Low Strip Unifying Hybrid RhinoSeptoplasty (LUHRS): A Novel Classification in Dorsal Preservation Surgery.

BACKGROUND: Preservation rhinoplasty techniques continue to evolve. Suture tip-plasty with minimal resection and grafting, lateral crural tensioning, minimal excision from the lateral crura, dorsal preservation, subperichondral dissection, and preservation of the ligaments have become the milestones of modern rhino-surgery. However, every time the dorsal frame is modified by means of rasping, shaving, or osteotomy or the nasal tip is structured using grafts, we are essentially applying structural concepts to our technique. Therefore, the term "hybrid rhinoplasty" seems to include a more appropriate definition of our approach. METHODS: We performed a retrospective analysis of the medical records of patients who underwent primary septorhinoplasty using the LUHRS concept from December 2019 to June 2022. Patient functional and cosmetic satisfaction was evaluated using the Rhinoplasty Health Inventory and Nose Outcome (RHINO) scale. RESULTS: All reported procedures had low revision rates with good cosmetic and functional outcomes. CONCLUSIONS: Tailoring the surgical technique is essential in rhinoplasty. We developed and present a new technical paradigm to help surgeons choose the best approach for dorsal preservation surgery.

Piezo-Assisted Dorsal Preservation in Rhinoplasty: When and Why.

BACKGROUND: Preservation rhinoplasty philosophy with its "down techniques" is currently undergoing a renaissance. Its goal is to spare and preserve noble nasal structures such as ligaments, nerves and vessels, reducing to a minimum local tissue manipulation and avoiding the drawbacks and pitfalls associated with classic dorsal reconstruction techniques often resulting in irregularities which often lead to an increased rhinoplasty revision rate. METHODS: In this article, we reviewed 107 consecutive cases in which a variety of preservation techniques were used. Indications, surgical techniques and complications are also described. RESULTS: All reported procedures showed low complication rates with good cosmetic and functional outcomes. CONCLUSIONS: Tailoring the surgical technique is essential in rhinoplasty. Authors have developed and present an anatomy-based diagram to help surgeons in choosing the right approach for dorsal surgery. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combining Autologous and Prosthetic Techniques: The Breast Reconstruction Scale Principle.

BACKGROUND: The latissimus dorsi (LD) flap remains a good option for immediate or delayed breast reconstruction. The main limitation of this flap is the small volume provided. To improve the reconstructed breast volume, the LD flap is usually combined with a breast implant. Recently, fat grafting to the LD flap was described to maximize flap volume and obtain a totally autologous breast reconstruction. We report our experience with hybrid breast reconstruction using both breast implants and fat-enriched latissimus dorsi (FELD) flaps. METHODS: Between 2013 and 2016, 74 patients underwent breast reconstruction with FELD flaps only or FELD flaps combined with a breast implant. The LD flap was harvested as previously described. Donor sites for fat harvesting were chosen according to each patient's natural fat distribution. Fat was harvested, centrifuged, and injected into the LD flap. After fat grafting, breast sizers were employed to determine the final breast volume when the addition of an implant was indicated. RESULTS: Good cosmetic outcomes were achieved in all cases, with a mean follow-up of 2.1 years. No patients had cancer reoccurrences. Four patients experienced a seroma of the LD donor site, 1 had a breast hematoma, and 1 developed Baker grade III capsular contracture. One year postoperatively, a clinically relevant area of fat necrosis was observed in 1 patient and was surgically treated. Additional fat grafting sessions were required in 3 cases. CONCLUSION: In elected cases, a FELD flap alone or in combination with a small implant is a valuable technique for breast reconstruction surgery.

Bilateral nasal ala reconstruction of the cocaine-injured nose with 2 free reverse-flow helical rim flaps.

Cocaine abuse can lead to nasal deformity because of local ischemia and subsequent fibrosis. Reconstruction can be challenging. We present a case of bilateral microsurgical nasal ala reconstruction with 2 reverse-flow helical rim flap.

Role of orthognathic surgery in the treatment of recurrent mandibular dislocation: importance of mandibular ramus inclination.

The management of chronic mandibular dislocation is controversial: many advocate conservative treatment, whereas others believe surgery can improve the symptoms and prevent dislocation recurrence. We report 7 consecutive cases of hyperdivergent patients with recurrent mandibular dislocation, who were treated using combined maxillary surgery that allowed the modification of the facial pattern from dolichofacial to mesofacial. At a 1-year follow-up, all patients did not have any episode of mandibular dislocation; moreover, a general improvement of symptoms associated with temporomandibular joint disorders was observed.

Digital nerve reconstruction by multiple Y-shaped nerve grafts at the metacarpophalangeal joint level.

Digital nerve injuries are common; injuries of the common digital nerves are less frequent than those involving the proper digital nerves. Traditional techniques used to reconstruct peripheral nerves are: direct suture, autologous nerve grafts, autologous vein grafts, vascularised nerve graft and alloplastic nerve grafts. Autologous nerve grafts remain the most common conduits for segmental defects. Difficulties can arise when attempting to repair complex nerve gaps, particularly when joining the proximal stump of the common digital nerve with two distal stumps of proper digital nerves as in lesions involving the web space. We present below a case of such a lesion. We describe the use of the lateral antebrachial cutaneous nerve (LABCN) as donor nerve, by exploiting its natural branchings.

The value of the maxillo-malar osteotomy in the treatment of Crouzon syndrome with exorbitism.

Premature fusion of the cranial sutures along with midface hypoplasia, shallow orbits, and ocular proptosis are the principal features of Crouzon syndrome. Treatment varies according to the variable expressivity of the disease and usually begins during a child's first year with fronto-orbital advancement with cranial decompression. Subsequent development of midfacial hypoplasia needs correction. Procedures for this purpose include the Le Fort III osteotomy or its segmental variants, monobloc frontofacial advancement, or bipartition osteotomy. Adult Crouzon often presents with marked midface hypoplasia and exorbitism. We report an adult-diagnosed Crouzon syndrome case with typical facial features and exorbitism corrected by orbital decompression and zygomaticomaxillary advancement.