The Paramedian Forehead Flap for Nasal Reconstruction: From Antiquity to Present.

Nasal reconstruction is considered the historic foundation of facial plastic surgery, and the forehead flap remains the workhorse of repair. To recreate both the aesthetic contour and function of the nose, all anatomic layers must be addressed-covering, lining, and structural support. This article reviews the noteworthy history underlying the development of the paramedian forehead flap as the primary tool in reconstruction of large nasal defects while highlighting its implications on modern nasal repair. Current developments in the use of 2-staged paramedian forehead flap reconstruction are examined and a modern technique is presented.

[History of breast cancer reconstruction treatment]. / Historique du traitement du cancer du sein.

The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.

The Utility of Superficial Musculoaponeurotic System Flaps in Facelift Procedures.

Facelift techniques widely vary with known individual surgeon modifications of and preference for particular techniques. This article provides an overview of the history of the superficial musculoaponeurotic system (SMAS), the changes of aging related to the soft tissues of the face, and the history of facelift procedures, including techniques to address the SMAS. In addition, a description of past studies and literature analyzing techniques of facelift procedures, safety of interventions involving the SMAS, low, extended, and high SMAS techniques, and evaluations of patient satisfaction with facelift outcomes including use of the FACE-Q are discussed. After review of the existing literature, a knowledge of the process of aging, and its effect on facial soft tissues, there is data to support SMAS flaps as a safe, effective, and logical means to handle the SMAS in facelifts. There is a paucity of the literature directly comparing differing techniques, particularly regarding SMAS flaps, leading to a challenging review but significant opportunity for additional study.

Breast Reconstruction: A Century of Controversies and Progress.

Breast cancer treatment has dramatically changed over the past century. Since Halsted's first description of radical mastectomy in 1882, breast reconstruction has evolved slowly from being considered as a useless or even dangerous procedure by surgeons to the possibility nowadays of reconstructing almost any kind of defect. In this review on the development of breast reconstruction, we outline the historical milestone innovations that led to the current management of the mastectomy defect in an attempt to understand the economic, social and psychological factors, which contributed to slow down its acceptance for several decades.

Otology at the Academy of Gondishapur 200-600 CE.

OBJECTIVE: To investigate the way in which otology was practiced at the Academy of Gondishapur in ancient Persia from 200 to 600 CE. METHOD: The pertinent literature, using German and English translations of Latin, Greek, Arabic, and Sanskrit documents, was identified and reviewed through the indices of available books and through a PDF search for the following topics: auricle, deaf, deafness, dizziness, ear, hearing, medicine, otitis, pinna, punishment-ear, speech, surgery, vertigo, and voice. RESULTS: The medical school at the Academy of Gondishapur followed the medical and surgical practices of Greece and Rome and, in the 6th century, incorporated those from India as detailed in the Shutra Samhita. This shutra, which originated during the first millennium BCE, detailed many interventions, among which one of the most unusual was the use of a pedicle cheek flap to restore the pinnae. The use of the pedicle flap for pinna restoration appears not have been reported in literature again until 1931, by Jacque Joseph. CONCLUSION: During the period of late antiquity, medical knowledge of both the east and west was preserved and taught in Persia. Among surgical interventions used during the first millennium BCE in India, knowledge of which passed, through the shutra, to the Sasanian Empire in the 6th century CE, was use of the pedicle cheek flap for pinna reconstruction. Even as late as the Renaissance, the pedicle flap was not known to surgeons in the West, and a pedicle flap, though not a cheek flap, was first incorporated into Western medical practice during the 1930s.

[Technical information: The 'so called' Camille Bernard lower lip reconstruction: An eponymous confusion clarified]. / La reconstruction de lèvre inférieure selon Camille Bernard : mise au point sur une confusion éponymique.

The use of eponyms honours those who have contributed to the development of medicine and facilitates communication between colleagues. Eponyms are based on historical knowledge to know who was the first to use a given technique. In the previous century, two different operative procedures have been attached to the 'so called' Bernard lower lip reconstruction. This historical literature on lip reconstruction with a focus on the years 1853-1855 elucidates the roles of Bernard, Saeman, Desgranges and Burow, and gives suggestions for eponyms that do justice to the innovating surgeons Bernard, Burow and Desgranges.

Hand Transplantation: Evolution of a Personal Outlook.

The field of vascularized composite allotransplantation-combining advances in reconstructive surgery, transplantation, and immunology-offers great promise for patients with heretofore unsolvable problems. In the last 30 years, hand transplantation has progressed through the phases of being a research subject, a controversial clinical procedure, a more widely accepted and expanding field, and now a promising endeavor undergoing refined indications. Although many lessons have been learned, few procedures in the author's experience have been as life-transformative in restoring the body image, motor and sensory functions, activities of daily living, and personal autonomy as successful hand transplantation.

The Chimera Flap: A Quarter Century Odyssey.

Incredibly complicated multidimensional defects have always strained the ingenuity of the reconstructive surgeon. Secondary perhaps to vascularized composite allotransplantation as a solution to this dilemma, the compound flap has been developed to be a more useful and available alternative. Their greatest versatility has been proven by its subtype, the chimera flap. The chimera flap itself consists of multiple flaps, the latter possibly composed of bone, skin, muscle, and so on, where each part has an independent vascular supply, and each part is independent of any physical interconnection whatsoever with the other components, except where joined ultimately only to a common vascular pedicle. An appellation for this concept was first introduced a quarter century ago in this very journal, a time frame now the impetus for a recapitulation of its origin and subsequent history that proves that it has eventually withstood the test of time and has been successfully assimilated into the reconstructive repertoire.

