Restoration of Lower Facial and Neck Esthetics by Application of Pre-Expanded Bipedicle Scalp and Free Scapular Flaps.

OBJECTIVE: To introduce the surgical procedures and experiences in restoration of lower facial esthetics for a male and a female patients who suffered from burn injuries. The difference of surgical methods which varied from sexes were discussed. MATERIALS AND METHODS: The clinical data of the patients was collected and retrospectively analyzed. The cervical contracture was repaired by pre-expanded free scapular flaps with sufficient pliable tissue for large defects. Moreover, for the male patient, prefabricated double pedicle scalp flap was applied to rebuild the beard region. The patients were followed up for 2 years. Surgical procedures and outcomes were detailed in the article. RESULTS: All the flaps were survived well. The facial hair-bearing area of the man was recovered with natural appearance. The reconstructed mental cervical angels and mandibular margins were clear. The neck extension mobility was improved. The 2 patients were satisfied with the outcomes of the treatments. CONCLUSION: The treatments of facial and neck scar varied from sexes and different requirements. For male patient, the combination of scalp and scapular flaps was a feasible method to achieve natural beard and cervical appearance. For female patient, bilateral expanded scapular flaps could meet the demands of large tissue supply and a relative hidden donor site.

Two Pre-Expanded Free Flaps Used for Auricular Reconstruction and Ipsilateral Facial Scar Release.

OBJECTIVES: Auricular reconstruction is a great challenge for surgeons to achieve good aesthetic outcomes when adjacent tissues were burned. Compared with pedicle flap therapies, there are some advantages of pre-expanded free flaps for ear rebuilding, such as thinner layer tissues for aesthetic requirements of delicate auricular structures and less donor site deformity. In this study, the authors introduced 6 sequential surgical procedures for total auricular reconstruction with severe ipsilateral facial scar. METHODS: Pre-expanded deltopectoral flap was used to release periauricular contracture and repair facial scar. The injured ear was restored by expanded forearm flap including autologous cartilage framework. The surgical procedures were lasted more than 2 years. An 8 and half year's follow-up was performed from November 2012 to April 2021. The clinical data and surgical techniques were recorded and analyzed. RESULTS: The patient was satisfied with the aesthetic outcomes of the new ear. The skin texture and color of the grafts were approximately matched to the recipient sites. Facial expression was not affected severely. Sensations of the transferred flap and new ear had partially recovered. The donor sites were recovered without severe complication. CONCLUSIONS: The pre-expanded free forearm flap is a feasible method for total ear reconstruction when local flap therapies could not be applied. Repair of ipsilateral facial scar is beneficial for auricular procedures.

Prenatal diagnosis of micrognathia: a systematic review.

Purpose: This systematic review aimed to analyze the characteristics of different diagnostic techniques for micrognathia, summarize the consistent diagnostic criteria of each technique, and provide a simple and convenient prenatal diagnosis strategy for micrognathia. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search was undertaken in three international databases (PubMed, Scopus, and Web of Science). The three reviewers assessed all papers and extracted the following variables: author's name and year of publication, country, study design, number of participants, gestational age, equipment for prenatal examination, biometric parameters related to micrognathia, main results. Results: A total of 25 articles included in the analysis. Nineteen articles described cross-sectional studies (76 percent), 4 (16 percent) were case-control studies, and 2 (8 percent) were cohort studies. Fifteen studies (60 percent) had a prospective design, 9 (36 percent) had a retrospective design, and one (4 percent) had both prospective and retrospective design. Thirty-two percent of the studies (n = 8) were performed in USA, and the remaining studies were performed in China (n = 4), Israel (n = 3), Netherlands (n = 3), UK (n = 1), France (n = 1), Italy (n = 1), Belgium(n = 1), Germany (n = 1), Spain (n = 1), and Austria (n = 1). The prenatal diagnosis of micrognathia can be performed as early as possible in the first trimester, while the second and third trimester of pregnancy were the main prenatal diagnosis period. The articles that were included in the qualitative synthesis describe 30 biometric parameters related to the mandible. Conclusion: Of the 30 biometric parameters related to the mandible, 15 can obtain the simple and convenient diagnostic criteria or warning value for micrognathia. Based on these diagnostic criteria or warning value, clinicians can quickly make a preliminary judgment on facial deformities, to carry out cytologic examination to further clarify the diagnosis of micrognathia.