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1.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500305

RESUMO

Nasal reconstruction following a total or subtotal resection presents a challenging clinical scenario. Ample external skin coverage is readily available using the paramedian forehead flap (PMFF), but restoring adequate internal lining of sufficient size and pliability is a major limitation. Intranasal mucosal flaps or free tissue transfer is often employed for this purpose, each with their own sets of limitations. Prelamination of the PMFF with a skin graft prior to transfer is a method to create a composite flap with both internal and external lining. Another challenge in subtotal nasal reconstruction centres around restoring adequate dimensions to the nose without an existing template to work from. Three-dimensional (3D) printing has become an increasingly popular tool in reconstructive surgery as it captures precise patient-specific dimensions to guide reconstruction. Herein, we describe a case of subtotal nasal reconstruction using a prelaminated PMFF using a patient-specific 3D printed model as a template for reconstruction.


Assuntos
Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Idoso , Carcinoma Basocelular/cirurgia , Testa , Humanos , Masculino , Neoplasias Nasais/cirurgia , Impressão Tridimensional , Neoplasias Cutâneas/cirurgia
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4187-4190, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018920

RESUMO

Recently, video plethysmography (VPG) - a heart rate estimation technique using a video camera - has gained significant attention. Most studies of VPG have used a visible RGB camera; only a limited number of studies investigating near-infrared light (wavelength 750-2500 nm), which can be used even in a dark environment, have been performed. The purpose of this study was to investigate the differences between VPG data collected using visible light (VPGVIS) or near-infrared light (VPGNIR) from four facial areas (forehead, right cheek, left cheek, and nose). An experiment was conducted to obtain both VPGVIS and VPGNIR simultaneously by alternately irradiating the face with NIR and VIS lights. Experimental results showed that the root mean squared error of heart rate estimated using VPGNIR was 1 bpm higher than that of VPGVIS. However, contrary to our expectations, the power of the heartbeat-related component included in VPGNIR was not reduced despite the absorbance of hemoglobin in the NIR light range being 1/100 of that in the VIS light range. This result supports the hypothesis that a main factor in the generation of VPG waves was change in the optical properties caused by blood vessels compressing the subcutaneous tissue and the venous bed. Additionally, the accuracy of the heart rate estimation using VPG tended to be high when the nose was set as the ROI. This result was likely associated with the anatomical structure of the nose.


Assuntos
Face , Pletismografia , Testa , Humanos , Raios Infravermelhos , Nariz
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 374-377, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018006

RESUMO

Continuous monitoring of blood oxygen saturation levels is vital for patients with pulmonary disorders. Traditionally, SpO2 monitoring has been carried out using transmittance pulse oximeters due to its dependability. However, SpO2 measurement from transmittance pulse oximeters is limited to peripheral regions. This becomes a disadvantage at very low temperatures as blood perfusion to the peripherals decreases. On the other hand, reflectance pulse oximeters can be used at various sites like finger, wrist, chest and forehead. Additionally, reflectance pulse oximeters can be scaled down to affordable patches that do not interfere with the user's diurnal activities. However, accurate SpO2 estimation from reflectance pulse oximeters is challenging due to its patient dependent, subjective nature of measurement. Recently, a Machine Learning (ML) method was used to model reflectance waveforms onto SpO2 obtained from transmittance waveforms. However, the generalizability of the model to new patients was not tested. In light of this, the current work implemented multiple ML based approaches which were subsequently found to be incapable of generalizing to new patients. Furthermore, a minimally calibrated data driven approach was utilized in order to obtain SpO2 from reflectance PPG waveforms. The proposed solution produces an average mean absolute error of 1.81% on unseen patients which is well within the clinically permissible error of 2%. Two statistical tests were conducted to establish the effectiveness of the proposed method.Clinical relevance- The proposed method ameliorates our current understanding of reflectance based pulse oximetry and provides a method to estimate SpO2 from reflectance pulse oximeters.


