Open-Approach Rhinoplasty with Use of Extended Incision

The purpose of this study was to introduce an extended incision in open-approach rhinoplasty for obtaining greater satisfaction in aesthetic rhinoplasty. This incision was similar with the usual open rhinoplasty incision but it is extended along the caudal border of the footplates of the medial crura onto the floor of the nasal vestibule in order to access the footplates of the medial crura more easily. This simple extended incision enabled us to achieve further tip projection because the pressure of the skin flap on the tip was reduced. In addition, a cartilage graft or an implant insertion for alar base augmentation could be performed through this extended incision without an additional incision. Another advantage was that in correction of caudal septal deviation, displaced septal cartilage could be repositioned by suturing to the periosteum or soft tissue around the anterior nasal spine without drilling into it through intraoral incision. Fifty-one consecutive patients who underwent our extended open-approach rhinoplasty between August of 1999 and September of 2000 were included in this study. A total of 40 patients had an adequate follow-up time of over 6 months. The majority of the patients(35/40 cases) were satisfied with the results of the procedure. Two patients had complications of nostril scar contracture requiring close follow-up. There were no cases of implant extrusion, displacement, or infection. Nor did any patients experience transcolumellar or extended incision scarring.

Second Toe Medial Plantar Free Flap for the Pulp Reconstruction of Fingertip

The aim of this study is to report usefulness and postoperative results of the second toe medial plantar free flap for fingertip reconstruction. From July 1997 to December 1999, 17 fingers of 17 patients with pulp defect of fingers were reconstructed by second toe medial plantar free flaps. The artery and nerve of the flap is obtained from the second toe medial plantar neurovascular bundle. Venous flow is obtained from dorsal vein. The donor site was closed with a full-thickness skin graft. The survival of these flaps was successful in all cases. All procedures were performed by the two-team approach. Average flap size was 2 X 2.5 cm. The follow-up period ranged from 2 months to 29 months. The mean value of moving and static 2 point discrimination test in 14 cases were 4.4 and 6.2 mm, respectively. We have obtained satisfactory sensory restoration and aesthetic appearance. No functional deficit was found at the donor site. We reviewed the medical records of our cases and analyzed them in several aspects. The major advantage of this flap is to provide aesthetic improvement of the recipient and donor site. We also modified the incision line of the second toe by including the medial portion of the flap, which is easier to dissect and enables neurovascular pedicles to be dissected in one operative field. We conclude that this surgical method is a safe and reliable procedure with a high successful rate for reconstruction of fingertip injury, especially for the pulp defect.

Second Toe Medial Plantar Free Flap for the Pulp Reconstruction of Fingertip

The aim of this study is to report usefulness and postoperative results of the second toe medial plantar free flap for fingertip reconstruction. From July 1997 to December 1999, 17 fingers of 17 patients with pulp defect of fingers were reconstructed by second toe medial plantar free flaps. The artery and nerve of the flap is obtained from the second toe medial plantar neurovascular bundle. Venous flow is obtained from dorsal vein. The donor site was closed with a full-thickness skin graft. The survival of these flaps was successful in all cases. All procedures were performed by the two-team approach. Average flap size was 2 X 2.5 cm. The follow-up period ranged from 2 months to 29 months. The mean value of moving and static 2 point discrimination test in 14 cases were 4.4 and 6.2 mm, respectively. We have obtained satisfactory sensory restoration and aesthetic appearance. No functional deficit was found at the donor site. We reviewed the medical records of our cases and analyzed them in several aspects. The major advantage of this flap is to provide aesthetic improvement of the recipient and donor site. We also modified the incision line of the second toe by including the medial portion of the flap, which is easier to dissect and enables neurovascular pedicles to be dissected in one operative field. We conclude that this surgical method is a safe and reliable procedure with a high successful rate for reconstruction of fingertip injury, especially for the pulp defect.