Georgia-Alexandra Spyropoulou

Reconstruction of the hypopharynx with the anterolateral thigh flap: defect classification, method, tips, and outcomes.

Background: The authors retrospectively reviewed their experience over the past 5 years with reconstructions of hypopharyngeal defects using anterolateral thigh flaps. The purpose of the study was to present a modified classification of defects, the method and tips used, and outcomes and morbidities. Methods: From 2002 to 2007, 55 anterolateral thigh flaps were harvested for reconstruction of hypopharyngeal defects after tumor ablation in 54 patients. Patient age ranged from 38 to 77 years (average, 54 years). In 24 cases, free flaps were used for reconstruction of circumferential defects; in 28 cases, they were used to reconstruct partial defects; and in three cases, they were used to reconstruct circumferential and skin defects. Results: Total flap loss occurred in one patient and partial flap loss occurred in three patients. Strictures occurred in three patients and fistulas occurred in 10. In one case, arterial occlusion was noticed postoperatively. The arterial anastomosis was revised and the flap was salvaged. In another case, venous occlusion was noticed. The vein was reanastomosed with a vein graft and the flap was salvaged. Postoperatively, seven patients tolerated a regular diet. The donor site was skin grafted in five cases, closed with reverse anterolateral thigh in one case and with retrograde V-Y advancement flap in one case, and closed primarily in the rest. There were no donor-site complications. Conclusion: Reconstruction of the hypopharynx with the anterolateral thigh flap offers versatility in the coverage of large and complex defects and is associated with minimal donor-site morbidity.

Reconstruction of perineoscrotal and vaginal defects with pedicled anterolateral thigh flap.

OBJECTIVE To present a series of perineoscrotal and vaginal defects reconstruction with the use of anterolateral thigh flap. METHODS We present a series of 11 patients in whom we used pedicled thigh flaps (10 anterolateral thigh flaps and 1 anteromedial thigh flap) to cover defects of perineum, scrotum, and vagina. Ten patients had perineoscrotal defects and 1 patient had vaginal agenesis. RESULTS Age group ranged from 26 to 79 years. The size of the flaps ranged from 105 cm² to 220 cm². The vascular pedicle length ranged from 10 cm to 12 cm. Stable closure was achieved in every patient. There were no complications from the donor site. In 1 patient, we found only 1 perforator at the superomedial edge of the flap that originated from the medial circumflex femoral artery; hence, in this patient, we used an anteromedial thigh flap as a salvage procedure. CONCLUSION With versatility in their design and low donor site morbidity, these flaps present an option in the armamentarium of the reconstructive surgeon for the coverage of defects at the perineoscrotal and vaginal area.

The conjoint medial circumflex femoral perforator and gracilis muscle free flap: anatomical study and clinical use for complex facial paralysis reconstruction.

Background: The aim of this study was to establish the anatomic basis of the conjoint medial circumflex femoral perforator and gracilis muscle flap and to expand the use of this flap in complex facial paralysis reconstruction. Methods: An anatomic study was initially undertaken to record the existence, consistency, and diameter of musculocutaneous perforators emanating from the proximal third of the gracilis muscle to provide blood supply to the overlying fascia, subcutaneous fat, and skin. In a total of 20 clinical cases of gracilis muscle harvesting, the aforementioned anatomical data were recorded during flap dissection. At least one musculocutaneus perforator, consisting of one artery and two accompanying veins (vein caliber > 0.3 mm) was found in 95 percent of cases. Results: The anatomical study was followed by successful use of the conjoint flap for reconstruction of longstanding facial palsy accompanied by a soft-tissue defect of the cheek. In the first stage, cross-face nerve grafting was performed. In the second stage, free transfer of the conjoint flap, consisting of the proximal third of the gracilis muscle and the overlying subcutaneous fat, was performed to the face. The only connection between the two components of the conjoint flap was one musculocutaneous perforator. When the flap was inset, the muscle was used for facial reanimation and partial obliteration of the soft-tissue defect, while the subcutaneous fat was used to obliterate the rest of the defect Conclusion: The proposed technique ensured symmetry of the face, on both rest and animation, and obliteration of the cheek deformity.

Buried anterolateral thigh flap for pharyngoesophageal reconstruction: Our method for monitoring

A noninvasive method for monitoring in cases of pharyngoesophageal defects reconstruction with the anterolateral thigh flap is presented.

A 35-year-old woman presenting with an unusual post-traumatic leiomyoma of the nipple: a case report

IntroductionLeiomyoma of the mammary papilla is one of the most uncommon nipple tumors with only 50 cases reported in the literature until now. To the best of our knowledge we present the first report of a nipple leiomyoma that originated from a traumatic abrasion caused by breastfeeding.Case presentationA 35-year-old healthy Caucasian female with a cauliflower-like tender and pink nodular mass that was approximately 10mm in diameter presented to our out-patients department. The patient suggested that the mass originated from a traumatic abrasion caused by breastfeeding three years ago and it has been slowly growing ever since.An excision biopsy was performed. The histological and immunohistochemical examination confirmed the diagnosis of leiomyoma. There were no postoperative complications or any sign of local recurrence four years postoperatively.ConclusionsLeiomyoma of the mammary papilla is a rare benign neoplasm that usually appears as a solid tender nodule. Differential diagnosis comprises breast carcinoma, leiomyosarcoma and myoid hamartoma. The recommended treatment is complete excision of the tumor with histologically confirmed tumor-free margins otherwise recurrence is possible. A detailed history of the patient’s disease can reveal the original etiology. This is an original case report that will have particular interest to plastic surgeons, dermatologists, and pathologists. The pathogenetic mechanism was trauma of the nipple. According to our review of the literature this particular information has never been reported and we think that it may advance our knowledge of this very infrequent tumor.