Assuntos
Oximetria , Oxigênio , Dedos , Testa , Humanos , Articulação do Punho
5.
Facial Plast Surg ; 36(4): 416-429, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866979

RESUMO

South America is a vast territory; its people were made from all parts of the world. The miscegenation made a unique population comprised of Indian, Asian, Caucasian, African, Mestizo, Mulatto, and Zambo. The South American patients tend to have a wider face with a skin-soft tissue envelope (S-STE) that is thicker, heavier, and has less elasticity than the Caucasian patient. Upper eyelids may hood easily. In the same way, malar eminences and round face look are more prominent. The chin can be a little retracted. With aging, the S-STE tends to sag more, making nasolabial folds and jowl area more prominent, and redundant neck skin will appear loose and heavy. Facelift is popular in South American patients. They have peculiar characteristics like heavy dark sebaceous skin which lead to peculiarities in face lifting. It is usually a procedure designed to rejuvenate all thirds of the face. In the forehead, skin excision in temporal incisions is usually necessary. Midface subperiosteal lift is a possibility for heavy skin patients who need great improvement in the center of the face. The neck lift is almost indispensable to the rejuvenation of the lower third. Extended superficial muscular aponeurotic system or deep plane dissection is commonly performed so the soft tissues of the midface, the jowls, and the neck can be lifted to reestablish their youthful relationship with the underlying skeleton.


Assuntos
Ritidoplastia , Testa/cirurgia , Humanos , Pescoço , Rejuvenescimento , Zigoma
7.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32784224

RESUMO

BACKGROUND AND OBJECTIVES: Metopic craniosynostosis can be treated by fronto-orbital advancement or endoscopic strip craniectomy with postoperative helmeting. Infants younger than 6 months of age are eligible for the endoscopic repair. One-year postoperative anthropometric outcomes have been shown to be equivalent, with significantly less morbidity after endoscopic treatment. The authors hypothesized that both repairs would yield equivalent anthropometric outcomes at 5-years postoperative. METHODS: This study was a retrospective chart review of 31 consecutive nonsyndromic patients with isolated metopic craniosynostosis treated with either endoscopic or open correction. The primary anthropometric outcomes were frontal width, interfrontal divergence angle, the Whitaker classification, and the presence of lateral frontal retrusion. Peri-operative variables included estimated blood loss, rates of blood transfusion, length of stay, and operating time. RESULTS: There was a significantly lower rate of lateral frontal retrusion in the endoscopic group. No statistically significant differences were found in the other 3 anthropometric outcomes at 5-years postoperative. The endoscopic group was younger at the time of surgery and had improved peri-operative outcomes related to operating time, hospital stay and blood loss. Both groups had low complication and reoperation rates. CONCLUSIONS: In our cohort of school-aged children with isolated metopic craniosynostosis, patients who underwent endoscopic repair had superior or equivalent outcomes on all 4 primary anthropometric measures compared with those who underwent open repair. Endoscopic repair was associated with significantly faster recovery and decreased morbidity. Endoscopic repair should be considered in patients diagnosed with metopic craniosynostosis before 6 months of age.


Assuntos
Craniossinostoses/cirurgia , Pré-Escolar , Craniossinostoses/diagnóstico por imagem , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Feminino , Testa/anatomia & histologia , Humanos , Lactente , Masculino , Duração da Cirurgia , Órbita/diagnóstico por imagem , Órbita/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
8.
Ann R Coll Surg Engl ; 102(8): e219-e222, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32808811

RESUMO

Rhinophyma is a skin condition that affects the nose. It is often characterised by a large, red, bulbous nose. It can have a physical, psychological and social impact on the patient. Management options include conservative medical therapy such as retinoids or surgical excision followed by reconstruction as required. The reconstruction options can range from a dermal substitute full-thickness skin graft to local flaps, depending on the wound bed. We present a severe case of rhinophyma that required a complex reconstruction with a three-stage forehead flap because of the mass effect and the wound that resulted from the surgical excision of an extremely large and troublesome rhinophyma.


