 10 mm strips each, and two of the seven tissue samples were reported positive. Made do with a double scalpel blade numbered by segments following clockwise order.Meanwhile, the defect reconstruction was done after histopathological examination confirmed tumor-free margins. A local skin flap, a paramedian forehead flap, transferred full-thickness skin and subcutaneous tissue into the surgical defect, which maintained the local blood supply via a vascular pedicle that remained connected to the donor site. Then, the advancement bilateral flap (Mustardé) was slid into the defect where the incisions were made tangentially to the defect to free neighboring tissue, with the wound edge acting as the free margin of the flap. Finally, for the frontal opening graft tissue, we used a pressure dressing on cutaneous grafts using a gauze wad (Brown Curative). Clinical lessons: This case exposes basal cell carcinoma (BCC), the most common skin malignancy with a predilection on sun-exposed areas such as the face. The surgical technical selected was a combination of skin flap techniques such as paramedian forehead flap, and the cheek rotational (Mustardé) flap showed excellent functional and cosmetic outcomes. Also, the oncological accepted margins depend on the risk group and the tumor size. For primary well-demarcated BCCs smaller than 2 cm, in the low-risk group, a safety margin of 3 mm gives satisfactory results. Presentation: Thursday, June 15, 2023

The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts.

Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient's life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.

Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach.

For patients with early, low-risk papillary thyroid carcinoma, an increasing number are opting for endoscopic thyroid surgery due to its ability to achieve favorable therapeutic outcomes while maintaining excellent cosmetic results. Among the available endoscopic procedures, the Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA) has gained popularity among surgeons. This is attributed to its straightforward cavity construction, spacious operating area, precise visual field exposure, and manageable learning curve. However, few studies have provided detailed descriptions of the specific surgical steps involved in GETTA. Drawing from a synthesis of existing literature and our own clinical expertise, we present a comprehensive outline of the GETTA procedure. This process can be categorized into five distinct stages: positioning and incision planning; establishment of surgical cavities; identification and protection of the recurrent laryngeal nerve, inferior parathyroid gland, and central neck dissection; localization and preservation of the superior laryngeal nerve, superior parathyroid gland, and dissection of the thyroid's superior pole; transection of the thyroid isthmus followed by en bloc resection of the thyroid gland and central neck lymph nodes. The five-step approach of GETTA is easy to learn and can be adapted for resecting both benign and malignant thyroid and parathyroid diseases.

Quantitative evaluation of pediatric umbilical loop stomas: 2 decades of experience from a single institution

PurposeSince pediatric stomas are often temporary, their creation, management, and closure should be simple, with minimal complications and excellent cosmetic results. We began employing umbilical stomas in 2000. This study aimed to characterize the ingenuity and utility of umbilical stomas and provide a quantitative evaluation of their cosmetic outcomes.MethodsWe examined cases of stoma construction and closure surgery performed in our department from January 2000 to December 2022. The umbilical and non-umbilical stoma groups included 54 and 42 cases, respectively, and the findings for both groups were compared and analyzed.ResultsThe two groups showed no significant differences in the incidence of complications. The Manchester Scar Scale score for the umbilical stoma group (8.42 ± 1.85) was significantly better than that for the non-umbilical stoma group (16.31 ± 2.96; P < 0.01). Likewise, in Patient and Observer Scar Assessment Scale assessments, the umbilical stoma group showed significantly better scores in both the observer scale (9.48 ± 2.50 vs. 21.78 ± 7.26; P < 0.01) and the patient scale (10.5 ± 1.39 vs. 22.40 ± 7.35; P < 0.01).ConclusionsUmbilical stomas are easy to manage and yield an inconspicuous closure incision with excellent cosmetic outcomes. Although patient selection is important, pediatric umbilical stomas are a valuable option that can be actively employed.

"Free-Floating Anus": A Flap-Free Approach for Definitive Excision of Circumferential Giant Condyloma Acuminata.

