Island mucochrondrocutaneous flap for reconstruction of total loss of the lower eyelid.

The methods usually employed for reconstruction of total lower eyelid loss include (1) tarsoconjunctival flaps from the upper eyelid and skin-graft cover and (2) chondromucosal grafts and local skin-flap cover. We report a technique for coverage of these defects with an island flap involving the full thickness of the ipsilateral nasal wall based on the dorsal (external) nasal vessels, terminal branches of the ophthalmic vessels. The advantages of this method are (1) the main components of the eyelid (skin, tarsus, conjunctiva) are reconstructed in a single short operation, even under local anesthesia, (2) there is one donor area that can be closed primarily without significant deformity, (3) the upper lid remains intact, and ectropion is improbable, and (4) the procedure involves a short hospitalization. As disadvantages we might mention bulkiness of the new eyelid and difficult dissection of the (subcutaneous) pedicle.

An unusual presentation of a metastatic hypernephroma to the frontonasal region.

We report a rare case involving an 85-year-old man who presented with a large metastatic hypernephroma to the frontal sinuses, the base of the nose, and the ethmoid sinuses, disfiguring the patient's face. Frequent but intermittent and mild epistaxis was one of the main symptoms. He had no history of renal malignancy, and even at the time of our examination (18 months after the appearance of the facial tumor) he did not have any symptoms of the primary renal carcinoma (not even hematuria). This metastasis may have occurred through the vertebral plexus of veins that communicate with the great venous plexus of the head and the plexus of the paranasal sinuses. If a metastatic hypernephroma to the sinonasal tract is the only clinical metastasis, as in our patient, a radical excision of the solitary metastasis, together with a nephrectomy, is recommended. Physicians dealing with head and neck lesions should always suspect a metastatic tumor and especially, a hypernephroma.

[The use of the platysma and the skin of the neck as a myocutaneous flap in reconstructing cheek defects. Technic and results apropos of 5 cases]. / L'utilisation du peaucier et de la peau du cou comme lambeau musculo-cutané dans la reconstruction des pertes de substance de la joue. Technique et résultats à propos de cinq cas.

Skin defects of the cheek are commonly the result of a radical surgical resection of extensive neoplasms of the parotid gland, the mandible or the skin, such as melanomas and squamous cell carcinomas. For the reconstruction of these defects, we have devised a myocutaneous flap which enables us to perform a radical neck dissection at the same operation. The transposed flap which involves the cervical skin, the platysma muscle and the superficial cervical fascia, has a wide pedicle on the lateral and dorsal side of the neck near the upper border of the Trapezius muscle. The border of the flap runs from the distal part of the defect and travels parallel and close to the midline of the neck down to the middle of the sternum. The border of the flap runs parallel and nearly 3-4 cm below the clavicle and as far as its acromial end. The advantages of this flap are: 1) better operative field for radical neck dissection; 2) good vascularization; 3) does not prolong the operative time; 4) does not need any "delay" procedure; 5) gives a good functional and cosmetic result, as it covers; the thickness of the cheek defect as well as protecting the neurovascular bundle of the neck.