Staged upper and lower lip reanimation following facial palsy: Peer-reviewed, patient-rated and objective outcomes.

Background: One approach to reanimating both upper and lower lips following facial palsy is through staged surgery: cross-face nerve grafting at stage I, free gracilis muscle transfer to levators at stage II and pedicled anterior belly of digastric muscle transfer (ABDMT) to depressors at stage III. The results of this approach were hitherto unquantified.

Methods: This study retrospectively assessed peer-reviewed, patient-rated and objective outcomes following staged reanimation in adults between 2010 and 2020.

Lower lip depressor reanimation using anterior belly of digastric muscle transfer improves psychological wellbeing in facial palsy patients.

The authors previously published positive peer-reviewed (21 raters using the Terzis scale) and photogrammetric (Emotrics) outcomes in patients who had undergone two-stage lower lip reanimations up to 2018. Other series have published surgeon and peer-rated results, but we know of only two (n=12) that have assessed patients' views using patient satisfaction surveys. This paper presents patient-rated outcomes (PROMS) in an 11-year series of both single and two-stage anterior belly of digastric muscle (ABDM) lower lip reanimations.

Long-term outcomes of dual innervation in functional muscle transfers for facial palsy.

Background: This study describes a different approach with a 2-stage facial reanimation in patients with long-standing unilateral facial paralysis using free gracilis muscle transfer, innervated by both cross-facial nerve graft and masseteric nerve. The authors present their rationale, surgical technique, and long-term outcomes.

Methods: Between August 2012 and March 2016, 11 patients (6 female and 5 male patients) underwent a 2-staged dually innervated gracilis muscle transfer.

Lower Lip Reanimation: Experience Using the Anterior Belly of Digastric Muscle in 2-stage Procedure.

Unlabelled: Lower lip depression was historically regarded a neglected area of facial paralysis, but, with refinement of techniques, has gained increasing attention. We present the first detailed description and evaluation of a 2-stage technique, using first cross facial nerve graft and then the anterior belly of digastric muscle (ABDM), innervated by the cross facial nerve graft, to restore dynamic and spontaneous lower lip depression.

Methods: Retrospective analysis of 2-stage lower lip reanimations between 2010 and 2018 was performed.

Outcomes of major head and neck reconstruction during the COVID-19 pandemic: The St. Andrew's centre experience.

Background: The coronavirus disease-2019 (COVID-19) pandemic has generated enormous pressure on healthcare establishments, prompting the restructuring of services to rationalise resources. Complex head and neck reconstructive surgery in this setting may carry substantial risk to patients and staff. This paper outlines the management strategy and outcomes of major head and neck oncological cases at a single regional tertiary referral centre.

The mini-temporalis turnover flap for midface reanimation: Photogrammetric and patient-rated outcomes.

Background: Mini-temporalis transposition (MTT) flaps, modified from Gillies' technique, have become less popular than temporalis tendon transfers for midface reanimation. MTT involves raising the middle third of the temporalis, transposition over the zygomatic arch and lengthening with deep temporalis fascia which is sutured to the orbicularis oris.

Aim: This retrospective study assessed subjective and objective outcomes following MTTs by a single surgeon from 2009 to 2019.

Primary cutaneous osteosarcoma of the scalp.

Primary cutaneous extraskeletal osteosarcoma (PCEO) is a rare malignant neoplasm with less than 20 cases reported in the literature to date. Presenting as a nodule or mass on the skin, commonly at sites of previous trauma or radiation, these lesions are differentiated from other neoplasms through their characteristic microscopic appearance. This report highlights a case of PCEO in a 75-year-old man with a history of squamous cell carcinoma (SCC) of the scalp.

Bell's palsy: a summary of current evidence and referral algorithm.

Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement.

Single flap reconstruction for complex oro-facial defects using chimeric free fibular flap variants.

In this article, we describe the use of chimeric free fibular flaps to reconstruct three-dimensional spatial defects in the orofacial region. Recent insights into permutations possible with the chimeric fibular flap have allowed us to achieve our reconstructive objectives with a single chimeric flap and minimise donor-site morbidity as well as operating time. In an overall series of 34 free fibular flaps from 2009 to 2012, we performed twelve cases of free chimeric fibular flaps with osseo-myo-cutaneous/OMC (n=7), multi-pedicled osseo-musculo-cutaneous/Mp-OMC (n=4) and multi-pedicled osseo-cutaneous/Mp-OC (n=1) variants for either post-excisional defects or osteo-radionecroses.

