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Flap surgery is a common method used to cover defects following tumor ablation, trauma, or infection. However, insufficient vascularity in the transferred flap can lead to flap necrosis and failure. Proper postoperative monitoring is essential to prevent these complications. Recently, research has explored the use of infrared thermal imaging in plastic surgery, leading to its clinical application. This study comprises two separate parts: an in vivo experimental study and a clinical study. In this study, 28 rats underwent reverse McFarlane flap surgery, and their flaps were analyzed using a FLIR thermal imaging camera seven days post-surgery. Additionally, thermal images of flaps were taken on postoperative days 0, 1, 2, 3, and 7 in 22 patients. This study focused on temperature differences between normal skin and the perforator compared to the average flap temperature. Results showed that the temperature difference was higher in the necrosis group and increased over time in cases of total necrosis. A lower perforator temperature compared to the flap's average indicated vascular compromise, potentially leading to flap failure. The FLIR camera, being contact-free and convenient, shows promise for understanding and inferring the clinical progression of flaps in postoperative monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Flaxseed is known for its anti-inflammatory and antioxidant properties, which could be attributed to periodontal wound healing. Early wound healing contributes to favourable treatment outcomes. Glutathione peroxidase is a ubiquitous antioxidant biomarker known for its scavenging action of free radicals, thereby maintaining the health of periodontal tissues. Aim: To evaluate the additive effect of brown flaxseed gel following surgical periodontal therapy. Materials and Methods: This randomised controlled trial was conducted at the Department of Periodontics, Saveetha Dental College in Chennai, Tamil Nadu, India from November 2023 to February 2024. Total of 30 patients were included in the study, with 15 patients in the control group and the other 15 patients (test group) were administered brown flaxseed gel following flap surgery. The included patients were allocated into test and control groups through simple randomisation. Postoperative flap surgery, the Early Healing Index (EHI), and healing scores were evaluated at the 1st and 2nd weeks. Salivary glutathione peroxidase levels were also assessed at the 1st and 2nd weeks following periodontal therapy. An Independent t-test was used to compare the mean values between the test group and the control group. Results: The mean age of the eligible participants was 35.6±4.57 years. Better healing was observed in the test group compared to the control group in the 1st postoperative week, as recorded by the EHI with a mean of 2.96±0.90 in the test group and 2.06±0.70 in the statistically significant control group. Salivary glutathione levels were significantly increased in the test group with a mean concentration of 14.1±.78 mu/mL and 10.5±0.42 mu/mL in the control group at the end of the 2nd week, respectively. Conclusion: Brown flaxseed gel is an efficacious therapeutic agent in improving periodontal wound healing and also has prudent antioxidant activity. [ABSTRACT FROM AUTHOR]

Aim of the Study: To describe methods and outcomes of using the forehead flap for reconstruction in patients with diverse facial defects. Patients and Methods: A retrospective analysis was conducted on patients who underwent forehead flap surgery for facial defect reconstruction at our centre between January 2022 and December 2023. This comprised of 7 individuals with various aetiologies. Patient demographics, preoperative assessments, surgical details, postoperative complications, and long-term outcomes were studied. Results: Of the 7 patients included in the study, 4 had post traumatic defects, 3 had defects following surgical resection. Forehead flap had been used for reconstruction of scalp, eyelids, nose, palate, lips and floor of mouth. Surgical outcomes were mostly successful with good patient satisfaction, although some patients had peri-operative complications due to co-existing morbidities. Conclusion: Forehead flaps are versatile, effective, reliable with tolerable morbidity; and can hence be used for addressing a variety of craniofacial defects [ABSTRACT FROM AUTHOR]

Background Split anterolateral thigh flap is a versatile reconstruction option, yet long underestimated as no practical perforator classification and no optimal strategy were present. Harvesting "capillary nonsizable perforators" could potentially expand flap splits to those with no existing multiple sizable perforators. Concerns over defect characteristics, recipient vessels, pedicle length, and split timing should all be weighted equally in designing the suitable flap. Refinement is thus required to enable precise reconstructions. Methods All patients undergoing anterolateral thigh flap harvests between 2014 and 2021 performed by a single surgeon were included. The perforator patterns of sizable pedicle, course, origin, and further successful flap-split methods were documented. Surgical outcome of flap survival was analyzed. Results Anatomical variants of 134 (48.4%) dual, 123 (44.4%) single, and 20 (7.2%) no sizable perforators were found in a total of 277 anterolateral thigh flaps. The overall flap survival rate was 97.5%. Flap split was performed in 82 flaps, including 29 single and 5 no sizable perforator cases previously considered "unsplittable," by utilizing a series of direct skin paddle split, capillary nonsizable perforators harvesting, and flow-through anastomosis technique. Comparable flap survivals were found between split and nonsplit flaps as well as between split segments supplied by sizable and capillary nonsizable perforators. Primary closure was achieved in 98.9% of the thigh donor sites. Conclusion A new classification of the common anterolateral thigh flap anatomical variants was proposed and a comprehensive algorithm of split flap strategy was developed along with the innovative "fabricate" concept. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the methodical protection of the lingual nerve via the use of a standardized step-by-step procedure in the surgical extraction of the lower third molar. A 5-year retrospective analysis of surgical third molar surgery conducted by third-year oral surgery specialty program students was performed in the oral surgery department of Policlinico Umberto I in Rome, from 2017 to 2022. All surgeries were carried out using a standardized step-by-step procedure to protect the lingual flap during the surgery. Every patient underwent a review on the initial postoperative day, and subsequently, one week after the surgery, coinciding with the removal of the sutures. During each postoperative visit, thorough examinations were conducted to assess any sensory nerve impairment of the inferior alveolar, lingual, or mylohyoid nerves. None of the cases reported postsurgical lingual nerve injury; there was zero incidence of lingual nerve paresthesia or dysesthesia. The systematic application of lingual flap protection proved to be an effective and reproducible approach for the surgical removal of lower third molars without raising the risk of lingual nerve sensory impairment, regardless of the operator's experience. [ABSTRACT FROM AUTHOR]

