In our experience, osteocutaneous flaps (especially the OCRFFF) are preferred for complete autologous reconstruction of high and middle ACF defects. Low skull base defects are more difficult to reconstruct, and consideration of free muscle flaps (no bone) should be weighed as an option in this anatomic area.

Abstract. Consider a compact Riemannian manifold with boundary. If all maximally extended geodesics intersect the boundary at both ends, then to each geodesic γ(t) we can form the triple (γ(0),γ(T ), T ), consisting of the initial and final vectors of the segment as well as the length between them. The collection of all such triples comprises the lens data. In this paper, it is shown that in the category of analytic Riemannian manifolds, the lens data uniquely determine the metric up to isometry. There are no convexity assumptions on the boundary, and conjugate points are allowed, but with some restriction.

The deep pyriform space is a midface cavity cradled by the pyriform aperture and deep medial cheek compartment. Bony recession of the maxilla with age predisposes this space for use as a potential area of deep volumization to support overlying cheek fat and draping lip elevators. The position of the angular artery in the roof of the space allows safe injection on the bone without concern for vascular injury.

Objectives: Microvascular reconstruction of composite scalp and skull defects requires careful planning of both cranial bone and soft-tissue coverage. The current body of literature has yet to identify a “best practice” approach to achieve these goals. Methods: A retrospective chart review was performed. Patients with composite defects who underwent combined microvascular surgery of the scalp and skull were included over a 6-year period. Reconstructions were classified by: microvascular flap, cranioplasty, timing of cranioplasty (primary or delayed), and exposure to radiation. Results: Forty-five microvascular flaps were performed for 36 patients. Fasciocutaneous flaps were more likely to experience complications than other microvascular flaps (50.0% versus 8.6%, P = 0.008). Forty of the 50 patients (80%) underwent cranioplasty, including 19 autogenous and 21 alloplastic reconstructions. There were 8 total complications: partial flap loss with implant exposure (n = 5), cranioplasty infection (n = 2), and wound dehiscence (n = 1). Alloplastic implants experienced more frequent complications than autologous reconstructions (33.3% versus 5.3%, P = 0.046). Titanium implants demonstrated the higher rates of complications than other groups (P = 0.014). Titanium implants also had more complications relative to poly-ether-ether-ketone implants (60.0% versus 9.1%, P = 0.024). Immediate alloplastic cranioplasty was associated with a significant increase in complications relative to autogenous reconstruction (54.5% versus 5.5%, P = 0.027), and no significant difference in the delayed group (10% versus 0%, P = 0.740). Conclusion: According to authors’ knowledge, myofascial flaps yield the lowest complication rate and when possible, autologous cranioplasty is preferred. When defects are too large to accommodate autogenous bone, the authors prefer delayed prefabricated poly-ether-ether-ketone implant reconstruction.

Background There are now over 2.2 million mobile applications (apps) in existence, with more than 250 identifiable by searching “plastic surgery.” Unfortunately, only 30% of these are academically relevant, which makes finding useful plastic surgery apps both challenging and inefficient. Objectives The authors sought to evaluate the use of digital resources and awareness of available apps within plastic surgery to improve their clinical/educational utilization. Methods An extensive search of the Apple and Android databases was performed to identify all relevant plastic surgery apps. An American Society of Plastic Surgeons-sponsored survey was distributed to a random cohort of American Society of Plastic Surgeons members (practicing surgeons, fellows, and residents) and students applying to an integrated plastic surgery residency. The survey queried utilization of resources to access medical information and awareness of apps relevant to clinical/educational plastic surgery. Results A total 153 relevant applications were identified between the Apple iTunes and Google Play stores. Of the 577 respondents (273 practicing surgeons, 117 residents, 11 fellows, and 177 medical students), 99.31% own a smartphone/tablet. Furthermore, medical students and residents/fellows utilized both smartphones and computers more frequently than practicing physicians (P < 0.0001 and P = 0.0022, respectively). Digital resources were also utilized more frequently than printed material (P < 0.00001). For app awareness, 82.1% of respondents reported knowing of fewer than 10 apps relevant to plastic surgery, and only 8.41% were aware of more than 20. Conclusions Smartphone usage is nearly ubiquitous among plastic surgeons, and most utilize these devices daily to access medical information. However, awareness of the many available and relevant plastic surgery apps is extremely limited.