Reconstruction of Achilles region defects: A single-centre experience.

BACKGROUND: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to the use of free flaps. The aim of this study was to discuss reconstruction options and to help the surgeon to select reliable approach to achieve favourable outcomes. METHOD: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single centre. RESULTS: Reconstructions were performed with secondary healing (n = 2), negative pressure wound therapy and skin grafting (n = 2), free flaps (n = 6) and local and distant flaps (n = 4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. CONCLUSION: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. The use of special digital imaging techniques facilitates flap surgery and helps minimise the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Super-thin free flaps offer a distinct advantage in skillful hands. The use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favourable outcomes.

Reconstruction of firearm and blast injuries in Syrian war refugees.

BACKGROUND: War injuries differ from other injuries owing to the large tissue defects they cause and their high risk of contamination. As fragments scattered by high-energy firearms and explosives cause serious composite tissue damage, repair of such injuries is difficult and requires a long treatment period. We discuss the treatment methods used for injured Syrian War refugees admitted to our clinic and present the most effective repair methods for war-related tissue defects for each region of the body. METHODS: A total of 61 patients treated between June 2012 and April 2015 were retrospectively evaluated in terms of age, gender, duration of hospitalisation, injury site and repair method employed. The patients were grouped by region injured (head/neck, extremities and trunk). RESULTS: The female-to-male ratio of the patients was 16/45, and their mean age was 25.2 (range, 3-51) years. Twenty-two patients were under the age of 18. The mean duration of hospitalisation was 28.5 days. A total of 130 operations were performed on the patients, including debridement and revisions. Repairs were conducted with free flaps in 17 patients (6 on the head/neck region, 11 on extremities) and with pedicle flaps in 28 patients (11 on the head/neck region, 12 on extremities, 5 on the trunk). Two patients experienced flap loss without other complications, and other patients experienced complications including bleeding, infection, flap detachment, hematoma and seroma. CONCLUSIONS: War injuries cause tissue damage of a composite and extensive nature. Most affect the extremities, followed by the head/neck and trunk regions. They are primarily sustained by the young population, not usually easy to treat, and require long hospitalisation periods. A variety of methods may be preferred to treat these injuries.

Retrorectal tumor: a single-center 10-years' experience.

PURPOSE: Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution. METHODS: A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated. RESULTS: Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma. CONCLUSION: RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.

Perforator artery response to tissue expansion: An experimental study in rabbits.

BACKGROUND: The reconstruction of defects is a major area of interest in plastic surgery. Tissues are expanded to extend the tissue surface area and to prepare more reliable perforator flaps. OBJECTIVES: Because expanded perforator flaps have become more popular, the aim of this study is to determine the response of the perforator artery to tissue expansion. MATERIAL AND METHODS: We used a rabbit S1 perforator (first perforator branch of the thoracodorsal arteries) flap model. In 12 New Zealand White rabbits, left flaps were used as the experimental group (n = 12) and right flaps were used as the control group (n = 12). Both flaps were constructed in the dorsal skin. The experimental group was further divided into 3 subgroups according to expansion volume: 150 mL (n = 4), 200 mL (n = 4) and 250 mL (n = 4). We evaluated the responses of the perforator arteries to tissue expansion using the resistivity index (RI), the pulsatility index (PI), vessel diameter (D), histopathological examinations, and angiography. RESULTS: After 3 weeks of expansion, the perforator artery diameter had increased (p = 0.002) and the RI had decreased (p = 0.031) in the experimental group. The perforator artery diameter (p = 0.006) and RI had increased (p = 0.003) in the control group. No significant changes were observed in the PI in either group (p > 0.05) and no significant differences in post-expansion measurements were observed between experimental subgroups (p > 0.05). CONCLUSIONS: Suprafascial expansion of a perforator flap leads to an increase in diameter and a decrease in the RI of the perforator artery. The decrease in RI may indicate increased flap perfusion.

Outcomes of Anatomic Reconstruction of Gunshot-Inflicted Lower Face Defects by Free Osteoseptocutaneous Fibula Flap and Expanded or Nonexpanded Temporal Scalp Flap Combination in Males.

