Good Aesthetic Results Research Articles

Surgical outcome after autologous bone chips replacement in depressed skull fractures: a single center experience

BackgroundSurgery for depressed skull fractures (DSFs) is always faced by multiple challenges including ideal timing, defect reconstruction and complications. Few data are available regarding the aesthetic results and patients’ satisfaction following DSFs management.MethodsA prospective non-randomized study included 59 traumatic brain injury (TBI) patients surgically treated for DSFs. Depressed bone fragments were elevated and washed with diluted hydrogen peroxide for 15 min then replaced within a net made of vicryl 0 through edges of the galea. Our objective was to evaluate outcome and patients’ satisfaction of using autologous bone fragments for skull defect reconstruction.ResultsThe mean Glasgow Coma Scale (GCS) score on admission was 14.51 ± 1.237. The mean age was 16.505 ± 12.426 years. DSFs were of compound type in 81.4% with predominance towards the parietal region 54.2%. Associated intracranial pathologies were found in 39.0% of cases. Mean time to surgery was 5.79 ± 9.982 h. Dura was found torn in 19 cases (32.2%). Postoperative complications were encountered in 5 cases (8.5%). The mean hospital stay was 3.61 ± 3.157 days. 96.6% of cases had good discharge outcome. Factors with significant impact on outcome included; admission GCS score (P < 0.001), type of associated pathology (P = 0.006), and venous sinus involvement (P = 0.003). At the end of follow up, 46 patients (82.5%) were satisfied about the aesthetic results, while 10 patients (17.5%) were not satisfied and 9 of them underwent re-surgery for late cranioplasty.ConclusionsUsing autologous depressed bone chips for skull defect reconstruction can be a safe and feasible surgical technique for TBI patients suffering DSFs with good aesthetic results, high patient satisfaction, decreased need for later cranioplasty and consequently low overall management cost.

Modified Hatchet Flap for Reconstruction of Large Full Thickness Defects of the Lower Lip.

Reconstruction of large lower lip defects due to malignancies with good aesthetic result remains challenging. In this study we presented reconstruction of full thickness lower lip defect with modified hatchet flap. The charts of patients with 50% to 95% of the total lower lip defect due to lower lip tumor resection who had reconstruction with modified hatchet flap were reviewed. Seven of the patients had unilateral, two had bilateral modified hatchet flap. After follow-up period, it was concluded that this method provided a wide and functional mouth opening. Six of the patients stated that they were aesthetically satisfied with their appearance, while 3 patients found the result acceptable. None of the patients required additional surgical procedure. Modified hatchet flap is an easy-to-design, easy-to-remember flap with good aesthetic and functional results which makes it a reliable flap in the reconstruction of the large lower lip defects.

An original method of nose reconstruction using an individualized titanium implant and a radial flap: a clinical case

In recent years, the number of oncological diseases of the facial area and the nasal area has increased. The consequences of surgical treatment of these diseases lead to the formation of functionally and aesthetically significant defects of the face and external nose, leading to disruption of such functions as breathing and speech. In this article, we propose a method for nose reconstruction using an individualized titanium implant in combination with a radial flap. Due to the use of additive technologies in combination with visualization and 3D modeling programs at the stage of preoperative planning, it becomes possible to analyze the defect, its localization, volume, tissue composition, as well as to model and create an individual implant. This approach allows you to get good functional and aesthetic results in one operation, reduce the number of complications and rehabilitation period.

