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1.
Artigo em Inglês | MEDLINE | ID: mdl-32559041

RESUMO

Several approaches for peri-implant soft tissue augmentation have been proposed, including autogenous soft tissue grafts and substitutes. Palatal pedicle flaps have been introduced for increasing facial soft tissue thickness, improving esthetics, and achieving primary closure following alveolar ridge preservation or guided bone regeneration. The main advantage of these approaches is to maintain the vascularization of the flap, which may result in better healing and less shrinkage than graft-based procedures. Nevertheless, different clinical scenarios require different palatal pedicle flaps. The aim of this article was to present several palatal pedicle flap techniques for peri-implant soft tissue augmentation and alveolar ridge preservation, showing flap designs and the main advantages through case presentations.


Assuntos
Aumento do Rebordo Alveolar , Processo Alveolar , Regeneração Óssea , Transplante Ósseo , Implantação Dentária Endo-Óssea , Palato/cirurgia , Retalhos Cirúrgicos/cirurgia
2.
World Neurosurg ; 140: 374-377, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32479908

RESUMO

BACKGROUND: A novel viral strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a worldwide pandemic known as coronavirus 2019 (COVID-19). Early reports from China have highlighted the risks associated with performing endoscopic endonasal skull base surgery in patients with SARS-CoV-2. We present a rare complication of nasoseptal flap (NSF) necrosis associated with COVID-19, further emphasizing the challenges of performing these procedures in this era. CASE DESCRIPTION: A 78-year-old man underwent an extended endoscopic endonasal transplanum resection of a pituitary macroadenoma for decompression of the optic chiasm. The resulting skull base defect was repaired using a pedicled NSF. The patient developed meningitis and cerebrospinal fluid (CSF) leak on postoperative day 13, requiring revision repair of the defect. Twelve days later, he developed persistent fever and rhinorrhea. The patient was reexplored endoscopically, and the NSF was noted to be necrotic and devitalized with evident CSF leakage. At that time, the patient tested positive for SARS-CoV-2. Postoperatively, he developed acute respiratory distress syndrome complicated by hypoxic respiratory failure and death. CONCLUSIONS: To our knowledge, this is the first reported case of NSF necrosis in a patient with COVID-19. We postulate that the thrombotic complications of COVID-19 may have contributed to vascular pedicle thrombosis and NSF necrosis. Although the pathophysiology of SARS-CoV-2 and its effect on the nasal tissues is still being elucidated, this case highlights some challenges of performing endoscopic skull base surgery in the era of COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Procedimentos Neurocirúrgicos/efeitos adversos , Pandemias , Pneumonia Viral , Base do Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Humanos , Masculino , Necrose/etiologia , Complicações Pós-Operatórias/virologia , Retalhos Cirúrgicos/virologia
4.
J Craniofac Surg ; 31(3): 642-647, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282663

RESUMO

BACKGROUND: Utilizing the concept of Barton's high superficial musculo-aponeurotic system (SMAS) technique, the authors performed the more extensive skin-attached SMAS/platysma flap elevation and the 'dual deep tissue support' technique involving multiple plications of the parotid-masseteric fascia, repositioning of the SMAS, and platysma muscle. Our aim was to demonstrate a specific surgical procedure for face and neck lift and offer its pitfalls and outcomes. METHODS: This study included 83 patients aged between 54 and 73 years. The pre- and 10-month postoperative photographs of all patients were used to assess the extent of the nasolabial folds, the labiomental fold, and the cervical band (platysma band). Each patient's subjective aesthetic satisfaction was also evaluated. RESULTS: At 3 and 6 months postoperatively, 94% (n = 3) of patients achieved "minimal" and "mild" nasolabial folds. Most patients (89.1%, n = 74) were satisfied with their outcomes. Two minor hematomas (2.4%) occurred locally over the temporal or retro-auricular area. No incidence of skin flap necrosis or permanent facial nerve injury was observed. CONCLUSIONS: Our extensive skin-attached SMAS/platysma flap elevation with dual deep tissue support, both by multiple parotic masseteric plication and SMAS/platysma repositioning, provided not only the definite lifting effect in the immediate postoperative period, but also resulted in long-lasting lifting outcomes without remission. LEVEL OF EVIDENCE: IV.


