Temporal Fascial Flap Research Articles

Clinical Analysis and Treatment Strategies About Cartilage Scaffold Exposure After Auricular Reconstruction With the Expanded Two-Flap Method.

Objectives: Soft tissue expansion is one of the main methods for autologous cartilage auricular reconstruction. The aim of this study was to analyze the risk factors for cartilage exposure after this method and to describe a surgical method for this complication. Methods: From January 2018 to December 2020, 853 patients (908 sides) underwent auricular reconstruction with an expanded two-flap method at our center. Thirty-two patients experienced cartilage exposure postoperatively. These patients were set as the case group, and 1:1 matched sampling was performed among patients who did not have cartilage exposure. The matched sample of 32 cases was set as the control group. All 64 patients were evaluated according to the Orbit, Mandible, Ear, Nerve, and Soft tissue (OMENS) classification system to analyze the correlation between cartilage exposure and hemifacial microsomia (HFM) and OMENS subtypes. The complication was repaired with superficial temporal fascial flap combined with skin graft. Results: HFM might be a risk factor for scaffold cartilage exposure, and there was a significant correlation between cartilage exposure and orbital malformation, facial nerve dysplasia, and soft tissue developmental malformation. The use of a superficial temporal fascial flap combined with a split-thickness skin graft to repair the complication achieved satisfactory outcomes. Conclusions: There is a correlation between cartilage scaffold exposure and the severity of HFM. Temporoparietal fascial flap transfer combined with skin grafting proved to be an effective method for cartilage exposure.

Fat-augmented Temporal Fascia Flap for Defect Coverage following External Auditory Canal Cancer Resection

Summary: Malignant tumors of the external auditory canal are rare and require surgical interventions such as lateral temporal bone resection (LTBR) for localized cases. This study introduces a novel approach, the lipofilling fascia flap technique, for external auditory canal reconstruction following LTBR or modified LTBR. The technique involves augmenting the temporal fascia flap with autologous fat grafting, aiming to enhance volume and improve outcomes. Two cases are presented, demonstrating successful reconstruction with minimal complications.

Vascularized fascial flap for reconstruction of combined oral mucosa-mandibular defects: The multi-modal biological assessment

ObjectiveThe reconstruction of composite defects in the oral and maxillofacial region using vascularized fascial flaps, such as the fibular, iliac, and temporal fascial flaps, has gained increasing attention among surgeons. However, there remains uncertainty regarding the suitability of fascial flaps as transplants, as well as their healing processes and outcomes, due to their non-mucosal nature. This study aims to comprehensively assess the biological aspects of vascularized fascial flaps at clinical, histological, and genetic levels, with the goal of providing essential biological references for their clinical application. Study DesignThis study enrolled three patients who underwent reconstruction of combined oral mucosa-mandibular defects using fibular vascularized fascial flaps between 2020 and 2023. Data regarding changes in the appearance of the fascial flaps, bulk-RNA sequencing, and histological slices of initial fascia, initial gingiva, and transformed fascia were collected and analyzed. ResultsWithin three months, the fascial flaps exhibited rapid epithelial coverage and displayed distinct characteristics resembling mucosa. High-throughput RNA sequencing analyses and histological slices revealed that the transformed fascia exhibited tissue structures similar to mucosa and demonstrated unique advantages in promoting blood vessel formation and reducing scarring through the high-level expression of relevant genes. ConclusionThese findings emphasize the potential and feasibility of utilizing vascularized fascial flaps for oral mucosa reconstruction, establishing their unique advantage as transplant materials, and providing significant biological information and references for their selection and clinical application.

Visual Field Improvement and Electrode Extrusion Prevention by Extended Endaural Incision With Cavity Obliteration for Cochlear Implantation in Ears After Canal Wall-Down Mastoidectomy: Experience of Four Cases.

