Postoperative Shrinkage Research Articles

Postoperative volume maintenance rate of microvascular free flap in oral and maxillofacial region: Systematic review and meta-analysis

Background and objectivesThe resorption of flap's volume can be frequently observed in the transplantation of microvascular free flaps, which could significantly affect postoperative function. Therefore, it's essential to comprehend the postoperative flap volume and the mechanisms behind before making clinical decisions. MethodsLiterature search was conducted from database on PubMed, EMBASE, Cochrane Library, Chinese database and Google Scholar. A random effects model meta-analyses and descriptive systematic review were performed. ResultsThe search identified 420 articles, of which 9 studies included in meta-analysis and 14 studies included in descriptive systematic review. Postoperative flap volume maintenance rate is used to represent the volume change. The pooled mean postoperative flap volume maintenance rate was 62.82 % for soft tissue flap (95 %CI: 58.83 to 66.82, p = 0.076, I2=56.3 %) and 85.96 % for bone flap (95 %CI: 84.19 to 87.73, p = 0.274, I2=20.4 %). Weight loss, muscle atrophy, and decreased serum albumin levels are risk factors for postoperative volume reduction of soft tissue flaps. The bone resorption rate of bone flaps in women is higher than that in men. ConclusionWhen designing microvascular free flaps for oral and maxillofacial surgery, soft tissue flaps should consider an anticipated postoperative shrinkage of 37 %, while bone flaps should consider an anticipated postoperative shrinkage of 14 %.

Antifibrotic Effect of Bletilla striata Polysaccharide-Resveratrol-Impregnated Dual-Layer Carboxymethyl Cellulose-Based Sponge for The Prevention of Epidural Fibrosis after Laminectomy.

The application of antifibrotic materials can alleviate epidural fibrosis by restricting excessive fibroblast proliferation and mitigating scar tissue formation. Here, a biodegradable carboxymethyl cellulose (CMC)-Bletilla striata polysaccharide (BSP)-resveratrol (RES) sponge was fabricated to inhibit scar tissue formation post laminectomy surgery. Fibroblasts NIH/3T3, myoblasts C2C12, neural cells PC-12, and Schwann cells RSC96 were used to evaluate the in vitro cytocompatibility. Laminectomies on 10 Sprague–Dawley rats with/without the application of the CMC-BSP-RES sponge were performed. The severity of adhesion between the dura mater and formed scar tissue was qualitatively scored. All cell lines exhibited good viability with no significant difference in cytotoxicity when cultured with variable extractions of the CMC-BSP-RES sponge. S100a4 and P4hb expressions were downregulated in NIH/3T3 cultured in the CMC-BSP-RES sponge, implying that this sponge potentially inhibits fibroblast activity. No post-operative shrinkage or dura mater expansion along the surgical site was detected. The peel-off tests revealed that the tenacity of adhesion de-creased. Histopathological examinations verified that the average number of fibroblasts in the CMC-BSP-RES group considerably decreased. The CMC-BSP-RES sponge is a biocompatible and effective material for alleviating post-operative epidural fibrosis and mitigating fibroblast expression following laminectomy.

A volumetric prediction model for postoperative cyst shrinkage

ObjectivesWith only limited information available on dimensional changes after jaw cyst surgery, postoperative cyst shrinkage remains largely unpredictable. We aimed to propose a model for volumetric shrinkage based on time elapsed since cyst surgery.Material and methodsWe used data from patients that underwent cyst enucleation or decompression between 2007 and 2017 and had at least three computed tomography (CT) scans per patient. We fitted one simple exponential decay model [V(t) = V0 · e−ɑt] and one model with a patient-specific decay rate [Vk(t) = V0 · e−βt + γkt].ResultsBased on 108 CT scans from 36 patients (median age at surgery: 45.5 years, IQR: 32.3–55.3, 44% female), our simple exponential decay model is V(t) = V0· e−0.0035t where V(t) is the residual cyst volume after time t elapsed since surgery, V0 is the initial cyst volume, and e is the base of the natural logarithm. Considering a patient-specific decay rate, the model is Vk(t) = V0· e−0.0049t + γkt where γk is normally distributed, with expectation 0 and standard deviation 0.0041.ConclusionsUsing an exponential regression model, we were able to reliably estimate volumetric shrinkage after jaw cyst surgery. The patient-specific decay rate substantially improved the fit of the model, whereas adding specific covariates as interaction effects to model the decay rate did not provide any significant improvement.Clinical relevanceEstimating postoperative cyst shrinkage is relevant for both treatment planning of jaw cyst surgery as well as evaluating the clinical success of the surgical approach.

