Scott Harris

The osteocutaneous free fibula flap: Is the skin paddle reliable

This clinical and anatomic study was undertaken to see if the skin paddle of the osteocutaneous fibula flap could be made more reliable. Eighty cadaver limbs were dissected to evaluate the type, number, and location of the cutaneous perforators supplying the lateral leg. Three types of perforators were identified: septocutaneous, musculocutaneous, and a type we termed septomuscular, which does not actually run within the muscle substance but is adherent to the muscle. Although not a true musculocutaneous perforator, it should be treated as such clinically. Musculocutaneous perforators were found to be more numerous and more proximal than the septocutaneous perforators. Eighteen clinical cases demonstrate a 33 percent skin paddle survival when dissected as a septocutaneous flap and a 93 percent skin paddle survival when dissected as a septomusculocutaneous flap. In using the osteocutaneous fibula flap, it is recommended that a cuff of soleus and flexor hallucis longus be incorporated into the flap to help ensure flap viability.

Cartilage warping: an experimental model.

Cadaveric cartilage was cut into blocks with a newly devised cartilage cutter. Over one-hundred pieces of cartilage were used to define a kinetics curve of cartilage warping. Kinetics curves were developed for a control group of cartilage blocks placed in saline-soaked gauze (n = 46). In addition, kinetics curves were developed for cartilage placed in hypotonic saline (n = 14), hypertonic saline (n = 14), and cyanoacrylate glue (n = 6). Photographs of all groups were taken at timed intervals in order to plot the cartilage warping. It was found that pieces of cartilage which were cut peripherally (n = 6) warped twice as much as those cut centrally (n = 40). This was significant to p = 0.001. Within 15 minutes, centrally cut pieces of cartilage warped to approximately 90 percent of their end warpage; on the other hand, peripherally cut pieces of cartilage required 30 minutes to warp 90 percent of their destined warpage. The variables used did not significantly alter the kinetics curves as compared with control.

Analysis and classification of the upper lip aesthetic unit.

Background: Disharmonies of the upper lip aesthetic unit generally stem from tall ergotrids and/or thin lips. Comprehension and correction of such defects has been stifled by a lack of metrics and organized systems of diagnosis and treatment. Methods: The philtral-labial score was devised to better analyze the upper lip region. Measurements were made with Adobe Photoshop CS6, and computations were performed on a standard calculator. A retrospective medical records review identified 908 patients of the senior authors’ (P.R. and S.W.H.) practices who underwent perioral rejuvenation between January 1, 2001, and July 31, 2012. Two hundred patients were randomly selected and assessed for disharmonies in three surveys that sequentially built on data points provided. Results: When preoperative anteroposterior and lateral photographs, dental show measurements, and philtral-labial scores were available, diagnostic concordance between the authors approached 100 percent. Pattern analysis resulted in a classification system (labral classification system), designating patients as either type 0 (no defects), type 1 (thin upper lip), type 2 (long philtrum), or type 3 (both) defects. Characteristic dental show values, philtral-labial scores, and suggested treatments were paired with each type. Conclusions: The labral classification system and its associated analytical tools serve as useful references in consultation, simplify discussion of patients with upper lip defects, furnish a practical alternative to complex algorithms, enable documentation of changes, and facilitate analysis of large sample sizes. When implemented judiciously, the tools described in this article will help surgeons confidently address upper lip problems by streamlining accurate diagnosis and guiding proper treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, III.

Five-year Experience with Perma Facial Implant

Summary: Augmentation cheiloplasty is becoming an increasingly popular aesthetic procedure despite current methodologies having met with disappointment among surgeons and patients. The goal of this study was to examine the benefits and drawbacks of 1 device in particular—Perma Facial Implant (PFI). The senior authors (P.R. and S.W.H.) performed 832 consecutive PFI lip augmentations with excellent results based on photographic documentation, patient satisfaction surveys, unbiased surgeon ratings, and low complication rates. In addition to augmenting thin lips, PFIs hide excess dentition and improve vermilion rhytids and pout. Contrary to alternatives, they are both permanent and reversible. However, they do not level out asymmetries or benefit razor-thin lips without prior lifting or mucosal advancement.

Liposuction-Augmentation Mammaplasty

Background: The female breast loses superior fullness and becomes more ptotic over time. Women often present to their plastic surgeon requesting reversal of this evolution. While liposuction alone has been proven to lift the breast, no solution combining augmentation and liposuction has been reported. Objectives: Herein, we introduce a technique called liposuction‐augmentation mammaplasty (LAM) that can achieve “scarless” lifting or simply volume equalization prior to inserting same‐sized implants. We then compare its safety and efficacy to two gold‐standard techniques with similar aims, mastopexy‐augmentation mammaplasty (MAM) and reduction‐augmentation mammaplasty (RAM). Methods: A retrospective 3‐year chart review was conducted on 359 patients (652 breasts) undergoing LAM (n = 125), MAM (n = 188), and RAM (n = 46). Patient demographics, operative details, and revisions were documented. Degree of lift was measured on pre‐ and postoperative photographs using sternal notch‐to‐nipple distances (SN‐N). Statistical differences were assessed between the groups. Results: The LAM groups mean age and OR time (37 years, 46 minutes) were significantly lower than those of MAM (43 years, 90 minutes) and RAM (42 years, 106 minutes). Mean BMIs and revision rates were uniform between the LAM and MAM groups (24, 2.5%), but significantly higher for RAM (28, 4.6%). Aspirate volumes and resection weights averaged 151 cc and 307 g (left breast) and 173 cc and 298 g (right breast). Minimum follow up was 12 months. The LAM groups mean SN‐N reduction (˜6%) was statistically significant, albeit much lower than MAM (˜16%) and RAM (˜22%). Conclusions: LAM is a safe, facile, reliable solution for the ptotic, fatty breast. Patients can direct their volumetric outcome and enjoy lower costs and shorter downtime. Level of Evidence: 3: Figure. No Caption available.