Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico / Proposal of an informed consent form to obtain audiovisual material from patients

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

[Proposal of an informed consent form to obtain audiovisual material from patients]. / Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico.

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Maximizing the Smile Symmetry in Facial Paralysis Reconstruction: An Algorithm Based on Twenty Years' Experience.

Over the last two decades, the senior author (B.H.) has had an extensive experience with facial paralysis reconstruction. During this period, the techniques have evolved substantially based on the experience and after observing and analyzing the surgical outcomes. The purpose of this article is to relay the lessons learned from the 20 years' experience and suggest an algorithm. In this retrospective study, we have included 343 cases of facial paralysis cases. Complete facial paralysis cases were 285 and 58 were incomplete facial paralyses, both requiring surgical procedures. Complete facial paralyses were divided in to short term (n = 83) and long term (n = 202). In total, 58% of the patients were women and 42% were men. The age range was 6 to 82 years. The techniques employed were direct suture, nerve grafts, cross-facial nerve grafts (CFNGs), masseteric-to-facial nerve transference, hypoglossal-to-facial nerve transference, free muscle transplants, and lengthening temporal myoplasty to achieve the best symmetry after reanimation of unilateral, bilateral, complete, and incomplete facial paralysis. The type of paralysis, objective measurements, the personal patient's smile, and the gender are key concepts to be considered before scheduling a dynamic facial paralysis reconstruction. For unilateral facial paralysis, the time of onset, the type of paralysis, the patient's comorbidities, and the healthy side status are some of the determining factors when selecting the correct technique. The preferred techniques for unilateral facial paralysis are direct repair, CFNG, masseteric-to-facial transposition, and free gracilis transfer. For incomplete facial paralysis, the masseteric-to-facial nerve transference is preferred. In bilateral facial paralysis, bilateral free gracilis transfer is performed in two stages using the nerve of the masseter muscle as the source of innervation. The authors provide an algorithm which simplifies facial paralysis reconstruction to achieve the greatest facial symmetry while thinking about the potential comorbidities and developing spontaneity smile according to the gender of the patient.

Bio-engineering a tissue flap utilizing a porous scaffold incorporating a human induced pluripotent stem cell-derived endothelial cell capillary network connected to a vascular pedicle.

Tissue flaps are used to cover large/poorly healing wounds, but involve complex surgery and donor site morbidity. In this study a tissue flap is assembled using the mammalian body as a bioreactor to functionally connect an artery and vein to a human capillary network assembled from induced pluripotent stem cell-derived endothelial cells (hiPSC ECs). In vitro: Porous NovoSorb™ scaffolds (3 mm × 1.35 mm) were seeded with 200,000 hiPSC ECs ±â€¯100,000 human vascular smooth muscle cells (hvSMC), and cultured for 1-3 days, with capillaries formed by 24 h which were CD31+, VE-Cadherin+, EphB4+, VEGFR2+ and Ki67+, whilst hvSMCs (calponin+) attached abluminally. In vivo: In SCID mice, bi-lateral epigastric vascular pedicles were isolated in a silicone chamber for a 3 week 'delay period' for pedicle capillary sprouting, then reopened, and two hiPSC EC ±â€¯hvSMCs seeded scaffolds transplanted over the pedicle. The chamber was either resealed (Group 1), or removed and surrounding tissue secured around the pedicle + scaffolds (Group 2), for 1 or 2 weeks. Human capillaries survived in vivo and were CD31+, VE-Cadherin+ and VEGFR2+. Human vSMCs remained attached, and host mesenchymal cells also attached abluminally. Systemically injected FITC-dextran present in human capillary lumens indicated inosculation to host capillaries. Human iPSC EC capillary morphometric parameters at one week in vivo were equal to or higher than the same parameters measured in human abdominal skin. This 'proof of concept' study has demonstrated that bio-engineering an autologous human tissue flap based on hiPSC EC could minimize the use of donor flaps and has potential applications for complex wound coverage. STATEMENT OF SIGNIFICANCE: Tissue flaps, used for surgical reconstruction of wounds, require complex surgery, often associated with morbidity. Bio-engineering a simpler alternative, we assembled a human induced pluripotent stem cell derived endothelial cell (hiPSC ECs) capillary network in a porous scaffold in vitro, which when transplanted over a mouse vascular pedicle in vivo formed a functional tissue flap with mouse blood flow in the human capillaries. Therefore it is feasible to form an autologous tissue flap derived from a hiPSC EC capillary network assembled in vitro, and functionally connect to a vascular pedicle in vivo that could be utilized in complex wound repair for chronic or acute wounds.