Radiological outcome after surgical treatment of syringomyelia-Chiari I complex in adults: a systematic review and meta-analysis.

Foramen magnum decompression (FMD) is widely accepted as the standard treatment for syringomyelia associated with Chiari type I malformation (CMI). Despite extensive clinical investigations, relevant surgical details are still matter of debate. The authors performed a systematic review and meta-analysis of the literature examining the radiological outcome of syringomyelia in adult patients with CMI after different surgical strategies. PRISMA guidelines were followed. A systematic search of three databases was performed for studies published between 1990 and 2018. Our systematic review included 13 studies with a total of 276 patients with CMI associated with syringomyelia. Overall, the rate of post-operative radiological improvement at last follow-up was 81.1% (95% CI 73.3-88.9%; p < 0.001; I2= 71.4%). The rate of post-operative syrinx shrinkage did not differ significantly among both groups of decompression with the extra-arachnoidal technique and arachnoid dissection (90%, 95% CI 85.1-94.8%, I2= 0% vs 79.8%, 95% CI 61.7-98%, I2= 85.5%). A lower rate of post-operative radiological syrinx shrinkage was observed after decompression with splitting of the outer layer of the dura (55.6% 95% CI 40.5-70.8%, I2= 0%). CSF-related complications and infections were similar among the different groups. Our meta-analysis found that FMD with the extra-arachnoidal technique and arachnoid dissection provides similar results in terms of post-operative shrinkage of syringomyelia. Patients undergoing decompression with splitting of the dura presented the lower rate of syrinx reduction. These data should be considered when choosing the surgical approach in adult patients with CMI associated with syringomyelia.

Immediate two-stage nipple reconstruction with a local mastectomy flap following secondary autologous breast reconstruction

Because of the inevitable postoperative shrinkage, an initial hypercorrection is emphasized in nipple reconstruction with a random skin flap. However, the breast shape will be damaged if an excessively large flap is raised on the surface of the breast mound. A technique for immediate two-stage nipple reconstruction with a local mastectomy flap during the secondary breast reconstruction was reported in this study. From February 2011 to March 2014, 33 patients underwent breast reconstruction and immediate two-stage nipple reconstructions. A bipedicle deep inferior epigastric artery perforator (DIEP) flap was raised and folded upward to form the breast. Simultaneously, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of the future nipple. After 3 weeks, the pedicle of the mastectomy flap was divided, and the paddle was modeled to form the new nipple. Both the new nipple and the DIEP flaps survived postoperatively. The average projection of the reconstructed nipple was 15.4 ± 2.7 mm immediately after the surgery, which gradually decreased to 8.2 ± 1.1 mm during the first year of follow-up. A total of 29 patients ranked the aesthetic appearance of the reconstructed nipple and breast as "very good" or "good." On the basis of our breast-shaping techniques, the proposed immediate two-stage nipple reconstruction approach is able to maintain long-term residual projection and results in considerable patient satisfaction. IV.

A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time.

IntroductionThe clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time.MethodsA surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch).ResultsThere was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm3 (4–118) and CT2ch: median 16 cm3, (2–99), (P = 0.01), but no significant volume reduction thereafter.ConclusionSurgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.

Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair.

BackgroundAneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance.MethodsPatients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6–18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks.ResultsSome 597 EVARs (71·1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47·6 per cent), moderate shrinkage (5–9 mm) in 142 (23·8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28·6 per cent). Four years after the index imaging, the rate of freedom from complications was 84·3 (95 per cent confidence interval 78·7 to 89·8), 88·1 (80·6 to 95·5) and 94·4 (90·1 to 98·7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3·11; P < 0·001). Moderate compared with major shrinkage (HR 2·10; P = 0·022), early postoperative complications (HR 3·34; P < 0·001) and increasing abdominal aortic aneurysm baseline diameter (HR 1·02; P = 0·001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage.ConclusionEarly change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance.

Tumor shrinkage after transsphenoidal surgery for nonfunctioning pituitary adenoma

Volume reduction of nonfunctioning pituitary adenomas has been described, for example, after radiotherapy and pituitary tumor apoplexy. Even when considerable remnants remain after surgery, spontaneous shrinkage and relief of mass lesion symptoms can sometimes occur. The aim of this study was to assess shrinkage of tumor residues after transsphenoidal surgery and to identify predictors of tumor shrinkage. A total of 140 patients with postoperative remnants of nonfunctioning pituitary adenomas treated at the Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany, were included in this study. All patients underwent transsphenoidal procedures with guidance by 1.5-T intraoperative MRI. The intraoperative images of remnants were compared with images taken at 3 months and at 1 year after surgery. The possible predictors analyzed were age; sex; preoperative and intraoperative tumor dimensions; tumor growth pattern; endocrinological, ophthalmological, and histological characteristics; and history of previous pituitary surgery. For statistical analyses, the Fisher's exact test, Mann-Whitney U-test, and multivariate regression table analysis were used. Follow-up imaging 3 months after surgery showed tumor remnant shrinkage of 0.5 ± 0.6 cm3 for 70 (50%) patients. This reduction was 89% ± 20% of the residual volume depicted by intraoperative MRI. In 45 (64%) patients, the remnants disappeared completely. Age, sex, and preoperative tumor volume did not significantly differ between the shrinkage and no-shrinkage groups. Positive predictors for postoperative shrinkage were cystic tumor growth (p = 0.02), additional resection of tumor remnants guided by intraoperative MRI (p = 0.04), smaller tumor volume (p = 0.04), and smaller craniocaudal tumor diameter of remnants (p = 0.0014). Negative predictors were growth into the cavernous sinus (p = 0.009), history of previous pituitary surgery (p = 0.0006) and tumor recurrence (p = 0.04), and preoperative panhypopituitarism (p = 0.04). Multivariate regression analysis indicated a positive correlation between tumor shrinkage and smaller tumor remnants (p < 0.0001) and no history of previous pituitary surgery (p = 0.003). No spontaneous change in tumor remnant volume was detected between 3 months and 1 year postoperatively. During a mean follow-up time of 2.7 years, 1 (2%) patient with postoperative tumor shrinkage had to undergo another operation because of tumor progression. Spontaneous volume reduction of nonfunctioning pituitary adenoma remnants can occur within 3 months after surgery. Predictors of shrinkage are smaller tumor remnant volume and no history of previous pituitary surgery.

Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases

ObjectivesFull thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery.Materials and MethodsIn a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records.ResultsThe width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%).ConclusionFTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

Lip Reconstruction with a Palatal Mucoperiosteal Graft

To achieve complete lip closure, the lips must have sufficient and uniform thickness, which provides good aesthetic and functional results. There are many advantages to using palatal mucoperiosteal grafts for vermilion lip reconstruction: (1) the graft structure is anatomically and histologically similar to the vermilion lip, (2) donor site morbidity is less than that at other donor sites, (3) the color and texture match are good, (4) there is little postoperative shrinkage, and (5) the graft tissue is thicker than a palatal mucosa graft, helping ensure complete engraftment. This article outlines a novel procedure for lip reconstruction with a palatal mucoperiosteal graft.

