Final Cosmetic Result Research Articles

Long-term results of minimally invasive strip craniectomy without helmet therapy for scaphocephaly - a single-centre experience.

Scaphocephaly is the most common type of craniosynostosis and various surgical techniques are used for treatment. Due to late postoperative changes of the head shape, long-term outcome data is important for evaluating any new surgical technique. At our institution, minimally invasive strip craniectomy without regular helmet therapy is the standard treatment in scaphocephalic patients. Between October 2021 and February 2023, we retrospectively examined the skull shape of patients who underwent minimally invasive strip craniectomy for scaphocephaly using a 3D surface scan technique. The cephalic index (CI), the need for helmet therapy and additional cosmetic outcome parameters were investigated. We included 70 patients (72.5% male). The mean follow-up time was 46 (10-125) months and the mean CI was 75.7 (66.7-85.2). In 58 patients, the final cosmetic result was rated as "excellent/good" (mean CI: 76.3; 70.4-85.0), in 11 as "intermediate" (mean CI: 73.3; 66.7-77.6), and in one case as "unsatisfactory" (CI 69.3). The presence of a suboccipital protrusion was associated with a "less than good" outcome. The CI correlated significantly with the overall outcome, the presence of frontal bossing, and the interval between scan and surgery (age at scan). Minimally invasive strip craniectomy is an elegant and safe method to correct scaphocephaly. Our data show good cosmetic results in the long term even without regular postoperative helmet therapy.

The Lateral Orbital Thickening and the Lateral Brow Thickening: A New Choice for the Lower Eyelid Suspension.

This study aimed to evaluate the effectiveness and safety of a double-suspension technique using the lateral orbital thickening (LOT) and the lateral brow thickening (LBT) in patients with lower eyelid defects. A total of 5 cadavers (4 males and 1 female) ranging in age from 50 to 78 years was subjected to observe the distribution of the orbicularis retaining ligament (ORL) and its characteristics. The ORL is a closed-loop structure that forms the LBT outside the supraorbital rim and forms the LOT in the lateral canthal region. A total of 17 patients (12 females and 5 males) with an average age of 12.3 years who underwent the ORL-assisted lower eyelid reconstruction were included in this retrospective study. After the ORL was completely released on the infraorbital rim for reducing down traction, the subocularis oculi fat and the orbicularis oculi were fixed to the LBT and the LOT for increasing the upward traction. The lower eyelid defects in 17 patients were reduced in different degrees. The defects were closed directly in 3 patients and were resurfaced by skin graft or flap in the other 14 patients. Physicians and patients were all satisfied with the final cosmetic results. Thus, the ORL is a rigid and restrictive internal connected structure, and the ORL-assisted technique decreases the defect size and reconstructs vertical force balance. The LOT and the LBT are strong and safe enough as new fixation choices for lower eyelid suspension.

ORIFICE (Interventional Radiotherapy for Face Aesthetic Preservation) Study: Results of Interdisciplinary Assessment of Interstitial Interventional Radiotherapy (Brachytherapy) for Periorificial Face Cancer.

(1) Background: Periorificial face cancer (PFC), defined as both squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) arising around the eyelids, the nose vestibule and the lips, has very high incidence rates worldwide. The aim of our retrospective analysis, focusing on local control (LC) and patients’ degree of satisfaction with the cosmetic outcome, is to present the results of a single institutional series of patients affected by PFC and treated by interventional radiotherapy (brachytherapy–IRT). (2) Methods: We retrospectively evaluated patients affected by PFC who were treated at our Interventional Oncology Center (IOC) with interstitial IRT from 2012 to 2021 with doses and volumes specific for each subsite considered. (3) Results: We report the results of 40 patients affected by PFC and treated by HDR interstitial IRT. The median follow-up was 24 months. The actuarial 3-year LC was 94%. Regarding patients’ satisfaction, we found that 93% of patients were satisfied and only 7% of patients were not completely satisfied with the final cosmetic result. (4) Conclusions: Interstitial HDR IRT could be an effective therapeutic option providing adequate disease control and preventing potentially disfiguring surgical approaches. More numerous and standardized studies are warranted to confirm the available evidence.

A giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review

Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5–4% of all cases of fibroadenomas. Giant fibroadenomas are rare variants and represent only 0.5% of all fibroadenomas, usually occurring in girls between the ages of 10 and 18. They are characterized by massive and rapid enlargement of a rubbery, mobile, and non-tender mass and defined as being larger than 5 cm or weighing more than 500 g. The aetiology is not well understood and is believed to be an increased sensitivity to normal oestrogen level. We present a 12-year-old Asian girl treated at the age of 8 for idiopathic precocious puberty, without known family history of breast masses or cancers, who developed spontaneous giant fibro-adenoma measuring 15cm X 17 cm. The patient was further evaluated via ultrasonography showing a sole large lesion of 15 X 17 cm in the left breast. Surgical excision with conservation of the developing breast parenchyma and nipple-areolar complex under general anaesthesia was performed. Histopathological findings after the surgical excision were suggestive of juvenile fibroadenoma. The patient has a normal breast development throughout 4 years follow-up. The rapid growth of a breast mass in such young patients can be of great concern causing a considerable impact on these patients’ psychological and emotional condition. One of the most important concerns is the impact on potential future mammary gland development. Therefore, it is crucial to promptly rule out malignant processes or phyllodes tumors and educate young patients and their families on treatment options that fit their concerns. In addition, the final cosmetic result is essential after the surgical excision; although the primary cause of asymmetrical breast enlargement is a benign mass, early surgical excision is efficient concerning the best possible cosmetic outcome. Keywords: Breast mass; juvenile fibroadenoma; giant fibroadenoma.

Hybrid Mathieu Urethroplasty: A Simple Modification Outcomes.

BackgroundDistal hypospadias repair is one of the most frequent surgical interventions in the pediatric age group. Successful hypospadias repair should provide a functional penis and good cosmetic results. Mathieu urethroplasty is one of the most popular techniques used. The authors aimed at performing a modification that expanded the scope of indications and improved the final cosmetic results of classic Mathieu urethroplasty.MethodsForty-three patients with distal hypospadias were operated by hybrid Mathieu urethroplasty (HMU) during the period from March 2012 to December 2020. All cases had small size glans. Creation of the perimeatal-based flap was performed as Mathieu disrobed. This was followed by the development of glanular wings. The additional step was deep incision of the urethral plate. Then, urethroplasty was performed. The catheter was left in place for 1–3 days.ResultsThe mean age was 1.5 years, and the mean operative time was 67 minutes (60–75 minutes). The mean size of glans was 12 mm (10–15 mm). Fistula developed in three cases. No stricture or meatal regression developed. Infection with disruption of repair occurred in one case.ConclusionHybrid Mathieu urethroplasty represents a reliable and successful solution for the cases of distal penile hypospadias with small glans and shallow urethral plate. It increases the scope of candidates of the Mathieu procedure, improves the final cosmetic results and has a reasonable rate of complications.

Congenital pseudarthrosis of the clavicle in an adult: case report and literature review

<p>A 27 years old male, presented with a bump over the middle third of is right clavicle and a foreshortened shoulder girdle causing a severe deformity. Radiographs revealed a Congenital pseudarthrosis of the clavicle (CPC).<em> </em>A resection of the pseudarthrosis was carried and internal fixation with a reconstruction plate was done using iliac graft. One year after he was asymptomatic, without any functional impairment and very satisfied with the final cosmetic result. There is no consensus about optimal treatment. We present a rare case of surgical in an adult patient, and demonstrate why treatment must be individualized and surgical associated complications must be discussed.</p>

Asian Upper Blepharoplasty in Women: A Comprehensive Approach for a Natural and Aesthetically Pleasing Outcome