Assuntos
Ritidoplastia/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sulco Nasogeniano/cirurgia , Pescoço/cirurgia , Glândula Parótida/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Sistema Musculoaponeurótico Superficial/cirurgia , Retalhos Cirúrgicos/cirurgia
5.
J Craniofac Surg ; 31(3): 731-736, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32217859

RESUMO

BACKGROUND: A supratip deformity (SD) is an iatrogenic convexity that occurs in the cephalic region of the nasal tip. SD is still a major problem after rhinoplasty surgery. OBJECTIVES: With the method we have described a ligamentous flap was used to create a supratip transition, with adjustable sharpness, while the refinements of the tip rotation and definition were ensured. The aim of the study is to present the results of this technique, which, to the best of our knowledge, has been described here for the first time. METHODS: Our ligamentous flap technique was applied to 24 patients between August 2017 and March 2018. All of the patients were evaluated in terms of the formation of an SD, a hanging columella, tip projection, and the loss of rotation at the postoperative followups. The photos of patients were evaluated by another independent plastic surgeon and patients themselves at 3 months after the surgery. RESULTS: There were no early or late complications, such as an infection, excessive bleeding, or prolonged edema. Moreover, SDs, hanging columellas, tip projections, and rotational losses, which would require revisions, were not detected in any of the patients. Postoperative scores given by the patients and surgeons were significantly higher than the preoperative values (P < 0.05). Only 2 patients required minor revisions due to dorsal irregularities in the upper 1/3 of the nasal segment. CONCLUSION: The early results of this Pitanguy composite flap technique, which can be easily applied in every case with thin or thick skin in an open rhinoplasty, are promising. However, there is a need for an evaluation of the long-term results, as well as the advantages and disadvantages in a larger case series. LEVEL OF EVIDENCE: Level IV.


Assuntos
Nariz/cirurgia , Rinoplastia/métodos , Retalhos Cirúrgicos , Hemorragia/cirurgia , Humanos , Infecções , Período Pós-Operatório , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento
6.
J Craniofac Surg ; 31(2): 436-439, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049922

RESUMO

INTRODUCTION: Traditionally, galeal flap or cranialization was often used to reconstruct the skull base defect caused by trauma or tumor removal. However, in the case of huge skull base defect, galeal flap is not enough to block the communication between nasal cavity and intracranial space. In this study, authors suggest combination flap of galea and reverse temporalis muscle as a method for reconstruction of huge skull base defect. MATERIALS AND METHODS: From 2016 to 2019, retrospective review was conducted, assessing 7 patients with bone defect which is not just opening of frontal sinus but extends to frontal sinus and cribriform plate. Reconstructions were done by combination of galeal flap and reverse temporalis muscle flap transposition. RESULTS: Defects were caused by nasal cavity tumor with intracranial extension or brain tumor with nasal cavity extension. There was no major complication in every case. During the follow up period, no patient had signs of complication such as ascending infection, herniation and CSF rhinorrhea. Postoperative radiologic images of all patients that were taken at least 6 months after the surgery showed that flaps maintained the lining and the volume well. DISCUSSION: Conventional reconstruction of skull base defect with galeal flap is not effective enough to cover the large sized defect. In conclusion, galeal flap in combination with reverse temporalis muscle flap can effectively block the communication of nasal cavity and intracranium.


Assuntos
Cavidade Nasal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Base do Crânio/cirurgia , Adulto , Idoso , Feminino , Seio Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia
7.
J Craniofac Surg ; 31(3): 685-688, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32028370

RESUMO

BACKGROUND: Nowadays, a sharp, well-defined supratarsal fold and appropriate fullness of the upper eyelid tissue are considered important features of beautiful and youthful eyes. Individuals with thin upper eyelid tissue are at high risk of developing multiple upper eyelid folds and/or sunken appearance after upper blepharoplasty. Innovatively, the authors propose the application of free orbital fat grafting to the postorbicularis oculi space during upper blepharoplasty in order to achieve better aesthetic results. METHODS: Fifty Chinese patients with congenital single eyelids combined with mildly sunken upper eyelid tissue were operated on between June 2017 and October 2018. During blepharoplasty, the lateral portion of the orbital septum was dissected, and appropriate lateral orbital fat was harvested. When the double-eyelid fold was formed and skin was interruptedly sutured, the harvested fat was divided into several pieces each side according to the sunken depth, and they were used to replace a layer on two-thirds of the central region of the supraseptal skin-muscle flap through the zipping gaps. RESULTS: Forty-five patients underwent the follow-up interview for 6 to 18 months with a mean period of 10 months. The satisfaction rate was 82%. No significant asymmetry, irregularities, and sunken upper eyelid and multiple upper eyelid folds occurred. CONCLUSION: The lateral orbital fat grafting to the central region of the supraseptal skin-muscle flap during upper blepharoplasty is an effective and simple method to correct or prevent multiple upper eyelid folds and/or sunken upper eyelid in Asians.


