Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction.

Objective/hypothesis: To assess the use of a three-dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction.

Study Design: Cohort study.

Methods: A 3D printed facial flap simulator was designed from a computed tomography scan and manufactured out of silicone for low-cost, high-fidelity simulation.

Reconstruction of the Nose.

Nasal reconstructive techniques have advanced significantly over the past 50 years. Modern techniques in nasal reconstruction are based on the nasal aesthetic subunits. In order to achieve ideal outcomes, reconstructive surgeons must consider differences in tissue qualities across the nasal aesthetic subunits and formulate reconstructive plans based on these differences.

Efficacy of Staged Excision With Permanent Section Margin Control for Cutaneous Head and Neck Melanoma.

Importance: Melanoma arising in chronically photodamaged skin, especially on the head and neck, is often characterized by poorly defined clinical margins and unpredictable occult extension. Staged excision techniques have been described to treat these challenging melanomas.

Objective: To investigate the local recurrence rates and margin to clearance end points using staged excision with comprehensive hematoxylin-eosin-stained permanent section margin control.

Cervicofacial Rhytidectomy After Radiotherapy for Head and Neck Tumors.

Importance: Whether undergoing cervicofacial rhytidectomy after radiotherapy for tumors of the head and neck is associated with increased complication rates and therefore should be avoided remains unknown.

Objective: To evaluate complication rates in patients who have undergone cervicofacial rhytidectomy after radiotherapy for head and neck tumors and compare these rates with those of patients who have not undergone radiotherapy.

Design, Setting, And Participants: Retrospective review of the medical records of 16 patients who underwent cervicofacial rhytidectomy after completing radiotherapy for head and neck tumors and those of 16 age-matched control participants who did not undergo radiotherapy.

A novel flap technique for repairing large lower lip defects.

Unlabelled: There are many well-established methods for the reconstruction of the lower lip. The selection of a particular method generally relies on the amount of lip resected and the amount of lip remaining. In cases of large defects (>50% of the lip length) where direct closure and lip-switch techniques are inadequate, a perioral flap is used.

Anticoagulant complications in facial plastic and reconstructive surgery.

Importance: The decision whether to discontinue antiplatelet and/or anticoagulant medications before a facial plastic surgical procedure is a complicated and multifactorial process that involves weighing the risk of perioperative thromboembolic complications with bleeding-related complications.

Objective: To determine the complication rates in patients who undergo a range of facial plastic surgical procedures while receiving antiplatelet and/or anticoagulation therapy.

Design, Setting, And Participants: A total of 9204 surgical procedures from January 1, 2007, through December 31, 2012, at an academic medical center and its affiliated surgical sites were analyzed, with patients who continued receiving antiplatelet and/or anticoagulation (aspirin, clopidogrel bisulphate, and warfarin sodium) therapy during the perioperative period identified and compared with a matched case-control group of patients who did not receive antiplatelet and/or anticoagulation therapy during this period.

Transcutaneous lower blepharoplasty with fat transposition.

Fat preservation lower lid blepharoplasty is the authors’ preferred technique for surgical rejuvenation of the aging lower lid. Key technical refinements are overlaid on a conceptual framework developed over the past 2 decades by several investigators. The use of the orbicularis oculi muscle suspension flap is a useful adjunct to the transcutaneous approach to lower lid blepharoplasty.

Local flaps: cheek and lip reconstruction.

Importance: The reconstruction of cutaneous defects of the cheek and lip is a foundational topic for facial plastic and reconstructive surgeons. Facial defects have a significant impact on patient quality of life that has been well demonstrated.

Objective: To review new findings that have an impact on the planning and understanding of local flaps for the reconstruction of cutaneous defects of the cheek and upper lip; recent research in facial soft-tissue anatomy and vascular anatomy is integrated into a discussion of local flap reconstruction.

Age-related histologic changes in human nasal cartilage.

Importance: Understanding age-related changes is important when considering cartilage-based implants or grafts during rhinoplasty and nasal reconstructive surgery.

Objective: To characterize the cellular and architectural changes in human nasal cartilage with aging.

Design: Laboratory study.

Full-thickness skin graft overlying a separately harvested auricular cartilage graft for nasal alar reconstruction.

Objective: To evaluate the aesthetic and functional outcomes of a full-thickness skin graft and a separately harvested auricular cartilage graft for nasal alar defects created by Mohs micrographic surgery.

