Good Aesthetic Results Research Articles

The first experience of treating linear types of capillary angiodysplasia of the skin in children with green laser light λ 520 ± 10.0 nm

Introduction. The linear type of capillary angiodysplasia (LCA) is represented by pathologically dilated vessels of the capillary flow located between the epidermis and hypodermis. LCA may be both congenital and acquired. By the type of blood supply, LCA are arterial, venous and mixed. Local infections and injuries, excessive solar insolation and hormonal imbalance are noted among LCA causes. LCAs are benign lesions, but they may have complications which may be triggered, for example, by traumatic damage to a pathologically enlarged vessel. There is a large number of non-invasive and invasive curative methods of LCA removal: cryotherapy, electrocoagulation, sclerotherapy, laser photodestruction and others. Among disadvantages, various authors mark: high risk of scarring, hyperpigmentation and high rate of disease relapse.Purpose. To improve results of treatment of children with LCA by using laser light.Material and methods. 32 children having LCA were treated with transcutaneous selective photodestruction ( green laser light, wavelength of 520 ± 10.0 nm generated by Russian-made laser device "Malachit") in Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in 2021–2022.Results. After treatment, 31 child had good results without residual vascular elements and scar deformation in the photodestruction zone. One patient required a repeated laser session because of remained residual elements after which she also had good results.Conclusion. The presented clinical trial has demonstrated that transcutaneous selective laser photodestruction with consideration of spatial localization of LCA structural elements in the skin, provides a precise treatment of pathological dilated vascular structures, practically without skin damage, and allows to achieve radical good clinical and aesthetic outcomes.

Pre- and Postoperative Evaluation of Immediate and Early Implant Placement in Esthetic Areas with Pre-Extraction Facial Dehiscence: A Retrospective Clinical Study.

The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.

Repair of Asian nasal subunit defects using nasolabial perforator flaps: A retrospective study.

The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons. To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re-operation. This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5-point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re-operation. The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm2 to 40 × 70 mm2 , and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re-operation (p = 0.004), but no risk factor was associated with complications. The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners.

Evaluation of outcomes of lower eyelid entropion and ectropion surgical repair.

<b><br>Introduction:</b> The imbalance of external and internal forces acting on the lower eyelid can result in entropion and ectropion, both of which cause ocular irritation and loss of proper eye protection. Potential complications of untreated cases include recurrent inflammation of the conjunctiva and cornea, conjunctival neovascularization, corneal abrasion or perforation, and ultimately even loss of vision. Although various surgical techniques are used to address this problem, their long-term outcome and effectiveness are still under discussion. </br> <b><br>Aim:</b> To evaluate outcomes of surgery for entropion and ectropion, including a modified Wheeler's method for entropion correction.</br> <b><br>Methods:</b> A non-comparative study (prospective and retrospective groups) included 100 patients operated on in two university hospitals' plastic surgery departments for lower eyelid entropion or ectropion, following formal ethics approval. The prospective group included 50 patients assessed preoperatively and at 3 and 12 months postoperatively. The retrospective group was comprised of 50 patients (2012-2018), whose preoperative documentation and clinical examinations were analyzed. The main outcome measures were change between pre- and postoperative patient-reported symptoms (VAS scale), ectropion/entropion grading scale (EGS/EnGS), quality of life (WHOQOL-BREF), and occurrence of complications.</br> <b><br>Results:</b> The differences in the severity of all symptoms before and after surgery evaluated with the VAS scale were statistically significant in both groups (p <0.05). We observed 6 recurrences (12%) in the prospective group and 9 (18%) in the retrospective group, with minor complications. Very good functional and esthetic postoperative results were confirmed in 70% (79) of the whole group and in 13 patients (81.3%) treated with the modified Wheeler's method. In the prospective group, the Mann- Whitney U test for dependent variables revealed significant improvement in the somatic, psychological, and environmental domains, with no significant change in the social relationships domain.</br> <b><br>Conclusions:</b> The results following entropion/ectropion surgery prove the effectiveness of the methods used. Complementing them with the modified Wheeler's method brought an increase in the number of very good outcomes. Surgery of lower eyelid malposition contributed to reduced symptoms and improved quality of life. The rates of postoperative sequelae were low.</br&gt.