Assuntos
Tecido Adiposo/transplante , Blefaroplastia/métodos , Pálpebras/cirurgia , Órbita/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Retalhos Cirúrgicos/cirurgia
8.
J Craniofac Surg ; 31(3): e309-e312, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32028366

RESUMO

The use of acellular dermal matrix (ADM) is well established in scalp burn reconstruction. However, its application in at-risk patients and hostile scalp wounds remains controversial and only described in the pediatric setting. This study aims to describe the pre-operative factors leading to the decision to use ADM in adult patients undergoing complex scalp reconstruction, and to describe the postoperative outcomes including wound breakdown and need for reoperation. This is a retrospective case series of patients undergoing scalp reconstruction with use of ADM. Data was collected from operations performed by a single surgeon over a period from January 2017 to October 2018. Nine patients underwent scalp reconstruction including placement of ADM during the study period. Seven patients were female, and median age was 64 years. Six patients had undergone prior craniotomies and three had undergone prior craniectomies for a variety of etiologies including neoplastic disease (n = 4), aneurysmal disease (n = 2), and trauma (n = 3). Wound breakdown or delayed wound healing necessitated reconstructive operations in all patients, 4 of whom had exposed/infected hardware that required removal. The median area of soft tissue defects was 30 cm. Two of the 4 patients with both benign and malignant tumors had been treated with radiation therapy, compromising the quality of the remaining adjacent scalp. Acellular dermal matrix was used in each setting to augment or buttress thin scalp. In 4 patients cranioplasty implants, hardware, or mesh were replaced concurrently. Two patients proceeded onto staged alloplastic cranioplasty without complication. Median follow up was 115 days. During follow up, only 1 patient suffered a major complication requiring reoperation to explant an osteomyelitic bone flap. Acellular dermal matrix can serve as an adjunct in hostile scalp reconstruction. Augmenting the areas of compromised scalp, especially over alloplastic cranioplasty material, can minimize the likelihood of future hardware exposure. Our study demonstrates its use in high-risk scalp wounds defined by frequent operation, chronic infection, and radiation.


Assuntos
Derme Acelular , Couro Cabeludo/cirurgia , Craniotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos , Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Deiscência da Ferida Operatória
9.
J Craniofac Surg ; 31(3): e299-e302, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049911

RESUMO

Hair-bearing areas reconstruction is a difficult field because of limited donor area. Various techniques have been described for hair-bearing areas reconstruction, but the choice of the flap is variable depending on surgeons and patients. In this study, the authors present 7 patients who underwent soft tissue reconstruction with the pedicled superficial temporal artery-based flaps in the hair-bearing areas. No postoperative complications like bleeding, flap congestion, wound dehiscence, and flap necrosis were observed. This flap can be an alternative to the other methods because it is compatible with the face by the flap color and thickness, it can be easily harvested, it has a reliable circulation and minimum donor site scar.


Assuntos
Cabelo , Procedimentos Cirúrgicos Reconstrutivos , Cicatriz/cirurgia , Face/irrigação sanguínea , Face/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Retalhos Cirúrgicos/cirurgia , Artérias Temporais/cirurgia , Adulto Jovem
10.
J Craniofac Surg ; 31(3): 737-740, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097383

RESUMO

Nasal hump removal and modification is a commonly performed procedure in rhinoplasty. The spreader flap is most commonly used in the reconstruction technique and involves suturing the medial end of the upper lateral cartilage (ULC) onto the septum. In this study, author presents a new hump removal technique that includes a novel procedure for hump reinsertion and suturing that is easy and comfortable to apply in hump removal operations. The records of the patients were assessed retrospectively from private practice. Patients who had undergone hump removal operations using a hump reinsertion graft were included. In total, 54 patients met the inclusion and exclusion criteria, and their records were assessed. The hump was divided into 3 parts longitudinally. The septum, which is a part of the nasal hump, was prepared as a strut graft, and the ULCs were prepared as spreader grafts. A novel suturing technique was used while the spreader grafts were fixed. This technique was used if the ULC was larger than 3 mm. The patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) 12 months after surgery. The initial median ROE score was 40.5; after surgery, it increased to 88.5. The ROE score changed significantly (P < .001). The postoperative results were satisfactory. After assessments, no asymmetry or functional problems were found in all participants. This technique allows for closed rhinoplasty without the need for an additional graft from the septum, enhancing the prevention of displacement and improving functionality.


