Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap.@*METHODS@#A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer.@*RESULTS@#Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes.@*CONCLUSION@#Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

Subcutaneous lateral brow lift, an option with local anesthesia / Levantamiento de cejas lateral con acceso subcutáneo, una opción con anestesia local

The aim of this article is to present a case series of subcutaneous lateral brow lifts withlocal anesthesia. The case series includes 9 subjects operated on between 2014 and 2016, with an averageage of 57 years and with no limitations on ethnic group or gender. The surgery was done bilaterally entirelyunder local anesthesia. After a minimum follow-up of 3 months, no major complications were observed, onlypartial suture dehiscence at two surgical sites that did not require surgical management of the zone. Goodresults were established, being fast, economical and with low morbidity. It is concluded that the subcutaneousbrow lift with local anesthesia can be applied with a low rate of complications and good results.

El objetivo de este articulo es presentar una serie de casos operados para levantamiento lateral de cejas, con disección subcutánea y con uso de anestesia local. Se diseño un estudio de serie de casos, incluyendo 9 sujetos operados entre el año 2014 y 2016, con una edad promedio de 57 años y sin restricción de etnia o sexo. Se realizó la cirugía totalmente bajo anestesia local de forma bilateral. Después de un seguimiento mínimo de 3 meses, no se observaron complicaciones mayores, presentado solo dehiscencia parcial de sutura en dos sitios quirúrgico que no requirieron manejo quirúrgico de la zona; se establecieron buenos resultados, siendo ellos rápidos, de baja morbilidad y de bajo costo. Se concluye que la técnica de levantamiento de cejas con disección subcutánea y anestesia local puede ser aplicado con bajo índice de complicaciones y buenos resultados.

Forehead reduction in patients with precapillary incision: 10 years of experience / Redução frontal em pacientes submetidos à incisão pré-capilar: 10 anos de experiência

Introduction: The long forehead gives a less harmonious appearance, seems disproportionate and characterizes the aging face. Surgical procedures for frontal reduction with precapillary incision present insightful information and provide harmonious and pleasant restoration of the frontal region. This study evaluated results obtained in patients who underwent frontal reduction using precapillary incision at Daher Hospital plastic surgery service within the last ten years. Methods: This was a retrospective longitudinal study. The surgical technique entailed a careful dissection of the bilateral supraorbital ridge. The scalp was dissected in the parietoccipital region in order to easily move forward the flap. The vigorous hemostasis and resection of excessive flap were performed. In the end, synthesis of plans were performed. Results: The age of patients ranged from 48 to 76 years, the mean age was 58 years. Mean surgical time was 3 hours and 38 minutes. No complications were seen such as hematoma, flap necrosis, supratrochlear nerve injury, alopecia, infections, deep vein thrombosis, pulmonary embolism and/or dehiscence. Four patients (7%) had seroma that was drained. The symmetric of eyebrows and scars positioning was considered satisfactory in both assessment by patients and the technical evaluator. Conclusion: The aesthetic results in patients who underwent frontal reduction by precapillary incision were satisfactory. The choice of the ideal patient was crucial for success of the surgery.

Introdução: A testa longa confere uma aparência menos harmônica, desproporcional e caracteriza o envelhecimento. Procedimentos cirúrgicos para redução frontal com incisão pré-capilar apresentam indicações criteriosas e proporcionam a restauração harmônica da região frontal. O estudo avalia os resultados obtidos em pacientes submetidos à redução frontal por incisão pré-capilar no serviço de cirurgia plástica do Hospital Daher nos últimos dez anos. Métodos: Trata-se de um estudo observacional longitudinal retrospectivo. A técnica cirúrgica consiste em uma dissecção cuidadosa até o rebordo supraorbital bilateral. O couro cabeludo é dissecado até a região parietoccipital de forma a avançar com facilidade o retalho. Procede-se à hemostasia vigorosa e ressecção do retalho excedente. Por fim, realiza-se a síntese por planos. Resultados: A faixa etária das pacientes variou de 48 a 76 anos, com média de 58 anos. O tempo médio operatório foi de 3 horas e 38 minutos. Não foram observadas complicações como hematoma, necrose do retalho, lesão do nervo supratroclear, alopécia, infecções, trombose venosa profunda, embolia pulmonar e/ou deiscências. Quatro pacientes (7%) apresentaram seroma, os quais foram todos drenados. A simetrização das sobrancelhas e a posição das cicatrizes foram consideradas satisfatórias tanto pela avaliação feita pelos pacientes quanto pela avaliação técnica. Conclusão: Os resultados estéticos obtidos em pacientes submetidos à redução frontal pela incisão pré-capilar foram satisfatórios. A escolha do paciente ideal foi fundamental para o bom sucesso operatório.

