Nasal Tip Reconstruction Using Integra Bilayer Wound Matrix: An Alternative to the Forehead Flap.

UNLABELLED: Large defects of the nasal tip with exposure of the underlying cartilage pose a significant reconstructive challenge to the plastic surgeon. OBJECTIVE: This article presents a case of a large nasal tip defect following basal cell excision that was successfully treated with Integra bilayer wound matrix and skin grafting. METHODS: Following tumor excision, meshed Integra bilayer wound matrix was placed over the exposed nasal tip cartilage. After 4 weeks, the silicone layer was removed and a full-thickness graft placed on the nasal tip. RESULTS: This reconstruction resulted in the restoration of patient's nasal tip with good contour and color match without the need for a forehead flap. CONCLUSION: This demonstrates the reconstructive potential of this modality in patients who are not candidates for reconstruction with a forehead flap.

Successful correction of velopharyngeal stress incompetence in musicians playing wind instruments.

Two professional musicians who played wind instruments developed velopharyngeal stress incompetence which prevented them from generating the high intraoral pressures required to play their instruments. In both cases, we did a V-Y pushback with a superiorly-based pharyngeal flap. At 1 1/2 and two years postoperatively, both patients remain free of velopharyngeal incompetence and are actively engaged in their musical careers.

Craniofacial and head and neck applications of the transaxillary latissimus dorsi flap.

The use of a transaxillary latissimus dorsi musculocutaneous flap is suitable whenever a large volume of tissue is required for head and neck reconstruction. Our series of 63 transaxillary latissimus dorsi musculocutaneous flap reconstructions included three cases of complete flap necrosis and ten cases of partial flap necrosis. When used in reconstructive head and neck surgery, the latissimus dorsi vascular pedicle is separate from the radiated field. The pedicled latissimus dorsi flap provides coverage of the orbitocranium, including the supraorbital region and central portion of the upper face. In the event that the pedicle muscle flap does not reach far enough cephalad, the nutrient vessels can be separated from the axillary artery and anastomosed to vessels in the neck. Combined defects of the esophagus, the mandibulofacial region, and the neck may be reconstructed with a single large latissimus dorsi flap. In our experience, aesthetic and functional deficits have been well tolerated by patients after latissimus dorsi reconstruction. Disadvantages of the latissimus dorsi flap include repositioning of the patient, increased blood loss, and longer operating time. Permanent brachial plexus injury can also occur. In general, the transaxillary latissimus dorsi musculocutaneous flap should not be used when defects can be reconstructed using simpler methods.