Satisfactory Aesthetic Results Research Articles

Effect of index thickness on the accuracy of direct restorations using composite resin injection technique with VPS indices.

To evaluate the accuracy of direct restorations using transparent vinyl polysiloxane (VPS) indices with different thicknesses for composite resin injection technique. Thirty-six standard resin teeth of tooth #11 were divided into 3 groups based on the index thickness including 2, 4, and 6 mm (n = 12). VPS indices were fabricated using customized trays corresponding to each thickness. Tooth defect was created by sectioning 4 mm of the crown, which was then restored using the composite resin injection technique under the VPS index. Pre- and post-treatment scans were fitted, generating a deviation distribution map of tooth #11. Overall root mean square (RMS) and distance deviations along the central longitudinal section were recorded for accuracy evaluation. One-way ANOVA with Tukey post hoc comparisons and the Levene test were used for statistical analysis (α = 0.05). Both mean and standard deviation values of RMS for injected restorations decreased as index thickness increased, with no significant differences observe between 4-mm and 6-mm index groups. Distance deviations of the injected restorations were generally less than 0 in all groups, and deviations of the middle third of the lingual surface significantly exceeded 50 μm in 2-mm index group. The accuracy including trueness and precision of direct restorations using the composite resin injection technique improved with increasing index thickness, but no significant differences were found between the 4-mm and 6-mm indices. Besides, all the results were within the clinically acceptable error values for the 4-mm and 6-mm indices. For achieving clinically acceptable accuracy in restorations using the composite resin injection technique, a VPS index thickness of 4 mm is both the minimum requirement and sufficient, ensuring satisfactory esthetic and functional outcomes.

Testicular lodges creation during scrotal reconstruction by ALT (anterolateral thigh) island flap after Fournier gangrene: A case report.

Fournier's gangrene is a severe infection of the perineum and genital regions, with high mortality rate. Treatment is medico-surgical and multidisciplinary, usually requiring extensive debridement of scrotal tissue and distant surgical reconstruction. Regarding scrotal reconstruction, numerous techniques have been described, however, to our knowledge, none has focused on testicular repositioning. We present the case of a 47-year-old patient treated for secondary Fournier's gangrene on post-traumatic colic fistula following a road traffic accident. We performed scrotal reconstruction using an ALT flap, with simultaneous positioning of testicular implants to create new lodges. In a second time, the testicular implants were removed and the previously buried testicles were repositioned in their new lodges, with bilateral orchidopexy. The anterolateral thigh flap has already been described for scrotal reconstruction. Its main advantages over a thin skin graft are partial innervation and more convincing aesthetic results, with notably less skin retraction. In addition, it allows a sufficiently large skin palette to be harvested, enabling satisfactory scrotal coverage. Placement of 2 testicular implants during scrotal flap reconstruction after Fournier's gangrene enables the creation of testicular lodges, facilitating subsequent repositioning of previously buried testicles. This technique also ensures a satisfactory aesthetic and functional result.

“The Forklift Flap: A Conjoined Perforator Flap for Bilateral Cervicofacial Reconstruction”

Background: Cervicofacial defects have a profound functional, aesthetic, and psychological impact. If optimal bedside wound care fails, surgical management is warranted. We propose our innovative forklift flap technique in the reconstruction of medically-refractory Hurley Stage III hidradenitis suppurativa (HS) affecting the lower face, submentum, and neck: providing both improved functionality and aesthetic appearance. Methods: Full-thickness excision of the area was performed with immediate reconstruction utilizing our novel forklift flap—a local, doublysupercharged, independent branch-based, conjoined perforator flap. The flap encompasses the vascular territories of the supraclavicular, parascapular and lateral arm flaps. The flap remained pedicled on the supraclavicular artery and supercharged with both the circumflex scapular and the posterior radial collateral arteries. The supraclavicular, parascapular, and extended lateral arm measured 33 cm × 8 cm, 30 cm × 10 cm, and 53 cm × 14 cm, respectively, and resulted in 1306 cm2 of coverage. The supraclavicular and parascapular sites were closed primarily with interspersed penrose drains. The lateral arm healed by secondary intention following application of a dermal regeneration template. Five months postoperatively, 2000 mL debulking was performed with liposuction. Results: Results were stable at subsequent postoperative visits. At 2 years follow up, minor recurrence of submental HS occurred adjacent to our flap. Conclusion: Surgical management is an optimal choice for patients with refractory HS lesions. Our forklift flap technique provides satisfactory aesthetic and functional outcomes for large cervicofacial defects.

