The neurotised estlander flap for lip reconstruction.
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ABSTRACT:
SUBMITTER: Correia Duarte M
PROVIDER: S-EPMC7735956 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The lips are highly visible structures on the face, providing oral competence and expressing emotion. The reconstruction of large full-thickness defects of the lips is a formidable challenge for the plastic surgeon. The most challenging defect of the lower lip is full thickness, larger than two thirds. Such an extensive defect requires either staged reconstruction or a flap of distant tissue. We consider that the gracilis muscle, due to its anatomic and functional features, is the ideal flap for reconstruction of the lips. A functioning gracilis matches all the requisites and allows normal movements that are uniform to all of the lip. The new commissure is symmetric and moves simultaneously with the residual commissure due to innervation by the facial nerve. Our indications to use the functioning gracilis muscle flap in lip reconstruction are as follows: resection of the lower lip larger than one quarter of the lip length in a patient younger than 60 years; resection larger than one third of the lip in all patients. When performing a free gracilis flap for lip reconstruction, we consider that, if possible, a facial artery musculomucosal flap and sensitive neurotization should be included to restore sensation of the reconstructed lip.
| S-EPMC3324240 | biostudies-other
Project description:The blood supply pattern of the partial-thickness musculomucosal pedicle flaps is different from the traditional Abbe flap. The arterial blood supply and venous drainage are highly reliable during clinical practice.To describe the reconstruction of the philtrum in the cross-lip flap transfer using nasolabial muscle tension line group reconstruction.From January 1, 2014, through June 31, 2015, a total of 6 patients with upper lip defect were treated with philtrum reconstruction in the same stage of the split cross-lip flap transfer at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. These patients underwent reconstruction of the philtrum by nasolabial muscle tension line group reconstruction. The patients were compared with a randomly chosen group of 5 individuals without upper lip defects by measuring the 3-dimensional scans.In the patient group, the split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided. Then the partial-thickness flap was rotated 180° horizontally and inverted 180° upward to the upper lip defect. The philtrum was reconstructed using the nasolabial muscle tension line group reconstruction.Three-dimensional scans were performed from the 2-month to 28-month revisits.A total of 11 individuals were included in the study: 6 in the patient group (mean [SD] age, 17.0 [4.8] years; 2 [33.3%] female and 4 [66.7%] male) and 5 in the control group (mean [SD] age, 15.2 [6.0] years; 2 [40.0%] female and 3 [60.0%] male). In the patient group, 5 of 6 musculomucosal pedicle flaps were viable. A stable philtrum with philtral ridge and philtral dimple was reconstructed on the 5 flaps. The shape of the philtrum was natural according to the 3-dimensional scan measurement. One flap partially necrosed, and the scar retraction was severe postoperatively.The blood supply of the partial-thickness cross-lip flap was from the small vascular network of the lower lip. It is reliable to reconstruct a philtrum in this stage of flap transfer. A complete philtrum structure can be reconstructed by applying muscle tension on the flap.4.
| S-EPMC5815113 | biostudies-literature
Project description:BackgroundRadial free forearm flaps is indicated patients with total or near-total defects in their lower lip. The purpose of our study was to evaluate a simple and effective barrel-shaped design of the radial free forearm flap for lower lip reconstruction and to compare its clinical outcomes with those of a conventional rectangular shaped free forearm flap.MethodsTwenty-two patients with a lower lip carcinoma who underwent radial forearm free flap reconstructive surgery were enrolled in this study between January 1, 2012, and December 31, 2017. A barrel-shaped design of radial forearm free flap for reconstruction was used in 8 patients (case group), and a rectangular design was used in 14 patients (control group). The patients' quality of life was evaluated preoperatively and postoperatively in all the patients using the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-HN35) questionnaire. We analyzed the differences in the EORTC QLQ-HN35 scores pre- and postoperatively between the case and control group.ResultsThe patients in the case group had better outcomes in swallowing, speech, social eating, social contact, and dry mouth than the control group at 1-year follow-up (P?<?0.05).ConclusionsThe use of a barrel-shaped design free forearm flap for lower lip reconstruction is an effective procedure and can achieve better results than the use of rectangular free forearm flap.
