Facial Tissue Defects Research Articles

Ways and methods of closing tissue defects of the middle zone of the facial skull after removal of malignant tumors with intracranial spread (case from practice)

A clinical case of locally advanced basal cell skin cancer with bone destruction is presented. Patient Ya., born in 1936, was under the supervision of doctors for basal cell skin cancer since 1982 (for 38 years). She was hospitalized in the department of extracerebral tumors of Romodanov Institute of Neurosurgery NAMS of Ukraine 09.27.2019. Multispiral computer and magnetic resonance imaging were performed.Considering the duration and spread of the tumor, the patient was offered an operation to remove the tumor within healthy tissue with resection of the auricle and parotidectomy. When receiving informed consent for surgical treatment, the patient put forward conditions regarding the scope of the operation: preservation of symmetry of the face, appearance of the face and integrity of the auricle. Surgery was performed, followed by symptomatic treatment. Reconstructive technologies for closing defects of the soft tissue of the facial skull were applied. She was operated on on October 4, 2019. The postoperative period was uneventful. Healing occurred by primary tension. The patient was discharged from the hospital in satisfactory condition on the 18th day (October 22, 2019). Postoperative distant gamma therapy was performed on the projection area of ​​the primary focus and the predominant anatomical routes of lymph drainage (total focus dose ‒ 45 Gy). Catamnesis postoperative ‒ 13 months. After 37 years, a relapse occurred with the tumor process involving all branches of the facial nerve, bones of the skull, metastasis to regional lymph nodes. The treatment was carried out at the Romodanov Institute of Neurosurgery NAMS of Ukraine. The patient did not consent to the extended scope of the surgical intervention, setting the condition of preserving the appearance. In this regard, the removal of affected tissues was carried out along the edge of the tumor invasion (without a reserve of healthy tissues) while preserving the trunk and branches of the facial nerve, i.e. in violation of the generally recognized principles of ablastics. The presented case of the course of the disease proves that timely radiation therapy at the first signs of a skin tumor contributes to a good clinical effect, which made it possible to achieve a long relapse-free period with a decent quality of life and full socialization. The progressive course of the disease (recurrence) justifies the feasibility of replacing large facial skull tissue defects after radical removal of parotid skin cancer with intracranial spread using the method of combining local plastic surgery and free skin flap transplantation, developed and implemented in the Department of Extracerebral Tumors.

Strategies of Prevascularization in Tissue Engineering and Regeneration of Craniofacial Tissues.

Craniofacial tissue defects caused by trauma, developmental malformation, or surgery are critical issues of high incidence, which are harmful to physical and psychological health. Transplantation of engineered tissues or biomaterials is a potential method to repair defects and regenerate the craniofacial tissues. Revascularization is essential to ensure the survival and regeneration of the grafts. Since microvessels play a critical role in blood circulation and substance exchange, the pre-establishment of the microvascular network in transplants provides a technical basis for the successful regeneration of the tissue defect. In this study, we reviewed the recent development of strategies and applications of prevascularization in tissue engineering and regeneration of craniofacial tissues. We focused on the cellular foundation of the in vitro prevascularized microvascular network, the cell source for prevascularization, and the strategies of prevascularization. Several key strategies, including coculture, microspheres, three-dimensional printing and microfluidics, and microscale technology, were summarized and the feasibility of these technologies in the clinical repair of craniofacial defects was discussed. Impact statement Prevascularization is an effective strategy to promote the survival and regeneration of the graft after transplantation. This review focuses on recent development in the technique of prevascularization and discusses the advantages and limits of current technologies. Furthermore, we summarized the progress in the repair of craniofacial tissue defect with prevascularization strategies. The development raised promising prospects of prevascularization strategies in the regeneration of cranial facial tissue defects in the future.

The Use of Bi-lobed Rotational Flap to Cover Large Body Defects: Two Clinical Cases

The bi-lobed skin rotational flaps are commonly used mainly to cover facial tissue defects on the nasal tip and dorsal side, also on head areas, where skin and surrounding tissues are tight. Recent literature shows that the bi-lobed flap is used to cover defects in other body areas as well.This report shows two clinical cases where the bi-lobed flap was used to cover large skin and soft tissue defects after the excision of pathologically damaged skin and soft tissue lesions of the popliteal and the chest area. In both cases the recipient areas were adequately covered, and donor sites were closed primarily.