Proboscis Lateral: A Case Report

Introduction: The lateral proboscis is a rudimentary nasal structure located off the vertical midline of the face. This malformation is often accompanied by other anomalies, most commonly ophthalmic conditions such as anophthalmia, microphthalmia, and colobomas, as well as facial anomalies like maxillary hypoplasia or facial clefts, and cranio-cerebral anomalies including encephalocele and holoprosencephaly. Methods: This report presents a case of a newborn with a lateral proboscis identified at birth. The pregnancy was poorly monitored, and the anomaly was discovered immediately after delivery. Results: The newborn exhibited a lateral proboscis with a rudimentary nasal structure extending from the right side of the face, along with associated ophthalmic anomalies including microphthalmia. No additional facial clefts or cranio-cerebral abnormalities were noted. The infant was managed with early reconstruction plans and supportive care. Discussion: Early reconstruction is recommended, starting at a young age. Cartilaginous or bony support may be considered by the end of adolescence to achieve a satisfactory aesthetic result. This case highlights the importance of early diagnosis and intervention for optimizing outcomes in such rare malformations. Conclusion The presented case of lateral proboscis demonstrates a favorable outcome despite the challenges associated with this rare condition. Early surgical intervention and proper management are crucial for achieving positive results and improving the patient's quality of life.

Modified lip repositioning for management excessive gingival display: A case report

Introduction: Excessive Gingival Display (EGD), commonly known as “gummy smile” is a condition in which the maxillary gingiva looks excessive (>2 mm) than normal when someone is smiling. This condition is considered aesthetically disturbing, affecting the patient's self-confidence and psychological state. The objective of this case report is to describe the stages of gingivectomy and modified lip repositioning for EGD reconstruction and attachment of the labial mucosa of the maxillary anterior region. Case Report: A 21-year-old male came with the main complaint of wanting to improve his smile which showed less attractive gums. The results of the examination obtained the presence of EGD and hypermobile upper lip so a combined surgical action was planned with gingivectomy and modified lip repositioning for EGD reconstruction and attachment of the labial mucosa of the maxillary anterior region. Case management: The first surgical procedure performed was gingivectomy. One month later, modified lip repositioning was performed. The patient was satisfied with the treatment results and at follow-up after 7 months there was no EGD when the patient smiled. Conclusion: Combined gingivectomy and modified lip repositioning surgery can be an alternative treatment to correct Excessive Gingival Display and provide satisfactory aesthetic results for patients

Management of Tessier No. 2 Facial Cleft Using Millard Technique with Zig- Zag Ad-vancement Flap: A Case Report

