The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients.

BACKGROUND: Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. METHODS: The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. RESULTS: The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. CONCLUSION: Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction. LEVEL OF EVIDENCE: Level III, case-control study.

Esthetic restoration of progressive hemifacial atrophy (Parry-Romberg disease) by free fat grafting using computerized-assisted mapping.

BACKGROUND: This study aimed to evaluate the use of fat grafting enriched with platelet-rich plasma through a computerized-assisted mapping for esthetic restoration in progressive hemifacial atrophy (Parry-Romberg disease). METHODS: This prospective study was conducted on 53 patients presented by Parry-Romberg disease and was corrected by facial fat grafting (FFG) enriched with platelet-rich plasma (PRP). A computerized software program was used to design a detailed map to achieve clinical symmetry with fat grafting application, as the anatomical subunits direct 3-dimensional volumetric symmetric, and compartments direct isolated recipient-specific grafting. Also, volumetric asymmetry was assessed through outlines of facial contour, projection, and proportions for both sides and comparing the mirror image of unaffected side as a template. RESULTS: Objective ultrasound and photogrammetric measurements showed a significant improvement in facial symmetry postoperatively compared to preoperative (P < 0.05), with no significant differences between 12 and 18 months after surgery. The FACE-Q score regarding comparison before surgery and 18 months after surgery showed a statistically significant improvement in all modules (P < 0.001) with overall satisfaction concerning outcome of 82.7 ± 0.8. CONCLUSION: Enriched fat grafting with platelet-rich plasma (PRP) is a good alternative to reconstruct soft tissue defects for patients with progressive hemifacial atrophy (Parry-Romberg disease) with a minimally invasive approach and low complications. It provides volumetric replacement, enhancement of skin texture, and improvement of hyperpigmentation with restoration of facial contour for an esthetic pleasing appearance. Isolated replacement in accordance with the anatomical facial subunits and fat compartments allows three-dimensional reconstruction and maximizes fat retention.

Anatomically Based Optimization of Outcomes in Middle Eastern Rhinoplasy.

BACKGROUND: The predominant character in the Middle Eastern noses is the thick skin, weak cartilages, amorphous bulbous nasal tip, and high incidence of postoperative supra-tip swelling, compared with the Caucasian noses. The purpose of this study was to describe some anatomical findings and find techniques to improve outcomes in these patients. METHODS: This is retrospective study in 624 patients of Middle Eastern origin, where the characteristic anatomical findings are described and the surgical endeavors to combat their detrimental effect on the outcomes of rhinoplasty are explained. RESULTS: The results have shown that in these 624 patients, 365 patients had excellent results, 223 patients had average results, while 36 patients had poor results. CONCLUSION: The nasal shape depends on the skin (skin barring) or the cartilages (cartilage barring), or both (skin and cartilage sharing). Middle Eastern patients are toward the skin barring category with the lateral crus of the lower lateral cartilage very broad with a lateral fibrous attachment replacing the minor (sesamoid) cartilages leading to ill definition of the alae from the sides of the nose. Outcomes in these patients were improved by identification and release of these lateral attachment to improve the bulbous tip and define the alar subunit from the side of the nose. Cephalic rotation is achieved mainly by M-shaped excision of the inner lining of the vestibule and the caudal part of the septum. Other methods described to combat the strong skin memory and allow skin to configure after surgery.