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The fat-augmented latissimus dorsi myocutaneous flap can overcome the volume insufficiency of latissimus dorsi flaps by immediate fat grafting into the flap. When breast skin supplementation is unnecessary, latissimus dorsi flaps can be harvested as a muscle flap to avoid an additional back incision. Here, we compared the efficacy of fat-augmented latissimus dorsi myocutaneous and muscle flaps in total breast reconstruction. We retrospectively reviewed 94 cases of unilateral total breast reconstruction using fat-augmented latissimus dorsi flaps (muscle: 40, myocutaneous: 54) at our hospital from September 2017 to March 2022. The muscle flap group had a significantly shorter operative time than the myocutaneous flap group (p < 0.0001). Mastectomy specimen weight did not differ between the 2 groups, but total flap weight in the muscle flap group was significantly lower (p < 0.0001). Conversely, total fat graft volume, fat graft volume to the latissimus dorsi flap, and fat graft volume to the pectoralis major muscle were significantly greater in the muscle flap group (p < 0.0001, p < 0.0001, and p = 0.02, respectively). The percentage of cases requiring additional fat grafting was significantly higher in the muscle flap group, but postoperative esthetic evaluation did not significantly differ between the 2 groups. Both groups scored high on each BREAST-Q item, but the muscle flap group scored significantly higher for "Satisfaction with Back." Although the frequency of additional fat grafting was higher than with fat-augmented latissimus dorsi myocutaneous flaps, total breast reconstruction with fat-augmented latissimus dorsi muscle flaps is a viable technique with a short operative time and high patient satisfaction. [ABSTRACT FROM AUTHOR]

No effective methods currently exist for breast neurotization in implant-based breast reconstruction. Here, we focused on direct neurotization (DN), in which axons regenerating from nerve stumps are directed to the mastectomy flap and aimed to assess whether DN can generate a new mechano-nociceptive field using a rat model of back skin sensory denervation. Dorsal cutaneous nerves (DCNs) of rats were exposed and transected, leaving only the left medial branch of the DCN of thoracic segment 13 (mDCN-T13) intact. This procedure resulted in an isolated innervated field surrounded by a denervated field. The mDCN-T13 was transected, and the proximal nerve stump was sutured to the subdermis (DN subdermal group, n = 6) or dermis (DN dermal group, n = 5) of a different region of the denervated field. In the Crush group (n = 5), the intact mDCN-T13 was only crushed. We evaluated the generation of a new mechano-nociceptive field over time using the cutaneous trunci muscle (CTM) reflex test and histomorphometrically evaluated regenerating nerves in the reinnervated region. In the DN groups, the CTM reflex appeared in the DN area after postoperative week 4. The new mechano-nociceptive field gradually expanded afterwards, and by postoperative week 12, the area was substantially larger than the original region innervated by the mDCN-T13 in the DN dermal group, although not as large as that in the Crush group. In histomorphometric evaluations, many S100-positive myelinated fibers were observed in the dermis of the reinnervated area for all groups. In targeted sensory reinnervation, DN of the skin is revolutionary in that it allows a new innervated area to be generated at a desired location regardless of whether a distal nerve stump is available. DN may present an effective approach for breast neurotization in breast reconstruction after mastectomy, particularly for procedures that cannot use sensate flaps such as implant-based breast reconstruction. [ABSTRACT FROM AUTHOR]

