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Harutyunyan A, Hakobyan G. Saddle Nose Deformity Reconstruction with a Allograft Bone. Aesthetic Plast Surg 2024:10.1007/s00266-024-04123-w. [PMID: 38806824 DOI: 10.1007/s00266-024-04123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Providing lasting cosmetic and functional results for patients with saddle nose deformity with allograft. METHODS This report describes experience with using a of freeze-dried allograft bone allograft in 58 patients who underwent dorsal augmentation over 5-year period (2018-2023). Thirty-eight patients had saddle-shaped deformity of the nose, and 16 patients had post-traumatic cases with saddle nose deformities. All patients underwent a clinical examination using computed tomography. Before surgery using a 3D model, the graft was contoured according to the shape of the nasal defect. The grafts were installed using a closed approach and were placed under the periosteum of the bone. Using lateral photographs, anthropometric measurements of the nose were taken before and after surgery to assess aesthetic outcome after surgery. To assess the results of aesthetic rhinoplasty (UQ), the Portuguese version of the Utrecht Questionnaire was used, which contains a visual analogue scale (VAS) on a 5-point Likert scale. RESULTS A total of 56 patients were satisfied with the results of the surgical procedure. No complications or major graft resorption was observed. An analysis comparing preoperative and 1-year follow-up data using 3D scanning showed a significant increase in dorsal height without dorsal expansion. After rhinoplasty, the mean visual analog scale (VAS) aesthetic score improved significant from 2.3 preoperatively, 3 months postoperatively 8.4, and 8.9 1 year postoperatively. CONCLUSION The use of freeze-dried allograft bone is a useful method of dorsal augmentation in rhinoplasty without donor site complications. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Armen Harutyunyan
- Astkhik Medical Center, Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Gagik Hakobyan
- Head of Department of Oral and Maxillofacial Surgery, Yerevan State Medical University, 0028 Kievyan str. 10 ap. 65 c, Yerevan, Armenia.
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Theelen FFM, Veldhuizen IJ, Zhou C, Lee EH, van Hensbergen LJ, Broekhuysen CL, van der Hulst RRWJ, Hoogbergen MM. Patient Satisfaction Following Primary Closure or Second Intention Healing After Conventional Nasal Skin Cancer Excision: A Cross-sectional Cohort Study. Dermatol Surg 2024; 50:247-255. [PMID: 38048208 DOI: 10.1097/dss.0000000000004037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing. OBJECTIVE Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer. METHODS All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer. RESULTS Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% ( n = 27) after second intention healing ( p = .004). Both groups experienced high facial and scar satisfaction, low appearance-related distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score ( p = .02). CONCLUSION This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC.
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Affiliation(s)
- Frederieke F M Theelen
- Department of Plastic and Reconstructive Surgery, Máxima Medisch Centrum, Veldhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Inge J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chao Zhou
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York
| | - Lusanne J van Hensbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Coralien L Broekhuysen
- Department of Plastic and Reconstructive Surgery, Máxima Medisch Centrum, Veldhoven, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
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Repairing Small Facial Soft Tissue Defects by Tissue Regeneration in Asians. J Craniofac Surg 2023; 34:708-711. [PMID: 36260432 DOI: 10.1097/scs.0000000000008812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND A variety of options are available to repair the small facial soft tissue defects after surgical removal of cutaneous tumor, including direct suture, skin grafts, local, regional or free flaps. However, tissue regeneration is another option for repairing facial defects. This study proposes the clinical application of the principle of tissue regeneration priority in small defects (diameter <1.3 cm) of facial soft tissue. METHODS A retrospective study of 33 patients whose facial defects were repaired by tissue regeneration healing in situ from January 2019 to January 2022. In this group, the facial soft tissue defects were treated with wound moist theory in order to promote wound regeneration. RESULT All patients underwent 1 month follow-up at least and the longest follow-up time was 6 months. Hundred percent of the patients were satisfied with their cosmetic outcome. Only some patients formed small depression scars after surgery, the appearance of which were similar to acne scar. In this situation, re-resection and laser treatment could be used as complementary procedures. However, no patient underwent the secondary treatments including laser and re-resection. CONCLUSION Healing by tissue regeneration is an effective option for the facial defects in Asians. For most of the small soft tissue defects of the face, tissue regeneration in situ can achieve satisfactory effects. More importantly, it has the advantages of simple operation and fewer complications.
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Veldhuizen IJ, Brouwer P, Aleisa A, Kurtansky NR, Dusza SW, Nehal KS, Hoogbergen MM, van der Hulst RR, Lee EH. Nasal skin reconstruction: Time to rethink the reconstructive ladder? J Plast Reconstr Aesthet Surg 2022; 75:1239-1245. [PMID: 34903490 PMCID: PMC8976754 DOI: 10.1016/j.bjps.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/17/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients' satisfaction after reconstruction for nasal defects following Mohs micrographic surgery. METHODS Patients presenting with nasal nonmelanoma skin cancer at Memorial Sloan Kettering Cancer Center New York, USA and Catharina Hospital Eindhoven, Netherlands from April 2017 to November 2019 were asked to participate. Reconstruction type, complications, and patients satisfaction were assessed. Patients completed the FACE-Q Skin Cancer - Satisfaction with Facial Appearance scale (preoperative and 1-year postoperative) and the Appraisal of Scars scale (1-year postoperative). RESULTS A total of 128 patients completed the preand postoperative scales. There were 35 (27%) surgical defects repaired with primary closures, 71 (55.5%) with flaps, and 22 (17.2%) with full-thickness skin grafts (FTSG). Patients that underwent a flap or FTSG reconstruction had higher scar satisfaction scores than primary closures (p = 0.03). A trend was seen with patients following flap reconstructions scoring 7.8 points higher than primary closures and patients with upper nose defects scoring 6.4 points higher than lower nose defects. Males were significantly more satisfied than females. No significant difference was observed in the preoperative and postoperative facial appearance scores between the three groups (p = 0.39). CONCLUSION Patients are more satisfied in the long term with their scars after flap reconstructions compared to primary closures. Therefore, nasal skin reconstruction may not follow the traditional reconstructive ladder and more complex approaches may lead to higher long-term scar satisfaction.
