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Howard BE, Patel S, Shockley WW, Clark JM. Total Nasal Reconstruction: Advances in Free Tissue Transfer for Internal Lining and Structural Support. Facial Plast Surg Clin North Am 2024; 32:247-259. [PMID: 38575283 DOI: 10.1016/j.fsc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved.
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Affiliation(s)
- Brittany E Howard
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Samip Patel
- Division of Head and Neck Surgery, Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - William W Shockley
- Division of Facial Plastic and Reconstructive Surgery, University of North Carolina, 170 Manning Drive Campus Box# 7070, Chapel Hill, NC 27599, USA
| | - Joseph Madison Clark
- Division of Facial Plastic and Reconstructive Surgery, University of North Carolina, 170 Manning Drive Campus Box# 7070, Chapel Hill, NC 27599, USA
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Wei M, Bu X, Wang G, Zhen Y, Yang X, Li D, An Y. Expanded forehead flap in Asian nasal reconstruction. Sci Rep 2023; 13:5496. [PMID: 37015929 PMCID: PMC10071462 DOI: 10.1038/s41598-023-30245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/20/2023] [Indexed: 04/06/2023] Open
Abstract
This article reviewed our experience of Chinese nasal reconstruction over 12 years and evaluated the effect of expanded forehead flap both aesthetically and functionally. The special skin type and other anatomic features of Chinese patients was understood thoroughly during the treatment. This article thus catered for the need of multiracial nasal reconstruction. We analyzed existing clinical data and demonstrated a typical case in detail. The postoperative result supported our strategy which advocated the extensive application of expanded forehead flap, together with flip scar flap as the internal lining. The features of Chinese patients also prompted the use of costal and auricular cartilage. Emerging technology like 3D-printing would benefit nasal reconstruction from more aspects.
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Affiliation(s)
- Muqian Wei
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xi Bu
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Li
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Safeek RH, Ching J, Chim H, Satteson E. The Role of Plastic Surgeons in Addressing Firearm Morbidity and Mortality. Cureus 2023; 15:e36414. [PMID: 37090311 PMCID: PMC10115152 DOI: 10.7759/cureus.36414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Firearm injuries are now the leading cause of pediatric mortality in the United States. With the number of firearm injuries increasing at an alarming rate, the American Medical Association (AMA) declared firearm violence a public health crisis. In response to this emerging public health issue, the American College of Surgeons (ACS) developed the STOP THE BLEED training to educate laypersons on how to mitigate acute hemorrhage following gunshot wounds (GSWs) and other ballistic injuries. Stabilization of patients following GSWs is often handled by a multidisciplinary team of trauma and reconstructive surgeons. Here, we describe the history and ongoing role of reconstructive surgeons in preventing and addressing firearm morbidity and mortality. Hand surgeons are uniquely positioned to counsel patients on firearm safety, e.g., educating patients on proper firearm storage away from minors in the home, in an effort to mitigate accidental firearm injury to the upper extremity. As the evolving climate of firearm violence continues to rise, plastic and reconstructive surgeons will continue to play a critical role in restoring form and function among patients afflicted with GSWs.
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Hong JP, Masoodi Z, Tzou CHJ. Attributes of a Good Microsurgeon-A Brief Counsel to the Up-and-Coming Prospects. Arch Plast Surg 2023; 50:130-140. [PMID: 36755651 PMCID: PMC9902200 DOI: 10.1055/s-0042-1759786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/17/2022] [Indexed: 02/09/2023] Open
Abstract
Microsurgery, which deservedly sits on top of the reconstruction ladder, has been a boon to plastic surgery. It is because of this marvelous tool that plastic surgeons the world over have been able to tackle many reconstructive dilemmas, which were once considered to be an improbability. Microsurgery-aided revolutions have rendered a new meaning to all forms of reconstruction-whether it is postoncological, posttraumatic, or postlymphedema reconstruction. As the most advanced reconstructive medium at our disposal that has broadened the horizons of plastic surgery exponentially, it is but obvious that many budding plastic surgeons are drawn toward this subspecialty. In lieu of the aforementioned facts, it is necessary to sensitize all such aspiring surgeons about the various intricacies concerning the field of microsurgery. This article with its focus on the six desirable microsurgical attributes of "Clarity, Curiosity, Perseverance, Passion, An Open Mindset and Action," is meant to be a modest attempt on part of the authors to share their microsurgical insights, procured through their respective journeys, with budding aspirants, hoping to sensitize as well as motivate them for the challenging path that lies ahead.
