Tip Defects Research Articles

Bilateral Alar Cartilage Reduction Rhinoplasty Allows Primary Repair of Alar Defects in the Bulbous Nose

Plastic surgeons have many reconstructive options for lower nasal skin defects, but given the unique aesthetic features of nasal skin the best source for reconstruction is nasal skin itself, when sufficient quantity exists. The purpose of this study is to determine the outcome of bilateral alar cartilage reduction rhinoplasty in combination with a nasal flap to facilitate immediate reconstruction of defects of the nasal tip, soft triangle and alar margin. This prospective study analyzed the aesthetic outcome after reconstruction with bilateral alar cartilage reduction rhinoplasty to reduce the nasal rim and create an excess of skin sufficient to facilitate immediate reconstruction of defects of the nasal tip, soft triangle and alar margin. All wounds healed primarily and patient satisfaction was achieved. Bilateral alar cartilage reduction rhinoplasty allows single-stage reconstruction of defects of the nasal tip, soft triangle, and medial alar rim in the bulbous nose. By placing incisions along the borders of the aesthetic subunits, this novel approach to primary reconstruction of the nasal tip, soft triangle, and medial alar rim provides skin with a superior color and texture match, maintains a satisfactory contour of the nasal rim, and optimizes the likelihood of good scar quality.

Alar Cartilage Grafts for Repair of Complex Tip Defects

Alar Cartilage Grafts for Repair of Complex Tip Defects

Application of modified Rintala flap in nasal tip reconstruction

IntroductionFor nasal tip reconstruction, we must consider optimal results including color match, good tissue coverage, excellent flap viability, and good aesthetic result. MethodsIn this study, 25 patients who had nasal tip skin tumors were included, and reconstruction of the defects by dorsal nasal advancement flap (Rintala) was done. The advantages and disadvantages of the Rintala flap were described for all patients with nasal tip basal cell carcinoma (BCC). All patients filled out the consent form before reconstruction and tumor surgery. ResultsIn this study, 25 patients (11 women and 14 men) ranging from 25 to 72 years old (mean, 53 years) underwent operation with dorsal nasal advancement flap (Rintala). Reconstruction of nasal tip defects after complete tumor excision was done with free margin. After sedation analgesia, we used bilateral parallel incision in both sides of the nasal sidewalls from corner to glabellar region; Burow triangles are excised bilaterally in lateral to the base of the flap. ConclusionsIn case of midline tip defects with 1.5 to 2.5 cm in diameter, a modified Rintala flap is a good choice for reconstruction of this difficult area. This is a superiority-based randomized flap that makes an aesthetic nasal tip after tumor excisions without any fear from ischemia or necrosis of the flap.

Reconstruction of the thumb tip using palmar neurovascular flaps

Reconstruction of the tip of the thumb using a neurovascular flap. Transverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5cm) with exposure of bone and/or tendons. Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0-2.5cm finger length), circumferential soft tissue defects, and previous defects/operations (relative). Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap's base (O'Brien). Finally, closure of the defect at the flap's base using a full thickness skin graft, Z plasty, or V-Y plasty. Plaster cast (finger slightly flexed) for 2 weeks. Reliable method. Good functional results with good sensibility and only minor reduction in range of motion.

Introduction of the real tip defect of Berkovich indenter to reproduce with FEM nanoindentation test at shallow penetration depth

Abstract

Extraction of Mechanical Properties with Second Harmonic Detection for Dynamic Nanoindentation Testing

In this article, a new method based on the detection of the second harmonic of the displacement signal to determine mechanical properties of materials from dynamic nanoindentation testing, is presented. With this technique, the Young’s modulus and hardness of homogeneous materials can be obtained at small penetration depths from the measurement of the second harmonic amplitude. With this innovative method, the measurement of the normal displacement is indirectly used, avoiding the need for very precise contact detection. Moreover, the influence of the tip defect and thermal drift on the measurements are reduced. This method was used for dynamic nanoindentation tests performed on fused silica and on an amorphous polymer (PMMA) because these materials are supposed not to exhibit an indentation size effect at small penetration depths. The amplitude of the second harmonic of the displacement signal was correctly measured at small depths, allowing to calculate the Young’s modulus and the hardness of the tested materials. The mechanical properties calculated with this method are in good agreement with values obtained from classical nanoindentation tests.