Reconstruction of gunshot-inflicted composite lower face defects is a challenge for plastic surgeons. Functional and aesthetic repair of such defects mostly requires free or pedicled flap applications or combinations of both.In this study, the authors evaluated 7 males with gunshot-inflicted composite mandibular defects. All patients underwent reconstruction with a free osteoseptocutaneous fibula flap (FOCF) for the composite mandibular defect and a pre or nonexpanded temporal artery-based scalp flap for beardless facial skin. All patients were evaluated aesthetically and functionally with a postoperative evaluation scale. Average patient follow-up time was 3.5 years.All FOCFs survived completely. Expander exposition was observed in 2 preexpanded temporal scalp flaps. The problem was solved by rapid expansion and early flap application. All patients had acceptable functional and aesthetic results.In conclusion, the scalp flap should be considered in male beardless skin reconstruction due to its ease of application, reliability, and proximity to the defect. Preexpansion of this flap can decrease donor area morbidities. Moreover, the FOCF and scalp flap combination is a convenient procedure for gunshot-inflicted lower face defects, and such procedures produce good aesthetic and functional long-term outcomes.

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: distally based cross-leg sural flap.

BACKGROUND: High voltage electrical injuries can cause devastating results especially in distal extremities. Although free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF), which can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury. The purpose of this study was to evaluate long term results of eleven patients who underwent a reconstruction to the lower extremity with cross-leg DBSF due to high voltage electrical burn injury between the years of 2003-2013. METHODS: Eleven patients suffering from high voltage electrical injury from 2003 to 2013 were evaluated retrospectively. All patients were male and had deep 2nd and 3rd degree electrical burns on many parts of their bodies, including their lower legs and feet. Seven of the defects were located on the right limb and four of them on the left. Defects were located in the ankle area in five patients, dorsum of the foot in four patients, achilles area in one patient, and the plantar region in one patient. RESULTS: The adaptation of flaps to the recipient site, colour, and quality were all acceptable. CONCLUSION: As an alternative to free flaps, the cross-leg DBSF has good tissue compliance, provides tissue of adequate quantity and quality, and has low complication rates in the long term in high voltage electrical injuries of the leg and foot.

Is the preoperative MPV value related to early thrombus formation in microvascular anastomosis?

OBJECTIVE: One of the most common encountered problems in free flap surgeries is anastomotic thrombosis. The mean platelet volume (MPV) may indicate the concentration of intra-platelet proactive substances and the thrombogenic potential of the platelets. MPV is used as a clinical monitoring index in routine blood counts, it has not yet been effectively used in free flap surgery. METHODS: This study evaluates the relationship between the preoperative MPV value and anastomotic thrombus formation during the postoperative 48 hours in 32 free flap operations from September 2013 to September 2014. The mean patient age was 36.75 years. The preoperative MPV value, which was obtained from the complete blood count, was recorded and correlation of MPV and postoperative thrombus formation was investigated. RESULTS: Four anastomotic thrombus were encountered in 34 free flaps during the postoperative 48 hours. Two of them were salvaged by performing thrombectomy and/or administration of i.v. heparin. There was no statistical relationship between MPV value and postoperative thrombus formation during 48 hours follow-up (p = 0.925). CONCLUSION: Even though this study didn't find a correlation between preoperative MPV value and postoperative early anastomotic thrombus, it would be helpful to validate the results using multi-centre and comprehensive studies with larger patient cohorts.

Alveolar Bone, Upper Lip and Columellar Reconstruction With Composite Abbe Flap.

Bilateral cleft lip and palate repair usually requires secondary corrective intentions. Abbe flap is a useful option and has many modifications for revision surgeries of cleft lip nose deformities. Study evaluated a 23-year-old woman for secondary cleft lip nose correction. The authors performed a composite Abbe flap, which included mental bone for repairing the upper lip harmony, maintaining the columellar elongation and bridging central alveolar bone cleft. No complications were observed and aesthetic and functional improvement was maintained. Presented new modification of Abbe flap maintains not only upper lip relaxation (additional skin soft tissue replacement) and columellar lengthening (extended designed flap) but also alveolar cleft reconstruction (vascularized mental bone) by a composite flap. Also, this modification prevents additional surgeries for alveolar cleft repair in cleft lip nose patients.

A convenient flap for repairing the donor area of a distally based sural flap: Gastrocnemius perforator island flap.

OBJECTIVE: The reconstruction of complex lower leg and foot defects is difficult for plastic surgeons. The distally based sural flap (DBSF) is an option for non-free flap lower leg reconstruction. However, one of the major drawbacks of the DBSF is its aesthetically non-acceptable donor area scarring. MATERIALS AND METHODS: Eight patients (six men and two women) who had lower leg or foot defects were evaluated in this study. We used an ipsilateral or cross-leg DBSF to repair the defect. A medial or lateral gastrocnemius perforator island flap (average size 8.1 × 6.1 cm) was used to cover the donor area of the DBSF in a two-stage operative procedure. RESULTS: We did not observe any complications with the gastrocnemius perforator island flap. Two patients had local infections under the DBSF and were treated with bacteria-specific antibiotherapy. All patients were followed up for 1 year postoperatively. The donor areas of the distally based sural flaps were aesthetically acceptable. Patients gained ambulatory status during the follow-up period. CONCLUSIONS: Reconstruction of the donor area of a DBSF with a gastrocnemius perforator island flap allows for more acceptable aesthetics and functional results than do other reconstructive procedures.

