Open Otoplasty Through Ventral Skin Incision and Abrasion of the Antihelix Under Vision.

BACKGROUND: Common otoplasties through incisions behind the ear with blind scoring or scratching the anterior perichondrium often leave an irregular surface of the antihelix. METHOD: To avoid these tiny side effects, a skin incision along the ventral antihelical fold (scapha) is used to thin and fold the flat antihelix under vision. After local anesthesia of the ventral ear skin, an incision along the scapha allows its blunt lifting toward the concha and to expose the cartilaginous antihelix. Its future shape is marked and the thickness of the cartilage is thinned with a dermabrader by approximately half or until one sees the gray of the inner cartilage. The now missing perichondrium causes the antihelix to fold by itself with an absolute smooth surface and is fixed with three absorbable mattress sutures. RESULTS: The technique has been developed in 1985 in Frankfurt and has since been performed on over 1000 patients with optimal results and a low complication rate. The skin flap is so well perfused that no skin necrosis and only 5.7% wound healing problems were experienced. CONCLUSION: This approach from ventral is safe, timesaving, and avoids contour irregularities of the antihelix often seen after traditional techniques. It can be left to beginners in plastic surgery without hesitation. The fear of hypertrophic scars or even keloids can be dispelled with the fact that ear keloids only occur after wound infection. 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.

INTERPLAST-Germany-adapting to global plastic surgery.

Background: INTERPLAST, Inc. was founded in 1969 by plastic surgeons in Stanford, CA, to create a financial basis through donations to operate foreign patients at Stanford or send surgical teams to developing countries. With the same financial effort, 50 to 100 times more patients can be operated on locally than in a hospital at home. Stanford's example was appealing to many plastic surgeons worldwide, who founded similar INTERPLAST NGOs in their own countries. Methods: A literature review revealed worldwide humanitarian actions of INTERPLAST teams, whose annual effectiveness is comparable to the operation numbers of large plastic surgery departments. Six patients with complex facial deformities requiring multiple surgical interventions were selected for temporary stay and operations in Germany. Results: Repeated missions at the same hospitals with training of local surgeons have increased significantly compared to earlier "parachute missions." Microsurgical procedures for free flaps with magnifying glasses are now possible for the experienced even in hospitals in developing countries. The most efficient medical aid in the future will be the expansion and establishment of departments or hospitals in developing countries supported or maintained by partner hospitals in our home country. Conclusions: Operations of humanitarian plastic surgeons in developing countries are becoming increasingly difficult. Local health authorities require temporary surgical permits, customs offices try to clear surgical material and look at expiration dates of medicines, and pandemics complicate planning of INTERPLAST missions. It therefore seems increasingly necessary to go as single teacher, training engaged local surgeons and assisting operations. The alternative is inviting local surgeons to Western hospitals and introducing them to the basic skills of plastic surgery and empathy with the poor. However, the lack of recognition of medical degrees from all developing countries remains a problem for their training in Europe.Level of evidence: Level V, risk/prognostic.

Explantation and reimplantation of a breast implant to facilitate minimally invasive mitral valve surgery and cryoablation of atrial fibrillation.

Clinicians can feel confident about performing mitral repair/replacement in patients who have previously undergone mammoplasty. It may also have applications in performing atrial septal defect closure, Maze procedures for atrial fibrillation, and tricuspid valve surgery in patients with breast implants.

First experiences with simultaneous skeletal and soft tissue reconstruction of noma-related facial defects.

Noma victims suffer from a three-dimensional facial soft-tissue loss. Some may also develop complex viscerocranial defects, due to acute osteitis, chronic exposure, or arrested skeletal growth. Reconstruction has mainly focused on soft tissue so far, whereas skeletal restoration was mostly avoided. After successful microvascular soft tissue free flap reconstruction, we now included skeletal restoration and mandibular ankylosis release into the initial step of complex noma surgery. One free rib graft and parascapular flap, one microvascular osteomyocutaneous flap from the subscapular system, and two sequential chimeric free flaps including vascularized bone were used as the initial steps for facial reconstruction. Ankylosis release could spare the temporomandibular joint. Complex noma reconstruction should include skeletal restoration. Avascular bone is acceptable in cases with complete vascularized graft coverage. Microsurgical chimeric flaps are preferable as they can reduce the number and complexity of secondary operations and provide viable, infection-resistant bone supporting facial growth.

Primary and secondary procedures in functional and aesthetic reconstruction of noma-associated complex central facial defects.

BACKGROUND: Most defects resulting from noma involve the lateral and anterolateral aspects of the face and are often combined with severe functional deficits. A subgroup, commonly called "central noma," is composed of defects of the upper lip, maxillary soft tissues, premaxilla, nasal cartilaginous infrastructure, and soft tissues. In contrast to unilateral involvement of the face, central noma does not affect opening of the jaw; however, it results in severe mutilation, with disfiguring three-dimensional defects erasing any individual traits from a face. The common surgical approach to centrofacial noma defects has been single-stage reconstructive procedures using locoregional flaps, but this approach often leads to disappointing outcomes in complex cases. METHODS: The authors' concept for complex central noma defects is a staged approach using free flaps for soft-tissue reconstruction of the upper lip and maxillary vicinity. This approach serves as a versatile base for introducing locoregional flaps for later functional and aesthetic refinements. A secondary procedure includes total nose reconstruction with a free cartilage framework and forehead flaps. RESULTS: In this series (n = 53), free radial forearm (n = 4), anterolateral thigh (n = 1), and parascapular (n = 7) flaps proved suitable for the central face in terms of pedicle length, tissue pliability, and bulk. All free flaps survived completely. Three total nose reconstructions by forehead flaps were performed successfully as a secondary step. CONCLUSION: Being of limited use for subtotal or total reconstruction of the outer nose, microvascular tissue transfer preserves local and regional donor sites--particularly the forehead--for secondary reconstruction.