A Clinical Score For Predicting Complications Following Breast Reduction.

Objectives: To establish a clinical score for morbidity prediction based on patient-related risk factors after breast reduction surgery. Method: The retrospective study was conducted at the Department of Plastic and Reconstructive Surgery, Kafrelsheikh University Hospital, Egypt, and comprised data of female patients with bilateral macromastia who underwent breast reduction, using the inferior pedicle invertedT technique between February 2019 and June 2020. After data retrieval, risk factors and complications were documented and related to the patients'risk factors Data was analysed using SPSS 20. RESULTS: Of the 30 cases, 20(66.7%) were aged ≥35 years, 16(53.3%) had body massindex ≥37kg/m2 and 27(90%) were non-smokers. The mean preoperative haemoglobin level was 12.15±1.115g/dL and the mean weight of tissue resected on both sides was 2074.17±696.12gm. Factors significantly associated with complications included smoking, suprasternal notch to nipple distance ≥38cm, haemoglobin <12.5g/dL, the weight of excised tissue ≥2000gm and a positive family history of macromastia. The total score of the morbidity prediction scale ranged 2-190, with the best cut-off value being ≥93. The scale had 100% sensitivity,specificity, positive predictive value, negative predictive value and 100 percent accuracy. CONCLUSIONS: Ability to predict postoperative surgical-site morbidity may optimise safety as well as outcome after reduction mammaplasty.

Early Postoperative Sequelae After Open Sky Access in Nasal Osteotomy: A Comparative Study.

INTRODUCTION: Nasal osteotomy is a powerful cornerstone step in almost all rhinoplasty procedures and is a major cause of postoperative periorbital ecchymosis and edema after rhinoplasty. Different accesses for osteotomy have been described, the most popular of which is the external perforating and the internal continuous methods. These accesses are blind maneuvers and have some drawbacks such as possible visible scar formation in the percutaneous access or high rate of mucosal tear in the endonasal access. Open sky access osteotomy after wide subperiosteal dissection had been described to overcome those disadvantages. Early postoperative sequelae have not been assessed in the literature after using this access. In the present study, we aim to assess early postoperative sequelae after using this technique in comparison with percutaneous perforating osteotomy. MATERIALS AND METHODS: The study was conducted between November 2017 and January 2021. Forty patients were randomly assigned into 2 equal groups. Group A was subjected to lateral osteotomy by percutaneous perforating method, whereas group B underwent lateral osteotomy by the open sky access technique using a 2-mm curved osteotome. Early postoperative periorbital sequelae were assessed on the second and seventh postoperative days, using the grading system suggested by Kara et al (Plast Reconstr Surg. 1999;104:2213-2218). Mucosal tear was assessed on the second postoperative day using nasal endoscopy after removal of nasal packs. RESULTS: There was a statistically nonsignificant difference between the studied groups regarding ecchymosis and edema occurring on the second or seventh days. Meanwhile, mucosal tear was significantly less in the open sky access osteotomy group. CONCLUSIONS: Open sky access osteotomy is a safe method for lateral nasal osteotomy with direct visualization of the surgical field. It does not require a skin incision that could lead to a scar formation. It produces less mucosal tear than percutaneous perforating osteotomy. No statistically significant difference is found between both techniques regarding postoperative periorbital ecchymosis and edema on the second and seventh postoperative days.

Dural Reconstruction Using Laparoscopic Gastro-omental Free Flap in Refractory Cranial Infections.

BACKGROUND: Epidural abscesses and subdural empyema after craniotomy are potentially lethal complications in neurosurgery. Patients with recalcitrant cranial wound infections may be difficult to manage, and dural reconstruction in these patients is challenging. METHODS: A total of 14 patients presented with recurrent intracranial infection after craniotomy. The symptoms and signs included persistent fever, despite prolonged systemic broad-spectrum antibiotic administration and repetitive debridement of the dural space. They underwent reconstruction with an omental free flap to cover the craniotomy defect. Microvascular anastomosis is usually performed between the gastroepiploic and superficial temporal vessels. Surgeries were performed in the chronic stages of infection, and the patients were reviewed and assessed for recurrence over the long-term postoperatively. RESULTS: The postoperative course was uneventful, and flap survival was excellent in all patients. The patients were discharged with no evidence of wound discharge, and there were no reports of infection recurrence, flap failure, or donor site morbidity. CONCLUSIONS: The use of vascularized free omentum flap was effective in cases involving intractable cranial wound infection.

Alar Base Augmentation Using Vomerine Bone Graft in Patients With Cleft Lip Nasal Deformity.

