Jeffrey Rawnsley

Radial forearm free flap pharyngoesophageal reconstruction.

Objectives This study evaluates the outcome of pharyngoesophageal reconstruction using radial forearm free flaps with regard to primary wound healing, speech, and swallowing in patients requiring laryngopharyngectomy.

Octogenarian Free Flap Reconstruction: Complications and Cost of Therapy

OBJECTIVE: The study goal was to document the reliability, incidence of complications, and cost of therapy for patients older than 80 years who undergo microvascular head and neck reconstruction. PATIENTS AND METHODS: Thirteen octogenarians underwent free flap reconstruction of defects resulting from the treatment of head and neck cancer at an academic tertiary care medical center. The incidence of medical and reconstructive complications and the cost of hospitalization were compared with those for 99 younger patients who were treated during the same time period. RESULTS: There were no cases of free flap failure or significant reconstructive complications in the octogenarians. The incidence of medical complications was 62% in the octogenarians and 15% in the younger patients. The average cost of therapy was

Microvascular flap reconstruction of the mandible: A comparison of bone grafts and bridging plates for restoration of mandibular continuity

54,702 per octogenarian patient compared with

Carcinoma of the buccal mucosa

30,397 per younger patient. The increased incidence of medical complications and increased cost arose primarily from an increased severity of preoperative systemic illness in the octogenarians. However, controlling for comorbidity did not eliminate the discrepancy in medical complications between the octogenarians and the younger patients. CONCLUSIONS: Although microvascular head and neck reconstruction in the elderly is very reliable, the incidence of medical complications and the cost of therapy are significantly increased in octogenarians.

Clinical evaluation of non-ablative radiofrequency facial rejuvenation.

OBJECTIVE To compare the efficacy of vascularized bone grafts and bridging mandibular reconstruction plates for restoration of mandibular continuity in patients who undergo free flap reconstruction after segmental mandibulectomy. Study design and setting A total of 210 patients underwent microvascular flap reconstruction after segmental mandibulectomy. The rate of successful restoration of mandibular continuity in 151 patients with vascularized bone grafts was compared to 59 patients with soft tissue free flaps combined with bridging plates. RESULTS Mandibular continuity was restored successfully for the duration of the follow-up period in 94% of patients who received bone grafts compared with 92% of patients with bridging mandibular reconstruction plates. This difference was not statistically significant. In patients who received bone grafts, most cases of reconstructive failure occurred during the perioperative period and were due to patient death or free flap thrombosis. In patients who received bridging plates, all instances of reconstructive failure were delayed for several months and were due to hardware extrusion or plate fracture. CONCLUSIONS Vascularized bone-containing free flaps are preferred for reconstruction of most segmental mandibulectomy defects in patients undergoing microvascular flap reconstruction. However, use of a soft tissue flap with a bridging mandibular reconstruction plate is a reasonable alternative in patients with lateral oromandibular defects when the nature of the defect favors use of a soft tissue free flap. SIGNIFICANCE Both bone grafts and bridging plates represent effective methods of restoring mandibular continuity following segmental mandibulectomy, with the former being the preferred technique for patients undergoing microvascular reconstruction.

Aesthetic considerations in scalp reconstruction.

OBJECTIVE: The goal was to analyze the outcome of surgical therapy for buccal carcinoma. STUDY DESIGN: A retrospective chart review was done. SETTING: The study took place in a major tertiary-care hospital. RESULTS: Twenty-seven patients received first-time surgical therapy for buccal carcinoma. Treatment was surgery alone in 15 and surgery followed by radiation therapy in 6 patients. Six additional patients received surgical salvage for radiation therapy failure. Composite resection of the tumor was performed in 16 patients (59%). Five-year observed actuarial survival rates were 100%, 45%, 67%, and 78%, and locoregional recurrence rates were 0%, 27%, 44%, and 0% for stages I to IV, respectively. The 5-year actuarial survival rates were 80% after surgery and 82% after surgery and postoperative radiation therapy. Patients who underwent surgical salvage after radiation therapy failure had a 1-year survival rate of 0%. CONCLUSION: Aggressive surgical treatment of buccal carcinoma may result in better survival rates. SIGNIFICANCE: The article analyzes buccal carcinoma in regards to the patterns of presentation, treatments rendered, and patterns of failure.