Introduction: Craniofacial cleft is a rare congenital disorder that affects facial and skull. development, with an incidence estimated between 1.4-4.9 per 100,000 births. This condition often results in significant complications such as feeding difficulties, impaired speech, hearing issues, and psychosocial challenges. Among craniofacial clefts, the oblique facial cleft, including Tessier No. 2 cleft, is the rarest and least documented. This cleft is characterized by specific soft and hard tissue deformities resulting from a failure of fusion among facial processes during embryonic development. Case: An 8-month-old female presented with a unilateral cleft of the lips, gums, and palate on the left side, accompanied by a Tessier No. 2 facial cleft. The patient's mother reported no history of teratogenic exposure or family history of clefts. Clinical examination revealed hypoplasia of the middle third of the nasal margin, a flattened lateral nose, a widened nasal bridge, and a deviated nasal septum. The patient was diagnosed with unilateral complete labiognatopalatoschizis accompanied by Tessier No. 2 cleft. Case Management: The patient was prepared for labioplasty under general anesthesia after meeting the "rules of ten" criteria (10 weeks old, 10 pounds, 10 grams/dl hemoglobin). The surgery was performed using the Millard technique with a zig-zag advancement flap to achieve optimal tissue coverage and symmetry. Postoperative care included antibiotics, pain management, and follow-up visits. At the 3-month follow-up, the surgical site showed good healing with no signs of infection or significant complications. Conclusion: Understanding the specific anatomy and pathophysiology of Tessier No. 2 clefts is essential for effective surgical planning and outcomes. The modified Millard technique provides satisfactory aesthetic and functional results, although challenges remain. Comprehensive postoperative management and long-term follow-up are crucial to monitor healing and address any complications. Further research and multidisciplinary.Keyword: Facial Cleft, Tessier 2, Millard Technique, Zig-zag Advancement Flap

Internally Submerged, Tapered, Bone-level Dental Implants in the Anterior Esthetic Region.

Aesthetics is a crucial consideration in the anterior region, alongside dental implant survival and marginal bone loss (MBL). Bone-level implants are advantageous in the esthetic zone as they create a natural emergence profile with the use of customized abutments. This study aimed to assess the esthetic outcomes of internally submerged, tapered, bone-level dental implants and to evaluate associated alveolar bone changes. Patients received Luna implants (Shinhung, Seoul, Korea) from 2012 to 2020. MBL was measured immediately after surgery and at 3-month, 6-month, and 1-year follow-ups. Pink and White Esthetic Scores (PES/WES) were evaluated after final restoration and at 6-month and 12-month follow-ups using standardized photographs. Seventy-eight patients (37 males, 41 females) with a mean age of 73.42 years met the study's inclusion criteria. At the 1-year follow-up, the mean MBL was 0.39 ± 0.74mm on the mesial aspect and -0.09 ± 0.97mm on the distal aspect. A statistically significant difference in MBL on the mesial aspect was observed between immediate functional loading and the 12-month follow-up (P = 0.029). All implants achieved PES/WES scores of 6 or higher, meeting the threshold for clinical acceptance. Within the study's limitations, Luna implants demonstrated satisfactory esthetic outcomes and stable bone levels. The results support their use as a viable option for implant placement in the anterior esthetic zone, ensuring both aesthetic and functional success.

Successful Management of Parry-Romberg Syndrome With Lipografting: A Case Report

Parry-Romberg Syndrome (PRS), or progressive hemifacial atrophy, is a rare disorder marked by the progressive atrophy of skin and soft tissues, sometimes affecting muscles, cartilage, and bones. Typically manifesting in childhood, PRS has a 66% female predilection and sporadic occurrence. Diagnosis is clinical, supplemented by tests to exclude other conditions. Treatment options include bone/cartilage grafts, fat grafts, dermal fillers, and free tissue transplantation. Lipoinjection, using autologous adipose tissue enriched with stem cells, is a promising technique. A 33-year-old female with PRS exacerbated by pregnancy presented with severe right hemifacial atrophy. Initial lipoinjection elsewhere resulted in significant graft reabsorption. At our institution, a second lipoinjection was performed at age 34 after disease remission. Five months postoperatively, 30% graft reabsorption was noted, but significant improvement in facial symmetry was achieved. A second lipoinjection session further enhanced facial volume and skin quality. Four months postoperatively, the patient showed substantial improvement, with 90% facial symmetry and stable disease remission. Autologous lipoinjection is an effective treatment for PRS-related facial atrophy, offering minimal tissue rejection and satisfactory aesthetic outcomes. The presented case highlights the potential of this technique in achieving significant clinical improvement and facial symmetry in PRS patients.

