[The triplane aesthetic reconstruction of the alar unit after removal of advanced basal cell carcinomas. About 26 cases]. / Rhinopoièses esthétiques triplan de l'unité de l'aile après ablation de lésions basocellulaires évoluées. À propos de 26 cas.

INTRODUCTION: The aesthetic reconstruction of full thickness defects of the entire ala is difficult because of its complex tridimensional anatomy. The triplan reconstruction of this unit which includes: -a lining with a mucosal flap, -a sculptured cartilage framework imitating the anatomy of the opposite ala -and a skin coverage by an immediate defatted forehead flap, gives regularly a very good aesthetic results, superior to the ones obtained by other techniques. PATIENTS AND METHODS: From may 2008 to December 2020, 26 patients aged between 49 and 78 years old have benefited from this triplan aesthetic reconstruction after an excision of evolved basal cell carcinomas interesting the ala unit. The defects resulting were located in the entire ala with slight extension to the adjacent units. In all cases, the lining was reconstructed by the BURGET'S homolateral septal mucosal flap. The shape of the ala was obtained by a precise sculpture of conqual cartilage, taking the opposite ala as the model. The cutaneous coverage was provided by a paramedian forehead flap tailored exactly to the defect's size and immediately defatted. RESULTS: With a mean follow up of 8 years, all the reconstructed ala were quasi symmetrical to the opposite ones with a very good shape of the new nostrils. No complications and no tumoral recurrence are reported. CONCLUSION: This triplan reconstruction of the entire ala's defects is really aesthetic and gives a natural look for the lower third of the nose.

Cartilage Grafting Outcomes in Intermediate and Definitive Cleft Rhinoplasty.

OBJECTIVE: To compare cartilage grafting outcomes in intermediate versus definitive cleft rhinoplasty. DESIGN: A retrospective chart review was conducted. The χ2 and Fisher exact tests were used for statistical analyses. Results were considered statistically significant at P < .05. PARTICIPANTS: All subjects who underwent revision cleft rhinoplasties between July 2011 and June 2019 were included. Subjects with syndromic conditions were excluded. RESULTS: A total of 46 subjects with a cleft nose deformity underwent 65 rhinoplasty procedures. The ages averaged 17 years (range 5-50) with 34 (73.9%) males and 12 (26.1%) females. In the intermediate group, 6 (28.6%) subjects required cartilage grafting as part of 6 cleft rhinoplasties, whereas 15 (71.4%) subjects underwent a total of 26 cleft rhinoplasties that did not require grafting. In the definitive group, 18 (76%) subjects required cartilage grafting over 21 cleft rhinoplasties, whereas 7 (24%) subjects underwent a total of 9 cleft rhinoplasties where cartilage grafting was not required. The difference between the number of subjects requiring cartilage grafting in the intermediate versus the definitive group was statistically significant (P = .007). Ear concha and nose were the most frequently used cartilage donor sites, with no observed complications. CONCLUSIONS: Cartilage grafting was significantly more common in the definitive rhinoplasty group. Intermediate cleft rhinoplasty during the 5- to 13-year age period was effective, with a low-risk profile. In our experience, ear concha and nose were the preferred cartilage donor sites, with effective results and an excellent safety profile.

[Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery].

Objective: To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. Methods: The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. Results: All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. Conclusion: Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Arthroscopic Cartilage Transplantation.

Arthroscopic cartilage repair has made several strides in recent years; however, no gold standard for cartilage restoration has been found. Simple treatment with bone marrow stimulation such as microfracture have shown good short-term results; however, concerns for long-term stability of cartilage repair as well as the subchondral bone health remain in question. Treatment of these lesions often comes down to surgeon preference, the aim of this study is to discuss some of the current options available on the market to further assist surgeons in their decision-making process.

Costal cartilage grafting in the treatment of concurrent osteochondral lesion of the talus in a trimalleolar fracture.

A 49-year-old female sustained a trimalleolar fracture concurrent with 10 years history of symptomatic osteochondral lesions of the talus. We performed a costal cartilage grafting for osteochondral lesions of the talus through the inherent medial malleolar fracture gap, followed by internal fixation of the fracture. During the follow-up, the fracture healed within the expected time, accompanied by favorable functional outcomes and pre-injury pain relief. At 3 years postoperatively, the graft merged with the bone bed of the talus, and progressive endochondral ossification was observed at the graft-bone interface. The case provides us a chance to verify whether the costal cartilage grafting is reliable for the treatment of osteochondral lesions of the talus.

Utilization of a partial rib-sparing procedure in microvascular breast reconstruction for preserving intercostal nerve and nipple reconstruction.