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Affiliation(s)
- Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine and Asian Medical Center, Seoul, South Korea,Address for correspondence Joon Pio Hong, MD, PhD, MMM Division of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Asan Medical Center, University of Ulsan88 Olympic-ro 43-gil, Songpa-gu, SeoulSouth Korea
| | - Zulqarnain Masoodi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria,Plastic Surgery Division, Florence Hospital, Srinagar, Jammu and Kashmir, India
| | - Chieh-Han John Tzou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria,Faculty of Medicine, Sigmund Freud University, Vienna, Austria,TZOU Medical, Vienna, Austria
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Jessop ZM, Hague A, Dobbs TD, Stewart KJ, Whitaker IS. Facial Cartilaginous Reconstruction-A Historical Perspective, State-of-the-Art, and Future Directions. Front Surg 2021; 8:680186. [PMID: 34485372 PMCID: PMC8415446 DOI: 10.3389/fsurg.2021.680186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Importance: Reconstruction of facial deformity poses a significant surgical challenge due to the psychological, functional, and aesthetic importance of this anatomical area. There is a need to provide not only an excellent colour and contour match for skin defects, but also a durable cartilaginous structural replacement for nasal or auricular defects. The purpose of this review is to describe the history of, and state-of-the-art techniques within, facial cartilaginous surgery, whilst highlighting recent advances and future directions for this continually advancing specialty. Observations: Limitations of synthetic implants for nasal and auricular reconstruction, such as silicone and porous polyethylene, have meant that autologous cartilage tissue for such cases remains the current gold standard. Similarly, tissue engineering approaches using unrelated cells and synthetic scaffolds have shown limited in vivo success. There is increasing recognition that both the intrinsic and extrinsic microenvironment are important for tissue engineering and synthetic scaffolds fail to provide the necessary cues for cartilage matrix secretion. Conclusions and Relevance: We discuss the first-in-man studies in the context of biomimetic and developmental approaches to engineering durable cartilage for clinical translation. Implementation of engineered autologous tissue into clinical practise could eliminate donor site morbidity and represent the next phase of the facial reconstruction evolution.
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Affiliation(s)
- Zita M. Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Adam Hague
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Thomas D. Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Kenneth J. Stewart
- Department of Plastic and Reconstructive Surgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Iain S. Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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Jung HJ, Lee HM. Footsteps of the Innovations in Rhinology. JOURNAL OF RHINOLOGY 2021. [DOI: 10.18787/jr.2020.00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Rhinology is the study of nose, paranasal sinus, and nasopharynx. The nose is the most prominent structure on the human face and has been a subject of study since ancient human civilization. The history of rhinology has reflected the sociocultural aspects of the times, and rhinology has achieved remarkable growth with innovative discoveries by numerous pioneers. The focus of surgical procedures of the paranasal sinus shifted from mucosal stripping to functional endoscopic surgery with advancement of technology. Furthermore, the field of rhinology is gradually expanding due to cutting-edge technologies such as image-guided surgery, three-dimensional endoscopy, and robotic surgery. Additional clinical experiences and technological developments are expected to further advance rhinology.
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Yousef J, Leow SKH, Morrison W. Plastic surgery in antiquity: an examination of ancient documents. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01763-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moon KC, Jung JE, Dhong ES, Jeong SH, Han SK. Preoperative Nasal Swab Culture: Is It Beneficial in Preventing Postoperative Infection in Complicated Septorhinoplasty? Plast Reconstr Surg 2020; 146:27e-34e. [PMID: 32590641 DOI: 10.1097/prs.0000000000006893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical-site infection following complicated septorhinoplasty may result in serious complications. Therefore, efforts to prevent surgical-site infections after complicated septorhinoplasty are important. The purpose of this study was to analyze the microbiological profile of preoperative nasal swab cultures and to evaluate the effect of antibiotic prophylaxis and topical antibiotic decolonization according to the antibiotic sensitivity results of surgical-site infections in complicated septorhinoplasty. METHODS This 10-year cohort study included the data on 437 consecutive patients who underwent complicated septorhinoplasty. The patients were categorized into three cohorts based on the time of preoperative nasal swab culture collection. Patients in cohort 1 did not undergo nasal swab cultures and received empirical antibiotics. Patients in cohort 2 underwent only one preoperative nasal swab culture and received microorganism-sensitive antibiotics. Patients in cohort 