Versatile Use of V-Y Advancement Flap for Facial Defect Reconstruction: A Case Series in Asian Patients.

BACKGROUND: V-Y advancement flap (VYAF) is a commonly used flap for facial reconstruction, but it is not popular in Asian society with limited aesthetic outcome evaluation. OBJECTIVE: To demonstrate our experience of facial VYAF with the quantitative aesthetic outcome assessment. METHODS AND MATERIALS: From January 2013 to December 2022, patients who underwent facial VYAF reconstruction were reviewed. Postoperative photographs were collected and independently graded by three plastic surgeons, three nurses, and six non-medical personnel using Manchester scar scale (MSS). The representative preoperative images were selected for surgeons' reconstruction preferences survey. RESULTS: Forty-eight patients (27 females and 21 males), with a mean age of 66.8 (23-97) years, were included in this study. All flaps survived with no flap necrosis. Only six patients (12.5%) developed minor postoperative complications, and they were treated conservatively and resolved uneventfully. The total MSS score was 7.8 ± 1.9 (scale of 4 [best scar] to 24 [worst scar]) and the overall scar VAS rating was 1.9 ± 1.1 (0 [best scar] to 10 [worst scar]), indicating satisfactory postoperative scar condition. From the survey of 22 plastic surgeons and 11 scenarios, VYAF was rarely chosen among other local flaps which only accounted for 8.7%. CONCLUSION: VYAF is an easy and safe method for facial reconstruction with low morbidity, but its usefulness is underappreciated. With a proper design and cautious dissection, we believe that good aesthetic and functional outcomes can be achieved with VYAF. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tumors Involving Skin, Soft Tissue and Skeletal Muscle: Benign, Primary Malignant or Metastatic?

BACKGROUND: Metastatic cancer with invasion of skin, soft tissue and skeletal muscle is not common. Examples presenting as soft tissue masses could sometimes lead to misdiagnosis with delayed or inappropriate management. The purpose of current study was to investigate clinical characteristics in the involvement of metastatic cancer. MATERIALS AND METHODS: A total of 1,097 patients complaining of skin or soft tissue masses and/or lesions were retrospectively reviewed from January 2012 to June 2013. Tumors involving skin, soft tissue and skeletal muscle of head and neck, chest wall, abdominal wall, pelvic region, back, upper and lower extremities were included in the study. RESULTS: Fifty-seven (5.2%) patients were recognized as having malignancies on histopathological examination. The most common involvement of malignancy was basal cell carcinoma, followed by cutaneous squamous cell carcinoma, sarcoma and melanoma. The most common anatomical location in skin and soft tissue malignancies was head and neck (52.6% of the malignancies). Four (0.36%) of the malignant group were identified as metastatic cancer with the primary cancer source from lung, liver and tonsil and the most common site was upper extremities. One of them unexpectedly expired during the operation of metastatic tumor excision at the scalp. CONCLUSIONS: Discrimination between benign and malignant soft tissue tumors is crucial. Performance of imaging study could assist in the differential diagnosis and the pre-operative risk evaluation of metastatic tumors involving skin, soft tissue and skeletal muscle.

Tailoring folded-fasciocutaneous flap for the restoration of oral commissure morphology.

The reconstruction of a through-and-through cheek defect with oral commissure involvement can be challenging. When attempting to reconstruct its seam-like structure or to replace its supple lip tissue, postoperative morbidities such as drooling, microstomia, and poor aesthetic appearance can often occur and be difficult to correct. After inspecting the oral commissure, one can observe that the morphology of the upper lip acts as a "drape" hanging over the upper teeth, whereas the lower lip functions similarly to a "dam" holding the constant pour of saliva within the oral cavity. We noted that if we tailored a single fasciocutaneous flap to satisfy these morphologies during reconstruction, not only were the mentioned morbidities of reconstruction greatly diminished, but the reconstructed oral commissure could also spontaneously mimic the contralateral side in form. We presented 10 consecutive patients with cheek defects with concomitant oral commissure involvement, which underwent reconstruction by using a single-folded fasciocutaneous flap. We described how the flaps are tailored to suit the mentioned upper and lower lip morphology. For certain defects, such as a cheek defect with oral commissure involvement, the loss of functional morphology greatly outweighs its anatomical or tissue losses. Our method provides a simple and straightforward surgical option in this area, which was previously perceived as a challenging reconstruction site.

The concept of "two arches" in mandibular reconstruction.

To optimize the outcome of the free fibula flap in mandibular reconstruction, the central portion of the mandible can be divided into upper and lower arches during preoperative evaluation and planning. We present 2 cases requiring mandibular reconstruction with free fibula flap after ameloblastoma excision, to illustrate the "two arches" concept and its applicability in mandibular reconstruction. The postoperative course was uneventful. Follow-up at 24 months postoperative revealed a considerable restoration in facial appearance and provided functional teeth. Recent advances in mandibular reconstruction could be further refined through the application of the "two arches" concept. This approach simplifies surgical planning in selective cases and directs the attention of surgeons to the specific needs of the 2 distinct regions of the mandible during reconstruction.

Evaluation of age-related intraorbital fat herniation through computed tomography.

BACKGROUND: Progressive herniation of lower eyelid fat has generally been accepted as a part of the aging process in the lower eyelid. Numerous theories have been proposed for the mechanism of periorbital aging, but to the best of the authors' knowledge, the actual occurrence of lower eyelid fat herniation has not been documented. METHODS: Using data of orbital and facial computed tomography from 167 patients, the authors evaluated curvature and protrusion of lower eyelid fat and its changes in different age groups. The relation of its occurrence to the position of the ocular globe was also evaluated. RESULTS: A statistically significant effect of age groups was detected for curvature (percent) of lower eye lid fat. Specifically, when compared with the reference group (younger than 30 years), each increase of 1 year shows a curvature increase of 0.48 percent for the group that was 30 to 69 years old (95 percent confidence interval, 0.27 to 0.69; p < 0.01). For the age group of 70 years or older, each increase of 1 year could predict a 1.22 percent increase of curvature (95 percent confidence interval, 0.81 to 1.63; p < 0.01). CONCLUSIONS: The authors found that although the amount of lower eyelid fat varies greatly between individuals, the process of lower eyelid fat herniation does occur. It retains a steady incline after the third decade of life and slows at approximately age 70. In the authors' study, ocular globe position appears unrelated to this process of herniation.