Resurfacing Partial Nose Defects With a Retroauricular Skin/Cartilage Free Flap

The retroauricular skin has always received much attention by plastic surgeons for use in nose reconstruction because of its rich vascularity. Anatomically, the skin of this area lies hidden behind the ear and is very similar to that of the face. More importantly, the retroauricular skin flap along with the cartilage can be used to repair defective cartilage of the nose. All these reasons make this area an ideal donor site for nose reconstruction. This article presents the surgical procedures for reconstruction of partial nasal defects with the use of retroauricular skin/cartilage free flaps. Based on the anatomy and blood supply of the retroauricular region, a flap was designed and harvested with the retroauricular vessels as its pedicle. This flap was used to repair the partial nose defects in 10 patients, between the years 2002 and 2008. Of these, 4 patients presented with unilateral ala defects; 2 with nasal tip defects; 2 with defects on the nasal tip and bilateral ala; 1 with unilateral ala and tip defect; and 1 with unilateral ala and lateral defect. The size of the defect ranged from 2.5 × 1.5 cm to 4.0 × 3.0 cm. The flap varied between 3.0 × 2.0 cm and 4.5 × 3.5 cm. In all cases, the auricular cartilage of 1.5 × 1.0 cm to 1.0 × 0.5 cm was taken along with the flap. The retroauricular vessels were anastomosed with the facial vessels. The donor site was covered with full-thickness skin graft or local flap. No flap failure was recorded. Excellent morphologic reconstruction was obtained with these flaps with no sequela at the donor site in terms of form and function. Postoperatively, the blood supply to the flaps was fairly good in 8 cases, although there was vein congestion in 2 cases on the fourth day. However, the postoperative results of the 10 cases were satisfactory after treatment. The retroauricular skin-cartilage free flap is a good choice for partial nasal reconstruction, having the merits of a well-hidden donor site, good color match, and 1-stage operation for cartilage support and nose reconstruction.

Repair of soft tissue defect at finger tip with square island flap pedicled with skin perforator of digital artery on the distal interphalangeal joint

To investigate the repair of soft tissue defect at finger tip with square island flap pedicled with skin perforator of digital artery on the distal interphalangeal joint (DIP). From Jun. 2009 to Mar. 2010, 15 cases with soft tissue defects at 15 fingers tip were treated with this island flaps. The flap size ranged from 1.2 cm x 0.8 cm to 2. 0 cm x 3.0 cm. The defects at donor sites were covered with skin grafts from forearm. All the flaps and skin grafts survived. 10 fingers in 10 cases were followed up for 6-12 months. The color, texture and contour of the flaps were good. The two-point discrimination distance was 5-6 mm on the directed island flaps, and 7-10 mm on the reverse island flaps. No obvious functional problem was found in DIP motion. The hand function was assessed as excellent in 8 fingers, good in 1 finger and medium in 1 finger. The main artery and nerve will not be sacrificed when the island flap is used. The operative procedures are easily performed for the treatment of fingertip skin defect.

Optimizing Outcomes in Trilobed Flap Reconstruction for Nasal Tip Defects

Optimizing Outcomes in Trilobed Flap Reconstruction for Nasal Tip Defects

Atomic Force Microscopy-Scanning Electrochemical Microscopy: Influence of Tip Geometry and Insulation Defects on Diffusion Controlled Currents at Conical Electrodes

Numerical simulations were performed to predict the amperometric response of conical electrodes used as atomic force microscopy-scanning electrochemical microscopy (AFM-SECM) probes. A simple general expression was derived which predicts their steady state limiting current as a function of their insulation sheath thickness and cone aspect ratio. Simulated currents were successfully compared with experimental currents. Geometrical parameters such as insulation angle and tip bluntness were then studied to determine their effect on the limiting current. Typical tip defects were also modeled using 3D simulations, and their influence on the current was quantified. Although obtained for SECM-AFM probes, these results are directly applicable to conical micro- and nanoelectrodes.