3 underwent repeated nasal swab cultures. The antibiotics were changed when microorganisms resistant to the empirical antibiotics were isolated. Microbiological data and the rates of surgical-site infection and inflammation were compared among the three cohorts. RESULTS Methicillin-sensitive Staphylococcus aureus was the most commonly isolated microorganism. In cohort 1, two (5 percent) and two (5 percent) patients experienced surgical-site infections and inflammation, respectively. In cohort 2, two (3 percent) and three (4 percent) patients experienced surgical-site infections and inflammation, respectively. In cohort 3, one (0.3 percent) and one (0.3 percent) patient experienced surgical-site infection and inflammation, respectively. CONCLUSION The present study demonstrated that preoperative screening using repeated nasal swab cultures, followed by appropriate antibiotic prophylaxis and topical antibiotic decolonization, may reduce surgical-site infection in complicated septorhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Kyung-Chul Moon
- From the Department of Plastic Surgery, Korea University Guro Hospital
| | - Jae-Eun Jung
- From the Department of Plastic Surgery, Korea University Guro Hospital
| | - Eun-Sang Dhong
- From the Department of Plastic Surgery, Korea University Guro Hospital
| | - Seong-Ho Jeong
- From the Department of Plastic Surgery, Korea University Guro Hospital
| | - Seung-Kyu Han
- From the Department of Plastic Surgery, Korea University Guro Hospital
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Karki D, Muthukumar V. Postburn Nasal Reconstruction With Distally Based Radial Artery Perforator Flap: A Novel Technique. J Burn Care Res 2020; 41:731-733. [PMID: 32020199 DOI: 10.1093/jbcr/iraa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Postburn total nasal reconstruction associated with face burns is challenge to all reconstructive surgeons. The local tissue flaps for reconstruction is virtually out of options, forcing surgeons to opt for distant tissues for nasal reconstruction. Here in, we have described the use of distally based radial artery perforator flap for total postburn nasal reconstruction which has not been described for nasal reconstruction. The anatomy and technique of the flap and case series is presented in this report. Two cases of total nasal reconstruction using the distally based radial artery perforator flap are presented, one case post thermal burn and another post chemical burn. Radial artery distal perforator-based pedicled flap is a versatile option for nasal reconstruction especially when there is a paucity of unscarred skin in loco regional options.
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Affiliation(s)
- Durga Karki
- Department of Plastic, Burns and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
| | - Vamseedharan Muthukumar
- Department of Plastic, Burns and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
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Post-rhinoplasty outcomes in an Indian population assessed using the FACE-Q appraisal scales: a prospective observational study. The Journal of Laryngology & Otology 2020; 134:247-251. [PMID: 32172693 DOI: 10.1017/s0022215120000638] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty. METHODS Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function. RESULTS Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome. CONCLUSION The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.
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Total nasal reconstruction: a review of the past and present, with a peak into the future. Curr Opin Otolaryngol Head Neck Surg 2020; 27:420-425. [PMID: 31461733 DOI: 10.1097/moo.0000000000000573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this article is to review the complex topic of total nasal reconstruction and present a wide range of options for completing this difficult surgical procedure. RECENT FINDINGS Nasal reconstruction has a long history dating back thousands of years. Some historical techniques still exist today, including the paramedian forehead flap. The introduction of free tissue transfer and other pedicled flaps has provided multiple options for the reconstructive surgeon. The future of nasal reconstruction will include facial transplantation and likely bioengineered tissues. SUMMARY The principles of nasal reconstruction have gone unchanged for decades; however, the techniques to meet the principles have. The current reconstructive methods of grafts, free flaps, and pedicled flaps used to replace lining, structure, and skin will likely be used for several years to come. However, the use of facial transplantation has proved effective and bioengineered tissues present an exciting future for organ replacement.
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Ahcan U, Didanovic V, Porcnik A. A Unique Method for Total Nasal Defect Reconstruction - Prefabricated Innervated Osteocutaneous Radial Forearm Free Flap. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:11-19. [PMID: 31489339 PMCID: PMC6711176 DOI: 10.1080/23320885.2018.1549494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022]
Abstract
A 52-Year-old woman underwent a two-stage total nose reconstruction for complete nasal defect due to skin cancer. In the 1st stage, innervated osteocutaneous radial forearm flap (“Neo nose”) was raised with the help of a 3D template. In the 2nd stage, well vascularised “Neo-nose” was transferred to the face and covered with pre-expanded forehead flap.