Advances and Innovations in Microsurgery.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. summarize the evolution of perforator, chimeric, and free style flaps; 2. define and give examples of supermicrosurgery as well as understand its application in treatment of lymphedema; and 3. appreciate the development and advancements of composite tissue allotransplantation. SUMMARY: Although microsurgery may seem like a highly specialized niche within plastic surgery, it is more than just a discipline that focuses on small anastomoses. It is a tool and a way of thinking that allows us to embody the true tenets of plastic surgery, as quoted by Tagliocozzi. What began as a challenge of returning amputated tissue to the body and achieving wound closure has evolved into a refinement of technique and change in philosophy that empowers the plastic surgeon to work creatively to "restore, rebuild, and make whole."

Transzygomatic Approach to Skull Base: History, Evolution, and Possibility of a Simple Modification.

The surgical approaches to anterior, middle, and lateral skull base have evolved drastically, transcending from an era of oblivion to well-defined and systematically executed, state-of-the-art, refined surgery. The transzygomatic approach, which was developed to access the nasopharynx, has been applied to versatile locations of skull base pathology, with continuous evolution and modification of the osteotomies and skin flaps involved. A simple modification is proposed which could help reach a compromise between the wide exposure provided by the hemicoronal incision and the minimally invasive preauricular approach.

Iginio Tansini revisited.

The origin of the muscolocutaneous latissimus dorsi flap dates back to 1906 when Igino Tansini, an Italian surgeon, described a procedure to reconstruct the mastectomy defect. After a detailed study of Tansini's original description and drawings, new insights about the pedicle of its compound flap have been found, showing that it has the same pedicle of the scapular flap. In the end, Tansini's flap should be more correctly considered as a compound musculocutaneous scapular flap.

Heinrich von Pfalzpaint, Pioneer of Arm Flap Nasal Reconstruction in 1460, More Than a Century Before Tagliacozzi.

Heinrich von Pfalzpaint (circa 1415-1465) was a Bavarian military surgeon of the Teutonic Order who treated more than 4000 casualties during the siege of Marienberg Fortress (1454-1457). In 1460, he reported "How to create a new nose if it has been chopped off and the dogs have eaten it" in his treatise on wound care Bündt-Ertznei. He used opium-soaked sponges for anesthesia, described the surgical extraction of bullets and cleft lip repair. Pfalzpaint would have been the first author to describe nasal reconstruction in Europe if his treatise had not been lost. Only 5 copies of his manuscript existed. One was rediscovered and printed in 1868. Pfalzpaint's technique for nasal reconstruction was performed in 2 stages using an undelayed skin flap from the upper arm, which was sutured to the nasal defect and the arm was bandaged to the head. After 8 to 10 days, he divided the pedicle; inset the flap; and fashioned the nasal dorsum, alae, and columella. Tagliacozzi described arm flap nasal reconstruction more than a century later in 1597. He used delayed skin flaps, with at least 6 operative stages over 4 months. Pfalzpaint was ahead of his time regarding his knowledge of wounds, insistence on surgical cleanliness, and his technically easier arm flap rhinoplasty, compared with Tagliacozzi. Pfalzpaint, who is rarely referenced in the literature, should be remembered as a great pioneer of reconstructive surgery in Europe.

Lower jaw reconstruction and dental rehabilitation after war injuries: The experience of Paul Tessier in Iran in the late 1980s.

Iraq-Iran war resulted in more than 400,000 people requiring prolonged medical care in Iran. An international team of prominent reconstructive surgeons led by Paul Tessier, the founder of craniofacial surgery, was invited to Iran during the war by official organizations entitled to support war victims. This team provided up-to-date oral and maxillofacial rehabilitation to patients with severe trauma defects in the lower third of the face. We collected the medical notes of 43 patients operated on by the Tessier team in Iran in the 1980s (files property of AFCF). The parameters we collected were: age of the patient, nature of the trauma (when available), previous procedures, number of implants placed (mandibular and maxillary), associated procedures (bone grafts, soft-tissue procedures, orthognathic surgery). A protocol based on soft-tissue rehabilitation using local flaps, parietal or iliac bone grafts and implant placement 6 months later was used in all patients. Paul Tessier's approach emphasizes the importance of keeping high standards of care in difficult situations and maintaining standard protocols.

Paul Tessier facial reconstruction in 1970 Iran, a series of post-noma defects.

BACKGROUND: Paul Tessier was a pioneering plastic surgeon who founded craniofacial surgery and had an international influence in the field of reconstructive surgery. We reviewed his techniques in the reconstruction of post-noma defects in Iran in the late 1970s. PATIENTS AND METHODS: We studied a series of 23 patients operated on by Tessier from 1974 to 1978 in Iran (property of Association Française des Chirurgiens de la Face). They all suffered from noma in childhood with major facial defects. RESULTS: Ten suffered from simple lip and cheek defects, nine also from nose defects and four from extensive facial defects. Abbe flaps were used in 15 patients to reconstruct the lips completed by commissuroplasty in six patients. Nose defects were reconstructed with nasofrontal flaps (ten cases). The outer cheek was reconstructed with a rotation flap (four cases), or with a frontotemporal flap (six cases). The inner cheek was reconstructed using a Barron-Tessier myocutaneous flap (ten cases). Of the 23 patients, partial flap necrosis occurred in five cases. CONCLUSIONS: Tessier was a pioneering plastic surgeon who used local flaps to reconstruct these important facial defects. He had a high rate of success, although nowadays local flaps are commonly replaced by free flaps.