There is no global consensus on the surgical technique of cochlear implantation (CI) in ears with an open cavity after canal wall-down (CWD) mastoidectomy. Here, we report CI surgery with an endauralincision for the ears after CWD mastoidectomy. The endaural incision was extended upward to obliterate the open cavity of the temporal fascial flap. The endaural incision was extended downward to close the open cavity inlet. After inserting the implanted electrode, the open cavity was obliterated using a temporal fascial flap, and the cavity was closed at the inlet. We performed this type of CI surgery in four ears in three patients. This extended endaural incision provided an excellent view for pedicling the temporal fascial flap with the superficial temporal artery and for open cavity closure without any serious complications. This technique allowed us to opt for CI surgery of the ears after CWD mastoidectomy.

Facial Reanimation After Peripheral Facial Nerve Paralysis: A Single-institution Surgical Experience.

Facial nerve trauma occasionally develops during oral and maxillofacial surgery. This study was aimed at enhancing the available knowledge on facial nerve reanimation correlated to surgery and proposing our surgical algorithm. We retrospectively analyzed medical records of patients who underwent facial reanimation surgery at our hospital. The inclusion criterion was surgery for facial reanimation from January 2004 to June 2021. We included 383 eligible patients who underwent facial reanimation surgery. Trauma or maxillofacial neoplasms were noted in 208 of 383 and 164 of 383 cases, respectively. In 238 of 383 cases, nerve branches were likely more vulnerable. Facial nerve anastomosis was performed in 256 patients. Sixty-eight patients received nerve grafts. In 22 patients, distal facial nerve transfer to the masseteric nerve, sublingual nerve, or contralateral facial nerve was performed. Twenty-five patients received static surgery; in most cases, the temporalis fascia flap (20/25) was used. The nerve function outcomes were HB grade I (n=17), Grade Ⅱ (n=108), Grade Ⅲ (n=118), Grade Ⅳ (n=94), and Grade V (n=46). The mean follow-up time was 4.88 ± 3.93 years. Facial paralysis caused by trauma ( P =0.000), branch injury ( P =0.000), and the primary reconstruction of facial nerve ( P =0.000) were predictive of favorable treatment outcomes. Although facial nerve injury caused by trauma was more likely, cases of interference in facial expression could be limited, and so did the injury to branches. Nerve anastomosis was prioritized if a tension-free suture was possible. Maintaining the integrity of the nerve and shortening the duration of mimetic muscular denervation were crucial.

RECONSTRUCTION OF POST-TRAUMATIC DEFECTS OF THE EXTERNAL EAR AND NOSE WITH AUTOLOGOUS COSTAL CARTILAGE

Traumatic ear amputation and post-traumatic nose defect are aesthetic deformities that can have negative consequences (lead to psychological trauma), leading to a change in the quality of life. The presented clinical case describes a protocol for the reconstruction of a partially amputated defect of the external ear and nose, which required various surgical steps; including the removal of cartilage from the ribs, followed by the creation of a cartilaginous model of the ear, the introduction of its subcutaneous region behind the ear, taking into account the anatomy of the outer ear as much as possible. The second stage after 1.5 months is the restoration of the amputated ear area with a combined superficial temporal fascial flap, costal cartilage with suturing to the amputated part of the ear and dorsal rhinoplasty using modeling costal autocartilaginous flap. The postoperative result is satisfactory with the restoration of a good aesthetic appearance of the ear and nose. Reconstruction of the external ear after partial traumatic amputation and post-traumatic nose defect with autocartilage from the ribs provides a stable aesthetic result and becomes the method of choice for such injuries.