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Affiliation(s)
- Uros Ahcan
- Department of Plastic Surgery and Burns, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Vojko Didanovic
- Department of Maxillofacial and Oral Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Ales Porcnik
- Department of Plastic Surgery and Burns, Ljubljana University Medical Centre, Ljubljana, Slovenia
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The learning curve in head and neck reconstruction with microvascular free flaps: a retrospective review. ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: Tissue defect around the head and neck region is a great challenge for reconstructive surgeons. Successful outcomes of surgery is influenced by many factors such as surgical technique in recipient and donor site, meticulous microvascular anastomosis, position of vascular pedicle, and post-surgery monitoring. The learning curve is important for any new microvascular surgeons. Objectives: Evaluate the quality of training for a new otolaryngologist, head and neck surgeon, on their performance of free flaps in facial plastic and reconstructive surgery using a retrospective review. Methods: Nineteen microvascular free flaps in patients from the ENT Center of Rajavithi Hospital were reviewed between November 2008 and October 2009. Incidences of free flap survival, and partial and complete necrosis were examined. Results: Eighteen patients with microvascular free flaps had head and neck cancer. 88.9% of the patients had squamous cell carcinoma. There were nine radial forearm free flaps, five anterolateral thigh free flaps, two rectus abdominis free flap, two iliac-free flap, and one fibular-free flap. The overall success rate of the free flap reconstructions was 84%. One partial and three total necrosis were done on the 19 flaps. Conclusion: Causes of free flap failure were similar and not dependent on the experienced of the surgeons. The postgraduate training program in facial plastic and reconstructive surgery is effective in providing new microvascular surgeons the skills to perform successful microvascular and reconstructive surgeries.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Perform aesthetic and functional nasal analysis to guide septorhinoplasty. 2. Recognize common complications associated with rhinoplasty. 3. Select appropriate septorhinoplasty techniques to refine nasal aesthetics and treat nasal airway obstruction. 4. Identify factors leading to poor patient satisfaction following rhinoplasty. SUMMARY Septorhinoplasty is among the most technically challenging procedures in the realm of plastic and reconstructive surgery. Moreover, it is a constantly evolving topic with extensive background literature. Surgeons must be comfortable with the traditional knowledge base and the current practices in the field. This article reviews the latest thinking on patient selection, functional indications, aesthetic analysis, and operative techniques in septorhinoplasty, with an emphasis on key cartilage grafting and tip suture techniques.
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Hosseinzadeh K, Hamadzadeh H, Khorasani M, Jamshidi M. Health-Related Quality of Life of Persons after Rhinoplasty: A Longitudinal Study among Iranian Population. J Clin Diagn Res 2017; 11:ZC60-ZC62. [PMID: 28511511 DOI: 10.7860/jcdr/2017/22903.9581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/15/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the growing number of cosmetic rhinoplasty surgeries in Iran in recent years, there is little information about the effects of this procedure on the subjects' Quality of Life (QoL). This study examined the QoL after rhinoplasty in subjects without nasal obstruction, who wanted the surgery for aesthetic reasons, three and six months postoperatively. AIM The aim of this study was to assess the changes of QoL in clients who take rhinoplasty. MATERIALS AND METHODS This was a prospective study conducted in Tehran, Iran. Using convenience sampling, 150 subjects who had undergone cosmetic rhinoplasty from June 2013 to June 2014 were invited to participate in the study. Patients' QoL was measured one week before and three and six months after rhinoplasty, using the Iranian version of the 36-item Short Form (SF-36) questionnaire. Descriptive statistics, Pearson correlation coefficient, one-way ANOVA, paired t-test, and independent sample t-test were used for data analysis. RESULTS Most of the participants were women (64%), and the mean age was 26.8±5.4 years (range: 18-41 years). The mean QoL scores before and three and six months after rhinoplasty were 67.26±26.01, 68.00±15.7 and 83.65±9.6, respectively. None of the measured demographic characteristics showed any correlation or relationship with the participants' QoL before and after the procedure (p>0.05). CONCLUSION QoL can be considered as a quality indicator of health care systems. This study shows that the persons' QoL improved six months after cosmetic rhinoplasty.