Cross-Face Nerve Grafting versus Masseteric-to-Facial Nerve Transposition for Reanimation of Incomplete Facial Paralysis: A Comparative Study Using the FACIAL CLIMA Evaluating System.

BACKGROUND: Incomplete facial paralysis is still a challenge because we must restore what is missing without causing damage to what has recovered. The current literature is insufficient, with a small number of cases. The use of nerve transfers has gained recent popularity for reanimating facial palsy. The authors present a comparative study between cross-face nerve grafting and masseteric-to-facial nerve transposition for incomplete facial paralysis. METHODS: Twenty-eight patients with incomplete unilateral facial paralysis were reanimated with either cross-face nerve grafting (group I, n = 10) or masseteric nerve transfer (group II, n = 18). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA dystem. Spontaneity of the movement and satisfaction were also assessed. RESULTS: When comparing the reconstructed and the healthy sides, statistical differences were found in group I but not in group II, suggesting that the resulting movement was symmetrical in group II but not in group I. Intergroup comparison showed that both commissural displacement and commissural contraction velocity were higher in group II. Spontaneity in group I was higher than in group II, but patients in group II showed more satisfaction, both without being statistically significant. CONCLUSIONS: Reanimation of incomplete facial paralysis can be satisfactorily achieved with both cross-face nerve grafting and direct masseteric-to-facial nerve transposition. However, with the masseteric nerve, better symmetry, a higher degree of recovery, and an increased level of satisfaction are achieved in a one-stage operation. Furthermore, both nerve sources are able to restore spontaneity in more than 50 percent of the patient's daily life, with no significant differences between them. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Melatonin promotes survival of nonvascularized fat grafts and enhances the viability and migration of human adipose-derived stem cells via down-regulation of acute inflammatory cytokines.

Nonvascularized fat grafting is a valuable technique for soft tissue reconstruction but poor survival of fat in the host environment remains a problem. A process known as cell-assisted transfer is used to enhance fat graft retention by adding stromal vascular fraction, an adipose-derived stem cell (ASC) rich content to lipoaspirate. We have recently shown that the use of melatonin, a reactive oxygen species scavenger, protects human ASCs from hydrogen peroxide-induced oxidative stress and cell death in vitro but its role as a pharmacological adjunct in clinical fat grafting has not been studied. Herein, the effect of melatonin was examined on human ASCs in vitro using survival and functional assays including the MTT assay, CellTox Green assay, monolayer scratch assay as well as a human cytokine chemoluminescence, and tumour necrosis factor-α assay. Further, the effect of melatonin-treated fat grafts was tested in vivo with a murine model. Haematoxylin and eosin staining, perilipin and CD31 immunostaining were performed with morphometric analysis of adipose tissue. The results demonstrate that, in vitro, the addition of melatonin to ASCs significantly improved their cell-viability, promoted cell migration and preserved membrane integrity as compared to controls. In addition, it induced a potent anti-inflammatory response by downregulating acute inflammatory cytokines particularly tumour necrosis factor-α. For the first time, it is demonstrated in vivo that melatonin enhances fat graft volume retention by reducing inflammation and increasing the percentage of adipose volume within fat grafts with comparable volumes to that of cell-assisted lipotransfer. Based on these novel findings, melatonin may be a useful pharmacological adjunct in clinical fat grafting.

Reconstrucción mamaria terciaria con tejido autógeno tras reconstrucción fallida con implantes / Tertiary breast reconstruction with autologous tissue after failed reconstruction with implants

Objetivo: Analizar nuestra experiencia en la reconstrucción mamaria terciaria tras el fracaso de procedimientos basados en implantes. Material y métodos: Entre 2005 y 2014, los autores (BH y CA) realizaron reconstrucción mamaria terciaria en 17 casos utilizando el colgajo de perforantes de arteria epigástrica inferior profunda (DIEP). Se revisaron en forma retrospectiva las fichas clínicas de dichas pacientes, registrando edad, comorbilidades, índice de masa corporal (IMC), presencia de cicatrices abdominales, historia de radioterapia y quimioterapia. Asimismo, se registraron los detalles de las cirugías realizadas, tanto de la reconstrucción con implante como de la reconstrucción terciaria. Resultados: Las complicaciones más frecuentes que motivaron el cambio de estrategia reconstructiva fueron: contractura capsular, rotura, exposición/infección del implante, dolor crónico y el fracaso de la expansión de la piel. En la reconstrucción terciaria se utilizó el colgajo DIEP en todos los casos, presentando pérdida parcial del colgajo un solo caso, sin pérdidas totales del mismo. Conclusiones: Las opciones actuales en reconstrucción terciaria con tejido autógeno incluyen principalmente colgajos perforantes, siendo el colgajo DIEP el más utilizado. De acuerdo con los resultados de esta serie y lo reflejado en la literatura, creemos que la reconstrucción terciaria es un procedimiento seguro, con una tasa de complicaciones similar a las de reconstrucción primaria y secundaria, y que otorga una serie de beneficios a las pacientes afectadas.

