Extended Pedicled Perforator Plus Submental Flap for Large Cheek Defect Reconstruction.

The submental flap is an alternative repair technique in the maxillo-facial region when microsurgical reconstruction is not required or is difficult to apply. The purpose of this study was to illustrate the benefits of restoring the cheeks with an extended pedicled submental flap. Method: Eight patients aged 58 to 81 years with cheek cancer presented to the surgery department at the Benha University Hospital in Egypt, from May 2019 to October 2021 for the removal of their tumors and reconstruction of the resulting defects, using the extended submental perforator plus pedicled artery flap. Results: The average blood loss was 250 cm3 (range: 50-400 cm3). The average operation took 3 hours to complete, including excision and rebuilding (a range of 2.5 to 3.5 hours). The length of the postoperative hospital stay was 2 to 4 days. Fortunately, there was no complete flap loss; nonetheless, distal flap necrosis in one case left a raw area, which was allowed to heal naturally, and hemorrhages in two cases were conservatively handled. Conclusions: For the reconstruction of cheek abnormalities, the submental flap is a viable alternative, particularly in older patients or patients whose overall health has declined and who need less severe therapies and quicker surgery. The submental flap, which conceals the donor site, provides a dependable supply of skin for facial resurfacing with excellent color, shape, and texture matching. The flap is quick, and easy to raise.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery.

BACKGROUND: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. METHODS: In this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. RESULTS: The average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. CONCLUSION: The treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery / Ventajas del colgajo pericondrial-adipo-dérmico con base medial en la cirugía de remodelación del cartílago de oreja prominente

Background: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures.MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence.ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma.ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion. (AU)

Antecedentes: El recorte y la remodelación del cartílago son los dos tipos de técnicas en los procedimientos de otoplastia. Debido al riesgo considerable de hematoma, necrosis cutánea y deformidad de la oreja, las técnicas de recorte del cartílago han sido cuestionadas. Como resultado, los procedimientos de remodelación del cartílago basados en sutura, tales como las técnicas de Mustarde y de Furnas, han ganado popularidad. Sin embargo, dichas técnicas tienden a recidivar la deformidad debido a la memoria del cartílago y a la fatiga de la sutura, así como hay la posibilidad de extrusión y de la sensación de pinchazo en ellas.MétodosEn el presente estudio utilizamos un colgajo pericondrial-adipo-dérmico con base medial que se eleva desde el dorso auricular para cubrir y soportar la otoplastia de remodelación del cartílago, habiendo operado a 34 pacientes con esta técnica (14 mujeres y 20 varones). El colgajo pericondrial-adipo-dérmico con base medial se avanza anteriormente y se fija al borde helical inferior para cubrir el colgajo cutáneo distal. El objetivo de este procedimiento fue cubrir la línea de la sutura, impidiendo la extrusión de la misma, y soportar la reparación de la deformidad previniendo su recidiva.ResultadosEl tiempo quirúrgico medio fue de 80min, fluctuando de 65 a 110min, transcurriendo el periodo postoperatorio temprano de los pacientes con normalidad, excepto en dos pacientes: uno de ellos (2,9%) desarrolló hematoma y el otro desarrolló una zona pequeña de necrosis en el nuevo pliegue antihelical. En el periodo postoperatorio posterior un paciente desarrolló recidiva de la deformidad. Ningún paciente desarrolló extrusión de la sutura ni granuloma. (AU)

Versatility of unilateral propeller groin flap for coverage of large scrotal defects and its impact on testicular function.

Background: There are many options for scrotal reconstruction, each having its own benefits and drawbacks. In the last years, the introduction of the propeller flaps gained great popularity, while the use of groin flap as propeller in scrotal reconstruction remains anecdotal, with only a few cases reported in the literature. Objectives: In this research, we study the versatility of unilateral propeller groin flaps in the reconstruction of large scrotal defects. Patients and Methods: This study was done on 10 patients with scrotal defects who were admitted to the plastic unit of the general surgery department at Benha University Hospital from 2019 to 2021 for scrotal reconstruction. Results: All surgeries were successful with a mean operative time of 103.5 min, ranging from 90 to 130 min. All flaps survived well with no flap necrosis, and only one case showed flap congestion. Donor site healed well with the scar hidden in a natural crease, with no affection on the testicular functions. Conclusions: The use of groin flap as a propeller allows for free movement and rotation of the flap, which allows for better coverage of a large scrotal defect with good vascularity, lesser complications, no need for further operations to separate the pedicle, and the lowest donor site morbidity. Level of evidence: Level IV, therapeutic study.

Glabellar superciliary bilobed flap for reconstruction of large medial canthus region defect.

The aim of this study was to describe a series of patients who have undergone a medial canthal reconstruction with a glabellar superciliary bilobed flap. A series of 30 patients were included with medial canthal defects after excision of medial canthal tumour who underwent reconstruction using a glabellar-superciliary bilobed flap of adjoining skin and subcutaneous tissue. Eighteen procedures were performed under local anaesthesia. The remaining 12 cases were combined with major lid reconstruction and performed under general anaesthesia. Complete closure of the defect, aesthetic outcome, complications, and re-operations were all used as outcome measures. Primary closure of the donor site was achieved in all cases without wound dehiscence. In all cases, the cosmetic appearance was highly satisfactory to the surgeons and patients and there were no intraoperative complications. The glabellar superciliary bilobed flap is an effective, quick, simple, and single-stage technique for medial canthal region reconstruction. It provides excellent cosmesis and is associated with minimal complications. It can be modified according to the nature of the periorbital skin, location, size, and depth of the defect.