Pedicled Free-style Perforator Flaps for Trunk Reconstruction: A Reliable Method

Background: By exploring the perforating vessels that supply the soft tissues adjacent to a given defect, a perforator flap can be designed in free-style fashion. Methods: From 2009 to 2013, 14 defects of the trunk (excluding the abdomen) were reconstructed using pedicle free-style perforator flaps at the Department of Plastic Surgery, E-Da Hospital, Taiwan. Several perforators at the periphery of the defect were detected and marked preoperatively using a handheld Doppler probe. Then, they were explored intraoperatively through the existing wound edge after wide excision of lesions. The most suitable perforator was selected by means of direct vision and chosen as the pivot point, and then the flap was designed around it, taking into consideration the axiality of the vessel and the ability to achieve direct donor-site closure. Results: All of the flaps survived completely, except for one flap that partially failed because of congestion, and for which the salvage procedure was a skin graft. Full coverage of the defect with excellent contour and color matching and primary closure of the donor sites was achieved in all of the patients. Conclusions: The free-style approach to trunk reconstruction allows the surgeon to complete a robust like-for-like reconstruction while confining the scar burden to a single site. Using the handheld Doppler device and visualizing the perforators directly through the wound edge eliminates the need for preoperative imaging, and allows for the optimal flap to be designed based on vessel size and quality and minimizes donor-site morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The use of suture anchors in reconstruction of sacral pressure ulcers with gluteal fasciocutaneous advancement flaps.

Suture anchors have already been successfully used for soft-tissue fixation to bone. In this study, suture anchors were used in sacral pressure ulcer reconstruction, aiming at secure midline attachment of gluteal fasciocutaneous flaps, obliteration of any dead space, and recreation of the natal cleft. Thirteen patients with sacral pressure ulcers were treated with bilateral gluteal fasciocutaneous V-Y advancement flaps. Suture anchors were used to invert and attach the flaps to the midline crest of the sacrum. All flaps healed well, no postoperative anchor failure or wound dehiscence was noticed, and the esthetic result was very pleasing. In conclusion, the use of suture anchors offers an easy, practical, and secure attachment of V-Y advancement gluteal fasciocutaneous flaps in sacral pressure ulcer reconstruction. Main advantages of the method suggested are reduction of suture-line tension, obliteration of any cavity at the midline, and recreation of the natal cleft.

Can an “Aesthetic” Intervention (Braided Hair Coil) Cause Hair Loss After an Aesthetic Operation?

UNLABELLED Postoperative pressure alopecia (PPA), defined as hair loss caused by prolonged pressure on the patients scalp during surgery, is an uncommon condition after aesthetic surgery. Originally, it was described for patients who underwent lengthy cardiovascular and gynecologic operations. The authors present a rare case, in which hair loss occurred after secondary breast augmentation (replacement of breast implants). The PPA appeared in the occipitoparietal region of the patients scalp approximately 2 weeks after surgery. The operation was completed in less than 3 hours, without any fluctuations in the patients blood pressure or any unusual blood loss. There were no other precipitating factors such as anemia or coagulopathies. The probable cause of this unexpected result was the patients braided hair coil, which had not been noted before the operation. The patient habitually, and on the day of her operation, combed her hair into a braided coil, which placed extra pressure on the occipitoparietal region. The hair loss was temporary, and hair regrowth was complete within 2 months. This incident may have been avoided if the braided hair coil had been noted by nursing or other medical staff preoperatively. Repositioning the head every 30 minutes and providing adequate head padding during surgery are advised to protect the patient and prevent such incidents. LEVEL OF EVIDENCE 5.

A 6-Year Experience in Flat Helix Correction With a Simple Procedure

OBJECTIVE To present our 6-year experience in flat helix correction with a simple procedure. Among the many different congenital ear deformities lies the flat helix. The correction of this anomaly must be considered owing to its significance to the overall shape and appearance of the auricle. METHODS Our surgical method is based on a geometrical approach, with radiating beveled incisions of the helical cartilage and subsequent overlapping and suturing of small triangular cartilaginous flaps. The method was applied in 15 patients over 6 years and was combined with correction of prominent ears in 9 cases. RESULTS Curling of the helix was achieved in all cases. A step deformity detected in 2 initial cases led to minor technique modification. No recurrences were recorded during the follow-up period (mean follow-up, 32 months). All patients were satisfied with the aesthetic outcome. CONCLUSIONS The method applied is a relatively simple and reliable procedure that allows the restoration of the curvilinear shape of the helix. It can be performed under local anesthesia (along with any other procedure that a prominent ear may require), causes no visible scars, and delivers consistently effective results.

Full Facial Feminization Surgery: Patient Satisfaction Assessment Based on 180 Procedures Involving 33 Consecutive Patients.

Sir:We read with great interest the article by Raffaini et al.1 concerning facial feminization surgery satisfaction assessment. Despite our personal high resistance in operating on transgender patients who want to undergo facial feminization, we feel that in some cases such operations are an unavoid