Objective: Analyze our experience on tertiary breast reconstruction after failed implant-based procedures. Methods: Between 2005 and 2014, the authors (BH and CA) performed tertiary breast reconstruction with the deep inferior epigastric artery perforator flap (DIEP) flap in 17 cases. The medical charts of these patients were retrospectively reviewed, registering age at tertiary reconstruction, comorbidities, body mass index (BMI), presence of abdominal scars and history of radiotherapy and chemotherapy. Likewise, details from surgeries were also gathered, both form the implant-based procedures and tertiary autologous reconstruction. Results: Complications motivating the change of reconstructive strategy included capsular contracture, implant rupture, implant exposure/infection, chronic pain and failure of skin expansion. Regarding tertiary reconstruction, the DIEP flap was used in all cases with one partial flap loss and no total failures. Conclusions: Current options for autologous tertiary reconstruction include mainly perforator flaps with the DIEP being by far the most utilized. Additionally, tertiary reconstruction is a safe procedure, with a rate of complications similar to that of primary and secondary free flap breast reconstruction.

Tissue Engineering by Intrinsic Vascularization in an In Vivo Tissue Engineering Chamber.

In reconstructive surgery, there is a clinical need for an alternative to the current methods of autologous reconstruction which are complex, costly and trade one defect for another. Tissue engineering holds the promise to address this increasing demand. However, most tissue engineering strategies fail to generate stable and functional tissue substitutes because of poor vascularization. This paper focuses on an in vivo tissue engineering chamber model of intrinsic vascularization where a perfused artery and a vein either as an arteriovenous loop or a flow-through pedicle configuration is directed inside a protected hollow chamber. In this chamber-based system angiogenic sprouting occurs from the arteriovenous vessels and this system attracts ischemic and inflammatory driven endogenous cell migration which gradually fills the chamber space with fibro-vascular tissue. Exogenous cell/matrix implantation at the time of chamber construction enhances cell survival and determines specificity of the engineered tissues which develop. Our studies have shown that this chamber model can successfully generate different tissues such as fat, cardiac muscle, liver and others. However, modifications and refinements are required to ensure target tissue formation is consistent and reproducible. This article describes a standardized protocol for the fabrication of two different vascularized tissue engineering chamber models in vivo.

Creation of a Large Adipose Tissue Construct in Humans Using a Tissue-engineering Chamber: A Step Forward in the Clinical Application of Soft Tissue Engineering.

Tissue engineering is currently exploring new and exciting avenues for the repair of soft tissue and organ defects. Adipose tissue engineering using the tissue engineering chamber (TEC) model has yielded promising results in animals; however, to date, there have been no reports on the use of this device in humans. Five female post mastectomy patients ranging from 35 to 49years old were recruited and a pedicled thoracodorsal artery perforator fat flap ranging from 6 to 50ml was harvested, transposed onto the chest wall and covered by an acrylic perforated dome-shaped chamber ranging from 140 to 350cm(3). Magnetic resonance evaluation was performed at three and six months after chamber implantation. Chambers were removed at six months and samples were obtained for histological analysis. In one patient, newly formed tissue to a volume of 210ml was generated inside the chamber. One patient was unable to complete the trial and the other three failed to develop significant enlargement of the original fat flap, which, at the time of chamber explantation, was encased in a thick fibrous capsule. Our study provides evidence that generation of large well-vascularized tissue engineered constructs using the TEC is feasible in humans.

