Pleasing Cosmetic Result Research Articles

Choice of Surgeons in Retractors used in Cleft Lip and Palate Surgery: An Original Research.

To ensure optimal exposure and enable precise tissue manipulation, cleft lip and palate abnormalities require surgical repair utilizing retractors. Different retractors may affect surgical outcomes; however, this is not yet evident. Examining surgeon preferences for retractors in cleft lip and palate surgery and assessing their impact on patient outcomes were the goals of this study. The patients who underwent primary cleft lip and palate repair were retrospectively analyzed. This study evaluated three widely used retractors: the Langenbeck, Gelpi, and Moult Mouth Gag retractors. This study looked at demographic information, surgical results (including scarring, aesthetic outcomes, and wound healing issues), and surgeon preferences for retractors. The study identified differences in surgical outcomes related to various retractor types. Both Group A (Langenbeck retractor) and Group B (Gelpi retractor) demonstrated similar favorable results, such as little wound healing issues, less scarring, and pleasing cosmetic results. The wound healing issues, scarring, and cosmetic outcomes were all worse in Group C (Moult Mouth Gag retractor). Retractors were not always preferred by surgeons doing cleft lip and palate surgery. The type of retractor had an impact on the surgical results; the Moult Mouth Gag retractor performed less well than the Langenbeck and Gelpi retractors. These results highlight the value of using evidence-based criteria to select retractors more effectively and enhance surgical methods for better patient outcomes in cleft lip and palate repair.

Hotspots of facial artery perforators and perforasomes for easier flap guidance: An anatomical study

BackgroundThe facial artery perforator flap is a valuable alternative for reconstruction of small to medium defects in the central midface and provide pleasing cosmetic results, allowing reconstruction in a one-stage procedure. Since Doppler ultrasound is not applicable to distinguish perforator from source artery, anatomical studies are needed to identify perforator areas along the course of the facial artery. MethodsTwenty facial arteries of 10 fresh anatomical head specimens were dissected. All perforators with an outer diameter of at least 0.50 mm were identified and injected with dye to color their respective vascular territories. Size and location of colored skin territories as well as the location of its perforators were documented and statistically analyzed. ResultsIn total, 89 perforators were identified. The average number of perforators per facial artery was 4.45±1.15. The mean outer diameter of the perforator at the origin of the facial artery was 0,65±0.14 mm. The mean size of the colored skin territories was 577.57±488.81 mm2. Perforator diameters were significantly associated with the size of its resulting perforasomes. Furthermore, perforators mostly originated in two specific areas: 3.5 cm lateral and caudal and 4.5 cm lateral and 5.5 cm caudal of the anterior nasal spine. ConclusionThis study provides evidence of two predominant locations of emergence of facial artery perforators. Additionally, the significant correlation between perforator size and its appendant perforasomes as well as their location with reference to the anterior nasal spine as relevant osseous landmarks helps surgeons in decision making for flap design and surgery.

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

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

Frontal-Temporal Triangle Area Hair for Eyebrow Restoration in Asians: A Comparative Study With Periauricular and Occipital Hair.

The frontal-temporal triangle area (FTTA) hair has a slow growth rate and thin caliber, which are similar to those of eyebrow hair. However, a comparison of cosmetic outcomes between FTTA and other scalp hair grafts in eyebrow transplantation has not been performed. To compare the cosmetic outcomes of FTTA hair and periauricular and occipital area (POA) hair in eyebrow restoration. A retrospective analysis of 155 patients with FTTA or POA hair transplants was performed. Comparative variables included patient characteristics, hair density, diameter, percentage of one-hair follicular units (FUs), number of transplanted FUs, harvesting time, transection rate, hair survival rate, frequency of eyebrow trimming, and patient satisfaction. There was a significant difference in hair density, diameter, percentage of one-hair FUs, and harvesting time between the FTTA and POA hair transplants. The FTTA hair grew significantly slower than the POA hair did. The patients in the FTTA group trimmed their postoperative eyebrows at a significantly longer interval than those in the POA group. The percentage of patients who were very satisfied with the surgery results was higher in the FTTA group. The FTTA hair grafts can provide aesthetically pleasing cosmetic results in eyebrow restoration.