Mesh in prolapse surgery: an imaging perspective

Mesh in prolapse surgery: an imaging perspective

Use of an Ultrasonic Surgical Aspirator to Expose Buried Coronary Arteries

In coronary artery bypass grafting, the target arteries for grafting can be buried in thick adipose tissue or myocardium, and exposure may be difficult. We used an ultrasonic surgical aspirator to expose buried coronary arteries. Fat tissue or myocardium covering coronary arteries was removed, and target arteries were exposed with little bleeding. No arrhythmia or coronary spastic event occurred during its application, and bypass grafting could be completed. In postoperative angiography, no deformity or shrinkage of coronary arteries was observed at the sites at which the ultrasonic aspirator was applied.

Tendon grafts with peritendinous areolar tissue increase the survival of endotendinous tissues and diminish postoperative shrinkage

We observed greater postoperative shrinkage of grafted fascia lata without peritendinous areolar tissue (PAT) than with PAT in blepharoptosis surgery. In this article, we sought to evaluate the influence of PAT on tendon grafts. Pairs of anterior tibial tendons with or without PAT were grafted onto the backs of 12 adult Wistar rats. The cephalic and caudal ends of the tendons with or without PAT were fixed tightly on the fascia of the erector spinae muscles with 6/0 polypropylene sutures. A 7-mm distance was maintained between the sutures. Changes in the length between the sutures as well as changes in the histology of the tendons with or without PAT were evaluated at 1 and 5 months after grafting. The mean lengths of the grafted tendons with PAT at 1 and 5 months after grafting were significantly longer than those without PAT at 1 and 5 months after grafting, respectively (5.4 mm and 4.5 mm vs. 3.8 mm and 2.9 mm, respectively; Wilcoxon signed-rank test; P < 0.05). The grafted tendons without PAT displayed central necrosis and scar formation, whereas those with PAT displayed no alteration in the tissue properties. At both 1 and 5 months after grafting, the grafted tendons with PAT were significantly longer and survived better than those without PAT. Tendon grafts with PAT had increased survival of the endotendinous tissue and diminished postoperative shrinkage, since the vascular network of the PAT potentially contributes to early revascularisation of the graft.

Ratio of directly necrotized volume to total volume of a submucosal myoma predicts shrinkage after microwave endometrial ablation

To explore parameters relating to shrinkage of submucosal myomas after microwave endometrial ablation. Fourteen patients underwent microwave endometrial ablation at 2.45 GHz using a curved microwave applicator to treat menorrhagia caused by a submucosal myoma. The size of myomas was measured on magnetic resonance images before, one month after, and six months after the operation. The average radius r was defined as half of the size of the myoma measured in three dimensions. The protrusion ratio alpha was defined as the ratio of the thickness of the protruding part of a myoma in the uterine cavity to the size of the myoma before the operation. The ratio of the directly necrotized volume by microwave irradiation to the total volume (RODNeV) of preoperative myomas was calculated using the following formula: (1) where d is the depth of myoma tissue directly necrotized by microwave irradiation. The relationships of preoperative alpha, r and RODNeV to postoperative shrinkage were then examined. Two-dimensional plots showing shrinkage of submucosal myomas versus the RODNeV indicated that shrinkage at six months after microwave endometrial ablation depends on the RODNeV. Myomas with a RODNeV greater than 0.17 had shrunk more than 50% at six months after the operation. RODNeV is closely related to postoperative necrosis and shrinkage of the submucosal myoma after microwave endometrial ablation. Prediction of the shrinkage rate of submucous myomas appears to be possible by calculating the RODNeV preoperatively.

