Simultaneous Restoration of Swallowing and Voice Function With Ileocolon Free Flap.

BACKGROUND: Free ileocolon flap is a reliable technique allowing simultaneous restoration of swallowing and speech. The aim is to report our 6-year experience in a single center. METHODS: Thirty-seven patients treated between 2010 and 2015 were included in the study. Swallowing and speech function were evaluated in 27 patients with a 7-point and 5-point Likert scale, respectively. Moreover, 12 of them consented to voice spectrum analysis (VSA). RESULTS: Complications noted were: aspiration (3), esophagocutaneous fistula (2), and stricture (1). Seven patients experienced self-limited diarrhea. Regarding swallowing function, 77.8% scored ≥5 on Likert scale whereas speech Likert scale showed excellent results (score >12) in 74%. VSA demonstrated mean phonation time of 10.75 seconds, mean frequency of 131 Hz and mean dynamic range of 56 dB. CONCLUSION: In experienced hands, the ileocolon flap is safe and effective, particularly in patients with long-life expectancy, providing good swallowing and speech function without further procedures/prostheses.

A Modified Closed-Open Approach as Part of a Graduated and Integrative Approach to Rhinoplasty.

Introduction Open versus closed approach in rhinoplasty is a frequently debated topic in aesthetic plastic surgery. Although good results can often be achieved with either technique, both have unique advantages and disadvantages. In this investigation, we present our experiences of a modified closed-open approach that has been applied on 482 complex primary and secondary rhinoplasties. Three representative cases are described in more detail. Materials and Methods The procedure begins as a closed approach through an intracartilaginous incision allowing cephalic trimming of the lateral crura, dorsal rasping, and/or excision. Patients requiring extensive nasal tip maneuvers are subjected to exposure of the alar cartilage framework through a transcolumellar/limited marginal incision. This provides not only adequate exposure of the alar cartilages but also easy access to the septum. Conclusion In our hands, this approach is easy and expeditious. It requires less tip dissection, and therefore may avoid the prolonged postoperative edema that is often a consequence of open or extended closed tip delivery approaches.