Complex nasal reconstruction after paracoccidioidomycosis infection - Case report

Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles.

Intralesional radiofrequency ablation for nodular angiolymphoid hyperplasia on forehead: A minimally invasive approach.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an idiopathic acquired condition characterized by erythematous papulo-nodular lesions with a predilection for the head and neck. The lesions are cosmetically disfiguring, resistant to most medical and surgical therapies and tend to recur. We report the novel use of radiofrequency equipment in the management of nodular ALHE on forehead of a 53-year-old man. Intra-lesional radiofrequency ablation was done using a modified 18 gauge intravenous cannula and three sittings over a period of four years yielded cosmetically acceptable results with no recurrence and minimal side effects.

Uso do retalho médio-frontal na reconstrução do nariz / Use of mid-forehead flap in nasal reconstruction

INTRODUÇÃO: Seiscentos anos antes de Cristo, foi descrito o retalho médio-frontal pelo indiano Sushruta Samhita. Até hoje, esse retalho, chamado ''retalho indiano", é usado na reconstrução do nariz. O objetivo deste trabalho foi analisar os resultados da 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, Serviço do Professor Ivo Pitanguy, na reconstrução nasal com emprego de retalho médio-frontal. MÉTODO: Foi realizado estudo retrospectivo com 10 casos operados no serviço referido para reconstrução nasal com retalho indiano, no período de 21 anos (1991 a 2012). RESULTADOS: O número de subunidades nasais atingidas variou de 4 a 9, com média de 6,5 subunidades. Em 70% dos pacientes foi realizada expansão prévia do retalho médio-frontal e em 90% foram utilizados enxertos cartilaginosos e/ou ósseos. Cinco pacientes apresentaram distorções pós-operatórias, que foram corrigidas por outras cirurgias. Nenhum caso de infecção pós-operatória, de necrose do retalho ou de extrusão de enxertos foi registrado. CONCLUSÕES: Este trabalho permitiu demonstrar que o retalho médio-frontal tem ainda importante papel na reconstrução nasal de grandes defeitos, com resultados satisfatórios, atribuídos a sua segurança vascular, à quantidade de pele que se obtém, e à semelhança de cor, textura e espessura cutâneas.

BACKGROUND: Six hundred years before Christ, the mid-forehead flap was described by the Indian Sushruta Samhita. Until today, this flap called ''Indian flap", has a major role in the reconstruction of the nose. The aim of this work was to analyze the results of the 38th Infirmary of the Santa Casa da Misericórdia of Rio de Janeiro, Professor Ivo Pitanguy's Service, in nasal reconstruction with the mid-forehead flap. METHODS: We did a retrospective study of 10 cases operated in the service for nasal reconstruction with Indian flap, during a 21 year period (1991-2012). RESULTS: The number of nasal sub-units affected varied from 4 to 9, with an average of 6.5 subunits. In 70% of the patients, was performed a previous expansion of the mid-forehead flap and in 90% were used cartilage grafts and/or bones. Five patients had postoperative distortions, that were corrected with other surgeries. No cases of infection, necrosis of the flap or graft extrusion were recorded. CONCLUSIONS: This study allowed to demonstrate that the mid-forehead flap still have an important role in nasal reconstruction of major defects, showing satisfactory results due to its vascular safety, the amount of skin which is obtained, likeness of color, texture and skin thickness.