Design: Twenty patients with deep Mohs micrographic surgery defects of the nasal ala who underwent reconstruction with a full-thickness skin graft and an auricular cartilage graft were prospectively studied at a single tertiary care institution between 2010 and 2011 in a nonrandomized, nonblinded study. An ordinal 5-point Likert scale evaluation of overall outcomes was performed by 4 independent surgeon raters.

Correction of caudal septal deviation and deformity using nasal septal bone grafts.

Objectives: To describe our technique of using septal bone grafts for correction and stabilization of caudal septal deviation and to evaluate the effectiveness of this technique in the treatment of the deviated caudal septum.

Methods: A retrospective review of 81 patients who underwent open septorhinoplasty using septal bone grafts for correction of a caudal septal deviation or deformity and nasal obstruction. We reviewed medical records to determine postoperative outcomes in nasal obstruction and caudal septal position.

Esthetic enhancements in upper blepharoplasty.

Traditional upper blepharoplasty typically involves resection of excess upper eyelid skin and muscle with or without fat excision. Well-established concepts in periorbital aging have been challenged by newer morphologic and histologic studies that have characterized the changes that occur in the various periorbital soft tissue components. Several modified or adjunctive techniques have recently emerged to improve esthetic outcomes in upper blepharoplasty.

Outcomes following V-Y advancement flap reconstruction of large upper lip defects.

Objective: To characterize revision surgery following V-Y subcutaneous tissue pedicle advancement flap repair of large upper lip skin defects.

Methods: Retrospective review of upper lip skin defects at least 3.0 cm(2) in area that were reconstructed with a V-Y subcutaneous tissue pedicle advancement flap at an academic tertiary care center.

Methicillin-resistant Staphylococcus aureus-associated infections following septorhinoplasty.

Septorhinoplasty is associated with postoperative infection in less than 2% of cases, even without the use of prophylactic antibiotics. However, there is a concern that increasingly prevalent, highly virulent pathogens such as MRSA may predispose to postoperative infections. Over the past several decades, MRSA has emerged as the most important cause of antibiotic-resistant nosocomial infection.

Diced cartilage augmentation: early experience with the Tasman technique.

Numerous methods have been used for dorsal augmentation in reconstructive and aesthetic rhinoplasty. The Tasman technique is a method for dorsal augmentation using diced cartilage solidified by tissue sealant. This article describes the author's early experience using the Tasman technique and offers some helpful suggestions to surgeons who might wish to use this unique method of preparing a cartilaginous graft.

Patient assessment of psychosocial dysfunction following nasal reconstruction.

Background: Postoperative psychosocial distress is a critical aspect of surgery, particularly in aesthetically sensitive areas. In this study, the authors assess the level of psychosocial distress associated with nasal reconstruction. The authors also compare postoperative distress levels associated with different reconstructive techniques throughout the healing process.

Reconstructive perspectives of cutaneous defects involving the nasal tip: a retrospective review.

Objectives: To create an algorithm that derives our preferred reconstruction technique for cutaneous defects involving the nasal tip and to review the management and outcomes of patients with nasal tip cutaneous defects after their initial reconstruction.

Methods: A retrospective review of patients undergoing repair of cutaneous defects involving the nasal tip between January 2006 and January 2009. After data compilation, a defect-based algorithm deriving our repair technique was created.

Transposition flaps in nasal reconstruction.

The aim of reconstructive nasal surgery is not only to rebuild all or part of the nose but also to blend and tailor the new and old tissues in such a way as to create the best possible result. Although a variety of reconstructive options exist, local or regional skin flaps are one of the most powerful reconstructive tools for the reconstruction of cutaneous nasal defects. This article discusses the fundamentals of nasal reconstruction and describes the local and regional transposition flaps for the reconstruction of nasal defects.

Clinical consensus statement: Diagnosis and management of nasal valve compromise.

Objective: To create a clinical consensus statement to address ambiguities and disparities in the diagnosis and management of nasal valve compromise (NVC).

Subjects And Methods: An updated systematic review of the literature was conducted. In addition, a Modified Delphi Method was used to refine expert opinion and facilitate a consensus position.

Key issues in nasal reconstruction.

Purpose Of Review: To review recent research and advances in nasal reconstruction over the last 12 months.

Recent Findings: Although the major principles of replacing surgically ablated tissues with like tissue and respecting the nasal aesthetic subunits have not changed, recent advances in nasal reconstruction have focused on producing superior aesthetic and functional results, while minimizing deformity and morbidity. Future directions may also include the application of allotransplantation and tissue engineering.