A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns.

BACKGROUND: The management of a high voltage electrical injury and lower limb salvage remains a challenging task for plastic surgeons. Reconstruction with flaps is often the only alternative to limb amputation. The purpose of this study was to present a cross flow-through pedicle free latissimus dorsi muscle flap for the salvage of severely traumatized lower limbs perfused by one remaining vessel (a single vessel lower limb) in high voltage electrical injuries. METHODS: In this retrospective study, between 2000 and 2014, six men underwent cross-leg free Latissimus dorsi muscle flap operations for limb salvage. They had soft tissue lower leg defects due to high voltage electrical injuries. Their medical records were retrospectively reviewed. All had only one artery that perfused the leg. Free pedicled thoracodorsal artery latissimus dorsi flaps were harvested and connected to the contralateral posterior tibial artery. RESULTS: All defects were successfully covered. No flap loss or major amputation occurred during follow-up (mean; 5.9 years). A computerized tomography angiogram showed intact vessel continuity in the recipient vascular system. The patients were able to walk without any apparatus or assistance after long term follow-up. CONCLUSION: We recommend that the cross flow-through pedicle free muscle flap should be considered as a salvage procedure for single vessel lower extremities resulting from high voltage electrical burns. Extremity perfusion was not compromised by this procedure.

Outcomes of Tissue Expander Application for Scalp Reconstruction in Extensive Aplasia Cutis Congenita.

INTRODUCTION: Aplasia cutis congenita (ACC) is a rare congenital disorder. The purpose of this study was to present outcomes of tissue expander application for scalp reconstruction in extensive ACC. PATIENT/METHODS: In this retrospective study, medical records were reviewed for six patients who underwent serial tissue expander application for scalp reconstruction in ACC between 2000 and 2015. Patient average age was 14.5 (range, 4-25 years). One of the six cases had frontal bone defect, the others had bone and soft tissue defect at the vertex. In the newborn period, all patients have been managed by split-thickness skin grafts without cranioplasty procedures. After grafting and calvarial regeneration, one (or more) sessions of tissue expanders and scalp flap applications were performed for alopecia and soft tissue correction. Radiologic and clinical examination was performed for complications and outcomes. RESULTS: Computerized tomography showed intact calvarium with patchy hyperostosis in all patients. The mean size of grafted areas was 69.5 cm(2) (range, 32-148.5 cm(2)). Minimal distal flap necrosis (6 × 1 cm) was observed in one patient. Serial scalp tissue expansion was performed with at least one session in a 1-year interval. One expander was extracted due to exposition and infection. No total flap losses and no calvarial defects were observed during follow-up (mean; 8.6 years). Clinical examination revealed acceptable cosmetic results in all patients. CONCLUSION: We advocate late expander scalp reconstruction for management of extensive ACC cases. 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.

Total or Near-Total Lower Eyelid Defect Reconstruction Using Malar Myocutaneous Bridge and Nasojugal Flaps and Septal Chondromucosal Graft.

PURPOSE: The purpose of this study is to repair total or near-total lower eyelid defects by single-staged operative technique. METHODS: The procedure was performed on 7 referred patients who had a total or near-total lower eyelid defects after tumor extirpation or trauma. Patients ages were between 13 and 67 years (average, 46.5). Defects were repaired by simultaneous reconstruction of anterior and posterior lamellae using a bipedicled malar myocutaneous bridge flap, a nasojugal transposition flap, and a septal chondromucosal graft in combination. RESULTS: Patients were followed up for 12 to 24 months (average, 18 months). No necrosis, hematoma, or infection was observed in flaps, and no recurrence was observed in any patients. Mild scleral show was observed at postoperative 12 months in 2 cases. CONCLUSIONS: As an addition to classical methods, the present novel single-staged surgical procedure with the malar myocutaneous bridge flap, nasojugal transposition flap, and septal chondromucosal graft combination provides anatomical, functional, and stable reconstruction for total or near-total lower eyelid defects.

Assessing the effects of melatonin and N-acetylcysteine on the McFarlane flap using a rat model.

