Recipient site scalp necrosis: A rare postoperative complication of hair transplantation.

BACKGROUND: Recipient area scalp necrosis is considered a potential complication of hair transplantation, but has rarely been reported. A small number of patients have developed scalp necrosis after hair transplantation with the widely used Follicular unit excision (FUE) technique. There are no guidelines to prevent and manage this complication. The aim of this study was to provide an insight into the pathogenesis, prevention, and management of scalp necrosis following hair transplantation. METHODS: From 2012 to 2021, among more than 10 000 patients who underwent hair transplantation, only three developed scalp necrosis in our clinical experience, besides, one patient transferred to our hospital because of scalp necrosis after undergoing hair transplantation. According to the disease etiology and patients' symptom, a combination of wound management and antimicrobial therapy was employed. This study was approved by the institutional ethics committee of Nanfang Hospital. RESULTS: Of the four patients, three received timely treatment and had a good prognosis. Necrosis became confined and healed within 2-3 weeks. Grafts in the lesion area partially survived. In case 4, due to improper treatment at the early stage, the lesion developed extensively and deeply, which not only delayed wound healing, but also resulted in complete loss of grafts. CONCLUSION: Preoperative prophylaxis, timely diagnosis, and immediate treatment of scalp necrosis can prevent serious complications and reduce morbidity after hair transplantation.

Latissimus dorsi musculocutaneous flap grafting to the infected recipient site in a patient with irradiated locally advanced breast cancer and multiple lung metastases.

BACKGROUND: Musculocutaneous (MC) flaps are more resistant to infection than implants, but no clinical results have been reported so far about the grafting of MC flap to the overtly infected sites. CASE PRESENTATION: A 66-year-old woman had received radiotherapy, a total dose of 50 Gy, to her large mucinous breast cancer to control bleeding from the tumor and was referred to our hospital for further treatment. On her first visit to our hospital, her left breast showed radiation-induced total necrosis with Pseudomonas aeruginosa infection. Removal of the necrotic breast tissue resulted in direct exposure of the left ribs and intercostal muscles with intractable chest pain requiring analgesics. The presence of concomitant life-threatening multiple lung metastases made us change the treatment from letrozole and palbociclib to bevacizumab and paclitaxel, leading to marked regression of the lung metastases. To alleviate her chest pain and get local wound healing, we treated the patient with latissimus dorsi (LD)-MC flap grafting to the exposed chest wall after four months of taxane-containing chemotherapy. The patient has got marked pain relief immediately after the operation. Skin island of the grafted LD-MC flap showed no problems for 4 days just after the operation but gradually turned out to be edematous to ill-colored in the distal part of the skin island. Post-operative clinical outcome suggested that Pseudomonas aeruginosa infection might have had some adverse effect, e.g., microemboli, on MC flap blood flow. Partial necrosis of the LD-MC flap made the patient receive conservative wound management for a very long period of 11 months, finally leading to complete wound healing. After palliative surgery, the patient has been receiving fulvestrant and palbociclib for 14 months and doing well with good control of multiple lung metastases. CONCLUSIONS: Breast surgical oncologists should note that partial flap necrosis can occur when a LD-MC flap is grafted to the infected recipient site and consider the anti-coagulant therapy just after the operation to avoid the adverse effects of the infection.

Recipient site creation for hair transplantation: A prospective half-side comparison study of hole versus slit.

Follicular unit strip surgery and FUE (follicular unit extraction) are techniques used for donor harvesting in hair transplantation. For recipient site creation, the slit technique is now commonly used. The hole technique is an alternative technique in which holes are created in the tissue at the recipient site. This study compared these techniques in order to evaluate the effectiveness of the hole technique. Mean time for recipient site creation was significantly shorter with the hole technique than with the slit technique (95.5 s vs. 121 s; p = 0.021). This can be explained by better visibility of the holes compared with slits. This study focused on recipient site creation and found that the hole technique was a rapid and effective for recipient site creation.

Comparison of the free thinned anterolateral thigh perforator flap with the free medial sural artery perforator flap for reconstruction of head and neck, and extremity defects.

