Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2008
Ear reconstruction following severe complications of otoplasty.
Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. ⋯ While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.
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J Plast Reconstr Aesthet Surg · Jan 2008
Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.
The ability of near infrared spectroscopy (NIRS) to predict vascular compromise in vascular free flaps postoperatively has been assessed, and the extent of regional tissue oxygen saturation (rSO(2)) after fibular flap transplantation was investigated quantitatively. To validate the sensibility and precision of the technique, the following methods were used. (1) Forearm vessel obstructive tests were conducted in four healthy volunteers. (2) Measurement and analysis of bilateral rSO(2) at the mandibular body and ramus were performed in 40 healthy volunteers by NIRS in the morning and afternoon. (3) Measurement and analysis of rSO(2) in transplanted fibular flaps for 41 cases with mandibular reconstruction were performed by NIRS at postoperative days 1-6. The results were: NIRS had high sensibility and precision in monitoring rSO(2) of living tissues. ⋯ However, rSO(2) in the transplanted fibular flaps was reduced compared to the value on the control side. rSO(2) decreased gradually 4-12 hours postoperatively. After that period, rSO(2) increased gradually and approached the value of the control side at 20 h after the operation. It can be concluded that NIRS is a reliable noninvasive method for monitoring blood circulation in transplanted tissues, particularly for buried flaps.
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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.