Changes of facial volume maintenance rate after single autologous fat grafted for repaired progressive facial hemiatrophy

Objective To measure the change of facial volume maintenance rate after autologous fat grafted for repaired progressive facial hemiatrophy by using three-dimensional digital technology. Methods 3D scanner was used to acquire facial data in 10 patients with progressive facial hemiatrophy before operation; Mimics 17.0 software was used to reconstruce patients＇ facial 3D model and to calculate the volume of facial tissue defect; autologous fat was grafted to repair facial deformity. The facial volume maintenance rate was calculated in all the patients 3 months and 6 months after operation. Results We had performed facial 3D data acquisition and facial repaired with autologus fat grafted in 10 patients; patients＇ facial morphology was improved. The mean facial volume maintenance rate was (35.80±3.44)% in 3 months and (27.82±3.80)% 6 months after surgery. Conclusions The mean facial volume maintenance rate in postoperative 3 months is inferior to that in 6 months in single autologous fat grafted for repairing progressive facial hemiatrophy. Key words: Facial Hemiatrophy; Autografts; Printing, three-dimensional; Autologous fat grafted; Facial volume maintenance rate; Progressive facial hemiatrophy

Treatment of complications following orofacial gangrenous infection in a resource limited setting: Experiences and a proposed classification

Background: Orofacial gangrenous infection may result in a devastating acquired facial tissue defect which is often challenging to manage.Objective: We present our experience in the management of noma defects in a resource limited setting.Patients and Methods: All cases of noma that were surgically managed for secondary deformities at the oral and maxillofacial surgery unit of our hospital between 1991 and 2006 were retrospectively studied. Information retrieved included age, sex, site of orofacial gangrene, nature of orofacial defects, treatment given, duration of hospital stay and complications. Data retrieved was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA).Results: A total of 21 patients were treated within the period reviewed and this consisted of 18 males and 3 females. Most patients (n=19, 90.5%) presented with defect involving both facial and oral tissues. The forehead and platysma flaps were the most commonly used flaps for soft tissue defect reconstruction. The duration of hospital stay ranged from 8 days to 120 days with a mean of 42.6 ± 27.7 days. One patient had reankylosis one year postoperatively.Conclusion: Orofacial gangrenous infection remains a threat to economically less developed countries such as in sub-Sahara Africa. Its management is further complicated by the existing poor human and non human health resources in these environments. Emphasis should be on prevention, and an improvement in the current level of health resources to effectively manage these cases.

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Clinical observation of individualized forearm flap in reconstruction of oral and maxillofacial defects

Objective To investigate the forearm flap personalized design method and the curative effect in repairing maxillofacial defects. Methods From March, 2011 to September, 2015, 16 cases with oral maxillofacial tumor and facial tissue defect were treated. There were 8 males and 8 females with an age range of 41-70 years (mean, 54 years). According to the shape and size of the defect after tumor resection in each patient, the forearm flap was designed to repair the defect. The effectiveness was evaluated after operation by observing the survival of the forearm flap transplantation, the patient’s facial appearance, the functions of speech, swallowing. Results The incision healed by first intention in this group, 16 cases of forearm flap survived. All cases were followed-up 8-36 months without tumor recurrence. The functions of speech, swallowing were basically normal. The facial appearance was satisfactory. The patients were satisfied with their appearance and functional recovery after operation. Conclusion Take personal way of forearm flap design according to maxillofacial soft tissue defect, can restore the maximum facial appearance and function of patients, improve the quality of life of patients after surgery to repair, can obtain satisfactory results. Key words: Maxillofacial defect; Radial forearm free flap; Individualization, repair; Microsurgical technique