The Efficacy of Open Mastoidectomy Versus Mastoidectomy with Temporalis Fascia Flap Obliteration

Objective To compare the efficacy of open mastoidectomy versus mastoidectomy with temporalis fascia flap obliteration in achieving postoperative dry ear chronic suppurative otitis media (CSOM) is a perforated tympanic membrane with persistent drainage of pus from the middle ear lasting more than 2-weeks. The global burden of illness from CSOM is estimated to involve about 65 to 330 million individuals with draining ears, 60% of them suffer from significant hearing impairment. Ninety (90) percent of burden is borne by developing countries, in Southeast Asia, the Western region of Africa. CSOM can occur with or without cholesteatoma, and the clinical history of both conditions can be very similar. The treatment plan for cholesteatoma always includes tympanomastoid surgery with medical treatment as an adjunct. The treatment plan for cholesteatoma always includes tympanomastoid surgery. After mastoidectomy the otologists facing mastoid cavity related problems such as otorrhoea, hearing loss. A variety of techniques have been proposed to perform obliteration. Methods Study design Randomized Controlled Trial. Setting Department of ear, nose, and throat (ENT), Head & Neck Surgery, Saidu Group of Teaching Hospital, Swat, Khyber Pakhtunkhwa, Pakistan. Duration of study From Jan, 2019 to 17 July, 2021. Sample size Randomly assigned patients with evidence of atticoantral disease to two groups, 47 in each group. After canal wall down mastoidectomy in Group A cavity left without obliteration, in Group B a superior based vascularized temporalis facial flap was used to obliterate the resultant mastoid cavity and they were followed up to 8-weeks. Results As per efficacy of both groups is concerned, in Group A, 34 (36.17%) patients had achieved post-operative dryness on 8th week of mastoidectomy whereas in Group B, 40 (42.55%) patients achieved post-operative dryness of ear on 8th week subject to mastoidectomy with temporalis fascia flap obliteration. (p value=0.130). Conclusion Patients who underwent mastoidectomy with temporalis fascia flap obliteration yielded better results in comparison to patients who underwent open mastoidectomy. Further the common organism were found in our region Staph Aureus and Bacteriodes and Proteus mirabilis.

Salvage of Ear Framework Exposure Following Autologous Microtia Reconstruction: Repair Strategy for Each Location of Exposure.

One of the most common complications of total auricular reconstruction is exposure of the ear framework. Various reconstruction methods have been reported depending on the location and size of exposed cartilage. This report describes a safe reconstruction method for each exposed part of the grafted ear framework. From January 2019 to August 2021, 2 cases (4 areas) of framework exposure were observed following autologous microtia reconstruction. The first case developed 2 small areas of skin necrosis on the anterior helix and lower antihelix to concha. The former was reconstructed with a temporal fascia flap and the latter with a local transposition flap. The second case also developed 2 small areas of skin necrosis on the posterior helix and lower antihelix to concha. The former was sutured directly and the latter with a local transposition flap. However, both wounds recurred due to flap necrosis and the cartilage was exposed again. The 3rd operation was performed by covering both wounds with a posterior auricular turnover flap and skin graft. In both cases, the exposed framework was completely covered with the flaps, and the reconstructed ears showed well-defined convolutions. Covering exposed cartilage with a local flap with a random pattern of blood circulation is convenient because no additional skin grafts are required. However, the blood circulation of the flaps is inadequate when an elongated flap is required; consequently, flap necrosis may occur. On the other hand, a temporal fascia flap and posterior auricular flap, which have axillary pattern blood circulation, are considered to be safer. We believe that it is safe to use a temporal fascia flap for cartilage exposure in the upper half of the auricle, and a posterior auricular turnover flap for the lower half.

Revision Operation of the Unsatisfactory Microtia Reconstruction With Autologous Costal Cartilage.

