Reconstruction of Concha-Type Microtia Using a Delayed Postauricular Skin Flap.

SUMMARY: Understanding how to remove and retain the relatively large residual auricle is important in concha-type microtia reconstruction. The authors present a method for concha-type microtia reconstruction using a delayed postauricular skin flap. A total of 40 patients with concha-type microtia who underwent ear reconstruction using a delayed postauricular skin flap were retrospectively examined. Reconstruction was performed in three stages. The first stage consisted of preparing a delayed postauricular skin flap and dealing with the residual auricle including removal of the upper residual auricular cartilage. In the second stage, an autogenous rib cartilage framework was placed and covered with a delayed postauricular skin flap, postauricular fascia flap, and autologous medium-thickness skin graft. The ear framework was carefully articulated and secured with the retained residual auricular cartilage to achieve a smooth junction between the two. The third stage involved modification of the reconstructed ear. Patients were followed up for 12 months after ear reconstruction. All reconstructed auricles had a good appearance, and there was a smooth connection between the reconstructed auricle and the residual ear, with similar color as well as a flat and thin scar. All patients were satisfied with the results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Ultrasound-based histological differences of pretarsal fat fascia before and after double eyelid blepharoplasty with the orbital septum method.

OBJECTIVE: To observe the changes of pretarsal fat fascia histological structure after double eyelid blepharoplasty with the orbital septum method. METHODS: From December 2019 to February 2022, the patients with congenital single eyelid who underwent double eyelid blepharoplasty with the orbital septum method at the Plastic and cosmetic surgery department of Hunan provincial people's Hospital and the same number of congenital double eyelid volunteers. Then divided into three groups: preoperative eyelid ultrasound images in Group A, postoperative eyelid ultrasound images in Group B, and congenital double eyelid volunteers in Group C. To study the histological differences of pretarsal fat fascia before and after double eyelid blepharoplasty with the orbital septum method and congenital double eyelid by ultrasound. RESULTS: Ninety-eight patients who underwent double eyelid blepharoplasty with the orbital septum method met the inclusion criteria. All 98 patients aged 22.88 ± 3.00 years, including 7 males and 91 females, followed up for 6-12 months. Included 98 volunteers with congenital double eyelid, aged 23.58 ± 2.59 years, including 49 males and 49 females. Ultrasound showed that the pretarsal fat fascia was divided into two layers. The dense layer adhered closely to the surface of the tarsus with no statistically significant differences. There was a statistically significant difference in the thickness of the pretarsal loose fat fascia layer between Group A and B. The points a b c in Group A were significantly thicker than those in Group B and C, and there was no significant difference between Group B and C. Postoperative evaluation: 83 cases were satisfied, 11 cases were basically satisfied and 4 cases were unsatisfied. CONCLUSION: After double eyelid blepharoplasty using orbital septum, the histological structure of pretarsal fat fascia is similar to that of congenital double eyelid, suggesting that double eyelid blepharoplasty with the orbital septum method can change the structure of pretarsal fat fascia and make it similar to congenital double eyelid, which is one of the anatomical bases for its good clinical effect.

Comparison of asymmetric Z-plasty and Stallard Z-plasty in correction of epicanthus.

OBJECTIVE: To investigate the clinical effect of asymmetric Z-plasty with central axis inward displacement and stallard Z-plasty in the correction of epicanthus. METHODS: We retrospectively analyzed 193 patients who underwent epicanthal plasty in the Department of Plastic and Laser Cosmetology of Hunan Provincial People's Hospital from 2009 to 2019. The patients were divided into two groups according to different surgical methods: group A (n = 125) received the asymmetric Z-plasty with central axis inward displacement method and group B (n = 68) received the stallard Z-plasty method. The incidence of early postoperative complications, epicanthus retraction and scar concealment from 6 months after the operation were analyzed and evaluated. RESULTS: After 7 days postoperation, both group A and B of patients had grade A wound healing without any infection or poor wound healing. As for the retraction of the epicanthus, 97.6% of group A patients had no retraction and 2.7% had mild retraction, while 92.6% of group B patients had no retraction and 7.4% had mild retraction. The rank-sum test showed no statistically significant difference (p > 0.05) between the two groups. Regarding scar concealment, 35.2% of group A patients had partially hidden scars and 64.8% had completely hidden scars, while 72.1% of group B patients had no hidden scars and 27.9% had partially hidden scars, with a statistically significant difference (p < 0.05). CONCLUSION: Compared with stallard Z-plasty, asymmetric Z-plasty with central axis inward displacement has the advantages of concealed incision, easier scar concealment, less scar hyperplasia and stable effect, which results in higher postoperative satisfaction.

Comparison of the Clinical Effect of Double Eyelid Blepharoplasty with the Orbital Septum Method and the Classical Method.