Assuntos
Nariz/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Rinoplastia/métodos , Retalhos Cirúrgicos/cirurgia , Técnicas de Sutura , Suturas , Adulto Jovem
11.
J Craniofac Surg ; 31(3): e291-e296, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32068730

RESUMO

BACKGROUND AND AIMS: Between 1997 and 2014, 3 protocols have been used in out cleft unit for primary repair of unilateral cleft lip and palate. During the Scandcleft randomized controlled trial closing the soft palate and lip at 4 months and the hard palate at 12 months (Protocol 1) was compared with closing the entire palate at 12 months (Protocol 2). Protocol 3 comprises closure of the lip and hard palate with a vomer flap at 4 months and the soft palate at 10 months. The purpose of this study was to compare subsequent velopharyngeal competence at age of 3 and 5 years. PATIENTS AND METHODS: The study consisted of 160 non-syndromatic patients with a unilateral cleft lip and palate. Protocol 3 was retrospectively compared with Protocols 1 and 2 within the previously published Scandcleft study. RESULTS: At 3 years of age, normal or borderline competent velopharyngeal function was found in 68% of patients in Protocol 1, 74% of patients in Protocol 2, and 72% of patients in Protocol 3. At 5 years of age, the corresponding figures were 84%, 82%, and 92%. 21% of patients in Protocol 1, 4% in Protocol 2, and 23% in Protocol 3 had palatal reoperations before the age of 5 years. CONCLUSION: No significant differences emerged in velopharyngeal competence at age 3 years between the 3 protocols. Palatal reoperations were performed earlier in patient groups 1 and 3, explaining the difference in the velopharyngeal competence rate at the 5-year time-point.


Assuntos
Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Seguimentos , Humanos , Masculino , Palato Duro/cirurgia , Palato Mole/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Fala , Retalhos Cirúrgicos/cirurgia , Vômer/cirurgia
12.
Int J Gynaecol Obstet ; 148 Suppl 1: 37-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943184

RESUMO

OBJECTIVE: To identify criteria to guide surgeons regarding indications for use of the Singapore and gracilis muscle flaps in obstetric fistula repair. METHODS: This is a retrospective case series. Obstetric fistula surgeons in Lilongwe, Malawi, have been incorporating plastic surgery techniques with the Singapore and gracilis muscle flaps since collaborating with plastic surgeons in 2016. We describe the surgical outcomes of procedures utilizing each flap individually and those using both. RESULTS: Between February 2016 and June 2019, 69 patients received a flap at the time of obstetric fistula repair at the Fistula Care Center in Lilongwe, Malawi. A total of 32 (46.4%) received a Singapore flap, 20 (29.0%) received a gracilis flap, and 17 (24.6%) received both types of flap. CONCLUSION: Based on our outcomes, we note the possible advantage of incorporating the gracilis flap even when it is thought that the Singapore flap is sufficient. However, more data are needed.


Assuntos
Músculo Grácil/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Fístula/cirurgia , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fístula Vesicovaginal/patologia
13.
J Int Acad Periodontol ; 22(1): 11-20, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31896103

RESUMO

BACKGROUND: Correct soft tissue management and achieving tension-free primary closure are pre-requisites for the success of bone augmentation procedures. Several techniques have been developed to facilitate a passive soft tissue primary closure. However, the current techniques are highly invasive and require advanced surgical skills. Hence, the present case series report will describe a novel and simple flap management technique. METHODS: The Periosteal Flap Stretch technique was utilized in bone augmentation procedures for four patients who presented with horizontal and vertical alveolar ridge deficiencies in the anterior maxilla, anterior mandible, posterior mandible, and posterior maxilla. This technique is performed using a blunt surgical curette that engages the periosteum of the mucosa below the mucogingival line of the full-thickness flap and stretches the periosteum in a coronal and outward direction, which results in stretching of the flap without the need for vertical or periosteal releasing incisions. RESULTS: Healing was uneventful for four all cases. No membrane exposure, no soft tissue dehiscence, or any other complications were observed during the six-months healing period after the respective bone augmentation procedures of cases. CONCLUSIONS: The Periosteal Flap Stretch technique is a novel and simple technique that facilities achieving passive and predictable primary soft tissue closure.