Revision operation of the unsatisfactory microtia reconstruction is 1 of the most difficult revision operations in plastic surgery. This study discussed the cases about revision operation of the unsatisfactory or failed ear reconstruction using autologous costal cartilage and residual. A prospectively maintained database of all consecutive patients who underwent secondary total ear reconstruction from 2013 to 2020 was reviewed. Demographic data and outcomes were assessed. Thirty-six patients with microtia met the inclusion criteria. The age of the patients who underwent secondary reconstruction ranged 6 to 56 years. The follow-up duration was from 1 to 8 years. Primary reconstruction using costal cartilage was performed in 34 cases, and Medpor (porous high-density polyethylene) were used in 2 cases. All 36 cases were treated with costal cartilage as the revision. One-stage revision was performed in 27 cases, including scaffold covered by superficial temporal fascia flap in 9 cases, retroauricular fascia flap in 12 cases and superficial temporal plus retroauricular fascia flap in 5 cases. Nine cases were renovated with expanders by stages, of which 8 cases were covered by retroauricular fascia and 1 case was covered by expanded skin flap. Complications occurred in 2 cases, and 1 patient was not satisfied with the partial scaffold repair. The effect of revision operation of ear reconstruction with costal cartilage is satisfactory, and different methods of ear reconstruction are indicated in different operation conditions, and the revision surgery requires adequate preoperative evaluation.Level of Evidence: Level IV, therapeutic study.

Classification and Surgical Strategies of Constricted Ears in a Chinese Specialty Clinic: A Retrospective Study.

BackgroundThe constricted ear is an auricular deformity produced by a deficiency in the circumference of the helical rim. The classification and corrective methods for constricted ears continue to be controversial. In order to identify them, the authors have reviewed and analyzed cases operated in a Chinese specialty clinic.MethodsCorrection of constricted ears from January of 2017 to June of 2021 was retrospect through medical records. Data of patients’ variables (including sex, age, laterality, type of constricted ear, presence of other ear anomalies), surgical techniques, esthetic outcomes, and postoperative complications have been collected.ResultsThe deformed ears were classified into four graded types by three criteria including deficiency of auricle cartilage, vertical height in dorsal view, and surgical outcome. A total of 68 constricted ears of 57 patients (type I, n = 6; type IIA, n = 41; type IIB, n = 19, and type III, n = 2) were enrolled in the study. Of the 66 constricted ears undergoing surgical correction, most of them were performed with helical expansion through auricular/costal cartilage graft, Mustardé-type mattress sutures, and tumbling cartilage flap. External molding using Vaseline gauze rolls was implemented on every case to assist reshaping the scapha. A triangular superficial temporal fascial flap was elevated to prevent the reoccurrence of lidding in some cases. Corrective techniques and esthetic outcomes for deformed cases of each graded type were described. Based on a four-point Likert scale, the average esthetic outcome score was 3.7.ConclusionsThe classification was practical and the constricted ears were effectively corrected by simple surgical procedures without removal of deformed auricular cartilage. All corrections were performed in one stage.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.

Reconstructive otoplasty in post-burn scar deformation of the parotid area

The result of using the temporal fascial flap in combination with autodermoplasty in the reconstruction of the total postburn auricle and parotid area defect is presented in this paper. The techniques of reconstructive otoplasty in conditions of cicatricial process of parotid zone are described.

Reconstruction of orbital exenteration defects: about 20 cases

The face is social support. Eyes allow the individual to interact with the environment and others. Orbital exenteration defects are the results of extreme disfiguring surgery, leading to functional, aesthetic and psychological sequelae. Reconstruction is essential and must meet several objectives: filling the cavity and closing any communications with the adjacent structures, obtaining rapid healing, allowing for local monitoring and finally enabling patients to reintegrate into society and achieve a satisfactory quality of life. We here present our experience in filling and reconstructing these cavities. Our study involved 20 patients with orbital exenteration defects over a period of 5 years (February 2015-February 2020). We analyzed the epidemiological features, clinical profile, and methods of the reconstruction as well as patients´ outcomes in our hospital. The average age of patients was 58.5 years. Squamous cell carcinoma was the main histological type, followed by basal cell carcinoma. Filling techniques included directed wound healing (7 cases), temporalis fascia flap (2 cases), temporalis muscle flap (10 cases). Methods of reconstruction included directed wound healing (6 cases), full-thickness skin graft (1 case), mediofrontal flap (6 cases; alone or associated with the temporalis muscle), converse scalping flap in three cases. Free latissimus dorsi flap was used in two cases. Thirteen patients showed good outcomes, with good healing after an average follow-up period of 9 months. The most common complication was infection and suture release. Two patients were lost to follow-up. Orbital exenteration defects can be approached in many ways. Temporalis muscle flap has been shown to be a robust and safe choice as well as an excellent filling solution. Prostheses are an aesthetic but expensive solution that should be developed in our hospital.

