Yukimasa Sawada

Functional reconstruction using a depressor anguli oris musculocutaneous flap for large lower lip defects, especially for elderly patients.

Described here is a new technique to reconstruct large lower lip defects using one or two musculocutaneous island flaps, which includes an innervated depressor anguli oris muscle and has a facial artery in its pedicle. Vermilion is simultaneously reconstructed using a mucosal transposition flap. Three patients who had a total lower lip defect and five patients who had a defect larger than one-half of the lower lip were treated by our procedure. All the flaps survived completely without any signs of vascular stasis. In six patients, sphincter function and sensation appeared within 3 months after surgery. In one patient who needed a total lower lip reconstruction, the depressor anguli oris muscle was atrophic and the motor nerve could not be found. This patient could not regain motion. One other patient complained of a sialorrhea accompanied by sensory loss; however, his sensation improved within 6 months after surgery. All of the reconstructed lower lips were large enough to enable the patient to wear dentures and were of a cosmetically acceptable appearance 1 year after surgery.

nasal Reconstruction Based on Aesthetic Subunits in Orientals

&NA; Reconstruction based on the aesthetic subunit principle has yielded good aesthetic outcomes in patients with moderate to severe nasal defects caused by trauma or tumor resection. However, the topographic subunits previously proposed are often unsuitable for Orientals. Compared with the nose in white patients, the nose in Orientals is low, lacks nasal muscle, and has a flat glabella; the structural features of the underlying cartilage and bone are not distinctly reflected in outward appearance. The authors devised aesthetic subunits suitable for Orientals, and they used these units to reconstruct various parts of the nose. The major difference between these units and those presented previously is the lack of soft triangles and the addition of the glabella as an independent unit. The authors divided the nose into the following five topographic units: the glabella, the nasal dorsum, the nasal tip, and the two alae. The border of the nasal dorsum unit was extended to above the maxillonasal suture. The basic reconstruction techniques use a V‐Y advancement flap from the forehead to reconstruct the glabella, an island flap from the forehead to reconstruct the nasal dorsum and nasal tip, a nasolabial flap to reconstruct an ala, and a malar flap to reconstruct the cheek. A combination of flaps was used when the defect involved more than one unit. This concept was used for nasal reconstruction in 24 patients. In one patient undergoing reconstruction of the nasal dorsum and in one undergoing reconstruction of the nasal tip, the texture of the forearm flap did not match well, which resulted in a slightly unsatisfactory aesthetic outcome. In one patient in whom the glabella, nasal dorsum, and part of the cheek were reconstructed simultaneously, a web was formed at the medial ocular angle, and a secondary operation was subsequently performed using Z‐plasty. In one patient undergoing reconstruction with a forehead flap, defatting was required to reduce the bulk of the subcutaneous flap pedicle at the glabella. However, suture lines were placed in the most inconspicuous sites in all patients, and the use of a trapdoor contraction emphasized the three‐dimensional appearance of the nose. The use of these aesthetic subunits for reconstruction offers several advantages, particularly in Oriental patients. Because the nasal dorsum is reconstructed together with the side walls, tenting of the nasal dorsum is avoided, which prevents a flat appearance of the nose. A forehead flap is useful in the repair of complex defects. Defects of the alae should be separately reconstructed with a nasolabial flap to enhance the effect of the trapdoor contraction and to highlight the three‐dimensional appearance of the nose. Candidates for reconstruction should be selected on the basis of nasal structure. The results suggest that these units can also be used in some white patients. (Plast. Reconstr. Surg. 106: 36, 2000.)

Reconstruction of large nasal defects with a combination of local flaps based on the aesthetic subunit principle.

Herein is described a technique that uses a combination of local flaps to reconstruct large defects involving the nasal dorsum and cheek. The flaps used are a transposition flap elevated from the area adjoining the defect and bilateral cheek advancement flaps. This technique leaves all suture wounds at borders of the aesthetic subunits that have been described previously. Color and texture matches were good and symmetrical. The transposition flap can be modified according to whether the defect includes the nasal tip. After raising the cheek advancement flap, it is also possible to use a dog‐ear on the nasolabial region for any alar defects. Nine patients were treated using this procedure. The technique is very reliable (no complications such as congestion and skin necrosis in our series) and is easy to perform. One patient had palpebral ectropion after the operation and underwent secondary repair. In this series, defects measuring 45 × 30 mm in maximum diameter and including the nasal dorsum, nasal tip, ala, and cheek were treated. (Plast. Reconstr. Surg. 107: 1358, 2001.)

Reconstruction of congenital and acquired earlobe deformity.