Videoendoscopia para lesiones benignas en región frontal / Video endoscopy for injuries benign in frontal region

En este trabajo se revaloriza el uso de videoendoscopia para el tratamiento de lesiones benignas frontales, con la presentación de 13 casos

In this paper, the use of video endoscopy revalued for the treatment of benign front tumors, with the presentation of 13 cases

Redução da região frontal com incisão pré-capilar: relato de experiência e indicações / Forehead reduction using precapillary incision: experience report and indications", "_e": "n

INTRODUÇÃO: A testa longa pode dar uma aparência menos atraente, desproporcional e caracterizar o envelhecimento. O objetivo deste trabalho é demonstrar a experiência dos autores na redução da região frontal com incisão pré-capilar e reforçar as indicações desse procedimento. MÉTODO: Foram estudados, retrospectivamente, pacientes submetidos a redução da região frontal por incisão pré-capilar, no período de 2005 a 2011. As indicações para incisão anterior na linha do cabelo foram ptose da sobrancelha, em pacientes que possuíam cabelos frontais finos e escassos, testa longa congênita ou enrugamento amplo de testa. RESULTADOS: A incisão pré-capilar foi realizada em 31 pacientes, com acompanhamento médio de 1,5 ano. Não houve problemas relacionados à vascularização do retalho. Todos os pacientes relataram parestesia temporária, com recuperação em até 1 ano. Três pacientes apresentaram seromas no pós-operatório, tratados com punção. Todos os pacientes relataram que os benefícios da redução da linha do cabelo ultrapassaram as desvantagens de uma cicatriz possivelmente mais visível. CONCLUSÕES: O procedimento de ritidectomia frontal com incisão pré-capilar é indicado para pacientes com cabelos frontais finos e escassos, com enrugamento amplo da testa ou com testa longa congênita/senil e que desejem reduzi-la.

BACKGROUND: A long forehead can give a less attractive and disproportionate appearance. It may also indicate aging. The objective of this study is to show the experience of the authors in forehead reduction using precapillary incision and to support the indications for this procedure. METHODS: Patients who underwent precapillary incision for forehead reduction between 2005 and 2011 were retrospectively analyzed. The indications for an anterior hairline incision were eyebrow ptosis in patients with thin and sparse frontal hair, congenital long forehead, or extensive forehead wrinkles. RESULTS: Precapillary incision was performed in 31 patients, who were followed up for an average of 1.5 years. No problems related to flap vascularization were detected. All patients reported temporary paresthesia, from which they recovered within 1 year. Three patients presented seromas during the postoperative period and were treated using puncturing. All patients reported that the benefits of altering the hairline were greater than the disadvantages of a possibly more visible scar. CONCLUSIONS: Frontal rhytidectomy using precapillary incision is recommended in patients who wish to correct thin and sparse frontal hair, extensive forehead wrinkles, or congenital/senile long forehead.

Frontoplastia endoscópica: três anos de experiência / Endoscopic frontoplasty: 3-year experience

A frontoplastia endoscópica (FE) representa um significativo avanço para a elevação das sobrancelhas, tendo substituído a técnica coronal clássica. OBJETIVO: Demonstrar a casuística e avaliar os resultados e complicações com a técnica de FE no Serviço de Otorrinolaringologia da Universidade Federal de Uberlândia. PACIENTES E MÉTODOS: De janeiro de 2001 a janeiro de 2004, 67 pacientes foram submetidos à FE, sendo que 7 à "técnica dos triângulos". As idades variaram entre 38 a 59 anos (média de 48,3 anos), sendo 65 (97 por cento) do sexo feminino. RESULTADOS: Destes, 56 pacientes apresentaram resultado satisfatório, 2 apresentaram déficit estético notado pelo cirurgião e pelo paciente. Dos 7 pacientes submetidos à "técnica dos triângulos", todos apresentaram resultado satisfatório. Todos apresentaram melhora da ptose lateral do terço lateral e glabelar das sobrancelhas e diminuição das rugas verticais e frontais. A cirurgia revisional foi necessária em 2 pacientes nos quais ocorreu recorrência da ptose. Houve um paciente que apresentou paralisia do ramo frontal do nervo facial unilateral. Com a "técnica dos triângulos", 5 pacientes apresentaram cicatriz visível no local das incisões. CONCLUSÃO: A FE é uma técnica que produz resultados satisfatórios na grande maioria dos casos, com baixo índice de complicações.