Perforasomes of the facial artery

BackgroundThe facial artery perforator flap is a valuable alternative for reconstruction of small to medium defects in the central midface. Not only does it provide pleasing cosmetic results, it also allows reconstruction in a one‐stage procedure. Even though facial artery perforators have been examined by anatomical studies during the past years, there is still little knowledge of the vascular territories provided by these vessels. Aiming to make facial artery perforator flaps a plannable and safer procedure, this study examines the location and size of the vascular territories provided by facial artery perforators.Material and methods20 facial arteries of fresh specimen have been dissected. All perforators with an external diameter of at least 0,50 mm have been identified and injected with Methylene blue‐ or Eosin Y‐solutions to color their appendant vascular territories. All colored skin territories have been photographed, digitalized and measured. Their location, as well as the location of the perforating vessels, has been shown. All results were statistically analyzed.Results95 perforators with an external diameter of at least 0,50 mm have been identified. The average number of perforators per facial artery was 4,75. The mean external diameter at the origin of the facial artery was 0,64 ± 0,14 mm. The mean size of the colored skin territories was 5,62 ± 4,83 cm2. There was a statistical correlation between perforator diameter and the size of its vascular territory.ConclusionTwo areas have been shown in which facial artery perforators originate frequently. Their location has been described in relation to a bone structure. Size and shape of the vascular territories show a high variability with regions of increased density. The graphical illustration of the location of the facial artery perforators and their vascular territories can help making facial artery perforator flaps a better plannable procedure.

The Modified Lateral Intercostal Artery Perforator Flap.

The main surgical options for treatment of breast cancer are breast-conserving surgery and mastectomy. BCS aims to achieve complete excision of the tumor while achieving a pleasing cosmetic result. Excision of tumors in the lateral aspect of the breast has been associated with issues such as contour deformities and asymmetry. Development of volume replacement techniques such as the lateral intercostal artery perforator flap (LICAP) aimed to address these issues. Our modification of the traditional LICAP offers a less visible scar, good access to the axilla, and no need to reposition the patient. All patients undergoing a modified LICAP were identified from our database. The lateral intercostal artery perforators were marked with ultrasound and 2 "lazy S" lines were drawn to mark the flap. The wide local excision (with or without axillary surgery) was performed and the flap mobilized to fill the defect. Twenty-two patients underwent modified LICAP in 14 months. The mean specimen weight was 86 g. Four patients (18%) had a re-excision for positive margins. Nineteen patients had axillary surgery performed at the time of their modified LICAP flap. No patients had a scar that extended posterior to the posterior axillary line; no patients required a separate incision for axillary surgery; and no patients needed to be repositioned intraoperatively. Our early experience with this innovative procedure has been favorable. The perioperative complication rate is low. Due to the relatively short follow-up, longer term outcomes such as postradiotherapy appearance are yet to be determined.

Tackling Post-Operative Cutaneous Scarring with Autologous Cell Therapy

Regenerative medicine has brought about refreshing new thinking about age old problems. However, some problems remain mostly untouched and are not being addressed. A point in question is the track of scar tissue left behind post-operatively, which reveals the surgeon’s line of invasive incision. This confers on the patient an adverse psychological reminder and burden for the rest of his/her life. Most patients cannot afford corrective plastic surgery to ameliorate this skin defect. This paper seeks to ask whether biomedical scientists could play a role in arriving at a more pleasing cosmetic result, using a simple cell culture procedure of isolating un-manipulated autologous primary epidermal and dermal cells from a small skin tissue segment in close proximity to the surgeon’s incision line.

Autologous Reconstruction of a Complex Form of Poland Syndrome Using 2 Abdominal Perforator Free Flaps

Poland syndrome is the most frequent cause of congenital breast aplasia and hypoplasia. Breast and possible chest wall deformities can be treated with several surgical techniques, including implants, and pedicled or free flaps.We describe the case of a young patient with severe Poland syndrome with amastia, athelia, and deformity of the chest wall, and aplasia of 2 ribs. Marked hypoplasia of the ipsilateral latissimus dorsi muscle ruled out a reliable reconstructive option.Two perforator flaps were performed in a single-stage operation. A hemi-deep inferior epigastric perforator flap was harvested to correct the chest deformity, whereas the contralateral superficial inferior epigastric artery flap allowed breast reconstruction.No complications occurred and a subjectively and objectively pleasing cosmetic result was maintained at 3-year follow-up.