OBJECTIVE: To determine the effects of N-acetylcysteine (NAC) and melatonin, alone and in combination, on McFarlane flap viability in a rat model. METHODS: Forty Wistar rats were divided into four groups and received daily intraperitoneal injections for one week before surgery: control (sham [n=10]); melatonin (n=10); NAC (n=10); and NAC+melatonin (n=10). One week after surgery, the experiment was terminated and photographs were taken for topographic studies. A transillumination study was performed to observe vascularization in the flaps and biopsies were obtained for histopathological studies. RESULTS: Flap viability was significantly greater in the antioxidant- (ie, NAC and melatonin) treated groups compared with the control group; however, there were no significant differences among the groups that received antioxidants. CONCLUSIONS: Melatonin and NAC are important antioxidants that can be used alone or in combination to increase flap viability and prevent distal necrosis in rats.

OBJECTIF: Déterminer les effets de la N-acétylcystéine (NAC) et de la mélatonine, seules ou ensemble, sur la viabilité d'un lambeau de type McFarlane dans un modèle de rat. MÉTHODOLOGIE: Les chercheurs ont réparti 40 rats Wistar en quatre groupes à qui ils ont administré des injections intrapéritonéales quotidiennes pendant une semaine avant l'opération: sujets témoins (n=10), mélatonine (n=10), NAC (n=10) et NAC+mélatonine (n=10). Une semaine après l'opération, ils ont mis fin à l'expérience et pris des photos en vue d'études topographiques. Ils ont réalisé une étude de transillumination pour observer la vascularisation des lambeaux et effectué des biopsies pour mener des études histologiques. RÉSULTATS: La viabilité des lambeaux était beaucoup plus importante dans les groupes traités aux antioxydants (NAC et mélatonine) que dans le groupe témoin. Cependant, les différences n'étaient pas significatives entre les divers groupes qui avaient reçu des antioxydants. CONCLUSIONS: La mélatonine et la NAC sont d'importants antioxydants qu'on peut utiliser seuls ou ensemble pour accroître la viabilité des lambeaux et prévenir la nécrose distale chez les rats.

Reconstruction of Acquired Breast Hypoplasia by Subcutaneous Scar Releasing and Repeated Fat Grafting Combination.

Breast hypoplasia may have a congenital or acquired etiology. One of the acquired reasons is postinfectious scars, which results in skin restriction and breast hypoplasia in the long term. Reconstruction of breast hypoplasia is performed by autologous tissues, implants, or both. In this report we present a hypoplastic breast reconstruction by subcutaneous scar releasing and multiple autologous fat grafting in a 21-year-old female with a right breast hypoplasia due to postinfectious scar. No complications were observed at 24 months follow-up after treatment by subcutaneous scar releasing and repeated (three times) fat grafting. Safe and natural reconstruction of mild breast hypoplasia due to fibrotic scars can be accomplished by performing a combination of subcutaneous scar releasing and multiple fat grafting.

A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps.

BACKGROUND: Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions. OBJECTIVE: To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region. METHODS: Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma. RESULTS: All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed. CONCLUSION: This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.

HISTORIQUE: Il est difficile de reconstruire des anomalies du canthus interne après l'excision d'une tumeur, en raison de la minceur de la peau et de la concavité des repères anatomiques, qui incluent des structures complexes comme le ligament du canthus interne et le système lacrymal. Les modes de reconstruction locale incluent la cicatrisation secondaire, les greffes de peau totales et les lambeaux cutanés des régions frontale, transnasale, glabellaire et de la paupière supérieure. OBJECTIF: Démontrer la combinaison utile de deux lambeaux locaux pour corriger de larges anomalies de la région du canthus interne. MÉTHODOLOGIE: Entre 1998 et 2012, 11 patients ayant de larges anomalies complexes après l'excision (incluant le périoste), d'un carcinome basocellulaire invasif, ont été soignés par une combinaison de rotation glabellaire et de lambeaux nasolabiaux d'avancement en VY. RÉSULTATS: Les patients, qui ne présentaient plus de tumeur, ont subi une reconstruction fonctionnelle et esthétique de la région du canthus interne. Ils n'ont pas présenté de complications majeures et n'ont pas subi de récidives. CONCLUSION: Cette technique assure une belle concordance de couleur et de texture et des résultats satisfaisants sur le plan esthétique et fonctionnel. Par ailleurs, la morbidité est minime dans la région du donneur, et la technique chirurgicale est simple.

Comparison of autologous and heterologous bone graft stability effects for filling maxillary bone gap after Le Fort I osteotomy.