Early management of columellar skin necrosis post-revision septorhinoplasty

Background: Columellar skin necrosis is a rare complication of Septorhinoplasty procedures. However, it is more frequent in patients who undergo multiple revision procedures and have poor skin quality. Therefore, some patients require wound care immediately post-operation. Dressing of the columellar region is difficult due to the location and anatomical configuration. Case presentation: In this paper, we present a case of partial necrosis of the columellar skin following an open Septorhinoplasty procedure which was noted on the first post-operative day. Improving circulation to the affected area was the key target of the treatment approach. Conclusion: A topical hemoglobin-based oxygenating spray (Granulox, SastoMed GmbH, Georgsmarienhütte, Germany) was applied immediately on the columellar skin wound as it is a simple and easy dressing material and can lead to healing without obvious scarring. Key points Question: Would an early, minimally invasive intervention with a hemoglobin-based oxygenating spray in a patient who was diagnosed with partial columellar skin necrosis 24 hours post revision Septorhinoplasty - without the need for surgical management provide a satisfactory outcome? Finding and meaning: The treatment yielded a good aesthetic outcome in a short duration with no significant side effects and demonstrated the ease of treating a difficult complication without the need for more surgeries.

Small-Incisional Double Eyelid Blepharoplasty: A Retrospective Study of Our Minimally Invasive Technique with Three Mini Incisions.

Small-incisional double eyelid surgery has been increasingly performed these years and achieved good aesthetic results, but the techniques vary greatly between literatures. The authors reviewed the cases of three-small-incisional double eyelid surgery performed in the past three years and introduced their surgical technique in detail. A total of 87 patients receiving bilateral three-small-incisional double eyelid surgery were included in this retrospective study. The pretarsal folds were designed meticulously, along which three evenly distributed 2mm-long incisions were made. A minimal amount of orbicularis oculi muscle and pretarsal soft tissue were removed to expose the pretarsal fascia for further fixation. An appropriate amount of orbital septal fat was removed through the lateral incision if required. The superficial orbicularis oculi muscle and dermis on the lower margin of the incision were fixed onto the pretarsal fascia with some underlying tarsus on the upper margin of the tarsus. The skin was closed by one stitch for each incision. The average follow-up was 9.9 ± 5.2 months (range: 6-27 months). All the patients were satisfied with the result. None of them experienced loss of the pretarsal fold, bilateral asymmetry, scar hyperplasia, or persistent swelling after surgery. Our three-small-incisional technique with minor soft tissue debulking offers a simple, safe, and reproducible approach to double eyelids. It can create a stable and natural-looking pretarsal fold with a short recovery period. 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 .

Clinical application of 675nm laser therapy for dorsal hand skin hyperpigmentation.

Noninvasive skin rejuvenation treatment is growing in recognition to aesthetic medicine. The objective of the study was to assess the efficacy and the safety of the 675-nm laser source treatment of photodamaged hands. The study included 21 patients (6 males and 15 females) with a mean age of 63(±9) years. Patients were treated with -two to three sessions of the 675-nm laser with a 1-month interval between sessions. Photos of each patient were collected at baseline, and 3 months after the last laser session. The 5-point Global Aesthetic Improvement Scale (GAIS) was recorded with their final assessment session (3 months). The total GAIS scores showed satisfactory results: 15 patients (71%) experienced 4 score (excellent improvement) changes and 6 patients (29%) experienced 3 score (good improvement) changes. Clinical images showed good efficacy and visible aesthetic results for the management of photodamaged skin. No serious adverse effects were recorded. This study demonstrates the safety and efficacy of for the aesthetic improvement of skin pigmentation and texture for photodamaged hands.

Результаты комплексного лечения пациентов с переломами скулоорбитального комплекса