Background and Aim: Periodontal surgeries complications and related factors are one of the most important things that surgeons in each clinic should be aware of to prevent them. Therefore, the aim of this study was to determine and compare the frequency, severity and trend of complications after periodontal flap surgeries with and without ostectomy and related factors in the periodontics department of Tehran University of Medical Sciences. Materials and Methods: patients in the periodontics department of Tehran University of Medical Sciences, who underwent periodontal flap surgery or gingivectomy, were included in this prospective study. The pain, swelling, and bruising levels were asked on the same day, one and three days later. At the follow-up session on the seventh day, the pain, swelling and bruising levels were asked again, the tenderness and swelling levels were recorded by the surgeon, and flap dehiscence and pus presence were assessed. The difference between the complications’ levels on different days and also the difference in their trends between different surgeries was measured by GEE test, alongside testing the association of background and surgery characteristics with the complications’ levels by MannWhitney and correlation tests. Results: The pain and swelling means on days 0 and 1 respectively were significantly higher than other days. The trend of means for complications were not different between the two groups of flap surgery with and without ostectomy. Tenderness, swelling, flap dehiscence and pus were present in 31%, 31%, 1% and 0% of patients after one week, respectively. Conclusion: Complications after periodontal flap surgeries were uncommon, except for mild pain and swelling. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long-term structural changes of the anterior chamber (AC) angle following gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: The AC angle of 10 eyes that underwent GATT at least 6 years previously was assessed for structural changes. A detailed gonioscopy was performed to determine the state of the cleft and the position of the trabecular flap. An anterior segment optical coherence tomography (AS-OCT) examination was performed on the corresponding areas on gonioscopy. Results: The typical finding of the angle following GATT was an open cleft with a visible trabecular flap. However, the gonioscopy of our patients revealed three different cleft appearances: open, closed, and segmentally open cleft. In the long-term, the trabecular flap re-approximated the incision site in some areas resulting in the appearance of a closed cleft on gonioscopy. On AS-OCT the cleft was identified when the lumen of Schlemm's canal was connected to the AC, while the position of the flap differed. The cleft was observed as open in median 4.0 (IQR: 2.8-6.0) clock hours. The cleft was found open mostly in the superior quadrants of the angle (nine eyes). No correlation was found between the extent of open cleft and the percentage of IOP reduction. Conclusion: AS-OCT, when used in conjunction with gonioscopy, was found helpful to evaluate the structural changes following GATT. As observed in the study, the cleft tended to close in some areas. It was found preserved mostly in the superior half of the angle in the long term. [ABSTRACT FROM AUTHOR]

Background: The goal of periodontal treatment is to stop this progressive destruction by controlling infection, thus preventing tooth loss. The aim of this work was to evaluate the efficacy of the combined effect of Chitosan, hyaluronan, and strontium chloride membranes in the treatment of periodontal intrabony defect. Methods: This research was randomized controlled trial. This study was carried out on 36 patients with an age range between 25 and 55 years. The patients were divided into two equal groups as follows: Group A (Control group): patients were treated with open flap debridement and group B (Test group): patients were treated surgically with hyaluronan, chitosan, and strontium chloride membrane. Results: The pain was significantly reduced in group B compared to group A at D1 and D2 (P<0.001), while the remaining durations were insignificantly different between both groups. The gingival index and probing depth was significantly reduced after 3 months and after 6 months compared to baseline in group A and in group B (P<0.001). Conclusions: The use of triphasic Hyaluronan – Chitosan – Strontium Chloride membrane in conjunction with periodontal flap surgery in treating intrabony defect did not show a statistically significant difference in comparison to OFD alone. Regarding periodontal probing depth, clinical attachment loss, gingival index, and radiographic bone fill, there was an improvement in both groups. Moreover, tissue response to the triphasic Hyaluronan -Chitosan- Strontium Chloride membrane was favorable as reflected by reduced pain and swelling. [ABSTRACT FROM AUTHOR]

Background: Soft tissue defects around the knee and proximal leg represent a challenging clinical scenario for plastic and reconstructive surgeons. These defects can arise from a variety of causes, including traumatic injuries, such as crush injuries and road traffic accidents, thermal injuries like burns, and surgical complications such as infection. Objective of the study was to evaluate the success of proximally based sural artery flap for soft tissue defects around the knee and proximal leg in patients presenting to our tertiary care hospital. Methods: This prospective observational study was conducted at the Department of Plastic & Reconstructive Surgery, Civil Hospital, Karachi, Pakistan. The study included patients with soft tissue defects around the knee and proximal leg, excluding those with specific comorbidities, high BMI, or active smoking. Non-probability convenience sampling was employed. After ethical review committee approval and informed consent, if needed wounds were optimized with thorough debridement then patients underwent proximal-based sural artery flap surgery for soft tissue defects around knee and proximal leg. Flap survival and complications were assessed over three to six weeks. Results: The study included 37 patients, with a median age of 30 years. The most frequent cause of defects was road traffic accidents (73%). Of the patients, 73% were male, and 27% were female. The median duration of soft tissue injury was 5 weeks, and the median duration of surgery was 90 minutes. Flap survival was 97.3%, with 28 flaps surviving without any complications. One patient with a 20-year-old chronic defect experienced partial flap failure. Conclusion: The use of the proximally based sural artery flap represents a promising approach for the successful reconstruction of soft tissue defects around the knee and proximal leg. [ABSTRACT FROM AUTHOR]