BACKGROUNDThe free anterolateral thigh (ALTP) and free medial sural artery perforator (MSAP) flaps are time tested donor for head and neck, and extremities defect reconstruction. Proponents of either flap have concluded each as workhorse flap in their large cohort studies. However, we could not find any literature comparing the donor morbidities, or recipient site outcomes of these flaps, objectively.METHODSRetrospective data, such as demographic details, flap characteristics and post operative course, from patients who underwent free thinned ALTP (25 patients) and MSAP flap (20 patients) were included. At follow-up, donor site morbidity and recipient site outcomes were assessed, using previously defined protocols. These were compared in-between the two groups. RESULTSFree thinned ALTP (tALTP) flap had significantly more pedicle length and vessel diameter and harvest time than free MSAP flap (p value<.00). The differences in incidence of hyperpigmentation, itching, hypertrophic scar, numbness, sensory impairment and cold intolerance at the donor site in-between the two groups, were not significant statistically. Scar at free MSAP donor site was considered a significant social stigma (p value=.005). Recipient site cosmetic outcome was comparable (p value=.86), measured using aesthetic numeric analogue.CONCLUSIONSThe free tALTP flap is superior to free MSAP flap in terms of pedicle length, vessel diameter, donor site morbidity, while the latter takes lesser time for harvest.

Application of concentrated growth factor to autotransplantation with inflammation in recipient area.

OBJECTIVE: The purpose of this study was to apply concentrated growth factor (CGF) to the transplanted area with inflammation, to observe the clinical effects of CGF on the inflammation area assisted by 3D printing technology. METHODS: A total of 52 compromised mandibular first or second molar with chronic periapical lesions were transplanted with mature third molars. The patients were divided into CGF group (n = 26) and control group (n = 26) and transplanted into fresh extraction sockets with or without CGF. All the patients underwent clinical and radiographic examinations during the follow-up. RESULTS: Average surgery and extra-oral time were 39 min (± 7.8) and 42 s (± 10.2). The success rates of CGF group and control group were 100% and 92.3% respectively. Most of the periapical lesions in CGF group healed completely within 3 months, which was significantly faster than control group. The initial stability of CGF group was better than control group immediately after operation, and the degree of pain in CGF group was lower than control group on the 1st and 3rd day after operation. CONCLUSIONS: The application of CGF in recipient site with chronic periapical lesions can accelerate the regeneration of alveolar bone and the healing of inflammation, greatly shorten the healing period. Meanwhile, CGF help to reduce postoperative pain and reaction at the early stage of healing and increase the success rate of autogenous tooth transplantation (ATT). Additionally, the use of 3D printing model can greatly reduce the extra-oral time of donor teeth.

Effect of different shapes of recipient site creation micro-blades at varying angles and wound injury.

BACKGROUND: Wound injury is a critical issue in hair restoration. The shape and size of blades cause varying degree of tissue trauma. AIMS: To check (mathematically) the tissue trauma (injury) caused by different shapes of the blades at varying angles. PATIENTS/METHODS: The trigonometric theories were applied to each shape and angles to calculate the surface area (correlating with the tissue injury). These shapes included rectangular blade, 30°-angled blades, 60°-angled blade, 30°-sapphire blade, and 60°-sapphire blade. The surface areas were calculated at 90°, 45°, 30°, and 15° insertion angles. RESULTS: The 30°-sapphire blade caused the least injury followed by 30°-angled blade. The rectangular blade had the largest surface area and hence will produce the maximum amount of tissue injury. The blade at 90° produced maximum injury whereas the blade entering at 15°, produced lowest amount of tissue injury. The blade in sagittal direction caused less injury as compared to the blade in coronal direction. CONCLUSION: The 30°-sapphire blade caused the least tissue injury whereas the rectangular blade caused maximum injury. The amount of tissue injury decreases as the angle of insertion decreases and vice versa.

Optimal Hair Transplant Recipient Site Slit Design: Minimizing Vascular Damage.

An often overlooked aspect of hair transplantation is the art of recipient site design and slit creation. There is also a lack of consensus on which technique provides the optimum coverage while minimizing vascular damage. This paper aims to provide logical arguments to determine the optimal instrument and method of slit creation, in order to ensure maximum density, optimal survival, minimal pop-out, and minimal damage to scalp vascularity. The use of semiconical blades reduces the damage to the dermis and vascular plexus as compared with rectangular blades and needles, as the depth of penetration required is lower. The use of acute angle reduces the depth of penetration for the same length of slit and decreases damage to deep plexus. Coronal slits produce less vascular damage than that of sagittal slits with the same size blades. We believe that these recommendations provide the optimum volume slits while causing minimal vascular damage.