Everted Pedicled Temporalis Fascial Flap to Augment Pedicled Pericranial Flap for Lax Duraplasty in Decompressive Craniotomy: A Cost-Effective Procedure.

Decompressive craniotomy is a commonly performed surgery to relieve raised intracranial pressure. At the end of the procedure, it is the convention to cover the exposed brain by performing a lax duraplasty which allows for both brain expansion and provides protection to the underlying parenchyma. Various commercially available dural substitutes are used for this purpose. These have the drawback of being both expensive and nonvascularized. We propose a technique of using pericranium along with everted temporalis fascia (both being locally harvested vascularized pedicle flaps) that can suffice in a vast majority of cases for covering the brain.

Correction of microtia with constriction features using a superficial temporal fascial flap combined with a rib cartilage graft.

BackgroundMicrotia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities.MethodsBetween February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively.ResultsNone of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively.ConclusionsOur technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.

Complex reconstruction of the orbitofrontal regions using three regional flaps after orbital exenteration for the treatment of basal cell carcinoma

Objective. The current paper presents an interesting case of facial reconstruction after the excision of a giant basal cell carcinoma located in the orbitofrontal region. Methods. Performing the excision while securing the appropriate oncologic safety margin has determined the appearance of a soft tissue defect that required a complex reconstruction using three regional flaps: frontal, temporal fascial and temporal muscle flaps. Results. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. Conclusion. Including the orbital exenterations in the excisional treatment of giant neoplasms located in the facial region requires a complex reconstructive plan. The surgical team has to consider the relief of the anatomical structures that are targeted, as well as the necessity of achieving satisfactory aesthetic results while ensuring oncological radicality.

Clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting

Objective: To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting. Methods: From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People's Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher's exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction. Results: The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group (P<0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (P<0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group (H=16.5, 9.8, P<0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (H=6.6, P<0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group (P<0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group (P<0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups (F=0.3, P>0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma. Conclusions: Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.

Long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint ankylosis and reconstructed mandibular condyle

Mandibular condyle injury usually results in malocclusion and disharmony of facial growth in growing children. This study aimed to evaluate the long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint (TMJ) ankylosis who underwent mandibular condyle reconstruction. Ten growing patients with unilateral bony TMJ ankylosis admitted in West China Hospital of Stomatology, Sichuan University between January 1st, 2008 and December 31st, 2016 were followed up and evaluated. These patients include three males and seven females with ages ranging from 5 years to 12 years at the time of surgery. Each patient underwent gap arthroplasty, condyle reconstruction with ipsilateral coronoid, and interposition of the pedicled temporalis fascial flap in a single operation. The postoperative follow-up ranged from 3 years to 8 years with an average of 4.9 years. Postoperative panoramic radiographs determined the growth of the mandibular height and length on the affected side and compared it with those of the healthy side. All patients recovered uneventfully after surgery. At the end of follow-up period, the maximal mouth opening ranged from 32 mm to 41 mm with an average of 35.6 mm. Mandibular height and length continued to grow after the successful treatment of ankylosis using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The final ramus height and mandibular length of the affected side at the end of follow-up increased by 25.3% (P<0.05) and 26.1% (P<0.05), respectively, compared with the initial values measured immediately after surgery. Growth rates of ramus height and mandibular length of the affected side were 47.1% and 27.2% lower (P<0.05) than those of the healthy side, respectively. Mandibular height and length continued to grow after the successful treatment of ankylosis by using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The growth rate of the affected mandible was reduced compared with that of the undisturbed side even after treatment of ankylosis.