Giant condyloma acuminata (GCA), or Buschke-Löwenstein tumor, is a rare exophytic cauliflower-like growth in the anogenital region. The spectrum of treatment options is wide, ranging from the application of topical ointments to the performance of an abdominoperineal resection. Currently, wide local excision is the most common approach and may entail the creation of a protective loop ileostomy or implementation of flaps or grafts that facilitate closure. We describe a unique surgical approach for the management of circumferential GCA void of the use a protective loop ileostomy, flaps, or grafts. Our report highlights that the implementation of a radical, circumferential, wide excision resulting in "free-floating anus" and healing via secondary intention can ultimately lead to excellent functional and cosmetic results and therefore may be considered a minimally invasive surgical option for patients afflicted with a large, circumferential GCA.

Surgical Repair of Mid-penile to Distal Hypospadias in Children; Report of 93 Cases

Objective: To present the single surgeon’s experience in surgical repair of mid-penile to distal hypospadias in a series of 93 cases.&#x0D; Methodology: This is a retrospective study of management of patients of mid penile to sub coronal hypospadias at a median age of 24 months between June 2011 to August 2021. All the children were followed up for 6 months. Eighty-three children were between the age of 1 to 4 years and 10 children were from the age of 5 to 8 years. All the patients underwent physical examination to confirm the diagnosis and to exclude associated anomalies. All the children having mid penile to sub coronal hypospadias were included. All children with glanular hypospadias were excluded from the study. The repair was done under general anesthesia while using tubularized incised plate (TIP) technique.&#x0D; At completion of surgery compression dressing with transparent Tagaderm was used for one week in all the patients.&#x0D; Results: All of 90 patients had excellent cosmetic and functional outcome. Only 3 patients developed fistula which needed surgical intervention.&#x0D; Conclusion: Surgical repair of mid penile to sub coronal hypospadias by tubularized incised plate (TIP) technique is safe and effective. Compression dressing with transparent Tegaderm prevents complications of hematoma formation and wound infection.

Surgical excision versus topical 5% 5-fluorouracil and photodynamic therapy in treatment of Bowen's disease: A multicenter randomized controlled trial

Randomized controlled trials comparing the effectiveness of 5-fluorouracil cream, methylaminolevulinate photodynamic therapy (MAL-PDT) and surgical excision in patients with Bowen's disease are lacking. In this multicenter noninferiority trial, patients with a histologically proven Bowen's disease of 4-40mm were randomly assigned to excision with 5mm margin, 5% 5-fluorouracil cream twice daily for 4weeks, or 2 sessions of MAL-PDT with 1week interval. The primary outcome was the proportion of patients with sustained clearance at 12months after treatment. A noninferiority margin of 22% was used. Between May 2019 and January 2021, 250 patients were randomized. The proportion of patients with sustained clearance was 97.4% (75/77) after excision, 85.7% (66/77) after 5-fluorouracil, and 82.1% (64/78) after MAL-PDT. Absolute differences were -11.7% (95% CI -18.9 to -4.5; P=.0049) for 5-fluorouracil versus excision and -15.4% (95% CI -23.1 to -7.6; P=.00078) for MAL-PDT versus excision. Both noninvasive treatments significantly more often led to good or excellent cosmetic outcome. Based on our predefined noninferiority margin of 22%, 5-fluorourcail is noninferior to excision and associated with better cosmetic outcome. For MAL-PDT noninferiority to excision cannot be concluded. Therefore, 5-fluorouracil should be preferred over excision and MAL-PDT in treatment of Bowen's disease.