Endoscopic forehead lift (EFL) represents a significant progress, even replacing the classic coronal and pretriquial techniques. AIM: To demonstrate a series of cases and to evaluate results and complications with EFL in the Department of Otorhinolaryngology of the Federal University of Uberlândia. MATERIALS AND METHODS: From January 2001 to January 2004, 67 patients were submitted to EFL, and 7 of these were submitted to the so called "triangles technique". Their ages ranged between 38 and 59 years; and 65 (97 percent) were females. RESULTS: Of these, 56 patients presented satisfactory result and 2 presented aesthetic deficits noticed by the surgeon and the patient. Of the 7 patients submitted to the "trianglesÆ technique", all showed satisfactory results. All the patients had improvements on their ptosis of the lateral and glabellar third of the brows and reduction in vertical and frontal wrinkles. Revision surgery was necessary in 2 patients that had ptosis recurrence. There was one unilateral paralysis of the front branch of the facial nerve. With the "trianglesÆ technique", 5 patients presented visible scars. CONCLUSION: EFL is a technique that produces satisfactory results in the great majority of patients, with low complication rates.

Ritidectomía frontal bicoronal subaponeurótica / Subaponeurotic bicoronal frontal rhytidectomy

Para el tratamiento del envejecimiento del tercio superior de la cara se han empleado diversas técnicas quirúrgicas. El abordaje bicoronal ha sido el más utilizado, pero a su vez el que más variantes y modificaciones ha tenido. Con este trabajo los autores se proponen evaluar los resultados de la ritidectomía frontal bicoronal siguiendo un mismo procedimiento dado por la disección subaponeurótica hasta los rebordes orbitarios, sección horizontal múltiple del músculo frontal y prócer, así como disección y sección de los músculos corrugadores. Solo se modificó la localización de la incisión frontal en dependencia de la longitud de la frente. Fueron operados 31 pacientes y se evaluaron los resultados a los 6 meses de la operación. Con la técnica empleada se modificaron las arrugas frontoglabelares hacia el borramiento o la desaparición, la ptosis de las cejas se corrigió de forma armoniosa y las complicaciones fueron escasas y poco relevantes. No se produjo afectación de la mímica frontoglabelar(AU)

For the treatment of the aging of the superior third of the face they have been used diverse technical surgical. The boarding bicoronal has been the most used one, but in turn the one that more varying and modifications have had. With this work the authors intend to evaluate the results of the ritidectomía front bicoronal following oneself procedure given by the dissection subaponeurótica until the edges orbitarios, multiple horizontal section of the front and eminent muscle, as well as dissection and section of the muscles corrugadores. Alone he/she modified the localization of the front incision in dependence of the longitude of the forehead. 31 patients were operated and the results were evaluated to the 6 months of the operation. With the technique employee they modified the wrinkles frontoglabelares toward the borramiento or the disappearance, the ptosis of the brows was corrected in a harmonious way and the complications were scarce and not very excellent. Affectation of the mimic frontoglabelar didn't take place(AU)

Síndrome de Parry-Romberg: relato de um caso / Parry-Romberg Syndrome: one case related

A atrofia hemifacial pregressiva (síndrome de Parry-Romberg) é uma atrofia facial lentamente progressiva da gorduta subcutânea e alterações da pele, cartilagem e osso. Esta desordem inclui uma fase progressiva ativa, seguida por um importante processo atrófico, com subseqüente estabilização. O artigo apresenta um relato de caso com revisão da literatura.