Minimal Access Kidney Transplant: A Novel Technique To Reduce Surgical Tissue Trauma

Minimally invasive surgery and minimal access surgery has replaced conventional surgical procedures during the last 15 years with benefits including a decrease in postoperative pain, time spent convalescing, early return to normal activities, and pleasing cosmetic results. Many centers perform kidney transplant through an oblique or J-shaped approach deep into the iliac fossa. Both approaches have possible disadvantages regarding the extent of tissue trauma. Therefore, we introduced a new minimal access kidney transplant technique in our kidney transplant program in 2008 and report the outcomes of the first 10 patients transplanted with this technique. Between November 2008 to May 2009, ten kidney recipients were subjected to the minimal access kidney transplant technique. These patients represent a consecutive series of kidney transplants performed by the senior surgeon or under the supervision of the senior surgeon of transplant surgery. The mean (± SD) age of the recipients was 47 ± 14.7 years (range, 28-67 y), the body mass index was 25 ± 2.02 (range, 23-30), the time of procedure was 126.2 ± 27.5 minutes (range, 90-165 min) with a mean (± SD) anastomoses time of 27.7 ± 8.4 minutes (range, 19-45 min). Follow-up for all recipients was at least 18 months. There was no reintervention necessary, no wound infections, no primary nonfunction or a delayed graft function, no need for dialysis, no acute rejection episodes, no graft loss, no wound dehiscence, no incisional hernia, or lymphocele. Furthermore, no urologic complications or vascular complications were observed. Our reported technique was used on heart-beating donor kidneys as well as on living-donor organs and is safe with less comorbidity. This minimal access kidney transplant technique might be an alternative procedure for avoiding some of the disadvantages of conventional approaches used for kidney transplant.

Oncoplastic Surgical Techniques for Personalized Breast Conserving Surgery in Breast Cancer Patient with Small to Moderate Sized Breast

Oncoplastic surgery has revolutionized the field of breast conserving surgery (BCS). The final aims of this technique are to obtain an adequate resection margin that will reduce the rate of local recurrence while simultaneously improving cosmetic outcomes. To obtain successful results after oncoplastic surgery, it is imperative that patients be risk-stratified based on risk factors associated with positive margins, that relevant imaging studies be reviewed, and that the confirmation of negative margins be confirmed during the initial operation. Patients who had small- to moderate-sized breasts are the most likely to be dissatisfied with the cosmetic outcome of surgery, even if the defect is small; therefore, oncoplastic surgery in this population is warranted. Reconstruction of the remaining breast tissue is divided into volume displacement and volume replacement techniques. The use of the various oncoplastic surgeries is based on tumor location and excised breast volume. If the excised volume is less than 100 g, the tumor location is used to determine which technique should be used, with the most commonly used technique being volume displacement. However, if the excised volume is greater than 100 g, the volume replacement method is generally used, and in cases where more than 150 g is excised, the latissimus dorsi myocutaneous flap may be used to obtain a pleasing cosmetic result. The local recurrence rate after oncoplastic surgery was lower than that of conventional BCS, as oncoplastic surgery reduced the rate of positive resection margins by resecting a wider section of glandular tissue. If the surgeon understands the advantages and disadvantages of oncoplastic surgery, and the multidisciplinary breast team is able to successfully collaborate, then the success rate of BCS with partial breast reconstruction can be increased while also yielding a cosmetically appealing outcome.

The Ventral V-plasty: a simple procedure for the reconstruction of a congenital megaprepuce

A buried penis secondary to a megaprepuce is defined clinically by a phimosis, failure of the corporal bodies to inhabit a variably deficient penile shaft skin and a basal hemispheric ballooning of the penis during micturition. Anatomically, it describes a condition in which a normal phallus is trapped within normal prepubic connective tissue by the excessive skin of a megaprepuce and a variable abundance of dartos fascia. Many surgical procedures have been described to correct this deformity, suggesting that no single method has a clear advantage. Most of them rely on relatively complex skin flaps or on the abnormal megapreputial tissue for reconstruction of the deficient ventral shaft skin. Herein, the authors describe an alternative technique for ventral skin coverage, the Ventral V-plasty. This surgical procedure allowed for the favorable reconstruction of 10 consecutive children with a buried penis secondary to a megaprepuce. This technique is distinguished by its simplicity and consistent, pleasing cosmetic results.

