Orbital floor fractures of varying sizes commonly occur after orbital injuries and remain a serious challenge. Serious complications of such fractures include enopthalmos, restriction of extraocular movement, and diplopia. There is a dearth of literature that can be applied widely, easily, and successfully in all such situations, and therefore there is no consensus on the treatment protocol of this pathology yet. Autogenous grafts and alloplastic and allogenic materials with a wide variety of advantages and disadvantages have been discussed. The value of preoperative and postoperative ophthalmological examination should be standard of care in all orbital fracture patients. An ideal reconstructed orbital floor fracture should accelerate the restoration of orbital function with acceptable cosmetic results. Management parameters of orbital fractures such as timing of surgery, incision type, and implant materials, though widely discussed, remain controversial. In this study, 55 patients with orbital floor fractures surgically reconstructed with conchal cartilage grafts between 2008 and 2014 were retrospectively evaluated. Complications and long-time follow-up visit results have been reported with clinical and radiographic findings. The aim of this study was to present the authors' clinical experiences of reconstruction of blow-out fractures with auricular conchal graft and to evaluate the other materials available for use.
Half-nose or heminasal aplasia is an extremely rare congenital malformation, which has a withering effect both on the patient and the family. Proboscis lateralis is a rare facial anomaly resulting in the incomplete development of one side of the nose, which was first defined in 1861 by Forster in his monograph. Proboscis lateralis, cleft nose, and nasal agenesis are rare anomalies; however, half-nose is also an extremely rare condition. In the formation of half-nose deformities, either a facial cleft or nasal dysplasia is the assumed theories of embryological origin. In the reconstruction of proboscis lateralis tissue, local flaps and forehead flaps can be used for a functional and esthetically acceptable structure. The expanded forehead flap has become commonly used in recent years. Estimating the cosmetic result of surgery is an extreme challenge because of the accompanying nasal growth of the transferred tissue and the nose. In this study, the authors report on the reconstruction of half-nose and proboscis lateralis deformity with clinical results.
Locating appropriate recipient vessels for anastomosis of flap vessels near lesions can be challenging during the reconstruction of radiation-damaged tissues using free flaps, and the vascular pedicle length of the flap can be insufficient. However, under these conditions, flap reach can be extended by completely dividing it from the main flap using a perforatorpedicled propeller (PPP) flap technique. Furthermore, this technique can be used to optimize flap configurations, such as the shape and direction of the transplant.In the present case, a thoracodorsal artery perforator (TAP) flap was harvested from within a free latissimus dorsi musculocutaneous (LDMC) flap, and a nuchal radiation ulcer defect was successfully reconstructed without complication. Herein, we report the clinical and surgical details of this case. Case ReportA 54-year-old man was admitted to our department complaining of an intractable nuchal ulcer in May 2006. He had received radiotherapy (60 Gy in total) and had undergone surgery for a nuchal squamous cell carcinoma at another hospital 11 years ago. About 10 years after radiotherapy, an ulcer appeared and grew with time. The patient complained of severe nuchal pain and stiffness, and an insufferable smell. Computed tomography analyses showed partial necrosis on the trapezius muscle and on spinous processes of the cervical spine. Tissue debris was removed during the first stage of the operation in June 2006, and 4 weeks after debridement a deep, oval, bowl-shaped soft tissue defect of approximately 13 Â 8 cm remained. Subsequently, the cervical spine was exposed at its base, revealing a bowl-shaped defect comprising shallow occipital and deep nuchal parts (►Fig. 1). Surgical ProcedureSurgery was designed to reconstruct the oval-and bowl-shaped soft tissue defect on the neck using a free LDMC flap. The carotid trigone was initially dissected to obtain suitable recipient vessels, but extensive radiation-induced fibrosis was observed, and the transverse cervical artery and external jugular vein in the supraclavicular fossa were chosen as recipient's vessels. Because the transverse cervical artery is relatively distal from nape and occipital regions, vertical placement of the LDMC flap at the longitudinal oval defect would require addition of a vein graft. Therefore, a division of the free LDMC flap into two parts to obtain a thick free LDMC flap and a thin TAP flap was considered to optimize the long axis and the thickness of the transplant for oval and uneven tissue defects (►Fig. 2). The free LDMC flap was then harvested, and vascular anastomosis was performed to cover the deep nuchal defect. The TAP flap was then divided into two perforators as a secondary flap from the distal half of the free LDMC flap, and was rotated approximately 90 degrees clockwise using the PPP flap technique to cover the shallow occipital defect (►Fig. 3, upper and lower center). Consequently, the long axes of the transplants were adjusted to fit that of the oval tissue defect (►Fig. 3, right). Accordingly, the deep ...
Craniofacial clefts are rare, severe challenges for surgeons about which there is limited literature. Tessier Number 4 (No. 4) clefts are one of the most complex craniofacial anomalies and present difficulties in surgical treatment. The most-common deformities associated with Tessier No. 4 clefts are displacements of the lower eyelids, medial canthus, and ala and decreased distance between the lower eyelids and lips. In surgery to correct these deformities, the greatest challenges are the design and the placement of the landmarks and incisions. Because of its relative rarity and wide range of severity, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. The present study presents a new lip-rescue flap technique as an alternative approach for reconstructing Tessier No. 4 facial clefts.
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