Application of Autologous Cartilage Transplantation in the Repair and Reconstruction of Nasal Soft-Tissue Triangle Deformities

Objective: To evaluate the effect of autologous cartilage transplantation in repairing nasal soft-tissue triangle deformities.
Methods: From January 2015 to January 2018, 23 patients underwent the surgery, got part of the costal cartilage, nasal septum cartilage or ear cartilage, An open incision was made along the medial nasal columella and lateral rim of nostril, the cartilage was carved into strips as a graft of the lateral and middle crus of the alar cartilage in order to reconstruct the nasal alar dome and correct the nasal soft-tissue triangle deformities. The costal cartilage or nasal septum cartilage was used as columellar strut. At the same time, a prosthetic or autologous costal cartilage scaffold was placed onto the nasal dorsum, and fascia tissue was placed on the tip of the nose to relieve tensions. The changes of the angle of the medial and lateral crus of the alar cartilage before and after autologous cartilage transplantation and the difference between the greatest distance from the long axis of the nostrils to the alar rim before and after the operation were statistically analyzed. The changes of nasal appearance pre and postoperation were compared. To evaluate the correction effect of nasal soft-tissue triangle deformities, bilateral asymmetry and overall surgical effect. The surgical results were evaluated by comparing the pre- and postoperative images, statistical analysis the difference of alar cartilage angle along inside and outside feet before and after the fornix reconstruction, and evaluate the efficacy satisfaction of repairation for retraction, notching, asymmetries of nasal soft-tissue triangle deformities and overall effect of the rhinoplasty.
Results: The alar cartilage angle of the 23 patients was (50.6±12.4)° preoperative, decreased to(35.0±5.6)° when the nasal dome reconstruction was finished, the difference was statistically significant(P<0.01). The patients were followed up for 6 to 18 months, the noses were with natural appearance and tactile impression, and there were no serious complications. The degree of satisfaction was 87.5%.
Conclusion: Using autologous cartilage to repair the soft-tissue triangle deformities is an ideal surgical method, the nasal morphology can be improved delicately, and the degree of satisfaction is high postoperatively.

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A New Technique of Mastopexy for Mastoptosis: With the Upturned Glandular Flap

A new surgical procedure was introduced for correction of moderate mammary ptosis in this paper. The double-ring incision around areola was taken, tongue-shaped gland flap at the lower part of breast was turned over and filled in the posterior space of breast. The glands at both sides of the lower part were sutured together, and the basal part of the breast was tighten fully. Then, the upper pole gland was sutured by raising so that the nipple-areola complex is fully raised. The breasts were conical through this shaping, thus the correction effect of breast ptosis was satisfactory. This technique is ingenious in design, convenient in operation and exact in curative effect. It can be used as one of the options for mastopexy.

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Distal Foot Reconstruction Using Distally based First Web Flap: A Case Series

Background: The reconstruction of distal foot for various defects or contractures mainly over or near the toes has always been a difficult task. A flap distally based on first web space is dependent upon a perforator arising from the distal communications between the first dorsal and plantar metatarsal arteries, can be used for the coverage of the toe or the distal foot defects.
Method: We had operated 10 patients with toe defects and contractures at the dorsum of the distal foot . Demographic data of the patients were collected and evaluated in terms of age, gender, etiology of injury, site and dimensions of defects, complications, final outcome.
Results: Complications were noted in only two cases in the form of wound infections. Both the cases were managed accordingly.
Conclusion: With our study we concluded that a distally based flap can be reliably raised from the first web space based upon a perforator arising from the distal communication artery between First Dorsal and First Plantar Metatarsal Artery to cover defects in distal foot.

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Postmastectomy Mammary Reconstruction with the Use of Tissue Expanders Plus Endoprotesis

Introduction: The reconstruction of the breast after mastectomy is included in the treatment of breast cancer and one of the most used techniques is tissue expansion.
Objective: To evaluate the use of tissue expansion in postmastectomy breast reconstruction.
Material and methods: A descriptive and retrospective study was carried out in the plastic surgery service of Hermanos Ameijeiras Hospital. We included 25 patients from the consultation of oncological deformities of the breast, from January 2016 to August 2018. Tissue expansion consists of expanding the skin and placing a silicone prosthesis. A temporary prosthesis is introduced with a valve, under the muscular plane in a deferred form. In the postoperative period, it will be filled until it reaches the necessary size that allows to place a definitive implant.
Results: 96% of women were over 30 years of age, 68% were white and histologically diagnosed with infiltrating ductal carcinoma 60%. 64% were reconstructed before the 2 years after the radical mastectomy and in the healthy breast; reductive mastoplasty was performed to achieve symmetry. Complications were present in 20% of the patients and the results obtained were good in 82.6% of the patients.
Conclusions: The use of tissue expanders with endoprotesis in postmastectomy breast reconstruction is a safe and effective technique with a high degree of satisfaction for the majority of patients.