Modified Technique of Temporal Osteotomy in Fronto-Orbital Advancement in Anterior Plagiocephaly

Background: Nonsyndromic anterior plagiocephaly is one of the most common types of craniosynostosis. In recent years, various surgical techniques have been introduced to correct this deformity, which many surgeons believe have not been associated with adequate clinical and aesthetic results. The aim of the study was to introduce a new surgical technique (modified Z-technique of temporal region osteotomy) and to evaluate the aesthetic and anthropometric outcomes of frontal orbital correction for the management of patients with nonsyndromic anterior plagiocephaly. Methods: In this cohort study, 47 patients with nonsyndromic anterior plagiocephaly who were operated on in 15-Khordad and Mofid Hospital affiliated to Shahid Beheshti University of Medical Sciences during the years 2018 to 2023 with the modified z-technique of temporal region osteotomy, were investigated. Aesthetic outcomes and changes in anthropometric parameters of the skull were evaluated 2 years after surgery. Also, the length of surgery, the mean length of stay in the hospital and ICU, the amount of bleeding and postoperative complications were evaluated. Postoperative recurrence of deformity was evaluated according to the Whitaker classification. Results: The mean age of the patients was 11.1±4.15 months. Twenty-seven (57.44%) patients were female and 20 patients were male. The mean follow-up period of the patients was 19.3±3.54 months. The mean weight of the patients was 13.12±7.45 kg. The mean length of hospital stay and ICU stay were 5.44±0.50 and 1.78±0.63 days, respectively. A significant positive correlation was observed between the duration of surgery and the duration of stay in ICU (r=0.23, P=0.023). According to Whitaker’s classification, 39 (82.97%) patients were classified in class I, 4 (8.51%) in class II, 2 (4.25%) in class III, and 2 (4.25) in class IV. Aesthetically, the surgical results were excellent (class I Whitaker) in 82.97%. No serious complications such as infection, CSF rhinorrhea, hematoma occurrence, skull defect occurrence, fever, bleeding, and postoperative mortality were reported. Conclusion: Our study showed that the modified z-technique of temporal region osteotomy was associated with good and excellent aesthetic and clinical results. Bleeding rate, average length of hospital stay, and average length of ICU stay in patients with nonsyndromic anterior plagiocephaly treated with modified Z-technique of temporal region osteotomy were low and comparable with other with other reported series. No cases of serious complication and death were reported during the follow-up period. Nonsyndromic anterior plagiocephaly can be successfully treated with modified Z-technique of temporal region osteotomy with good results and low complication rates.

Delayed breast reconstruction with the thoracodorsal flap and endoprosthesis after complex treatment of breast cancer

Breast reconstruction with a thoracodorsal flap (TDF) in combination with a tissue expander/implant is a wellestablished technique.The purpose of the study was to present current data on the results of delayed breast reconstruction with thoracodorsal flap and tissue expander after combined/complex treatment in patients with breast cancer.Material and methods. The search for relevant sources was carried out in the PubMed, Cochrane Library, E-library systems, publications from 2014 to 2022 were studied. Delayed breast reconstruction using TDF in combination with a tissue expander/implant is a reliable method of reconstruction for the group of patients who have previously undergone radical mastectomy or adjuvant external beam radiation therapy in terms of combined/complex treatment of breast cancer, allowing to achieve good and excellent aesthetic results with a low incidence of surgical complications.Results and discussion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, high patient satisfaction. Patients with a low body mass index or obesity, a history of abdominal surgery, including abdominoplasty, are not candidates for reconstruction using anterior abdominal wall flaps, and therefore the only possible method of breast reconstruction for them is the method using the TDF. In addition, the use of the TDF may be most appropriate for women who are planning a pregnancy in the future and for whom the use of anterior abdominal wall flaps will not be an optimal method of reconstruction due to reduced abdominal wall compliance. Other reasons why the use of TDF is the method of choice for many surgeons are the possibility of closing the donor site regardless of the size of the skin flap taken, the possibility of closing such defects of the mammary gland as extrusions, protrusions, in case of insufficiency of the skin cover after skin-preserving mastectomies.Conclusion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, a high degree of patient satisfaction.

Refinements in Gender-Affirming Feminizing Chest Surgery.

Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery. A retrospective chart review was conducted using our institution's electronic health record between December 2019 and May 2023 with a minimum follow up period of 12 months. Inclusion criteria included transgender women, nonbinary patients, and all patients who did not identify as cis-gender women and who underwent feminizing top surgery. Demographic data including age, race, ethnicity, and gender were collected. Complication rates were recorded for hematoma, infection, seroma, wound dehiscence, hypertrophic scar, minor contour abnormalities, implant asymmetry, and revision surgery. Our surgeons' subfascial approach, which uses 2 equations to calculate dissection pocket dimensions and determine placement of pocket and incision based on desired implant base diameter and projection, was performed on 140 gender-diverse patients and resulted in a hematoma rate of 4.29%, an infection rate of 2.86%, and a seroma rate of 1.42% with good cosmetic outcomes, as evidenced by our low rates of minor contour abnormalities (5.71%) and implant asymmetry (1.43%). Only 5 patients (3.57%) required revision surgery. Bilateral breast augmentation with round implants in a subfascial plane using a concealed IMF incision following equations to determine the dissection pocket size and new IMF position and incision position is a reproducible technique that results in good aesthetic outcomes and minimizes complications.

Correction of Severe Pterygium Colli with a Staged, Double, Posterior and Lateral Approach: A Case Report

AbstractPterygium colli is a rare congenital disorder characterized by excessive skin in the lateral and posterior neck, often associated with genetic syndromes such as Turner's syndrome or Klippel–Feil syndrome. Severe presentations present special challenges for surgeons since its diagnosis is not always evident and its treatment often results in important scaring. Surgical correction of the typical cases mostly involves a lateral approach, but in this “special” case, we used a double, posterior and lateral approach. A 15-month-old girl with prenatal diagnosis of a cystic lesion in the posterior neck presented with massive neck webbing at birth. Genetic studies ruled out chromosomal disorders and RASA 1 mutations. Surgical correction involved a modified posterior approach combined with a lateral approach 1 year later. The cervical tissue redundancy was successfully reduced achieving a good aesthetic outcome with very acceptable scars. At 1 year of follow-up, the patient continues with good neck appearance and mobility. The goal of surgical treatment of pterygium colli is achieving a harmonious neck contour with good function and minimal scarring while minimizing complications and sequelae. No consensus exists on the optimal approach for its correction, emphasizing the need for individualized treatment considering patient-specific characteristics, particularly in the severe cases.

"Floating Island Flap"-A New Technique for the Reconstruction of Full-Thickness Lower Eyelid Defects with Spontaneous Healing (Folded V-Y Island Flap with Orbicularis Oculi Muscle).

Background: Due to the high incidence of malignant tumors of the lower eyelids and the widespread use of surgery for their treatment, the reconstruction of tissues in this area is a frequent task for surgeons. Methods for restoring full-thickness lower eyelid defects are often invasive, pose a significant risk of complications, and do not provide optimal results. Methods: The authors developed a simple technique for the reconstruction of full-wall defects of the lower eyelids. It is a V-Y-type musculocutaneous island flap from the lower eyelid, with the orbicularis oculi muscle folded in the upper part and partially left for spontaneous healing, called by the authors a "floating island flap". Between 2012 and 2023, 39 patients were operated on using this method. Results: Surgical procedures performed under local anesthesia were well tolerated by the patients. The healing process was quick and well accepted. Complications were rare. The most common were: eye irritation and temporary swelling of the flap. In 37 patients, proper protection of the eyeball and good esthetic results were achieved; only in two cases was the cosmetic result assessed as poor. Corneal defects occurred in two cases and healed after conservative treatment. In no cases was reoperation necessary. Conclusions: The developed method is simple and effective. It can be widely used in the reconstruction of full-thickness defects of the lower eyelids.

A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients

IntroductionThe ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety. Patients and methodsBetween April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed. ResultsIn all cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5,6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option. ConclusionsThe breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using ICG imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low and thus the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction. Level of EvidenceLevel IV

Physiological and Functional Restoration of the Modiolus Using a Double Tendon Sling in Patients With Full-Thickness Oral Defects.

