Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2008
Microtia: ear reconstruction using tissue expander and autogenous costal cartilage.
Ear reconstruction is one of the most challenging surgeries faced by the reconstructive surgeon. Currently, the use of autogenous costal cartilage is still best practice for microtia reconstruction. However, the relative deficiency of thin skin for coverage of the cartilage framework remains a limiting factor. ⋯ All these innovations may solve the deficiency of the skin and improve cartilaginous framework definition. In conclusion, tissue expander offers a non-hairbearing, thin, well-vascularised skin to envelope an erect, contour-accentuated framework. Most patients with microtia are satisfied with their ear reconstruction.
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J Plast Reconstr Aesthet Surg · Jan 2008
Skin tension or skin compression? Small circular wounds are likely to shrink, not gape.
The final appearance of a scar may be influenced by tension or mechanical factors [Borges AF. Scar prognosis of wounds. Br J Plast Surg 1960;13:47-54; Arem AJ, Madden JW. ⋯ J Invest Dermatol 1966;46:341-6] of skin has individual components which are under tensional force due to elastic retraction. Wounds smaller than the rhomboidal unit will reduce in area, due to the intact tensional forces in the individual dermal components, giving an appearance of the skin overall being under compression. Larger wounds, disrupting more of the lattice structure, will gape.
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Release and autografting remains a mainstay of treatment of cutaneous and joint-associated contractures. However, owing to secondary contraction of grafts and the increase of children undergoing burn reconstructive surgery, recurrence of contractures is not uncommon. Locally available, well-vascularised tissue that will contract minimally and grow with the patient is the ideal for contracture release. ⋯ Only one patient required a skin graft to close the flap donor site, and no patients required revisional surgery for contracture recurrence. The ad hoc perforator flap is a safe and simple technique for the management of contractures, and fulfils the ideal of well-vascularised tissue that can grow with the patient. The flap can be designed as required and, with experience, the concept is applicable not only to contracture release, but many other reconstructive scenarios.
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J Plast Reconstr Aesthet Surg · Jan 2008
Burned ear: the use of a staged Nagata technique for ear reconstruction.
Four features, manifested in various combinations, characterise deformity in the burned ear: (i) the presence of scarred skin at the site of and surrounding the ear, with dramatic loss of skin elasticity; (ii) the presence of longitudinal scars of the pinna due to previous drainage of the perichondritis as an initial trial for saving the ear; (iii) absence of different components of the framework of the ear, mostly the helix/antihelix complex (the cartilage-containing part) with or without the ear lobule; (iv) scarred chest wall due to associated burns of the skin of the chest. In the face of these deformities, the surgical goals for auricular reconstruction include the following: (i) removal of the remaining cartilage of the burned ear, part or the whole of it in severe cases, because it may be a source of infection; (ii) wide exposure of the cartilage of the ribs through sufficient chest wall incision to overcome the severe fibrosis of the burned chest wall skin; (iii) creation of delicate smooth cartilage framework, free of sharp edges; (iv) creation of a skin pocket of sufficient size. ⋯ There was a good colour match between the reconstructed auricle and the surrounding skin. Patient satisfaction was high and the results were well accepted.