Outcome of Superomedial Pedicle Flap for Lower Outer Quadrant Breast Cancer

Abstract Background Breast cancer is the most common cancer among women and is the second leading cause of cancer deaths. The surgical treatment of patients with breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women. The patient needs to be aware that the reconstructed breasts will neither feel nor function like a normal breast but may help in restoring body image and self-confidence. Objective To evaluate the intraoperative and postoperative outcomes and showing advantages and disadvantages of Superiomedial pedicle flap for lower outer quadrant breast cancer in cup ≥ c. Patients and Methods It was a prospective study that included 10 patients aiming to assess outcome of the superomedial pedicle flap oncoplastic technique for lower outer quadrant breast cancer in oversized breast. This study was conducted at Ain Shams University Hospitals. Approval of the ethics committee and written informed consent from all participants were obtained. Results In our study, all of the patients had free safty magins as confirmed by the pathologist in our MDT proving that we had performed a superior medial technique safely from the oncological point of view. We were able to conduct an excellent cosmetic outcome for relatively large tumor excisions which fall in good and fair score groups as those two patients noticed asymmetry of the two breasts. None of our cases have had a poor or an ugly score. Overall, the satisfaction rate with this technique was high, with very few and easily manageable complications. There were no cases of NAC loss. Conclusion Superomedial pedicle can be safely utilized in large size breast reduction without increase of NAC necrosis. The technique is an efficient method to achieve minimal to moderate breast reduction with minimal NAC transposition. The primary surgical goals are attained by appropriate resection of the breast parenchyma. Moreover, a youthful and aesthetically appealing breast is achieved by maintaining superior and medial fullness and reshaping the breast using the parenchyma and skin envelope for support. Superomedial pedicle flap technique offers breastconserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome.

Efficacy of secondary intention healing for scalp defects-Case series from a single institution.

As surgical techniques evolve, there remains underutilisation of secondary intention healing as a valid reconstruction option. This is largely due to concerns regarding inferiority of wound cosmesis, increased downtime with wound healing and infection risk (Dermatol Surg. 2020; 46(12): 1492-97). We sought to look at the outcome of secondary intention healing in a cohort of patients seen at a private dermatology practice with small to medium sized scalp defects. All patients completed a satisfaction survey that further evaluated its feasibility. Excellent cosmetic outcome was noted with secondary intention healing for small to medium scalp defects, specifically in patients with thinning scalps that allowed healing without patchy alopecia. Secondary intention healing should be considered as a reconstructive option for scalp defects, especially in the right patient cohort.

A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.

To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. Retrospective case series. All wounds that were managed with the Tension Tile System (TTS) at four Equine Hospitals between March 2017 and May 2021 were evaluated. The wounds were classified according to various criteria including anatomical location, time elapsed prior to surgery, depth of wound and post-surgical use of immobilisation. Outcome criteria were based on the success of primary intention healing. The duration of convalescence (weeks) after surgery was also recorded. During the study period, the TTS was used in 191/860 (22%) wounds repaired under general anaesthesia or standing sedation. Overall, primary intention healing (Group A) was achieved in 132 of 191 cases (69%, CI 62%-75%), with partial dehiscence (Group B) in a further 30/191 cases (16%, CI 11%-22%). Severe dehiscence (Group C) was recorded in 29/191 cases (15%, CI 11%-21%). The median convalescence time was 4 weeks (Range 3-15, interquartile range 4-6) in Group A. Retrospective nature of the study and subjective outcome assessment. The technique was applied to wounds under significant tension; however, this was based on a subjective assessment by the surgeons involved. The Tension Tile System is an economical and effective technique for challenging equine wounds under tension, in a variety of anatomical locations.

Endoscope-Assisted Hairline Approach for Head and Neck Masses: A Review.

Conventional surgery through a transcervical incision is indicated for the treatment of certain tumors in the head and neck. However, this method can cause multiple problems, including scarring and cosmetic concerns. The endoscope-assisted hairline approach, which serves as an alternative to conventional surgical procedures, is gaining popularity due to its excellent cosmetic and functional outcomes. However, given the anatomical complexity involved, the endoscope-assisted hairline technique is not frequently employed in head and neck surgery. The evolution of the hairline surgical approach has been influenced by changes in disease conditions and recent advances in surgical tools. This review article discusses the use of endoscope-assisted hairline approaches in the resection of head and neck masses, focusing on the surgical procedure and postoperative clinical outcomes.

