Bipedicled dorsal intercostal artery propeller flaps for reconstruction of extensive cervicothoracic midline defects.

BACKGROUND: Propeller flaps have been reported to cover cervicothoracic midline defects with lower donor site morbidity compared to muscle flaps. When these defects are extensive, we propose a propeller flap technique that we have named dorsal intercostal artery perforator plus (DICAP+) flap based on two perforator pedicles, to secure the large skin paddle. In this article, we present our experience. METHODS: Six propeller DICAP+ flap procedures were performed on five patients, to reconstruct cervicothoracic midline defects. Three of them were caused by tumors and two were secondary to hardware exposure after spinal surgery. Defect sizes ranged from 16 × 5 to 24 × 9 cm. Every propeller flap was harvested on two perforators including one DICAP, and rotated from 80° to 180°. RESULTS: Skin ellipse size ranged from 15 × 7 cm or 82.4 cm2 to 25 × 12 cm or 235.5 cm2 , equal to a mean surface area of 160 cm2 . The donor site was closed by primary suturing in four of the six procedures, by a contralateral propeller DICAP flap in one patient, and was left to heal by secondary intention in another one. All six flaps successfully covered the underlying defects with no evidence of partial or complete necrosis. No other complications were observed at recipient and donor sites. The follow-up period ranged from 9 months to 2 years. CONCLUSIONS: Propeller flaps based on two dorsal perforators including one dorsal intercostal artery perforator, DICAP+, are a reliable means of reconstructing extensive cervicothoracic midline defects.

Anthropometry of the Saudi Arabian nose.

All previous studies on nasal anthropometry of Middle Eastern populations were done on Persian, Turkish, and North African populations; with no studies arising from the Arabic Gulf Region. This study aimed to define nasal anthropometric measurements in Saudi Arabia (the largest Arabic Gulf country) and compare them with different races. A total of 104 Saudi men and 105 Saudi women with a mean age of 22 years (range, 18-27 years) were included in the study. A total of 25 nasal anthropometric variables were measured. Comparison with other races was done using the t-test (P < 0.05 is considered significant). The intercanthal distance of Saudi men is significantly smaller than that in women (the reverse is true for other races). Hence, Saudi women (and not men) have significantly wider intercanthal distance than do whites. The nasal widths of Saudi men and women lie between the whites and the Chinese. A unique feature of the Saudi nose is the significantly larger nasofrontal angle of Saudi men and women compared with all other races. Within the Saudi race, the nasofacial angle of men is so much larger than that of women (41.4 vs 33.3 degrees). In other races, the difference between men and women is usually slight (0- to 1-mm difference only). In Saudi men, the nasofacial angle is significantly larger than that in whites, but the value for Saudi women is significantly smaller than that for whites. Finally, in both Saudi sexes, the nasal tip angle/nasal tip protrusion is significantly smaller than all other races. It was concluded that the Saudi nose has several unique features when compared with other races including other Middle Eastern populations.