Colgajo de Mustardé como tratamiento de un carcinoma basocelular. A propósito de un caso

Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.

Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.

Comparison of clinical effects of the Yu flap and the Karapandzic flap in repairing greater than 2/3 lower lip defects / 口腔疾病防治

Objective@#To compare the clinical effect of the Yu flap and the Karapandzic flap in repairing greater than 2/3 defects of the lower lip and to provide a reference for clinical application.@*Methods@#Ten patients with greater than 2/3 lower lip defects after surgical resection of lower lip tumors and vascular malformations were enrolled: 5 patients were repaired with the Yu flap (Yu flap group) and 5 patients were repaired with the Karapandzic flap (Karapandzic flap group). Follow-up for at least 1 year was conducted to evaluate the morphology (symmetry, stoma, exposure of vermilion) and function (sensory function, motor function) of the reconstructed lower lip.@*Results @#All the flaps survived, and all wounds showed primary healing. The lower lips reconstructed with the Yu flap or the Karapandzic flap obtained similar satisfactory oral function. The sensory function was essentially restored. There were no obvious obstacles in speech and expression, and no saliva leakage occurred. In the Yu flap group, only 1 patient had slight microstomia. In the Karapandzic flap group, 2 patients had slight microstomia and 3 patients had moderate microstomia. 90% (9/10) of the patients were very satisfied with the postoperative outcome, and 1 patient in the Karapandzic flap group was basically satisfied. @*Conclusion@#Both the Yu flap and the Karapandzic flap can be used to repair greater than 2/3 lower lip defects and reliable outcomes can be achieved. These two methods can achieve similar oral functions, but the effect of the Karapandzic flap is inferior to that of the Yu flap in terms of aesthetic appearance, and microstomia often occurs, while the Yu flap can generally maintain the original size of the mouth cleft.

Effectiveness of upper eyelid rotation flap via blepharoplasty incision for correction of mild to moderate epicanthus / 中国修复重建外科杂志

Objective: To evaluate an modified epicanthoplasty which can reduce epicanthic scar in blepharoplasty with mild to moderate epicanthus, by using upper eyelid rotation flap via blepharoplasty incision. Methods: A clinical data of 34 patients with mild and moderate epicanthus (trial group), who were treated with blepharoplasty and epicanthoplasty by using upper eyelid rotation flap, between July 2016 and October 2017, was retrospectively analyzed. And 38 patients who were treated with blepharoplasty and epicanthoplasty by using traditional "Z" plastic method were recruited as control group. There was no significant difference in age and degree of epicanthus between 2 groups ( P>0.05). The lengths of palpebral fissure were measured at preoperation and at 6 days and 6 months after operation, and the length difference between pre- and post-operation was calculated to evaluate the improvement degree. The effectiveness was evaluated with reference to the scale of epicanthus orthopedics. Results: All incisions of 2 groups healed by first intention, and all patients were followed up 6 months. The epicanthi of 2 groups were significantly corrected. The inner canthus of trial group had no incision; and there were scars at inner canthus of control group, with obvious hyperplasia in 6 cases. The improvement degree of the length of palpebral fissure in trial group and control group were 3.63%±0.07%, 3.70%±0.05% and 4.64%±0.09%, 4.46%±0.10% at 6 days and 6 months after operation, respectively. There was no significant difference between 2 groups ( t=0.005, P=0.996; t=0.287, P=0.871). The effectiveness was excellent in 20 cases, good in 12 cases, and poor in 2 cases in trial group, with an excellent and good rate of 94.12%; meanwhile, the effectiveness was excellent in 16 cases, good in 16 cases, and poor in 6 cases in control group, with an excellent and good rate of 84.21%. There was no significant difference between 2 groups ( χ2=0.796, P=0.372). Conclusion: The modified epicanthoplasty by using upper eyelid rotation flap via blepharoplasty incision can significantly reduce epicanthic scar with simple operation and satisfactory effectiveness.

A Case of Basal Cell Carcinoma on the Nostril Sill Reconstructed with Rotation Flap / 대한피부과학회지

No abstract available.

Effective Lateral Canthal Lengthening with Triangular Rotation Flap

In Korea, lateral canthoplasty, along with medial epicanthoplasty, has become popular over the past years to widen the horizontal length of the palpebral fissure. However, the effect of the surgery differs greatly depending on the shape and structure of the eyes. If over-widened, complications such as eversion, scarring, and conjunctival exposure may occur. Thus, the author of this study suggests a more effective and safe method for lateral canthal lengthening that causes minimal complications. A total of 236 patients underwent lateral canthoplasty between July 2007 and December 2015. For each patient, a triangular flap 4-5 mm away from the lateral canthus was elevated and rotated 45 degrees laterally while the continuity of the lower eyelid gray line was maintained. A new lateral canthus was created by fixating the rotation flap to the lateral orbital rim with minimal skin trimming and tension-free sutures, preventing relapse and maintaining a triangular shape. In more than 95% of cases, effective and satisfactory extension was achieved. On average, a 3 mm extension of the lateral canthus was achieved. There were minor complications such as wound dehiscence, webbing, and scarring, which were easily corrected. The author not only extended the lateral canthus 3-4 mm laterally but also maintained the continuity of the gray line on the lower lid as a more natural-looking triangular shape, while minimizing complications such as webbing and conjunctival exposure.

