Cranioplasty Using Three-Dimensional-Printed Polycaprolactone Implant and Free Latissimus Dorsi Musculocutaneous Flap in a Patient with Repeated Wound Problem following Titanium Cranioplasty.

Titanium mesh is an alloplastic material widely used for the reconstruction of moderate-to-large skull defects. Repeated wound problems or infection following these reconstructions inevitably lead to the replacement of the cranioplasty material. Among the various alloplastic materials, polycaprolactone implants are usually used for the coverage of small defects such as burr holes. 1 Herein, we present a case of a large cranial defect successfully reconstructed with three-dimensional-printed polycaprolactone implant and a free latissimus dorsi musculocutaneous flap. Until 1-year follow-up, the patient showed a favorable esthetic outcome with no complications or wound relapse.

Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery.

Anatomies of the vascular and lymphatic systems have been vital research topics in reconstructive surgery. Harvey was a pioneer who provided the earliest descriptions of the cutaneous vasculature in the 17th century. The concept of vascular territories of the skin was first described by Manchot. The radiographic injection method in cadavers was developed by Salman, who defined more than 80 vascular territories. The arterial system has been thoroughly investigated with the development of regional and free flaps. The concept of axial and random pattern flaps was introduced by McGregor and Morgan. Manchot's vascular territories were refined by Taylor and Palmer as the angiosome concept. Detailed information about the venous circulation is essential for reconstructive surgeries. The concept of intrinsic and extrinsic venocutaneous vascular systems was introduced by Nakajima and led to the development of the venoadipofascial flap. The importance of venous augmentation in flap survival was emphasized by Chang. The lymphatic system was discovered much later than the arterial and venous systems. Aselli was credited for discovering the lacteal vessels in the 17th century; mercury was popularly used as a contrast agent to distinguish lymphatic vessels for the next three centuries. A radiographic method in cadavers was developed by Suami. Lymphatic imaging devices are constantly upgrading, and photoacoustic imaging was recently introduced for three-dimensional visualization of architecture of superficial layers of the lymphatic and venous systems.

Long-Term Effect of Intermediate Rhinoplasty in Unilateral Complete Cleft Lip Nasal Deformity.

BACKGROUND: Intermediate rhinoplasties are performed during preschool to reduce the patients' psychosocial burden. At our institution, limited dissection of the cartilages followed by suspension and interdomal sutures was performed through an alar rim incision on the cleft side to minimize the risk of iatrogenic nasal growth restriction. However, the long-term outcomes of "limited intermediate rhinoplasty" through skeletal growth are uncertain. MATERIALS AND METHODS: A retrospective review of all unilateral complete cleft lip and/or palate patients who underwent definitive rhinoplasty was performed. To avoid the confounding effect of primary rhinoplasty, only the patients who did not receive primary rhinoplasty were included in the analysis. The maneuvers performed during definitive rhinoplasty were analyzed and compared between patients who underwent intermediate rhinoplasty and those who did not. RESULTS: A total of 60 Korean patients (27 female and 33 male) underwent definitive rhinoplasty at the average age of 20.6 years old (17.1-25.5). Forty-three (71.6%) patients previously underwent intermediate rhinoplasty. A combination of 6 maneuvers was performed based on the deformity of each subunit (alar medialization, interdomal with suspension sutures, nostril sill depression correction, septoplasty, osteotomy, and hump rasping). The average number of maneuvers performed during definitive rhinoplasty was significantly higher in the intermediate group (3.31 versus 2.1, P=0.012). Alar medialization and nostril sill depression correction were more frequently performed in the intermediate group, while the frequencies of other maneuvers were not statistically different. CONCLUSION: While intermediate rhinoplasty improves the patients' psychosocial well-being, the effects of "limited intermediate rhinoplasty" manipulating only the cartilages do not seem to last until skeletal maturity. A more comprehensive dissection allowing the release of the lower lateral cartilage in the hinge area along with septoplasty may be more effective in providing longer-lasting effects.

Effect of Stromal Vascular Fraction on Sustained Volume Retention of Five Different Hyaluronic Acid Fillers.

BACKGROUND: The technology of manufacturing hyaluronic acid (HA) fillers is evolving to increase their safety and durability. This study aimed to compare the volume maintenance effect of stromal vascular fraction (SVF) on different types of HA fillers. METHODS: In this controlled experiment, HA fillers mixed with SVF were injected into the right upper back and HA fillers alone were injected into the left upper back of each mouse. A total of 35 mice were separated into five groups according to the type of commercially used HA filler: Juvederm Voluma XC, Restylane Lyft, Restylane Skinboosters Vital, Giselle Ligne Signature 2, and Giselle Ligne Universal. Nodule size inspection was performed on post-injection days 0, 3, and 56. Ultrasonography for maximal two-dimensional area of filler nodule measurement and histology were performed on the last day of the inspection. RESULTS: While most of the groups showed a volume reduction of over 50% on day 56, regardless of SVF administration, significant volume maintenance was observed when Giselle Ligne Signature 2 was injected with SVF. Ultrasonographic measurement of two-dimensional filler nodule size showed no significant difference regarding filler types and SVF injection. When compared with the histological results of other fillers mixed with SVF, Giselle Ligne Signature 2 showed marked increase in cell survival and extracellular matrix components in HA particles. CONCLUSION: SVF showed different efficacies in terms of volume maintenance and cell survival for various HA filler types. The SVF mixture in selective HA filler injections may improve maintenance in clinical settings. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.