Preventing nasal airway collapse with irradiated homologous costal cartilage versus expanded polytetrafluoroethylene: a novel animal model for nasal airway reconstruction.

Airway collapse can occur when the forces of inhalation overpower the strength of the nasal lining flap. The authors established an animal model of the reconstructed nasal airway, and examined mechanical properties of tissue composites based on various materials. Twenty-three Sprague-Dawley rats were divided into three experimental groups: control (n = 5), irradiated homologous costal cartilage (IHCC, n = 10), and expanded polytetrafluoroethylene (ePTFE, n = 8).

Computer-aided design and three-dimensional printing improves symmetry in heminasal reconstruction outcomes.

Background: Symmetry and balance in nasal reconstruction can be hard to achieve. Traditionally, a foil template modeled after the unaffected contralateral side is used in the design of a forehead flap. Crude two-dimensional models often generate underwhelming results.

Lateral Inframammary Approach for Asian Augmentation Mammaplasty.

Background: The inframammary fold (IMF) approach for augmentation mammaplasty is less popular in Asia. The incision was modified to lateral IMF(L-IMF) for easy access and better outcome. The aim of this study was to evaluate if L-IMF approach is feasible in Asian women.

The Influence of Paranasal Augmentation on the Measurement of the Nose for the Treatment of Midfacial Concavity.

Background: A concave midface with its associated deep nasolabial folds is more aesthetically displeasing than a convex midface. Midfacial concavity may be addressed with autologous tissue and implants.

Objectives: The aim of this study was to determine the effect of paranasal augmentation on photogrammetric parameters.

Aesthetic Refinements in Forehead Flap Reconstruction of the Asian Nose.

Background: Traditional paramedian forehead flap reconstruction exploits the aesthetic subunit principle. Refinements and outcomes of forehead flap nasal reconstruction largely reflect Western experience. Differences in ethnic Asian anatomy and wound healing may foster suboptimal outcomes.

Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest.

Background: The groin flap has been relied upon for more than 4 decades and is well suited for reconstruction of the mutilated hand. Classic groin flap harvest is subfascial and includes the superficial circumflex iliac artery (SCIA). SCIA perforator flaps have shown that one perforator is sufficient to supply a large flap without breaching fascia.

Nasolabial and forehead flap reconstruction of contiguous alar-upper lip defects.

Background: Defects of the nasal ala and upper lip aesthetic subunits can be challenging to reconstruct when they occur in isolation. When defects incorporate both the subunits, the challenge is compounded as subunit boundaries also require reconstruction, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, we used nasolabial flaps for upper lip reconstruction and a forehead flap for alar reconstruction.

The Transareolar-Periareolar Approach.

The periareolar approach is limited by areolar diameter. Asian women typically have smaller areolae than Western women. Voluminous and form-stable silicone implants demand larger incisions.

The Pi Graft for Correction of Severe Saddle Nose Deformity.

Saddle nose deformity is challenging because there is both aesthetic and functional compromise, and high rates of recurrence have been reported. Autologous costal cartilage is the widely preferred medium for reconstruction, but there may be room for improvement in the configuration of the cartilage struts. The pi graft is stabilized at two points, proximally and distally, distinguishing it from the traditional L-strut.

Double forehead flap reconstruction of composite nasal defects.

Background And Aim: Composite nasal defects require skin, framework, and lining reconstruction. The forehead flap is an ideal donor for skin coverage because of good color match and excellent donor-site healing. Intranasal flaps and grafts are reserved for lining reconstruction of small defects.

Silicone-Polytetrafluoroethylene Composite Implants for Asian Rhinoplasty.

Background: Silicone and Gore-Tex implants are mainstays of Asian rhinoplasty. Silicone implants are inexpensive and wieldy, but may elicit a foreign-body reaction and are prone to migration. Gore-Tex implants are more biocompatible and capable of ingrowth but expensive.

Asian Breast Augmentation: A Systematic Review.

Background: Economic, cultural, and regulatory phenomena may explain recent popularization of implant-based augmentation in Asia; but the collective Eastern experience remains limited. Asian surgeons and their patients rely on evidence-based medicine that originates elsewhere and may not be entirely relevant. Distinct anatomic and cultural features of Asian women warrant a tailored approach to breast augmentation.

Preventing Elevated Radix Deformity in Asian Rhinoplasty with a Chimeric Dorsal-Glabellar Construct.