Reconstruction of the oral modiolus should be considered for facial defects involving the lip and cheek. We have performed free flap reconstruction using a novel technique that includes a vertical and a horizontal sling for full-thickness defects involving the oral commissure. We used a free radial forearm flap and the palmaris longus tendon to correct lip and cheek defects in 6 patients (3 men, 3 women; age, 55-84 years). The tendon was divided into 2 portions for use as the double sling. One sling was used to connect the upper and lower stumps of the orbicularis oris in the vertical direction and the other to connect the vertical sling and masseter muscle. The outcomes assessed were esthetic appearance and functional results. The facial defects ranged in size from 3.0 cm × 4.0 cm to 7.0 cm × 6.0 cm and the mucosal defects from 1.5 cm × 4.0 cm to 6.5 cm × 5.0 cm. The length of the harvested tendon ranged from 11.5 to 13.5 cm. All flaps survived without complications. Good esthetic outcomes were achieved (excellent facial appearance, n = 1; no lip deviation or drooping, n = 5). Functionally, all patients had acceptable mouth opening and were able to eat a regular diet. Good physiological and functional results can be achieved using a double tendon sling for reconstruction of the modiolus in patients with full-thickness defects involving the oral commissure.

ORAL FINDINGS AND CLINICAL BEHAVIOR IN PATIENT HAVING AUTOIMMUNE POLYENDOCRINOPATHY CANDIDIASIS ECTODERMAL DYSTROPHY (APECED)

Introduction: APECED (Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy) is a rare autosomal recessive disease with significant impacts on oral health, including oral candidiasis and varying degrees of enamel hypoplasia. Objective: To present the oral findings of a girl with APECED and the minimally invasive approach taken in recovery and rehabilitation, taking into account the complexity of her medical condition. Material and methods: A case of a 16-year-old girl with APECED, who visited the dental clinic due to defects of the hard dental tissues and severe dentinal hyperesthesia, is described. There was an underbite with a reduced lower facial floor and enamel hypoplasia in the coronal and middle third of the anterior teeth and first molars. Results: Through direct composite restorations and a minimally invasive approach, a good healing, functional and aesthetic result was achieved.

Modified Technique of Gummy Smile Treatment: Double M-V Plasty for Esthetic and Functional Lip Reposition Surgery.

Excessive gingival display is a common problem that results in an unaesthetic appearance while smiling. Lip reposition surgery is a powerful, noninvasive surgery approach for gummy smile treatment, frequently performed in outpatient oral and maxillofacial surgery units. The procedure as such, provides camouflage of the increased gingival display through re-attachment of the upper lip and limits the pull effect of the muscles by reducing the depth of the upper vestibule. Few techniques of surgical treatment of maxillary gingiva overexposure have been described so far. Proposed midline double V- plasty provides anatomic reposition of the frenulum, whereas bilateral vertical M-plasty enables wider excision of the mucosa than the conventional approach providing better adaption of the wound margins without residual dog-ear defects giving more functional, esthetic, and satisfactory effect to the patients. It can also be performed in patients who do not desire orthognathic surgery with good esthetic results.

Ultrasound-Assisted Liposuction for Top Surgery in Transgender Men: Clinical Experience and Evaluation of Satisfaction and Quality of Life with TRANS-Q and BREAST-Q.

During the last decade, the demand for top surgery in female-to-male transgender (FMT) has increased worldwide. This study aims to present our initial experience with the novel use of ultrasound-assisted liposuction (UAL) in top surgery. Additionally, we evaluate the satisfaction and quality of life with TRANS-Q and BREAST-Q. We conducted a retrospective study analyzing FMT undergoing UAL in top surgery from 2019 to 2021 at a single institution. We analyzed demographic variables, comorbidities, surgical techniques, operative time, complications, and follow-up time. We used TRANS-Q and BREAST-Q to evaluate patient-reported outcomes. A p value < 0.05 was considered significant. We performed 34 UAL combined subcutaneous mastectomies in 17 patients. Twelve patients (70.6%) underwent mastectomy double incision with free nipple grafting (DIFNG), and 29.4% underwent concentric circular mastectomy. In the DIFNG group, BMI (p < 0.02), the weight of each mammary gland (p < 0.001), and use of chest binder (p < 0.03) were significantly higher. The mean operative time was 115min. The complication rate was 11.7% (one hematoma and three hypertrophic scars). The mean follow-up was 29.4months, and no aesthetic revision surgeries was reported. The response rate for TRANS-Q and BREAST-Q was 76.5%, and high satisfaction with the results and significant improvement in quality of life were reported. We present the first cohort of transgender men who underwent UAL in top surgery. With proper training, the use of UAL could be a feasible and safe technique, offering good long-term esthetic results. Additionally, TRANS-Q and BREAST-Q demonstrated improved satisfaction and quality of life. 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 .