Currently there is limited literature available on fungating soft tissue sarcoma and its effect of outcomes. In the current study we evaluated the surgical management and oncologic outcomes of patient with fungating soft tissue sarcoma. This was a retrospective observational study of patients with fungating sarcoma between January 2015 till January 2019 at a tertiary cancer care centre. A total of 59 patients were considered of which 16 had metastasis at presentation. The duration of symptoms prior to presentation averaged 10.2 months (median, 7.2months; range, 1–57 months). Median tumor length was 10 cm. 56% patients underwent amputation and 44% were treated with limb salvage. Following limb salvage surgery in10 cases primary closure of defect was performed and 6 cases required skin grafting for closure of defect. In 6 patients local flap was used for coverage of defect and 4 patients required free flap surgery. Two-year overall survival (OS) of the study cohort were 52.2% and 58% respectively. Two-year disease free survival (DFS) and OS in 43 non metastatic patients at presentation was seen in 58%(95% CI,38%–74%) and 66.5%(95% CI,42%–81%) respectively. The two-year disease OS in 16 patients with metastasis at presentation was 33.2 %. On univariate analysis, tumor size and metastatic at presentation had significant effect on survival. Tumor size and metastatic at presentation has significant impact on survival in these patients. The oncologic outcomes including Disease free survival, overall survival and local recurrence rates similar amongst the two surgical modalities (amputation versus limb salvage). Amputation rates are more amongst fungating soft tissue sarcoma but limb salvage can be attempted whenever feasible keeping tumor free surgical margins under consideration. [ABSTRACT FROM AUTHOR]

Objective: To discuss advantages, disadvantages and strategical application of anatomical subunit approximation technique in complete unilateral cleft lip repair. Design: Analysis of consecutive 28 cases. Setting: A single surgeon experience at a university hospital. Patients: Among 77 patients who underwent cleft lip repair between May 5, 2019 and June 30, 2021, 28 patients with complete unilateral cleft lip who received cheiloplasty by author's technique. Main Outcome Measures: Surgical outcomes were assessed by frontal view medical photographs obtained postoperatively at follow-up visits. Results: The average length difference between cleft and noncleft sides was <10% for transverse lip length and philtral height. Nostril sill height demonstrated about twenty percent of difference with much variable results. Although the one sample t-test revealed that differences exist between the cleft and noncleft side, they were within an acceptable range. Conclusions: Understanding the strengths and limitations of anatomical subunit approximation technique enabled strategic application in complete unilateral cleft lip repair. Satisfactory outcomes were achieved not only regarding the scar placement but also regarding the symmetry of the lips and augmentation of nasal sill. [ABSTRACT FROM AUTHOR]

Objective: To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. Methods: This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. Results: A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. Conclusion: The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia. [ABSTRACT FROM AUTHOR]

Excessive compression after parotidectomy can lead to flap necrosis, while inadequate pressure can cause fluid accumulation. This study aimed to determine the optimal pressure and compression properties of different types of dressings. Initially, pressure measurements were taken for conventional Barton's dressing and a pre‐fabricated facial garment. In the subsequent phase, patients were randomly assigned to receive one of three types of pressure dressings: conforming bandage Barton's dressing, elastic bandage Barton's dressing or pre‐fabricated facial garment. The dressing types were randomly crossed over the following day. The mean pressure exerted by conventional Barton's dressing and the pre‐fabricated facial garment was 15.86 and 14.81 mmHg, respectively. There was no significant difference in the proportion of optimal pressure among the three types of pressure dressing (p‐values of 0.195, 0.555 and 0.089 at pre‐auricular, angle of mandible and post‐auricular sites, respectively). The pre‐auricular area demonstrated the highest proportion of optimal pressure, while suboptimal pressure was noted at the angle of the mandible and post‐auricular area. Dressing types had no effect on pressure stability (p = 0.37), and there was no significant difference in patient preference (p = 0.91). Conforming bandage Barton's dressing, elastic bandage Barton's dressing and pre‐fabricated facial garment exhibit comparable compressive properties, with no significant difference in patient preference and pressure stability. [ABSTRACT FROM AUTHOR]

Osteosarcoma, a primary bone malignancy, predominantly affects children and adolescents. It arises from primitive bone-forming mesenchymal cells, presenting as aggressive bone tumors. The most common sites include the long bones, particularly around the knee. Diagnostic tools encompass imaging techniques revealing characteristic bone destruction and potential metastases. Treatment typically involves a multimodal approach combining surgery and chemotherapy, with advancements improving survival rates. However, challenges persist in managing metastatic and recurrent cases, warranting ongoing research for more effective therapies. We will present the case of a patient treated in our clinic with surgical wide resection for a massive osteosarcoma, followed by reconstruction using a vascularized fibula autograft and latissimus dorsi flap. [ABSTRACT FROM AUTHOR]

Background and Aims: Several methods have been used in plastic and reconstructive surgery to reduce post-surgical complications, such as partial or complete flap loss due to ischemia and necrosis. Nitroglycerine application has been introduced as a viable alternative to papaverine to act as a local vasodilator to improve perfusion and reduce vasospasm. However, the literature has not thoroughly studied its efficacy and administration dose. This systematic review and meta-analysis study has been designed to assess the efficacy of topical nitroglycerine applications in reducing post-surgical flap necrosis and complications. Methods and Materials: A systematic literature search was performed on PubMed, Scopus, and Web of Science from inception to January 2023 with relevant keywords and terms. Case reports, review articles, letters, articles in any language other than English, and animal studies were excluded. The Newcastle-Ottawa and Jadad scales were used to assess the quality of the included studies. The pooled effect sizes were calculated using the random effect model with the Mantel-Haenszel method. Results: Overall, 2031 studies were obtained, among which 454 articles were duplicated and removed. Of the remaining 1577 articles, based on the eligibility and exclusion criteria, 20 articles were retrieved for full-text review. Finally, eight articles were included in our study. Three thousand nine hundred six patients had undergone reconstructive microsurgery and received topical nitroglycerin for the prevention of possible complications. The pooled rate of flap complication was 15% (95% CI: 8% to 25%, I2 = 96%, p-value < 0.01), and the pooled odds ratio of flap complication was 0.35 (95% CI: 0.15 to 0.83, I2 = 91%, p-value = 0.02). The heterogeneity of the included studies was significantly high. The dose and regimen of application significantly differed between each study. Conclusion: Topical administration of nitroglycerin compounds post reconstructive microsurgery can reduce the risk of flap necrosis. However, the precise dosage, duration of application, and possible underlying factors affecting drug efficacy are yet to be discovered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Autologous fat grafting (AFG) has shown promise in the treatment of complex wounds, with trials reporting good healing rates and safety profile. We aim to investigate the role of AFG in managing complex anorectal fistulas. METHODS: This was a retrospective review of a prospectively maintained IRB-approved database. We examined the rates of symptom improvement, clinical closure of fistula tracts, recurrence, complications, and worsening fecal incontinence. Perianal disease activity index (PDAI) was obtained for patients undergoing combination of AFG and fistula plug treatment. RESULTS: In total, 52 unique patients underwent 81 procedures, of which Crohns was present in 34 (65.4%) patients. The majority of patients previously underwent more common treatments such as endorectal advancement flap or ligation of intersphincteric fistula tract. Fat-harvesting sites and processing technique were selected by the plastic surgeons based on availability of trunk fat deposits. When analyzing patients by their last procedure, 41 (80.4%) experienced symptom improvement, and 29 (64.4%) experienced clinical closure of all fistula tracts. Recurrence rate was 40.4%, and complication rate was 15.4% (7 postoperative abscesses requiring I&D and 1 bleeding episode ligated at bedside). The abdomen was the most common site of lipoaspirate harvest at 63%, but extremities were occasionally used. There were no statistically significant differences in outcomes when comparing single graft treatment to multiple treatments, Crohns and non-Crohns, different methods of fat preparation, and diversion. CONCLUSION: AFG is a versatile procedure that can be done in conjunction with other therapies and does not interfere with future treatments if recurrence occurs. It is a promising and affordable method to safely address complex fistulas.

