The cranially based contralateral nasolabial flap for reconstruction of paranasal and periorbital surgical defects.

The importance of the paranasal and periorbital regions on the aesthetics of the face presents a variety of reconstructive challenges for surgical and traumatic defects of those regions. We used the cranially based nasolabial flap in patients with full-thickness soft-tissue defects of the paranasal and periorbital regions harvested from the contralateral side of the present defect. We present our experience in 25 patients of geriatric population (13 females and 12 males with a mean age of 76) with complex soft-tissue defects in the paranasal and periorbital regions whose defects were reconstructed with contralateral nasolabial skin flaps. Sizes of the defects changed between 2 × 3 cm and 6 × 7 cm. The flap sizes varied from a width of 2 to 5 cm (average 3 cm) and a length of 7 to 11 cm (average 8 cm). Primary closure of the donor sites of the flaps was possible in 24 of the patients in this series. Twenty-one flaps of this series (84%) healed without any necrosis and completely survived. The contralateral nasolabial flap is a very convenient, safe and reliable flap that can be used in medium to large paranasal and periorbital defects. Optimal aesthetic results for a variety of central facial defects could be obtained with this flap, especially when the ipsilateral nasolabial flap cannot be used due to various reasons.

The double scalpel flap: a new technique for the closure of circular skin defects.

Reconstruction needs to be designed attentively to obtain a functional and a good aesthetic consequence for closing skin defects. Numerous local flaps have been defined to conceal skin defects. However, new techniques are still required, especially for circular type of skin defects.This study describes a new technique that has been well defined to repair the circular type of skin defects. The technique basically uses extra skin relaxation provided with 2 opposing flaps' rotation maneuver in favor of the defect closure. The objective of this technique is for the flaps to start from one border of the defect and extend just to the other border, not invading beyond the defect borders. This enables us to apply the procedure on defects that are close to important anatomical structures because it is sufficient to use only the opposing 2 sides of the defect for its closure.With this method, 2 opposing flaps that resemble the tip of a scalpel were rotated to the existing circular defect; and by suturing these 2 flaps at the midline, the defect was closed. This technique was applied to 17 patients between the ages of 48 and 83 years. Defect sizes were between 2.5 × 2.5 and 5 × 5 cm.With the use of opposing flaps designed narrower than half-width of the defect, a tension-free closure could be achieved on both the donor and the recipient site. No flap necrosis was detected on any patients. After a mean follow-up of 11 months (3-26 months), it was realized that a good aesthetic appearance could be achieved in all the patients about 2 to 3 months postoperatively.

The role of upper lateral cartilage in correcting dorsal irregularities: section 2. The suture bridging cephalic extension of upper lateral cartilages.

BACKGROUND: Dorsal irregularity after hump reduction is one of the most annoying problems in aesthetic nasal surgery. Spreader grafts, cartilaginous autogenous thin (CATS) grafts, Skoog-type dorsal grafts, cartilage grafts, bone grafts, fascia grafts, dermal grafts and nonbiologic products such as silicon and polytetrafluoroethylene are used to overcome this problem. In cases managed with spreader flaps rather than graft procedures, problems may persist in the area of the nasal bones, whereas irregularities in the cartilage dorsum can be minimized. More specifically, the surgically treated surface of the dorsum's upper third and the rhinion area [nasal bone and upper lateral cartilage (ULC) junction], which has the thinnest nasal soft tissue, present the greatest challenge for hiding irregularities and call for special attention. METHODS: The ULC has a cephalic extension with varying lengths under the nasal bone. When these pieces of cartilage are protected during hump excision and sutured to each other, a strong, smooth, and a single-unit structure can be obtained. This technique was applied to 76 patients between 2009 and 2010. RESULTS: Manual examination during the postoperative period showed no irregularities in 60 patients. In the remaining 16 patients, minimal irregularities in the bony region were encountered. In 4 of these patients, the irregularities were visible in the profile view, and in the remaining 12 patients, they were felt only by manual examination. CONCLUSION: The bridging suture technique using cephalic extensions of the ULC is an improvement of the spreader flap technique to obtain a straight, smooth, and single-unit dorsum in rhinoplasty patients. 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 .

The use of titanium clips in septal surgery for correction and strengthening.

Permanent correction of septal deformities is one of the most difficult and controversial subjects in aesthetic nasal surgery. The main reasons for failure in most of the corrective procedures are either not to weaken the septal cartilage enough to straighten it, or to treat the septum too radically causing iatrogenic deformities or predisposing it to new deformities postoperatively. Our approach to correct septal deformities relies on the principle of strengthening/reinforcing the septal cartilage (with or without some weakening maneuvers to correct the deformities beforehand) with application of titanium hemoclips at some critical locations in septum. Eighty-seven patients operated on between 2007 and 2009 are included in this study. Thirty-six of these patients had combined septo-nasal deformities while the remaining 51 had solely septal deformities. In 30 patients with septo-nasal deformity the technique was proven to be successful. The remaining 6 patients of this group had axial nasal deformity (rather than intrinsic septal problems) and did not respond to our technique successfully. Within four years of follow up, we did not encounter any recurrences, infections, ulcerations or exposure in the mucosa covering the titanium clips. None of the titanium clips were required to be removed for any reasons.