Internal Fixation Method Using EZ-Tcon for Transconjunctival Fat Repositioning: Clinical Outcomes and Efficacy.

BACKGROUND: Transconjunctival fat repositioning is the gold standard for the correction of tear trough deformity. For fixation of fat pedicle, the internal fixation (IF) and externalized percutaneous suture (EPS) techniques are used, which have their own advantages and disadvantages. The present study aimed to introduce a new IF technique using a devised needle (EZ-Tcon) and to compare its outcomes with those of the conventional EPS technique. METHODS: Patients with primary tear trough deformity who underwent transconjunctival fat repositioning were reviewed and categorized into two cohorts according to the fixation technique: cohort 1 consisted of patients treated using the conventional EPS technique and cohort 2 consisted of those in whom the new IF technique using EZ-Tcon was adopted. Post-operative complications and aesthetic outcomes were assessed using a four-scale grading system. RESULTS: A total of 545 patients, 211 from cohort 1 and 344 from cohort 2 were evaluated with a median follow-up of 70 days. Compared to cohort 1, cohort 2 showed significantly lower rates of long-standing conspicuous scars on lower eyelid, re-operation and overall complications. In the analysis of aesthetic outcomes, 88.9 percent of cohort 2 showed grade 0 (no deformity) or I (mild deformity) post-operatively. The rate of excellent outcomes (improvements of ≥ two grades) was significantly higher in cohort 2 than in cohort 1 (p-value < 0.001). CONCLUSION: Our technique using EZ-Tcon could possess advantages of the conventional IF and EPS techniques, showing lower complication rates and aesthetically satisfactory outcomes, and could be a safe and reliable method of transconjunctival fat repositioning. 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 .

The influence of pedicle length on the viability of twisted perforator flaps in rats.

The pedicled perforator flap is now regarded as a valuable tool in the reconstructive armamentarium, but variable degrees of perforator twisting upon flap transposition are frequently encountered intraoperatively. The aim of this study was to investigate the effect of pedicle length on twisted perforator flap viability. Forty Sprague-Dawley rats were randomly divided into four groups of 10 animals each: group I (short pedicle, no rotation), group II (short pedicle, 720 degrees rotation), group III (long pedicle, no rotation), and group IV (long pedicle, 720 degrees rotation), and cranial epigastric artery perforator flaps were elevated. Mean group flap survival ratios were 88.47 +/- 13.87% (group I), 60.23 +/- 28.95% (group II), 87.06 +/- 13.85% (group III), and 84.28 +/- 31.76% (group IV). Viable flap ratios in group II were significantly lower than in groups I, III, and IV, respectively (p < 0.05). Our findings suggest that when perforator twisting is unavoidable, longer pedicles are significantly more likely to result in secure flap survival.

New Internal Fixation Technique for Transconjunctival Fat Repositioning.

To treat tear trough deformities in young patients, transconjunctival orbital fat repositioning has been widely used. Although internal fixation of transposed fat enables more secure and stable fixation than the externalized percutaneous suture method, the latter is used more commonly because of the narrow operation field and consequent technical difficulty of the internal fixation method. We describe a novel technique using a newly devised needle (Chang's needle) that facilitates internal fixation of transposed fat pedicles.

Cavernous vascular tumor of the accessory parotid gland.

Accessory parotid gland tumors are uncommon and account for only 1% to 7.7% of all parotid gland tumors. Only one case report of hemangioma of the accessory parotid gland in infancy has been issued, and no report is available on this condition in an adult. We present the case of a 44-year-old woman with an accessory parotid gland tumor, which was finally diagnosed as a cavernous hemangioma histopathologically.