Aim. To determine the effectiveness of complex treatment of patients with concomitant orbital injuries based on functional and hemodynamic parameters. Methods: from 2019 to 2020, 152 patients with traumatic brain injury were hospitalized in the Department of Maxillofacial Surgery, 103 of them were diagnosed with various fractures of the bones of the middle zone of the face, among which 35 patients (35 eyes) had fractures of the zygomatic-orbital complex complicated by traumatic optic neuropathy. Patients were divided into two groups, depending on the therapy. Results. Analysis of the results of combined surgical and joint ophthalmic conservative treatment of patients in the main group showed a significant improvement in hemodynamic parameters, which indicate stabilization of the ischemic process in 95 % of cases, and the analysis also showed the achievement of good anatomical, functional and aesthetic results. These parameters in patients of the main group significantly correlated with visual acuity. Conclusions. A decrease in the LBF in the ACR (12.62±1.21; 8.83±0.54) and PSCA (12.98±1.29; 11.58±0.86) was revealed which shows blood flow deficiency in retinal and choroidal vessels already on the first day after injury. The increase in the rate of hemodynamics in the AO (39.38±4.59; 37.0±2.61) most likely has a compensatory character for slowing down the hemodynamics of smaller vessels. The proposed complex treatment significantly improves hemodynamic parameters in 83 %, thereby helping to prevent the progression of traumatic optic neuropathy. Key words: traumatic optic neuropathy; zygomatic-orbital complex; hemodynamics; concomitant injury.

Handheld Doppler Detection and Light Illumination for Vascular Mapping in Nasal Reconstruction.

The application of the expanded forehead flap in nasal reconstruction has the advantage of being able to provide a sufficient amount of flap and can provide good aesthetic results. For an expanded forehead flap to survive, there must be adequate arterial supply and venous return. Despite this, limited studies have been conducted on preoperative vascular mapping and the design of the expanded forehead flap for nasal reconstruction. In this article, the authors present a technique of hand-held Doppler detection with light illumination for vascular mapping. The study included patients who underwent total nasal reconstruction with expanded forehead flaps between May 2016 and April 2021. The design of the flap was based on the result of preoperative vascular detection by hand-held Doppler detection assisted by light illumination. A total of 32 patients underwent total nasal reconstruction with an expanded forehead flap. The distal part of the flap became necrotic 1 week after the surgery in 2 patients. Following dressing changes and the administration of antibiotics, the distal flap in these patients survived well. No complications were reported in the long term. Hand-held Doppler detection combined with light illumination is a convenient and effective preoperative design method for nasal reconstruction with an expanded forehead flap. All flaps survived well in the long term. Level IV.

BONEPLANT: INNOVATION IN ALVEOLAR RIDGE ONE-STEP RECONSTRUCTION AND IMPLANTATION

Objectives: The aim of study was to evaluate the results of use Bone Plant implant in patients with different stages of alveolar ridges resorption. Materials and Methods: This clinical study included 17 patients (30-78 years old) 11 maxillary and 6 mandibles, with different stages of alveolar ridges resorption, with functional and aesthetic complaints requiring and with follow up period of average 4 years. Clinical, laboratory and computed tomography methods were used to plan implant therapy. Total installed 19 Bone Plant implant. Loading time was approximately 4 months after surgeries. Prostheses were made in the clinic according to the generally accepted protocol. The patients were rehabilitated with a fixed prosthesis on implants with good aesthetic and functional results. To evaluate the results of prosthetic rehabilitation, the following parameters were evaluated: implant success, prosthesis survival, implant marginal bone level (MBL). MBL was assess by digital x-ray were taken immediately and 3 months, 1 year, and 4 years after implant installation. A follow-up CT scan was performed to assess the accuracy of the implant. Results: The postoperative periods in all patients passed without complications, there were no serious intraoperative or immediate postoperative complications. 6 months after the prosthetic rehabilitation, clinical and X-ray studies showed no signs of inflammation in the area of the implants. We had one case of implant exposure due to applying a wrong surgical technique, so we had to cover the exposed wound by doing the second surgery. Unfortunately, we lost 2 Bone Plant implant because of infection. After 3 months loss of the marginal bone of 0.2 ± 0.25 mm (MBL), after 12 months of observation, there was a slight loss of the marginal bone over time 0,8 ± 0.48 mm (MBL), 1,3 ± 0.32. mm (MBL), after 4 years of observation. After 5 years, the effectiveness of implants was 97.4%. Conclusion: Boneplant is an innovative product which gives us the chance to reconstruct and remodel different alveolar ridges defects, and simultaneously doing implantation, avoiding other complications of traditional techniques. Achieved graft is very reliable and gives the opportunity of loading in less period of time․

Crouzon Syndrome (Congenital Craniofacial Dysostosis): from the Clinical Case to the Review of Craniosynostosis