Assuntos
Testa/cirurgia , Rinofima , Transplante de Pele/métodos , Retalhos Cirúrgicos/cirurgia , Idoso , Humanos , Masculino , Rinofima/patologia , Rinofima/cirurgia
11.
Medicine (Baltimore) ; 99(27): e20726, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629647

RESUMO

INTRODUCTION: Scleromyxedema (rare cutaneous mucinosis), is characterized by the formation of lichenoid papules and presence of Serum monoclonal IgG in most cases, or all; after repeated testing. PATIENT CONCERNS: The patient is a 51-year-old male presented with thick, disfiguring elephant-like erythematous skin folds over the forehead, papular shiny eruptions over ears and trunk and waxy erythematous papules over arms and hands without dysphagia or respiratory or neurologic symptoms DIAGNOSIS: : Skin biopsy from right arm was consistent with scleromyxedema. Serum cryoglobulin was reported negative. Complete blood count and routine blood biochemistry were normal. Thyroid function tests were normal. Serum protein electrophoresis and immunofixation showed monoclonal band of 14.5 g/L typed as IgG lambda. INTERVENTIONS: Our patient was refractory to lenalidomide however improved clinically on immunoglobulins infusions on monthly basis without change in the MGUS level. OUTCOMES: NGF analysis revealed approximately 0.25% Lambda monotypic plasma cells in the bone marrow expressing CD38, CD138, and CD27 with aberrant expression of CD56 and were negative for CD45, CD19, CD117, and CD81. We also detected 0.002% circulating plasma cells (PCs) in peripheral blood. CONCLUSION: The immunophenotype of circulating tumor cells (CTCs) remain close to the malignant PCs phenotype in the BM. Hence, we report NGF approach as a novel diagnostic tool for highly sensitive MRD detection in plasma cell dyscrasias including scleromyxedema.


Assuntos
Citometria de Fluxo/métodos , Células Neoplásicas Circulantes/patologia , Escleromixedema/patologia , Orelha Externa/patologia , Testa/patologia , Humanos , Imunoglobulina G/sangue , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paraproteinemias/imunologia , Paraproteinemias/patologia , Escleromixedema/terapia , Pele/patologia
13.
Hautarzt ; 71(10): 802-804, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32533203

RESUMO

We present a rare case of a 4-year-old girl suffering from a sclerotic lesion on the forehead as well as uveitis and epileptic seizures. The patient was diagnosed with linear scleroderma "en coup de sabre" (LSECDS). Faced with no gold standard for treatment of LSECDS with severe extracutaneous manifestations, the case was intensively discussed within an interdisciplinary team setting and successfully treated.


Assuntos
Esclerodermia Localizada/diagnóstico , Dermatopatias/complicações , Pré-Escolar , Eletroencefalografia , Feminino , Testa , Humanos , Esclerodermia Localizada/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do Tratamento
14.
J Plast Reconstr Aesthet Surg ; 73(9): 1692-1699, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32536462

RESUMO

BACKGROUND AND PURPOSES: Multi-staged forehead flaps are a well-recognised reconstructive workhorse for subtotal and total nasal defects. It carries the disadvantage of repeated trips to theatre for revisional surgery, which is not suited to all patient cohorts. The single-stage islanded forehead flap eliminates this need. We detail our indications and outcomes of using this flap to highlight the maintained versatility of the technique without significant compromise on reconstructive and patient outcome. SUBJECTS STUDIED AND METHODS: A prospective surgical database was collated where patients were categorised as partial or total reconstruction. We detail surgical technique and review of rationale of patient selection. Patient demographics, perioperative data and follow-up course were recorded. MAIN FINDINGS: A total of 22 patients were recorded from both the U.K. and Ethiopia via working with the charity Facing Africa. Defects occurred from a mixture of trauma, Noma and cancer resections. Thirteen were total nasal reconstructions and nine partial. The mean follow-up period was 2.25 years. We experienced two major complications which required minor revision in the theatre and two minor complications, all resolved satisfactorily. CONCLUSIONS: We demonstrate good outcomes and safety of the procedure in this first report of a varied cohort of nasal reconstructions in a heterogenous cohort of patients. We advocate the use of this flap in the multi-morbid patient where recovery can be expedited or those who have limitations from economical restraints.