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Affiliation(s)
- Kazem Hosseinzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Hamadzadeh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mansour Khorasani
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Jamshidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
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Septorhinoplasty: Our Experience. Indian J Otolaryngol Head Neck Surg 2017; 69:385-391. [PMID: 28929073 DOI: 10.1007/s12070-017-1127-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
Abstract
Rhinoplasty is one of the oldest known surgeries to the human kind. However, being a cosmetic of surgery of utmost importance, it has been an attractive and fascinating surgery for the otolaryngologists and plastic surgeons. Along with the evolution of improved techniques and better surgical modalities, this surgery has been growing in panorama including its indications, needs and techniques. We present our experience with rhinoplasty in a tertiary care center of north India. We have included all cases operated with septorhinoplasty from 2001 to 2014 by the senior author in the manuscript. We reviewed their presentations, investigations, preoperative counselling records, operative details and post-operative clinical records to audit our results and hence to document our experiences in septorhinoplasties. A total of 53 cases including 37 males and 16 females had undergone rhinoplasty surgeries. The most common reason of disfigurement was road traffic accident (58.5%). All these patients included different deformities and required varied corrections. There were no major post-operative complications except persistent edema with longest lasting for 23 weeks. Thermal splints gave a better patient satisfaction in post-op compared to POP splints. Results were completely and partially satisfying for 50 patients and not satisfying for three. Unrealistic expectations from the procedure might be the reason for non-satisfactory results in rhinoplasty. Rhinoplasty is a delicate procedure and has greater aesthetic implications in planning surgical techniques and approaches. For better satisfaction of patients, adequate preoperative counseling and realistic expectations are warranted. Skillful surgical techniques null chances of complications.
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Vaira LA, Massarelli O, Deiana G, Meloni SM, Dell'aversana Orabona G, Piombino P, De Riu G. Aesthetic and Functional Evaluation of Total Nasal Reconstructions. Indian J Otolaryngol Head Neck Surg 2017; 70:71-78. [PMID: 29456947 DOI: 10.1007/s12070-017-1061-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/09/2017] [Indexed: 12/01/2022] Open
Abstract
The loss of a portion or the totality of the nose has great relevance on the perception of the beauty of a face and can result in a catastrophic quality of life impairment. Several surgical techniques are currently available for the reconstruction of the nasal pyramid. However, there are very few nasal reconstruction quality evaluation protocols that allow the surgeon to choose objectively the best technique for each kind of defects. Six total nasal reconstruction performed in University of Sassari Maxillofacial Unit were evaluated with a protocol that investigate objectively and subjectively the surgical aesthetic and functional outcome. Sensitivity recovery on the reconstructive flaps was also assessed. Patients reported a satisfactory nasal reconstruction both functionally and aesthetically. Sensitivity recovery on the forehead flap was always present even after pedicle resection or in case of traumatic section of the infraorbital nerve. The use of a three layer reconstruction has proved a viable technique both aesthetically and functionally. In particular the use of the forehead flap to reconstruct the outer layer of the nose allows to carry a tissue with very similar characteristics to the original with a recovery of the sensitivity almost complete.
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Affiliation(s)
- Luigi Angelo Vaira
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy.,3Operative Unit of Maxillo-Facial Surgery, University of Naples "Federico II" Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Olindo Massarelli
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
| | - Giovanna Deiana
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
| | - Silvio Mario Meloni
- 2Dental School, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
| | - Giovanni Dell'aversana Orabona
- 3Operative Unit of Maxillo-Facial Surgery, University of Naples "Federico II" Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Pasquale Piombino
- 4ENT Operative Unit, Second University of Naples Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Giacomo De Riu
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
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Innocenti A, Innocenti M. An alternative single-stage application of the paramedian forehead flap in reconstruction of the face. J Craniomaxillofac Surg 2016; 44:1678-1681. [PMID: 27569383 DOI: 10.1016/j.jcms.2016.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Paramedian forehead flap represents a workhorse in facial soft tissue reconstruction but always requires a second step in order to interrupt the skin bridge. Direct visualization and dissection of vascular pedicle may avoid this drawback. METHODS Twenty one patients were treated between January 2012 and January 2014: 6 underwent nasal reconstruction and 15 full thickness defect of medial canthus of an orbital region. The follow-up ranges between 6 months and 2 years. All procedures were carried out in a single stage. RESULT All flaps were performed in a single-stage procedure, survived and healed uneventfully. CONCLUSION The authors describe a refinement of the original technique to be reserved for cases where vessels could be identified by Doppler, consisting in the direct visualization and dissection of the initial tract of the vascular pedicle, thus providing an extremely mobile pedicle whose size allows to locate the first part of the pedicle in the nasion, tunneling under a skin bridge between the emergence of the vessels and the defect.
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Affiliation(s)
- Alessandro Innocenti
- Department of Plastic and Reconstructive Surgery, CTO Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Marco Innocenti
- Department of Plastic and Reconstructive Surgery, CTO Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Marsden NJ, Kyle A, Jessop ZM, Whitaker IS, Laing H. Long-term outcomes of microsurgical nasal replantation: review of the literature and illustrated 10-year follow-up of a pediatric case with full sensory recovery. Front Surg 2015; 2:6. [PMID: 25759812 PMCID: PMC4338602 DOI: 10.3389/fsurg.2015.00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/06/2015] [Indexed: 11/13/2022] Open
Abstract
We present a case of successful artery only total nose replantation in an 18-month-old child, with 10 years of follow-up and full sensory recovery despite no nerve repair. The common absence of veins for anastomosis does not prevent successful replant, as demonstrated with the use of Hirudo medicinalis use in this unique case. We comprehensively review the literature of this rare and complex injury and advocate microsurgical replantation where possible over other methods of nasal reconstruction.