Assuntos
Perda do Osso Alveolar/cirurgia , Aumento do Rebordo Alveolar , Transplante Ósseo , Implantação Dentária Endo-Óssea , Humanos , Periósteo , Retalhos Cirúrgicos/cirurgia
14.
J Craniofac Surg ; 31(2): 517-519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895861

RESUMO

Primary carcinoma of the frontal sinus is very rare, with an incidence of 0.3% to 1.0% of all paranasal sinus carcinomas. Although complete resection with a clear margin is definitely essential to achieve tumor control, radical surgery with osteoplastic flap using bicoronal incision has significant postoperative morbidities including scalp numbness, hair loss, and frontalis palsy. This article reports a rare case of primary frontal sinus squamous cell carcinoma extending to the orbit, which was treated successfully by mini osteoplastic flap through supra-eyebrow incision combined transnasal endoscopic approach.


Assuntos
Seio Frontal/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos/cirurgia , Artrodese , Sobrancelhas , Seio Frontal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Ferida Cirúrgica
15.
J Craniofac Surg ; 31(2): e169-e171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895852

RESUMO

Skin cancer of the nose remains a common challenge for the reconstructive surgeon with full-thickness defects being particularly problematic. Reconstruction of the internal nasal lining poses the greatest difficulty with local tissue often having unsatisfactory vascularity or surface area. We describe the reconstruction of a full thickness nasal alar defect in a patient after failed full-thickness skin graft using a single stage procedure combining a bilobed flap with a turnover flap. The patient achieved excellent initial and long-term cosmesis and functionality and was very satisfied with the results. We demonstrate that selected full-thickness nasal alar defects may be reconstructed in a single procedure using a carefully placed turnover flap for the internal nasal lining and bilobed flap for outer skin cover.


Assuntos
Nariz/cirurgia , Idoso , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/cirurgia
16.
World J Surg Oncol ; 18(1): 8, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918725

RESUMO

BACKGROUND: Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. METHODS: We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015-2019) in the 1st ENT University Department, University of Athens, Greece. RESULTS: We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey's syndrome. CONCLUSIONS: The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.


Assuntos
Neoplasias Parotídeas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ritidoplastia/métodos , Sistema Musculoaponeurótico Superficial/cirurgia , Retalhos Cirúrgicos/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Ritidoplastia/efeitos adversos
17.
J Craniofac Surg ; 31(2): 534-537, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977714

RESUMO

BACKGROUND AND OBJECTIVE: Craniofacial malignant tumors require not only extended resection but also appropriate reconstruction to restore appearance, which remains a major challenge. Here the authors introduced the application of superficial temporal artery (STA) flap in wound repairing after the resection of craniofacial malignant tumors. METHODS: From January 2015 to December 2018, 16 patients with craniofacial malignant tumors were enrolled into the study, including squamous cell carcinoma (n = 6), basal cell carcinoma (n = 3), melanoma (n = 4), neuroendocrine carcinoma (n = 2), and dermatofibrosarcoma protuberance (n = 1). All of the tumors underwent extended resection. The defects formed were repaired by flaps pedicled with superior or frontal branch of STA. Donor sites were repaired with skin grafts. Patients were followed up for 6 months to 3 years to monitor the recurrence of tumor. RESULTS: All the flaps survived well. Venous congestion occurred in two cases but resolved after blood-letting and application of drugs promoting venous draining. During the follow-up, no recurrence of tumors was observed and the appearance of flaps was satisfying. But flap donor sites suffered from relatively poor appearance or alopecia deformity. CONCLUSIONS: The STA flap is reliable for wound repairing after resection of craniofacial malignant tumors. The STA parietal branch flap is preferred for repairing scalp defects, while the STA frontal branch flap is preferred for repairing facial defects. However, the STA flap should be used prudently due to its disadvantage of the deformity in scalp donor sites.