BACKGROUND: Although many trials have been made to augment the unilateral alar base depression, the ultimate aesthetic satisfaction has proven difficult to achieve. In our study, we present a novel submucosal dissection technique to harvest the vomer bone and use it as an onlay graft to correct the alar base depression. METHODS: We collected a prospective cohort study of 11 patients with unilateral cleft lip nasal deformity. Using CorelDRAW X7 software, we obtained perioperative clinical photographs to analyze the nostril and lateral lip morphometric measurements on the cleft side. Computed tomography scans were used to assess the required graft's volume and to detect resorption. We performed vomerine ostectomy and placed and fixed the bone graft in with a lag screw over the alar base depression. RESULTS: The nostril width showed a significant increase, in addition to the height/width ratio. The columellar angle with the lateral lip height increased remarkably, with a general improvement in the nasal tip aesthetics. CONCLUSIONS: The vomer bone graft has been shown to correct the lateral and inferior disorientation of the alar base and improve the nostril and nasal tip aesthetic measurements. The vomer bone is therefore a sufficient bone source for grafting with high viability and no resorption.

Lateral Malleolar Defect Coverage Using Abductor Digiti Minimi Muscle Flap.

INTRODUCTION: The lateral malleolar region is a prominent anatomic structure vulnerable to repetitive trauma and ulcer formation. The abductor digiti minimi (ADM) muscle flap offers a promising treatment option for the reconstruction of small- to moderate-sized defects that have exposed bone, joint, or tendons in the lateral malleolar area. METHODS: Between 2013 and 2016, 8 patients with foot ulcers were reconstructed with ADM muscle flap. The muscle component of the flap obliterated the dead space and provided a vascularized muscle over the debrided ankle joint. When it is needed, the flap is covered with a small split-thickness skin graft. RESULTS: In all cases, complete healing was achieved. The muscle flap functioned well as a versatile and shock absorbent coverage without recurrence of the ulcer during a mean follow-up period of around 2 years. CONCLUSIONS: Coverage of a soft tissue defect at the lateral side of the ankle remains a challenge for surgeons because of the limited possibilities for local transposition. Free flaps have frequently been associated with postoperative complications and higher costs. Also, not all patients are suitable candidates for free tissue transfer because of existing comorbidities. Coverage with a split-thickness skin graft will not be possible for wounds with exposed bone or neurovascular structures or in wounds involving the weight bearing surface of the foot. Using ADM muscle offers no donor site morbidity, good soft tissue coverage, and an effective healing process. Also, no limb movement affection and normal daily life are acquired.

Laterally Based Orbicularis Oculi Myocutaneous Flap: Revisiting for the Secondary Ectropion Correction.

BACKGROUND: The management of lower eyelid ectropion is considered a challenge. Lower eyelid ectropion is conventionally reconstructed with a full-thickness skin graft or a local flap. However, complications as scar contracture and the recurrence of ectropion frequently occur. This article describes an effective surgical technique for ectropion correction using an upper eyelid as the laterally based orbicularis oculi myocutaneous flap. METHODS: The flap was used in 7 patients who were subjected to lower eyelid reconstruction. A strip of unipedicled orbicularis oculi myocutaneous flap from the lateral canthus was elevated and transposed to the lower eyelid to suspend the lower eyelid and repair the skin defect. RESULTS: Satisfactory eyelid function and cosmetic appearance were obtained and no recurrence was found in 2-years follow-up. The method proved that the donor scar was well hidden in the supratarsal crease. Mild flap color change occurred in the early stages but disappeared gradually within 2 months after. CONCLUSIONS: The use of this flap not only gives similar tissue reconstruction, additional support, well-hidden scar, and no loss of function, but also fast flap rising with the reliable donor. With a thorough knowledge of anatomy, the authors believe that their technique described below will expand anatomical understanding and powerful reasons for using laterally based orbicularis oculi myocutaneous flap for not only reconstructive but also aesthetic surgeons.

Caterpillar Graft for Secondary Rhinoplasty.

BACKGROUND: Different autologous materials are recently used in the purpose of augmentation of the nasal dorsum. Despite the benefits and drawbacks, nasal reconstruction with autologous tissue remains a better method for excellent results and lower morbidity rates. METHODS: The authors harvested conchal cartilage from the ears and use it after dicing. The superficial temporal fascia was harvested from the temporal region. Diced cartilage was wrapped with superficial temporal fascia, making a roll. After creating a cavity in the nasal dorsum, the combined roll graft was inserted over the nasal dorsum in a "caterpillar" fashion. The authors have operated on 18 patients of secondary nasal deformity cases. RESULTS: The results were excellent in most of the cases. This procedure presented many advantages: optimum nasal contouring, satisfactory volume for the nasal dorsum, and with low rates of infection and exposure. CONCLUSIONS: Nasal deformities were reconstructed using crushed cartilage harvested from the concha and enclosed in temporal fascia. This procedure could provide more psychologic comfort and long-lasting appearance.