Frontalis suspension with fascia lata for severe congenital blepharoptosis using enhanced involuntary reflex contraction of the frontalis muscle

Increased stretching of the mechanoreceptors in Mueller's muscle induces involuntary reflex contraction of the ipsilateral frontalis muscle. We used this neurophysiological mechanism during surgery on 50 patients with severe unilateral or bilateral congenital blepharoptosis that does not have the levator muscle but has Mueller's muscle. To facilitate contraction of the superior rectus muscle to sufficiently stretch the mechanoreceptors in Mueller's muscle, transverse fibrous tissues that restrict the stretching are medially and laterally incised. Without fascial or muscular advancement, the fascia lata was grafted as far between the frontalis muscle and the tarsus as possible. After 15.5% postoperative shrinkage of the grafted fascia lata, all 50 patients involuntarily elevated their ptotic eyelids over the pupillary centre on primary gaze without severe lagophthalmos on eye closing. Forty-five patients could lift the upper eyelid over the pupillary centre even on upward gaze. Our procedure appeared to enhance the involuntary reflex contraction of the ipsilateral frontalis muscle, providing satisfactory dynamic retraction of the upper eyelid through fascia lata. We consider our procedure an alternative for reconstructing not only severe congenital blepharoptosis but also severe acquired blepharoptosis after orbital trauma or orbital tumour resection, in patients who do not have or lose the levator muscle while the Mueller's muscle, the superior rectus muscle and the trigeminal proprioceptive nerve function to induce involuntary reflex contraction of the frontalis muscle.

Evaluation of Intrasyrinx Fluid Motion by Spatial Modulation of Magnetization-Magnetic Resonance Imaging in Syringomyelia With Long-Term Follow-Up

To evaluate the use of measuring intrasyrinx fluid motion in syringomyelia by spatial modulation of magnetization (SPAMM)-magnetic resonance imaging (MRI) for predicting postoperative results. Fourteen patients with syringomyelia, who underwent surgery between 1995 and 2004 and took both preoperative SPAMM-MRI and postoperative MRI, were reviewed retrospectively. The SPAMM-MRI was obtained on a 1.5-T system using the electrocardiogram-triggered multiphase image technique with repetition time/time to echo/diffusion time/flip angle = 42 milliseconds/7.2 milliseconds/0 to 600 milliseconds/20 degrees. Three radiologists analyzed the tagging band shifting of the intrasyrinx fluid motions on the preoperative SPAMM-MRI. If the tagging band shifting during the systolic phase was more than half of the band space, it was regarded as good fluid motion. The correlation between the preoperative intrasyrinx fluid motion and the postoperative shrinkage of the syrinx was statistically analyzed. The underlying causes of the syringomyelia were Arnold-Chiari malformation (7 patients), trauma (4 patients), and infectious disease (3 patients). Eight of 9 patients who had good fluid motion in the syrinx showed postoperative shrinkage of the syrinx. However, the 5 patients who had poor fluid motion showed no shrinkage of the syrinx. The fluid motion of the syrinx was highly correlated with the postoperative shrinkage of the syrinx (P < 0.01). Evaluation of the intrasyrinx fluid motion in syringomyelia using the SPAMM-MRI can be a useful predictor of postoperative results and may indicate how well the pulse wave is transmitted from the heart to the syrinx.

Long-term nipple shrinkage following augmentation by an autologous rib cartilage transplant in free DIEP-flaps

Aesthetically pleasing nipple-areola reconstruction is a satisfying part of a two-stage breast reconstruction. The up to 50% [Banducci DR, Le TK, Hughes KC. Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction. Ann Plast Surg 1999;43(5):467-9; discussion 469-70] postoperative shrinkage following a conventional nipple reconstruction is a well-known problem. Augmentation of the nipple with autologous banked cartilage seems to be a promising solution. From 2000-2003, 17 patients underwent a nipple-areola-complex reconstruction following secondary breast reconstruction using free perforator flaps. The rib cartilage harvested during the preparation of the internal thoracic vessels was banked subcutaneously and six months later replanted under the 'arrow flap' after contouring it in a 'mushroom' shape. One year later the shrinkage of the nipple in comparison to the intraoperative status was measured. In addition, patients were asked about their personal palpation impression and the aesthetic outcome. The average height decreased one year postoperatively about 25%. Thirteen of 17 patients judged the aesthetic outcome as very good, 16 nipples healed without cartilage protrusion and no patient felt discomfortable stiffness of the nipple. Our concept of a nipple augmentation with rib cartilage improves the projection and allows a more correct judgement of the later nipple shrinkage. We consider this technique to be an aesthetically satisfying and safe method, which could be used with any kind of breast reconstruction.