Correction of Microtia with Constricted Ear Features Using Helix Costal Cartilage Scaffold and Postauricular Flap Advancement.

Microtia with constricted ear features represents a challenging congenital deformity characterized by the variable shape and large volume of the remnant cartilage and skin involved. This study aims to evaluate the efficacy and safety of a method using helix costal cartilage scaffold and postauricular flap advancement for the correction. This retrospective study analyzed the clinical and postoperative data of 121 patients diagnosed with microtia and constricted ear features, treated at our institution between January 2020 and January 2023. All patients underwent helix reconstruction using the eighth or ninth costal cartilage combined with postauricular flap advancement. Outcomes were assessed based on the incidence of postoperative complications and auricular aesthetic scores. The aesthetic evaluation of the reshaped auricle was based on a four-point Likert scale (i.e. 1 = poor, 2 = fair, 3 = good, 4 = excellent). The postoperative follow-up period ranged from 12 months to 3 years (mean 18.5 months). All patients achieved successful helix expansion, with reconstructed ears showing improved symmetry and shape comparable to the contralateral normal ears. The average aesthetic score was 3.4 out of 4. Complications included suture exposure in 8.3% of cases and cartilage protrusion in 4.1%, both managed without significant issues. There were no instances of skin necrosis, costal cartilage exposure, or infection. The combination of helix costal cartilage scaffold and postauricular advancing flap offers a reliable and effective method for correcting microtia with constricted ear features, providing satisfactory aesthetic outcomes with minimal complications.

To Sew or Not to Sew: A Case Report

Introduction-Tongue injuries in children vary from slight lacerations to complete amputations. It could be due to fall, self-mutilation, epilepsy, child abuse, or sport injury. The anterior dorsum is the most common site followed by the mid dorsum and anterior ventral part. These injuries may cause dysfunction of tongue, hemorrhage, and disfigurement. Management of injuries of tongue in young children is challenging. There are no established guidelines for managing tongue lacerations. This is a case report of a three-year-old girl with a laceration on the anterolateral part of the tongue with non-approximating wound edges. The laceration extended from the dorsal to the ventral part. The parents were apprehensive about the surgical management of the injury due to the age of their daughter. Hence, healing of the injury with conservative management without suturing was achieved. Conclusion-The management of traumatic injuries of tongue in children is difficult due to their age and cooperation. The pediatrician has to decide whether to heal the tongue by primary or secondary intention. Our decision to allow the healing by secondary intention was successful. The tongue healed without any complications barring a small scar with satisfactory aesthetic and functional outcome. Both the parents and the child were satisfied with the management of the injury.

Wide-Based Columellar Strut Graft: A Novel Boost for Enhanced Nasal Tip Support in Ethnic and Revision Rhinoplasty.

Adequate nasal tip support is crucial for achieving both aesthetic and functional outcomes in rhinoplasty. This study introduces a wide-based columellar strut graft (WB-columellar strut graft) as a new modification to provide enhanced support for the nasal tip, especially in challenging ethnic and revision rhinoplasty cases. To present and evaluate the effectiveness of the WB-columellar strut graft in providing sufficient nasal tip support and achieving satisfactory aesthetic outcomes in patients with ethnic noses, Asian noses, and revision rhinoplasty cases presenting with weak caudal septum or anterior nasal spine. A total of 32 patients, aged between 17 and 48, were included in this study. Of these, 11 were revision cases, 12 had ethnic noses, and nine had Asian noses. The technique involved preparing a WB-columellar strut graft in two different ways according to the need of particular case. WB-columellar strut graft-1: Constructed from either costal or septal cartilage, with a widened columellar base using bilateral grafts and a columellar strut graft. WB-columellar strut graft-2: Exclusively from costal cartilage, featuring a groove on the anterior surface for insertion of a columellar strut graft to form a wide-based structure. The grafts were applied to provide robust support in cases, where the caudal septum and spine were excessively resected. In 25 patients, the graft was prepared from costal cartilage, while in seven patients it was from septal cartilage. The WB-columellar strut graft-1 modification was used in 22 patients, and the WB-columellar strut graft-2 in 10 patients. Follow-up ranged from 12 to 24months, with only one case requiring a mini-revision due to visible tip graft. No significant complications were reported in other patients. The WB-columellar strut graft is an effective boost for enhancing nasal tip support in ethnic and revision rhinoplasty cases. It provides a more robust structural foundation, leading to long-lasting and satisfactory aesthetic results. This technique is particularly beneficial for patients with retracted caudal septum and weak anterior nasal spine, providing improved nasal tip projection and rotation. 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 .