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Affiliation(s)
- Inge J. Veldhuizen
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Philip Brouwer
- Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Abdullah Aleisa
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stephen W. Dusza
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S. Nehal
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - René R.W.J. van der Hulst
- Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erica H. Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Depani M, Grush AE, Parham MJ, Jones LM, Thornton JF. Use of Biologic Agents in Nasal and Scalp Reconstruction. Semin Plast Surg 2022; 36:17-25. [PMID: 35706556 PMCID: PMC9192160 DOI: 10.1055/s-0042-1742750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Oncologic reconstruction of the nose and scalp following Mohs micrographic surgery poses a significant challenge for plastic surgeons. While these defects are traditionally reconstructed using primary closure techniques, skin grafts, local flaps, pedicled flaps, and free tissue transfer, the incorporation of biologic healing wound agents such as Integra and Cytal provides patients and surgeons with alterative reconstructive options without additional donor site morbidity. Herein, we review the use of biologic agents used in soft tissue reconstruction of the nose and scalp following Mohs surgery.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew E Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Matthew J Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Lloyd M Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Veldhuizen IJ, Budo J, Kallen EJJ, Sijben I, Hölscher MC, van der Hulst RRWJ, Hoogbergen MM, Ottenhof MJ, Lee EH. A Systematic Review and Overview of Flap Reconstructive Techniques for Nasal Skin Defects. Facial Plast Surg Aesthet Med 2021; 23:476-481. [PMID: 33650884 PMCID: PMC10027346 DOI: 10.1089/fpsam.2020.0533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Reconstruction of nasal skin defects can be challenging due to limited skin laxity and underlying cartilage and, therefore, often require a complex repair. The aim of this review is to systematically analyze the literature on nasal skin reconstructions with specific detail to flap reconstructions. Methods: A systematic literature review of nasal skin reconstruction was performed and focused on flap reconstructions. Flap reconstructions were stratified based on defect size, nasal subunit, and reconstruction type. Complication rates (CRs) and patient outcomes were also assessed. Results: A total of 176 articles (11,370 patients) met the inclusion criteria. Of these, 59 articles showed various flap techniques. For defects ≤1.5 cm, every subunit had four to six options except the alar rim, which showed one option. Rotation-advancement flaps were mostly used for the nasal tip and sidewall, whereas bilobed flaps were used more for the ala and dorsum. Defects >1.5 cm were most commonly reconstructed with the forehead flap. The mean CR of flap reconstructions was 13.8%. Only 8 of the 176 articles (4.5%) reported patient satisfaction using a standardized questionnaire. Conclusion: This review shows various flap reconstruction options with their corresponding CR that will help guide the surgeon in choosing reconstructive options for different nasal skin defects.
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Affiliation(s)
- Inge J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessie Budo
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Emily J J Kallen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Isha Sijben
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marleen C Hölscher
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Maarten J Ottenhof
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Abstract
Congenital and pediatric nasal lesion resection and their reconstructive outcomes are not well studied. A surgeon must consider the site, size, depth, etiology, age, and effect on future function (including growth). As such, it is important to contrast the differences between the adult's and child's nose. The authors propose that more conservative resection and reconstructive methods may better serve congenital and pediatric nasal lesions. An Internal Review Board approved study of congenital and pediatric nasal lesions using a defect only approach from 2005 to 2017 was performed. Lesions, type of surgeries, complications, aesthetic outcome, and additional interventions were reviewed. One hundred twenty-seven patients met the study criteria with a median age at surgery of 5.4 years with follow-up of 1.4 years (1 week-11.3 years). The most common diagnosis was congenital melanocytic nevus (47, 37%). The lesions were located on more than 1 subunit in 34 (27%) patients with an average surface area of 3.7 (0.04-32) cm. The most common primary procedure was excision and primary closure with adjacent tissue undermining/rearrangement (73, 57.4%) followed by full-thickness skin graft (23, 18.1%). The aesthetic outcome was considered acceptable in a high number of patients 117 (92%), while 10 (8%) patients had unacceptable aesthetic outcomes, mostly due to scarring. The authors' data supports the concept of minimal healthy tissue excision or lesion only excision when treating pediatric and congenital nasal lesions.
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A Stepwise Approach to Reconstruction of a Complex Central Facial Defect Involving Multiple Cosmetic Subunits After Mohs Micrographic Surgery. Dermatol Surg 2019; 46:1433-1435. [PMID: 31567614 DOI: 10.1097/dss.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Update on reconstructive options for nasal Mohs defects 1.5 cm or less. Curr Opin Otolaryngol Head Neck Surg 2018; 24:300-8. [PMID: 27389925 DOI: 10.1097/moo.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The article reviews the current literature to provide an overview on contemporary reconstructive options for closure of Mohs defects of the nose that are 1.5 cm or less. RECENT FINDINGS Although some of the techniques described in the literature are of historical importance only, others have undergone modification and metamorphosis to be broadly used in their contemporary form. Others are implemented in their original design, irrespective of relative age or multiple attempted adaptations. The increase in variable closure options available provides the surgeon with the ability to tailor reconstruction in such a way as to maximize form and function for the patient. SUMMARY Here we will provide an update on the core techniques in terms of subtle modifications, expanded applications, and examination of outcomes as well as newly described closure techniques that may fill a certain niche in nasal reconstruction.
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