Can definitive chemoradiation offer a cure along with cosmesis in locally advanced IVA carcinoma buccal mucosa? a case report

Surgery is the mainstay of the treatment in ca buccal mucosa. It is extensive in nature and may require efficient reconstruction for good cosmetic outcome. Adjuvant radiation or chemo-radiation may be needed in advanced cancers. Definitive chemoradiation or palliative radiation are reserved for inoperable patients. We present a case report of advanced carcinoma of oral cavity in the left buccal mucosa along with involvement of retromolar trigone along with bone involvement in left sided mandible who opted out for undergoing definitive surgery. She was treated with definitive chemoradiation with 2.4 Gy per day /0.4 Gy in morning, 2 Gy in evening five days a week along with paclitaxel on Sunday. Patient reported after seven years disease free with excellent cosmetic outcome. Definitive surgery along with adjuvant radiation or chemoradiation is the standard of care in advanced cancers of buccal mucosa. However, in inoperable patients or the patients refusing surgery definitive chemoradiation with altered fractionation schedules may still offer a chance of cure and good cosmesis.

D‐OCT‐assisted and histology‐controlled evaluation of 1064 nm Nd:YAG laser therapy of basal cell carcinomas

AbstractBackgroundBasal cell carcinomas (BCC) have classically been surgically removed. Alternative treatments for superficial BCC include local immunotherapy, topical chemotherapy and photodynamic therapy. Recent data suggest 1064 nm Nd:YAG laser as a new treatment for those lesions.Dynamic optical coherence tomography (D‐OCT) is an established imaging procedure analysing BCC margins and its vascular plexus.ObjectivesOur goal is to further evaluate 1064 nm Nd:YAG laser therapy of BCC as a potential alternative treatment, employing D‐OCT and histopathology to standardise effective treatment protocols.MethodsIn this retrospective cohort study, 50 histologically confirmed superficial and nodular BCC with tumour thickness ≤1 mm were treated with 1064 nm Nd:YAG laser. Initial D‐OCT scans were performed and repeated for 3 months posttreatment. Tumoral clearance was histologically confirmed and local adverse effects, patient tolerability and satisfaction were recorded. Clinical remission was evaluated after 1 year.ResultsComplete clearance was achieved in 78% of BCC (39/50) at a 3‐month follow‐up. Treatment failures were slightly more likely to correspond to superficial BCC (91%, 10/11) of thickness ≤0.5 mm (73%, 8/11), located on the trunk (64%, 7/11). No treated lesions presented scarring. Patient satisfaction and tolerability displayed excellent results. Remission at 1 year occurred in 100% of initially cleared BCC (35/35, four patients were lost to follow‐up due to nonmedical reasons).ConclusionsOCT‐assisted 1064 nm Nd:YAG laser treatment of superficial BCC is a safe and effective method with excellent patient satisfaction, tolerability, practicability and cosmetic end result.

Island Pedicle Flap Pada Dinding Hidung Dengan Karsinoma Sel Basal

A flap is a tissue unit that is transferred from one area (donor site) to another area (recipient site) while still maintaining its blood circulatory system. The island pedicle flap, also known as the V-Y flap, is a modified advancement flap. This flap is a very useful reconstruction option for small to intermediate-sized defects. A 69-year-old Acehnese woman with a history of working as a farmer came with complaints of a non-painful nodule on the wall of her left nose for the last 6 months. Based on the history and physical examination, the patient was provisionally diagnosed with nodular type Basal Cell Carcinoma. An excisional surgical was performed, then a pedicle island flap was performed to close the defect. Anatomical pathology examination results concluded basal cell carcinoma. The island pedicle flap technique is one of the surgical techniques that can be an option to close tumor excision defects. This technique offers a one-stage reconstruction with excellent cosmetic results for defects in the nasal wall. The color and texture of the skin after surgery are almost perfect because the flap originates from the skin immediately adjacent to the defect.

Longitudinal cosmetic outcome after planned IORT boost with low kV X-rays-monocentric results from the TARGIT BQR registry.