| S-EPMC7291574 | biostudies-literature
Project description:BackgroundTo improve the rotation of Cupid's bow and achieve sufficient vertical lip height, several variations of the Millard rotation-advancement have incorporated a small laterally based triangular flap above the cutaneous roll. This study uses three-dimensional photogrammetry to evaluate the outcomes of unilateral cleft lip repairs performed with and without pennant flaps.MethodsThree-dimensional photographs were analyzed to assess postoperative lip height asymmetry in 90 unilateral cleft lip patients (58 complete and 32 incomplete) treated between 2001 and 2012. Cleft lip repairs were performed by three pediatric cleft surgeons using different techniques. Thirty-nine of 90 procedures (43 percent) used an inferiorly placed triangular flap. All patients were photographed at least 9 months postoperatively (mean, 4.2 years). Lip height asymmetry was based on the vertical distances from the subnasale to the peaks of Cupid's bow.ResultsRegression analysis revealed that the use of a pennant flap was a significant predictor of postoperative lip height asymmetry (β = 4.2 percent, p = 0.015). The surgeon performing the repair was also a significant factor in patients with complete cleft lips (β = 3.6 percent, p = 0.005). All three surgeons achieved greater lip height symmetry when a pennant flap was performed.ConclusionsThe results of unilateral cleft lip repairs are affected by both the surgeon and the surgical technique. Procedures that used a pennant flap showed better philtral height symmetry than nonpennant repairs.Clinical question/level of evidenceTherapeutic, III.
| S-EPMC4708256 | biostudies-literature
Project description: Not available
| S-EPMC5053009 | biostudies-literature
Project description:Summary: Fingertip amputations represent an important spectrum of injuries, and most are avulsions or crush trauma. There is no consensus about one single standard treatment, and a wide number of techniques are available. The authors present the P3 flap as an option for covering fingertip defects with bone exposure, avoiding painful scars in the pulp area, without a donor site. This study included 12 fingertips with amputated segment not available for replantation. Volar oblique fingertip defects and transverse amputations with bone exposure, not more proximal than Hirase Zone IIB, were included. Defects were less than 2 cm. The patients were followed up for an average of 6 months. The aesthetic and functional outcomes and fingertip discrimination recovery were evaluated at 6 months by the static two-point discrimination (2-PD) test and DASH score (quick version). The average postoperative 2-PD test at 6 months was 5.9 mm (range from 5 to 8 mm). The mean healing time of the fingertip was 4 weeks. Nail deformity was reported in three cases with level IIB of amputation. None of the P3 flaps failed, and local infection was not reported. The average DASH score at 6 months was 1.1. The mean time to return to work was 38 days (range from 30 to 53). The P3 flap proposed in this study demonstrates a reliable single-stage technique, performed under local anesthesia, for fingertip defect reconstruction, avoiding skin incision and scars in the pulp region and preserving digital length and nail bed.
| S-EPMC10287140 | biostudies-literature
Project description:BackgroundIn earlobe reconstruction, it is a challenging task to find a simple one-stage technique that is applicable to the variable configurations of defects and that results in a longstanding naturally appearing earlobe.MethodsIn this article, we present a perforator-based flap design for earlobe reconstruction with preoperative perforator detection by pencil doppler to ensure the maximum vascularity of the used flap. Thirty cases of earlobe reconstruction were performed in the Department of Plastic and Reconstructive Surgery at Tanta University in the period from July 2015 to July 2019 using the technique described in this article.ResultsNone of our cases developed necrosis of the flaps. The mean result for the aesthetic evaluation of our cases was 4.7 and the mean patient satisfaction was 4.8 where the maximum score was 5.Conclusionfreestyle perforator flap with preoperative doppler perforator detection is a safe and reliable method of earlobe reconstruction.
