Utility of Keystone Flap in Armory of Dermatosurgeons.

Purpose And Background: To create awareness among dermatosurgeons about the versatility of keystone flaps in re-surfacing post-excisional small, medium and large skin defects.

Aims And Objectives: Single-staged tension-free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome.

Material And Methods: This retrospective study was conducted, between October 2021 - January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years.

[Secondary reconstruction of the forehead defects].

The forehead is the protective helmet of the brain, if we refer to the etymology of the word calvaria. Destroyed, it must be rebuilt; priority is given to its bone infrastructure, even though we can live without it, as long as the other tissues (skin, muscle, aponeurosis, meninge) are intact. Complex surgical project which will be mentioned when the multiplicity of techniques described demonstrates their imperfection and until now the best restoration of a missing tissue requires its replacement by the same tissue.

Local Flaps for Concomitant Reconstruction of 3 Adjacent Forehead Defects: Is It Feasible?

The cornerstones of forehead reconstruction are the provision of adequate skin paired with a satisfactory cosmetic outcome without hairline and eyebrows distortion. Several techniques have been described over the years to reconstruct sizable defects. Currently, an individualized approach, based on the patient's medical status and needs, the defect characteristics, and the local tissue quality and availability, should be considered for an optimal outcome.

The Nasolabial Flap in Nose Reconstruction: Tips and Tricks Towards Expanded Usage and Optimized Cosmesis.

The nose is the most critical aesthetic element of the face and even the smallest loss of substance can create a deformity of concern. The forehead flap has been the workhorse for nasal reconstruction for centuries but requires multiple surgical steps and leads to prominent donor-site scarring. The nasolabial flap allows a single-step reconstruction with a donor-site scar concealed in the nasolabial crease but is conventionally designated for small defects involving the ala.

Reconstructive Techniques Following Malignant Eyelid Tumour Excision-Our Experience.

: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. : This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient.

The free style "Twin V/Y Nasal Perforator Flaps". An alternative to the forehead flap for nasal tip reconstruction. A case control study.

Introduction: Replacing the skin along the nasal tip remains a challenge. Depending on the extent of the skin loss, various local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully.

Choke Anastomosis: A Key Element Acting as a Shunt Converter Between Adjacent Angiosomes.

Background: Choke anastomosis is commonly recognized as a resistance factor that detrimentally affects the hemodynamics of the skin flap; however, its additional potential physiological roles in normal skin function are currently not fully understood.

Methods: Ten cadaveric forehead flap specimens pedicled with unilateral STAs were perfused with lead oxide-gelatin mixture, and then dissected into 3 layers, including the super temporal fascia-frontalis-galea aponeurotica layer, the subcutaneous adipose tissue layer, and the "super-thin flap" layer. The forehead flap and stratified specimens underwent molybdenum target x-ray and subsequent transparent processing to effectively visualize the microscopic spatial architecture of arterial vessels across all levels.

Full Thickness Nasal Reconstruction With Paired Pericranial and Paramedian Forehead Flaps.

Purpose: The reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed.

A Case of Nasoseptal Flap Reconstruction for Refractory Medial Canthal Fistula.

Sino-orbital cutaneous fistulas (SOCFs) are a rare and challenging complication from conditions including granulomatosis with polyangiitis. SOCFs are difficult to manage due to poor vascular supply, compromised tissue, and systemic immunocompromise, which lead to a high rate of recurrence. Given the overall rarity of SOCFs, optimal surgical repair remains controversial, with options ranging from conservative management, onlay grafts, and vascularized flaps.

Case Report: A new variant of the forehead flap for subtotal nose reconstruction in a single stage: the dragonfly flap.

Background: The forehead flap is probably the most used method for nose reconstruction after cancer resection. During the past century, this technique has been continuously refined to achieve better functional and aesthetic outcomes. Different variations have been described, with the original technique being modified based on tissue loss, the layer to be replaced, and the management of the donor area.

An alternative reconstruction for the complex nasal and facial defect with a thinned anterolateral thigh flap.

Reconstructive surgeons often use a free radial forearm flap for nasal reconstruction when a forehead flap is not an option, but this flap has drawbacks. This article presents a series of patients with complex defects who underwent reconstruction with an anterolateral thigh (ALT) flap. Severe burns and cancer resection may lead to the loss of multiple anatomical units, including the entire nose and nearby structures.

Joseph Pancoast (1805-1882) and His Innovations in Plastic Surgery.

Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his career While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy. Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration.

[Forehead burns].

Severe burns on the forehead are rare; well-conducted initial surgical treatment also limits the occurrence of sequelae. Therefore, indications for repairing the forehead arise from complex burns often extending to adjacent units. Repair techniques depend on the location and size of the lesions, associated nearby damage, and the patient's ability to withstand the burden of treatment.

The Reconstruction of the Nasal Columella Defect Using Domino Flaps.

Skin defects of the total nasal columella can significantly impact both nasal respiratory function and aesthetics. The reconstruction of total columella is a complex process and represents a significant challenge for plastic surgeons. Various factors can cause the loss of the columella.

A New Two-Staged Method for Total Columellar Reconstruction.

The nasal columella is considered by many to be the most difficult nasal aesthetic subunit to reconstruct, due to its delicate anatomy and central location. Full thickness columellar defects are particularly challenging. Being in the midline of the face, the nasal columella receives vascularization from terminal arterial branches, so adjacent local flaps have limited arcs of rotation or may be too bulky, thus withdrawing the options for reconstruction.