The Utility of Ultrasound in the Evaluation of Submental Fullness in Aging Necks

OBJECTIVE: To evaluate the clinical efficacy of non-ablative cutaneous radiofrequency (RF) facial rejuvenation. DESIGN: Prospective study with longitudinal follow-up of a validation cohort set in an urban, private practice of an ambulatory facial plastic surgery center in southern California. METHODS: A consecutive sample was enrolled of 35 healthy adults with moderate facial aging, manifested by skin laxity, rhytids, and ptosis (brow, midface, jowls). Following intravenous sedation anesthesia, the study area was treated with 115-144 J/cm2 using the non-ablative RF device (ThermaCool TCTM). The main outcome measures were the objective measurement of brow height, investigator evaluation of skin parameters, a patient satisfaction questionnaire, and standardized photography, at fixed time intervals. RESULTS: At 12 weeks, a statistically significant increase in mean vertical brow height of 1.6-2.4 mm was observed in patients treated exclusively with the RF device (p<0.0001). All skin parameters (laxity, wrinkles, clarity, pore size) were improved. Complications and side effects were minimal. Patients were uniformly satisfied. CONCLUSIONS: The ThermaCool TC RF system represents a promising non-invasive method of obtaining moderate facial rejuvenation in the appropriately selected patient. Long-term results are pending.

Platelet-Rich Plasma for the Aesthetic Surgeon

This article reviews common methods of reconstructive surgery in patients with wounds that involve the scalp, including primary wound repair, healing by secondary intention, and the use of skin grafts, local tissue flaps, regional myocutaneous flaps, and microvascular free flaps. Special attention is paid toward consideration of aspects of the reconstruction that affect the aesthetic outcome, including preservation of the hairline and hair follicle orientation, scar camouflage, avoidance of alopecia, and secondary restoration of alopecia.

Autologous Fibroblasts for Treatment of Facial Rhytids and Dermal Depressions: A Pilot Study

OBJECTIVES To evaluate the submental region of the aging neck with high-frequency ultrasound and to assess the relative contribution of its various components to the appearance of age-related soft-tissue ptosis. METHODS Ten patients with submental soft-tissue excess were recruited from the senior authors (G.S.K.) private practice. The subcutaneous fat compartment, the subplatysmal fat compartment, and the anterior bellies of the digastric muscles were imaged with high-frequency ultrasound and measured in the cephalocaudal dimension. Pseudoherniation of subplatysmal fat, judged in relation to the inferior surface of the digastric muscles, was also assessed from acquired images. RESULTS A clear delineation of submental anatomy was obtained with ultrasound in all patients (N = 10, 100%). Hypertrophied digastric muscles (n = 1, 10%) and excessive subplatysmal fat (n = 5, 50%) adversely contributed to the appearance of submental fullness in 6 patients (60%). These findings would not have been predicted with the same degree of accuracy from the physical examination alone. CONCLUSIONS High-frequency ultrasound provides useful imaging of the submental region and its components. Deeply situated subplatysmal fat and anterior bellies of the digastric muscles, both of which may be difficult to assess on physical examination, can be readily evaluated with ultrasound. When sufficiently enlarged and ptotic, deep tissues of the submental space necessitate an open submentoplasty to restore a youthful neck contour. Preoperative ultrasonography can assist with anatomical imaging of the submental space and help in planning a targeted operative intervention in patients with submental soft-tissue excess.

Elevation of the Malar Fat Pad With a Percutaneous Technique

Abstract Platelet‐rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated levels of platelets and growth factors. PRP has been identified as a promising treatment for enhancing wound healing and has been used for decades in multiple medical specialties including cardiac surgery, oral surgery, ophthalmology, and orthopedic surgery. Growing evidence for multiple aesthetic surgery applications has recently been developed, particularly for hair restoration and skin rejuvenation. The goal of this article is to review the current medical literature on PRP and identify promising applications that may be integrated into a modern aesthetic surgery practice. The evidence for the use of PRP technology is rapidly expanding as a powerful therapy for select cosmetic surgery patients.