The posterior surface of the ear is an uncommon site for skin cancer. It has anatomical and cutaneous characteristics that make local reconstruction difficult using standard surgical techniques. We present a case of reconstruction of a defect on the posterior surface of the ear secondary to excision of a basosquamous carcinoma, using an interpolation flap.

Abstract This study aimed to evaluate the efficacy of a xenogeneic collagen matrix (XCM) in treating gingival recessions (GR) in a thin gingival phenotype. This double-blind, planned, controlled, split-mouth clinical trial included 30 patients with bilateral recessions, randomly assigned to a test group (extended flap + XCM) and a control group (extended flap + connective tissue graft; CTG). Root coverage at 18 months was 1.75 ± 0.8 mm (72.9%) and 2.4 ± 0.51 mm (88.9%) in the test and the control groups, respectively. The upper limit of the confidence interval was not greater than the non-inferiority margin of 0.69 mm. The increase in gingival thickness was greater for autogenous graft (p = 0.003). Both treatments improved quality of life at 18 months. The keratinized tissue width (KTW) increased significantly in the grafted teeth, in both the test (p < 0.001) and the control groups (p < 0.001). Total root coverage was similar in both groups, reaching 70% and 66.7% in the control and test groups, respectively, with no significant differences observed for partial or complete root coverage (CRC). An association was observed in the quality of the gingival phenotype at 18 months according to the treatment group, i.e., a higher percentage of cases with a thicker phenotype was observed in the control group (86.7%), compared with the test group (53.3%) (p = 0.005). XCM was effective in treating GR, but CTG had better results because of significantly increased gingival thickness and phenotypic conversion.

The article discusses a case of severe scrotal lymphedema in a patient with hidradenitis suppurativa (HS) and the surgical management of this condition. HS is a chronic skin condition that can lead to irreversible tissue damage, requiring a multimodal treatment approach. The patient underwent radical resection of affected tissue, scrotal reconstruction, and postoperative care to address the lymphedema. The integration of anti-inflammatory medical treatments with surgical interventions is crucial for successful outcomes in advanced cases of HS. [Extracted from the article]

The article presents a technique in addressing nasocutaneous fistulas (NC-SCFs). Topics discussed include effect of the utilization of multiple local flaps in a double-layer soft tissue closure on NC-SCFs, the standard for extirpation of advanced sinosonal malignancies of the maxillary sinus, and analysis of the absence of underlying bony support and high rate of adjuvant radiation therapy.

Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis. [ABSTRACT FROM AUTHOR]

This study evaluated the efficacy of buccal fat pad (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). Twelve consecutive patients with 14 vertical bone defects in need of bone augmentation for implantprosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of customized titanium meshes, titanium-reinforced d-PTFE membranes, or resorbable membranes and titanium plates. After buccal flap release, the BFP was identified and isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as a free graft in 3 cases. The mean BFP surface area was 13.5 ± 5.5 cm2. Healing was uneventful in all 14 augmented sites. No patients reported healing complications or facial volumetric changes. The mean vertical bone gain (VBG) was 4.2 ± 1.8 mm. In this limited number of cases, using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it improved the healing process while reducing the risk of complications. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to evaluate the efficacy of a cross-linked xenogeneic volume-stable collagen matrix (CCM) in treating gingival recessions (GRs) at teeth presenting with cervical restorations or noncarious cervical lesions (NCCLs). Fifteen patients with esthetic concerns for multiple sites with GRs and cervical restorations were consecutively enrolled. The sites were treated with a coronally advanced flap (CAF) design in combination with a CCM. When present, the previous restoration was removed, and the cementoenamel junction was reconstructed with a composite material. The CCM was stabilized on the root surface(s) previously occupied by the restoration. The CAF was sutured to completely cover the graft. Clinical measurements and intraoral digital and ultrasonographic scans were collected at baseline and at 3 and 6 months postsurgery. Limited postoperative discomfort was reported by patients during the healing. The mean root coverage at 6 months was 74.81%. Average increases in gingival thickness of 0.43 mm and 0.52 mm were observed when measured with ultrasonography 1.5 mm and 3 mm apical to the gingival margin, respectively (P < .05). Relatively high patient-reported satisfaction and esthetics were associated with the treatment outcomes. The treatment resulted in a significant reduction in dental hypersensitivity (mean: 33 VAS points). The present study demonstrated that CAF + CCM is an effective approach for treating GRs at sites with cervical restorations or NCCLs. [ABSTRACT FROM AUTHOR]

