Jim Gilmore

Comparison of microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant.

IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012, at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose. LEVEL OF EVIDENCE 3.

Use of vicryl mesh in prevention of postrhinoplasty dorsal irregularities

Small, palpable, and visible dorsal irregularities may occur in as many as 5 to 10% of rhinoplasties. They can be unacceptable to both the surgeon and patient and can lead to unwanted secondary surgery. In 88 patients treated over an 18-month period, Vicryl mesh implants consisting of one to three layers of Vicryl were placed under direct vision over the dorsal cartilage; care was taken to avoid disturbing any cartilage implants. Early results were impressive; there was an absence of palpable dorsal irregularities. This report describes the surgical technique and impressions during the 18-month period.

Septal perforation repair without intraoperative mucosal closure.

To report a technique for septal perforation repair that does not rely on intraoperative mucosal closure of the perforation defect.

The Rare Presentation to the Cosmetic and Plastic Surgeon of a Patient with Myxedema

Myxedema results from hypofunction of the thyroid gland. Symptoms include dry skin, loss of and dryness of hair, mental apathy, drowsiness, and sensitivity to cold. Ocular complications associated with myxedema may be the symptoms that first prompt patients to seek a physician or cosmetic surgeon, however, though other symptoms may be present before eyelid myxedema occurs. The case reported here illustrates the value of a correct diagnosis and appropriate medical treatment, and demonstrates how surgical intervention to correct remaining eyelid problems can succeed when it is part of a comprehensive treatment plan.

Scar Avoidance in Removal of Forehead Lipomata: An Endoscopic Approach:

Lipomas are among the most commonly presenting benign forehead masses. They commonly cause cosmetic concerns for patients. The purpose of this report is to introduce a novel endoscopic technique allowing for forehead soft tissue mass removal with superior cosmetic outcomes. We detail a case of a large 3.5-cm lateral forehead lipoma that was successfully removed endoscopically through a single incision via a subtemporoparietal approach. The lipoma presented is the largest documented case removed endoscopically using this approach. We introduce a novel technique using a single incision in the temporal area to remove a forehead mass via a dissection between the temporoparietal fascia and deep temporal fascia. Our broad literature search only found one other report of this approach used for forehead lipoma removal. Our report further validates this approach and highlights its efficacy in removing large masses. Patients with cosmetic concerns about having a facial scar, children, and those with predisposition ...Lipomas are among the most commonly presenting benign forehead masses. They commonly cause cosmetic concerns for patients. The purpose of this report is to introduce a novel endoscopic technique allowing for forehead soft tissue mass removal with superior cosmetic outcomes. We detail a case of a large 3.5-cm lateral forehead lipoma that was successfully removed endoscopically through a single incision via a subtemporoparietal approach. The lipoma presented is the largest documented case removed endoscopically using this approach. We introduce a novel technique using a single incision in the temporal area to remove a forehead mass via a dissection between the temporoparietal fascia and deep temporal fascia. Our broad literature search only found one other report of this approach used for forehead lipoma removal. Our report further validates this approach and highlights its efficacy in removing large masses. Patients with cosmetic concerns about having a facial scar, children, and those with predisposition for keloids or hyperpigmented/hypertrophic scars stand to benefit most from this procedure. When comparing the endoscopic approach with the commonplace open-incision approach, our approach shows superior cosmetic results, less risk of damage to important neurovascular structures, and, most importantly, higher patient satisfaction. Even when contrasting the technique outlined in this report versus other endoscopic approaches, our method produces enhanced results.

Septal Perforation Repair Without Intraoperative Mucosal Closure in a Patient With Graft Versus Host Disease

We report a technique used to achieve successful repair of 2 large septal perforations in a patient with graft versus host disease, chronic use of corticosteroids, and chronic use of immunosuppressive medications. A multilayered interposition graft was constructed out of temporal fascia and flexible polydioxanone plates and placed between the mucoperichondrial flaps. Due to large size of the perforations and poor tissue quality, no attempt at mucosal closure of the perforations was made. Instead, silicone sheets were placed for 52 days to facilitate healing. Complete healing of both perforations sites was obtained along with resolution of the patient’s symptoms. The described technique provided an optimal surgical outcome in the setting of multiple large septal perforations, graft versus host disease, chronic corticosteroids, and chronic immunosuppressive medications.

The J-Lift/Internal Face-Lift for Facial Rejuvenation

Objective: To evaluate our experience with the J-lift/internal facelift, which includes lipoaspiration of the lateral cheek and neck, limited subcutaneous dissection with multivector superficial musculoaponeurotic system plication, and subperiosteal dissection in the jowl and malar areas with implant placement. Methods or Design: A retrospective chart review of 139 patients who underwent J-lift and internal face-lift between 2001 and 2004. The number of complications was addressed and results analyzed photographically using a 3 point scale. Results: 137 patients expressed satisfaction with the technique. The two that did not suffered from extensive adiposity in the neck tissues. There were three complications, which consisted of a small eschar over the tragus, a widened preauricular scar and some asymmetry of one prejowl implant which were successfully addressed with minor revision surgery. There were no cases of expanding hematoma, postoperative auricular displacement, injury to cranial nerves V or VII, or loss of hair in the temporal area. Photographic assessment of the results indicated fair to moderate improvement in the midface and good to excellent improvement in the jowl and cervicomental angle. Conclusions: The J-lift is an effective and safe technique for patients with jowl and cervicomental angle rhytids.

Use of Vicryl Mesh in Prevention of Postrhinoplasty Dorsal Irregularities

Small, palpable, and visible dorsal irregularities may occur in as many as 5–10% of rhinoplasties. They can be unacceptable to both the surgeon and patient and can lead to unwanted secondary surgery. In 88 patients treated over an 18-month period, VICRYL mesh implants consisting of one to three layers of VICRYL were placed under direct vision over the dorsal cartilage; care was taken to avoid disturbing any cartilage implants. Early results were impressive; there was an absence of palpable dorsal irregularities. This report describes the surgical technique and impressions during the 18-month period.

A Case for Traditional Surgical Treatment of Postrhinoplasty Arteriovenous Malformations

Arteriovenous malformations or hemangiomas are rarely reported complications postrhinoplasty. While surgical lasers are gaining increasing use in the treatment of other etiologies of arteriovenous malformation, the potential for unacceptable cosmetic results justifies examination of other, more traditional techniques for repair of these difficult vascular problems. This case presentation details a successful surgical approach to treatment of the postrhinoplasty arteriovenous malformation and outlines the clinical judgments and findings used to rule out use of the laser as a primary surgical modality.