Effectiveness of results of complex treatment of pathological wear of hard tissues of teeth

Background:Tooth wear is a multifactorial condition that results in the loss of hard dental tissue. Physiological wear does not usually result in any subjective symptoms. Pathological abrasion of hard dental tissues is accompanied by both morphological and functional disorders of the dental system Objective: To evaluate the functional and aesthetic results of complex treatment of pathological abrasion of dental hard tissues. Materials and methods: This is a prospective controlled study that included 82 patients with a clinically confirmed diagnosis of Increased tooth wear of the first and second degree of severity (from 2020 to 2024). The age of the patients ranged from 34 to 68 years (48 men, 34 women). The examination of patients included: collecting complaints and identifying concomitant somatic diseases, X-ray examination, photographs of the patient's face, bite height, and nasolabial folds. Distribution of the group: Group 1 included patients with the first degree of hard tissue loss 47 (29 men, 18 women) Group 2 included patients with the second degree of hard tissue damage 35 (21 men, 14 women). During examination, patients complained of aesthetic defects caused by tooth wear and discoloration, discomfort when closing, chewing and phonetic disorders, typical symptoms of TMJ dysfunction, such as pain and crunching in the joints, fatigue of the masticatory muscles and muscle pain, displacement of the lower jaw to the side during vertical movements, a feeling of distension in the ears, headaches and bruxism. In patients of group 1: tooth wear was restored with orthopedic structures. In patients of group 2: temporary prosthetic structures and occlusal splints were used to normalize occlusal relationships in case of TMJ and masticatory muscle dysfunction. Gradual raising of the bite was carried out by means of a set of kappa-splints for 14 days, 1 month and 3 months from 1.0 to 5.0 mm until complete restoration of the occlusal height depending on the severity of pathological abrasion of teeth, abrasion of teeth restored by orthopedic structures. Dynamic observation of the clinical condition of the prosthesis structure was carried out in the following periods: 1 week, 1, 6, 12, 24 months,assessment of the condition of the performed restorations were recorded in the medical record of the dental patient. Results:Clinical radiological results showed satisfactory results and are encouraging in patients of groups 1 and 2. After treatment in patients of groups 2, according to the analysis of the lateral teleroentgenogram of the head, an increase in the height of the lower third of the face is noted, in 28 patients the nasolabial folds were smoothed out. Patients were satisfied with the aesthetic and functional results of the treatment Conclusions: The results of the study showed that treatment using occlusal splints at the preparatory stage in patients of group 2 with occlusion disorders due to pathological abrasion of hard dental tissues and restoration with orthopedic structures is relevant for normalizing the occlusal relationships of the jaws and this complex treatment method provides a good aesthetic and functional result.

Full Thickness Nasal Reconstruction With Paired Pericranial and Paramedian Forehead Flaps.

The reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed. A retrospective review of a single surgeon practice was done between 2019 and 2024. Cases of nasal reconstruction with a paired PCF and PMF following oncologic resection were reviewed. Defect characteristics, reconstructive technique, and postoperative complications were evaluated. A literature review summarizing the evolution of this technique from inception to April 2024 was conducted using PubMed. The literature review identified 7 reports describing the use of a paired PCF and PMF for nasal reconstruction. The modifications and enhancements described in each study are summarized. The case series included 13 patients requiring oncologic resection for squamous cell carcinoma (8 patients) or basal cell carcinoma (5 patients). Every case required reconstruction of at least 2 nasal subunits, primarily involving the nasal tip, alae, and columella. Reconstruction was performed with the ipsilateral PCF, contralateral PMF, and structural grafts. Auricular cartilage grafts were universally used for structural support, with additional costal cartilage grafts and a split calvaria bone graft in select cases. The technique showed good functional and esthetic outcomes without any notable graft failures or donor site complications. The combination of an ipsilateral PCF and contralateral PMF is an effective strategy for reconstructing full-thickness nasal defects involving multiple nasal subunits.