BACKGROUND: The amount of postoperative maxillary relapse of two different bone graft materials after Le Fort I osteotomy were compared in this study. OBJECTIVES: The aim of this study is to compare postoperative maxillary relapse rates using heterologous and autologous graft materials after Le Fort I osteotomy. MATERIAL AND METHODS: A total of 80 patients who had developmental malocclusion were analyzed retrospectively in this study. Twenty nine (36.2%) and 51 (63.8%) patients underwent Le Fort I osteotomy, and Le Fort I and bilateral sagittal split ramus osteotomy (two-jaw surgery), respectively. Forty two (52.5%) maxillary bone gaps were filled with heterologous bone grafts (group A) and 38 (47.5%) were filled with autologous bone grafts (group B) after Le Fort I osteotomy. The cephalometric graphics and measurements were taken before (T1), 1 week after (T2), and 1 year after (T3) the surgery. The results were documented and determined by the Dolphin imaging 10.5 (Dolphin Imaging, Chatsworth, Calif.) computer program for skeletal relapse. Whether or not the relationship between group A's and B's maxillary relapse rates was evaluated in the postoperative period. RESULTS: It was observed that both graft materials have positive effects on maxillary relapse rate in the postoperative period. When the groups are compared to each other, the relapse rates were similar between group A (8.3%) and group B (10.8%) (p>0.05). CONCLUSIONS: Heterologous bone graft material (Osteoplant®-Flex) is thought to be a good alternative to autologous grafts in decreasing the relapse rates and reducing the morbidity of the donor area of the patients who underwent Le Fort I osteotomy.

Reconstruction of transhumeral amputation stumps with ipsilateral pedicled latissimus dorsi myocutaneous flap in high voltage electrical burns.

Injury due to high-voltage (>1000V) electricity is one of the most challenging problems in emergency medicine and plastic surgery. Extremity amputation because of electrical injury yields a stump that leaves vital structures, such as bone, muscle, blood vessels, and nerves, exposed; these structures should be covered with appropriate tissue. We designed a retrospective study that included twelve patients with a high-voltage electrical injury followed by trans-humeral amputation who were evaluated between 2004 and 2013. The ages of the patients ranged between 8 and 35 years (mean, 16.9 years). Following amputation, the defects were covered with an ipsilateral pedicled latissimus dorsi (LD) myocutaneous flap for stump protection and functional transfer. We concluded that the use of an ipsilateral LD myocutaneous flap is an adequate surgical operation in upper extremity amputations resulting from high-voltage electrical burn injuries and that this procedure permits stump length maintenance, contributes to arm functioning, avoids extended operation times, and prepares patients for prosthesis usage.

Reverse nasal SMAS-perichondrium flap to avoid supratip deformity in rhinoplasty.

BACKGROUND: Supratip deformity is an iatrogenic convexity that occurs cephalically to the nasal tip. This is also known as "parrot beak" deformity and causes an unnatural appearance of the nose. In the literature there are several explanations of the mechanism of the deformity and methods to correct it. One of the most accepted theories about the cause of supratip deformity is overresection of the caudal dorsum. Healing soft tissues fill in the gap created between the septum and the tip of the lower lateral cartilages, leading to fullness in the supratip area. The lower third and basically distal third of the middle third of the nose include several muscle groups, ligamentous structures, and perichondrium as the subcutaneous soft tissues. METHODS: With the idea of elevating a reverse-based flap basically from the lower third and the lower third of the middle third of the nose, including the perichondrium and SMAS tissue, we aimed to reduce this gap, which has the potential to accumulate soft tissues that cause supratip fullness. Between December 2008 and July 2010, the reverse nasal SMAS-perichondrium flap was used in 42 primary rhinoplasty patients. RESULTS: This flap was used in 42 patients. Follow-up ranged from 3 to 18 months. No early or late complications were noted, such as infection, excessive bleeding, or extended edema. Minor revisions were performed in only two patients with the aim of achieving a smoother nasal dorsum. CONCLUSIONS: The reverse nasal SMAS-perichondrium flap is a new flap. The results presented here are not long term; however, the preliminary results are promising. The flap should be avoided in cases of thin skin, or at least be used with caution, whereas in thick skin cases it is very safe. Further studies in larger groups are required to better define the advantages and disadvantages of this flap.

Squamous cell carcinoma in discoid lupus erythematosus: reconstruction with a free forearm fasciocutaneous flap.

We present the first free flap operation to our knowledge for a patient with squamous cell carcinoma on a lesion of discoid lupus erythematosus. Although the disease affects the skin, the defect was reconstructed successfully with a free radial forearm fasciocutaneous flap.