Versatility of cervicofacial flaps: Cervical-medial cheek flap for reconstruction in cutaneous substance loss of the inner cheek

BACKGROUND

Preservation of facial harmony is a major challenge in reconstruction after resection of head and neck skin tumors. For large medial cheek-skin defects, we used a derived posterior-based cervicofacial flap, or cervical-medial cheek flap (CMCF).

METHODS

We present a retrospective review of cases treated at a university-based cancer center. Patient characteristics, surgical technique, and complication rates are described.

RESULTS

Eighteen patients were treated between 2014 and 2017 with reconstruction for integumentary cheek defect after skin tumor surgery using CMCF. Mean defect size was 5.7 cm in length and 3.9 cm in width. The main histological subtype was lentigo maligna (33.3%). We report no flap necrosis but 4 minor complications occurred over a mean follow-up of 14.4 months. At last follow-up, satisfaction rate was very high (88.9%) with no evidence of recurrence.

CONCLUSION

The CMCF is a promising yet infrequently used option in medial cheek reconstruction, with excellent cosmetic and functional outcomes.

Anatomy and Aesthetics of the Labia Minora: The Ideal Vulva?

Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

BACKGROUND

Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow.

METHODS

Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators.

RESULTS

A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months.

CONCLUSIONS

The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction.

CLINICAL RELEVANCE

The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.

[Face and neck lift using a superficial musculo-aponeuro­t­ic system (SMAS) plication: Radiological analysis of tissu displacement, a case report]

OBJECTIVES

Face and neck lift (FNL) using SMAS plication is a simple and well-known surgical technique. The principle of smas plication from two fixed points allows an important tissue ascension. Our purpose was to objectively evaluate the SMAS plication results, although a common critic may be due to its early deep tissular displacement.

MATERIALS AND METHODS

We present the case of a 65 y.o. female patient who received a FNL. Miniature metal pins were placed on the external surface of the SMAS in order to ensure radiological monitoring. A cephalo­metric and photographic monitoring were performed pre­operatively and on day 1, months 2, 6 and 16 postoperatively . We performed a computed numerised analysis of the movement of the markers in an orthogonal axis.

RESULTS

All our bearings kept a constant position in the radiographic follow-up , demons­tra­ting the fixity of SMAS kinked 16 months postoperatively. Clinically the correction remained a good appearance with a very slight relaxation of the superficial tissues (skin and subcutaneous fat).

CONCLUSION

In the case of our patient, the tensioning of the deep facial plan (the SMAS) objectively appeared to be efficient over time, with an overall delay of 16 months. Our protocole appeared to be coherent without any specific complication. It permits to objectively differentiate the relaxation of the deep or superfial tissues after a facial lift procedure.

Radial artery pseudoaneurysm: a rare complication after arthroscopic treatment of a volar wrist ganglion in a hemophilia patient

Vascular complications of wrist arthroscopy are rare. We report the case of a 42-year-old male patient with a history of hemophilia who had a ganglion located where the radial pulse is taken that had been causing him pain for five months. After infusion of Exacyl (antifibrinolytic agent), the ganglion was drained arthroscopically. Fifteen days later, the patient presented with a pseudoaneurysm of the radial artery requiring urgent reoperation.

[Mastectomy and immediate breast reconstruction using a prosthesis and lower dermal flap: description of five cases]

INTRODUCTION

When performing mastectomy involving immediate reconstruction with prosthesis, it is required to obtain a complete cover of the implant. However, this is hardly ever possible for patients having a significant breast volume, despite the use of the skin-reducing technique. Using the lower dermal flap makes it possible to fully cover the implant for these patients.

PATIENTS AND METHODS

We will describe five cases of patients on whom skin-reducing mastectomy and immediate reconstruction with prosthesis and lower dermal flap were performed. Preoperative drawings were made following the so-called "Saint-Louis" pattern. During surgery, the future skin flap representing the skin cover of lower breast quadrants was de-epidermised. Mastectomy was then performed via an incision at the upper limit of the future flap. Then, a retro-pectoral pocket was created by lifting the pectoralis major muscle. The implant was introduced into this pocket and covered up at its lower part by the dermal flap, the upper edge of which was sutured to the lower edge of the pectoralis major muscle. The implant was thereby fully covered. Finally, the skin was closed with inverted T-scars.

RESULTS

Postoperative effects were minor. Two patients suffered from skin pain at the junction between the vertical and horizontal scars of the inverted T. These injuries were treated via healing by secondary intention. We have not observed any infection. Cosmetic results assessed by the patients and surgical team were considered as satisfactory.

CONCLUSION

Mastectomy with immediate reconstruction using a prosthesis and lower dermal flap makes it possible to fully cover the implant in patients who require the skin-reducing technique. This technique seems to minimise the risk of major complications and generates satisfactory cosmetic results.