The Versatility of Cheek Rotation Flaps

BACKGROUND: The cheek rotation flap has sufficient blood flow and large flap size and it is also flexible and easy to manipulate. It has been used for reconstruction of defects on cheek, lower eyelid, or medial and lateral canthus. For the large defects on central nose, paramedian forehead flap has been used, but patients were reluctant despite the remaining same skin tone on damaged area because of remaining scars on forehead. However, the cheek flap is cosmetically superior as it uses the adjacent large flap. Thus, the study aims to demonstrate its versatility with clinical practices. METHODS: This is retrospective case study on 38 patients who removed facial masses and reconstructed by the cheek rotation flap from 2008 to 2015. It consists of defects on cheek (16), lower eyelid (12), nose (3), medial canthus (3), lateral canthus (2), and preauricle (2). Buccal mucosa was used for the reconstruction of eyelid conjunctiva, and skin graft was processed for nasal mucosa reconstruction. RESULTS: The average defect size was 6.4 cm², and the average flap size was 47.3 cm². Every flap recovered without complications such as abnormal slant, entropion or ectropion in lower eyelid, but revision surgery required in three cases of nasal side wall reconstruction due to the occurrence of dog ear on nasolabial sulcus. CONCLUSION: The cheek rotation flap can be applicable instead of paramedian forehead flap for the large nasal sidewall defect reconstruction as well as former medial and lateral canthal defect reconstruction.

A Case of Keratoacanthoma at the Nasal Vestibule

Keratoacanthoma is the epidermal tumor characterized by the benign course such as rapid growth and spontaneous resolution. Rarely keratoacanthoma invades adjacent structures. Therefore, controversies have arisen about the biologic behavior whether keratoacanthoma is a benign tumor or a variant of low grade cutaneous squamous cell carcinoma. We report a case of the recurred keratoacanthoma at the nasal vestibule treated with the surgical excision and the reconstruction by local bilobed rotation flap in a 54-year old female whose final pathology was confirmed as well differentiated squamous cell carcinoma.

Buccal rotation flap and nasal septal chondromucosal flap: a one-stage reconstruction for full-thickness lower eyelid defect / 中华医学美学美容杂志

Objective To describe an ideal technique to repair full-thickness lower lid marginal defects in a one-stage procedure. Methods The buccal rotation flap and the nasal septal chondromucosal flap were used in one-stage operation to repair full-thickness lower eyelid defect. Results Eleven patients including 6 male patients and 5 female patients underwent lower eyelid reconstruction since January 2000.The age ranged from 29 to 64 years with average 43. Seven patients with full-thickness lower eyelid defect were caused by basal cell carcinoma excision, while four patients were caused by trauma. All the fullthickness lower eyelid defects were reconstructed by using the buccal rotation flap and the nasal septal chondromucosal flap in one-stage operation. All the flaps survived completely after operation. There were no other complications excepting that two patients developed to mild lower eyelid retration after six months. Conclusion The technique consisting of the buccal rotation flap and the nasal septal chondromucosal flap is a simple and useful alternative procedure to close full-thickness defects in the lower eyelid.

Rotation Flap of Tenon's Capsule for Treating Hypotony

PURPOSE: To report a case of rotational flap of Tenon's capsule for hypotony with choroidal detachment occurring after trabeculectomy and needle revision (NR) of a nonfunctioning bleb. METHODS: An 15-year-old female, suffering acute angle-closure glaucoma with lens dislocation into anterior chamber, underwent pars plana vitrectomy, lensectomy, and intraocular lens scleral fixation. Three months later, trabeculectomy with mitomycin C (MMC) and NR with MMC were performed to decrease intraocular pressure (IOP). After 5th NR, hypotony with choroidal detachment occurred. Consequently, bleb revision and rotation flap of the autologous Tenon's capsule were performed. RESULTS: One week after surgery, IOP was 18 mmHg, and a diffuse bleb was formed. Choroidal detachment improved with remaining vascular tortuisity and chorioretinal folds. At five months, best corrected visual acuity was 0.5, IOP was 20 mmHg, vascular tortuisity decreased, and chorioretinal folds disappeared in the macula. CONCLUSIONS: Hypotony with choroidal detachment occurring after needle revision was treated effectively with bleb revision and rotation at flap of autologous Tenon's capsule.