Immediate fat grafting to the latissimus dorsi myocutaneous (LD) flaps is a breakthrough that addresses the issue of insufficient volume of LD. However, the use of this procedure in Asian patients has not yet been reported. Retrospective chart reviews were conducted on 54 Japanese cases of total breast reconstruction using fat-augmented LD flaps at our hospital from September 2017 to June 2019. There were 24 immediate reconstruction cases, 18 immediate two-stage reconstruction cases, nine delayed reconstruction cases, and three delayed two-stage reconstruction cases. Median age was 46 years (range, 29–69 years), and median body mass index was 21.5 (17–33.8). Median mastectomy specimen and flap weight was 225 g (123–993) and 225 g (130–796), respectively. The median volume of fat graft was 114 ml (46–305) for the LD flap and 58 ml (15–200) for the pectoralis major muscle. Of the 53 completed reconstruction cases, 38 (71.7%) achieved sufficient volume with the initial operation and six (11.3%) required additional fat grafting. The proportion of cases in the immediate reconstruction group, which achieved sufficient volume in the initial operation was significantly higher than those of the other three reconstruction groups (p = 0.007). Total breast reconstruction with fat-augmented LD flaps is a viable procedure for thin patients who have insufficient abdominal tissue, for those who wish to avoid abdominal scars, and for those in whom abdominal flaps have already been used. The procedure allows for large volume transplantation even with small skin paddles, which allows for smaller skin paddles to be designed without the need for extensive subcutaneous dissection. [ABSTRACT FROM AUTHOR]

Summary Background Multiple-branch reconstruction is required in order to attain facial reanimation for extensive facial nerve defects. We previously reported that end-to-side nerve grafting, with the use of a single nerve graft for defect reconstruction, was easy to perform. We have also demonstrated the efficacy of end-to-side nerve suture of the recipient nerve to the donor graft nerve, in experimental rat models and clinical cases. The regenerating axons, which extended into the nerve graft, were “distributed” to multiple recipient nerves via end-to-side nerve-suture sites. Methods Thirty-two patients who underwent facial nerve reconstruction (five to 10 branches) had a single sural nerve graft coapted to the proximal stump of the facial nerve in an end-to-end manner, followed by end-to-side nerve suture of the recipient nerve stumps to the side of the nerve graft. In 19 patients who were expected to undergo postoperative radiotherapy and/or chemotherapy, the distal end of the graft was connected to the side of the hypoglossal nerve for “axonal supercharging,” to enhance the recovery of the facial muscles. Results Initial facial movements were noted at 5–12 months postoperatively, and good recovery (House–Brackmann grade III/IV) was observed during long-term follow-up in most patients. Conclusion End-to-side nerve suture of the recipient nerve stumps to the nerve graft requires less graft nerve material and less technical mastery to reconstruct multiple branches of the facial nerve. We also described the concept of “axonal supercharging,” namely the connection of double-donor neural sources to the graft, and “axonal distribution,” namely the reinnervation of multiple recipient nerve stumps connected to the graft in an end-to-side manner. This combination of axonal supercharging and distribution can be a useful option in facial nerve reconstruction. [ABSTRACT FROM AUTHOR]

Summary Local flaps and composite grafting are the procedures of choice for reconstructing relatively small soft tissue defects. However, despite their limited conveyable volume, local flaps sometimes require a wide dissection area and long new incisions. Composite grafts also have serious limitations and require a well-vascularized recipient bed. To overcome these limitations, we used a free vascularized perivascular tissue flap based on the descending branch of the lateral femoral circumflex artery. Using this method, we performed reconstructions for seven patients (four cases in head and neck region and three cases in lower limb) with various soft tissue defects (ranged from 4.0 cm 3 to 40.0 cm 3 ). This flap was easily elevated, without the need for precise preoperative flap design, and the flap volume was adjustable regardless of whether deep fascia and muscle were included. The flap has a rich vascular supply, which allows bone and cartilage tissue to be combined with the transfer of soft tissue, and satisfactorily treats chronic wounds with poor blood supply. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no well-known indicator that can assist with a precise intranasal incision during open rhinoplasty on the caudal border of the lower lateral cartilage. However, the vibrissae-bearing area is clinically known as a good landmark for cartilage. The aim of this study was to investigate the features of the vibrissae-bearing area in relation to the lower lateral cartilage. Methods: Twenty-four heminoses of fixed Japanese cadavers were dissected to clarify the anatomical location of the vibrissae-bearing area in relation to the lower lateral cartilage. Results: The medial part of the vibrissae-bearing area was precisely located on the medial crus of the lower lateral cartilage. Via a transitional state at the dome, the lateral part was located cephalic to the lateral crus in a manner in which the vibrissae-bearing area was adjacent to the lateral crus (adjacent type) in 22 cases, whilst the vibrissae-bearing area overlapped the lateral crus to some extent (overlap type) in two cases. Conclusions: The anatomical location of the vibrissae-bearing area in relation to the lower lateral cartilage is almost uniform, suggesting its utility as an open rhinoplasty incision landmark. [Copyright &y& Elsevier]