Asian upper blepharoplasty is the most popular cosmetic procedure for Asian women. However, there is no standardized approach to this procedure and suboptimal results are still common. The aim of this article was to describe a comprehensive approach to Asian upper blepharoplasty in women and report the clinical outcomes obtained with this approach. The comprehensive approach described here for Asian upper blepharoplasty in women includes: (1) determining the height and length of the upper eyelid skin crease; (2) creating a more optimal anatomy of the upper eyelid by removing excess eyelid skin, a portion of the orbicularis oculi muscle, and septal fat; (3) reconstructing the desired anatomic structures of the upper eyelid skin crease through plication of the levator aponeurosis, if necessary, and closure of the upper eyelid skin incision through the septum and the mobile portion of the levator aponeurosis; (4) adding a medial epicanthoplasty if needed to enhance final cosmetic results. Over a 5-year period, 332 Asian women underwent upper blepharoplasty for creation of double eyelids, or conversion from less visible to more ideal double eyelids, with the above comprehensive approach. There were no surgical complications postoperatively and 326 patients (98.2%) rated their outcome satisfactory over a 5-year follow-up. Only 6 patients (1.8%) required surgical revision for asymmetry or suboptimal shape of the upper eyelid. The comprehensive approach to Asian upper blepharoplasty described here can be used for Asian women and produces a natural and aesthetically pleasing outcome and low revision rates.

Synchronized "One-Step" Resection and Cranio-Orbital Reconstruction for Spheno-Orbital Lesions With Custom Made Implant.

In the last few years, skull base tumors involving the fronto-orbital region have been approached with complex, invasive, and time-consuming cranial reconstruction techniques. On the other hand, recent custom-made implants allow easier and faster procedures, with excellent aesthetic results. The authors propose an easy surgical-planned protocol with a synchronized "one-step" resection and reconstruction of these complex lesions, with a preformed poly-methyilmethacrylate (PMMA) cranioplasty. Our technique consists of a 2-phases procedure. In the first one, the so-called "virtual" phase, the authors get a tailored 3D-PMMA model based on high-resolution (HR) CT-scans of the patient's skull. Afterward, the authors perform the planned craniotomy on the 3D-PMMA model with the assistance of intraoperative navigation system. Therefore, a further CT-scan of the resected model is performed to develop the final implant. In the second phase, the "surgical phase," a single procedure consisting in a cranial resection and custom reconstruction is performed with the assistance of stealth-navigation. The authors describe 6 cases of complex fronto-orbital-sphenoidal benign tumors that required skull reconstruction. All patients were examined 3 months after surgery through cosmetic (facial and eyes symmetry and globe position) and ophthalmology tests (visual field, visual impairment, and diplopia). Postsurgical HR CT-scans of the head and MRI-scans of the brain documented a total resection of the tumor and an optimal accuracy of skull reconstruction. In all cases, the authors obtained a highly accurate skull reconstruction following cranio-orbital tumor resection, with a less aggressive and faster procedure compared to autologous bone graft. Final cosmetic and functional results were excellent, with good results in cases of presurgical exophthalmos and orbital asymmetry. None of the patients developed implant-related complications. The "one-step" resection and reconstruction of benign tumors involving the spheno-orbital region with neuronavigation assistance is a technique that allows an accurate tumor removal and a cranial-bone reconstruction within a single surgical procedure, with fewer complications and excellent cosmetic and functional results.

Nerve-sparing circumcision: Myth or reality?

Circumcision is a common procedure. Recently, tissue-sparing approaches have become a matter of interest, and a nerve-sparing approach is described in adults. Although circumcision is common in the practice, the nerve-sparing approach has not been evaluated in the pediatric age group. To give a contemporary evaluation of the preputium histology, challenge the phenomenon of a genuine nerve-sparing approach, and report the results of a prospective cohort contrasting the tissue-sparing fine dissection technique to the regular sleeve circumcision in the pediatric age group. A total of 20 healthy children between 7 and 12 years of age were enrolled in the study. All circumcisions were carried out for religious purposes, and children with any anatomical anomaly, skin lesions, or Balanitis Xerotica Obliterans were not included in the study. The first 10 children underwent regular sleeve circumcision, while the latter 10 children underwent tissue-sparing fine dissection modification of the sleeve technique. All materials obtained from the circumcision were examined by a single pathologist, and relevant tissue structures were counted and compared between the groups. Both techniques were satisfactory in terms of final cosmetic results, without significant complications, such as bleeding, massive edema, iatrogenic chordee, or unacceptable cosmetics. None of the children required readmission or medical intervention other than analgesics and topical moisturizing creams. Preservation of all nervous system structures, including the receptors, appeared to be not possible with macroscopic dissection techniques due to micrometer scale depth of the touch receptors. Nerve trunks were also located in less than 1-mm depth. The tissue-sparing technique could preserve significantly more vascular structures, nerve trunks, and Pacinian Corpuscles, which can be a matter of further long-term research. We propose the term "tissue-sparing" instead of "nerve-sparing" for the available techniques. The tissue-sparing technique did not affect the clinical outcomes and the postoperative course in our study. However, it showed to be superior in terms of preserving the vascular structures, nerve trunks, and Pacinian Corpuscles.

