The supraclavicular artery island flap: a salvage option for head and neck reconstruction / 대한악안면성형재건외과학회지

BACKGROUND: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. CASE PRESENTATION: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. CONCLUSION: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

What is the outcome 5 years after cervicoplasty? / O que muda no resultado de uma cervicoplastia 5 anos depois?

Introduction: An approach based on multiple anatomical structures and the use of different surgical strategies seems to achieve more lasting results in cervical rejuvenation surgery. Thus, extended cervicoplasty is an option with favorable results and low complication rates. However, little has been published regarding the durability of the results. This study aimed to objectively evaluate the long-term results obtained with extended cervicoplasty in difficult cases. Methods: Twenty patients, classified as having a "difficult neck," underwent extended cervicoplasty and were followed for 5 years. The results at 1- and 5-year post-operative follow-up were evaluated by eight plastic surgeons, using six objective criteria based on a theoretically ideal neck. The comparison of the results obtained at these time points was performed using a paired Student's t-test, with a level of significance of 5%. Results: There was no significant difference in five of the six items evaluated (p-value ranging from 0.137 to 1.000), in the comparison between the first and fifth postoperative years. Subhyoid depression displayed a significantly better mean score in the fifth evaluation year than that observed in the first year after surgery (p = 0.039): from 5.80 ± 0.25 points (mean ± standard error of the mean) in the first year, to 6.45 ± 0.30 points in the fifth postoperative year. Conclusion: Extended cervicoplasty is an important alternative in the treatment of the neck region, and even provides lasting results in difficult cases.

Introdução: A abordagem de múltiplas estruturas anatômicas e a utilização de diferentes estratégias cirúrgicas parece contribuir para a obtenção de resultados mais duradouros na cirurgia do rejuvenescimento cervical. Para isso, a cervicoplastia ampliada é uma opção com resultados agradáveis e baixos índices de complicações. A durabilidade dos resultados obtidos é, no entanto, pouco discutida na literatura. O objetivo desse estudo é avaliar objetivamente a manutenção dos resultados a longo prazo obtidos com a cervicoplastia ampliada aplicada em casos difíceis. Métodos: Vinte pacientes, classificadas como "pescoço difícil", foram submetidas à cervicoplastia ampliada e acompanhadas por 5 anos. Os resultados do pós-operatório de 1 e de 5 anos foram avaliados por oito cirurgiões plásticos, por meio de seis critérios objetivos vinculados a um teórico pescoço ideal. A comparação entre os resultados obtidos nestes momentos foi realizada por meio do teste t-student pareado, considerando um nível de significância de 5%. Resultados: Não houve diferença significativa em cinco dos seis itens avaliados (valor de p variando entre 0,137 a 1,000), na comparação entre o primeiro e o quinto ano de pós-operatório. A depressão subhioideia apresentou pontuação média na avaliação do quinto ano significativamente melhor do que aquela observada no primeiro ano após a cirurgia (p = 0,039), passando de 5,80 ± 0,25 pontos (média ± erro padrão da média) no primeiro ano, para 6,45 ± 0,30 pontos no quinto ano de pós-operatório. Conclusão: A cervicoplastia ampliada se valida como alternativa importante no tratamento da região cervical mesmo em casos difíceis, proporcionando a obtenção de resultados duradouros.

Cervicoplastia con suspensión dinámica del platisma / Cervicoplasty with dinamic suspension of platysma

