The authors present their experience with the reversed submental perforator-based island flap for nose reconstruction and their anatomic and clinical studies. There have been several descriptions on the reversed pattern of the submental flap, but its anatomic background and clinical availability are still questionable. The submental area was analyzed by anatomic dissection on four fresh cadavers that were injected with a barium mixture. The anatomic data were accumulated with the authors' clinical experience with eight patients treated with a submental island flap. On the basis of these studies, the location of reliable perforators was constant at the lateral and/or medial border of the anterior belly of the digastric muscle, but their locations were not always symmetric on both sides in the submental territory. Unlike the comitant submental vein, another larger superficial vein has a different course before reaching the lateral border of the anterior digastric belly, and therefore, it must be included in the reversed flap. The premised anatomic results and the clinical experience prove the reliability of the reversed submental perforator-based island flap as a versatile option in midface reconstruction, including the nose, once the dissection has been carefully done, respecting the anatomic points that can be found in this study.
Nicolau syndrome is a rare complication of intramuscular injection consisting of ischemic necrosis of skin, soft tissue, and muscular tissue that arises locoregionally. The characteristic pattern is pain around the injection site, developing into erythema, a livedoid dermatitis patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. Three patients were injected with drugs (diclofenac sodium, ketoprofen, meperidine) for pain relief. Three patients complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks. Each patient underwent debridement and coverage. The wound healed uneventfully. We report three cases of Nicolau syndrome in the buttocks following diclofenac intramuscular injection.
The septal extension graft is a very useful method of controlling nasal lengthening and tip projection, rotation, and shape by fixing a graft to the septum, which leads to a strong supporting structure. Enhancing graft stability is important for better long-term outcomes and minimizing complications or relapse, and even more efficient application of these methods is needed for East Asians who lack enough cartilage to be harvested in addition to possessing a weak cartilage framework. In this paper, the methods for overcoming the drawbacks of the septal extension graft, such as instability, a fixed tip, and insufficiency of cartilage, are presented, and the applications of each method for greater satisfaction with surgical outcomes are also discussed.
BackgroundAlprostadil and sildenafil are known vasodilators used independently to improve flap survival in animal models. In this study, we investigate whether these agents act synergistically to decrease flap necrosis in rat models.MethodsAfter acclimation period, 4 groups of 10 male white rats were given a modified McFarlane skin flap. The postoperative treatment included saline control (Group A), sildenafil citrate-only (Group B), alprostadil-only (Group C), and both sildenafil and alprostadil (Group D). The flaps were observed on postoperative days 1, 3, 5 and 7. The animals were euthenized on postoperative day 7, and the flaps were evaluated for inflammation and neovascularization.ResultsAt each observation, the mean necrotic index was significantly lower for all three treatment groups (Groups A, B, C) and was the lowest for the combined treatment group. On histologic evaluations, combined treatment was associated with decreased inflammation and increased capillary vessel formation, when compared with control group.ConclusionBoth sildenafil-only and alprostadil treatments were independently associated with increased flap survival rate. Sildenafil citrate and alprostadil had a synergistic effect in increasing flap survival rate.
BackgroundCryptotia is a congenital ear deformity in which the upper pole appears buried beneath the mastoid skin. Cryptotia is a common auricular malformation among Asians. The aim of this paper is to examine the surgical techniques for and complications of 34 cryptotic patients.MethodsSurgery was performed for 34 cryptotic deformities (January 2005 to January 2012). Twenty-two patients (64.7%) were classified as having type I cryptotia, and 12 patients (37.5%) type II cryptotia. Among the type I cryptotia patients, 8 patients had mild deformity and 14 severe deformity. Among the type II cryptotia patients, 10 patients had mild deformity and 2 severe deformity.ResultsThe mild deformities were corrected via Z-plasty, V-Y plasty, full-thickness skin graft, and transposition flap, while the severe deformities were corrected via cartilage graft or Medporfor the spread of cartilage adhesion of antihelix. There were two cases of reinvagination in the autologous cartilage graft group. Implant exposure occurred with Medpor (two cases). There were two cases of hypertrophic scar on the previous surgical wound with Medpor. There were no complications in the 18 patients who had mild deformities.ConclusionsThe type I cryptotia patients had more severe deformities than the type II cryptotia patients. As most of the type II cryptotia patients had only mild deformities, their deformities were corrected without using autologous conchal cartilage graft or Medpor, except for two patients. Through more case analyses, researchers should make an effort to identify methods for recurrence and prevention of complication.
Various methods have been developed for vaginoplasty, of which the rectosigmoid flap has its own advantages including sufficient increase in the vaginal length and lower incidence of complications such as contracture or strain after vaginoplasty. Laparoscopic operation can greatly minimise the abdominal scar associated with laparotomy and allow cosmetically superior outcomes. Its minimally invasive procedure can also achieve rapid recovery and shorten the duration of hospital stay. Twelve patients (age range 18-40 years) had vaginoplasty using the rectosigmoid colon. We evaluated the ecological changes of the neovagina from the change of pH in the neovagina, culture of the normal flora, and vaginal wall biopsy taken 6 to 12 months postoperatively. Details of sexual activity were also examined. No patient from interviews developed vaginal narrowing as a result of the contracture that caused painful intercourse, or had smelly discharge or spontaneous bleeding from the vagina. Laparoscopic procedures may need only five-openings of 1-1.5 cm in diameter. Mean operating time was 130 minutes (IQR, 113-140) and duration of hospital stay 8.5 days (IQR, 7-11). Twelve months postoperatively the intravaginal pH was about 6. In one case, the histological test showed that the original columnar cell of the intestinal mucosa had been transformed to stratified squamous cell tissue. The key to the vaginoplasty is that it should give functional satisfaction and a minimal rate of complications. The laparoscopic rectosigmoid flap technique of vaginoplasty allowed less morbidity and excellent aesthetic and functional postoperative outcomes.
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