Reconstrucción mamaria: estado actual del tema / Breast reconstruction: state of the art

Nowadays most plastic surgery units worldwide perform breast reconstruction and hence basic updated knowledge in the topic is mandatory for every plastic surgeon and trainee. Breast reconstruction may be performed either immediately after mastectomy or in a delayed fashion. Each of these timings has its advantages and drawbacks and albeit there are a number of factors influencing the decision to perform one or another, probably the most important one has to do with the delivery of radiotherapy. In this sense, while in patients who are candidates for post mastectomy radiation, a delayed reconstruction is strongly recommended, in those without adjuvancy, immediate reconstruction is a very good alternative. In general terms, breast reconstruction techniques fall into one of three groups: those using alloplastic materials only; those performed with autologous tissue only; and those using a combination of both alloplastics and autologous tissue. Again the administration of radiotherapy, as well as patient and surgeon-related factors, play a fundamental role when choosing anyone technique. Finally, during the last years there has been growing interest and evidence on the use of acellular dermal matrices for breast reconstruction, which have expanded the armamentarium of techniques available for these patients. The following paper aims to provide an updated review on breast reconstruction regarding timing of reconstruction, techniques available, the influence of radiotherapy and the use of acellular dermal matrices.

La reconstrucción mamaria constituye una parte importante de la práctica de muchos servicios y unidades de cirugía plástica y por tanto resulta muy necesario que tanto cirujanos plásticos con experiencia como aquellos en formación tengan conocimientos básicos actualizados sobre el tema. La reconstrucción mamaria puede llevarse a cabo de forma inmediata después de la mastectomía o de forma diferida. Cada una de estas modalidades tiene ventajas y desventajas. Si bien existen distintos factores para elegir uno u otro timing, la necesidad de radioterapia postmastectomía es probablemente el factor más importante a considerar. De esta manera, en términos generales, se recomienda realizar una reconstrucción diferida en pacientes subsidiarias de irradiación, mientras que en pacientes sin indicación de dicha adyuvancia, la reconstrucción inmediata es una muy buena alternativa. Dentro de las técnicas de reconstrucción, existen tres grandes grupos: las que utilizan materiales aloplásticos únicamente; las que utilizan tejidos autólogos; y las que usan ambos elementos. La decisión de cuál técnica utilizar estará influenciada por factores tanto de la paciente como del cirujano y el centro hospitalario. Durante los últimos años ha habido un interés creciente en el uso de matrices dérmicas acelulares en reconstrucción mamaria que han permitido ampliar el arsenal de alternativas terapéuticas que ofrecer a las pacientes mastectomizadas. El siguiente trabajo tiene por objetivo presentar una revisión actualizada de la literatura sobre reconstrucción mamaria en cuanto a tiempos de reconstrucción, técnicas más frecuentes, influencia de la radioterapia y el uso de matrices dérmicas acelulares.

The effect of late infection and antibiotic treatment on capsular contracture in silicone breast implants: A rat model.

BACKGROUND: The effect of late infection on capsular contracture has yet to be established, leaving a gap in clinical guidelines for the treatment patients with breast implants. This trial is the first to assess if the treatment of these infections can reverse this effect in an in vivo rat model and whether late distant infections increase the incidence of capsular contracture. MATERIALS AND METHODS: Three groups of female Wistar rats (n = 42) received two silicone implants in separate dorsal, subcutaneous pockets. All groups except control underwent injection of a human strain of methicillin-sensitive Staphylococcus aureus (MSSA) at least 30 days after implantation, allowing for physiologic capsule formation. The infection group received a peritoneal injection, inducing a transient bacteremia, the treated group received a course of antibiotics following bacterial inoculation, and a final group received no intervention and served as control. RESULTS: Implants were removed 4 months after insertion, and capsules measured for thickness and sent for bacterial quantification. Compared to both the control and treated groups, capsule thickness in the infection group was statistically greater (p < 0.05), a difference not observed between treated and control groups. In addition, a statistically significant positive correlation was found between capsule thickness and bacterial count (R = 0.614, p < 0.01). CONCLUSIONS: The difference in thickness between the control capsules and those from the infection group is an indication that bacterial contamination of a capsule from a remote late infection may increase the incidence of capsular contracture suggesting that treating late infections could in fact prevent capsular contracture.

Masseteric-facial nerve transposition for reanimation of the smile in incomplete facial paralysis.

Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face nerve grafting is one of the most useful techniques for reanimation. Transfer of the masseteric nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the masseteric nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients' satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The masseteric nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site.

Cross-face neurotized platysmal muscular graft for upper eyelid reanimation: an anatomic feasibility study.