Assuntos
Artérias/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos/cirurgia , Artérias Temporais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Transplante de Pele , Resultado do Tratamento , Cicatrização
18.
J Craniofac Surg ; 31(2): e153-e155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977695

RESUMO

For the management of cleft palate, the surgical approach has been suggested at an early stage even in childhood, varying in the number of interventions. Once the interventions are not performed at appropriate times, such as sequences that may accompany specific psychological, functional, and aesthetic effects. Since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive clef palate in adult patients. The purpose of this paper is reporting a case of temporal muscle flap in the soft and hard palate of an adult with a reconstruction of the donor area with a titanium mesh. A 37 year old male patient with cleft lip/palate, complained of difficulty in speech, chewing, swallowing, and breathing. Clinically, it was observed oroantral communication in the region of the hard and soft palate, with a previous cheiloplasty. A temporal rotation was planned to close the fissure for the treatment. The modified coronal approach was used. Temporal muscle traction and its interposition in the palate region were performed through the tunneling technique, and mass suturing was performed. After 3 years, he presented satisfactory results, with the improvement of the quality of life, as well as the area of exposure. In conclusion, since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive cleft palate in adult patients.


Assuntos
Fissura Palatina/cirurgia , Retalhos Cirúrgicos/cirurgia , Músculo Temporal/cirurgia , Adulto , Fissura Palatina/diagnóstico por imagem , Humanos , Masculino , Palato Duro/cirurgia , Palato Mole/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos
19.
J Craniofac Surg ; 31(2): e133-e135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31934976

RESUMO

Recently, several adjunctive procedures have gained traction to aid cleft surgeons in repairing especially challenging palatal clefts. Buccal fat flaps and buccal myomucosal flaps have demonstrated particular utility in reinforcing thin palatal flaps or tissue deficits. Although their use has not been widely accepted, they may be particularly helpful in the setting of significant scarring or vascular compromise. Here the authors describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomucosal flap after transection of the right Greater Palatine artery (GPA) during palatoplasty on a 14-month old female with Pierre Robin Sequence and a wide Veau II cleft palate. For this operative salvage, bilateral buccal fat flaps were used to reinforce the hard-soft palate junction and a 4 cm × 2 cm flap of the right-sided buccal mucosa and buccinator muscle was inset along the majority of the right-sided soft and posterior hard palate. At 2 years follow-up, the patient had no significant complications and was doing well with healthy-appearing palatal tissue and age-appropriate speech.


Assuntos
Artérias/cirurgia , Fissura Palatina/cirurgia , Síndrome de Pierre Robin/cirurgia , Terapia de Salvação , Artérias/diagnóstico por imagem , Bochecha/cirurgia , Fissura Palatina/complicações , Fissura Palatina/diagnóstico por imagem , Músculos Faciais/cirurgia , Feminino , Humanos , Lactente , Cuidados Intraoperatórios , Mucosa Bucal/irrigação sanguínea , Mucosa Bucal/cirurgia , Palato Duro/irrigação sanguínea , Palato Duro/cirurgia , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos/cirurgia
20.
J Plast Reconstr Aesthet Surg ; 73(3): 460-468, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31928962

RESUMO

INTRODUCTION: The specific patterns of revascularization of allograft nerves after the addition of vascularization remain unknown. The aim of this study was to determine the revascularization patterns of optimized processed allografts (OPA) after surgically induced angiogenesis to the wound bed in a rat sciatic nerve model. MATERIALS AND METHODS: In 51 Lewis rats, sciatic nerve gaps were repaired with (i) autografts, (ii) OPA and (iii) OPA wrapped in a pedicled superficial inferior epigastric artery fascia flap (SIEF) to provide vascularization to the wound bed. At 2, 12, and 16 weeks, the vascular volume and vascular surface area in nerve samples were measured using micro CT and photography. Cross-sectional images were obtained and the number of vessels was quantified in the proximal, mid, and distal sections of the nerve samples. RESULTS: At 2 weeks, the vascular volume of SIEF nerves was comparable to control (P = 0.1). The vascular surface area in SIEF nerves was superior to other groups (P<0.05). At 12 weeks, vascularity in SIEF nerves was significantly higher than allografts (P<0.05) and superior compared to all other groups (P<0.0001) at 16 weeks. SIEF nerves had a significantly increased number of vessels compared to allografts alone in the proximal (P<0.05) and mid-section of the graft (P<0.05). CONCLUSIONS: Addition of surgical angiogenesis to the wound bed greatly improves revascularization. It was demonstrated that revascularization occurs primarily from proximal to distal (proximal inosculation) and not from both ends as previously believed and confirms the theory of centripetal revascularization.


Assuntos
Nervo Isquiático/transplante , Aloenxertos , Animais , Modelos Animais de Doenças , Sobrevivência de Enxerto , Masculino , Ratos , Ratos Endogâmicos Lew , Nervo Isquiático/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia
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