Reconstruction of the nasal tip including the columella and soft triangle using a mastoid composite graft

This paper describes the use of a composite graft from the mastoid area consisting of full-thickness skin peripherally and selectively localised fascia-fat tissue underneath the skin centrally for immediate reconstruction of moderate defects of the nasal tip including the columella and soft triangle. Mastoid composite grafting is a simple and safe procedure that avoids partial graft loss and provides adequate augmentation of soft tissue, easy reshaping of the new nostril rim, minimal post-operative shrinkage, and no donor-site morbidity. Then, it results in a satisfactory nasal appearance with adequate tip projection and symmetry. This procedure may represent a preferred method of nasal tip reconstruction.

Surgical Results of Foramen Magnum Decompression for Chiari Type 1 Malformation associated with Syringomyelia:

To evaluate neuroradiological characters affecting postoperative shrinkage of syringes associated with Chiari type 1 malformation, we assessed 56 patients who underwent foramen magnum decompression (FMD) and were followed-up at least one year. In 48 cases (85.4%), the postoperative courses were quite satisfactory. The cerebellar tonsils have moved upward during surgery and the syringes have decreased in size on MRI taken one or three months after surgery (the prompt group). In eight of 56 patients (14.3%), however, the syringes were slow to shrink and remained over one year after surgery (the delayed group). Basilar impression was more common in the delayed group (p=0.026). These patients had a wider basal angle (142.6 degrees for the delayed group compared with 135.4 degrees for the prompt group), narrower clivo-axial angle (CAA; 121.7 and 142.8 degrees, respectively) and severely lordotic cervical spine (8.0mm and 4.5mm, respectively) on plain X ray films. Those with CAA narrower than 130 degrees showed significant delay in shrinking of the syringes. The CAA might be a good indicator to predict the time course of syrinx shrinkage after FMD.

Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia

We describe method for reconstructing full-thickness ear defects using conchal cartilage graft covered by a pedicled temporoparietal fascial flap with a full-thickness skin graft. We treated eight partial, full-thickness defects of the ear in eight patients, two males and six females. The patients' ages ranged from 10 to 68 years. In five patients, the ear defects were caused by malignant tumor resection (three) and trauma (two). In the remaining three patients, the defect was created after correction of congenital ear deformity (constricted ear). In all cases, the defect included the helical rim and involved the upper third of the ear. The defect size to be reconstructed ranged from 10×14 mm to 16×20 mm. The ipsilateral conchal cartilage could be harvested without any problems in all cases. Grafted skin was obtained from the lower lateral abdomen. In all cases, the blood supply to the fascial flap was good, and the grafted skin took completely. The post-operative course was uneventful in all donor sites for cartilage, temporoparietal fascia, and full-thickness skin. Post-operative shrinkage was not significant and the reconstructed ear was close to the expected contour and size. In all cases, the defects were reconstructed almost completely satisfactorily in terms of contour of the helical rim and support. Although the color match of the grafted skin was not ideal, all patients were satisfied with the results. No donor deformity of the conchal cartilage was found in any case, and the donor scar of the temporoparietal fascia was hidden by the hair. We conclude that the use of conchal cartilage graft and temporoparietal fascial flap with full-thickness skin graft is useful in one-stage reconstruction of medium-sized full-thickness defects of the ear.