| S-EPMC9673429 | biostudies-literature
Project description:This article reviewed our experience of Chinese nasal reconstruction over 12 years and evaluated the effect of expanded forehead flap both aesthetically and functionally. The special skin type and other anatomic features of Chinese patients was understood thoroughly during the treatment. This article thus catered for the need of multiracial nasal reconstruction. We analyzed existing clinical data and demonstrated a typical case in detail. The postoperative result supported our strategy which advocated the extensive application of expanded forehead flap, together with flip scar flap as the internal lining. The features of Chinese patients also prompted the use of costal and auricular cartilage. Emerging technology like 3D-printing would benefit nasal reconstruction from more aspects.
| S-EPMC10071462 | biostudies-literature
Project description:ImportanceParamedian forehead flaps are commonly used to reconstruct facial defects caused by skin cancers. Data are lacking on the complications from this procedure, postoperative outcomes, and association of cancer diagnosis with rate of deep venous thrombosis (DVT).ObjectivesThe primary objective was to determine complication rates after paramedian forehead flap reconstruction for defects resulting from resection of facial cancers; and the secondary objective was to determine patient factors and complications that are associated with readmission.Design, setting, and participantsRetrospective cohort study of patients who underwent paramedian forehead flap reconstruction for skin cancer reconstruction from January 1, 2007, through December 31, 2013. Data analysis took place between October 1, 2017, and June 1, 2018.Main outcomes and measuresComplication rates including DVT, emergency department visits, and hospital readmissions.ResultsA total of 2175 patient were included in this study; mean (SD) age, 70.3 (13.4) years; 1153 (53.5%) were men. Postoperative DVT occurred in 10 or fewer patients (≤0.5%); postoperative bleeding in 30 (1.4%), and postoperative infection in 63 (2.9%). Most patients went home on the day of surgery (89.6%; n = 1949), while 10.4% stayed one or more days in the hospital (n = 226). Overnight admission was associated with tobacco use (odds ratio [OR], 1.65; 95% CI, 1.11-2.44), hypothyroidism (OR, 1.93; 95% CI, 1.10-3.39), hypertension (OR, 1.82; 95% CI, 1.29-2.57), ear cartilage graft (OR, 2.20; 95% CI, 1.51-3.21), and adjacent tissue transfer (OR, 1.88; 95% CI, 1.33-2.67). Risk factors strongly associated with immediate return to the emergency department or readmission within 48 hours of surgery included postoperative bleeding (OR, 13.05; 95% CI, 4.24-40.16), neurologic disorder (OR, 4.11; 95% CI, 1.12-15.09), and alcohol use (OR, 7.70; 95% CI, 1.55-38.21).Conclusions and relevanceIn this study, the most common complication of paramedian forehead flap reconstruction was infection. Risk factors for readmission included development of postoperative bleeding, having a neurologic disorder, and alcohol use. Deep venous thrombosis was a rare complication. Because bleeding is a more common complication in this patient population, discretion should be used when deciding to administer anticoagulation medication to low- to medium-risk patients prior to surgery.Level of evidenceNA.
| S-EPMC6583852 | biostudies-literature
Project description:Introduction Flap reconstructions of upper extremity defects are challenging procedures. It is important to understand the surgical outcomes of upper extremity flap reconstruction, as well as associations between preoperative/perioperative variables and complications. Materials and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for patients from 2005 to 2016 who underwent flap reconstruction of an upper extremity defect. Patient and perioperative variables were collected for identified patients and assessed for associations with rates of any complication and major complications. Results On multivariate analysis, American Society of Anesthesiologists (ASA) classification >2, bleeding disorder, preoperative steroid use, free flap reconstruction, wound classification other than clean, and nonplastic surgeon specialty were independently associated with any complications. Bleeding disorder, ASA classification >2, male gender, wound classification other than clean, and preoperative anemia were independently associated with major complications. Free flap reconstruction was associated with increased length of stay, operative time, any complications, transfusions, and unplanned reoperations. Conclusion There is an association between complications in patients undergoing upper extremity free flap reconstruction and ASA classification >2, preoperative anemia, preoperative steroid use, bleeding disorders, and contaminated wounds. Male patients may require more thorough counseling in activity restriction following reconstruction. Free flaps for upper extremity reconstruction will require increased planning to reduce the chance of complications.
| S-EPMC8041497 | biostudies-literature