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Affiliation(s)
- Nicholas J Marsden
- Welsh Centre for Burns and plastic Surgery, Morriston Hospital , Swansea , UK ; Reconstructive and Regenerative Medicine Research Unit (ReconRegen), Institute of Life Science, College of Medicine, Swansea University , Swansea , UK
| | - Amanda Kyle
- Welsh Centre for Burns and plastic Surgery, Morriston Hospital , Swansea , UK ; Occupational Therapy Department, Morriston Hospital , Swansea , UK
| | - Zita M Jessop
- Welsh Centre for Burns and plastic Surgery, Morriston Hospital , Swansea , UK ; Reconstructive and Regenerative Medicine Research Unit (ReconRegen), Institute of Life Science, College of Medicine, Swansea University , Swansea , UK
| | - Iain S Whitaker
- Welsh Centre for Burns and plastic Surgery, Morriston Hospital , Swansea , UK ; Reconstructive and Regenerative Medicine Research Unit (ReconRegen), Institute of Life Science, College of Medicine, Swansea University , Swansea , UK
| | - Hamish Laing
- Welsh Centre for Burns and plastic Surgery, Morriston Hospital , Swansea , UK
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Abstract
Currently, the gold standard for reconstruction after rhinectomy or severe trauma to the nose, includes transposition of autologous mucosal flaps plus autologous cartilage grating and coverage using a skin flap. Difficulties with this approach arise where; cartilage and mucosa harvested from autologous donor sites is insufficient to achieve a passable aesthetic and functional reconstruction. Skin flaps are often bulky, poor color matches with hair follicles that reduce the aesthetic quality of the reconstruction. We suggest that tissue engineering could be a source of functional replacement tissues for nasal reconstructive surgery. However, the advancement of such an approach is dependent on the dissemination of scientific information into the clinical community, regarding the engineering of tissues such as mucosa, skin, and cartilage. This paper therefore reviews how the tissue engineering strategies available for producing clinically viable tissues could help resolve issues around reconstructing the human nose.
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My first 100 consecutive microvascular free flaps: pearls and lessons learned in first year of practice. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e27. [PMID: 25289221 PMCID: PMC4173838 DOI: 10.1097/gox.0b013e31829e1007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 05/20/2013] [Indexed: 12/12/2022]
Abstract
Background: Microvascular reconstruction for oncologic defects is a challenging and rewarding endeavor, and successful outcomes are dependent on a multitude of factors. This study represents lessons learned from a personal prospective experience with 100 consecutive free flaps. Methods: All patients’ medical records were reviewed for demographics, operative notes, and complications. Results: Overall 100 flaps were performed in 84 consecutive patients for reconstruction of breast, head and neck, trunk, and extremity defects. Nineteen patients underwent free flap breast reconstruction with 10 patients undergoing bilateral reconstruction and 2 patients receiving a bipedicle flap for reconstruction of a unilateral breast defect. Sixty-five free flaps were performed in 61 patients with 3 patients receiving 2 free flaps for reconstruction of extensive head and neck defects and 1 patient who required a second flap for partial flap loss. Trunk and extremity reconstruction was less common with 2 free flaps performed in each group. Overall, 19 patients (22.6%) developed complications and 14 required a return to the operating room. There were no flap losses in this cohort. Thorough preoperative evaluation and workup, meticulous surgical technique and intraoperative planning, and diligent postoperative monitoring and prompt intervention are critical for flap success. Conclusions: As a young plastic surgeon embarking in reconstructive plastic surgery at an academic institution, the challenges and dilemmas presented in the first year of practice have been daunting but also represent opportunities for learning and improvement. Skills and knowledge acquired from time, experience, and mentors are invaluable in optimizing outcomes in microvascular free flap reconstruction.