Utility and Outcomes of a Keystone Perforator Island Flap for Reconstruction at Various Anatomical Locations: A Prospective Study.

Background In Yemen, traumatic wounds are prevalent, imposing a substantial burden on plastic surgery teams operating within limited-resource settings. Advanced microsurgical reconstruction options are scarce, and expertise in free flap techniques is limited. While local flaps are commonly used for soft tissue reconstruction, there is a need for simpler, effective alternatives with lower complication rates. This study aimed to evaluate the effectiveness and outcomes of the keystone island perforator flap (KIPF) as a viable alternative for soft tissue coverage in resource-challenged facilities. Methods From February 2021 to December 2023, a single surgeon's team in three plastic and reconstructive surgery departments in Sana'a, Yemen, conducted this prospective study, which included 35 patients who underwent KIPF for various soft tissue defects. We assessed patient demographics, intraoperative variables, and postoperative outcomes, including aesthetic outcomes evaluated using the Patient and Observer Scar Assessment Scale (POSAS) at six months postoperatively. We analyzed the factors influencing flap success and complication rates. Results The mean age of patients was 29 ± 11.75 years, with the majority being males, comprising 86% of the sample. Trauma was the leading cause of tissue defects (77.1%), primarily affecting the legs (57.14%) and feet (11.43%). The mean operative time was 73.57 minutes. Complications occurred in 26% of patients, with flap dehiscence being the most common (11.43%). Ninety-seven percent of patients experienced flap survival, and 91.4% experienced complete wound healing within a median of 16 days.Scar assessments at six months postoperatively indicated satisfactory aesthetic outcomes, with scars resembling normal skin. Conclusion The KIPF technique proves to be a reliable and practical option for soft tissue reconstruction in resource-limited settings. Its simplicity, minimal postoperative care needs, and high flap survival rates make it an advantageous alternative to more complex reconstructive techniques. This study supports the adoption of KIPF as a standard approach in similar environments with limited reconstructive surgery capabilities.

