Tip Defects Research Articles

Split Dorsal Nasal Flap: A Modification to Expand Its Utilization.

Nasal reconstruction presents the facial plastic surgeon with a complex problem given its functional and aesthetic importance. The dorsal nasal flap is a composite rotational flap of the glabella and nasal dorsum that can be used for nasal dorsum and tip defects of medium to large sizes. Given its composite nature, this flap can be split into its constituent parts-the epidermis and dermis and the subcutaneous tissue and superficial musculoaponeurotic system-without flap loss. This case series describes this technique and various potential applications within nasal reconstruction.

Facial Artery Perforator Flap for Perioral and Perinasal Oncologic Defect Reconstruction: Surgical Technique and Postoperative Outcomes.

Facial artery perforator (FAP) flap is a versatile and reliable one-step facial reconstruction technique. However, its full potential remains underutilized due to a lack of clear guidelines and rigorous technique requirements. This study report the use of FAP flaps in our centre for the management of perioral and nasal oncologic defects, focusing on surgical technique performed and post-operative management. We conducted a retrospective review of all patients who underwent reconstruction with a perioral or perinasal FAP flap only following tumor resection over a 4-year period (n = 29). Parameters measured included flap survival, complication rates, surgical technique performed, and the need for touch-up procedures. Patients were grouped based on age, defect size, and location and outcomes were compared across these groups. The mean histological tumor defect area was 331 mm2. During at least 6 months of follow-up, no local recurrence was observed. Twenty-seven (93.1%) flaps survived completely. Major postsurgical complications occurred in seven (23.8%) patients, including complete flap necrosis (1), partial flap necrosis (1), flap collapse (1), venous congestion (1), wound dehiscence (1), and local infection (2). A higher complication rate was associated with nose tip defects (80.0% vs. 12.5%, p = 0.007). Touch-up procedures were more frequently required for reconstructions involving the nasal sidewall and dorsum (53.8% vs. 13.3%, p = 0.04). Based on our experience, the FAP flap is highly effective for the reconstruction of the upper lip, nasolabial fold, and certain oncologic nasal defects. However, specific defect locations, such as the nose tip, may be associated with higher complication rates, necessitating careful patient selection and surgical planning.

Algorithm for the Treatment ofTip Malformation Combining a Clinical Qualitative Assessment and Specific Closed-Rhinoplasty Techniques Based on Retrospective Analysis of Pellegrini's Fellows 40 Years' Experience.

The aesthetic importance of nasal tip and the complexity of its surgical correction make the surgery of this area one of the most fascinating facial surgical procedures. Despite description of different sculpturing techniques to correct nasal tip defects, this surgery remains one of the most discussed and challenging aesthetic procedures. The objective of this study was to define an algorithm of treatment for nasal tip surgery based on 40-year experience on Caucasian patients evaluated by our proposed clinical qualitative assessment, who were treated by closed rhinoplasty. We retrospectively reviewed 19,643 Caucasian patients (15,266 females and 4,377 males) who underwent primary closed rhinoplasty from 1979 to 2019 due to different tip defects. The patients were evaluated by volume projection rotation (VPR) assessment. The surgical indications options, long-term aesthetic results and complications were analysed. 22% patients with minimal nasal defects were treated by non-delivery approach and 78% patients with important tip malformation by delivery approach. In all cases, the surgery was performed to reduce tip volume and modify tip projection and rotation based on the specific nasal defects. 67% patients, who needed important reduction of tip projection, were treated by tip-interrupting techniques. 88.7% patientsdeclared full satisfaction after surgery,and only 12.3% needed a requiring minor revision surgery during the 20 years follow-up. The proposed algorithm may be a useful tool to plan surgery. The use of an adequate technique depending on the evaluation of volume, projection and rotation may guarantee higher patients satisfaction and a stable long-term aesthetic result. 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 .

