It is estimated that more than four million people are bitten by dogs in the United States each year. The majority of such injuries are minor, and their treatment does not usually require surgical consultation. However, the authors report a case in which a Rottweiler inflicted a mutilating nasal tip/alar rim avulsion on a 5-year-old boy. They report their experience with immediate reconstruction of the nasal defect using a large ipsilateral auricular cartilage composite graft (crus helix). Adjunctive hyperbaric oxygen therapy (without sedation or anesthesia) was used to maximize the stimulus for graft revascularization. Reconstructive goals were achieved while avoiding the need for a central facial donor site defect.
Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel’s sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.
Reconstruction of multilayer defects of the lower nose, using composite grafts from the ear is a widespread technique. Little information exists about important aspects of managing the ear as a donor site for composite grafts. In a retrospective study, patient data were worked up concerning special preoperative planning features (donor site, recipient site), defect closure techniques, donor site morbidity, and esthetic and functional long-term results. One hundred ten composite grafts from the auricle were harvested for different defects at the lower nose. Skin and soft-tissue defect reconstruction at the auricle was carried out by tissue advancement in 43 cases or local flaps in 66 cases. Donor site morbidity was low (5 cases of delayed wound healing, 1 abscess). No flap necrosis occurred. Long-term follow-up (2-5 years) revealed no esthetic or functional impairments. Composite graft harvesting from the auricle is safe with minimal donor site morbidity, proper implementation assumed.
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