Anorectal Malformations: the Brooke Ileostomy Technique Moves to the Colon

Colostomy is considered by most authors the first step of treatment for neonates affected by high or intermediate anorectal malformations (ARMs). However, for this subset of patients, the debate between total diverting colostomy (TDC) and loop colostomy (LC) is still ongoing among the paediatric surgeons community. The aim of this paper is to present our experience consisting in applying the Brooke technique, until now used only for ileostomy, in order to perform a functionally diverting loop colostomy (FDLC) in patients with high or intermediate ARMs. At our institution, from January 2014 to December 2018, 12 patients (6 males and 6 females) with high or intermediate ARMs underwent colostomy according to the Brooke ileostomy technique. The only complication observed was mild proximal stoma prolapse in 1 patient. Creation and closure of the stomas were easy, and the final cosmetic result was very satisfying in all patients. We believe that this is a promising technique since it might overcome the drawbacks of a TDC as it is less invasive, easier, and quicker to perform. Furthermore, it guarantees final better cosmetic results, albeit functioning as a TDC.

Efficacy and safety of two post-operative drains: results of a prospectively randomized clinical study in breast cancer patients after breast conserving surgery

To compare the efficacy and safety of two post-operative drains in breast cancer patients after breast conserving surgery. This was a prospectively randomized comparative study of two drains investigated in breast cancer patients after breast conserving therapy. The Redon drain ends in a tip with 28 double perforations while the Quadrain drain features 4 flexible flaps of about 0.15m length. The drains cost 0.28 € and 3.54 €, respectively. Primary target parameter was the duration of the drains staying in the surgical site. Secondary target parameters were pain post-surgery, seroma volume, final cosmetic result and surgical site infections. A total of 88 patients were randomized, 47 and 41 received the Redon drain and the Quadrain drain, respectively. The mean duration of the drains staying in the surgical site was not different between the Redon and the Quadrain drain, 42.6h (± 25.8h) and 50.1h (± 28.5h), respectively (p = 0.1959). The post-operative pain score, seroma size, cosmetic result and surgical site infections were not different for both systems. The Redon drain and the new Quadrain drain were not significantly different with respect to duration in the surgical site, post-operative pain, seroma volume and cosmetic result.

Comparison of postoperative pain according to the harvesting method used in hair restorative surgery.

BackgroundPostoperative pain is one of the most common concerns of patients undergoing hair transplantation surgery. Because most patients are satisfied with the cosmetic improvement after transplantation, amelioration of postoperative pain would help to increase patient accessibility to hair restorative surgery and greatly impact patient satisfaction with the final cosmetic results. This study was performed to investigate postoperative pain after hair transplantation.MethodsIn total, 241 patients (202 who underwent follicular unit transplantation [FUT] and 39 who underwent follicular unit extraction [FUE]) were eligible for the study. Postoperative pain was evaluated on postoperative days 1, 2, 3, 4, 5, and 7 using the Wong-Baker Faces Pain Scale. The patients’ medical records were retrospectively reviewed for information on the harvesting method, number of transplanted grafts, size of donor design, and laxity, elasticity, and glidability of the scalp in relation to postoperative pain.ResultsPostoperative pain after hair transplantation, assessed with the Wong-Baker Faces Pain Scale, seemed to provide very subjective results. None of the variables were correlated with postoperative pain in the FUT group. Such pain, however, tended to disappear by postoperative day 3. Patients in the FUE group experienced significantly less severe pain than those in the FUT group.ConclusionsPostoperative pain was significantly less severe in patients whose donor hair was harvested by the FUE than FUT method. Postoperative pain had almost disappeared by postoperative day 3 in the FUT group, whereas only minimal pain was present even on postoperative day 1 in the FUE group.