Introducción: La Cervicoplastia es una Técnica quirúrgica diseñada para corregir la ptosis congénita o senil del músculo platisma del cuello y la piel que lo recubre. Diseño: Observacional descriptivo tipo serie de casos. Metodología: Previa firma del consentimiento informado. 96 pacientes operados en la práctica privada del autor en la ciudad de Cartagena, desde Enero/08 hasta Diciembre/15. Fotografías prequirúrgicas en las siguientes vistas: frente, perfiles, semiperfiles, con la cabeza en flexión y extensión, exámenes de laboratorio y fotografía post-quirúrgica, las cuales fueron tomadas a los 8,15, 30, 60, 90, 120, 360 días y 2 años después de la cirugía. Registro en la historia clínica del grado de satisfacción del paciente como: felices, satisfechos o insatisfechos. Resultados: De los 96 pacientes operados 89 (92.7%) manifestaron estar felices, 5 (5.2%) se engordaron y se refirieron como Satisfechos y 1 (1.04%) se declaró "insatisfecho", por cicatriz hipertrófica en la incisión submental. Conclusiones: Por la completa corrección de la ptosis del platisma y de piel del cuello; así como la posibilidad de hacer procedimientos complementarios por la misma vía de abordaje, con alta tasa de felicidad de los pacientes (92.7%) la Cervicoplastia con suspensión dinámica del platisma se ha convertido en el procedimiento estándar por el autor para rejuvenecer el cuello y el tercio inferior facial.

Introduction: Cervicoplasty is a technique to fix congenital or senile ptosis, from the platisma muscle and the skin that surrounds it. Design: Case series study. Method: Previous informed consent signed up, 96 patients submitted to this study, which already had such procedure, in Cartagena de Indias from January of 2008 to December 2015. Using pre-surgical photography, with the following view: front, side face, and with the head on flexion and extension. Laboratory exams, and post-Surgical photography, which have been taken at 8, 15, 30, 60, 90, 120, 360 days and 2 years after the surgery is made. Alongside the help of medical history records, and satisfaction grades from the patients as: happy, satisfied and unsatisfied. Results: From the 96 patients, 89 (92.7%) acclaimed to be mostly happy, 5 (5.2%) got fatter on time and acclaimed to be satisfied with the procedure, and 1 (1.04%) declared himself unsatisfied, as he has a hypertrophic scar on the lower chin incision. Conclusions: The complete correction of the platisma and neck skin ptosis, as well as the possibility of having complementary procedures on the same incision, exists a high rate of satisfied patients (92.7%), which makes the Cervicoplasty with dynamic suspension of the platisma the standard procedure for the author, in order to embellish the neck and the facial inferior third.

A Modified, Direct Neck Lift Technique: The Cervical Wave-Plasty

BACKGROUND: Major problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a "wave-plasty". METHODS: This prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery. RESULTS: The mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%). CONCLUSIONS: In select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients.

Total Facelift: Forehead Lift, Midface Lift, and Neck Lift

Patients with thick skin mainly exhibit the aging processes of sagging, whereas patients with thin skin develop wrinkles or volume loss. Asian skin is usually thicker than that of Westerners; and thus, the sagging of skin due to aging, rather than wrinkling, is the chief problem to be addressed in Asians. Asian skin is also relatively large in area and thick, implying that the weight of tissue to be lifted is considerably heavier. These factors account for the difficulties in performing a facelift in Asians. Facelifts can be divided into forehead lift, midface lift, and lower face lift. These can be performed individually or with 2-3 procedures combined.

Cervicoplastia ampliada para correção de alterações cervicais / Expanded cervicoplasty to correction of cervical changes

INTRODUÇÃO: A cervicoplastia é considerada parte importante na cirurgia do rejuvenescimento facial. Apesar das diversas técnicas já descritas, a busca pelo tratamento ideal ainda persiste. As dificuldades aumentam nos casos considerados complexos, em que a flacidez excessiva de pele e a ptose muscular pronunciada prejudicam a manutenção dos resultados a longo prazo. OBJETIVOS: No intuito de discutir as opções técnicas disponíveis para a cervicoplastia e apresentar a rotina cirúrgica utilizada pelo autor - com ênfase no tratamento ampliado sobre o músculo platisma - é que este estudo foi delineado. MÉTODO: Dezoito pacientes foram submetidos ao round lifting associado à confecção de retalhos musculares de platisma, na linha médio-cervical, e à retirada parcial da gordura subplatismal. Os pacientes foram acompanhados por 12 meses e o resultado pós-operatório tardio foi avaliado por cinco cirurgiões plásticos da SBCP. RESULTADOS: Quatro pacientes foram excluídos do estudo por não retornarem para o acompanhamento pós-operatório tardio. Dos 14 pacientes avaliados, 7 (50 por cento) tiveram o resultado classificado como excelente, 5 (35,7 por cento) como moderado e 2 (14,3 por cento) como fraco. Nenhum paciente teve o resultado classificado como perfeito ou ruim. CONCLUSÃO: A cervicoplastia ampliada proporcionou a obtenção de resultados satisfatórios, mesmo em casos difíceis. Acreditamos que a técnica é uma alternativa válida para o cirurgião plástico, podendo contribuir para que obtenhamos um resultado pós-operatório agradável, natural e mantido com o tempo.