013Novel Method of Substitution for Combine Through-and-through Angle of the Mouth, Fragments of Upper and Lower Lips Defect

Through-and-through defect of soft tissues of the cheek, mouth angles, upper and lower lip originate from surgical intervention of tumors of the oral cavity involving external skin, soft tissue and oral lining. The article describes an original method of one-stage reconstruction in N. N. Blokhin National Medical and Research Center of Oncology. Russian Federation’s patent № 2489096 was granted for this method. We propose to use 3 different flaps from different anatomic areas, which have varying histological structures and independent blood supply. The first flap - muscle, is formed from the biggest part of the muscles masseter from the affected side and serves to restore the functions of the lips and cheek due to the fact that after the formation of the flap two its parts fixed to the remnants of the muscles of the upper and lower lips and part of the buccal muscle. The flap is perfusion by a. maxillaris and a. facialis. The second flap - musculocutaneous, formed from the skin of areas adjacent to the defect, nasolabial or submandibular. The flap serves to replace a skin defect, defect of the cheek, upper and lower lips. The flap is perfusion by a. facialis. The third flap - fascial, formed from the temporal fascia on the affected side. The temporal fascial flap is used to replace the defect of the mucous membrane of the cheek, upper and lower lips, in addition, the red border of the lips and the corner of the mouth. The flap is perfusion by aa. temporalis profunda et superficialis. All three flaps perfectly carry out hermetic sealing of the oral cavity, independent perfusion of each flap, even in the case of necrosis of one of the flaps, allows preservation of hermeticism. The use of three flaps with different histological structure allows to achieve a good functional and aesthetic result. Flaps perform various functions, ensuring the functional and anatomical usefulness of the resected tissues. By improving the blood suppling of flaps, we reduce time for patient’s rehabilitation and postoperative damage.

TMJ Ankylosis Management: Our Experience.

Temporomandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance and hygiene. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Temporomandibular joint ankylosis is very common among young children. The aim of treatment is not only to treat the movement of the joint but also to prevent relapse. In this series, 18 cases of temporomandibular joint ankylosis were treated at our institute from January 2012 to January 2017 with osteoarthrectomy and interpositional arthroplasty. Patients were in the age range of 5-57years, with 11 males and 7 females and including 8 unilateral and 10 bilateral cases. Duration of ankylosis ranged from less than 2years to more than 6years. Seven of the patients were secondarily taken up for correction of their deformities with either orthognathic surgery or distraction osteogenesis. Good mouth opening was achieved in all the patients with a mean follow-up period of 12months. The early post-operative mouth opening ranged from 24 to 37mm. The late post-operative mouth opening ranged from 20 to 33mm. There was a stress on aggressive physiotherapy for a minimum of 6months in all our patients. Interpositional arthroplasty using vascularized temporalis fascia flap is a very reliable method to prevent recurrence of ankylosis, and it also avoids the disadvantages of alloplastic materials as well as nonvascularized autogenous tissues.

Reconstruction of Deep Burn Wounds Around the Ankle With Free Fascia Flaps Transfer and Split-Thickness Skin Graft.

We aimed to introduce a technique by combining free fascia flaps transfer with split-thickness skin graft for the reconstruction of deep burn wounds at the ankle. Fifteen patients from 2009 to 2016 were enrolled in this study. Patients in this series suffered from a deep burn injury around the ankle, which was accompanied with exposure of tendon and medial or lateral malleolus exposure due to severe soft-tissue defects (N = 15). All the 15 wounds were repaired combining free fascia flaps with split-thickness skin graft operations, including nine anterolateral thigh fascia lata flaps (ATFL flaps) and six superficial temporal fascia flaps (STF flaps). All the fascia flaps completely survived. Two patients showed partial grafting skin necrosis due to either wound infection or subcutaneous hematoma infection, and this was eventually healed satisfactorily after conventional dressing change. All patients achieved esthetic outcome and acceptable functionality without further revisions needed. Our present study reports a useful method that involves using free fascia flaps in combination with split-thickness skin graft to repair deep burn wounds around the ankle. This method provided reliable and durable soft-tissue coverage with good outcomes.