Intranasal lining flaps

This article summarizes various surgical techniques useful in restoring intranasal lining required during reconstruction of full thickness nasal defects. Bipedical vestibular skin advancement flaps may be used for lining defects of the nostril that do not have a vertical height greater than 1.0 cm. Lining defects larger than 1.0 cm in vertical height are best repaired with an ipsilateral septal mucoperichondrial hinge flap. If this by itself is insufficient, a contralateral dorsal septal mucoperichondrial flap may be used to provide additional lining to the nasal sidewall and middle nasal vault. For full-thickness defects of the nasal tip or dorsum, some form of a septal composite chondromucosal pivotal flap may be necessary for lining the nasal passages. Inferior and middle turbinate mucoperiosteal flaps may on occasion supplement any of the septal mucosal flaps.

Reconstructive Perspectives of Cutaneous Defects Involving the Nasal Tip

To create an algorithm that derives our preferred reconstruction technique for cutaneous defects involving the nasal tip and to review the management and outcomes of patients with nasal tip cutaneous defects after their initial reconstruction. A retrospective review of patients undergoing repair of cutaneous defects involving the nasal tip between January 2006 and January 2009. After data compilation, a defect-based algorithm deriving our repair technique was created. Seventy-two patients were identified: 57% underwent full-thickness skin graft repair (n = 41), 19% underwent forehead flap repair (n = 14), and 17% underwent bilobe flap repair (n = 12). The remaining 7% underwent repair using nasal cutaneous flaps harvested adjacent to the defect (n = 5). Nasal tip defect involvement of an adjacent nasal aesthetic unit was the most critical factor in selecting a reconstruction technique. Further categorization by the presence of nasal ala involvement, cartilage exposure, and defect surface area allowed reliable prediction of our reconstruction technique. Dermabrasion was routinely performed early in the postoperative course (25% [18 of 72 patients]). Corticosteroid injection was commonly used for those undergoing forehead flap (71% [10 of 14 patients]) and bilobe flap (50% [6 of 12 patients]) repair. Aesthetic revision surgery was infrequently required (15% [11 of 72 patients]). All aesthetic outcomes were good or satisfactory. The included algorithm offers a systematic approach for managing cutaneous defects involving the nasal tip and derives our preferred technique with high reliability.

Nasal Reconstruction after Malignant Tumor Resection: An Algorithm for Treatment

Sir: We read with great interest the article entitled “Nasal Reconstruction after Malignant Tumor Resection: An Algorithm for Treatment” by Moolenburgh et al. (Plast Reconstr Surg. 2010;126:97–105).1 This article reviews the surgical options for nasal defects and proposes an algorithm based on the authors' personal experience with 788 cases and a literature review. We would like to congratulate the authors for this excellent article that provides guidelines for nasal defects after skin cancer ablation. The authors' algorithm emphasizes various reconstructive techniques for skin only; skin and cartilage defects; and skin, cartilage, and mucosa defects. Reconstructive options were categorized also based on the location of nasal defect (i.e., dorsum, lateral sidewall, ala, columella, vestibulum nasi, and tip). Although their algorithm is invaluable, we would like to emphasize the fact that selection of a particular reconstructive option is at the discretion of the reconstructive surgeon and depends on a variety of factors such as surgical knowledge and skill, simplicity versus complexity of the procedure, patient motivation, patient comorbidities, and other factors. Obviously, the authors attempted to include the most commonly used reconstructive options for nasal defects. However, we believe that another very common technique, the banner flap,2–5 should be included among the reconstructive techniques used for nasal defects. The banner flap is a triangular skin flap that is transposed 90 degrees to cover skin-only defects less than or equal to 1.2 cm in the lateral aspect of the nose, domal-alar groove, and nasal tip (Fig. 1). However, by basing the flap opposite the defect, the flap reach is increased and larger defects can be effectively closed. The amount of skin available should be judged by pinching the skin between the index finger and thumb before its design. The banner flap is simple to use. However, there is often a need to correct the dog-ears, and maximum caution should be taken to avoid compromising the pedicle base. Also, there may be a tendency toward pincushioning, as with all rounded flaps.Fig. 1.: Application of a banner flap in a 45-year-old female patient. The banner flap is designed for use as a transposition flap to reconstruct a nasal tip defect after excision of a skin lesion as outlined.We would also like to take this opportunity to comment on skin-only defects of a specific region in the distal third of the nose, an area known as the infratip. This area that can be better observed from the basal projection of the nose is located between the tip and the apex of the nostrils. Bilobed flaps may provide coverage for the infratip area; however, dorsal scarring caused by multiple incisions on the leading surface of the nose makes the procedure less attractive. Instead, two triangular skin flaps designed to include the remaining skin of the infratip lobule and the anteroinferior surfaces of the alar sidewalls based on the columella can be used for isolated defects (Fig. 2). These flaps are suitable for defects 10 to 12 mm in diameter in both the tip and the infratip regions. However, in some individuals, the width of the columella and infratip lobule may not be sufficient to raise these flaps.6Fig. 2.: The design of two triangular flaps after excision of a basal cell carcinoma in a 65-year-old female patient. These two triangular flaps are raised to be used as transposition-advancement flaps to reconstruct the nasal defect.Raffi Gurunluoglu, M.D., Ph.D. Susan A. Williams, P.A.-C. Plastic and Reconstructive Surgery Denver Health Medical Center University of Colorado Health Sciences Denver, Colo.