Temporoparietal Fascia Sandwich Technique in the Immediate Reconstruction of Human Bite Ear Amputation.

Traumatic ear amputation is a rare injury. Ear replantation is the gold standard in dealing with amputated ears. However, this is not always feasible. In this case series, the authors discuss the immediate reconstruction of traumatic ear amputation using temporoparietal fascia with the same skin from the amputated ear, which provided a high esthetic result and patient satisfaction. The authors present a case series of 3 patients from July 2018 to May 2020 who suffered from traumatic ear amputation due to a human bite and were successfully reconstructed using temporoparietal fascia and the same skin from the amputated ear as FTSG.The cartilage was sutured back, the temporoparietal fascia was raised and flipped over the exposed cartilage, and the FTSG previously harvested from the same amputated ear was put on the fascia. Quilting sutures were taken to ensure proper inset of the graft on the fascia. The authors measured the patient-reported outcome using an Ear-Q validated questionnaire. All patients were males, with a mean age of 30.6 years. They were all smokers, and none of them had any comorbidities. No major complications occurred. However, partial graft loss occurred in one patient and healed properly with secondary intention. All patients had high satisfaction scores of more than 70 in the EAR-Q questionnaires. Traumatic human bite ear amputations can be reconstructed with good esthetic outcomes by using single-stage temporoparietal fascia and the same skin of the amputated ear as a full-thickness skin graft whenever replantation is not feasible.

ROLE OF AUTOLOGOUS NANOFAT GRAFTING IN THE TREATMENT OF POST ACNE AND POST BURN SCARRING OF THE FACE.

Post acne and post burn facial scarring are more common in young generation leading to disfigurement and unpleasing result. These scars have major aesthetic, functional, and social effects on the affected person. Aim of the study was to establish the role of Autologous Nanofat grafting in treating post acne & post burn facial scarring in terms of pleasing aesthetic appearance of face & patient satisfaction. A total no. of 24 patients with mean age of 23 years was enrolled in the study. Thirteen patients were of post acne face scarring and 11 patients were suffering from post-burn face scarring. There were 10 male and 14 female patients. All patients were treated with Nanofat grafting with an average of 3 sessions at an interval of 4-6 weeks. The results were assessed after 6 months from the last session by comparison of pre procedure & post procedure pictures and patient satisfaction. Scars started improving after first session of Nanofat grafting and significant improvement in the scars was noted after 3rd session in terms of pigmentation, scar thickness and softness. Overall appearances of the scar were aesthetically improved a lot with a higher patient satisfaction rate. Autologous Nanofat grafting is a potential effective treatment modality for post-acne and post burn facial scarring with a good aesthetic outcome and higher patient satisfaction rate.

Classification of Microtia With Unusable Remnant Ear and Techniques in the First Stage of Two-Stage Auricular Reconstruction.