The appearance and symmetry of the auricle is crucial for the maintenance of facial cosmetic harmony. The earlobe is considered to be an important attribute of beauty in most cultures, and earlobe decoration with color or earring is a common practice in many societies. A reconstructive technique for congenital or acquired deformity of the earlobe is described. In addition, the postauricular chondrocutaneous flap is very convenient for reconstruction of various auricular parts.

Management of the hairline using a local flap in total reconstruction for microtia.

In cases of microtia with a low hairline, the manner in which hair is removed from the reconstructed auricle must be taken into consideration. This is one of the most common but difficult problems with reconstruction for microtia. The authors describe a new technique that uses a simple regional flap to resolve this problem. The hair-bearing skin in the estimated auricular region and its covering are removed using a local flap from the hairless mastoid region. This is done in the first stage of auricular reconstruction, the costal cartilage grafting is done in the second stage, and elevation of the auricle is done in the last stage. In 38 auricles of 36 patients who were treated from 1993 to 1995, eight auricles of eight patients were treated with this technique. In all cases, the hairless flap healed well, without vascular stasis or skin necrosis. In addition, no complications from using this technique occurred in the later stages of auricular reconstruction. With this technique, the skin of the flap provides a good texture and color match to the auricle. In addition, the skin of the flap has good elasticity for the cutaneous pocket for cartilage grafting. The harvested area of the flap can be hidden behind the reconstructed auricle. The authors initially wondered whether the marginal scar of the transposed flaps position in the auricle would be conspicuous. However, all of the scar became inconspicuous because it was positioned in the scaphoid fossa.

Helical crus reconstruction using a postauricular chondrocutaneous flap

The authors describe a helical crus reconstruction technique using a postauricular chondrocutaneous flap vascularized by the postauricular vessels. They used this procedure on 7 patients who had developed a large defect on the helical crus following surgery. In each patient the flap design was adjusted to fit the form of the defect. All flaps were in easy reach of the defect and all flaps survived without any complications. The reconstructed ears had good three-dimensional form, and the color and texture match was satisfactory. The flap donor site was not noticeable because it was hidden behind the ear. Constriction did not occur and a good form was maintained. Neither deformity due to scar contracture nor absorption of the cartilage was observed.

Reconstruction of a three-dimensional structure using cartilage regenerated from the perichondrium of rabbits.

Human tissues such as those found in the ear, nose, eyelid, lip, and larynx have complicated and delicate three-dimensional structures, which are difficult to reconstruct and restore to normal function following damage by tumor, congenital disease, or trauma. We devised a new reconstructive technique for the lost tissues by using cartilage regenerated from the perichondrium. In 12 ears of 12 rabbits, the layer between the perichondrium and the cartilage was stripped off. The exposed cartilage was punched out in large amounts to resemble a flexible, honeycomb-like structure. Then, we sandwiched the rabbit ears with two thermoplastic plates, which maintained a structure of the anterior surface of the human ear for 8 weeks. Structural change was studied in all cases, and some parts of the remodeled tissue were studied pathologically. Out of 12 ears, 8 had a rigid structure with a shape like a human ear using regenerated cartilage from the perichondrium of rabbits, 2 were infected, and 2 had a decubitus ulcer on the conchal surface as a result of compression from the plate. This study suggests that the use of the cartilage regenerated from the perichondrium may lead to a successful treatment also in humans for a variety of three-dimensional structures that have been damaged.

Reconstruction of a subtotally amputated auricle: A case report

A 42-year-old woman presented with a subtotal amputation of the left auricle except for the helical skin. The treatment was by primary suture with debridement of some margins, and the auricle healed well. The fact that the treatment was successful without microvascular anastomoses is important, considering the anatomical features of the auricular vascular networks.A 42-year-old woman presented with a subtotal amputation of the left auricle except for the helical skin. The treatment was by primary suture with debridement of some margins, and the auricle healed well. The fact that the treatment was successful without microvascular anastomoses is important, considering the anatomical features of the auricular vascular networks.

Aesthetic reconstruction for large upper lip defects in men.

Abstract. Although many techniques use hair-bearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function. Available techniques can also result in an unnatural appearance, because the entire upper lip is covered by a dense region of hair. We have developed a new technique and successfully repaired a large defect in the upper lip of three men. This technique uses flaps pedicled by angular vessels and includes the orbicularis oris muscle. A good outcome can be obtained both functionally and cosmetically when used in men with defects involving more than one-half of the upper lip.

Auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap

A technique to take an auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap is described. Not only can this procedure remove the composite graft without auricular deformity, but it is also useful for covering small auricular defects after trauma or tumor excision.