Reconstructive Perspectives of Cutaneous Defects Involving the Nasal Tip

Objectives:Tocreateanalgorithmthatderivesourpreferredreconstructiontechniqueforcutaneousdefectsinvolving the nasal tip and to review the management and outcomes of patients with nasal tip cutaneous defects after their initial reconstruction. Methods: A retrospective review of patients undergoingrepairofcutaneousdefectsinvolvingthenasaltipbetween January 2006 and January 2009. After data compilation, a defect-based algorithm deriving our repair technique was created. Results: Seventy-two patients were indentified: 57% underwent full-thickness skin graft repair (n=41), 19% underwentforeheadflaprepair(n=14),and17%underwent bilobe flap repair(n=12). The remaining 7% underwentrepairusingnasalcutaneousflapsharvestedadjacent to the defect (n=5). Nasal tip defect involvement of an adjacent nasal aesthetic unit was the most critical factor in selecting a reconstruction technique. Further categorization by the presence of nasal ala involvement, cartilage exposure, and defect surface area allowed reliable prediction of our reconstruction technique. Dermabrasion was routinely performed early in the postoperative course (25% [18 of 72 patients]). Corticosteroid injection was commonly used for those undergoing forehead flap (71% [10 of 14 patients]) and bilobe flap (50% [6 of 12 patients]) repair. Aesthetic revision surgery was infrequently required (15% [11 of 72 patients]). All aesthetic outcomes were good or satisfactory. Conclusion: The included algorithm offers a systematic approach for managing cutaneous defects involving the nasal tip and derives our preferred technique with high reliability.

On determination of the damping factor of linear viscoelastic materials using dynamic indentation: a theoretical study

In this study, we theoretically investigate the dynamic indentation for measuring the loss (damping) factor of a linear viscoelastic material from its indentation response. A rigid indenter with arbitrary tip profile is assumed to indent into a viscoelastic substrate with arbitrary shape. We perform a theoretical analysis and identify the conditions under which the loss factor of the material can be determined from the phase angle between the applied harmonic indentation load and the corresponding harmonic displacement, a directly measurable quantity in a dynamic indentation test. To validate the conclusion drawn from our theoretical analysis, a series of numerical experiments are performed, including the spherical indentation of a soft layer with irregular surface morphology bonded to a rigid substrate, a conical indenter with tip defects indenting into a half-spherical particle, and the indentation of porous materials. This study may facilitate the use of the dynamic indentation technique to evaluate the damping properties of linear viscoelastic materials, including some advanced polymers and biological soft tissues.

Multiscale analysis of defect initiation on the atomistic crack tip in body-centered-cubic metal Ta

The quasi-continuum method (QC), a multiscale method, is used to analyze body-centered-cubic (bcc) metal tantalum (tantalum, Ta) type Ⅱ crack-tip dislocation nucleation. Based on the relationship curves between dislocations emission position and stress intensity factor, the processes of dislocation defect initiation and development are investigated. Dislocation travels forward with different characteristics in different stages and the new nucleated dislocations expedite the already nucleated dislocation to move away from the crack tip. The analysis of initiation of the crack tip defects shows that they are the local defects that first appear, and with loading, more local defects emerge, which eventually move to the boundary, and lead to the type Ⅱ fracture. Furthermore, dislocation dissociation as well as extended dislocation is discussed. The partial dislocation nucleating before the perfect dislocation nucleation and emission is full proof that the dissociation of perfect dislocation takes place step by step, which means that the two minimum points on the energy curve have different formation mechanisms.

