Ted A. Cook

The 'butterfly' graft in functional secondary rhinoplasty

Objective To describe a surgical technique (the conchal cartilage “butterfly” graft) which, when used in properly selected patients, has been found to be a dependable method for alleviation of postrhinoplasty internal nasal valve dysfunction.

Immediate Reconstruction of Extruded Alloplastic Nasal Implants With Irradiated Homograft Costal Cartilage

Objective To describe a novel surgical protocol for the management of patients presenting with extruded nasal implants.

Complications Associated With Alloplastic Implants in Rhinoplasty

OBJECTIVE To evaluate the incidence of infection and extrusion of porous high-density polyethylene (pHDPE) and expanded polytetrafluoroethylene (ePTFE) implants used in rhinoplasty at a high-volume, academic facial plastic surgery practice. METHODS A total of 662 rhinoplasty procedures performed by 3 faculty surgeons from 1999 to 2008 were retrospectively reviewed. Patient demographics, medical comorbidities, operative details, and postoperative course findings were collected from patient records. RESULTS The incidence of postoperative infection was 2.8% (19 of 662 patients). In each case of infection, alloplastic material had been used. Infections occurred in 1 in 5 rhinoplasty procedures in which pHDPE implants were used. In patients in whom ePTFE was used alone, the infection rate was 5.3%. Exposure developed in 12% of patients in whom an alloplast was used during surgery. Factors notably not associated with infection on bivariate analysis included sex, surgeon, purpose of procedure (functional vs cosmetic), current tobacco use, or history of cocaine use (P > .05 for all). CONCLUSIONS To our knowledge, this study represents the largest evaluation of the use of pHDPE implants in rhinoplasty to date. Our findings are in contrast to those of previous studies regarding the use of pHDPE in rhinoplasty and parallel to those regarding the use of ePTFE. Caution is strongly recommended when considering the use of pHDPE in rhinoplasty.

Conchal cartilage butterfly graft in primary functional rhinoplasty

To validate the use of the conchal cartilage butterfly graft in primary functional rhinoplasty and to review our experience using this technique.

The rat ventral island flap: a comparison of the effects of reduction in arterial inflow and venous outflow.

The relative importance of reduced arterial inflow versus reduced venous outflow in determining flap necrosis remains undefined, even though this is critically important in understanding the effects of pharmacologic agents on flap survival. By means of a rat bipedicled ventral island flap, the amount of random flap necrosis was examined in four experimental groups: (1) unilateral arteriovenous ligation (n = 19), (2) unilateral vein ligation (n = 20), (3) unilateral artery ligation (n = 20), and (4) alternate side vein and artery ligation (n = 18). No necrosis occurred on the side of the vein ligation in groups 2 and 4, indicating that independently reducing venous outflow does not cause flap necrosis. A predictable necrosis occurred ipsilateral to artery ligation in groups 1 (37.63 +/- 17.34 percent), 3 (32.74 +/- 17.32 percent), and 4 (15.70 +/- 9.86 percent). These data indicate that the rat ventral island flap is more sensitive to a decrease in arterial inflow than to a decrease in venous outflow. This model may therefore be useful in clarifying the effect and determining the mechanism of action of pharmacologic agents that alter flap survival.

Correction of internal nasal valve stenosis: a single surgeon comparison of butterfly versus traditional spreader grafts.

Nasal obstruction due to internal nasal valve (INV) collapse is relatively common. This article evaluates 2 different methods repairing the INV.Our subject population is a single-surgeon group of 82 patients who underwent a septorhinoplasty for nasal airway obstruction. Patients received either a spreader graft or butterfly graft. There are 30 patients who received spreader grafts and 52 patients who received a butterfly graft. All patients had a minimum of 3 months follow-up. All patients were evaluated with standardized questionnaire. Participants were asked to evaluate improvement in their nasal airway on an analog scale of 1 to 5. Participants were also asked to comment on changes in pre and postoperative snoring and sleep habits. Lastly, participants were queried regarding the ear cartilage harvest and if this bothered them.Patients undergoing both procedures demonstrated an overall improvement in their nasal breathing. Significant differences in improvement were observed for patients in the categories of postoperative snoring, sleep, and continuous positive airway pressure use. Patients were not bothered by the ear cartilage harvest.In select patients, the butterfly graft is a useful solution for INV collapse correction.

Effects of Pentoxifylline on Experimental Skin Flap Survival

We studied the effects of pentoxifylline on experimental skin flap survival in the domestic pig. Random skin flaps were designed using a length-width ratio of 5:1. The pigs were then given pentoxifylline (25 mg/kg/d) or placebo for seven days. Fluorescein sodium was used to help determine surviving skin flap length seven days postoperatively. Results showed no significant difference in mean surviving skin flap length between the study and control groups. We question the value of pentoxifylline in increasing skin flap survival.

The total nasal defect and reconstruction.

The structures of the nose are arguably the most complex within the face to reconstitute when absent. Total nasal reconstruction has evolved to encompass advanced surgical techniques in an effort to achieve increasingly satisfactory cosmetic results while restoring nasal function that mimics the function of a patients natural nose. In this article, the history of total nasal defects and their reconstruction, relevant nasal anatomy, etiologies of the defect, and the surgical approaches to reconstructing each of the three-layered structure of the nose (ie, nasal skin, cartilage/bone, and lining mucosa) are explored.

Middle and inner ear anomalies in a conjoined twin

A pair of temporal bones obtained from a thoracopagus conjoined twin revealed malformation of the facial nerve and vestibular fenestra (oval window) on one side, and underdeveloped petrous bone and aplastic inner ear apparatus on the other.

Assessment of Survival and Microscopic Changes in Porcine Skin Flaps Undergoing Immediate Intraoperative Tissue Expansion

The technique of rapid Intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skins ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random-pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under-predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under-predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunoflurescence, collagen, and elastic tissue stains.