Crouzon disease or Crouzon syndrome (CS) is a rare congenital anomaly that is caused by intrauterine premature closure of the coronal, sagittal and lambdoid sutures causing abnormal growth of the skull. It is considered an ultra-rare (ultra-orphan) disease, with an incidence of 1/50,000-60,000 neonates. We present the case of a 78-year-old woman with CS who presented congenital craniosynostosis with turricephaly, hypertelorism, external strabismus with bilateral exophthalmos and blindness (due to atrophy of the optic nerve of the right eye), maxillary hypoplasia, hearing loss, narrow palate, mandibular prognathism, malocclusion with crossbite, anosmia, parrot-beak nose, thin upper lip and facial asymmetry. It is a genetic disease with autosomal dominant inheritance, complete penetrance and variable expressivity. It is caused by mutations in the FGFR2 gene (chromosomal locus 10q25-10q26). From 30 to 60% of the cases are sporadic because they are new mutations (de novo mutations). The prenatal diagnosis of this entity is difficult, since the early welding of the sutures generally begins after birth. The diagnosis is fundamentally clinical, which must be complemented with imaging studies. Appropriate genetic counseling is necessary. In the future, with advances in clinical genetics, most craniosynostoses could be avoided if we incorporate the genetic study of the different genes involved (already known) to carrier screening. For this, it is necessary to promote assisted reproduction techniques (preimplantation genetic diagnosis). The cases that correspond to de novo mutations cannot be avoided through these strategies. Regarding treatment, an early diagnosis is required to plan a highly specialized surgery that allows the remodeling of the skull and face so as to achieve good aesthetic and functional results, and avoid some of the auditory and visual complications. In this article we review the embryology of the skull, craniosynostosis, and more specifically of CS.

Revisiting the pedicled circumflex scapular artery (pCSA) perforator flap: From simple to complex locoregional reconstructions

Soft tissue defects involving the axilla and the upper back region are often complex to treat. The complexity of these defects may be extremely different, ranging from superficial skin damage to large loss of substance with lymphatic drainage impairment. The pedicled circumflex scapular artery (pCSA) perforator flap represents a valid procedure in this setting. It can be tailored according to the patient's needs, and its intraseptal pedicle allows a quick dissection with a wide range of motion. Twenty-four consecutive patients treated by means of pCSA perforator flap were included. All the flaps were pedicled and were used for locoregional reconstructions. The etiology of the defects was an oncologic resection in 15 cases, acne/hidradenitis suppurativa resection in 6 cases, lymphatic complication in 2 cases, and burn in 1 case. Patients' mean age was 61 years old; seventeen were males and seven were females. All the patients were successfully treated with good aesthetic and functional results. One patient presented with a wound dehiscence, which required secondary surgical treatment. No partial or complete flap losses were encountered. Primary closure of the donor site was achieved in all cases. The mean follow-up period was 10.5 months (range 6-12). This case series shows the reliability and versatility of the pCSA perforator flap for locoregional reconstructions. Because of its rich vascularisation, extensive or unconventionally-shaped flaps are possible. Moreover, its lymphatic rich tissues make it suitable for the treatment of complications related to axillary lymphadenectomy.

Conversion rate and the probable factors for conversion from laparoscopic to open cholecystectomy

Background and objective: In western countries, the incidence of Cholelithiasis is found to be more than 10% in general populations. After performing the first successful laparoscopic cholecystectomy (L.C.) in Germany by Muhe in 1986, it rapidly became the procedure of choice in treating symptomatic gall stone. L.C. has a lot of advantages, including minimal trauma, rapid recovery, less analgesic requirement with a good esthetic outcome, however even in the hands of a best surgeon still there is a small percentage of conversion to open laparotomy, some risk factors has been recognized as a reason for the conversion to open laparotomy. This study aims to evaluate the rate with the underlying risk factors that increase the chance of conversion to open cholecystectomy. Methods: A total of 1400 patients for whom L.C. was attempted, 54 were enrolled in this prospective study from January 2014 to January 2020. The exclusion criteria were malignancy or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rates of conversion to open cholecystectomy with the underlying reasons for conversion were analyzed. Results: The overall rate of conversion to open cholecystectomy was 3.86% (54 patients). Out of 54 cases nearly two-thirds (61.1%) of the patients (33) were males and 38.9% of the patients (21) were females. Male: female ratio is 1.57:1. In the study sample, the conversion rate among obese (14/54) patients was 25.9% compared with the rate of 74.1% among non-obese (40/54) patients. Out of 3.86% of the conversion rate, 2.86% were non-obese and 1% were obese patients. The commonest etiology for conversion was thickened gall bladder due to severe gall bladder inflammation with fibrosis (21 patients) 38.9% followed by Acute cholecystitis (8 patients) 14.8%, then fibrosis (7 patients) 13% with aberrant anatomy at the calot’s triangle (6 patients) 11.1%. Conclusion: A thickened gall bladder was found to be the commonest risk factor for conversion to open cholecystectomy, the conversion from L.C. to O.C. should not be regarded as a failure of the procedure or as a complication, rather it should be regarded as a prudent maneuver for achieving the desired objective namely safe removal of the gall bladder.