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Review: Treacher Collins Syndrome: A Brief Review on Diagnostic Aids and Review of Literature with a Case Description

Importance: Treacher Collins syndrome (TCS), also called Treacher Collins-Franceschetti syndrome or mandibulofacial dysostosis, is an autosomal dominant disorder. This condition affects an estimated 1:10,000 to 1:50,000 of living births.
Observations: This paper describes a 19 year old male patient suspected with Treacher Collins syndrome. He displayed a moderate form of the disease and a classic phenotype, demonstrating many cardinal features of the disorder.
Conclusion and Relevance: Along with diagnostic aids which are helpful in diagnosing the disease, this paper also reviews the literature and syndrome in the light of recent publications with emphasis on pathogenesis (role of neural crest cells) and broad discussion on the syndrome as a whole.

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Postmastectomy Mammary Reconstruction with Musculocutaneous Flap of Latissimus Dorsi and Placement of Definitive Endoprosthesis

Introduction: The increase in the incidence of breast cancer at a global and national level, presupposes a challenge both for the surgical elimination of breast cancer and for breast reconstruction postmastectomy, as an integral part of the definitive treatment. There is an important group of techniques, within which breast reconstruction with the use of the myocutaneous flap of the Dorsal Ancho muscle is one of the most implemented.
Objective: To evaluate the use of the myocutaneous flap of the Dorsal Ancho muscle in postmastectomy mammary reconstruction and definitive prosthesis placement. Material and methods: A retrospective, descriptive and longitudinal study was carried out by the Plastic Surgery Department of the Hermanos Ameijeiras Hospital in the implementation of this surgical procedure, between 2016 to 2018, 22 mastectomized patients were operated on for breast restoration using a Dorsal Ancho myocutaneous flap breast endoprosthesis placement.
Results: The 22 postmastectomy patient’s predominantly infiltrating ductal carcinoma and they performed the Madden technique mostly. In more than 70% of the cases a skin island of horizontal design was planned on the muscle and complications were scarce except for the seroma in the donor area, which was observed in 63% of the cases. In general in more than 80% of the cases, results were obtained between very good and good.
Conclusions: The complication rate was low, with very good results and a high degree of satisfaction of the majority of the patients, which allowed to show the utility of the application of this procedure in postmastectomy breast reconstruction.

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Reconstruction of the Areola-Nipple Complex after Mastectomy

Introduction: The creation of the Areola-Nipple complex is the last time of breast reconstruction, transforming the breast mound into a real breast.
Objective: Show the results, advantages and disadvantages of different techniques applied in the reconstruction of the Areola-Nipple Complex.
Material and methods: A retrospective descriptive study of 70 patients with oncological deformities of the breast at Hermanos Ameijeiras Hospital from January 2008 to December 2018 was carried out. Results: 18 patients were created the nipple by local flaps method, 44 were grafted and 8 without reconstruction since it was not desired, and others had no projection of the healthy nipple. Of these 53 were tattooed, 15 grafted with contralateral areola and 2 without reconstruction. There were no complications in the contralateral nipple graft, but with the other method 100% suffered flattening with regular results. Of the 53 tattooed patients, good results predominated and only 16 had slight pigmentation disorders.
Conclusions: The reconstruction of the Areola-Nipple Complex after ablative surgery of the breast transforms the breast of more natural aspect and the ideal methods are the contralateral nipple graft and the intradermal tattoo.

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The Chrysalis Graft: Combination of Diced-Cartilage-Fascia Grafts and PRP in Augmentation Rhinoplasty

Introduction: This dorsal nasal augmentation technique utilizes a combination of the diced-cartilage with Platelet-RichPlasma (PRP), Platelet-Poor-Plasma (PPP) and fascia graft in a chrysalis form, which provides a regenerative and moldable technique.
Methods: Patients requiring dorsal augmentation underwent rhinoplasty using diced-cartilagein a PRP-clot carrier, wrapped in a sleeve of deep-temporal fascia in achrysalis form. The PRP fraction was extracted after blood centrifugation and used to carry the diced-cartilage graft. The PPP and middle platelet layers were used as fibringlue sprayed over the chrysalis graft avoiding the use of stitches.
Results: A total of 31 patients, with a mean age of 42 years old underwent augmentation rhinoplasty with this technique. The mean follow-up was 14 months. Donor sites for cartilage included nasal septum (n=13), concha (n=6), combination of both septum and concha (n=5) and rib (n=7). The surgical approach was open rhinoplasty in 20 cases and closed approach in 11 patients. No major complications requiring surgical revision were observed. No extrusions, no graft displacement and no skin irregularities were observed. Three cases (9.67%) of partial graft resorption were observed. Other complications included one case of local infection and two keloids in ear donor site. Satisfactory nasal dorsal augmentation was achieved in all other cases.
Conclusions: This report describes a technique of dorsal augmentation using a mixture of diced-cartilage grafts, PRP, PPP and deep temporal fascia graft in a chrysalis manner. This approach offers a moldable and regenerative construct for nasal augmentation without major complications and minimal graft resorption.

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