Single Incision Dual Cover with Temporoparietal Fascial Flap for Exposed Cochlear Implant: A Novel Take on a Workhorse Flap.

Cochlear implant surgeries have become increasingly common in India, leading to a rise in complications such as cochlear implant exposure. To address this issue, we present a novel technique involving a single incision dual cover using the temporoparietal fascial flap (TPFF) and skin flap to give durable cover for exposed cochlear implants. Materials and Methods A retrospective study was conducted between December 2019 and December 2022 on patients who underwent the dual flap procedure for exposed cochlear implants. Results The average defect size was 2 × 2 cm, and the average length of hospital stay was 10 days. Fourteen skin flaps were closed primarily, while two required skin grafting for donor site closure. At the time of discharge, all wounds showed successful healing with intact skin coverage over the cochlear implant device site. The average follow-up period was 12 months, during which two patients had donor site scar alopecia, while others had adequate hair growth masking the scar. All patients consistently used their cochlear implants. Conclusion Our single-incision, dual cover TPFF + skin flap technique offers a reliable and innovative solution for managing exposed cochlear implants. With successful implant salvage and favorable postoperative outcomes, this approach demonstrates the versatility and reliability of the TPFF as an excellent option for reconstructive surgeons dealing with cochlear implant complications.

Eril's Branch-Based Perforator Plus Chondro-Cutaneous Flap for Reconstruction of Upper Third Helico-Scaphal Defects: A Clinical and Cadaver Study.

Reconstruction of upper third helico-scaphal defects (HSDs) exacts the expertise of the reconstructive surgeon. These three-dimensional defects deviate from normal facial form and cause a significant impact on the psyche of the patients. The origin, course, and dimensions of the perforators of the Eril's branch arising from superficial temporal vessels (EBSTV) were delineated by dissection and injection study. They were examined in twenty-four adult specimens. A prospective cohort study was conducted from March 2017 to March 2020, including six patients whose upper third HSDs were reconstructed with perforator plus chondro cutaneous flap based on EBSTV. After the debridement of the defect, the perforator plus chondro cutaneous flap was harvested from retro auricular sulcus skin with attached cartilages from triangular fossa and interhelical groove. The donor site was closed primarily, and the flap was rotated onto the defect. Superficial temporal vessels give a constant Eril's branch at the level of the root of the helix (otobasion superioris), which in turn divides into two perforators -superficial (lateral) and deep (medial) perforators. All six patients with post-traumatic upper third HSDs (4 males and 2 females) after reconstruction were followed for an average period of 15 months. The average age was 36.5 yrs. On average, two cartilages of maximum dimensions 3 × 2.5 mm were included in the perforator plus chondro cutaneous flap based on the medial-deep perforator of the EBSTV. In all six cases, the flaps survived without any complications. The average final computed institutional objective and subjective score was 15.67 (excellent results) (chi-square test, the p value was (p = 0.035) significant). The perforator plus chondro-cutaneous flap based on deep medial perforator of EBSTV may be a useful addendum in the armamentarium of plastic surgery. This novel reconstruction technique of upper helical defects provides good shape, size, and aesthesis of the upper external ear.

Regulating Microvascular Free Flaps Reconstruction in "Schobinger Stage 4" Arteriovenous Malformations of Face.

Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme-a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm 2 . Fourteen patients (87.5%) had good-to-excellent score ( p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups ( p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVMs.

Single-Stage Continent Reconstruction of Composite Pericommissural Defects Using a Combination of Pacman-Style Free Radial Forearm Flaps and Modified Elastic Musculomucosal Flaps.

Introduction Based on the cross-innervation of buccal and marginal mandibular branches of the facial nerve, oblique elastic musculomucosal flaps (OEMMFs) can be harvested and used for continent neo-commissure and modiolus reconstructions. The composite pericommissural defects can then be reconstructed with double cutaneous paddles in Pacman-style free radial forearm flap (PFRFF). This novel single-stage continent reconstruction of composite post-excisional commissure and pericommissural (CPECPC) defects is evaluated in this study. Patients and Methods This retrospective cohort study was conducted from April 2016 to March 2019. Forty-two patients underwent this type of reconstruction using a combination of PFRFF and OEMMF for the CPECPC defects. They were followed for an average period of 11.5 months. At the end of the follow-up period, they were assessed using the objective institutional scoring system by two independent observers and final score was computed for each patient. Results The average score obtained at the end of the follow-up period was 11.5 ( p = 0.035) using the institutional assessment scoring system, which evaluated both the overall aesthesis and function of the neo-commissure and modiolus. Conclusions The combination of OEMMF and PFRRF for the single-stage reconstruction of CPECPC defects is a useful addendum for re-establishing the aesthesis and continence at the reconstructed site.