The 'double headed slug flap': a simple technique to reconstruct large helical rim defects.

Reconstructing partial defects of the ear can be challenging, balancing the creation of the details of the ear with scarring, morbidity and number of surgical stages. Common causes of ear defects are human bites, tumour excision and burn injuries. Reconstructing defects of the ear with tube pedicled flaps and other local flaps requires an accurate measurement of size of the defect with little room for error, particularly under estimation.

Gustilo IIIC fractures in the lower limb: our 15-year experience.

Controversy continues to surround the management of patients with an open fracture of the lower limb and an associated vascular injury (Gustilo type IIIC). This study reports our 15-year experience with these fractures and their outcome in 18 patients (15 male and three female). Their mean age was 30.

Essays on the facial nerve: Part I. Microanatomy.

Background: Facial nerve explorations and microstimulation of distal nerve branches during facial reanimation procedures by the senior author (J.K.T.

Necrotizing fasciitis following drainage of Streptococcus milleri empyema.

Streptococcus milleri (SM) is a heterogeneous group of Streptococci, which is a recognized cause of purulent infections of the mediastinal and pleural spaces. These infections are notoriously resistant and require aggressive surgical management. We present our experience with a 60-year-old patient, who developed necrotizing fasciitis of the chest wall after initial bedside drainage of a SM empyema.

Outcomes of mini-hypoglossal nerve transfer and direct muscle neurotization for restoration of lower lip function in facial palsy.

Background: Most reconstructions for lower lip palsy focus on paralyzing the contralateral normal lip or providing static support on the affected side. The authors' unit has reported dynamic strategies for lower lip reanimation and use of 40 percent of the hypoglossal nerve (mini-hypoglossal) in facial reanimation. They report their experience with mini-hypoglossal nerve transfer for lower lip palsy.

"Babysitter" procedure with concomitant muscle transfer in facial paralysis.

Background: The "babysitter" procedure combines cross-facial nerve grafting with segmental transfer of the hypoglossal to the affected facial nerve. Introduced by Terzis in 1984, the technique can produce satisfactory to excellent results. In long-lasting paralysis, nonetheless, the babysitter procedure may need to be combined with a muscle(s) flap(s) for outcome upgrading, which was the focus of the present study.

Prostaglandin EP2 and EP4 receptor agonists in bone formation and bone healing: In vivo and in vitro evidence.

Background: Using agonists that selectively stimulate PGE2 receptors, the adverse effects that have limited the clinical utility of PGE2 can be avoided and there may be potential for their use as therapeutic agents in the treatment of bone loss in humans.

Objective: A comprehensive review of the recent literature on the effect of prostaglandins and their agonists on bone mineral density and fracture healing.

Methods: In vitro and in vivo evidence was collected using medical search engines MEDLINE (1950 to March 2008) and EMBASE (1980 to March 2008) databases.

The "babysitter" procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting.

Background: In 1984, Terzis introduced the "babysitter" procedure, a new concept in facial reanimation. It involves two stages, with coaptation of ipsilateral 40 percent hypoglossal to facial nerve on the affected side, performed concomitantly with cross-facial nerve grafting and secondary microcoaptations 8 to 15 months later. This article presents the senior author's (J.

Review of community-referred hand infections.

Purpose: A retrospective review is presented of 76 patients with infections of the hand, referred from the community and admitted to our plastic surgery unit for treatment over a 30 month period.

Methods: Retrospective chart review and review of the pertinent English-language literature.

Results: The majority of the patients (82%) were male.

Evaluation of the factors related to postmastectomy breast reconstruction.

A retrospective study was conducted in 75 consecutive patients requiring postmastectomy breast reconstruction over a period of 30 months. Each woman was offered one of the following four reconstructive options: free transverse rectus abdominis musculocutaneous flap (total number of reconstructions, n = 34); latissimus dorsi musculocutaneous flap (with or without expander and implant, n = 14); endoscopically assisted harvest of the latissimus dorsi muscle (with expander and implant, n = 13); and application of expander and implant only (n = 12). Of those patients originally selected for retrospective study, six did not meet the short-term prognostic criteria, and concerted attempts to contact two others proved unsuccessful.

Endoscopically assisted gracilis harvest for use as a free and pedicled flap.

Endoscopic assistance in soft tissue surgery may prove to greatly aid in the improvement of cosmesis and reduction of morbidity in certain procedures. The scar produced from open gracilis harvest is the most common complaint following surgery. We present five cases of endoscopically assisted gracilis harvest for use as a neosphincter and in foot reconstruction.