Perforator-based Fasciocutaneous Rotation Flap

Myocutaneous flaps have improved the management of soft tissue defects on buttocks and lower extremity. However, there are several inherent disadvantages of muscle flaps such as functional deficits of the donor sites and the bulkiness at the recipient site. To overcome these disadvantages, we have used perforator-based fasciocutaneous rotation flaps for reconstruction of the buttock and lower extremity defects. From March 2003 to February 2005, we have treated 14 patients using perforator-based fasciocutaneous rotation flaps. 10 flaps were based on perforators of the gluteus maximus muscle, and 4 flaps were nourished by perforators from the tibialis anterior and posterior system. The mean postoperative follow-up period was about 1 year. The technique involves localization of the flap perforators preoperatively with a Doppler. The flaps were elevated superficial to the fascia with preservation of one to three perforators. The donor site is then closed primarily. All flaps completely survived and there was no perioperative complications. There was no functional disability of the donor area with esthetically pleasing results. Perforator-based fasciocutaneous rotation flaps for the reconstruction of buttock and lower extremity defects are excellent alternatives to musculocutaeous flaps. The vascularity of the flaps is robust and dissection is technically easy. Perforator flaps do not require sacrificing muscles, but provide sufficient volume and are durable Furthermore, these flaps result in less scar formation and allow more liberal dissection with safety. We conclude that perforator-based fasciocutaneous rotation flaps are very useful for reconstruction of the buttock and lower extremity.

Surgical Correction of Cryptotia using Hirose's Rotation Flap

Cryptotia is rare in Caucasians but more common in Orientals, particularly in Japanese people, where incidence has been reported as 1:400. The features of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformation of the auricular cartilage itself. The principles of the surgical correction are the coverage of skin deficit and the correction of deformed cartilage if needed. For the correction of cryptotia, several methods have been tried. But, inadequate amounts of local tissue often result in undercorrection of the cephalo-auricular sulcus, with a tendency to recurrence of the buried ear. Incision scars, hair line distortion, poor color match of graft and multi-staged operation of tissue expansion are noted as the their shortcomings. Therefore, We have performed Hirose's rotation flap method in 15 cases of the 12 patients that available skin in the inferior part of the cephalo-auricular sulcus is transferred to the upper part where skin is deficient, and satisfactory results were achieved. This method has many advantages that the design is simple and the procedure easy, the required depth of the cephalo-auricular sulcus is achieved, the correction of the cartilage deformity can be carried out with unrestricted access, the hairline is not disturbed by the operation, the scar behind the auricle is not visible, and there is no need for additional skin grafting.

FINGERTIP COVERAGE WITH LARGE NEUROVASCULAR ROTATION FLAP AND Z-PLASTY

The purpose of this study is to introduce a new method for fingertip coverage for cases of soft tissue only defects and finger tip amputations including bone. 86 lingers in 67 patients haute undergone coverage with a large rotation flap based on digital artery and nerve and Z-plashy after fingertip amputation or finger pulp avulsion from October 1991 to December 1995. There were 53 thumbs, 12 index fingers, 5 long fingers, 3 ring fingers and 13 little fingers. All injured fingers had exposure of the distal phalanx bone. A large volar flap based on either the radial or ulnar aspect including both digital neurovascular bundles was elevated just abode the pulleys and flexor tendon sheath after longitudinal incision along the lateral border of the digit. Then a large Z-plasty was performed at the MP joint crease to release the tension. The volar flap was easily rotated to cover the fingertip and was sutured with slight flexion of the interphalangeal joints. All fingertip defects healed completely. These flaps successfully covered the fingertip, and up 2/3 of the distal phalanx on the volar or lateral aspect. Sensation returned to normal and fingers could be fully extended within 3 months of surgery. All patients only required a single operation for complete fingertip coverage and did not require bony shortening. We conclude that this large rotation, axial pattern, neurovascular flap and Z-plasty provided a durable, completely sensate, well vascularized coverage fort the fingertip with minimal discomfort for the patient.

Repair with Combined Flap of Bilobed and Rotation of a Defect Following Mohs Micrographic Surgery

A 30-year-old man developed basal cell carcinoma 3 years ago which showed as a pea sized, crusted nodule with extending pigmentation and telangiectasia on the inner side of the right lower eyelid. Five stages of Mohs micrographic surgery were required for the complete eradication of all tumor cells in the lesions of the nodule and extending pigmentation. The defect following the surgery was 4.5 × 3.5cm and was too large to repair with a primary closure or simple single flap. So, the defect was repaired with a combined flap of glabellar bilobed and cheek rotation. We report that the combined flap of glabellar bilobed and cheek rotation is a useful and relatively simple method for the reconstruction of a large defect on the inner side of the lower eye-lid area.