This study evaluated the efficacy of trapezoidal coronally advanced flap (tCAF), envelope coronally advanced flap (eCAF), and coronally advanced tunnel flap (TUN) in treating gingival recession (GR) through a network meta-analysis. Eligible articles from the PubMed, Embase, and Cochrane Library databases published up to September 2020 were selected to identify randomized controlled trials (RCTs) on tCAF, eCAF, and TUN treatments. Sample size, treatment time, and outcome measures including complete root coverage (CRC), root coverage esthetic score (RES), and other data were extracted from the article, and integrated analysis was conducted. In total, 10 RCTs met the inclusion criteria, involving 310 patients. Direct meta-analysis showed no significant differences in CRC among the three surgical methods; A significant difference was seen for RES, with TUN worse than tCAF (weighted mean difference: -0.73; 95% CI: -1.44, -0.02; P = .045). The network metaanalysis showed no statistical significance in the cross-comparison of tCAF, eCAF, and TUN. However, eCAF had the most significant effect on improving CRC (SUCRA = 69.2) and RES (SUCRA = 85.0). eCAF has the best prognosis in the treatment of GR, followed by tCAF and TUN. This may influence the surgeon's treatment choice, as eCAF may be more effective in root coverage procedures. [ABSTRACT FROM AUTHOR]

These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. [ABSTRACT FROM AUTHOR]

Local tissue flaps are a fundamental technique in cutaneous reconstruction. Reducing the risk of flap failure is of critical importance. The intrinsic vascularity of a flap is the most important determinant of success. Good surgical techniques, including flap design, delicate tissue handling, and tension-less closure, help reduce the risk of flap compromise. Determining the etiology of compromise, including arterial, venous, hematologic, or infectious, is the first step in salvaging a failing flap. Common causes include pedicle kinking, hematoma, pressure/tension, systemic patient factors, and poor surgical technique. Swift action to restore perfusion or venous outflow through numerous strategies is required.

A common goal in reconstructing the umbilicus is to achieve an aesthetically pleasing result. This single-subject study demonstrates the outcome of managing an umbilical keloid scar using a single excisional line. A patient presented with a large, oval keloid scar at the center of his abdomen. The scar, measuring 4×3 cm in diameter, was deformed to the extent that it completely obscured the umbilicus. The patient frequently experienced intermittent inflammation at the site of the scar. We planned a triangular incision around the keloid. The umbilical keloid was excised and reconstructed using a flap anchored along the lower edge of the triangle. The triangular flap was elevated and the deep dermis of its cephalic portion was attached to the linea alba. The remainder of the flap was sutured at the center to create a conical shape. Eleven months post-procedure, the umbilicus maintained an aesthetically pleasing appearance with proper depth, superior hooding, and a concave shape without protrusion. An advantage of this straightforward surgical method is that it allows for simultaneous resection and reconstruction without the need for additional flap design. This method is expected to be a useful option for reconstructing umbilical keloids the size of a fully developed umbilicus.

Background An autologous abdominal flap can provide an aesthetically pleasing breast with a natural feel. However, contracted scars and hourglass contour deformities at the abdominal donor site can sometimes occur. These complications can reduce patient satisfaction and quality of life. Therefore, we performed different oblique plane closure of the abdominal donor site and evaluated the aesthetic scores in comparison with the conventional vertical single plane closure. Methods The procedures begin with a beveled incision down to the fascia level during transverse rectus abdominis muscle flap elevation. At the time of donor site closure, Scarpa’s fascia and the subcutaneous layers are sutured while being pulled downward. Sixty patients were divided into two groups: group A (single vertical plane closure) and group B (different oblique plane closure). Abdominal scars were scored by five reviewers using the scar scale. Results There were no significant differences in scores for vascularization, dog-ear presence, and umbilical shape of the scar between the two groups. However, group B showed marked improvements in flatness, contracture, and thickness of the scar surface. Notably, the different oblique plane closure in group B achieved much higher scores for the abdominal contour than group A. Conclusions The vertical single plane suture of the abdominal donor site may result in depressive contracture with poor cosmetic outcomes. The different oblique plane closure technique markedly improved the appearance of scars on the abdomen. This technique is likely to enhance patient satisfaction with both the breast and abdominal outcomes of breast reconstruction using an abdominal flap.

Various surgical flap advancement techniques for bone regeneration have been described in the literature; however, the clinical challenges of managing tissue that contains scars or embedded foreign materials have not been thoroughly described, especially around metal foramen. Fibrotic and thickened scar periosteum as well as mental foramen restrict the tissue from responding in the same way as native tissue. Therefore, additional considerations and approaches must be considered to achieve tension-free flap closure. This article presents a flap advancement classification that describes three common clinical scenarios based on the periosteum and soft tissue quality and provides surgical approaches for tissue management in each classification, with a focus on flap advancement around the mental foramen. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to describe the facially oriented crestal incision (FOCIS) and assess the incidence of flap dehiscence and its efficacy in simultaneous and staged guided bone regeneration (GBR) procedures. The data of 41 patients treated with FOCIS GBR were analyzed. The primary outcome analyzed was the rate of initial wound closure. Secondary outcomes were related clinical parameters, including mean resolution of dehiscences and fenestrations, crestal buccal bone thickness (BBT), and bone width (BW) increase. A total of 53 implants were placed. The initial wound closure rate was 92.7% (38/41) and 94.3% (50/53) at the patient and implant levels, respectively. The complete dehiscence resolution rate was 79.31%, and the mean dehiscence reduction was 3.12 ± 2.46 mm (95% CI: 2.19 to 4.06 mm). BBT had a mean increase of 1.22 ± 1.07 mm (95% CI: 0.86 to 1.59 mm), and the final BBT was an average of 1.56 ± 0.79 mm (95% CI: 1.32 to 1.80 mm). Lastly, BW increase averaged 3.38 ± 1.49 mm (95% CI: 2.58 to 4.17 mm) for the staged cases. Utilizing FOCIS at partially edentulous sites can help achieve and maintain wound closure in horizontal GBR procedures. [ABSTRACT FROM AUTHOR]