The remnant ear is a very important material in auricular reconstruction surgery; its dimension, position, and shape determine how it is used. However, the local conditions of microtia patients are complex and variable. Situations may be encountered where a series of abnormal remnant ears cannot be utilized in clinical practice. Currently, there are no literature that elaborates on this type of microtia and provides systematic treatment methods. The purpose of this article is to systematically classify them and optimize the two-stage method auricular reconstruction, to provide an effective surgical method for these patients. Based on the size, shape, and relative position of the residual ears, the unusable remnant ears were classified into three types: tiny size, abnormal shape, and relative position anomaly (over 1-cm higher than the contralateral earlobe). Fifty-three microtia patients with unusable remnant ear (54 ears) who underwent two-stage auricular reconstruction from August 2020 to August 2023 were reviewed. All patients had experienced earlobe reconstruction by using autologous rib cartilage during the first stage of surgery. Aesthetic assessments were evaluated from the naturalness of the earlobe reconstructed with autologous rib cartilage and the connection with the overall framework. The data on any complications that occurred during the follow-up period and patient satisfaction were collected. Among all patients, 31 had tiny size, 14 had abnormal shape, and 8 had excessively high positions. Patients were followed up for an average period of 9.2 months (6 to 12 months). No complex complications such as infection, skin necrosis, or cartilage exposure occurred. Fifty patients (94.3%) achieved excellent or good aesthetic outcomes. Fifty-one patients (96.2%) were satisfied with the reconstruction outcomes. An accurate assessment of the residual ear preoperatively is essential. Reconstructing and splicing the earlobe with autologous rib cartilage in cases where the residual ear cannot be utilized compensate for the defect that the soft tissue cannot provide the earlobe flap. This is an effective surgical method for the ear reconstruction in such patients.

Clinical effect of free chimeric anterolateral thigh flap and chimeric thoracodorsal artery perforator flap in chronic osteomyelitis

BackgroundChronic osteomyelitis poses a formidable challenge for orthopedic practitioners in the realm of clinical practice. Chimeric perforator flap is a commonly used repair method for chronic osteomyelitis. The purpose of this study was to compare the clinical efficacy of chimeric anterolateral thigh flap (C-ALTP) and chimeric thoracodorsal artery perforator flap (C-TDAP) for the treatment of chronic osteomyelitis. MethodsA retrospective analysis was performed on patients with chronic osteomyelitis of the lower extremity who underwent two kinds of treatment with chimeric perforator flaps from January 2014 to March 2022. The preoperative basic data, the operative and postoperative basic information of the two groups were collected and statistically analyzed. ResultsSixty-six patients were included in this study, and both groups achieved good aesthetic and functional results. Intraoperative results showed that the intraoperative blood loss and flap acquisition time in the C-TDAP group were less than those in the C-ALTP group. The incidence of postoperative complications in the donor and recipient sites in the C-TDAP group was significantly lower than that in the C-ALTP group, which led to a high reoperation rate in the C-ALTP group. Long-term follow-up showed that the wound healing time and weight-bearing walking time in the C-TDAP group were less than those in the C-ALTP group. ConclusionsBoth chimeric perforator flaps can effectively treat osteomyelitis with composite tissue defects, effectively eliminate inflammation of affected limbs and promote wound healing. However, C-TDAP flaps have more reliable healing effects on wounds and donor sites, and have fewer complications. Level of evidenceIII, Case–control study.

Satisfaction and results of the subareolar incision as treatment for gynecomastia in adolescents: experience of two centers.

Gynecomastia is a benign glandular proliferation that can affect adolescents causing significant psychological discomfort. Generally, it is idiopathic but underlying endocrinological conditions must be excluded. Different surgical techniques are available, the surgical correction with subareolar incision achieves the goal of satisfactory aesthetic result for patients. We studied all patients treated for gynecomastia in two centers of pediatric surgery. After collection of a detailed family history, we evaluated the presence of early onset of puberty, congenital abnormalities of the external genitalia, use of drugs, eating habits and the presence of genetic disorders. Laboratory tests and ultrasound were made to exclude endocrinological disorders. The surgical treatment was performed by a subareolar incision with gland and adipose tissue excision. A Body - Q chest module to evaluate patient satisfaction has been proposed to everyone before and after surgery. 47 adolescents with median age of 15 years were surgically treated. Three presented endocrinological disorders. Grade of gynecomastia for surgery was: III in 40 patients and IIb in 7 patients. Postoperative complications occurred in 5 patients. The Body - Q chest module was completed by 42 patients and showed good results for all points analyzed, except for social feelings. Gynecomastia in adolescents can be surgically treated with subareolar incision, reporting good aesthetic results and low incidence of complications. Specific tests are useful to assess patient satisfaction.