Nasal monobloc osteotomy for correction of late nasal and orbital asymmetry of unicoronal synostosis: A morphometric and outcomes study.

BACKGROUND: Craniofacial asymmetry associated with unicoronal synostosis (UCS) may persist into the teenage years despite surgery in infancy. This study evaluated outcomes following a nasal monobloc procedure by mobilizing a united nasomaxillary and bilateral medial orbital segment of bone (nasal monobloc) to perform corrective translational and rotational movement for secondary correction of residual nasal-orbital asymmetry associated with UCS. METHODS: A retrospective review of all UCS patients treated with nasal monobloc at our institution was performed. Demographic information was recorded, and pre- and postoperative 2D imaging was used for morphometric outcome analysis. Outcomes and complications were tabulated. RESULTS: The study included 14 patients (5 males, 9 females; mean age 14.6 years; range 9.6 to 22.5 years; mean follow-up 70.6 months range 12 to 132 months). Ancillary procedures (scar revision, forehead/orbital contouring, MEDPOR® augmentation) were performed in all patients at the time of the nasal monobloc. One patient underwent a repeat procedure 6 years later following technique modification. Additionally, another patient experienced late overgrowth of the frontal sinus with forehead asymmetry. The morphometric analysis demonstrated significant (p < 0.05) pre-op to post-op improvements in naso-orbital asymmetry, as demonstrated by horizontal orbital aperture ratio (0.88 vs 0.99), midline to exocanthion ratio (0.91 vs 0.98), orbital index ratio (1.15 vs 1.01), and midline discrepancy (7.1 degrees vs 2.7 degrees). CONCLUSION: Nasal monobloc osteotomy provides a reasonable surgical treatment to improve both the nasal and orbital asymmetries associated with unicoronal synostosis, including frontal nasal deviation, basal nasal deviation, and orbital aperture asymmetry. It is important to note that confounding anatomic variables such as globe dystopia, strabismus, and scleral show may affect the perception of orbital symmetry.

Distal profunda femoris artery perforator island flap for distal thigh and knee reconstruction: a CT-based anatomical analysis and a case-series study.

BACKGROUND: Locoregional flap options for reconstructing defects of the anterolateral distal thigh/knee region are limited. The distal profunda artery perforator island (PAPI) flap is a local fasciocutaneous propeller-type flap that utilizes the most distal perforator of the profunda femoris artery. The aim of this study is to conduct a CT-based angiographic analysis of the perforator system of the profunda femoris artery and present outcomes on the application of the PAPI flap in the management of post-oncologic defects of the distal thigh and knee. METHODS: CT angiograms were utilized on the lower limbs of 25 healthy patients (mean age, 57 years; 76% male) and the number and location of septocutaneous perforators with a diameter greater than 1 mm were measured. A case series of patients undergoing reconstruction of post-ablative defects which involved the anterolateral and posterior knee performed by the senior author were reviewed. RESULTS: CT angiography demonstrated a robust collection (mean 3.5, range 2 to 5) of septocutaneous perforators from the profunda femoris artery with the most distal perforator located 3.3 cm from the superior patella border. The PAPI flap was successfully used in 10 patients (6F; 4M; mean age 60.6 years; range 30 to 88 years) with a mean defect size of 87.5 cm2 (range 48 to 150 cm2 ). Hand-held Doppler was used to detect the perforator. No flap loss was encountered, and no knee function limitation was noted at follow-up. Minor complications include seroma (1) and intra-articular infection (2). CONCLUSIONS: We conclude that the distal PAPI flap is a reliable and versatile flap that has potentially wide applications.