Comparison of wound closure techniques in median sternotomy scars in children: subcuticular suture versus Steri-Strip™ S

Objectives: The aim of this retrospective study was to compare subcuticular sutures and Steri-Strip™ S in closing median sternotomy incisions in children with regard to wound healing and scar formation.Methods: Fifty-three children and adolescents were enrolled in this study who all underwent a median sternotomy at age 0–18 years and had their presternal cutaneous wounds closed with either a running subcuticular suture (Group 1) or Steri-Strip™ S (Group 2). Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcome measures were the scar measurements and the incidence of wound problems post-surgery.Results: A significant difference was found between both groups in median POSAS observer scale scores for the items thickness (p = .027), pliability (p = .045), surface area (p = .045) and the total score (p = .048). All in favor of the subcuticular suture group. There were no significant differences concerning the POSAS patient scale scores. Middle parts of scars of patients in Group 2 were significantly broader (p = .001) than scars of patients in Group 1. No significant differences concerning wound problems were found.Conclusions: There are, according to our results, no significant differences in wound healing of median sternotomy incisions in children closed with either a subcuticular suture or Steri-Strip™ S. Significant differences do exist regarding scar formation and final cosmetic results of the scars, in favor of subcuticular closure.

A Rare Case of Auricular Endochondral Pseudocyst

Auricular endochondral pseudocyst is a very rare, benign intracartilaginous cystic lesion which most commonly presents as a cystic mass in the anterior plane of the auricle. We present a case report of a 48-year-old man with a fluctuating lesion of 3 week s duration on the left auricle, with no specific history of trauma or disease. Initial incisional drainage revealed an abundance of serous fluid, which quickly recurred. Surgical removal of the hypertrophic perichondrium forming the pseudocyst anterior wall and ear cartilage curettage was carried out with intraoperative absolute alcohol sclerotherapy, followed by compression dressings. The auricle healed uneventfully, with a good final cosmetic result and no recurrence within a 6-month follow-up period. We report this unusual case as the first in Korean plastic surgery with a review of the literature.

The COSMAM TRIAL a prospective cohort study of quality of life and cosmetic outcome in patients undergoing breast conserving surgery

BackgroundCosmetic result in breast cancer surgery is gaining increased interest. Currently, some 30–40% of the patients treated with breast conserving surgery (BCS) are dissatisfied with their final cosmetic result. In order to prevent disturbing breast deformity oncoplastic surgical techniques have been introduced. The extent of different levels of oncoplastic surgery incorporated in breast conserving surgery and its value with regard to cosmetic outcome, patient satisfaction and quality of life remains to be defined. The aim of this prospective cohort study is to investigate quality of life and satisfaction with cosmetic result in patients with breast cancer, undergoing standard lumpectomy versus level I or II oncoplastic breast conserving surgery.MethodsFemale breast cancer patients scheduled for BCS, from 18 years of age, referred to our outpatient clinic from July 2015 are asked to participate in this study. General, oncologic and treatment information will be collected. Patient satisfaction will be scored preceding surgery, and at 1 month and 1 year follow up. Photographs of the breast will be used to score cosmetic result both by the patient, an independent expert panel and BCCT.Core software. Quality of life will be measured by using the BREAST-Q BCT, EORTC-QLQ and EQ-5D-5 L questionnaires.DiscussionThe purpose of this prospective study is to determine the clinical value of different levels of oncoplastic techniques in breast conserving surgery, with regard to quality of life and cosmetic result. Analysis will be carried out by objective measurements of the final cosmetic result in comparison with standard breast conserving surgery. The results of this study will be used to development of a clinical decision model to guide the use oncoplastic surgery in future BCS.Trial registrationCentral Commission of Human Research (CCMO), The Netherlands: NL54888.015.15.Medical Ethical Commission (METC), Maxima Medical Centre, Veldhoven, The Netherlands: 15.107.Dutch Trial Register: NTR5665, retrospectively registered, 02-25-2016.

Breast-specific factors determine cosmetic outcome and patient satisfaction after breast-conserving therapy: Results from the randomized COBALT study.