Research progress on autologous fat transplantation in the treatment of velopharyngeal insufficiency / 口腔疾病防治

@#Autologous fat transplantation in the treatment of velopharyngeal insufficiency has the advantages of good histocompatibility, small local trauma, few complications, reversible operation and simple postoperative nursing, which can effectively increase the velopharyngeal closure area. If the clinical effect is poor, other surgical methods can be used at any time for replacement. Although there are many advantages in the treatment of velopharyngeal insufficiency with autologous fat transplantation, there are still some problems in the selection of indication, donor site, injection dose, recipient site, follow-up evaluation, complications and prevention and treatment. Current research shows that autologous fat transplantation is mainly used in patients with mild or moderate velopharyngeal insufficiency, but with the improvement of fat acquisition and treatment techniques, the indications for autologous fat transplantation continue to expand, and autologous fat transplantation combined with palatoplasty or pharyngoplasty has been proposed for the treatment of severe velopharyngeal insufficiency. However, there are complications, such as fat absorption and obstructive sleep apnea syndrome. In addition, the application of autologous fat transplantation in severe VPI patients and how to improve the long-term stability of autologous fat transplantation need further study.

Modifications of Multi Slit Knife for Enhanced Versatility in Balding and Vertex Area Hair Transplant.

In hair transplantation, recipient-site creation is an important step. It is a repetitive and time-consuming step, which increased the "out-of-body time" for the grafts, which could hamper their survival. To solve this problem, we had devised an instrument called the Multi Slit Knife (MSK). The MSK has advantages of creating a high-density brick pattern of recipient sites in significantly less time. It had the undesirable side effect of damaging the preexisting hair follicles while making slits in the balding region. The MSK had some limitations. It was also difficult to maneuver the MSK in the vertex region where maintaining the natural whorl pattern of hair is important to obtain optimal aesthetic results. To overcome the shortcomings of the original MSK, we made a few changes to it to make a new modified MSK. It has fewer knives and a smaller platform as compared to the original MSK, better ergonomics, and more customizability with choices for blade sizes, number, and spacing. It tries to retain the advantages of the original MSK while reducing the damage to the preexisting hairs in the recipient regions. It is also better adapted at creating the recipient sites in a whorl pattern, closely mimicking the natural direction and angles of the hair in the vertex region. The modified MSK can be used singly or in combination with the original MSK, based on the patient's recipient areas, making it a versatile set of instrument for making multiple coronal slits for hair transplant.

[Initial exploration of choice of the donor site of flap and its repair strategy].

Objective: To explore the choice of the donor site of flap and the repair method of secondary wound of flap donor site in tissue repair and reconstruction operation. Methods: From January 2014 to September 2018, 62 cases of scar contracture deformity, 15 cases of skin tumor, 20 cases of skin and soft tissue injury, and 25 cases of chronic wound were admitted to the Burn Center of People's Liberation Army of First Affiliated Hospital of Air Force Medical University, with 84 males and 38 females, aged from 3 to 89 years. Four repair strategies adopted for tissue repair and reconstruction and good repair of the donor site of flap were as follows: designing the flap rationally according to the condition around the wound or the size and shape of wound, choosing pre-expanded technique of the donor site of flap for repair of scar deformity optimally, making full use of the surrounding condition of flap donor site, and repaired with the distal flap, i. e. replacing the important site with secondary site. The donor site of flap was repaired by direct suture or peripheral flap and distal flap. The wound size of patients ranged from 3.0 cm×2.0 cm to 20.0 cm×18.0 cm, and the flap area ranged from 3.5 cm×2.0 cm to 25.0 cm×22.0 cm. The survival condition of flap, healing condition of donor site and recipient site, and follow-up condition of donor site and recipient site were recorded. Results: Wounds of 122 patients were repaired with a total of 148 flaps designed by the above four repair strategies. All the flaps survived well, and the wound and flap donor site healed well. Follow-up for 3 to 36 months showed that the shape and function of recipient site and flap donor site were satisfactory. Conclusions: According to the specific condition of the wound and anatomical structure of the surrounding tissue of flap donor site, overall surgical design with flexibility and personalization can achieve effects of good repair of the wound and reduce the secondary damage of flap donor site.

Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis.

OBJECTIVES: This study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery. MATERIALS AND METHODS: In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2nd generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime. RESULTS: The free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2nd generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2nd and 3rd generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin. CONCLUSION: Smaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2nd and 3rd generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin. CLINICAL RELEVANCE: A combination of 2nd and 3rd generation cephalosporins may be used to prevent recipient sites in head and neck surgery.