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Akkus AM, Eryilmaz E, Guneren E. Comparison of the effects of columellar strut and septal extension grafts for tip support in rhinoplasty. Aesthetic Plast Surg 2013; 37:666-73. [PMID: 23708246 DOI: 10.1007/s00266-013-0141-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to compare the effects of columellar strut and septal extension grafts for reconstruction of caudal nasal supportive structures on the long-term stability of nasal projection and rotation. METHODS A comparison was done on the differences between the early- and long-term results of the ratios of nasal projection to nasal length and columella labial angle values in 36 patients who were operated on by the same surgeon using columellar or septal extension grafts. RESULTS Both grafts had the effect of increasing nasal projection, and this effect was found to be stable over time. Some increased values of nasal projection obtained in the early postoperative period were lost over time. Although no significant difference was found between the groups, clinical and numerical observations showed that the values decreased less in the group that received septal extension grafts. CONCLUSION The tip position was more stable in cases with septal extension grafts than in those with columellar strut grafts. LEVEL OF EVIDENCE IV 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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Narushima M, Iida T, Kadono T, Hara H, Yamamoto Y, Todokoro T, Mihara M, Koshima I. Free concha flap for sensitive nasal reconstruction using the infraorbital artery and nerve as a recipient vessel and a recipient nerve. Microsurgery 2013; 33:311-4. [PMID: 23568643 DOI: 10.1002/micr.22091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 11/08/2022]
Abstract
Free auricular flap transplantation is one of the treatments for nasal reconstruction. This report presents a case of nasal reconstruction where the infraorbital artery was used as a recipient vessel, and the infraorbital nerve as a recipient sensory nerve. A 75-year-old female underwent resection of malignant melanoma of the right nasal ala. A free ear concha flap was used for the reconstruction. The facial artery could not be found intraoperatively; instead, the infraorbital artery was identified and anastomosed with the posterior auricular artery. The great auricular nerve was coapted with the infraorbital nerve. The results of the sensory examination were the same as those of the unaffected side. This procedure not only achieves a good aesthetic outcome, but also restores sufficient sensory function.
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Affiliation(s)
- Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, School of Medicine, Bunkyo-ku, Tokyo 113-8655, Japan.
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Gulbas LE. Embodying racism: race, rhinoplasty, and self-esteem in Venezuela. QUALITATIVE HEALTH RESEARCH 2013; 23:326-335. [PMID: 23349127 DOI: 10.1177/1049732312468335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article, I examine how race motivates women's decisions to undergo aesthetic rhinoplasty in Caracas, Venezuela. Through a combination of cultural domain analysis and thematic analysis of qualitative interviews, I explore how the preference for whiteness and associated facial features dovetail with the aesthetic ideals promoted by cosmetic surgeons. Rhinoplasty is offered by physicians and interpreted by patients as a resolution to body dissatisfaction and low self-esteem. The clinical ethos of objectivity established by cosmetic surgeons fails to acknowledge how perceptions of the self and body are strongly tied to racial marginalization: patients' efforts to alter the nose reveal attempts to change not only how the body looks, but how it is lived. As a result, cosmetic surgery only acts as a stop-gap measure to heighten one's self-esteem and body image.
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Affiliation(s)
- Lauren E Gulbas
- Dartmouth College, Department of Anthropology, Hanover, New Hampshire 03755, USA.
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Abstract
Man has considered the nose to be a key feature, if not the key feature, of facial appearance, beauty, and dynamics. However, because of its central facial location and weak cartilaginous support, the nose is susceptible to disfiguring infection, trauma, pathologic entities, and human-associated carnages. This article discusses the various methods (eg, endonasal approach, external approach, and osteoplastic operations) surgeons have tried throughout history to give their patients a more attractive face by altering the one physical anatomic structure that one usually notices first.
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Oseni A, Crowley C, Lowdell M, Birchall M, Butler PE, Seifalian AM. Advancing nasal reconstructive surgery: the application of tissue engineering technology. J Tissue Eng Regen Med 2011; 6:757-68. [PMID: 22095677 DOI: 10.1002/term.487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/20/2011] [Accepted: 07/12/2011] [Indexed: 12/17/2022]
Abstract
Cartilage tissue engineering is a rapidly progressing area of regenerative medicine with advances in cell biology and scaffold engineering constantly being investigated. Many groups are now capable of making neocartilage constructs with some level of morphological, biochemical, and histological likeness to native human cartilage tissues. The application of this useful technology in articular cartilage repair is well described in the literature; however, few studies have evaluated its application in head and neck reconstruction. Although there are many studies on auricular cartilage tissue engineering, there are few studies regarding cartilage tissue engineering for complex nasal reconstruction. This study therefore highlighted the challenges involved with nasal reconstruction, with special focus on nasal cartilage tissue, and examined how advancements made in cartilage tissue engineering research could be applied to improve the clinical outcomes of total nasal reconstructive surgery.