Aesthetic Improvements of Skin Grafts in Nasal Tip Reconstruction

Defect closure on the nasal tip subunit still remains challenging. Full-thickness skin transplantation still is used despite its poor outcome in terms of the nasal tip contour caused by lack of dermal tissue. To avoid subsidence deformities associated with nasal tip reconstruction with skin transplants, this study analyzed methods using combined epidermal and dermal replacement. For 30 consecutive patients with a nasal tip defect, a retrospective comparison was made between conventional full-thickness skin transplantation, retroauricular perichondrodermal composite grafts, and skin transplantation supplemented with the collagen-elastin matrix, Matriderm, used as a dermal substitute (n=10 per study group).The postoperative results were evaluated in a randomized and blind manner by external facial surgeons using the Manchester Scar Scale. The findings showed a marked improvement in nasal tip contour with combined epidermal/dermal replacement without any deterioration in other graft qualities, justifying the additional effort involved in this procedure. Two patients developed fistulae after Matriderm-aided skin transplantation. Therefore, the authors do not consider this a suitable method for nasal tip reconstruction.

Barrel Roll Technique for the Correction of Long and Concave Lateral Crura

To describe the barrel roll technique that is capable of concurrently correcting 2 associated deformities--overprojection and ptosis of the nasal tip. Thirty-two patients with concavity of the upper section of 1 or both lateral crura combined with a droopy tip were treated from January 1, 2005, through December 31, 2007. In all cases, the barrel roll technique was used, which involves rotating the lateral crus by 180° on its major axis so that the concavity is transformed into convexity, and carrying out lateral crural overlay to correct the overprojection concurrently. All the patients displayed functional and aesthetic improvement by correcting the droopy tip and concavity of the lateral crura. Revision was necessary in 1 case of monolateral concavity. The comparison of preoperative and postoperative rhinomanometric data showed significant improvement of nasal airway resistance. A combination of the overlay technique and rotation of a portion of the lateral crus on its axis is capable of concurrently correcting serious functional problems and aesthetic defects of the nasal tip. The open approach is essential for perfect positioning of the mobilized cartilaginous segments and ensuring stable results over time.

Barrel Roll Technique for the Correction of Long and Concave Lateral Crura

To describe the barrel roll technique that is capable of concurrently correcting 2 associated deformities—overprojection and ptosis of the nasal tip. Thirty-two patients with concavity of the upper section of 1 or both lateral crura combined with a droopy tip were treated from January 1, 2005, through December 31, 2007. In all cases, the barrel roll technique was used, which involves rotating the lateral crus by 180° on its major axis so that the concavity is transformed into convexity, and carrying out lateral crural overlay to correct the overprojection concurrently. All the patients displayed functional and aesthetic improvement by correcting the droopy tip and concavity of the lateral crura. Revision was necessary in 1 case of monolateral concavity. The comparison of preoperative and postoperative rhinomanometric data showed significant improvement of nasal airway resistance. A combination of the overlay technique and rotation of a portion of the lateral crus on its axis is capable of concurrently correcting serious functional problems and aesthetic defects of the nasal tip. The open approach is essential for perfect positioning of the mobilized cartilaginous segments and ensuring stable results over time.

Repair of thumb tip defect with thumb island flaps at ulnar side by V-Y advancement

To investigate the method for treatment of thumb tip defect. The thumb tip defect was treated with thumb island flaps at ulnar side by V-Y advancement. The flap size ranged from 1.4 cm x 2.0 cm approximately 1.4 cmx 2.5 cm. The wounds at donor sites were covered by skin grafts. From March 2007 to October 2009, 10 cases of thumb tip defects were treated. All the flaps and skin grafts were survived with primary healing. The patients were followed up for 6-18 months with both satisfactory functional and cosmetic results. The two-point discrimination was 5-6 mm at the thumb tip. The thumb tip defect can be successfully repaired with thumb island flaps at ulnar side by V-Y advancement.