This study evaluated the use of a xenogeneic acellular dermal matrix (XADM) combined with a modified coronally advanced flap (MCAF) and partial resin composite filling (anatomic crown plus 1 mm of the root surface) to treat multiple Type 1 gingival recessions associated with B+ noncarious cervical lesions (NCCLs). The study included 24 recessions in 10 patients. Bleeding on probing, probing depth, combined defect height, relative gingival recession, clinical attachment level, esthetics, and dentin hypersensitivity were recorded. After 6 months, the treatment provided statistically significant outcomes: It reduced the combined defect height by 2.02 ± 0.65 mm, increased clinical attachment level by 1.96 ± 0.83 mm, and increased keratinized tissue thickness by 0.46 ± 0.47 mm, and shallow probing depths were seen. Significant dentin hypersensitivity reduction and esthetic improvements were observed. Therefore, XADM associated with MCAF and partial restoration might be a promising alternative to autogenous grafts used to treat multiple gingival recessions associated with B+ NCCLs. [ABSTRACT FROM AUTHOR]

An internal root resorption lesion in the maxillary right central incisor was treated with orthodontic extrusion to improve the surrounding soft and hard tissue. Simultaneously with extraction, socket preservation was performed. After 4 months of healing, guided bone regeneration was performed and an implant was placed. At the second surgical phase, a flap was coronally advanced, and a connective tissue graft was placed. The emergence profile was modeled with a provisional crown before the final crown. The result was successful and well maintained over the 10-year follow-up period. The hard and soft tissue levels were stable, and no signs of inflammation were observed. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE: There is active research involving the radiographic appearance of the skull base following reconstruction. The purpose of this study was to describe the radiographic appearance of the vascularized pedicle nasoseptal flap after endoscopic skull base surgery across time. MATERIALS AND METHODS: We performed chart and imaging review of all patients with intraoperative nasoseptal flap placement during endoscopic skull base surgery at a tertiary academic skull base surgery program between July 2018 and March 2021. All patients underwent immediate and delayed (>3 months) postoperative MR imaging. Primary outcome variables included flap and pedicle enhancement, flap thickness, and flap adherence to the skull base. RESULTS: Sixty-eight patients were included. Flap (P = .003) enhancement significantly increased with time. Mean nasoseptal flap thickness on immediate and delayed postoperative scans was 3.8 and 3.9 mm, respectively (P = .181). The nasoseptal flap adhered entirely to the skull base in 37 (54.4%) and 67 (98.5%) patients on immediate and delayed imaging, respectively (P

Simple Summary: Vulvoperineal defect reconstruction after oncological resection often leads to complications, which affect approximately 30% of patients. In recent decades, flap design has evolved towards perforator-based approaches to reduce this complication rate and reduce functional deficits. The aim of our systematic review and meta-analysis was to assess and compare the complication rate between perforator- and non-perforator-based reconstructions. Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. We found that the overall short-term surgical complication rate was comparable in patients receiving a perforator or a non-perforator flap, with a tendency towards fewer complications when using a perforator flap. Perforator flap-based reconstruction allows the surgeon to spare relevant anatomical structures and is therefore associated with fewer functional deficits, with a comparable complication rate. Background: Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards perforator-based approaches to reduce functional deficits and (donor site) complications, since they allow for the preservation of relevant anatomical structures. Next to their greater surgical challenge in elevation, their superiority over non-perforator-based approaches is still debated. Methods: To compare outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction, we conducted a systematic review of English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series. Data on demographics and surgical outcomes were extracted and classified using the Clavien–Dindo classification. We used a random-effects meta-analysis to derive a pooled estimate of complication frequency (%) in patients who received at least one perforator flap and in patients who received non-perforator flaps. Results: Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. The overall short-term surgical complication rate was comparable in patients receiving a perforator (n = 276) or a non-perforator flap (n = 1564) reconstruction (p* > 0.05). There was a tendency towards fewer complications when using perforator flaps. The assessment of patients' QoL was scarce. Conclusions: Vulvoperineal reconstruction using perforator flaps shows promising results compared with non-perforator flaps. There is a need for the assessment of its long-term outcomes and for a systematic evaluation of patient QoL to further demonstrate its benefit for affected patients. [ABSTRACT FROM AUTHOR]

Background: In reconstructive surgery, improvements are needed in the effective teaching of free flap surgery. There is a need for easily accessible and widely available training without high financial costs or ethical concerns while still providing a realistic experience. Our aim was to develop an appropriate training model for microvascular flaps. Methods: We identified pig head halves as most appropriate regarding availability, cost, and realism. These accrue largely by the food industry, so no animals need to be sacrificed, making it more ethical from an animal welfare perspective. We evaluated the suitability as flap donor site and analyzed the vascular anatomy of 51 specimens. Results: Anatomical evaluation revealed a reliable and constant vascular anatomy, allowing the design of a flap model that can effectively illustrate the entire process of microvascular flap surgery. The process was divided into 6 key steps. The flap can be harvested after marking the vascular pedicle 5.3 cm from the lateral corner of the mouth. Skin island design and subsequent tissue dissection follow until a fasciocutaneous flap is raised, similar to a radial flap. Upon completion of flap harvesting, it can be freely transferred for defect reconstruction. Microvascular anastomosis can be performed on recipient vessels in the cervical region, and the difficulty can be individually adjusted. Conclusions: The developed training model is a reasonable compromise in terms of surgical realism, availability, didactic value, and cost/time effectiveness. We believe it is a powerful and effective tool with high potential for improving surgical education and training. [ABSTRACT FROM AUTHOR]

Objective: We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. Methods: The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. Results: The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 3.2% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 2.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 3.1% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis (P >.05). Conclusion: The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified. [ABSTRACT FROM AUTHOR]

We aimed to summarize the surgical treatment for pharyngolaryngeal stenosis and discuss prognosis in patients with Behcet's disease. Six cases of pharyngolaryngeal stenosis caused by Behcet's disease were analyzed retrospectively. All underwent surgical treatment for pharyngolaryngeal stenosis after systematic medical treatment. The follow-up time for the 6 patients was between 1 and 12 years. Four of the 6 patients underwent adhesiolysis as their first procedure. Two of these 4 experienced recurrence of stenosis within 6 months and underwent flap repair as their second procedure. The remaining two patients underwent flap reconstruction as their first procedure and maintained good swallowing function. Three of the 6 patients underwent preoperative tracheotomy because of dyspnea. Tracheal decannulation was successful in all patients. None of the patients experienced recurrence after their final surgical procedure and all recovered to a near-normal condition. Pharyngolaryngeal stenosis caused by Behcet's disease is a rare but severe complication; surgical intervention should be considered in patients with dysphagia after systematic medical treatment. [ABSTRACT FROM AUTHOR]

