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Between 1986 and 1995, 48 microvascular flaps (14 fasciocutaneous, 13 muscle, and 21 musculocutaneous) were performed on 47 patients with foot defects. The study group consisted of 19 patients who successfully underwent weightbearing surface reconstruction with free musculocutaneous flaps or muscle flaps with a skin graft. The groups were identified on the basis of the free flap used. Group 1: Latissimus dorsi musculocutaneous flaps (11 patients); group 2: Skin grafted muscle flaps (8 patients: latissimus dorsi - 6, gracilis - 1, rectus abdominis - 1). The follow-up period was 1–11 years (average: 8.3 years). Follow-up included documentation of foot pain, presence of ulceration, sensory recovery, the ability to wear normal shoes, and the need for a second operation. In group 1, debulking operations were necessary (8 patients, 72.7%). Debulking was not required in group 2. Ulceration occurred in four (36.4%) group 1 patients and in one (12.5%) group 2 patient. All patients had good deep pressure sensation. All the group 2 patients could wear normal shoes. Four (36.4%) of the group 1 patients had to wear special orthopedic shoes. The gait analysis consisted of two parts: footprint analysis with the Harris mat technique and plantogram of Parotec system by Kraemer. Foot analysis with the Harris mat showed that the pressure on the muscle flap is less than the pressure on the musculocutaneous flap. Gait analysis by the Parotec system showed that in patients with musculocutaneous flaps, static load distribution on the reconstructed bare foot is nearly normal, but dynamic load distribution is pathological. In patients with muscle flaps, both static and dynamic load distribution were close to normal. [ABSTRACT FROM AUTHOR]

Prominent ears are the most common congenital deformity. Numerous techniques for the correction of this deformity have been described in the literature, but there is no single technique widely accepted by most surgeons. Usually, more attention is focused on sculpturing or suturing techniques but not on suture material. The aim of this study is to evaluate clinical outcomes after otoplasty for surgical correction of prominent ears with different suture materials for the formation of new antihelical fold. During a 3-year period (2006-2008), 133 patients underwent operative correction of protruding ears in a private plastic surgery center. A total of 100 patients came for the follow-up visits, and the data of these patients were included in further analysis. The surgical technique consisted of scoring of the antihelical cartilage, suturing to recreate the fold of the antihelix (in the manner of Nachlas), and conchal setback procedure according to Furnas technique. According to suture material used for formation of new antihelix fold, the patients were divided into three groups: 4/0 Monocryl group (35 patients, 70 ears; Group 1), 4/0 PDS group (27 patients, 54 ears; Group 2), and 4/0 Mersilene group (38 patients, 7 ears; Group 3). Distances from the temporomastoid surface of the skull to the helix border in the upper, middle, and lower parts of the ear were measured before surgery and 6 months following surgery, and these measures were compared among groups. In addition, early and late complications were analyzed. There were 48 men and 52 women, and the median age was 20 years. The groups were matched for age, sex, and protrusion degree. No statistically significant differences were found comparing the groups of different suture material by skull-helical rim distance before operation. Comparison of skull-helical rim distance among groups after surgery showed that this distance in the medial and lower parts of the ear was the same in all groups, but this distance was smaller in the upper part of the ear in the Mersilene group; however, this difference was not statistically significant. Three patients in the Monocryl group (6 ears, 8.57%) and 3 patients in the PDS group (6 ears, 11.11%) had unsatisfactory aesthetic outcome because of recurrence of protrusion in the upper part of the ear. All of them underwent reoperation. In the Mersilene group, no recurrence was documented, but suture extrusion occurred in one patient (2 ears, 2.63%), and the sutures were removed. In our experience, formation of new antihelical fold with a 4/0 Mersilene suture resulted in the lowest rates of late complications. Using this type of suture material, some suture extrusions occurred, but this problem was easily solved by removing sutures. No recurrences of protrusion were documented in this group; therefore, no revision surgeries were necessary.

The endoscopic approach to forehead and midface lifting has become popular method of face rejuvenation with minimal incisions. We have performed 67 endoscopic facelift procedures in the last four years. Forehead lifting technique included five small scalp incisions, wide subperiosteal elevation, endoscopic myotomy and forehead tissue fixation with srews, superficial temporal fascia (STF) suture to deep temporal fascia (DTF). Midface lifting technique included temporal 2.5 cm and 1.5 cm vertical intraoral incision, midface subperiosteal undermining and midface elevation with cable sutures Bichat's fat to DTF. Age mediana of patients who underwent endoscopic front lift was 46, patients who had endoscopic front lift and midface lift procedure age mediana was 40. Postoperative complication rate was 7.5% and included frontal branch weakness (n=2), hematoma (n=1), infraorbital nerve paresthesia (n=1) and asymmetrical smile (n=1). The main question is the quality of the results. We have reviewed 49 patients who were followed 6 months or more. Preoperative and postoperative life-size photographs were analyzed. The mean elevation mediana at medial canthus was 2.2 mm, at medial limbus 2.3 mm, at lateral limbus 2.5 mm, at lateral canthus 2.9 mm. Midface - lift effect resulted cheek elevation from 1.07 till 4.71 mm lip corner elevation 1.03 mm to 3.27 mm. We observed cheek elevation, improving nasolabial line, increasing volume of malar region, elevating lip angles in patients after endoscopic midface lift. We have found that important advantage of subperiosteal midface lift, when performed in conjunction with endoscopic brow lift, is its ability to move the cosmetic eye unit, proportionally, leading to a harmonious facial appearance. Endoscopic facelift is effective procedure for face rejuvenation especially for eyebrows and cheek elevation.

We describe a case of severe face and upper extremities injury obtained in accident. 30 cm x 12 cm left arm soft tissue defect covered with thoracodorsal myocutaneous flap after necrectomy. After 10 days a microvascular transplantation of scapular fasciocutaneous flap was performed thus covering a 15.8 cm x 10.5 cm soft tissue defect in face. Eighteen days after trauma autodermoplastica was done in a 35 cm x 11 cm would of the right arm. The patient was discharged after 6 weeks of treatment. October 19, 2000 reconstruction of left ulnar nerve (n. ulnaris) was performed using sural nerve (n. suralis) grafts. Debulking of scapular flap in face was done simultaneously. Eighth months after trauma the patient returned to work. A good esthetic effect was observed.