CAD/CAM silicone auricular prosthesis with thermoformed stiffening insert

Purpose: Epitheses (facial prostheses) for large facial tissue defects manufacturedfrom silicones exhibit unsatisfactory rigidity and its stiffening is required, which createstechnological problems. Moreover, facial epitheses have to be replaced in a relatively shortperiod of use which creates a significant costs, often impossible to realize. The hypothesisof the study was that with use of additive manufacturing is possible to obtain the reusableform for thermoforming of the stiffening insert of auricular prosthesis and the mould whichallows multiple casting of silicone prosthesis with the insert.Design/methodology/approach: Manufacturing of the epithesis consisted of designingand manufacturing. In the first step, the auricular prosthesis and the stiffening insert weredesigned with use of engineering CAD software. In this first computer step, the split form forvacuum thermoforming of the stiffening insert and the split mould for casting of the siliconeear were designed. In the second step, additive printing was used for manufacturing thesplit and reusable model for vacuum thermoforming of the stiffening insert and the splitform of ear. In the third step, stiffening insert was made of thermoformed polyurethane sheetof 0.1 mm thick (Biolon, Dreve), where dental thermoforming machine (Drufosmart, Dreve)was used. In the fourth step, the stiffening insert was located in the mould and the ear wascasting of silicone.Findings: CAD/CAM of epitheses with stiffening insert for large tissues defect/loss wasproposed, where in case of re-producing, it required only thermoforming of insert andcasting silicone with use of the reusable models. Dental technician, in case of damage orloss of a forms, is not much involved in their creation.Research limitations/implications: Bond strength test between stiffening insert vs. softsilicone and manufacturing tolerance of epitheses have not been investigated.Practical implications: Method of casting in a negative form, despite the more timeconsumingwhen comparing with epithesis direct-printing, allows introducing a stiffeninginsert and performing a manual adjustment of margin shape and thickness. Method ofnegative form allows the use of a commercially available medical silicone without the needfor medical tests of a new printed materials.

Cost Analysis of Conventional Face Reconstruction versus Face Transplantation for Large Tissue Defects

Large facial tissue defects are traditionally treated with staged conventional reconstruction. Facial allograft transplantation has emerged as a treatment modality. Facial allografts are procured from a dead donor and transplanted to the recipient. Recipients are then subjected to lifelong global immunosuppression to prevent immunologic rejection. This study analyzes the cost of facial allograft transplantation in comparison with conventional reconstruction. Hospital billing records from facial allograft transplantation (2009 to 2011) and conventional reconstruction (2000 to 2010) patients were compiled. Comparative 1-year costs were calculated, segregated by physician, hospital, and hospital's department costs. Because most conventional reconstruction patients had smaller facial deficits than their facial allograft transplantation counterparts, regression models were used to estimate costs of conventional reconstruction for full facial defects, mirroring the facial transplantation cohort. All costs were adjusted using the medical consumer price index. One-year costs for facial allograft transplantation were significantly higher than those for conventional reconstruction (mean/median, $337,360/$313,068 versus $70,230/$64,451, respectively). One-year costs for a hypothetical full-face conventional reconstruction were $184,061 (95 percent CI, $89,358 to $278,763). The per-patient cost in a hypothetical cohort of conventional reconstruction patients with deficits identical to four facial allograft transplantation recipients was $155,475 (95 percent CI, $69,021 to $241,929). Initial cost comparison portrays facial allograft transplantation as significantly more costly than conventional reconstruction. However, after adjustments for case severity, the cost profiles are similar. Gains in efficiency and experience are expected to lower costs. Additional unmeasured benefits may also positively influence the cost-to-benefit ratio of facial allograft transplantation.

Clinical application and Fuzzy evaluation of autologous platelet-rich plasma mixed with fat graft in facial tissue depression

Objective To evaluate the clinical effect of the facial soft tissue defect treated with platelet-rich plasma （PRP） mixed with purified fat. Methods 35 patients with facial soft tissue de- fects were treated by PRP mixed with centrifuged fat tissue. Using Fuzzy judgment method the clinical effectiveness of therapeutic outcomes were evaluated on fullness, injection of frequency and satisfaction during 3 to 6 months of follow-up. Results The therapeutic outcomes showed that the reconstructed face became a relative symmetrical and natural appearance with not evidently fat resorption and stable after operation, Both patients and surgeons were satisfied with the results. The score of effectiveness was highest in Fuzzy judgment. Conclusions The efficacy of PRP is significant in enhancing fat graft, reducing fat necrosis and resorption. The fat tissue mixed with PRP is a reliable reconstruction option for the facial soft tissue defect. Key words: Platelet-rich plasma; Fat grafting; Au＊ologous; Facial tissue defect; Fuzzy judgment

Lambeau composite médiofacial vascularisé par l’artère faciale : étude anatomique préliminaire