Intraoperative radiotherapy can serve as an anticipated boost (IORT boost) in combination with a subsequent external whole breast irradiation in high-risk breast cancer patients and is part of many guidelines. Nevertheless, there are only few prospective data available regarding cosmetic outcome after IORT boost using kV X-rays. The aim of this study was to evaluate the cosmetic outcome of patients treated within the prospective phase IV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) in one center. In the context of the TARGIT BQR study standardized photos in three positions (arms down, arms up, from the side) were available for different time points. For this analysis a layperson, a radiation oncologist and a gynecologist evaluated available photos at different time points during follow-up with up to 4 years using the Harvard scale (comparison of treated and the untreated breast; rating: excellent, good, fair, poor). Longitudinal results were compared to preoperative results (baseline). Seventy-three patients were available for the analysis. Baseline cosmetic assessment was excellent/good in 98.8% (mean value for all three positions). Postoperative cosmetic outcome (median) was good for all positions and remained constant for 4 years. Around 30% of the patients showed a constant or even improved cosmetic outcome compared to baseline. Only few patients showed a poor result at 4 years. The majority of patients showed an excellent or good cosmetic outcome at all time points. Patients from the prospective TARGIT BQR study treated with IORT boost and additional whole breast irradiation showed good or excellent cosmetic outcomes in most cases during 4 years of follow-up. These results add important information for shared decision making in breast cancer patients.

Evaluating the safety and efficacy of aminolevulinic acid 20% topical solution activated by pulsed dye laser and blue light in the treatment of facial cutaneous squamous cell carcinoma in situ.

Squamous cell carcinoma (SCC) is the second most common cutaneous malignancy, after basal cell carcinoma (BCC). Photodynamic therapy (PDT) involves converting a photosensitizer to reactive oxygen intermediates, which preferentially bind to hyperproliferative tissue. The most commonly used photosensitizers are methyl aminolevulinate and aminolevulinic acid (ALA). Presently, ALA-PDT is approved in the US and Canada for the treatment of actinic keratoses on the face, scalp, and upper extremities. This cohort study evaluated the safety, tolerability, and efficacy of aminolevulinic acid, pulsed dye laser, and photodynamic therapy (ALA-PDL-PDT) for treatment of facial cutaneous squamous cell carcinoma in situ (isSCC). Twenty adult patients with biopsy-confirmed isSCC on the face were recruited. Only lesions 0.4-1.3 cm in diameter were included. Patients underwent two treatments with ALA-PDL-PDT spaced 30 days apart. The isSCC lesion was then excised 4-6 weeks following the second treatment for histopathological assessment. No residual isSCC was detected in 17/20 (85%) patients. Two of the patients with residual isSCC had skip lesions present that explained the treatment failure. Excluding the patients with skip lesions, the posttreatment histological clearance rate was 17/18 (94%). Minimal side effects were reported. Our study was limited by small sample size and lack of long-term recurrence data. The ALA-PDL-PDT protocol is a safe and well-tolerated treatment option for isSCC on the face, providing excellent cosmetic and functional results.

Supraorbital Rim and Roof Reconstruction with Vascularized Fascia Lata and Autogenous Rib Graft.

Describe a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof. Retrospective chart review and description of surgical technique. Four patients underwent tumor resection with neurosurgery (2 intraosseous hemangioma, 1 meningioma, and 1 ossifying fibroma), with mean tumor size of 42.6 cubic centimeters on preoperative imaging. All defects involved supraorbital rim and orbital roof. Patients were reconstructed with autogenous osseous rib graft for structure and contour and anterolateral thigh fascia lata (ALTFL) free flap to provide robust vascularity to rib bone and as a barrier between skull base dura and the orbit and/or sinonasal cavities. Two patients underwent resection and reconstruction using minimal access incisions, and two underwent major cranial and skull base resections. All flaps are vascularized via superficial temporal vessels. On postoperative follow-up (mean 33.5 months, range 8-48), all patients report no vision change or diplopia, with excellent contour symmetry to contralateral orbit. Follow-up imaging (mean 29.5 months, range 3-48) demonstrated maintained orbital volume and retention of rib bone graft compared to immediate postoperative imaging. There were no complications related to graft use. Minor complications include 1 patient with cerebrospinal fluid leak managed with lumbar drain placement and 1 patient with mild enophthalmos at 7-month follow-up. We describe a series of patients who underwent a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof with autogenous osseous rib and vascularized ALTFL-free flap with excellent functional and cosmetic outcomes. This can be accomplished using minimal access techniques to minimize patient morbidity. 4 Laryngoscope, 134:654-658, 2024.

Nose tip defect reconstruction with a modified extended Rintala flap: A case report.

Nose tip defect reconstruction with a modified extended Rintala flap: A case report.