INTRODUCTION: Cervicoplasty is considered an important part of facial surgery. Despite the various techniques already described, the search for optimal treatment still persists, especially in complex or difficult cases, where the skin excess and the muscular ptosis affect the maintenance of long-term results. OBJECTIVE: This study was designed to discuss the technical options available to cervicoplasty and present the routine used by the author - with emphasis on platisma muscle extended treatment. METHOD: Eighteen patients were submitted to "Round Lifting" associated with a platisma muscle flap in cervical mid-line and partial removal of subplatismal fat. The patients were followed for 12 months and late postoperative outcome was evaluated by five of SBCP plastic surgeons. RESULTS: Four patients were excluded for not returning for follow-up. Of the 14 patients evaluated, 7 (50 percent) patients had an excellent result, 5 (35.7 percent) patients moderate and 2 (14.3 percent) weak. No patient had the result classified as perfect or poor. CONCLUSION: The expanded cervicoplasty described here provided great results, even in difficult cases. We believe that the technique is a valid alternative to the plastic surgeon, which can help you obtain a pleasing postoperative result, natural and maintained over time.

Pullout test in expansive unilateral open-door laminoplasty of the cervical spine with OsteoMed M3 plate and screws: the screw orientation matters / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the impact of screw orientation on the pullout strength of OsteoMed M3 titanium screws in expansive unilateral open-door laminoplasty of the cervical spine.</p><p><b>METHODS</b>Six fresh human cervical spine specimens were randomly numbered and OsteoMed M3 plate and screws were used for an expansive unilateral open-door laminoplasty. The screws were inserted in the lateral mass at different extraversion angles (0°, 30° and 45°). The maximum pullout strength was tested on the ElectroForce material testing machine.</p><p><b>RESULTS</b>The maximum pullout strength was 81.60∓7.33 N, 150.05∓15.57 N, and 160.08∓17.77 N in extraversion angle 0°, 30°, and 45° groups, respectively. The maximum pullout strength was significantly less in extraversion angle 0° group than in 30° and 45° groups (P<0.05), but similar in the latter two groups.</p><p><b>CONCLUSION</b>The pullout strength of the screws inserted at an extraversion angle over 30° provides stronger fixation than an angle of 0° in the unilateral open-door laminoplasty using OsteoMed M3 titanium plate and screws.</p>

Cervicoplastia na flacidez cutânea por síndrome de Ehlers-Danlos: relato de caso / Cervicoplasty in cutaneous laxity from Ehlers-Danlos syndrome: a case report

Introdução: A síndrome de Ehlers-Danlos é um distúrbio raro, caracterizado por anormalidades diversas na estrutura, síntese e secreção do colágeno, resultando em um quadro clínico variado, com alterações cutâneas, articulares e vasculares. Procedimentos cirúrgicos realizados nestes pacientes, muitas vezes, complicam com sangramentos de difícil controle, deiscência de suturas, friabilidade dos tecidos, hematomas recorrentes e dificuldade de cicatrização, com pobres resultados estéticos. Relato do caso: No presente relato, os autores apresentam um caso de cervicoplastia em paciente portadora da síndrome de Ehlers-Danlos, evidenciando seus resultados.

Introduction: The Ehlers-Danlos syndrome is a rare disorder characterized by multiples anomalies in collagen synthesis, structure and secretion, resulting in in numerous clinical manifestations such as cutaneous, articular and vascular abnormalities. Surgical procedures are often complicated by difficulty in control bleeding, wound dehiscence, tissue friability, recurrent hematomas and problems in wound healing, leading to poor aesthetic results. Case report: In the present report, the authors present a case of cervicoplasty in a patient with Ehlers-Danlos syndrome, exposing their results.