Augmentation of temporal fossa hollowing with Mersilene mesh

Temporal fossa hollowing can represent a serious cosmetic concern to patients', whether congenital; part of a post-traumatic deformity; following oncological resection; or following orbital decompression procedures. Various methods have been described to augment the defect including high density polyethylene (HDPE) implants, methyl methylmethacrolate and lipotransfer, but all have their relative drawbacks. We describe 13 temporal defects in 10 patients whose defects have been reconstructed with Mersilene mesh (Ethicon, Livingstone UK). When the temporalis muscle is still adequately suspended; folded mesh can be placed in a submuscular/subperiosteal plane. The mesh can be folded as many times as necessary to recreate the appropriate volume, thereby allowing fine control of temple width. If the temporalis is attenuated or displaced inferiorly by previous surgery, its insertion can be recreated using titanium screws to attach the mesh superiorly to the appropriate site on the cranium; the temporalis resuspended and the fascia sutured to the mesh. We report very pleasing cosmetic results with no associated complications such as implant, extrusion or exposure. One patient was complicated by infection requiring removal of the mesh as well as titanium cranioplasty, screws and plates. Mersilene mesh is easy to use, contours naturally to the defect and is considerably cheaper than alternatives like HDPE implants.

Transvaginal Extraction of the Specimen After Total Laparoscopic Right Hemicolectomy With Intracorporeal Anastomosis

Laparoscopic surgery for colonic disease has experienced an increased utilization by surgeons owing to decreased morbidity, less pain, earlier ambulation, earlier bowel function, fewer complications, decreased narcotic use, and improved cosmesis compared with open colon surgery. Current techniques require an abdominal incision, albeit smaller than an open laparotomy incision, which increases pain and complication rates such as infection, hernia development, and a less pleasing cosmetic result. The ability to perform a totally intracorporeal anastomosis will be an initial step to allow surgeons to perform natural orifice colon surgery in the future. One benefit of the intracorporeal anastomosis technique is that the only incision needed is for trocar placement. By combining the 2 techniques of totally intracorporeal anastomosis and transvaginal extraction of the specimen, surgeons will have the option to perform a totally laparoscopic colectomy on female patients. This case study describes a patient with a transvaginal route of specimen extraction after an oncologic laparoscopic right colon resection with intracorporeal anastomosis. It is the intent to further advance the technical options in the field of natural orifice surgery with the description of this technique. After completing a totally laparoscopic right colectomy with intracorporeal anastomosis and transvaginal extraction, an excellent postoperative recovery was demonstrated and has shown future potential for natural orifice surgery.

Immediate correction of sagittal synostosis

✓ A technique for correction of sagittal synotosis with achievement of an immediately pleasing cosmetic result is presented. Even with replacement of bone and no attempt to inhibit bone union, premature reclosure does not occur. Moss' theory of dural tensions is discussed to explain the effect.

Endoscopic vocal cord medialization: A new surgical technique without neck incision for laryngeal palsy

Different types of surgery have been reported for glottal insufficiency due to unilateral vocal cord paralysis. We recently developed a new surgical technique of fascia implantation known as vocal cord medialization. This new method achieves a wide glottal gap during phonation, without the use of an external approach. This new technique is described in detail herein, together with the satisfactory results we obtained in six cases of unilateral vocal cord paralysis with a wide glottal gap during phonation. We recommend this technique in cases of unilateral vocal cord paralysis in which both a satisfactory clinical result and an aesthetically pleasing cosmetic result are required.

Denis Browne's thoracotomy revised.

The three main issues involved in thoracotomy technique for the repair of oesophageal atresia (OA) are: (1) prevention of chest wall deformities; (2) adequate surgical exposure; and (3) the cosmetic appearance of the skin scar. Adequate surgical exposure should be the first priority. The technique described is an endeavour to address all the above concerns, a modification of the technique described by Denis Browne that eliminates the risk of injury to the long thoracic nerve (LTN). A retrospective analysis from case notes of 70 children (1974-1997) with OA from a single surgeon's practice was performed. Data collected included the presence of complications such as wound problems, chest-wall deformities, and evidence of nerve palsies including winged scapula. A uniform technique of a vertical skin incision in the mid-axillary line, preservation of the latissimus dorsi, and division of the serratus anterior muscle anterior to its nerve was followed in all cases. No wound infection, breakdown, or seroma formation was seen in any case. On long-term followup (range 1-22 years, mean 10.5 years) no chest wall deformities or nerve palsies were observed. This modification gives excellent exposure, avoids injury to the LTN, does not lead to chest-wall deformity, and gives a pleasing cosmetic result. The scar is hardly noticeable with the arm by the side of the body.

