Requirement of the Preservation of Mental Nerve During the Transfer of Depressor Anguli Oris Composite Flap.

OBJECTIVES: Reconstruction of wide lower lip defects is still a challenging subject in terms of obtaining functional and aesthetically acceptable results. Lower lip reconstruction with depressor anguli oris muscle was first described by Tobin in 1983. Since the sensory innervation of this composite muscle flap is provided by the mental nerve, it has been advocated that the mental nerve should be preserve during flap elevation. However, no further study has been conducted about this subject since then. METHODS: Sixteen patients with lower lip mass have undergone excisional biopsy. The resultant defects were higher than 30% of the total lower lip. All the defects were reconstructed with Depressor anguli oris composite flaps. In 9 of the patients, the mental nerve was preserved and included to the flap, while in remaining patients it was sacrificed. The results were evaluated in terms of sensation, function, and aesthetic appearance. RESULTS: In unilaterally reconstructed cases, the results regarding sensation and general complications were similar. However, in bilaterally reconstructed cases, especially where the mental nerve was preserved, the limited arc of rotation has resulted in functional complications, such as whistle deformity in the midline and drooling. CONCLUSION: The mental nerve does not just limit the arc of rotation of the Depressör anguli oris composite flap but also remains as a potential route for metastasis via perineural invasion. Preservation and inclusion of the mental nerve during reconstruction with Depressor anguli oris flap do not provide any superior outcome; on the contrary, these results in various unfavorable events make this flap a poor option. The skin and mucosa of the DAO flap are innervated by the buccal branch of the trigeminal nerve; thus, the mental nerve should not be preserved during surgery.

Surgical treatment of auricular malignancies when the anterior or posterior skin is intact.

The layers of the auricle from front to back were addressed, respectively, as follows: anterior skin, anterior perichondrium, cartilage, posterior perichondrium, and posterior skin. Thus, if a tumor on the auricle was holding 4 of these 5 layers and not holding the anterior or posterior skin, whether it was marginally located or stabilized in the mid parts, without having to apply complete resection, the intact parts were preserved, and the defect area was repaired with full-thickness skin graft. I practiced this method on a total of 17 patients, and histopathologic analysis showed that 13 of the patients had squamous cell carcinoma, 2 had Bowen disease, 1 had basocellular carcinoma, and 1 had granulomatous chondritis. I observed the patients for 7 years at the most. Auricular amputation, partial or total, is not a pretty decision and should not be made unless certainly necessary.

Periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus periorbital necrotizing fasciitis.

PURPOSE: To report a case of a patient with periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Case report. A previously healthy 33-year-old man was presented with pain and rapidly progressive swelling of the right upper eyelid following a minor trauma. Computed tomography scanning revealed soft tissue swelling and fracture of the anterior wall of the right frontal sinus. Oral amoxicillin + klavulanat 1 g, twice daily was started. Over the next 24 hours periorbital necrotizing fasciitis was developed. A wound swab was taken and sent for microscopic evaluation, culture, and antibiotic sensitivity. The patient was started on intravenous crystallized penicillin, third-generation cephalosporin, and metronidazol treatment. An urgent extensive necrotic tissue debridement and frontal sinus curettage were performed. RESULTS: Wound culture yielded MRSA which showed sensitivity to the given antibiotics. The patient responded to the treatment which was continued for 14 days. CONCLUSIONS: Monomicrobial MRSA should be considered in the etiology of periorbital necrotizing fasciitis. Early diagnosis and prompt surgical and medical therapy are essential in the management of periorbital necrotizing fasciitis.

Secondary transplantation following a period of isografting: experimental study in rats.

The authors describe a study in which groin flaps from 20 Wistar rats were transplanted to another group of 20 Wistar rats and, after various time intervals, the groin flaps were re-transplanted back to the original animals. The goal of the first transfers was to preserve the flap in the second group of animals (isopreservation). During the isopreservation period, the second rat (the preserver) was treated with steroids or FK506 for immunosuppression. Thirty-three free groin flap transfers were performed between 40 rats. If possible, the same flap was transferred twice between two animals, one as an isograft, and other as an autograft following an isopreservation period in 13 pairs of animals. (A second transfer was not possible in seven pairs of animals.) The period for isopreservation varied between 2 days and 1 week. The survival of the flap was observed by visual inspection, laser Doppler flowmeter measurements, and was correlated with serial histopathologic examinations of skin and vessel biopsy specimens, including the anastomosis site. The severity of histopathologic signs that might be related to developing rejection was increased by the preservation time, and was more noticeable after the second transfer. The authors showed that successful secondary transplantation of the rat groin flap with a 1-week follow-up could be achieved, following isopreservation of at least up to 5 days.