Lifting cervical gravitacional / Gravitational cervical lifting

Introdução: Os procedimentos cirúrgicos visando ao rejuvenescimento facial vêm evoluindo desde 1920. Os primeiros relatos descreviam pequenas ressecções de pele que se revelaram totalmente ineficazes. A exigência progressiva por melhores resultados ocasionou a busca por abordagens cirúrgicas mais eficazes, principalmente no que diz respeito ao tratamento do terço inferior da face e pescoço, onde as deformidades eram mal corrigidas ou apresentavam recidiva precoce. Objetivo: Apresentar uma nova abordagem para o tratamento do terço inferior da face, principalmente nos pacientes que apresentam grande flacidez de pele e dos músculos platismas, com ou sem excesso de gordura na região cervical, pois com as condutas atuais existe elevada taxa de resultados insatisfatórios. Método: Cento e oitenta pacientes foram operados, seguindo técnica proposta pelo autor sênior, e acompanhados durante cinco anos (janeiro de 2003 a maio de 2008) foram avaliados. Foram analisadas 172 (95,6%) pacientes do sexo feminino e 8 (4,4%) do masculino. A média de idade foi de 57,7 anos, tendo 41 anos e 1 mês o mais jovem e 81 anos e 5 meses o mais idoso. Na maioria dos casos, realiza-se extensa lipectomia com tesoura, completa dissecção das bandas platismais com posterior ressecção total da flacidez das bandas platismais e seu tracionamento vetorial inferior, além da tração oblíqua da pele na região cervical em sentido à linha de implantação do cabelo na região cervical. Conclusão: Os efeitos duradouro se o sucesso da técnica podem ser comprovados pelo crescente número de procedimentos realizados neste período e pela grande satisfação dos pacientes.

Background: The surgical procedures searching the anti aging face come evolving since 1920. The first stories described small resections of skin that if had disclosed inefficacious total. The gradual requirement for better resulted caused the search for more efficient surgical procedures mainly in what it says respect to the treatment of the cervical region of face and neck where the deformities were badly corrected or presented precocious return. Objective: The objective of this study was to introduce a new approach for treatment of the cervical region of face and neck, mainly in the patients who present great flaccidity of skin and the muscles platysma, with or without excess of fat in the cervical region, therefore with the current behaviors still we have resulted unsatisfactory. Method: One hundred and eighty patients had been operated, following the technique of gravitational cervical lifting, and followed during five years (January of 2003 to May of 2008). There were 172 (96.6%) women and 8 (4.4%) men. The average age was 57.7 years old, the young est was 41 years old and the oldest was 81 years old. Conclusions: In most cases is done extensive lipectomy using scissors, complete resection of the platysma bands and their traction vector lower. Besides, it made the skin traction in the cervical area in oblique sense to the line of hair implantation in the cervical area. The durable effect and the success of this technique can be proved by the increase in the procedure number performed in this period and by the great patient’s satisfaction.

Lipofacelift: plástica facial com descolamento mínimo da pele / Lipofacelift: facelift with minimal skin undermining

Introdução: Procedimentos cirúrgicos menos extensos, com tempo de recuperação maiscurto, têm atualmente sido mais solicitados pelos pacientes candidatos à ritidoplastiafacial. Objetivo: Apresentar procedimentos cirúrgicos menos invasivos, que atinjamos objetivos dos pacientes e dos cirurgiões com o menor tempo de recuperação, narealização de ritidoplastias. Método: Dissecação mínima do tegumento cutâneo daface, restrita ao redor da orelha num raio de 4 cm. As restantes áreas do segmento médioda face e cérvico-mandibular são “tunelizadas” mediante cânula de lipoaspiração,somente aspirando o tecido adiposo nos depósitos submentoniano e submandibularquando necessário, mantendo as conexões vásculo-nervosas da pele com o planosubjacente. Foram comparados 309 pacientes operados de ritidoplastias, dos quais 89foram submetidos à técnica proposta e os restantes 220 à técnica convencional de ampladissecação e tratamento do SMAS. Resultados: Os pacientes operados pela técnicaproposta apresentaram melhores resultados estéticos, com preservação da textura e dotrofismo da pele. Conclusões: A técnica proposta permite diminuir o tempo cirúrgicoem 50%, por ser um procedimento menos invasivo e apresentar menor morbidade, alémde melhorar a qualidade do resultado.