“Flap-in-Flap” Technique: Double V-Y Flap in Fingertip Injury Management

Abstract Background Fingertip injuries with amputation are one of the common hand injury problems. Several reconstructive options are available for fingertip injury. V-Y advancement flap is one of the common flaps. In some cases, their advancement capacities are not sufficient to cover the whole defect, resulting in flexion deformity of the distal interphalangeal (DIP) joint, loss of finger pulp shape, or hooked deformity. The double V-Y flap consists of harvesting two cutaneous flaps on the same neurovascular digital palmar bundle. The first V-Y flap is raised as a neurovascular flap and the second flap is an advancement V-Y plasty. Objectives This article evaluates the outcomes of the double V-Y advancement flap for the fingertip reconstruction. Materials and Methods This is a prospective study on 19 patients with zone II and III fingertip amputation tip defects between December 2021 and June 2023. The majority were workplace injuries. Results There were 16 males and 3 females. The average static two-point discrimination was 6 mm. Average advancement of first flap is 8.5 mm and the average advancement of second flap is 4.3 mm. The average total advancement of a double V-Y flap is 12.94 mm (10–15 mm). All of them had “good” total active motion with movement > 210. One patient had flexion deformity at the DIP joint without causing any functional disturbance. All the flaps settled well except for one patient who had superficial partial necrosis of flap which was managed conservatively. Conclusion This is simple and safe for the reconstruction of zone II and III fingertip amputations with the advantage of like-for-like tissue with near-normal sensation. The second flap increased the advancement of the proximal flap, restoring the pulp shape, and thereby reconstructing a functional and aesthetic fingertip.

The Horn Flap outcome in the nasal tip defect: Evaluation of postoperative scarring through patient and observer scar assessment scale score

The Horn Flap outcome in the nasal tip defect: Evaluation of postoperative scarring through patient and observer scar assessment scale score

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction.

Classification and a decade-long follow-up of rat bite injuries in the nasal region

BackgroundNasal defects due to rat bites are frequently encountered in rural regions of China. In addition to serving as disease vectors, rats can also inflict bite injuries. In this study, we delineated the characteristics of rat bite injuries in the nasal region and discussed the clinical features observed during a 10-year follow-up period. MethodsWe retrospectively reviewed hospital records for patients admitted due to rat bites. This study outlines the demographics, clinical features, and follow-up outcomes supported by comprehensive photo documentation of the patients’ progress. ResultsTwenty-five patients, with a mean age of 29 years, were admitted due to rat bites. Treatment was provided for three distinct types of injuries: nasal tip defect (type I), nasal defect (type II), and full-thickness nasal defect with loss of surrounding tissues (type III). All patients recovered fully. ConclusionsThe treatment for rat bites should be based on the wound type. The long-term follow-up outcomes are more favorable when fewer subunits of the nose affected. We recommend early surgical intervention, along with psychological therapy, to prevent interference with growth and development.

Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation.

Thumb tip injuries constitute one of the most common hand injuries. There are various reconstructive options for thumb tip injuries. We present our series of thumb tip injuries reconstructed using Elliot's modification of the Moberg flap, which provides like-for-like tissue. We also present our flap improvisation, which can be useful in the armamentarium of plastic surgeons. Background Moberg described the advancement flap for thumb defects in 1964, which was modified by O'Brien in which the proximal part of the flap is incised and advanced. Although it is a popular flap, it has the disadvantage of interphalangeal (IP) joint flexion deformity. Among the various modifications of the Moberg flap, Elliot's flap provided more tissue with minimal donor site morbidity and no usage of skin grafts or first web skin. Methods We retrospectively analyzed the patients who underwent reconstruction of thumb defects by Elliot's modified Moberg's flap. The size of the defect, etiology, and IP joint movement were analyzed. Two patients underwent our improvised flap where a daughter flap was elevated within Elliot's flap. Results Between January 2021 and September 2023, 12 patients underwent reconstruction by Elliot's flap. All flaps settled well. There was no IP joint deformity. Two patients had scar hypertrophy that was managed conservatively. Conclusion Elliot's modification of the Moberg flap is a very useful but underutilized flap for thumb tip injuries that provides like tissue with sensation and with little donor site morbidity. It can be used for thumb tip defects of up to 3 cm . It is possible to incorporate a second V-Y flap in patients for whom additional movement is required for tension-free closure.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction

A 65-year-old man presented with a Melanoma in situ of the nasal tip. Complete excision was achieved after 2 “Slow Mohs” stages, resulting in a circular 2.7 X 2.4 cm defect involving the right lateral nasal tip, dorsum and sidewall and extending to the perichondrium.

Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve.

