An Innovative and Economical Device for Ischemic Preconditioning of the Forehead Flap Prior to Pedicle Division: A Comparative Study.

BACKGROUND: Ischemic preconditioning of the forehead flap prior to pedicle division helps to improve angiogenesis. Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied. However, the severe pain and unstable blocking effect influenced the preconditioning process. In this study, we described an innovative device designed for ischemic preconditioning and compared its efficacy with the clamped rubber band. METHODS: The device consists of a self-locking nylon cable tie with a buckle and a rubber tube. The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion for ischemic preconditioning. This device and the standard clamped rubber band were applied respectively before division surgery. The constriction effect, reliability, reproducibility, and the patients' pain tolerance were compared. RESULTS: A total of 20 forehead flaps were included. The cable tie had less incidence of loosening (7.7% vs. 16.6%, p < 0.05) and maintained the pressure more effectively. The pain score for the nylon cable tie was significantly lower than the clamped rubber band (4.25 ± 1.02 vs. 6.75 ± 1.12, p < 0.05), especially for 10 pediatric patients (4.50 ± 0.85 vs. 8.10 ± 1.20, p < 0.01). All 20 pedicles were successfully divided at 19 to 22 days with no surgical complications. CONCLUSION: Compared with the clamped rubber band, the cable tie produces a more reliable and reproducible ischemic preconditioning effect. It is also better tolerated by the patients. Therefore, we recommend using the nylon cable tie as the preferred device for ischemic preconditioning of the forehead flap.

Septal Reconstruction With Folded Porous Polythylene Implants: An Alternative Technique for the Correction of Severe Saddle Nose Deformities in Asian Populations.

BACKGROUND: Congenital or secondary deficiency in septal cartilage leads to an unpleasant cosmetic appearance and compromised function as well. Rhinoplasty maneuvers such as spreader graft and septal extension graft with autologous tissue have been exhibited to correct the deformities. However, the relatively severe donor site morbidity stands as a main concern for both surgeons and patients. METHODS: From January of 2014 to April of 2018, 52 patients presenting septal deformities underwent rhinoplasty with our modified technique. A piece of Medpor (8438) was tailored, folded and then placed as a combination of spreader and septal extension graft. The surgical outcomes were evaluated both objectively and subjectively. RESULTS: All the patients were followed up for 12 to 24 months postoperatively. The ratio of tip projection and the nasal length exhibited significant improvement in all our patients. Nasal obstruction subjectively mended among the 24 patients who had airway obstruction complaint preoperatively. Only 2 patients had severe adverse events and the implants were removed instantly. CONCLUSIONS: With our modified technique, Medpor proved to be an effective and reliable material for the reconstruction of septal cartilage, which provides us an alternative way to achieve extended spreader and septal extension graft with one single implant in the correction of saddle nose.Level of Evidence: Level IV, therapeutic study.