GINGIVAL MARGIN, CORRECTION IN ORTHOPEDIC DENTISTRY

A big problem for obtaining aesthetic and functional results of dental treatment is the condition of the gingival papillae. The effectiveness of orthopedic interventions without high-quality correction of the marginal edge of the gums can lead to an unsatisfactory result and the occurrence of numerous complications Materials and methods. A literature search was conducted in the PubMed and Medline databases for the period 2000-2024, for which the following keywords were used: correction of soft gingival tissues, fixed dentures, effectiveness, front group of teeth. A general search revealed 112 sources regarding gingival margin correction in fixed dentures. The primary exclusion referred to literary sources in which the correction of the gingival margin applied to all types of prosthetics. Literary sources that contained only reference information were included in the secondary exclusion. As a result, only relevant full-text articles in professional journals remained (n=25). The purpose of the research is to analyze the methods of gingival margin correction in orthopedic dentistry at the current stage, to formulate relevant tasks for further research. Research results. Methods of restoration of the aesthetics of the marginal part of the gums during orthopedic treatment are divided into the following groups: plastic of soft and bone tissues; laboratory and technical procedures; use of materials for artificial gums. It has been established that the plastic-surgical method is used for the loss of the gingival papilla, defects of the ridge of the alveolar process, asymmetric contour of the gums, and their unaesthetic shape. Correction of the gums allows to achieve satisfactory aesthetic results both at the final stage of orthopedic treatment (prosthetics with fixed orthopedic prostheses) and at the intermediate stage of temporary prosthetics with plastic fixed prostheses. It was found that the most common methods of gingival margin correction are flap operations on the gums using the technique of lateral movement of the muco-osseous flap. These include the following types of interventions: endothelial modification from the tooth-alveolar ridge; oblique displaced flap; periosteally stimulated flap; partial or complete split flap. The positive effect of hyaluronic acid on the healing of the gingival margin and tissue regeneration has been proven. Several researches have shown the positive effects of hyaluronic acid on gingival margin healing and tissue regeneration due to its properties to stimulate cell adhesion, migration and proliferation, mediate cell signaling. The authors indicate a better effectiveness of hyaluronic acid in relation to periodontal parameters during the correction of the marginal gingival margin. The use of a laser scalpel is characterized by less pronounced traumatization of tissues, lower temporary costs for intervention, reduced blood loss, less pronounced signs of inflammation in the postoperative period, relative simplicity and cost-effectiveness of use. Conclusions. To date, only a combination of various orthopedic and surgical manipulations allows to achieve an optimal aesthetic result during prosthetics with fixed dentures of the front group of teeth.

Reconstructive Techniques Following Malignant Eyelid Tumour Excision-Our Experience.

Background: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. Method: This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient. The most commonly used techniques included regional flaps, local flaps, and skin grafts. The most frequently employed reconstruction techniques were forehead flaps (59 cases), simple excisions (38 cases), and Mustarde cheek flaps (16 cases). Result: The postoperative complications, including ectropion, epiphora, and flap necrosis, were recorded. However, no significant correlation was found between the risk of complications and either the location of the tumour or the reconstruction method employed. Despite the complexity of medial canthal and lower eyelid reconstruction, satisfactory aesthetic and functional outcomes were generally achieved. Conclusions: This study emphasises the importance of individualised surgical planning, highlighting the advantages and limitations of various techniques to optimise both the functional and aesthetic results.

Dry Liposculpture of the Calves and Ankles—A Novel Technique for Sculpting the Lower Legs

BackgroundLiposuction of the calves and ankles was historically described as a “taboo” procedure and linked with higher postoperative pain and unpleasing aesthetic results.ObjectivesThis study presents a Novel technique for dry liposculpture of the calves and ankles using a tourniquet, as a safe and less painful procedure, which achieves better aesthetic results.MethodsThis single surgeon, retrospective study included 70 women who underwent surgery based on the technique described. Details regarding the surgical outcomes and pain levels were collected, and patients completed 2 years of follow-up.ResultsA mean of 1395 cc fat was aspirated from both legs, combined, and the mean duration of surgery was 98 minutes. No major complications were observed, and postoperative pain levels were low. Pre- and post-surgery pictures were evaluated by 8 certified senior plastic surgeons for aesthetic results.DiscussionThe findings suggest that dry liposculpture is suitable for reshaping the calves and ankles.ConclusionsThis technique is safe, with precise and satisfactory aesthetic results, low levels of postoperative pain, and may take less time to perform than wet liposuction.Level of Evidence IVThis 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.

Single- versus multi-visit approach for fragment reattachment in complicated crown-root fractures: a cohort study

BackgroundComplicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth.MethodsTwo cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ‘ clinical visit in multi-visit approach group.ResultsAll the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively.ConclusionFragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance.Trial registrationThis prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023.

Coverage of Soft-Tissue Defects of the Palm of the Hand: Introduction of a New Flap Design.