To determine urethral outcomes of single-stage metoidioplasty and radial forearm free flap (RFFF) phalloplasty using the labia minora ring flap for urethral lengthening (UL). A retrospective review was performed of patients undergoing single-stage metoidioplasty and RFFF phalloplasty utilizing the labia minora ring flap technique. The ring flap consists of endodermal labia minora tissue ventral to the clitoris and surrounding the vaginal introitus. During metoidioplasty, the ring flap accounts for the entirety of UL. During RFFF phalloplasty, the ring flap becomes the pars fixa (PF) urethra. The primary outcomes measured were rates of fistula, stricture, and surgical revision. Between November 2017 and August 2023, 311 patients underwent metoidioplasty or RFFF phalloplasty (mean follow-up 37 months). Of the 69 metoidioplasties, urethrocutaneous fistulas developed in 11 patients (16%); strictures occurred in 4 (6%). Of the 242 phalloplasty patients, there were 71 fistulas (29%), 56 of which resolved spontaneously. Strictures developed in 44 patients (18%). Twenty-five patients (10%) developed both a stricture and fistula. Surgical repair was required in 8/69 (12%) metoidioplasty patients and in 46/242 (19%) RFFF phalloplasty patients for an overall revision rate of 17%. UL during metoidioplasty or RFFF phalloplasty can be accomplished in a single stage using the labia minora ring flap with comparable surgical revision rates to previously described techniques. This approach can also be applied to other phalloplasty techniques. Many fistulas of the PF urethra resolve spontaneously. Higher urethral revision rates were seen in phalloplasty compared to metoidioplasty. [ABSTRACT FROM AUTHOR]

This case addressed patient and free flap survival after cardiac arrest with the contentious use of vasopressors amid concerns about potential vasoconstrictive effects on flap vitality. A 59-year-old male with mucoepidermoid carcinoma underwent post-total maxillectomy and double free flap reconstruction (free fibular flap and anterolateral thigh free flap). Intraoperatively, he experienced cardiac arrest after anastomosis due to hypovolemia or hypoxia, requiring external cardiac massage and vasopressor administration. Despite the initial restoration of circulation, subsequent cardiac arrest ensued, necessitating further resuscitation. Postoperatively, vasopressors were also administered due to hemodynamic instability. Contrary to concerns, both flaps demonstrated sustained vitality, challenging prevailing apprehensions about vasopressor-induced vasoconstriction compromising flap viability. This observation suggests that vasopressors may not significantly threaten flap viability, prompting reconsideration of hesitations and encouraging further investigation. The study advocates for a judicious evaluation of vasopressor administration in free flap procedures, enriching clinical considerations for optimal patient care. [ABSTRACT FROM AUTHOR]

Purpose: Skull base reconstruction is one of the most difficult reconstructive surgical procedures. Due to its complexity, most surgeons have modified the reconstruction methods to minimize the postoperative complications and mortality rate. In the past, flap surgery was not usually performed, but it has recently become more common due to advances in medicine. In this study, we analyzed successful flap surgery methods in skull base reconstruction for large cranial-nasal communications. Methods: Patients who underwent skull base reconstruction from April 2015 to January 2024 were eligible for this study. Of these patients, we included those who underwent reconstruction using a volumetric flap. Reconstructions that only used the conventional galeal flap, allograft skin, or bone substitute were excluded. The reconstruction methods used local flaps and free flaps. Results: In total, 22 patients underwent skull base reconstruction. The most frequently used local flap was the bilateral reverse temporalis muscle flap (seven of 11 cases), and the most frequent free flap was the anterior lateral thigh flap (10 of 11 cases). Other local flap operations used the modified temporalis muscle flap and scalp flap. A rectus myocutaneous flap was also used. There were no cases of flap necrosis. Conclusion: Flap surgery is needed for skull base reconstruction in patients with large cranial-nasal communications. As long as the flap volume is large enough to block and fill the defect, either a local flap or a free flap can be used for reconstruction. [ABSTRACT FROM AUTHOR]

The latissimus dorsi muscle flap (LDMF) is commonly used in breast reconstruction procedures using autologous tissues. However, traditional harvesting of LDMF leaves a long scar. Herein, a robot-assisted LDMF harvesting technique for immediate breast reconstruction after partial mastectomy is described that helps overcome this disadvantage. A 3–4 cm long skin incision was made along the mid-axillary line, 15–20 cm below the axillary fold. A single-site multi-instrument silicon port was placed through the incision. Latissimus dorsi muscle dissection was performed after the port device was attached and docked. The deep muscle surface was dissected first (submuscular plane) followed by superficial muscle surface dissection (subcutaneous plane). Subsequently, the LDMF was detached from the muscle origin site and used to fill the partial mastectomy surgical defect. As a result, good symmetry was achieved in both breasts, without a long scar at the LMDF donor site. The patients were satisfied with the cosmetic results. [ABSTRACT FROM AUTHOR]

The mouth, located in the lower third of the face, is a uniquely visible structure. It serves as a vital organ both aesthetically and functionally, playing a key role in speech, expression, and fundamental oral functions. Consequently, any alterations or defects in its shape, due to various causes, can lead to aesthetic and functional deficiencies. These issues may also result in challenges with social interactions and a decrease in confidence. In cases of microstomia, various surgical approaches are proposed based on the location, extent, shape, and cause of the defect, leading to numerous case reports. Plastic surgeons are proficient in oral reconstruction; however, cases of microstomia are relatively rare, which reduces their familiarity and interest in these cases. Additionally, preferences for oral size and shape vary according to factors such as geographical region and ethnicity, further complicating the functional definition of microstomia. Therefore, both subjective patient and physician judgments play crucial roles in the diagnosis and treatment of microstomia, as these may vary depending on individual and societal aspects. This review aims to classify the various causes and definitions of microstomia, as well as its non-surgical and surgical treatment options, with the goal of the treatment of this condition. [ABSTRACT FROM AUTHOR]

