Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision.

BACKGROUND: Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction. PATIENTS AND METHODS: We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them. RESULTS: There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps. CONCLUSIONS: Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

A new flap design: prefabricated neuro-osseous flap.

We hypothesized that an osseous tissue can be prefabricated with a peripheral nerve by vascular induction, and by using a rat model, we tested this hypothesis.Twenty Wistar rats were used in the prefabricated neuro-osseous flap study. Bilateral sciatic nerves were placed linearly within the medullary cavities of the femurs. Left femurs were accepted as the experimental group. The right femurs of all the rats were used as internal control where the sciatic nerves were ligated at the bony entrance of the flap.After 6 weeks, all experimental femur flaps were viable. Radioactivity counts and metabolic activity studies showed viable and functional bone tissue in experimental group compared with control group (P = 0.001). On microangiographic evaluation, significant dilatation of the perineural vasculature was observed in experimental group. Histologic investigations showed viable bone tissue only in the experimental group flaps.Due to its easy applicability, reproducibility, and robust circulation, the prefabricated neuro-osseous flap would be an option in reconstructive surgery.

The effects of hyperhomocysteinemia on the microcirculation of skin flaps.

BACKGROUND: Hyperhomocysteinemia is an independent risk factor for atherothrombotic disease and venous thrombosis. The effects of hyperhomocysteinemia on the microcirculation were studied in vascular diseases. The authors aimed to investigate the effects of hyperhomocysteinemia on the microcirculation of random-pattern skin flaps. METHODS: Twenty-two male Sprague-Dawley rats, divided into two groups, were used in this study. The rats in group 1 (control) were fed the TD.07112 diet, and the rats in group 2 (experimental group) were fed the TD.07114 diet, enriched in methionine for 30 days, to induce severe hyperhomocysteinemia. The plasma homocysteine, folic acid, vitamin B12, and vitamin B6 levels were evaluated on days 0 and 30. Distally based skin flaps were elevated on day 30 and evaluated by direct observation, microangiography, and light microscopy on day 37. RESULTS: Mean homocysteine blood levels were 211.76 ± 56.55 µM/liter in group 2 and 14.48 ± 2.00 µM/liter in group 1 on day 30. The rate of necrosis was significantly higher in group 2 (59.00 ± 4.38 percent) compared with group 1 (32.54 ± 6.13 percent; p < 0.01). Microangiographic findings were similar to direct observation results. Microvessel calibration was reduced in group 2. In group 1, structures of epidermis and dermis were normal; however, there was a slight mononuclear cell infiltration along with thick collagen fibers. A more prominent mononuclear cell infiltration with fields of loose epidermis, associated with inflammation and infiltration, were observed in group 2. CONCLUSION: The authors demonstrated, for the first time, that hyperhomocysteinemia severely suppressed the microvasculature of skin flaps, as shown by increased flap necrosis and reduced microvessel calibration in the experimental group.

Prefabricated osteocutaneous neural island flap model.

Neural-based flaps are an interesting clinical choice particularly in difficult cases that may not be reconstructed with known techniques. Their popularity is gradually increasing because these flaps offer the advantage of preservation of major extremity arteries and avoidance of microsurgical techniques. Our aim was to explore the feasibility of prefabrication of an osteocutaneous neural island flap model in this study. A peripheral nerve of the rat was implanted into the subcutaneous tissue of a skin flap that was connected to a segment of bone by a soft-tissue bridge, to prefabricate an osteocutaneous flap that was supplied only by the intrinsic vasculature of that nerve after a preliminary delay period. At the end of this study, based on direct observation, microangiographic findings, and additionally, a detailed histologic analysis consisting of both qualitative and quantitative assessments, we have proved that it was possible to prefabricate an osteocutaneous composite flap based on the vascularity of a peripheral nerve after a 2-step delay period. We believe that the clinical application of this new flap will gradually develop based on further experimental studies.