Internal Fixation Method Using EZ-Tcon for Transconjunctival Fat Repositioning: Clinical Outcomes and Efficacy.

BACKGROUND: Transconjunctival fat repositioning is the gold standard for the correction of tear trough deformity. For fixation of fat pedicle, the internal fixation (IF) and externalized percutaneous suture (EPS) techniques are used, which have their own advantages and disadvantages. The present study aimed to introduce a new IF technique using a devised needle (EZ-Tcon) and to compare its outcomes with those of the conventional EPS technique. METHODS: Patients with primary tear trough deformity who underwent transconjunctival fat repositioning were reviewed and categorized into two cohorts according to the fixation technique: cohort 1 consisted of patients treated using the conventional EPS technique and cohort 2 consisted of those in whom the new IF technique using EZ-Tcon was adopted. Post-operative complications and aesthetic outcomes were assessed using a four-scale grading system. RESULTS: A total of 545 patients, 211 from cohort 1 and 344 from cohort 2 were evaluated with a median follow-up of 70 days. Compared to cohort 1, cohort 2 showed significantly lower rates of long-standing conspicuous scars on lower eyelid, re-operation and overall complications. In the analysis of aesthetic outcomes, 88.9 percent of cohort 2 showed grade 0 (no deformity) or I (mild deformity) post-operatively. The rate of excellent outcomes (improvements of ≥ two grades) was significantly higher in cohort 2 than in cohort 1 (p-value < 0.001). CONCLUSION: Our technique using EZ-Tcon could possess advantages of the conventional IF and EPS techniques, showing lower complication rates and aesthetically satisfactory outcomes, and could be a safe and reliable method of transconjunctival fat repositioning. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

New Internal Fixation Technique for Transconjunctival Fat Repositioning.

To treat tear trough deformities in young patients, transconjunctival orbital fat repositioning has been widely used. Although internal fixation of transposed fat enables more secure and stable fixation than the externalized percutaneous suture method, the latter is used more commonly because of the narrow operation field and consequent technical difficulty of the internal fixation method. We describe a novel technique using a newly devised needle (Chang's needle) that facilitates internal fixation of transposed fat pedicles.

Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer.

BACKGROUND: The preoperative localization of thoracodorsal artery perforators has been a challenge because of their topographic variation. METHODS: From November of 2005 to January of 2007, 25 patients underwent free thoracodorsal artery perforator flap transfer for reconstruction of the lower extremities (22 flaps) and the head and neck (three flaps). All of the patients underwent multidetector-row computed tomographic angiography for preoperative perforator mapping. The computed tomographic findings were compared with the acoustic Doppler flowmetric and intraoperative findings. Surgical outcomes were compared with those of a historical group of patients treated before the adoption of computed tomography-based perforator mapping. RESULTS: The flap sizes ranged from 3 x 5 cm to 27 x 13 cm. One to four perforators (mean, 2.2) were marked on the three-dimensional computed tomographic image for each patient and the locations correlated with the handheld Doppler examination. Intraoperatively, all perforators marked were confirmed, and three additional perforators that had not been identified on the computed tomographic images were observed. All of the flaps survived, with the exception of two cases with marginal necrosis. Concrete planning based on knowledge of the precise location of the perforators allowed a shorter harvest time, minimized the incision for flap harvest, particularly with small flaps, and enabled the planned use of multiple perforators for better perfusion or complex designs. CONCLUSIONS: Perforator mapping with preoperative multidetector-row computed tomographic angiography is valuable for both planning and executing thoracodorsal artery perforator flap transfer. The targeted perforator flap harvesting allows a safe and straightforward harvest and an elegant reconstruction, with less donor-site morbidity.

Endoscopic excision of cheek lipomas.

Although the removal of forehead and brow benign tumors using an endoscopic technique has proven to be valuable, the efficacy of an endoscopic excision for cheek masses is unclear. A retrospective review was performed on 8 patients with a lipoma (7) and a foreign body granuloma (1) located at the cheek region. There were 7 men and 1 woman with a mean age of 34.8 years (range, 22-54 years). All the excisional procedures were performed with an endoscope through 2 small incisions, one on the hair-bearing sideburns and the other behind the earlobe. The masses varied from 0.7 x 0.7 cm to 4.0 x 3.0 cm in size. There were no intraoperative or postoperative complications, and no recurrence was detected after a 5- to 61-month follow-up. An endoscopically assisted excision of cheek lipomas is an effective procedure and might be a good alternative to the more conventional procedures.