BACKGROUND: Upper eyelid reanimation is one of the most important aspects of facial paralysis. The ideal method would be one that provided dynamic restoration of voluntary eye closure, involuntary blinking, and corneal reflex. Innervation to the platysma has shown to be relatively consistent, which would allow its use as a muscle graft neurotized by the contralateral healthy facial nerve for eyelid reanimation. METHODS: Six fresh cadavers, 12 sides, were studied by dissecting the main trunk of the facial nerve and its cervicofacial division. Special attention was paid at the emergence of cervical branches to the platysma and its distribution on the undersurface of the muscle as well as its relationships with regional anatomic references. RESULTS: One major branch with 1 or 2 accessory branches was found to emerge from the cervicofacial division, 1.5 cm distal to its origin in the facial nerve trunk. The major branch showed an oblique course, starting approximately 1 cm below the angle of the mandible and coursing toward the inferomedial border of the muscle. Harvest of a 3 × 2 muscle piece with a 10-cm-long neural pedicle was possible in all specimens. When presented over the superior eyelid, the nerve branch was found to reach the contralateral frontal branch of the facial nerve. CONCLUSIONS: Innervation to the platysma muscle is relatively constant and consists of 1 major branch accompanied by 1 or 2 accessory branches. Harvest of a muscle flap with a neural pedicle long enough to reach the contralateral healthy side is anatomically feasible.

Cross-face nerve grafting for reanimation of incomplete facial paralysis: quantitative outcomes using the FACIAL CLIMA system and patient satisfaction.

Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction.

Effect of postoperative brachytherapy and external beam radiotherapy on functional outcomes of immediate facial nerve repair after radical parotidectomy.

BACKGROUND: There is much controversy regarding the effect of radiotherapy on facial nerve regeneration. However, the effect of brachytherapy has not been studied. METHODS: Fifty-three patients underwent total parotidectomy of which 13 were radical with immediate facial nerve repair with sural nerve grafts. Six patients (group 1) did not receive adjuvant treatment whereas 7 patients (group 2) received postoperative brachytherapy plus radiotherapy. Functional outcomes were compared using Facial Clima. RESULTS: Mean percentage of blink recovery was 92.6 ± 4.2 for group 1 and 90.7 ± 5.2 for group 2 (p = .37). Mean percentage of commissural excursion restoration was 78.1 ± 3.5 for group 1 and 74.9 ± 5.9 for group 2 (p = .17). Mean time from surgery to first movement was 5.7 ± 0.9 months for group 1 and 6.3 ± 0.5 months for group 2 (p = .15). CONCLUSION: Brachytherapy plus radiotherapy does not affect the functional outcomes of immediate facial nerve repair with nerve grafts.

Differences between sexes in dissociation and spontaneity of smile in facial paralysis reanimation with the masseteric nerve.

BACKGROUND: A patient's sex is likely to play an important role in facial paralysis reanimation, with women being superior in terms of development of brain plasticity after reanimation. The purpose of this study was to compare the rate of movement dissociation and spontaneity of men versus women reanimated with gracilis transfer neurotized to the masseteric nerve. METHODS: We conducted a retrospective chart review of 27 patients who underwent facial paralysis reanimation with microvascular gracilis transplants neurotized to the ipsilateral masseteric nerve. Patients were classified by sex, comparing age at surgery, denervation time, and follow-up, as well as the rates of movement dissociation and smile spontaneity. RESULTS: After reanimation with gracilis to masseteric nerve, movement dissociation and spontaneity were higher in women during the first year after onset of facial movement (p=.02 and p=.01, respectively). CONCLUSION: After reanimation with masseteric nerve, women seem to be able to smile spontaneously and independently from teeth clenching earlier than men.

Masseteric nerve for reanimation of the smile in short-term facial paralysis.

Our aim was to describe our experience with the masseteric nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side.

Surgical management of large venous malformations of the lower face.

UNLABELLED: We describe the benefits of an early surgical approach to large (more than 3 cm) venous malformations in the lower face, and discuss the advantages over conservative treatment. Fifty-eight patients with venous malformations of the lower face were treated in this hospital between 2005 and 2010 with sclerotherapy (lipidocanol), or láser, or resection, or all three. Only patients with recurrent malformations and a history of previously ineffective conservative treatment were included in the study (n=17). Follow-up ranged from 23-65 months (mean 40). Functional and cosmetic outcomes and recurrence were recorded on a single questionnaire. Seventeen patients with a history of recurrent malformations, which had previously been treated ineffectively with conservative treatment and were more than 3 cm in diameter, benefited from early and wide resection. No recurrences were recorded during follow-up. Patients were satisfied with the postoperative cosmetic and functional results. Large malformations are both deforming and functionally disabling. These patients, who initially do not respond to conservative treatment, benefit from early definitive resection. LEVEL OF EVIDENCE: 4 (case series with comparison).