ABSTRACT
We present a novel method for columellar reconstruction using a hidden donor site and review the challenges and limitations of columellar reconstruction in children with Fitzpatrick VI skin type. A staged reconstruction was conceived in which a full-thickness skin graft was transferred to the superior gingivolabial sulcus in the area of the maxillary frenulum. Six months later, the prelaminated soft tissue flap was delivered through a horizontal incision at the subnasale, and the donor site closed primarily. We report satisfactory results following a novel approach to composite soft tissue reconstruction of the columellar subunit in a 9-year-old child. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:2718-2720, 2018.
Subject(s)
Labial Frenum/transplantation , Nasal Septum/transplantation , Nose Deformities, Acquired/surgery , Plastic Surgery Procedures/methods , Rhinoplasty/methods , Skin Transplantation/methods , Child , Humans , Male , Photography , Skin Pigmentation , Surgical FlapsABSTRACT
PURPOSE: Evaluate different surgical techniques in the management of the contracted anophthalmic socket. PATIENTS AND METHODS: A retrospective study including 12 patients with acquired anophthalmic socket presenting inadequate fornices and/or orbital volume loss. The surgeries performed were conjunctival suture to the periosteum (mild fornix contraction), buccal mucosa graft (moderate fornix retraction), auricular cartilage graft (severe fornix retraction), and dermis-fat graft (loss of orbital volume). RESULTS: Fornix retraction was mild in two patients, moderate in three patients, and severe in two patients. We observed five patients with loss of orbital volume. Successful correction was achieved in all patients with fornix retraction who were able to wear an external prosthesis. One patient with orbital volume loss developed graft atrophy. CONCLUSION: Autologous grafts are useful in the rehabilitation of the contracted socket.
Subject(s)
Anophthalmos/surgery , Orbit/surgery , Orbital Diseases/surgery , Plastic Surgery Procedures/methods , Adipose Tissue/surgery , Adipose Tissue/transplantation , Adolescent , Adult , Aged , Buttocks , Child , Ear Cartilage/surgery , Ear Cartilage/transplantation , Epidermis/surgery , Epidermis/transplantation , Eye, Artificial , Female , Humans , Labial Frenum/surgery , Labial Frenum/transplantation , Male , Middle Aged , Mouth Mucosa/surgery , Mouth Mucosa/transplantation , Plastic Surgery Procedures/adverse effects , Retrospective Studies , Young AdultABSTRACT
OBJECTIVES: Megameatus, whether primary or iatrogenic, can be managed by one of several tubularization techniques. Repair after prior circumcision or after failed hypospadias repair can occasionally be challenging because of the lack of local vascularized tissues. The use of an inferiorly based frenulum flap as a buttressing layer for these unusual repairs is described. METHODS: An inferiorly based island flap of frenulum skin is de-epithelialized and advanced over the urethral repair. RESULTS: The procedure has been used in 5 cases: two reoperative hypospadias repairs, one primary megameatus repair, and two repairs of traumatic fistula/megameatus after circumcision. Overall, the cosmetic results were excellent, with one postoperative fistula. CONCLUSIONS: This is a straightforward technique providing added vascularity in these relatively unusual cases in which a dorsal or meatal-based flap is not convenient or feasible.