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Affiliation(s)
- Adelola Oseni
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery and Interventional Sciences, University College London, London, UK
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Ashrafian H, Darzi A, Athanasiou T. Autobionics: a new paradigm in regenerative medicine and surgery. Regen Med 2010; 5:279-88. [PMID: 20210587 PMCID: PMC3715838 DOI: 10.2217/rme.10.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The concept of bionics was developed 50 years ago and represented the development of engineering and technology based on natural biological systems. Traditional applications of bionics in healthcare include artificial bionic organs that apply engineering principles to replace or augment physiological functions by integrating electronic, mechanical or electromechanical components to inherent body tissues/organs (we term this as 'exobionics'). Recently, there has been a new wave of bio-inspired treatments that act through the reorganization of the existing biological organs in an individual to enhance physiology. Here, the technology does not replace biological tissue, but rather applies engineering principles to replace or augment physiological functions by the rearrangement and manipulation of inherent tissue/organs; we term this autobionics. Examples include: dynamic cardiomyoplasty (artificial heart pump using skeletal muscle), the Ross procedure (pulmonary autograft), dynamic graciloplasty (artificial sphincter) and metabolic gastric bypass (rearranging the gastrointestinal tract to modify gut- and pancreatic-hormone release). Autobionic therapies can be classified into dynamic, static and metabolic procedures. This results in tissue redesignation (one tissue used in place of another), tissue replacement and systems reorganization (rearranging inherent organ/tissue anatomy). In some cases autobionic procedures can enhance physiological function beyond normality and represents a new era in bio-inspired versatility.
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Affiliation(s)
- Hutan Ashrafian
- Department of Surgery & Cancer, Imperial College London at St Mary's Hospital, Praed Street, London, W2 1NY, UK.
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Abstract
The structures of the nose are arguably the most complex within the face to reconstitute when absent. Total nasal reconstruction has evolved to encompass advanced surgical techniques in an effort to achieve increasingly satisfactory cosmetic results while restoring nasal function that mimics the function of a patient's natural nose. In this article, the history of total nasal defects and their reconstruction, relevant nasal anatomy, etiologies of the defect, and the surgical approaches to reconstructing each of the three-layered structure of the nose (ie, nasal skin, cartilage/bone, and lining mucosa) are explored.
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Lambeaux libres et reconstruction en carcinologie cervicofaciale : état des lieux après 20 ans. ACTA ACUST UNITED AC 2009; 126:226-35. [DOI: 10.1016/j.aorl.2009.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 03/11/2009] [Indexed: 11/18/2022]
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Li Q, Weng R, Gu B, Liu K, Shen G, Xie F, Zheng D. Anchor-shaped nasal framework designed for total nasal reconstruction. J Plast Reconstr Aesthet Surg 2009; 63:954-62. [PMID: 19574117 DOI: 10.1016/j.bjps.2009.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 04/03/2009] [Accepted: 05/03/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nasal frame grafting has been widely used in nasal reconstruction; however, a stable nasal frame with satisfactory functional and aesthetic results is hard to achieve in total nasal reconstruction. In this study, we devised a technique to create an individually designed anchor-shaped nasal frame composed of an L-strut and two C-battens, and applied it in the total nasal reconstruction procedure to achieve satisfactory functional and aesthetic results. METHOD In a 9-year period, 17 patients with total nasal defect were treated with autogenous costal grafting utilising forehead flap as the covering. The techniques of the individualised design of the anchor-shaped nasal frame were applied to fit the facial features. All cases were followed for at least 18 months, and outcomes were evaluated separately by the patients and plastic surgeons in terms of aesthetics, stability and function. RESULTS Satisfactory results were achieved in most of the cases after the operation. More than 82.4% of the patients in this series were assessed as satisfactory by both groups in the aesthetics survey; more than 76.5% in the stability survey; and more than 64.7% in the function survey. Complications included flap hyperpigmentation (one case), flap-skin paleness (one case), L-strut distortion (three cases) and stuffiness of the nostrils (one case) as well as minor brow elevation of the donor side (five cases). CONCLUSIONS The procedure of applying individually designed anchor-shaped nasal frame with forehead flap technique has obvious advantages for restoration of distinct and delicate subunits, stable nasal structure and good nasal function.
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Affiliation(s)
- Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Shanghai 200011, PR China.
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16:394-7. [PMID: 18626261 DOI: 10.1097/moo.0b013e32830c1edc] [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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Cairns SA, Whitaker IS. Reconstructive microsurgery; not nonoperative facial rejuvenation: Essentials of plastic surgery in the 21st century. Microsurgery 2007. [DOI: 10.1002/micr.20418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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