ABSTRACT
Background@#The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. @*Methods@#This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. @*Results@#Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p= 0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R = 0.479, p< 0.001) and depth (p< 0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. @*Conclusion@#There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.
ABSTRACT
Background@#Due to the different handling properties of unsintered hydroxyapatite particles/poly-L-lactic acid (uHA/PLLA) and polycaprolactone (PCL), we compared the surgical outcomes andthe postoperative implantation accuracy between uHA/PLLA and PCL meshes in orbital fracturerepair. @*Methods@#Patients undergoing orbital wall reconstruction with PCL and uHA/PLLA mesh, between2017 and 2019, were investigated retrospectively. The anatomical accuracy of the implantin bony defect replacement and the functional outcomes such as diplopia, ocular motility, and enophthalmoswere evaluated. @*Results@#No restriction of eye movement was reported in any patient (n = 30 for each group), 6months postoperatively. In the PCL group, no patient showed diplopia or enophthalmos, while theuHA/PLLA group showed two patients with diplopia and one with enophthalmos. Excellent anatomicalaccuracy of implants was observed in 27 and 22 patients of the PCL and uHA/PLLAgroups, respectively. However, this study showed that there were neither any significant differencesin the surgical outcomes like diplopia and enophthalmos nor any complications with thetwo well-known implants. @*Conclusion@#PCL implants and uHA/PLLA implants are safe and have similar levels of complicationsand surgical outcomes in orbital wall reconstruction.
ABSTRACT
Background@#In light of increasing demands for the use of a shorter incision during implant-based reconstructive surgery due to a paradigm shift to short-incision mastectomy and prior radiotherapy, as well as concerns about breast implant contamination, the use of funnels during implantation is recommended. We aimed to describe our preliminary experiences with funnel-assisted implant insertion and to determine the indications for funnel usage in reconstructive breast surgery. @*Methods@#A series of 15 consecutive patients who underwent funnel-assisted implant insertions between March 2018 and January 2019 were included. Funnel-assisted implantation was indicated in patients with a small linear scar (<5 cm) at the mastectomy site and those who previously underwent chest radiotherapy before implant insertion. @*Results@#Eight patients (53.3%) previously received radiotherapy, while seven (46.6%) underwent total mastectomy using a short incision. In all mastectomy patients, the mean incision length was 4.73 cm (range, 4.5–5.5 cm), while that of patients who previously received radiotherapy was 4.62 cm. The patients did not develop wound-related complications (e.g., major and minor skin necrosis). At 6- and 12-month follow-ups, no patients showed definite capsular contracture (Baker grade III and IV). @*Conclusions@#The study confirmed that the use of a highly durable and elastic funnel enabled reconstructive surgeons to perform “no touch” implantation using a short incision. This technique is beneficial for patients who previously received radiotherapy and reduces the risk of wound-related complications through the use of a shorter skin incision.