Involutional Entropion Surgery: A Modified Technique

Purpose: A study to evaluate the effectiveness of a modified procedure to correct involutional entropion. Methods: Seventeen cases of involutional entropion underwent surgery and had a postoperative follow-up of 18 months. The authors describe a technique of vertically shortening the anterior lamella (skin and orbicularis muscle), using a blepharoplasty incision and reflection of a skin muscle flap. Results: In 16 of 17 eyelids affected by involutional entropion, this operative procedure showed good functional outcome (good correction of the relation between lower eyelid edge and eyeball) and aesthetic outcome (no hypertrophic scar, dyschromia or unnatural folding of the skin). Conclusions: A correct approach to entropion surgery needs an accurate preoperative evaluation of the individual physiopathogenic factors. This procedure gives lasting functional and pleasing cosmetic results when preseptal orbicularis muscle override has been identified as the cause of senile entropion.

Phenytoin induced rhinophyma treated by excision and full thickness skin grafting

A 49-year-old man suffering from post-traumatic epilepsy presented with a severe rhinophyma probably induced by phenytoin. Initial surgical shaving was soon followed by recurrence, formation of intraepidermal cysts and persistent infection. Ultimate treatment by full thickness excision and a full thickness skin graft resulted in a pleasing cosmetic result. Radical excision of the affected skin followed by full thickness skin graft nasal reconstruction should be considered for cases of recurrent severe rhinophyma with inclusion cysts to eradicate chronic infection and improve cosmesis.

A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap.

The temporomandibular joint is occasionally encountered in extirpative surgery of the head and neck. It presents a difficult management issue. Little has been reported on functional outcomes after resection and reconstruction of the temporomandibular joint. A retrospective analysis consisting of chart reviews and phone interviews was performed on 17 patients who underwent fibular free flap reconstruction of the temporomandibular joint from 1993 to 1998. Mean follow-up in surviving patients (10) was 41.3 months. Mean age of the group was 62; male-to-female ratio was 11:6. Average hospital stay was 11.6 days. Four patients had no radiation therapy, 2 had preoperative and 11 had postoperative treatment. Five patients had one osteotomy, seven had two, one had three, and one had four. Ten patients could chew, one could not, and none were recorded for the remaining. Diet consisted of regular food for two patients, soft food for seven, full liquids for four, and tube feeds for four. Cosmesis was judged as excellent by eight patients, acceptable by two, and unacceptable by two. Five patients did not describe cosmesis. Most patients stated that bony contour was excellent, but that the soft tissue defect was noticeable. Speech was judged as intelligible by seven and moderately understandable by one. Nine patients did not describe speech. Two patients had postoperative displacement of the fibular head out of the fossa. Primary reconstruction of the temporomandibular joint with microvascular fibular flaps is a viable and effective means of restoring function. The majority of patients are able to resume oral feeds, obtain excellent or pleasing cosmetic results, and maintain intelligible speech.

Oromandibular reconstruction.

Oromandibular reconstruction is one of the greatest challenges of the head and neck surgeon. The ideal rehabilitation of the mandible and associated soft tissues requires maintaining premorbid occlusion, providing the opportunity for dental restoration, and preventing salivary incontinence. The approach to each patient must be individualized to maximize speech, swallowing, and mastication. Additionally, the surgeon must strive to fulfill these goals while achieving the most pleasing cosmetic result possible. Although some patients may be treated without reconstruction or with a metal plate and soft tissue flap, the majority of patients benefit from bony reconstruction utilizing a free flap. Reconstruction with free flaps results in more primary healing and fewer wound complications. Challenges specific to reconstructing the temporomandibular joint are discussed. We also review the indications for the different rehabilitative options and the merits of the individual flaps.