Extended facial tissue defects are difficult to reconstruct because of the anatomical and functional complexity of the area. Recently, composite facial allotransplantation was used for reconstruction. This could be performed because of specific facial blood supply and its facial and maxillary anastomoses. Could a composite naso-labio-mental flap rely on the sole blood supply of a facial artery anastomosis? We performed an anatomic study of a naso-labio-mental composite flap vascularized by the facial artery. The study relied on arteriographies made on cadaveric heads and in vivo. The following data was analyzed: caliber of facial and maxillary arteries, terminal branch of facial arteries, and vascular territories. Sixteen facial arteries and six maxillary arteries were studied. The mean facial artery caliber was 2.06 mm (1-3.2mm). The facial artery ended in the nasal area in 68.8% of the cases. The latero-nasal artery was always present; it was a branch of the facial artery in 66.7% of cases. The two facial arteries, when injected bilaterally, always allowed complete facial composite flap circulation. The nasal territory of the flap was not opacified by the homolateral facial artery in 16.7% of the cases. Both facial artery anastomoses are recommended as blood supply for composite midfacial flaps. Preoperative imaging should be used systematically to assess the vascular network before harvesting.

Application of slender narrow pedicle flap in facial skin cancer treatment

To introduce the application of slender narrow pedicle flap in repairing facial tissue defects after skin carcinoma excision, and investigate its survival mechanism. The slender narrow pedicle iateral maxillocevical flap was designed with its pedicle including skin fascia or only the fascia located in front of auricle or behind of it, repaired 26 cases of facial defects, including 5 temporal skin basal cell carcinoma, 6 skin squamous cell carcinoma, and 1 facial skin malignant melanoma, 8 skin basal cell carcinoma, 5 skin squamous cell carcinoma, 1 skin mucinous carcinoma. In 26 cases, 24 cases their pedicles in front of the auricle, 2 cases behind of the auricle; 4 cases their pedicles only including fascia. The size of the flaps ranged from 3.0 cm x 2.5 cm to 10.0 cm x 8.0 cm. The width and length of the pedicle ranged 1.0-1.5 cm and 2-6 cm. 26 cases of the slender narrow pedicle flaps all survived and the results were satisfactory except 5 cases of distal congestion, then gradual recovery. This slender narrow flap don't include any major blood vessel, without dissecting the blood vessels in operating. Due to its slender pedicle, the whole flap looks like "pingpang bat", the flap rotation is easy and its coverage area is very large, without cat ears. The postoperative appearance (color, texture, cosmetic aspect) is satisfactory. This slender narrow flap is an extraordinary new flap design and is ideal for the repair of the facial tissue defect after skin carcinoma excision.

Complex Craniofacial Reconstruction With Prostheses as an Alternative Method to Autogenous Reconstruction

Reconstruction of facial organ and tissue losses using autogenous tissue is a permanent and effective method in plastic surgery. However, in cases where the patient's general condition does not allow for surgical reconstruction or where the patient is in need of reconstruction of complex organs such as the eye, nose, or ear, an epithesis can be considered as an alternative to treatment with autogenous tissue. The purpose of this study was to investigate the factors affecting the success rate of facial reconstructions with an externally retained prosthesis in relation to the defect location and radiotherapy treatment. Between September 2004 and October 2008, 11 patients with facial tissue defects who had been treated with an osseointegrated implant system were evaluated. Because 1 patient with a midfacial defect died 3 months after the surgery, this case was excluded, leaving a total of 10 patients for evaluation. Five patients' facial defects were located in the ear, 2 patients had nasal defects, and 3 patients had defects in the midfacial region. The total numbers of implants applied to these regions were 13, 6, and 25, respectively. A total of 44 implants applied were followed for an average period of 52.4 months (between 6 and 77 months). In cases where the reconstruction was considered satisfactory, no infections were observed, and there were no implant losses in the mastoid region. Implant losses were observed in a total of 14 implants (31.8%), 2 of which were in the glabellar region (4.5%), and 12 were in the midfacial region (27.2%). The implant losses were observed between the first and 18th postsurgical months (with an average of 6 months). The remaining implants were sufficient to retain the prostheses. Because of these results, the use of implant-assisted epitheses can be considered a viable alternative in patients whose facial defects cannot be corrected through reconstructive surgery performed with autogenous tissue.

Autologous Fat Transplantation Versus Adipose-Derived Stem Cell–Enriched Lipografts: A Study

Several techniques for lipoinjection have been described in the literature. Recently, the role of adult stem cells in adipose tissue has gained interest. The authors compare autologous fat transplantation to adipose-derived stem cell-enriched lipografts. A group of 20 patients with congenital or acquired facial tissue defects were included in this study and randomly divided into two groups. Ten patients were treated with autologous fat transplantation (Group A; 12-165 mL per session), and the remaining ten were treated with adipose-derived stem cell-enriched lipografts (Group B; 8-155 mL per session). Overall patient satisfaction after both treatments was evaluated at six, 12, and 18 months after the initial surgical procedure. In Group A, three patients achieved aesthetically-acceptable results after the first treatment; the remaining seven patients required additional sessions. In Group B, all patients required only one treatment. Analysis of patient satisfaction in the first six months clearly demonstrated better results in Group B. However, by the 18-month evaluation, there was no statistical difference between the two groups in terms of patient satisfaction. Adipose-derived stem cell-enriched lipografts produced aesthetically-acceptable results without the need for repeat treatment sessions, which are necessary with autologous fat transplantation. Further long-term studies are necessary to confirm the favorable results seen in this study.