While different methods are employed for fixing narrowed nasal valves and preventing the notching of soft triangles, this study aims to demonstrate the effectiveness of a new technique called Süreyya-Dani Technique. This prospective study composed 100 patients who underwent rhinoplasty using the Süreyya-Dani technique. All patients presented with either notching of the soft triangle and/or external nasal valve dysfunction. Patients with the absence of soft triangle notching and external nasal valve dysfunction were excluded from this study. Facial analysis was conducted for all patients to identify any asymmetry in the face, and all nasal defects were identified. Descriptive statistics were calculated for different variables. Analytical statistics, namely Chi-Square test, was conducted with a significance level set at P < 0.05. In the current study, 100 patients were involved, out of which 63 (63%) were female and 37 (37%) were male. The participants' ages ranged from 18 to 46 years, with a mean age of 30 years. various chief complaints were found among patients, with the majority 37(37%) expressing cosmetic concerns. A statistically significant difference was found for the association of nasal tip defects with genders, intraoperative findings, and chef complaints, and the association between the degree of external valve insufficiency and crural weakness (P-value < 0.05). Despite many techniques that have been put forward to fix narrowed nasal valves and prevent notching of the soft triangle, the Süreyya-Dani Technique could work to prevent its occurrence successfully.

Tuning defect chemistry of vertical graphene arrays toward highly stable and dendrite-free sodium metal anodes

Vertical graphene (VG) arrays, characteristic of particularly porous microscopic structures, are one promising host to accommodate Na deposition, relieve the formidable volume change and eliminate uncontrolled dendrite growth, by decreasing the local current density. However, in practice, the prepared VG arrays possess superabundant defect sites in the local tip positions, which would guide the accumulation of rampant Na-ion flux concentration on these tip defect sites, and thus result in strong local electric field distribution and the divisional dendritic growth. Herein, a novel reconstruction strategy is proposed to re-build the edges and stacking of VG, by removing some unstable carbon defects and changing turbostratic stacking structure of VG to a Bernal stacking mode of the graphited VG, which enables to guide the comparatively smaller and stable interface with Na. Benefiting from the synergistic effect of microscopic structure and defect chemistry design, the re-build VG achieves a long-term reversible Na plating/stripping over 6400 h at an areal capacity of 8 mAh cm−2 in half cell, as well as a long cycle life of up to 3300 h at 1 mA cm−2 with a plating capacity of 4 mAh cm−2 in symmetric cells. Concomitantly, the density functional theory calculations demonstrate that Na atoms tend to nucleate and grow into lateral Na plating on the re-build VG arrays at an atomic level. As a result, the full cell coupled with a P2-Na2/3Ni1/3Mn1/3Ti1/3O2 cathode has a predominant improved cycling stability. This microscopic structure/defect chemistry engineering strategy provides new insight into guiding the uniform deposition of Na metal for high-performance sodium metal battery.

Repair of Defects of the Nasal Tip After Mohs Surgery.

Mohs Micrographic Surgery (MMS) is a treatment option for high-risk facial nonmelanoma skin cancer with high cure rates. Especially on the nasal tip, the tissue sparing properties of MMS are appealing. The nasal tip is a common location of nonmelanoma skin cancer and can be a challenging anatomical structure for reconstructive surgery due to its prominent location in the face, the shortage of spare tissue, as well as the stiffness and composition of different skin types, cartilage and bone. The aim of the present paper is to review and demonstrate how reconstruction of the nasal tip can be done successfully to improve the care for patients undergoing MMS in this area. Using selected literature on the area and the surgeons experience, each method of repair are described including their individual advantages and challenges. Pictures and consent were selected from one patient who underwent each repair method and three photos are presented in this paper: one after tumor resection, one immediately after repair, and one minimum 6 months post-surgery. We present eight surgical methods as well as pictures from previous surgeries. The results demonstrate obtainable results using very different surgical methods and the importance of an individualized approach to repairing cutaneous defects of the nasal tip.

Reconstruction of a Nasal Tip Defect.

Reconstruction of a Nasal Tip Defect.

PID Control Algorithm Based on Particle Swarm Optimization for Quadrotor UAV with Tip Defect

For the four-rotor UAV (Unmanned Aerial Vehicle), blade is one of the most important actuator, the four-rotor UAV is prone to blade tip defect during use, which will directly affect the reasoning size of the four-rotor UAV, resulting in the flight quality or performance decline of the four-rotor UAV, ordinary PID control in the case of blade tip defect, it can still be optimized by other algorithms. In this paper, particle swarm optimization will be used to optimize PID parameters in the case of tip defect of quadrotor UAV, and simulation experiments will be conducted in MATLAB Simulink to verify the reliability of particle swarm optimization by comparing and optimizing data curves such as forward and backward roll Angle and yaw Angle.

