Guy M. Stofman

The Buccinator Myomucosal Island Pedicle Flap: Anatomic Study and Case Report

The buccinator myomucosal island pedicle flap is a useful means of introducing relatively large amounts of vascularized mucosa into the oral cavity. Using cadaver dissections and clinical cases, the anatomy and clinical relevance of this tissue are defined. Emphasis is placed on the technical caveats and pitfalls of the procedure.

Current trends in vaginal labioplasty: a survey of plastic surgeons.

Background:Labioplasty serves to resolve an anatomic variation that results in aesthetic and functional difficulties for many women. To date, little effort has been made to compare the efficacy or prevalence of various techniques, and furthermore, evidence-based practice guidelines have not yet been established for this procedure. The purpose of this study is to elucidate the current armamentarium and practice guidelines for labia minora reduction, as well as to examine self-reported outcomes for this procedure. Methods:A 2009 web-based survey was sent to members of the American Society of Plastic Surgeons via electronic mail. The survey was used to assess surgeon demographics, practice guidelines for labioplasty, and self-reported outcomes measures. Results:A total of 750 surgeons responded to the survey (19.7% response rate), and 51.0% of surgeons currently offered labioplasty. The total number of procedures over the past 24 months for all respondents was 2255. Per surgeon over 24 months, the mean number of procedures was 7.37 (range, 0–300). Surgeons that directly advertised that they performed labioplasty performed a mean of 14.2 procedures over 24 months versus a mean of 5.01 for those who did not (P = 0.001). The mean time suggested to refrain from intercourse was 31.3 days. Redundancy or inadequate resection and wound dehiscence were the 2 most common reasons that caused surgeons to reoperate. Surgeons using plain gut suture material had the highest reported rates of reoperation. The prevalence of each technique was as follows: simple amputation (52.7%), W-SHAPED resection (9.5%), S-shaped resection (8.8%), central v-wedge (36.1%), central wedge with z-plasty (13.9%), and deepithelialization (1.2%). The mean perceived patient satisfaction rate reported by surgeons was greater than 95% for all techniques, and there was no statistically significant difference when comparing perceived patient satisfaction among the techniques (P = 0.337). Conclusions:This study provides data suggesting that labioplasty has been safely and effectively used by many plastic surgeons. However, there is great variation with regard to both techniques and practice guidelines. In establishing these discrepancies among surgeons, we hope to provide the impetus for further academic dialogue and prospective trials.

Three-dimensional imaging of Poland's syndrome

Use of a three-dimensional CT scan as an adjunct for planning chest-wall and breast reconstruction in Polands syndrome is presented with follow-up MRI with three-dimensional reformation to demonstrate the results of the implant reconstruction. The imaging techniques are capable of accurately portraying the three-dimensional tissue deficit and asymmetry. This imaging may assist in the choice of muscle transposition flaps and reconstructive technique.

Posttraumatic epidermal inclusion cyst of the deep infratemporal fossa.

The authors report a case of an epidermal inclusion cyst found in the deep infratemporal fossa 12 years after the patient sustained blunt trauma to that region. Posttraumatic epidermal inclusion cysts are rare and occur mainly in the fingers, palms, and soles. Introduction of the epidermal elements into the dermis during the trauma is thought to be the cause. This case is rare in presentation, with few reports in the English literature that describe an epidermal inclusion cyst in the deep infratemporal fossa. Review of the English literature disclosed no other cases of epidermal inclusion cyst after blunt trauma involving the deep infratemporal region.

A new approach for repair of oro-antral-nasal fistulae: The anteriorly based buccinator myomucosal island flap

Oral-antral-nasal fistula (OAN) is a commonly encountered clinical problem. The literature is filled with a plethora of methods described for closing a persistent OAN. Local flaps are available to close minor to moderate defects, however, large fistulae can be a very challenging reconstructive problem. Various areas of the oral cavity have been used for closure of OAN. We describe a technique to reconstruct the oral cavity, in this case an OAN. The anteriorly based buccinator myomuosal island pedicle flap (BMIP) provides an alternative method for reconstructing the oral cavity. An extensive review of the literature as well as the anatomy of the buccinator, its reconstructive capabilities, and two case reports are included.

