The Use of Botulinum Toxin in Flap Surgery: A Review of the Literature.

Botulinum neurotoxin-A and botulinum neurotoxin-B have been shown to play a potential role in improving flap survival in animal models. The aim of this study is to review indications as well as to study injection timing, technique, and doses of botulinum neurotoxin-A and botulinum neurotoxin-B in animal models. Seventeen articles describe a total of 266 animals that underwent botulinum toxin injections before or during flap harvesting or vascular anastomosis procedure. All the studies demonstrated a beneficial effect of botulinum toxin administration in flap surgery or vascular anastomosis. Botulinum neurotoxin-A injection was shown to be a reliable approach in reducing vascular complications rate and increasing survival of flaps in animal models. The main conclusions drawn from the study include the following: perivascular injections targeting each vascular pedicle are preferred in cases of free flaps or axial flaps; subdermal injections are favorable in cases of random pattern skin flaps; and injections should be performed 7 days before flap elevation.

Functional Results of a Modified Extracorporeal Septoplasty With Open Access.

BACKGROUND: Nasal septal deviation is one of the major causes of nasal respiratory flow disorders. During the rhinoseptoplasty, the septum can be treated through a closed traditional access or through an open access. To date, there are still no objective functional indications of the best access to use in rhinoseptoplasty. For this reason, we evaluated, objectively and subjectively, the functional efficiency of open access and compared it with that of closed access. The aim is to highlight any functional outcome differences between the 2 types of access. METHODS: The study involved up to 50 patients, from January 2006 to June 2017; 20 patients underwent modified extracorporeal rhinoseptoplasty with open access, and 30 patients underwent modified extracorporeal rhinoseptoplasty with closed access. We evaluated the nasal obstruction by using the validated questionnaire Nasal Obstruction Symptoms Evaluation (subjective method) and by performing the anterior active rhinomanometry (objective method). Both evaluations were performed in 3 different times: preoperative period, 3 months, and 6 months after surgery. RESULTS: In the open cohort, the rhinomanometric analysis showed a statistically significant increase between preoperative period and sixth month after surgery; however, the nose score had a statistically significant increase in both 3 and 6 months after surgery. At 3 months after surgery, the rhinomanometric score was higher in patients with closed access than patients with open access; this difference has disappeared at 6 months after surgery. At 3 and 6 months after surgery, the improvement in the Nasal Obstruction Symptoms Evaluation average score was greater in patients with open access compared with patients with closed access. No complications were observed. CONCLUSIONS: Based on the results obtained from our work, we can declare that open access is a functionally valid procedure. At 6 months after surgery, the 2 accesses have a comparable functional efficacy.

Modified Extracorporeal Septoplasty: Functional Results at 6-Year Follow-up.

BACKGROUND: Septal deviations represent a major cause of aesthetic disorders and respiratory obstruction. The traditional septoplasty techniques may often be inadequate to treat severe deviations. Recently, we described a modified extracorporeal septoplasty approach based on partial resection of the cartilaginous septum, with preservation of a superocaudal L-strut measuring approximately 0.5 cm in height. At 6-month follow-up, we demonstrated this technique to be functionally and aesthetically effective in addressing mild to severe septal deviation. The aim of the present study was to evaluate the long-term outcomes of this technique in the patients included in the initial prospective study, followed up during a period of 4 to 6 years. METHODS: One hundred fifty-three patients underwent modified extracorporeal septoplasty from January 2006 to June 2009. One hundred twenty of these patients were included in the present study. Patients were grouped according to the preoperative septal deviation as follows: mild (one-third reduction of the nasal cavity), moderate (half reduction), and severe (two-thirds reduction). Follow-up ranged from 4 to 6 years. Respiratory flow improvement was assessed with active anterior rhinomanometry; subjective evaluation of the respiratory function was obtained by mean of Nasal Obstruction Symptom Evaluation (NOSE) scale. Active anterior rhinomanometry values and NOSE scores were compared with the results obtained preoperatively and at 6-month postintervention. RESULTS: In the whole cohort, rhinomanometric analyses and NOSE scores at long-term follow-up demonstrated a statistically significant improvement in inspiratory flow and obstructive symptoms (P = 0.0122 and P < 0.0001, respectively) compared to preoperative values. In group analysis, a significant improvement in NOSE scores was found in patients with severe (P < 0.0001) and moderate (P < 0.0001) deviations. A significant improvement in inspiratory flow was reported in the severe (P < 0.0001) and moderate (P = 0.0212) deviation groups. CONCLUSIONS: The modified extracorporeal septoplasty technique proved to be functionally effective at long-term follow-up in cases of moderate or severe septal deviation: the improvements in respiratory function and obstructive symptoms found 6 months postoperatively were maintained at 4 to 6 years postintervention. With this technique, structural support is achieved without destabilizing the keystone area; moreover, conservative remodeling of the quadrangular cartilage allows the use of septal cartilage grafts in secondary or revision rhinoplasty.