Partial Extracorporeal Septoplasty in Crooked Noses.

In crooked noses, the standard septoplasty is a challenge because of the complex deviation of the septum, where straightening of the cartilage in situ is impossible. Hence, it is required to remove the partial/total septum and later is replaced backafter being straightened; the procedure is called partial/total extracorporeal septoplasty. In the present study, we shared our experience of partialextracorporeal septoplasty in patients with crooked noses. It is a retrospective analysis of 30 crooked noses who underwentextracorporeal septoplasty due to gross septal deviation from March 2020 to August 2022. The functional and aesthetic outcomes were evaluated at the end of 12 months. Of 30 cases, partial and totalextracorporeal septoplasty was performed in 28 casesand twocases respectively. Neoseptum was reconstructed with septal cartilage in 27 (90%) cases, costal cartilage in one case and conchal cartilage was usedin two instances. All the patients had good functional and aesthetic outcomes till 12 months of follow-up, and there were no major intraoperative or postoperative complications. Extracorporeal septoplasty can be an excellent surgical procedure in the highly deviated nasal septum, in Indian noses with a crooked nasaldeformity. It provides adequate exposure to the whole septum, ensuring good functional and aesthetic outcomes with minimal complication rate. 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 .

Comparative analysis of the frequency of complications in one-stage and two-stage breast reconstruction after subcutaneous/skin-saving mastectomy in combination with radiotherapy

Background. Breast cancer (BC) is not only a global medical problem, but a social problem associated with its steady growth and spread. Thus, the prevalence of BC in women in Russia in 2021 was 21.1 %. Combined or complex treatment is used in the vast majority of cases (surgery, drug and radiation therapy); in 2021, this percentage was 64.5 %. Currently, there is no doubt that radiation therapy is necessary as part of the complex treatment of patients with T1–3N1–2 BC, as it leads to an increase in survival rates. The development of reconstructive plastic surgery makes it possible to restore the removed breast using implants or autologous tissues. Reconstruction with endoprostheses is the main method, it accounts for up to 70 % of all reconstructive breast surgeries. Until recently, the most popular method was a two-stage reconstruction. Especially in cases where radiation therapy is planned. However, our own experience of one-stage reconstructions in combination with radiation therapy showed good aesthetic results with a low complication rate, which was the reason for this study.Aim. To study and compare the incidence of complications in one- and two-stage breast reconstruction after subcutaneous/skin-sparing mastectomy in combination with radiation therapy.Materials and methods. A prospective study of 92 patients diagnosed with BC was carried out. The patients were divided into 2 groups: group I (study) included 50 women, who underwent one stage – subcutaneous/skin-sparing mastectomy with breast reconstruction using an implant, II (control) group included 42 patients, who underwent subcutaneous/skin-preserving mastectomy with breast reconstruction with an expander, followed by replacement of the expander with an implant. After radiation therapy, the groups underwent a comparative assessment of anthropometric and anamnestic data, a study of the somatic anamnesis, the results of pathomorphological typing of the tumor, treatment tactics and complications.Results and conclusion. Subcutaneous/skin-sparing mastectomy with simultaneous breast reconstruction using an implant does not increase the incidence of postoperative complications when combined with radiation therapy, and also does not limit the appointment of concomitant treatment methods in the complex therapy of women with BC. This method of surgical treatment can be used in patients with IIA, IIB and IIIA stages of tumor growth.