Better Sex From the Knife? An Intimate Look at the Effects of Cosmetic Surgery on Sexual Practices

BACKGROUND The positive effects of aesthetic plastic surgery with respect to body image and self-esteem have been reported in the literature. However, the possible effects of aesthetic surgery on the sexual practices and characteristics of patients have been largely unexplored. OBJECTIVE This paper seeks to examine the degree to which a major aesthetic procedure affects the patients postoperative psychosexual life. METHODS An anonymous questionnaire regarding preoperative versus postoperative psychosexual health and sexual behaviors was mailed to 330 male and female patients who had undergone a major aesthetic procedure by the senior author (G.M.S). Major procedures were defined as breast augmentation and/or mastopexy; facial aesthetic surgery, including face lift, brow lift, and rhinoplasty; and body contouring procedures, including abdominoplasty with or without lipoplasty, or lipoplasty alone. RESULTS Of the 330 surveys mailed out, 54 were returned as undeliverable. Seventy completed surveys were returned. All the respondents were women, with a mean age of 38 years. More than 95% of respondents reported improvements in body image. Eighty percent of breast augmentation respondents and 50% of body surgery respondents declared improvements in sexual satisfaction. Fifty percent of breast and 60% of body respondents had changed to more provocative attire. Approximately 70% of the breast and body group testified that their partners sex life had been enhanced. More than 30% of breast patients and 50% of body patients reported an enhanced ability to achieve orgasm. When body and breast respondents were compared with face surgery respondents, statistical significance (P < .01) was found among most psychosexual variables investigated. CONCLUSIONS The results of this study affirm that cosmetic surgery patients overwhelmingly tend to feel better about their body after surgery. The sex lives of both patients and their sexual partners can be strikingly enhanced after elective cosmetic surgery, particularly if the surgery is focused on the breasts, abdomen, and thighs.

Aesthetic and functional considerations of radical neck deformities

Radical neck surgical procedures, like other techniques, have evolved with time. The first description, by Crile1 in 1906, involved en bloc resection of cervical lymph nodes. In the 1940s, Hayes Martin, who was a neurosurgeon in the Army during World War II, improved on this procedure.2 He emphasized the use of antibiotics, blood transfusions, intratracheal anesthesia, and split-thickness skin grafting to decrease the mortality rate for his “commando” operation to approximately 1 percent. Concurrently, Batson,3 in a brilliant study, observed that the cross-sectional area of the paravertebral system was greater than that of the jugular system. This led to the advances of Bocca and colleagues,4,5 who advocated bilateral neck dissections after recognizing the high rate of metastasis of supraglottic tumors. By that time, the mortality rate of bilateral neck dissection was becoming acceptable, with preservation of the spinal accessory nerve, the sternocleidomastoid muscle, and the internal jugular vein.6–9 The use of adjuvant external-beam radiotherapy, as reviewed by DeSanto and Beahrs10 in the 1980s, led to greater use of this method for the treatment of metastatic disease. This led to a larger population of patients presenting with more severe deformities secondary to compounding radiation-induced injuries. The original goal of reconstruction of defects resulting from neck dissection (modified/radical or unilateral/bilateral) was primary closure, if possible. The use of the drum principle for split-thickness skin grafting provided another method for coverage.8,9 Further advances in radical neck reconstruction focused on local pedicle flaps, such as the pectoralis major flap advocated by Ariyan11 and the deltopectoral flap described by Bakamjian.12 Microvascular surgical advances in the 1970s allowed more elaborate free flap tissue coverage. This brings us to the present, and we describe an aesthetic technique for elective delayed reconstruction of radical neck deformities.