The Use of the PlasmaBlade and Acellular Dermal Matrix in Rhinophyma Surgery: A Case Report.

BACKGROUND: Rhinophyma is a rare, disfiguring disease characterized by a slow progressive overgrowth of the soft tissue of the nose associated with end-stage severe acne rosacea. OBJECTIVE: We present a case of severe rhinophyma treated successfully using PlasmaBlade and acellular dermal matrix with split-thickness skin graft. METHODS: This procedure combines deep excision with PlasmaBlade followed by coverage with an acellular dermal matrix for dermal substitution and split-thickness skin graft. RESULTS: Functional and aesthetic results were satisfactory. CONCLUSION: We offer a new approach to surgical treatment of rhinophyma. Total excision of phymatous tissue and single session replacement of epidermal-dermal components is an effective treatment for patients with severe rhinophyma, resulting in satisfactory functional and aesthetic outcome. This combined treatment modality prevents the recurrence of rhinophyma. It should be considered an appropriate alternative in cases of severe rhinophyma.

Multidetector computed tomography angiography to evaluate the subscapular arterial tree.

OBJECTIVE: The subscapular artery has an important place in reconstructive surgery. The major pedicles of several different flaps used widely in reconstructive surgery take their roots from this arterial tree. This study aimed to provide anatomical data relating to these vessels through the use of multidetector computed tomography angiography (MDCTA) and to evaluate the clinical utility of MDCTA tool prior to surgery. METHODS AND MATERIALS: A radiological evaluation using a MDCTA was made of the bilateral subscapular arteries and branches measuring >0.5 mm in diameter that could be sufficiently identified as vascular structures in 92 patients (44 men and 48 women) with pneumonia, pleural effusion, lung masses, or nodules for which a thoracic MDCTA was requested for the purpose of diagnosis. RESULTS: The mean diameter of the subscapular artery origin was 3.86 ± 0.60 mm on the left and 3.93 ± 0.62 mm on the right. The mean diameter of the circumflex scapular artery origin was 2.41 ± 0.37 mm on the left and 2.44 ± 0.39 mm on the right. The mean diameter of the thoracodorsal artery origin was 2.29 ± 0.27 mm on the left and 2.31 ± 0.29 mm on the right. Mean length of the circumflex scapular artery was 46.34 ± 9.41 mm on the left and 46.10 ± 8.81 mm on the right. Mean length of the latissimus dorsi branch of the thoracodorsal artery from the origin of the subscapular artery was 110.11 ± 17.42 mm on the left and 112.21 ± 14.60 mm on the right. Mean length of the serratus anterior branch was 124.25 ± 19.00 mm on the left and 120.84 ± 15.67 mm on the right. No differences were detected between the left and right sides or between sexes. Doubled circumflex scapular arteries were found in 4.3% of patients, and the circumflex scapular artery branched directly off the axillary artery in 3.2% of patients. CONCLUSION: This study showed that MDCTA is a highly valuable, non-invasive imaging tool for studying vascular anatomy and detecting variations in vascular structure during preoperative planning, thus enhancing surgical safety.

Effects of isoflurane and sevoflurane on the survival of skin flaps in rats.

The effects of inhalational anaesthetic agents on survival of flaps are not well known. We investigated the effect of isoflurane and sevoflurane anaesthesia on survival of flaps using a caudally-based McFarlane skin flap in 20 male Wistar rats. Sevoflurane 1 minimum alveolar concentration (MAC) and isoflurane (1 MAC) in oxygen mixture was given to the animals. A 4 x10 cm caudally-based standard McFarlane flap was raised. There were no differences in any haemodynamic values or blood gases between the sevoflurane group and the isoflurane group. Skin flaps were assessed on the seventh day. The isoflurane group had a significantly smaller area of skin flap necrosis and an increased area of flap surviving than the sevoflurane group. We conclude that survival is significantly improved when isoflurane is used as the inhalational anaesthetic rather than sevoflurane.

Experience with vaginoplasty.

We did 27 vaginoplasties (7 gracilis musculocutaneous flaps, 8 pudendal thigh flaps, 12 full-thickness skin grafts) during the period 1994-2000. The preoperative assessment and postoperative follow up were done in collaboration with the gynaecologists. All patients had vaginal agenesis. With the gracilis flaps we found it difficult to achieve an adequate blood supply. With pudendal thigh flaps we achieved perfect innervation and a good contour, but they did tend to be hairy. With full-thickness skin grafts the innervation was not perfect, but the contour was good. Having compared the three operations during a follow up period ranging from 1-5 years we think that the full-thickness skin graft gives the best results.

Reconstruction of microform cleft lip.

Partial cleft of the orbicularis oris muscle without skin and mucosa can also be called "discontinuity of the orbicularis oris muscle" or "subepithelial cleft". Microform cleft lip or mini-cleft lip are better definitions. We present two women aged 25 and 29 years old who complained of vermilion notching, vertical depression on the upper lip, and asymmetry of lower lateral cartilage of the nose. The "discontinuity of the muscle" was found at operation in both cases and reconstructed successfully.