Background: The medial canthal region features a complex three-dimensional and internal anatomical structure. When reconstructing a defect in this area, it is crucial to consider both functional and aesthetic aspects, which presents significant challenges. Generally, local flaps are preferred for reconstruction; however, skin grafts can be used when local flaps are not feasible. Therefore, we conducted a comparative analysis of surgical outcomes skin grafts when local flaps were not feasible, to determine which surgical method is more effective for medial canthal region reconstruction. Methods: Twenty-five patients who underwent medial canthal region reconstruction using skin grafts or local flaps from 2002 to 2021 were enrolled. Patient information was obtained from medical records. Five plastic surgeons evaluated the surgical outcomes based on general appearance, color, contour, and symmetry. Results: Skin grafts were used in eight patients and local flaps were used in 13. Combined reconstructions were employed in four cases. Minor complications arose in four cases but improved with conservative treatment. No major complications were reported. Recurrence of the skin cancer was noted in two cases. All categories showed higher scores for the local flap compared to both skin graft and combined reconstruction; however, the differences were not statistically significant respectively. Conclusion: The choice of appropriate surgical methods for reconstructing defects in the medial canthal region depends on various factors, including the patient's overall health, the size and depth of the defect, and the degree of involvement of surrounding structures. When a local flap is not feasible, a skin graft may provide favorable surgical outcomes. Therefore, a skin graft can serve as a viable alternative for reconstructing the medial canthal region. [ABSTRACT FROM AUTHOR]

Aim: To test whether early implant placement into the extraction socket containing an uncalcified provisional matrix leads to successful osseointegration and stable marginal bone levels. Materials and Methods: In six mongrel dogs, the mandibular molars were extracted. Three weeks later, early implant placement was performed according to three experimental protocols: (i) flapless implant placement with preservation of the provisional matrix; (ii) flap elevation, socket debridement and implant placement; and (iii) flap elevation, socket debridement, implant placement and guided bone regeneration (GBR). One untreated extraction socket served as a control group. Data analyses were based on histologic slides 3 months after implant placement. Results: There were no differences in bone‐to‐implant contact between the three experimental groups (66.97%, 58.89% and 60.89%, respectively) (inter‐group comparison p =.42). Marginal bone levels, first bone‐to‐implant contact as well as the thickness of the connective tissue did not reveal any significant differences between the groups (p =.85,.60 and.65, respectively). Conclusions: Flapless early implant placement into posterior extraction sockets was as effective as an open flap approach in conjunction with GBR. Mineralization of the socket seems to occur irrespective of the presence of dental implants or biomaterials. [ABSTRACT FROM AUTHOR]

Orbital fractures are a frequent and serious problem for practicing ophthalmologists. The complexity of the pathology is explained by the combined nature of the injuries (often associated with craniofacial injuries), multistage treatments, results that are often unsatisfactory, and a wide range of complaints about functional and cosmetic limitations. Over the years, significant progress has been made in the field of orbital reconstruction, allowing the transition from traditional methods using simple materials to innovative bioengineering solutions. This evolution has been driven by advances in surgical technologies, imaging techniques, and biomaterials aimed at optimizing the restoration of the shape and function of the orbital region. Traditional approaches are based on the use of autologous tissues such as bone grafts and muscle flaps, which provide biocompatibility and natural integration, but have limitations in terms of customization and accessibility. The advent of patient-specific implants and 3D printing technology has revolutionized the reconstruction of the orbit, allowing implants to be precisely adapted to a patient's anatomy. Biocompatible materials, such as porous polyethylene, titanium, and silicone, have become the basis for orbital reconstruction, ensuring durability and compatibility while minimizing long-term complications. Bioengineered solutions hold promise for further advancements in orbital reconstruction. We searched PubMed, Cyberleninka, and other verified databases for published articles on orbital reconstruction reported in the literature between 1960 and January 2024. In this article, we consider the advantages and disadvantages of each category of reconstruction materials and provide up-to-date information on the methods for modifying their properties using modern processing technologies. [ABSTRACT FROM AUTHOR]

Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management, are available. In flap surgery for pressure sores, a variety of flap types may be used; each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforatorenhanced rhomboid flap technique for ischial sore construction. Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital. The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap. Postoperative follow-ups and evaluations were performed. Results: The mean age of the study group was 43.7 x 13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases. The mean surface area of sores was 24.8 x 6.3 cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 x 0.98 cm and required around 6.8 x 1.9 weeks to heal. Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore. [ABSTRACT FROM AUTHOR]

Objective: To determine if performing popliteal nerve blocks preoperatively in patients undergoing fibula-free flap surgery for head and neck cancer reconstruction decreases subjective pain scores decreases narcotic usage, and improves mobility in the acute postoperative time period when compared to alternative pain control regimens. Methods: A retrospective review of the medical records of patients who underwent fibula-free flap reconstruction for head and neck malignancy at SUNY Upstate Medical University during the time period from 2015 to 2022 was performed. Collected data consisted of patient demographics and clinical characteristics, postoperative pain management modalities, reported pain scores, postoperative narcotic usage, length of hospital stay, and days until out of bed without personal assistance. Results: A total of 40 patients were included in the study. The average reported pain score was reduced in the nerve block group compared to the control group (1.7 vs. 4.0, p-value = .003). Similarly, the average maximum reported pain score was also lower in patients who received a nerve block (3.4 vs. 6.9, p-value = .002). None of the patients who received popliteal nerve blocks required pain control with parenteral narcotics postoperatively, whereas 82.9% of patients without a nerve block did. Patients who received a popliteal nerve block consumed an average of 103.5 MME, whereas those who did not receive a block consumed an average of 523.0 MME. No statistically significant difference was found between the groups regarding time from surgery until transfer without personal assistance or length of hospital stay. Conclusion: Popliteal nerve blocks can reduce postoperative pain in patients undergoing fibula-free flap reconstruction for head and neck cancer. [ABSTRACT FROM AUTHOR]

Background Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. Methods This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. Results Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). Conclusion Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis. [ABSTRACT FROM AUTHOR]