Earfold: A New Technique for Correction of the Shape of the Antihelix.

An absent or poorly defined antihelix often plays a central role in the perception of the prominent ear. A wide variety of otoplasty techniques have been described over the last 50 years that aim to reshape, create, or enhance the definition of the antihelix, which can, in turn, help to reduce the prominence of an ear. In addition to conventional suture and cartilage-scoring techniques, a permanent implantable clip system (Earfold® ) has recently become available that is placed using a minimally invasive approach performed under local anesthesia. In this review, we summarize conventional otoplasty techniques to correct the antihelix and compare these with the Earfold implantable clip system. Laryngoscope, 128:2282-2290, 2018.

Earfold Implantable Clip System for Correction of Prominent Ears: Analysis of Safety in 403 Patients.

BACKGROUND: The Earfold system, a new treatment for the correction of prominent ears, consists of 3 components: the Earfold implant, the Earfold introducer, and the Prefold positioner. METHODS: This is an interim report based on an ongoing analysis of safety in a series of patients treated for prominent ears with the Earfold implant between February 2013 and September 2014. Safety was assessed based on adverse event reports and the need for implant revision; follow-up is ongoing. RESULTS: Seven surgeons used 1,200 Earfold implants to treat 403 patients (ages, 7-70 years; 63% male); the time since the initial implant procedure now ranges from 30 to 48 months. To date, 145 patients (36%) have returned for a follow-up visit (mean, 7.7 months [range, 1-34 months]). Adverse events requiring intervention have affected 39 of 403 (9.7%) patients; these include implant revisions (n = 17 [4.2%], most often due to implant visibility), skin erosion over the implant (n = 15 [3.7%]), and infection (n = 7 [1.7%]). Bleeding, recurrence of prominence, hematoma, deformity, or adverse scarring did not occur. CONCLUSIONS: This interim analysis has shown that Earfold prominent ear correction system is associated with relatively few adverse events that require intervention; a small number of patients experienced infection, implant extrusion, or implant visibility that required revision. Most adverse events were related to either patient selection or technical errors at implantation. It is expected that with continued use of Earfold by surgeons experienced in otoplasty, the adverse event incidence will decrease.

The Postauricular Helix-based Adipodermal-pedicle Turnover (PHAT) Flap: An Original Single-Stage Technique for Antihelix and Scapha Reconstruction.

BACKGROUND: In reconstructing anterior defects of the ear, postauricular flaps represent a popular option. The pedicle of such transauricular flaps can be superior, inferior, medial, or lateral. The postauricular helix-based adipodermal-pedicle turnover (PHAT) flap is an original single-stage transauricular technique for defects of the antihelix and scapha. Its skin paddle is on the posterior aspect of the ear. Its lateral de-epithelialized pedicle in front of the helix allows for it to easily reach peripheral anterior defects. In cases in which the underlying cartilage is involved, the extended PHAT (ePHAT) flap allows for restoring the contours of the ear without a cartilage graft. MATERIALS AND METHODS: Between 2009 and 2011, a PHAT flap was used in 5 cases of defects of the antihelix or the scapha after tumor resection, 3 of which are in an extended version (ePHAT flap). RESULTS: There were no complications and a satisfactory aesthetic result was achieved in all cases. CONCLUSION: The PHAT flap is an original single-stage procedure for anterior auricular defects located on the antihelix or scapha. The single-layer PHAT flap is indicated in purely skin defect. The triple-layer ePHAT flap includes two subcutaneous extensions which increase its thickness and is indicated to restore the ear contours when cartilage has been removed.

The midline-based nasolabial transposition (MNT) flap: an original single-stage technique for nasal tip reconstruction.

BACKGROUND: Nasolabial flaps based on the lateral side of the nose for the reconstruction of lateral nasal defects in a single-stage procedure have been described. Similarly, in midline defects, nasolabial flaps can be used but a 2-stage procedure is classically required. The Midline-based Nasolabial Transposition (MNT) flap is presented as a new single-stage procedure for nasal tip reconstruction. MATERIALS AND METHODS: Between 2009 and 2011, an MNT flap was used as a single-stage procedure in 3 cases of large nasal defects of the tip where the forehead flap was either contraindicated or rejected as an option by the patient. RESULTS: There were no complications and a satisfactory aesthetic result was achieved in all cases. CONCLUSIONS: The MNT flap is a new single-stage procedure for large nasal tip defects and as such represents an interesting alternative to the classical 2-stage forehead and nasolabial flaps, especially in elderly patients.

A case of large sporadic neurofibroma of the hand.

We report the case of a large sporadic neurofibroma arising in the palm of the 40 year old nurse. Isolated neurofibroma in the hand are rare and pose both diagnostic and treatment challenges for the surgeon. Preoperative imaging can be useful to delineate the anatomical relationships of a soft tissue lesion but is not always diagnostic. The key points in the management of these tumours are discussed.

Compression of the median nerve in the proximal forearm by a giant lipoma: A case report.

BACKGROUND: Compression of the median nerve by a tumour in the elbow and forearm region is rare. We present a case of neuropathy of the median nerve secondary to compression by giant lipoma in the proximal forearm. CASE PRESENTATION: A 46-year-old man presented with a six month history of gradually worsening numbness and paresthesia on the palmar aspect of the left thumb and thenar eminence. Clinical examination reveals a hypoaesthesia in the median nerve area of the left index and thumb compared to the contralateral side. Electromyography showed prolonged sensory latency in the distribution of the median nerve corresponding to compression in the region of the pronator teres (pronator syndrome). Radiological investigations were initially reported as normal. Conservative treatment for one month did not result in any improvement. Surgical exploration was performed and a large intermuscular lipoma enveloped the median nerve was found. A complete excision of the tumour was performed. Postoperative revaluation the X-ray of the elbow was seen to demonstrate a well-circumscribed mass in the anterior aspect of the proximal forearm. At follow-up, 14 months after surgery, the patient noted complete return of the sensation and resolution of the paresthesia. CONCLUSION: In case of atypical findings or non frequent localization of nerve compression, clinically interpreted as an idiopathic compression, it is recommended to make a pre-operative complementary Ultrasound or MRI study.

The reverse shoulder prosthesis--surgical technique.

In this article, the surgical technique of the reverse shoulder prosthesis is described in detail. Indications for the procedure, difficulties encountered during surgery, and potential postoperative complications and their solutions are discussed.

Milk bottle burns.

In recent years numerous infants have been treated at Stoke Mandeville Hospital's Burns' Unit for scalds sustained in accidents that occurred during the preparation of warm milk. These were significant burns affecting young children with susceptibly thin skin that often resulted in the injured child requiring a long stay in hospital. Frequently, formal intravenous fluid resuscitation was required as was burn excision and skin grafting. We recommend the use of milk bottle warmer to avoid all the hazards associated with use of different techniques of warming milk bottle.