Search

Background: Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals., Objectives: Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects., Methods: Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics., Results: Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83 ± 4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81 ± 1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10 ± 5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2 ± 1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection., Conclusions: The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: When traditional V-Y advancement flaps cannot span cutaneous defects, the modified Pacman™ V-Y advancement flap (Pacman™ VYAF) design increases its utility for challenging facial defects., Objective: To describe the usage and surgical outcomes of Mohs micrographic surgery (MMS) defects repaired with the Pacman™ VYAF., Methods: A retrospective review was performed on MMS defects repaired with the Pacman™ VYAF in the division of dermatologic surgery at a large academic institution between January 01, 2013 and August 01, 2019., Results: Twenty-nine instances of Pacman™ VYAF reconstructions were identified. Reconstruction of the cheek (22/29, 76%) was the most common, followed by the temple (4/29, 14%), and the post-auricular neck (3/29, 10%). Distal flap necrosis occurred more frequently in large Pacman™ VYAF repairs (6/29, 21% of cases), requiring surgical revision in 1 case. Surgical scars from the Pacman™ VYAF are rated favorably by dermatologic surgeons., Conclusion: The Pacman™ VYAF is a useful reconstruction option for surgical defects of the head and neck, and it is advantageous compared to traditional V-Y advancement flaps for defects with length greater than width., Competing Interests: Declaration of Competing Interest Conflict of interest: none. No authors involved in the production of this manuscript have any commercial associations that might create or pose a conflict of interest with information presented herein. Such associations include consultancies, stock ownership, or other equity interests, patent licensing arrangements, and payments for conducting or publicizing a study described in the manuscript. JFS and JRE are supported by a Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Scalp wounds pose reconstructive challenges due to the lack of skin elasticity, potential for compromised adjacent tissue, and desire for the restoration of esthetic contour. Bilayer Wound Matrix (BWM) has been successfully employed as a treatment modality for complex, full-thickness wounds of the scalp. We aimed to highlight risk factors for BWM success and failure in complex wounds of the scalp., Methods: A retrospective case-control study was performed from 2012 to 2019 of adult subjects who presented to plastic or dermatological surgery with complex scalp defects with or without exposed calvarium, who underwent staged reconstruction with BWM and split-thickness skin grafting or secondary intention. Success was defined as complete wound re-epithelialization within 90-day follow-up without additional operative procedures for wound coverage. Demographics, comorbidities, treatment history, wound characteristics, and clinical course were analyzed and correlated with reconstructive outcomes., Results: In total, 127 subjects were identified for inclusion, with mean age 74.6 ± 12.2 years, defect area 80.2 ± 89.4 cm 2 , and wound age 10.0 ± 65.4 days. Successful wound reconstruction occurred in 107 (84%) subjects. Postoperative wound infections were an independent predictor of BWM failure at 90 days (Odds Ratio: 6.4, 95% Confidence Interval: 1.5 - 26.7, and p<0.012). Additionally, subjects who underwent preoperative radiation were more likely to suffer from reconstructive failure (p<0.040) as well as those who require postoperative inpatient admission (p<0.034)., Conclusion: BWM represents a reliable and efficacious modality in the treatment of complex scalp wounds. Patient comorbidities may not heavily influence the success of BWM to establish adequate wound coverage; however, preoperative radiation and postoperative wound infection may often lead to reconstructive failure., (Copyright © 2021 Elsevier Ltd. All rights reserved.)