Reconstruction of facial defects with superficial temporal artery island flaps: a donor site with various alternatives.

Color and texture match is crucial in reconstruction of facial tissue defects. Between March of 1997 and July of 2000, island flaps based on the parietal, anterofrontal, centrofrontal, posterofrontal, and superior auricular branches of the superficial temporal artery were used in the reconstruction of tissue defects localized on different regions of the face in 28 patients. According to the size and the location of the defect, the flap was selected. There were 15 male patients and 13 female patients, with ages ranging between 19 and 74 years. In six of the flaps, venous congestion was observed. Because of the elevation of the eyebrow on the flap side, three patients required a sling to the opposite eyebrow. Excellent color and tissue match and transfer of hair-bearing tissue to the eyebrow and beard areas were achieved with no other complications. Satisfactory aesthetic results were gained.

顔面悪性腫よう切除後再建におけるＵｎｉｔ Ｐｒｉｎｃｉｐｌｅの応用

Malignant skin tumors are generally found on the face and should be treated with surgical excision routinely. The importance of surgical excision is beyond question and immediate reconstruction of facial full-thickness tissue defects is a commonly accepted surgical principle used to preserve function and minimize cosmetic deformity.In facial reconstruction, the excellent functional and esthetic results according to regional esthetic unit are familiar to most plastic surgeons. Recently, subunit principle has generally been employed and now further advanced miniunit principle has come to be advocated and applied.Tequniques and three case reports describe its application to facial full-thickness tissue defects after skin cancer surgery.Case 1: A 67-year-old man presented with a basal cell carcinoma measuring 32 × 21mm of the right cheek. There were no clinically positive lymphnodes. Excision of the tumor produced a defect of three-fourth of the right suborbital cheek zone. After arranging the defect fit the natural suborbital cheek subunit, recostruction was performed with an anteriorly based cervicofacial flap in exact size of missing subunit and secondary donor site defect was covered with an anteriorly based neck flap. Additional skin graft was performed to the retroauricular region hidden behind the ear.After operation the patient received chemotherapy with 90mg dose of pepleomycin. No evidence of recurrence has been noted for 2 years postoperatively and the patient now has almost normal symmetric appearance and function with concealed edge scars of the flap.Case 2: A 71-year-old man presented with a squamous cell carcinoma measuring 22 × 18mm of the right mandible. There were no clinically positive lymphnodes. Excision of the tumor produced a defect of three-fourth of the right buccomandibular cheek zone. After arranging the defect fit the natural buccomandibular cheek subunit, reconstruction was performed with a posteriorly based neck flap in exact size of missing subunit and secondary donor site defect was almost sutured primarily with an additional skin graft using formerly excized normal skin.After operation the patient received chemotherapy with 60mg dose of pepleomycin. No evidence of recurrence has been noted for 12 months postoperatively and the final result left the patient with adequate facial contour, normal appearing skin cover and concealed grafted skin.Case 3: A 49-year-old man presented with a dermatofibrosarcoma protuberans measuring 12mm in diameter of the right upper lip.Excision of the tumor produced a full thickness defect of three-fourth of the lateral subunit of the upper lip. The remaining tissues of the lateral subunit were excised. An exact pattern of the opposite normal lateral subunit is outlined and an Abbe flap was taken from the midline of the lower lip and transferred in two stages. No evidence of recurrence has been noted for 10 months postoperatively.Like tissue was replaced in kind, border scars are positioned esthetically, and the orbicularis sphincter is reconstituted with an intact symmetrical comissure, muscular modiolus, and upper and lower lip symmetry. In this series of patients, we have presented a method of facial reconstruction emphasizing the judicious choice and modificatin of recipient and donor tissue to provide for the exact replacement of facial full-thickness tissue defects as subunits, thereby reproducing the expected contours and landmarks that create the final excellent esthetic result.