Postoperative Sensibility Test in Patients Undergoing Reconstruction of Donor Defect of Flap Surgery with an Acellular Allograft Dermal Matrix ( AlloDerm )

Numerous choices exist for closing any wound, so the surgical challenge is that of selecting the optimal method. It is necessary to balance multiple factors, including recipient site requirements, donor site morbidity, operative complexity, and patient factors. Limiting the donor site morbidity is emphasized in the aphorism "Never rob Peter to pay Paul unless Peter can afford it. Certainly, documented cases exist in which donor site morbidity exceeds the original recipient problem, necessitating a second procedure to reconstruct the donor site. The flap survived and the wound was closed, but the donor site was often worse than the original defect. Numerous donor site complications are often overlooked while one concentrates on the successful flap transfer. The standard method for grafting donor wound after harvesting of a flap uses thick split-thickness skin grafts. This method, however, creates an additional comlication-prone wound at the donor sites. Donor sites for grafting can be painful and may develop infection, hypertrophic scarring, blistering. The problem of donor sites scar hypertrophy occurs most frequently when a graft is taken at more than 0.012 inch thick, leaving a residual dermal bed is too thin. AlloDerm processed allograft dermis was developed as a permanent dermal transplant for full thickness wounds. Between 1997 and 1999, we have applied AlloDerm grafts and ultra-thin autografts on 11 patients with donor sites after harvesting flaps. All the composite AlloDerm /autograft were noted to be firmly adherent except 2 cases, which showed focal loss of the grafts and was healed after second graft. AlloDerm exhibited a high percentage take and supported an overlying ultra thin split-thickness skin autograft, applied simultaneously. By providing a dermal replacement, the grafted dermal matrix permitted a thin autograft from the donor site. The ultra-thin autografts leave donor sites that heal faster and with fewer complication. AlloDerm dermal transplants exhibit excellent elastisity and good pigmentation with minimal scarring or wound contracture. Sensory reinnervation after the composite AlloDerm/autograft was not fully recovered. The reason was that these grafts were placed on the bone or tendon exposed sites which were not sufficiently well- innervated graft bed. The high reproducibility of excellent results with this composite graft, coupled with the reduced trauma and rapid healing of donor sites associated with ultra-thin autograft STSG, has made composite grafting with the use of AlloDerm dermal transplants our new method of choice for treatment of donor defects of flap surgery.

A Philtral Reconstruction and the Correction of Alar Base Depression Using a Transposition of the Orbicularis Oris Muscle Flap In Secondary Cleft Lip Repair

The philtrum of the upper lip is important to the facial contour and general appearance of individuals. In patients who have undergone cleft lip surgery, reconstruction of the philtrum is important in restoring the normal appearance of the upper lip and it also helps in diverting people`s attention away from the surgical scar. Several methods of philtral dimple creation have been used, but the postoperative results have not always been satisfactory. Between 1991 and 1997, reconstruction of the philtrum with unilateral cleft nasal deformity was performed in 43 patients, transposing the orbicularis oris muscle of the central upper lip to the depressed alar base. Using this method, efforts were made to achieve reconstruction of the philtrum and correction of alar base depression simultaneously. The results were rated good to excellent by a panel of judges using the ordinary scale method. Although reconstruction of the philtral dimple and correction of the depressed alar base were very successful, reconstruction of philtral column(especially the upper portion) was not satisfactory. Therefore, other procedures such as temporal fascial grafts in the upper portion of the philtral column should also be considered at the time of primary surgery or revisional surgery.