BACKGROUND: In microvascular breast reconstruction, internal mammary vessel (IMV) exposure has been performed. The preservation of intercostal nerve (ICN) is effective for preserving sensibility and decreasing postoperative pain. In nipple reconstruction, cartilage grafting is performed to provide additional support and projection. We considered that ICN preservation and costal cartilage banking could be performed simultaneously. This method was described as the "partial rib-sparing procedure." The purpose of this study was to introduce this procedure. METHODS: Surgical technique of this procedure was as follows. The second intercostal space was used. The width of the trimmed cartilage was kept within the superior half of the third costal cartilage. Soft tissue within 5 mm of the inferior border of the second rib edge was preserved to save the second ICN. The length of IMVs in the partial rib-sparing procedure and that in the total rib-sparing procedure was compared. RESULTS: The number of patients in the partial rib-sparing and total rib-sparing groups was 137 procedures and 57 procedures, respectively. The length of IMVs was significantly longer in the partial rib-sparing procedure (median 20.5 mm vs. 17.6 mm, P < 0.001). In the partial rib-sparing group, no patient complained of prolonged local pain, and chest wall contour abnormalities were absent in all cases. CONCLUSIONS: The partial rib-sparing procedure is superior, especially for patients with narrow intercostal spaces and/or patients who decide to undergo nipple reconstruction with costal cartilage. This procedure could be performed to preserve the soft tissues around the ICN and decrease the postoperative pain.

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction.

AIM: To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. METHODS: Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as "good", "fair", and "poor" by evaluating the margin appearance, eyelid appearance, and complications. RESULTS: A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a "good" outcome (88.1%), 5 patients had a "fair" outcome (11.9%), and no one had a "poor" outcome. CONCLUSION: Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.

Correction of the Overly Shortened Nose.

The overly shortened nose can often be the result of previous rhinoplasty. The causes can include weakening or missing cartilage for nasal tip support as well as contraction and scarring of the skin. The purpose of this article was to provide the authors' approach to this deformity.

Cell-based cartilage repair strategies in the horse.

Damage to the articular cartilage surface is common in the equine athlete and, due to the poor intrinsic healing capabilities of cartilage, can lead to osteoarthritis (OA). Joint disease and OA are the leading cause of retirement in equine athletes and currently there are no effective treatments to stop the progression of OA. Several different cell-based strategies have been investigated to bolster the weak regenerative response of chondrocytes. Such techniques aim to restore the articular surface and prevent further joint degradation. Cell-based cartilage repair strategies include enhancement of endogenous repair mechanisms by recruitment of stem cells from the bone marrow following perforation of the subchondral bone plate; osteochondral implantation; implantation of chondrocytes that are maintained in defects by either a membrane cover or scaffold, and transplantation of mesenchymal stem cells into cartilage lesions. More recently, bioengineered cartilage and scaffoldless cartilage have been investigated for enhancing repair. This review article focuses on the multitude of cell-based repair techniques for cartilage repair across several species, with special attention paid to the horse.

Controversies in Revision Rhinoplasty.

Revision rhinoplasty is a complex operation with many variables that may influence the final esthetic and functional outcome of the procedure. Cartilage forms the structural framework of the lower two-thirds of nose and is essential for long-term support and maintenance of a patent nasal airway. The use of autologous cartilage grafting is the primary source of this material, limited by donor site quantity, quality, and harvest morbidity. Alloplastic materials, solid and injectable, are often used for augmentation purposes and may have devastating consequences. This article discusses past and current treatment concepts for various nasal deformities using available autologous grafting techniques.

Free spreader grafts in rhinoplasty.

BACKGROUND: Spreader grafts (SPG) are widely used for different purposes in rhinoplasty procedures. However, selection of the size of the grafts, trimming and fixation often proved time consuming and difficult. We used an original method of placement of "free" SPG to improve both ease of placement and fine trimming of the grafts. To assess pertinence of this approach, we evaluated retrospectively our rate of correction of the middle third of the nose. METHODS: We used a personal method for securing SPG after suturing upper lateral cartilages (ULC). Grafts were inserted between the ULC and nasal septum, adding fibrin glue for fixation. We reviewed the aesthetic results of a series of 420 consecutive rhinoplasties in whom free SPG were used in 218 patients and conventional fixed SPG were used in 33 patients. Retrospective analysis of the photographic data of all patients was performed. Adequacy of brow tip lines, symmetry and relative width of the middle third was assessed by an independent observer and the surgeon. RESULTS: No evidence of postoperative displacement was noted. Symmetry of the middle third of the nose and adequacy of aesthetic brow tip lines were obtained in the vast majority of the patients. Comparable rates of middle vault correction and harmony were obtained in patients with free SPG or conventional SPG. On occasion during revision surgeries, we found the grafts resting in adequate position. CONCLUSIONS: Free SPG placement appeared a straightforward and timesaving method in rhinoplasty procedures and proved especially meaningful when limited to moderate amount of support was needed in the middle vault reconstruction. Repositioning, resizing of the graft or placement of additional pieces of cartilage were feasible instantly if needed. This technique might help to obtain better correction of the middle third due to easiness and possibility of fine adjustments in rhinoplasty procedures. Level of Evidence: Level III, therapeutic study.