To identify breast-specific factors and the role of tumor, treatment, and patient-related items in influencing patient opinion on cosmesis and satisfaction after breast-conserving therapy (BCT). Data from the randomized COBALT study was used. At 3, 12, and 36 months, 128 patients with T1-T2 breast cancer completed a questionnaire on breast-specific factors and overall cosmetic outcome and patient satisfaction, using a 4-point Likert scale. There was a strong positive correlation between breast-specific factors, overall cosmetic outcome,and satisfaction at all time-points. Excellent/good cosmetic outcomes and satisfaction decreased during follow-up. A shift was noted in the degree of influence of the various breast-specific factors. At 3 years, symmetry factors such as size, shape, and nipple position largely determined a patient's opinion on the final cosmesis, followed by firmness. The risk of an unacceptable outcome was associated with young age and large excision volumes. A questionnaire including breast-specific questions provides important information on final cosmetic results and satisfaction after BCT. These outcomes can also be of great value as quality indicators and pre-operative counseling. The major influence of breast-specific factors on asymmetry underlines the importance of achieving an optimal excision volume at the initial procedure.

Four Petal Evisceration : Pros and Cons

purpose: To evaluate four petals evisceration as one of the best modifications in evisceration surgery, allowing the use of large orbital implant with low incidence of complications. Methods: We conducted a retrospective, interventional study on evisceration with placement of spherical non porous orbital implant after four petal evisceration. Preoperative examination included full history, ophthalmological examination, indication for surgery, B-scan ultrasonography, axial length in cases of atrophic and socket surface in secondary cases. All patients were operated a four petal evisceration with spherical non porous implant of size 18 to 22. Postoperative, all patients were followed for at least 6 months for presence of complications, implant and prosthesis motility and the final cosmetic results. Results: 18 eyes were included. Diagnosis necessitating evisceration was atrophia bulbi in 8 patients, endophthalmitis in 2 patients, and implant exposure in 4 patients, corneoscleral melting due to caustic exposure in 1 patient, self-eviscerated globe due to severe trauma in 1 patient and anopthalmic socket following evisceration without implant in 2 patients. Implant size was 18 in 1 patient, 20 in 6 patients, and 22 in 11 patients. No implant exposure occurred; superior sulcus deformity occurred in 3 patients, downward implant migration occurred in 1 patient. Regarding implant motility, it was good with mean of 75% in 14 patients; moderate with mean of 66% in 4 patients. The prosthesis motility was fair with mean of 35% in 12 patients (66.6%) and poor with mean (10%) in 6 patients. Conclusion: Four petals evisceration facilitates the use of large sized implant in all cases even in implant exposure with deficient sclera with good post-operative final cosmetic results, very low rate of complications and moderate prosthesis motility.

Comparative study of steristrips and subcuticular suture for wound closure after thyroid surgery

Background: Any skin closure technique aims at opposing the skin edges precisely without tension for sufficient time to allow healing to take place. The ease and speed with which the skin closure is completed, the level of patient discomfort, the complication rate, and the final cosmetic result are the factors which has to be considered in making a comparison of different types of wound closure. This study aims at comparing steristrips and subcuticular sutures for wound closure after thyroid surgery based on assessment of post-operative pain, neck mobility and cosmetic appearance.Methods: A comparative study was carried out among 90 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex undergoing thyroidectomy will be randomized to had their wounds closed by steristrips or subcuticular sutures using a simple randomization table. Patients who underwent previous neck irradiations, secondary neck surgeries, and patients with poor compliance were excluded from the study. Descriptive statistics, unpaired t-test and chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 48.6 (range 24-76) years. The gender distribution showed a higher number of females (82) as compared to males (8). 70 patients were diagnosed with multinodular goitre, 16 patients were of thyroid neoplasms and 4 were of inflammatory thyroid conditions. 12 patients underwent subtotal thyroidectomy and 78 patients underwent total thyroidectomy. Wound closure by steristrips had less post-operative pain, acceptable neck mobility and excellent scar appearance as compared to subcuticular sutures.Conclusions: The choice of materials for wound closure will depend on the surgeon's preference. However, this study does show that steristrips sutures can be removed more quickly and is more acceptable method of wound closure as compared to subcuticular sutures after thyroid surgery.

Reconstruction Techniques of Choice for the Facial Cosmetic Units

Background and objectivesA broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. Material and methodsThis was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. ResultsThe total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. ConclusionsThe results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.

Técnicas reconstructivas de elección por unidades estéticas faciales

Background and objectivesA broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. Material and methodsThis was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. ResultsThe total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. ConclusionsThe results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.