Full-thickness elliptical excision of lobular capillary hemangioma over upper eyelid with good aesthetic outcome: A report of two cases

Abstract Lobular capillary hemangioma (LCH) or pyogenic granuloma is a benign vascular tumor seen in children and adults, with a propensity to bleed profusely. Diagnosis can be made on the basis of sudden onset, rapid growth, history of trauma, and recurrent bleeding, though histopathological evidence is confirmatory. As these tumors do not usually regress spontaneously and have a high rate of recurrence, full-thickness surgical excision is a good option, especially in areas of low tension, such as the eyelids, as it offers satisfactory results with good aesthetic outcome and low chances of recurrence. Here, we report two cases of LCH over the upper eyelids, which were treated by full-thickness elliptical excision.

Comparative evaluation of conventional versus modified lip repositioning surgery for gummy smile: A Two-year follow-up study

Abstract Background and Aim: Excessive gingival display can be managed by a variety of treatment modalities, depending on the specific diagnosis. Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. The aim of the present study was to minimize gingival display by comparing the modified lip repositioning procedure with the conventional lip repositioning procedure. Materials and Method: A total of 12 patients with gummy smile were selected for the study. The patients were randomly divided into two groups (group A and group B), consisting of six patients each. Group A patients were treated with conventional lip repositioning procedure and group B patients were treated with modified lip repositioning procedure. Result: The procedure resulted in a narrower vestibule and restricted muscle pull, thereby reducing gingival display during smiling. Conclusion: The lip repositioning technique that was meant to decrease the amount of gingival display proved to be more conservative and provided good aesthetic outcome.

Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision.

Nipple-sparing mastectomies (NSMs) have become a common surgical approach in the management of invasive breast cancers and ductal carcinoma in situ, and as a risk-reducing approach in genetically predisposed patients. The current standard of care in the management of positive nipple margin after NSM is total excision of the nipple-areola complex. In this article, we aimed to present a case series describing a novel approach to positive nipple margins with nipple-only excision and immediate nipple reconstruction using areolar flaps in patients who underwent NSM for noninvasive tumors. We conducted a retrospective review of patients who underwent NSM and were found to have positive nipple margins and underwent subsequent nipple excision with immediate areolar flap reconstruction. We identified 6 patients who underwent NSM and were found to have nipple margins-5 for ductal carcinoma in situ and 1 for invasive ductal carcinoma. These patients underwent nipple excision with immediate reconstruction using "sickle" flaps. We concluded that if nipple excision and immediate reconstruction with areolar sickle flaps can be performed, it results in good aesthetic outcomes without compromising oncologic results.

Bioengineered human tissue regeneration and repair using endogenous stem cells

We describe a general approach to produce bone and cartilaginous structures utilizing the self-regenerative capacity of the intercostal rib space to treat a deformed metacarpophalangeal joint and microtia. Anatomically precise 3D molds were positioned on the perichondro-periosteal or perichondral flap of the intercostal rib without any other exogenous elements. We find anatomically precise metacarpal head and auricle constructs within the implanted molds after 6months. The regenerated metacarpal head was used successfully to surgically repair the deformed metacarpophalangeal joint. Auricle reconstructive surgery in five unilateral microtia patients yielded good aesthetic and functional results. Long-term follow-up revealed the auricle constructs were safe and stable. Single-cell RNA sequencing analysis reveal early infiltration of a cell population consistent with mesenchymal stem cells, followed by IL-8-stimulated differentiation into chondrocytes. Our results demonstrate the repair and regeneration of tissues using only endogenous factors and a viable treatment strategy for bone and tissue structural defects.

Combined genioplasty, chondrolaryngoplasty, and glottoplasty: A novel scarless procedure in facial feminization surgery

Facial feminization is a long process with multiple surgical steps that is known to improve quality of life in transgender patients. Visible scars are a frequent complaint by this community as it adds to the stigmatization in this population. Combined procedures have been shown to be effective, by reducing the number of hospitalizations and the total length of recovery periods. In this context, we propose a novel scarless procedure combining a chondrolaryngoplasty, a glottoplasty, and a genioplasty using solely a transoral approach. First, we perform a glottoplasty according to the technique described by Wendler et al. and then a contraction genioplasty. Finally, the thyroid cartilage is approached by a subplatysmal dissection, between the mandibular osteotomy fragments. For now, 15 patients have benefited from this procedure in our department. Preliminary results demonstrate that this is an easy and safe procedure with good esthetic results and good patient satisfaction.