A Numerical Simulation Study on DC Positive Corona Discharge Characteristics at the Conductor’s Tip Defect

For investigating the relationship between the surface corona discharge of a DC wire and other influencing factors, a hybrid numerical model based on a fluid-chemical reaction was proposed to simulate the discharge process at the tip defect of the wire. Under different defect geometries and gas pressures achieved via simulation, the microscopic process of the reaction and movement of electrons and heavy particles during a positive corona discharge was studied, and characteristic parameters such as corona inception voltage and discharge current were analyzed. Furthermore, through the corona cage test, for a specific electrode configuration, corona inception voltages under different pressures were compared and verified, which showed that the model was reasonable. The results showed that the maximum electron density of the streamer head was about 1 × 1020 m−3, the rise time of the pulse current was about 10 ns, and the decay time was about 300–500 ns. The corona inception voltage decreased with an increase in the tip height and decreases in the tip curvature radius, conductor radius, and background air pressure; the amplitude of the pulse current increased with increases in the wire radius and curvature radius of the defect tip and decreases in tip height and background air pressure. The experimental results are consistent with the simulation results, which verifies the reasonability of the model.

Finger defect reconstruction using the radial artery superficial palmar branch free flap

Purpose: The radial artery superficial palmar branch (RASP) free flap is accepted as a surgical technique for the reconstruction of finger defects. This study revisited the RASP free flap and evaluated its reliability and usefulness in a variety of finger defects. Methods: From January 2017 to December 2022, multiple surgeons at a single institution performed a total of 315 RASP free flap reconstructions. Basic patient demographics and information on the finger defect and flap were assessed, and immediate postoperative flap and donor site-related complications were also studied. Data regarding long-term outcomes, such as the thumb joint range of motion and static two-point discrimination (S2PD), were collected and evaluated to identify statistically significant differences from the unaffected or non-innervated side. Results: The mean postoperative follow-up was 14.8 months. The total flap survival rate was approximately 91.4%. There was no statistically significant difference in mean postoperative palmar abduction and radial abduction between the affected and unaffected thumbs in both groups. In the single-digit group, there was a statistically significant difference in S2PD between the innervated flap and unaffected side. A statistically significant difference was also found between innervated and non-innervated flaps in the multiple-digits group. Conclusion: The RASP free flap is a valuable surgical option in reconstructing finger defects. It has already been proven to be safe and useful in coverage of single and tip defects. Stability should be ensured when there are multiple defects. Finally, the donor site morbidity is minimal and the recovery of sensation, once the flap is reinnervated, could be promising.

Inconsistent nanoindentation test hardness using different Berkovich indenters

When testing the nanoindentation hardness of the same sample with different Berkovich indenters, inconsistencies arise even when the frame stiffness and indenter tip area functions are regularly calibrated. This phenomenon has not been fully understood, making it challenging to accurately test and compare material hardness data from different laboratories. To address this issue, incremental test hardness caused by indenter tip defects and indentation size effects (ISE) is quantified. The ISE correction method proposed in this study is based on the Nix-Gao model for nanoindentation load-indentation depth (P-h) curves, and an area function equivalent modeling method is used to reproduce the geometry of Berkovich indenters in finite element (FE) analysis. Although the test hardness using different Berkovich indenters is inconsistent, their intrinsic hardness remains consistent. The proposed ISE correction method is validated by FE simulation results for A508-3 and 316 L steel that match perfectly with the ISE-corrected experimental P-h curves. The analysis of load increments shows that tip defects affect the test result through statistically stored dislocation (SSD) and geometrically necessary dislocation (GND). Indenter tip defects mainly affect the nanoindentation test results through GND. The smaller the indenter tip radius, the higher the GNDs, and the higher the test hardness. The different effects of indenter tip defects on GND lead to inconsistent hardness measurements using different Berkovich indenters.

Valsalva Maneuver to Identify Dermal Bleeders after Paramedian Flap Elevation Under Local Anesthesia.

The paramedian forehead flap (PFF) provides a reliable reconstruction option for complex nasal tip defects. The robust blood supply from a well perfused pedicle allows for reconstruction of large defects of the nasal tip for which simpler methods/techniques would provide inadequate coverage or result in inferior cosmesis. A well-designed PFF containing the supratrochlear artery inherently predisposes to small vessel bleeding from the pedicles cut edge. Due to the well perfused nature of the pedicle, there is an increased risk of post-operative bleeding. We describe a technique for better identifying bleeding points from the pedicle to optimise intra-operative haemostasis by performing the Valsalva maneuver using a syringe intraoperatively.

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

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

Repair of a Nasal Tip Defect.

*All authors are affiliated with the Division of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York Address correspondence and reprint requests to: David H. Ciocon, MD, Mohs Micrographic Surgery and Procedural Dermatology at the Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Avenue 2nd Floor, Bronx, NY 10467, or e-mail: [email protected] The authors have indicated no significant interest with commercial supporters.