Introduction: Less extended surgical procedures with short recovery post-operativeperiod of time have been requested by patients submitted to rhitidectomies. Objective:Study of minimal invasive surgical procedures in facelift that offer the desiredresults in less post-operative recovery period. Method: Four centimeters ratio skinundermining around the ear combined with cannula skin tunneling along the mid-faceand neck regions with or without liposuction according to the necessity, preservingthe nervous-vascular connections with the deep skin plane. 309 patients submitted tofacelift, 89 were operated by this technique and the other 220 patients operated throughconventional procedures by extensive skin undermining and SMAS treatment. Results:Patients operated by the proposed technique presented better aesthetic results due to skinconnection preservation, less secondary skin fibrosis and better skin trophic conditions.Conclusion: These less invasive technical procedures reduce 50% of the surgical time,maintaining the quality of the results with minor morbility.

[ temporo-Parietal fascia pedicle flap. Bringing intofocus on applications in maxillo-Facial surgery]

The temporo-parietal fascia pedicule flap, described by DUFOURMENTEL in 1958, find many indications in head and neck reconstructive surgery. the authors remember the benifits of this flap through many illustrations in different anatomic regions: 1-auricular region [ear reconstruction]; 2-mastoid region; 3-parotidis region; 4-orbito-froton-palpebral region; 5- cheeck and labial commissure region. Reviewing the applications of this flap in maxillo-facial surgery will allow an assesment of adequate operative technique, indications, advantages and limits

use of platysma myocutaneous flap and auricular cartilage graft for cervical tracheal reconstruction an experimental study in dogs

Cervical tracheal reconstruction using platysma myocutaneous trap door flap strengthened with. auricular cartilage was studied in 16 dogs. Window defects involving 5 and 10 tracheal rings from the anterior tracheal wall were produced in different 2 groups of animals [group A and B]. The results were evaluated by clinical follow up to 3 months. In group A. six of the 8 animals completed the scheduled follow up while in. group B. five animals completed the follow up of 3 months without significant complications. Gross examination of the animals of both groups which completed the pre-established period of follow-up showed maintenance of the intraluminai diameter at the levels of the reconstructed segment. The mucosal cutaneous junction was healed with no apparent granulation tissue free edges of the resected tracheal rings were closely attached to the rotated flap. Hair was fully grown and covered with mucous. Histologically, the flap was covered by stratified squamous epithelium which was closely attached to the free margin or the trachea by fibrous tissue. The cartilage was seen intact with mature chondocytes. The use of platysma cutaneous door flap strengthened with auricular autologous gives relatively good anatomic and functional results in. reconstruction of tracheal defects. This may call for considering the clinical use of flap in selected cases of tracheal wall lesions in human

Some plastic reconstructions applied for cancer in head, neck and face

The plastic reconstruction of defect in the head, neck and face played an important role in the rehabilitation and plastic recovery for patients suffered cancer in the head, neck and face. Some techniques and materials are being applied in the plastic reconstruction comprised the autologous cutaneous transplantation, local cutaneous transplantation, pedicular flaps, expanded flaps and artificial materials.

Some opinions of results of surgical treatment of 55 cases of contracted and adherence scars in the axilla in the plastic surgical department of National Institute of Burn during 1996- 1998

In two years (1996 -1998) there were 55 patients with contracts and adherence of the scars in the axilla due to burn that had been operated in the department of plastic surgery of the national institute of burn with results: Good: 78,18%. - Medium: 21,82%. We have used surgery methods: transfer skin flap on the spot with Z,Y,V model, full thickness skin grafts or skin flap with vascular pedicle to cover defect after removed scars. But these methods must depend on the disposition, the position and the degree contracts of the scar. With these results, we affirmed that the effects of surgery methods in treatment for contracts and adherence of the scar in the axilla with a view giving back the movement function and the aesthetic for the those patients.