Assuntos
Testa/cirurgia , Rinoplastia/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Leishmaniose Cutânea/cirurgia , Masculino , Pessoa de Meia-Idade , Nariz/lesões , Nariz/cirurgia , Neoplasias Nasais/cirurgia , Complicações Pós-Operatórias , Adulto Jovem
15.
Facial Plast Surg ; 36(3): 297-304, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32557436

RESUMO

Restoration of the inner nasal lining is an essential factor in successful nasal reconstruction. Among various methods, free full-thickness skin grafting represents a readily available and feasible technique. A prerequisite for success is a secure and immobile fixation to the undersurface of the nourishing forehead flap. This retrospective study aims to evaluate the results of multiple quilting sutures to secure free full-thickness skin grafts for the reconstruction of the inner nasal lining in partial and extended nasal reconstruction. Between February 1, 2015, and December 31 2018, 16 patients underwent three-stage nasal reconstruction of all three layers using a forehead flap. All full-thickness free flaps were harvested from either the neck or inguinal area and fixated to the undersurface of the distal part of the forehead flap by multiple quilting sutures. All but one free skin grafts healed well (seven ♀; mean: 63 years; range: 52-81). Four patients developed minor complications that resolved completely through conservative treatment. One patient with a history of stroke, extensive nicotine abuse, and arterial hypertension developed flap necrosis that required two surgical revisions and ended up with a stenosis of the left nostril. The follow-up time averaged 18.4 months (range: 3-55 months). Multiple quilting sutures are an effective and feasible option to fixate full-thickness free skin grafts on the undersurface of the forehead flap for the reconstruction of the inner nasal lining. They are not associated with increased risks for necrosis and can be applied even to extended full-thickness nasal defects in selected cases.


Assuntos
Neoplasias Nasais/cirurgia , Rinoplastia , Testa/cirurgia , Humanos , Estudos Retrospectivos , Transplante de Pele , Suturas
16.
Acta Chir Plast ; 61(1-4): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32380839

RESUMO

Basal cell carcinoma (BCC) is the most prevalent malignancy, with rising incidence worldwide. Despite its naturally slow growth and initially low metastatic potential, it can cause significant morbidity and mortality when unrecognized, inadequately treated or poorly followed up. Authors present the case of a 61-year-old male with a 7-year history of multiple incomplete excisions of a “simple” BCC on the forehead. A CT scan of the head revealed an invasive mass (5.2 cm laterolateral x 4.0 cm craniocaudal) in the frontal area. There was no evidence of metastasis. Complete resection of the lesion and reconstruction was achieved in three stages. Final reconstruction was achieved using a left frontal fasciocutaneous flap. The secondary defect was closed with an advancement flap of the scalp and donor sites were covered using a split-thickness skin graft from the upper limb. This case demonstrates the necessity for vigilance in the approach to, diagnosis, treatment and follow-up of these skin neoplasms. The development of giant BCCs should be avoided at all costs. Increased size of BCCs corresponds with increased recurrence rate, metastatic rate, morbidity, mortality, treatment difficulties and overall costs.


Assuntos
Carcinoma Basocelular/prevenção & controle , Neoplasias Faciais/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/cirurgia , Neoplasias Faciais/diagnóstico por imagem , Neoplasias Faciais/cirurgia , Testa , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X
17.
Acta Chir Plast ; 61(1-4): 32-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32380841

RESUMO

Third degree burn trauma of the head and neck requires an interdisciplinary approach. After emergency care and hemodynamic stabilization of the patient the focus lies on the reconstruction of the damaged tissue. The options of reconstruction are influenced by the general condition of the patient and by the condition of the surrounding tissues. The deep defects of the head are dangerous for a high risk of wound infection and possible fatal complications. In particular cases the first methods of choice for closure of the defect may be ineffective and a free flap transfer should be considered. We present a case report of a 62-year-old woman who suffered third degree burn trauma of the head and neck leading to a deep defect of the forehead reaching behind the hairline. On the bottom there was an exposed bone with no healing tendency. Due to surrounding fragile scarred tissue we chose a free flap transfer using serratus anterior muscle as a method of closure. The flap was fully healed and provided good aesthetic and functional outcome.