Background: Asian facial aesthetic surgery should enhance, but not change, natural features. Augmentation rhinoplasty is a hallmark of Asian cosmetic surgery. In the authors' experience, I-shaped implants can elevate and efface the radix, leading to an unnatural appearance (elevated radix deformity).

An Economical Approach to Ethnic Asian Rhinoplasty.

Septal cartilage is deficient in Asians seeking augmentation rhinoplasty. Economized utilization of resources is necessary for durable tip enhancement that complements a dorsal implant. We introduce a modified tongue-in-groove method designed to transmit forces across the dorsum, eliminating the need for robust caudal support and prioritizing nasal lengthening and tip projection.

Scaphoid Proximal Pole Fracture Following Headless Screw Fixation.

Background Headless screw fixation of scaphoid fractures and nonunions yields predictably excellent outcomes with a relatively low complication profile. However, intramedullary implants affect the load to failure and stress distribution within bone and may be implicated in subsequent fracture. Case Description We describe a posttraumatic fracture pattern of the scaphoid proximal pole originating at the previous headless screw insertion site in three young male patients with healed scaphoid nonunions.

The Folded Ulnar Forearm Flap for Nasal Reconstruction.

Background: Many strategies exist to reconstruct composite nasal defects, but free flaps are necessary for extensive defects. The workhorse radial forearm flap is hair-bearing and donor-site cosmesis is unfavorable. The ulnar forearm flap is overlooked despite important aesthetic benefits.

Ectopic Hydrocele After Testicular Transposition.

A 55-year-old man was treated for Fournier gangrene in 2004 with radical debridement and bilateral testicular transposition to the medial thighs. Eight years later, bilateral hydroceles formed. After conservative measures failed for treatment of the hydroceles, the condition was treated during desired testicular relocation, and creation of a neoscrotum.

Proposed pathway and mechanism of vascularized lymph node flaps.

Objective: To investigate the pump mechanism and pathway of lymph transit in vascularized lymph node flaps.

Background: Microsurgical treatment of lymphedema with vascularized lymph node transfer can improve signs and symptoms of disease, but the pathways and mechanisms of these flaps warrant further exploration.

Methods: (Animal model) 72 flaps were raised in 18 rats: 36 groin flaps contained lymph nodes (LN), 36 deep inferior epigastric artery perforator flaps did not (non-LN).

Donor Site Aesthetic Enhancement With Preoperative Botulinum Toxin in Forehead Flap Nasal Reconstruction.

Background: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes.

First-Person Long-term Follow-up Using Autologous Mosaicplasty for Osteochondral Lesion Accompanying Femoral Head Fracture.

Unlabelled: I present my perspective as a patient and surgeon on complete functional recovery after a devastating hip injury. This report represents the longest follow-up in the literature for autologous osteochondral mosaicplasty to treat an osteochondral defect associated with a femoral head fracture. I was 21 years old when I fractured my hip in a skiing accident.

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update.

Background: Indocyanine green (ICG) is a widely available dye of clinical importance that has been used for more than 50 years. Near-infrared (NIR) ICG fluorescence imaging has found a niche in cancer care since 2005, and was reviewed in 2011. There is a need for a comprehensive update and we aim to provide this through a review of the most recent literature.

Digital mobile technology facilitates HIPAA-sensitive perioperative messaging, improves physician-patient communication, and streamlines patient care.

Background: Mobile device technology has revolutionized interpersonal communication, but the application of this technology to the physician-patient relationship remains limited due to concerns over patient confidentiality and the security of digital information. Nevertheless, there is a continued focus on improving communication between doctors and patients in all fields of medicine as a means of improving patient care. In this study, we implement a novel communications platform to demonstrate that instantaneously sharing perioperative information with surgical patients and members of their support networks can improve patient care and strengthen the physician-patient relationship.

An Algorithm for Forefoot Reconstruction With the Innervated Free Medial Plantar Flap.

Background: Because of shearing forces, the forefoot is more prone to trophic ulcers than the heel. Reconstruction of trophic ulcers and other forefoot defects is a vexing challenge. We favor the innervated free medial plantar flap to replace like-with-like and confer protective sensation.

Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps.

Background: Complications arising from anastomotic failure may occur after pharyngoesophageal reconstruction. In this report we present results of pharyngoesophageal reconstruction with free thigh flaps using a refined design and inset strategy in a series of patients.

Methods: From May 2011 to December 2012, pharyngoesophageal oncologic defects were reconstructed in 12 men using thigh flaps.