Background: Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. Methods: The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty. Results: The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided. Conclusion: Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.

Neo-adjuvant chemotherapy (NAC) refers to systemic therapy for breast cancer (BC) prior to definitive surgical treatment and is proved safe and effective. The purpose of administering NAC is to downstage the tumor, allowing for less extensive surgery and improved cosmetic outcomes. [1][2][3][4] While originally intended for patients with locally advanced BC, for whom even a mastectomy may not be feasible, NAC is now frequently administered to patients with operable BC, in attempt to improve cosmetic outcomes or to limit the extent of axillary lymph node removal. 5 Surgical management of BC has evolved considerably over the past decades with a major shift occurring from mastectomies to breast-conserving therapy. Both surgeons and patients share concerns that NAC may increase the risk for infection after immediate breast reconstruction (IBR) due to its effect on the immune system and the relatively short duration between chemotherapy and surgery. While breast reconstruction plays an increasingly significant role in the treatment of BC, little has been written about the effect of NAC on postoperative complications after reconstruction. We identified 120 patients (154 breasts) who underwent surgery for BC with IBR between the years 2013-2016 at Kaplan Medical Center. The cohort was divided into patients who received NAC (n = 36) and those who did not (n = 84). All analyses were performed with the patient being the analytical unit. Data collected retrospectively from hospital records included: demographics, comorbidities, disease characteristics, neo-adjuvant treatment, indication for mastectomy, and immediate postoperative complications (30 days). 6The mean follow-up time was 19 months (2-44 months). Standard NAC at our institution is indicated for large tumors, lymph node involvement, and in cases where the tumor to breast size ratio might dictate a large excision with a poor aesthetic result. It consists of four cycles of adriamycin (60 mg/m²) and cyclophosphamide (600 mg/m²) given every other week followed by 12 cycles of weekly paclitaxel (80 mg/m²). Time to surgery after completion of NAC is not specified by protocol. For patients undergoing NAC, the mean interval from the last treatment until surgery was 37.2 days (SD ± 15.6, 21.6-52.8). Mastectomy was further classified into nipple sparing mastectomy (NSM) or skin sparing mastectomy (SSM). Reconstruction after mastectomy was implant based, tissue expander, or free flap. Patients who had a lumpectomy and oncoplastic reconstruction were also included. The primary outcome of interest was whether any complication occurred.We used SPSS software to analyze the data. The statistical significance was set in advance to be (P < 0.05). Univariate analyses and multivariate logistic regression model were used to analyze the data. First, we examined risk factors (diabetes, smoking, prior breast irradiation) for complication rates among our total study population and found that smoking was a significant predictor of any complication (P = 0.02). Next, we examined the surgical...

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Background: Metopic craniosynostosis is traditionally repaired with fronto-orbital advancement (FOA) or, alternatively, limited short scar strip craniectomy (LSSSC) followed by helmet therapy. There is controversy among surgeons regarding resultant head shape outcomes between the 2 methods. This study aims to assess how surgeons perceive the postoperative aesthetic results of the 2 metopic craniosynostosis repair methods. Methods: A retrospective analysis was performed on 13 (n ¼ 6 LSSSC; n ¼ 7 FOA) patients who presented for surgical correction of isolated metopic craniosynostosis via either LSSSC (followed by helmet therapy) or FOA. Clinical photographs at 1 year postop were shown to 10 craniofacial surgeons who rated the aesthetic outcomes on a Likert scale of 1 (poor) to 5 (excellent) and guessed which surgical method was performed. Results: Mean age at the time of the procedure was younger in LSSSC than FOA (3.1 AE 1.0 versus 17.5 AE 8.5 months; P < 0.001). Mean blood loss was significantly lower with LSSSC versus FOA (202.0 AE 361.2 versus 371.43 AE 122.9 mL; P < 0.001), as was mean blood transfusion requirement (92.5 AE 49.9 versus 151.3 AE 51.2 mL; P < 0.001) and mean duration of the operation (3:06 AE 0:24 versus 7:53 AE 0:31 hours; P < 0.001). Mean surgeon scores of aesthetic outcomes were similar between groups: LSSSC, 3.27 AE 1.09; FOA, 3.51 AE 0.95 (P ¼ 0.171). When asked to identify which procedure patients had received, only 63.8% of responses were correct. Conclusions: Limited short scar strip craniectomy offers an important alternative to traditional open FOA and should be considered as an option for children diagnosed with metopic craniosynostosis.

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The Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were required to position the medial arm fasciocutaneous flap over the nasal construct. The arm was immobilized for 3 weeks to allow for vascularization of the recipient bed. The child successfully tolerated the splint. She has improved breathing and nasal contour.

Summary: Ear protrusion is the primary indication for otoplasty. Many methods have been developed for addressing this defect, based on cartilage-scoring and excision and suture-fixation techniques. Disadvantages include irreversible distortion of the anatomy, irregularities, or overcorrection, or forward bulging of the conchal bowl. One of the most common long-term sequelae of otoplasty is an unsatisfactory result. A novel, cartilage-sparing, suture-based technique has been developed that aims to minimize the risk of complications and provide a natural-appearing aesthetic result. The method is based on two to three key sutures that shape the concha into the desired natural appearance while preventing a conchal bulge, which otherwise could appear if no cartilage is removed. Furthermore, these sutures support the neo-antihelix created by four further sutures anchored to the mastoid fascia, thus achieving the two main goals of otoplasty. The sparing of cartilaginous tissue means that the procedure is reversible if needed. In addition, permanent postoperative stigmata, pathologic scarring, and anatomical deformity can be avoided. This technique was used on 91 ears in 2020 and 2021, with only one ear (1.1%) requiring revision. Rates of complications or recurrence were low. The presented technique appears to be a rapid and safe method for treating the prominent ear deformity, providing aesthetically pleasing results.

Background: Deep sternal wound infections, mediastinitis and sternal osteomyelitis are devastating and lifethreatening complications of median-sternotomy incisions after cardiac surgical procedures. The incidence of surgical wound infection in sternotomies is relatively high among heart disease patients since these patients are burdened with a high number of risk factors compared to the general population.