OBJECTIVE: To observe the clinical effect between orbital septum incision and classical incision of double eyelid plasty. METHODS: We retrospectively analyzed 381 patients who underwent double eyelid blepharoplasty in the Department of Plastic and Laser Cosmetology of Hunan Provincial People's Hospital from January 2019 to December 2019. The patients were divided into two groups according to different surgical methods: group A (n = 146) received the classical method and group B (n = 235) received the orbital septum method. The incidence of early postoperative complications, scar depression from 6 months to 1 year after the operation, the condition of 'meat strip' (the accumulation of soft tissue in front of the tarsal plate after double eyelid surgery, including skin, muscle, and fascia fat, results in a hypertrophic appearance of the upper eyelid) below the double eyelid line, and the symmetry of double eyelids were analyzed and evaluated. RESULTS: The total number of early postoperative complications in group A was seven cases (incidence rate: approximately 4.80%), and the total number of early postoperative complications in group B was two cases (incidence rate: approximately 0.85%), with a statistically significant difference (P < 0.05). The degree of scar depression in group B was significantly lighter than that in group A from 6 months to 1 year after the operation (P < 0.05). The score of 'meat strip' below the double eyelid line in group B was significantly lighter than that in group A (P < 0.05). The symmetry of double eyelids in group B was better than that in group A (P < 0.05) CONCLUSION: Compared to the classical double eyelid method, the orbital septum method has the advantages of reducing early postoperative complications, reducing the severity of the scar, slighting the 'meat strip,' and improving symmetry, which results in higher postoperative satisfaction LEVEL OF EVIDENCE III: 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 https://www.springer.com/00266 .

Epicanthus correction with a modified asymmetric Z-plasty.

The study aimed to explore the clinical efficacy of the modified asymmetric Z-plasty with a central axis from the point near the edge of the skin fold of the medial canthus to the point of the innermost palpebral edge of medial canthus for epicanthus correction. A total of 130 followed-up patients who received modified asymmetric Z-plasty for epicanthus correction in Hunan Provincial People's Hospital from January 2019 to December 2019 were included. All patients were followed up with at 1, 3, and 6 months after surgery, and the scarring and surgical outcomes were assessed. The results showed the surgical wounds were healing well, and the sutures were removed at 7 days postoperatively in all patients. At 6 months postoperatively, epicanthus correction was successful in all patients, the lacrimal caruncle was moderately exposed, the incision was not red, and there were no obvious prominent scars. Slightly prominent and uneven scars below the edge of the lower eyelid were observed in 3 patients. Among these 3 patients, 1 patient received no further treatment, and the outcomes were considered acceptable; the outcomes were improved in the remaining 2 patients after a single session of fractional laser treatment, and none of these patients received further surgery. In conclusion, the modified asymmetric Z-plasty with a central axis from the point near the edge of the skin fold of the medial canthus to the point of the innermost palpebral edge of medial canthus is relatively simple and provides good surgical results for epicanthus correction.

Treatment of Ectopic Earlobe in Microtia Reconstruction Using Delayed Postauricular Skin Flap.

OBJECTIVE: This article discusses a treatment technique for ectopic earlobe in microtia reconstruction using a delayed postauricular skin flap. METHODS: From January 2015 to September 2018, microtia reconstruction using a delayed postauricular skin flap was performed on 10 patients with microtia. During the operation, the position of the affected-side earlobe was designed according to the position of the opposite side. The ectopic earlobe was corrected by performing asymmetric Z-plasty or using an irregular "Y-V" advancement skin flap. This allowed full use of the remnant tissue of the microtia-affected ear to form a soft, plump, and realistic earlobe. RESULTS: After the earlobe displacement surgery, the blood supply of the earlobe was good, and the reconstructed earlobe survived well without ulceration in all 10 patients. All patients were followed up for 2 months to 2 years. During this time, the positions of the reconstructed ear and the healthy side were basically symmetrical, and the shape of the earlobe formed by the remnant ear was natural. CONCLUSION: The use of asymmetric Z-plasty or an irregular "Y-V" advancement skin flap for the treatment of ectopic earlobe in microtia reconstruction using a delayed postauricular skin flap is a safe and effective method.

A Case of Parotid Gland Fistula After Microtia Reconstruction Successfully Treated With Botulinum Toxin Type A.

Parotid gland fistula after microtia reconstruction is relatively rare, with only 3 cases having been reported in the literature. It may be caused by the presence of an accessory parotid gland or surgical damage to parotid gland tissues. The principal treatment is dressing the wound. Here, we report the first case of parotid fistula after microtia reconstruction using a delayed retroauricular flap, which healed following wound dressing and an injection of botulinum toxin type A (CBTXA) into the parotid gland.