The palm is of great importance for maintaining a functioning hand. The reconstructive demands of thickness, texture, color matching, pliability, and sensation for palmar defects represent a unique challenge for plastic surgeons. This study introduced a novel versatile design for the ulnar palmar artery perforator flap (UPAPF) to cover large palmar soft-tissue defects of the hand. The fifth metacarpophalangeal joint was identified as a landmark where the perforator was nearly 1 to 1.5 cm proximal. A template of the defect was outlined after adequate debridement. Meticulous dissection was executed under loupe magnification to trace the perforator until an adequate length of the pedicle was obtained for rotation. The harvested type B fasciocutaneous flap was rotated nearly 90° to be insetting on the palmar defect. Two patients were presented with a soft-tissue defect of the palm measuring 4.8 × 5.5 cm2 and 3.8 × 5 cm2, respectively. The flap was harvested and positioned at the defects. The flaps survived in the 2 cases with minimal donor site complications. The patients acquired protective sensations within the flap at the end of the follow-up period. The UPAPF provides a stable coverage for palmar soft-tissue defects with satisfactory aesthetic and functional results. It is a convenient addition to the armamentarium for reconstructing palmar soft-tissue defects of the hand.

Primary Open Reduction and Internal Fixation of Isolated Compound Depressed Nasal Fractures.

The aim of this study was to assess the efficacy of primary open reduction and internal fixation (ORIF) utilizing the existing dorsal wound for the management of isolated nasal fractures characterized by significant depression and to determine its effectiveness in preventing the need for subsequent nasal revisions. A retrospective review was conducted on patients who underwent ORIF of nasal bone for isolated compound depressed nasal fractures from January 2018 to January 2024. The primary outcomes included the assessment of clinical and radiographic results postoperatively, focusing on nasal symmetry, projection, airway patency, and the incidence of secondary surgical interventions. The study included 15 patients, predominantly males (60%), with an average age of 39.33 years. The mechanisms of injury included motor vehicle accidents (40%), falls (26.7%), interpersonal violence (20%), and occupational injuries (13.3%). All patients were treated on the first (73.3%) or second day (26.7%) after the injury. All patients had satisfactory esthetic and functional outcomes and did not require secondary rhinoplasty. The hardware was removed in 4 patients (26.7%). Primary ORIF through an existing dorsal wound for significantly depressed isolated nasal fractures was effective in obviating the necessity for subsequent nasal revisions.

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.

The importance of otorhinolaryngology in correcting rhinoplasties with adverse events

Introduction: Rhinoplasty is a complex intervention aimed at enhancing both nasal aesthetics and functionality. The literature underscores the occurrence of adverse events in this procedure, prompting the search for effective correction strategies. In this context, otorhinolaryngology plays a crucial role, with a fundamental need to comprehend the incidence and types of complications to improve clinical practices. Methods: A systematic literature review was conducted to identify studies addressing adverse events in rhinoplasties and the role of otorhinolaryngology in their correction. The consulted databases included PubMed, Scopus, SciELO, Cochrane Library, LILACS, and Embase. Keywords such as "Rhinoplasty," "Otorhinolaryngology," "Adverse events," "Aesthetic outcomes," "Functional outcomes," "Nasal surgery," and "Complications in rhinoplasty" were combined using boolean operators "OR" and "AND." Results: The compiled results reveal a variety of adverse events in rhinoplasties, ranging from aesthetic complications to functional challenges. The analysis underscores the importance of a specialized otorhinolaryngological approach in minimizing these adverse events, emphasizing the need for treatment personalization to optimize outcomes. Conclusion: It is concluded that otorhinolaryngology plays an essential role in correcting adverse events in rhinoplasties. The systematic review highlights the complexity of these interventions, emphasizing the necessity of a multidisciplinary and specialized approach to achieve satisfactory aesthetic and functional outcomes. These findings support the significance of the otorhinolaryngologist's role in optimizing the quality of care provided to patients undergoing rhinoplasties.