Application of botulinum toxin type A in myocutaneous flap expansion.

BACKGROUND: Although the use of the expanded myocutaneous flap has many advantages, the time course is prolonged. The net gain in surface area during acute expansion is insufficient. In this study, botulinum toxin type A was applied to shorten the flap expansion period while obtaining an adequate surface area that would meet surgical requirements. METHODS: Seven minipigs were used for the authors' experiments. Two sides of the dorsolumbar section in each pig were divided randomly into the botulinum toxin type A-treated and the saline-treated groups. Two 200-ml expanders were implanted in the submuscular pocket. Inflation began 2 weeks later, and the period of expansion was observed in a double-blind manner. Two weeks after the final inflation, the expansion area was measured, and a 10 x 6-cm myocutaneous flap was elevated and sutured in situ, and the contraction of the myocutaneous flap was observed. RESULTS: Botulinum toxin type A shortened the expansion time by 17 days (p < 0.001). The average increment of effective expansion area (p = 0.009) and the average recruitment area (p = 0.001) in the botulinum toxin type A-treated group were significantly higher than in the saline-treated group. Moreover, contraction in axial length and width of the botulinum toxin type A-treated group was lower than that of the saline-treated group at each time point following transposition (p < 0.001). CONCLUSIONS: Botulinum toxin type A could decrease the resistance to myocutaneous flap expansion, speed up the inflation, increase the expansion area, and reduce the contraction of the myocutaneous flap. It is a safe and convenient method with which to assist myocutaneous flap expansion.

Using a remnant ear to reconstruct the tragus in total ear reconstruction.

Although the tragus is a small part of the auricle, it is necessary for a reconstructed ear because the excavated conchal region looks quite like a meatus when a prominent tragus casts a shadow on it. To our knowledge, there have been very few reports that specifically address tragus reconstruction. This article discusses various techniques and provides detailed knowledge regarding tragus reconstruction. According to various sizes, shapes and location of the remnant ear, the following methods have been used to reconstruct the tragus. (1) Inversion of a W-shaped skin flap; (2) modifying the concavity of the conchal trace to the convexity of the tragus; (3) obtaining a cartilage-containing composite graft from the remnant ear. At follow up between 3 months and 2 years, most reconstructed tragi have a satisfactory appearance and projection. These methods have proved to be extremely safe, simple and practical, justifying their wide use.

Technical innovations in ear reconstruction using a skin expander with autogenous cartilage grafts.

Pioneers such as Tanzer and Brent have established the foundations of microtia reconstruction using an autogenous costal cartilage framework. The framework and its skin coverage are the two limiting factors in ear reconstruction. At the present time autogenous rib cartilage and mastoid skin are still first choice materials for most surgeons. They have the combined advantages of well-matched texture and colour. To reconstruct a symmetrical, accurate, prominent auricle and minimise as much as possible the chest wall deformity caused by rib cartilage harvesting, we set out to improve our techniques for cartilaginous framework definition and to use the remnant ear to enhance the projection of the reconstructed ear. Since 2000, 342 cases (366 ears) were treated using our current techniques. Data pertaining to complications were recorded. Final results were assessed a minimum of 1 year postoperatively. The follow-up period ranged from 1 to 6 years. Most of the patients with microtia were satisfied with the results of their ear reconstruction. In conclusion, our techniques help to reduce the quantity of rib cartilage needed to fabricate ear framework and minimise chest wall deformity. The frameworks are accurate, prominent and stable. Reconstructed ears are similar in colour and appearance to the normal side. Our innovations are practical and reliable for microtia reconstruction using skin expanders in combination with a sculpted autogenous rib cartilage framework.

vrk1 gene mutation test in two Chinese pedigrees of the first and second branchial arch syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the role of vrk1 gene in two Chinese pedigrees of the first and second branchial arch syndrome.@*METHOD@#Sixty members in 2 Chinese pedigrees were recruited. The exon 2 -13 were analyzed by polymerase chain reaction and direct sequencing.@*RESULT@#We found a new SNP in proband of Shandong pedigree.@*CONCLUSION@#vrk1 gene mutation can be excluded in 2 Chinese pedigrees of the first and second branchial arch syndrome.