Assuntos
Queimaduras/cirurgia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Lesões do Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Queimaduras/complicações , Traumatismos Faciais/etiologia , Feminino , Testa/lesões , Testa/cirurgia , Humanos , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Resultado do Tratamento
18.
Sensors (Basel) ; 20(10)2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32438729

RESUMO

Many types of thermometers have been developed to measure body temperature. Infrared thermometers (IRT) are fast, convenient and ease to use. Two types of infrared thermometers are uses to measure body temperature: tympanic and forehead. With the spread of COVID-19 coronavirus, forehead temperature measurement is used widely to screen people for the illness. The performance of this type of device and the criteria for screening are worth studying. This study evaluated the performance of two types of tympanic infrared thermometers and an industrial infrared thermometer. The results showed that these infrared thermometers provide good precision. A fixed offset between tympanic and forehead temperature were found. The measurement values for wrist temperature show significant offsets with the tympanic temperature and cannot be used to screen fevers. The standard operating procedure (SOP) for the measurement of body temperature using an infrared thermometer was proposed. The suggestion threshold for the forehead temperature is 36 °C for screening of fever. The body temperature of a person who is possibly ill is then measured using a tympanic infrared thermometer for the purpose of a double check.


Assuntos
Temperatura Corporal/fisiologia , Infecções por Coronavirus/diagnóstico , Febre/diagnóstico , Pneumonia Viral/diagnóstico , Termômetros , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Febre/fisiopatologia , Febre/virologia , Testa/fisiopatologia , Humanos , Raios Infravermelhos , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia
19.
Plast Reconstr Surg ; 145(5): 1155-1162, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332530

RESUMO

BACKGROUND: Cosmetic treatment of the forehead using neuromodulators is challenging. To avoid adverse events, the underlying anatomy has to be understood and thoughtfully targeted. Clinical observations indicate that eyebrow ptosis can be avoided if neuromodulators are injected in the upper forehead, despite the frontalis muscle being the primary elevator. METHODS: Twenty-seven healthy volunteers (11 men and 16 women) with a mean age of 37.5 ± 13.7 years (range, 22 to 73 years) and of diverse ethnicity (14 Caucasians, four African Americans, three Asians, and six of Middle Eastern descent) were enrolled. Skin displacement vector analyses were conducted on maximal frontalis muscle contraction to calculate magnitude and direction of forehead skin movement. RESULTS: In 100 percent of investigated volunteers, a bidirectional movement of the forehead skin was observed: the skin of the lower forehead moved cranially, whereas the skin of the upper forehead moved caudally. Both movements converged at a horizontal forehead line termed the line of convergence, or C-line. The position of the C-line relative to the total height of the forehead was 60.9 ± 10.2 percent in men and 60.6 ± 9.6 percent in women (p = 0.941). Independent of sex, the C-line was located at the second horizontal forehead line when counting from superior to inferior (men, n = 2; women, n = 2). No difference across ethnicities was detected. CONCLUSIONS: The identification of the C-line may potentially guide practitioners toward more predictable outcomes for forehead neuromodulator injections. Injections above the C-line could mitigate the risk of neuromodulator-induced brow ptosis.


Assuntos
Blefaroptose/prevenção & controle , Técnicas Cosméticas/efeitos adversos , Músculos Faciais/anatomia & histologia , Fármacos Neuromusculares/efeitos adversos , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Idoso , Blefaroptose/etiologia , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversos , Músculos Faciais/efeitos dos fármacos , Músculos Faciais/inervação , Feminino , Testa , Voluntários Saudáveis , Humanos , Injeções Intramusculares/efeitos adversos , Injeções Intramusculares/métodos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Adulto Jovem
20.
Indian J Dent Res ; 31(1): 153-156, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32246700

RESUMO

Reconstruction of critical-sized defects of composite facial units is a challenging one. This is amplified when facial hair-bearing areas are included. A case of reconstruction of multiple midfacial defects is presented. Initially, defective jaws were addressed. Later, appropriate modification of existing extended paramedical forehead flap to sequentially reconstruct defective lip, moustache, and parts of alae are described. The flap design was such that hair-bearing areas were used to reconstruct moustache while the nasal alar defect was reconstructed using the non-hair-beating forehead skin. Finally, dental implants were also placed. The technique was reliable, giving minimal donor site deformity but with maximum result. However, it is a multi-stage procedure. The paper also describes the challenges of midfacial unit reconstruction as handled in this case.


Assuntos
Testa , Nariz , Face , Cabelo , Retalhos Cirúrgicos
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