Summary: Auricular composite grafts represent a well-established technique in facial reconstruction surgery, with several advantages including high survival rate as well as less contraction and good colour match. Although the revascularisation of composite grafts reportedly occurs by inosculation and angiogenesis through both the dermal-dermal connections and the wound bed, we hypothesised that the auricular dermis might have a distinct vascular profile as compared with other regions, that might contribute to the high survival rate of auricular composite grafts. To elucidate this hypothesis, we investigated the dermal vascular profiles of several regions in fresh cadavers using a von-Willebrand factor antibody-binding technique. We assessed the vascular profiles by calculating the blood vessel density and the endothelial surface. Furthermore, we present herein some clinical cases using novel composite grafts in which graft revascularisation was likely based on the dermal-dermal connections. There was a positive correlation between the blood vessel density and the endothelial surface. We found that the postauricular dermis had a significantly richer vascularity than other skin graft donor sites such as the peri-clavicle, groin, back, buttocks and thigh, whereas the scalp and sole demonstrated an abundant vascularity as the postauricle. Unexpectedly, the cheek dermis, which is just adjacent to the auricular region, had a poor vascular profile. Because of its rapid and reliable revascularisation through dermal-dermal connections, the auricular composite graft should be more widely used in reconstructive surgery. It offers an especially good alternative in treating intractable ulcers and in tracheal reconstruction. [Copyright &y& Elsevier]

Summary: Background: The effectiveness of end-to-side nerve graft for multiple branch reconstruction was confirmed using a new rat four-branch facial nerve reconstruction model with end-to-side cross-face nerve graft. Methods: Forty Lewis rats were randomly divided into four groups with different reconstruction methods for four branches (bilateral buccal and marginal branches) of the bilateral facial nerves as follows: group I (n =12), single sciatic nerve graft with end-to-side neurorrhaphy; group II (n =12), four cable grafts using two sciatic and two ulnar nerves with end-to-end neurorrhaphy; group III (n =8), no repair; and group IV (n =8), sham operation. The four groups were compared with double retrograde tracing of the facial nucleus, electrophysiological and histomorphometrical assessment of the reconstructed facial nerve. Results: Although there were no significant differences between groups I and II in the electrophysiological tests, group I showed more uniform and better reinnervation in the histomorphometrical assessment. Retrograde tracing of facial nucleus revealed significantly higher number of double-labeled neurons in group I although the total number of labeled neurons was not different between the two groups. Conclusions: End-to-side nerve graft shows a good functional recovery, requires less graft, and is easy to perform. With the availability of the side of the nerve graft itself as a nerve coaptation site, it can be an effective alternative in facial nerve reconstruction and be of great value in various kinds of peripheral nerve surgery. [Copyright &y& Elsevier]

Summary: Objective: The superior orbital fissure syndrome results from damage to the nerves passing through the superior orbital fissure. In the present case, the superior orbital fissure syndrome developed after repair of facial bone fractures, although the symptoms were not observed before surgery and no obvious cause was found. To investigate the aetiology of this syndrome, we examined the superior orbital fissure anatomically. Methods: We measured the width of superior orbital fissure on the horizontal plane including the optic canal using the computed tomography (CT) scans of other patients and cadavers. Results: The results indicated that the width was 3.73±1.64mm in the CT scans of patients and 3.21±1.09mm in the cadavers. There was no significant difference between the width in the CT scans and cadavers. The width in the present patient on the affected side was 1.6mm, that is relatively narrow. Conclusion: After operation, narrow superior orbital fissure may reduce the tolerance to compression of the nerves by oedema. We consider the narrow superior orbital fissure as a risk factor for superior orbital fissure syndrome. When the superior orbital fissure is congenitally narrow, the surgeons should try to avoid excessive pulling of the bone fragment and compression of the orbital tissue during repair of the facial bone fractures. [Copyright &y& Elsevier]