Initial exploration of choice of the donor site of flap and its repair strategy / 中华烧伤杂志

Objective@#To explore the choice of the donor site of flap and the repair method of secondary wound of flap donor site in tissue repair and reconstruction operation.@*Methods@#From January 2014 to September 2018, 62 cases of scar contracture deformity, 15 cases of skin tumor, 20 cases of skin and soft tissue injury, and 25 cases of chronic wound were admitted to the Burn Center of People′s Liberation Army of First Affiliated Hospital of Air Force Medical University, with 84 males and 38 females, aged from 3 to 89 years. Four repair strategies adopted for tissue repair and reconstruction and good repair of the donor site of flap were as follows: designing the flap rationally according to the condition around the wound or the size and shape of wound, choosing pre-expanded technique of the donor site of flap for repair of scar deformity optimally, making full use of the surrounding condition of flap donor site, and repaired with the distal flap, i. e. replacing the important site with secondary site. The donor site of flap was repaired by direct suture or peripheral flap and distal flap. The wound size of patients ranged from 3.0 cm×2.0 cm to 20.0 cm×18.0 cm, and the flap area ranged from 3.5 cm×2.0 cm to 25.0 cm×22.0 cm. The survival condition of flap, healing condition of donor site and recipient site, and follow-up condition of donor site and recipient site were recorded.@*Results@#Wounds of 122 patients were repaired with a total of 148 flaps designed by the above four repair strategies. All the flaps survived well, and the wound and flap donor site healed well. Follow-up for 3 to 36 months showed that the shape and function of recipient site and flap donor site were satisfactory.@*Conclusions@#According to the specific condition of the wound and anatomical structure of the surrounding tissue of flap donor site, overall surgical design with flexibility and personalization can achieve effects of good repair of the wound and reduce the secondary damage of flap donor site.

Autotransplantation in combination with orthodontic treatment.

INTRODUCTION: Autotransplantation is a surgical method in which a tooth is repositioned within the same patient. It can be described as a controlled reimplantation of an extracted tooth into a new, surgically prepared socket. The key to success of this treatment is the preservation and regeneration of the periodontal ligament. It is an underutilized technique which, if conducted with a multidisciplinary team, can be an ideal treatment option for patients with failing or missing teeth. OBJECTIVES: The detailed clinical procedures, indications for this technique, and the factors affecting its success are discussed.

Autotransplantation after primary bone repair of a recipient site with a large periradicular lesion: a case report.

AIM: To describe a case of autotransplantation nine weeks after the extraction of a hopeless tooth with a large periradicular lesion, which enabled the healing of the recipient site. SUMMARY: A 19-year-old male in generally good health was referred for evaluation of tooth 46. Clinically, there were class III mobility and sensitivity to percussion and palpation. There was a mesio-lingual swelling and a single narrow deep pocket of 15 mm at the disto-lingual aspect. CBCT imaging revealed a radiolucent area over 15 mm in diameter that extended from the mesial aspect of the mesial root of tooth 47 to the distal aspect of tooth 45. The radiolucent area was in proximity to the inferior alveolar canal and penetrated the buccal and the lingual cortical plates. The tooth was diagnosed with previously treated tooth, acute apical abscess and vertical root fracture. Tooth 46 was extracted, and a delicate curettage and drainage were performed. Nine weeks afterwards, a second surgery was performed: extraction of the impacted immature third molar (tooth 48). Immediately after the extraction, the tooth was replanted in the healing socket of tooth 46, and sufficient initial stability achieved. At a 1-year follow-up, the tooth had normal mobility, no sensitivity to palpation and percussion, and responded to thermal pulp testing. The soft tissue was normal, probing depths up to 3-mm, without swelling or sinus tract. Radiographically, periapical healing at the recipient site was observed. Compared to the post-operative periapical radiography immediately after the procedure, there was no change in the distal root dimensions. In the mesial root, development of the root length and a closed apex was demonstrated.

Cutaneous malignant melanoma of the oral cavity following skin graft reconstruction: Case report.

BACKGROUND: Malignant melanomas on skin graft recipient sites are rare, with few cases reported in the literature. METHODS: We present a case report of a patient with recurrent cutaneous melanoma in the grafted anterolateral thigh flap of the tongue. RESULTS: A patient underwent hemiglossectomy with free flap reconstruction for squamous cell carcinoma of the tongue. Five years later the patient was seen with a 1-cm nodule and surrounding erythroplakia at the recipient site of the graft. Analysis revealed cutaneous malignant melanoma. Patient then related a remote history of a suspected skin melanoma of the donor leg that had been treated with excision, with unknown histology. CONCLUSION: This may be the first reported case of a cutaneous malignant melanoma in the oral cavity following an anterolateral thigh free flap reconstruction, emphasizing the importance of obtaining a comprehensive history of skin cancers and closely inspecting the donor site prior to graft harvesting.

Early and late complications in the reconstructed mandible with free fibula flaps.

BACKGROUND AND OBJECTIVES: Evaluation of mandibular reconstructions with free fibula flaps. Identification of factors associated with major recipient site complications, that is, necessitating surgical intervention under general anaesthesia. METHODS: Seventy-nine reconstructions were included. The following factors were analyzed: fixation type, number of osteotomies, site of defect (bilateral/unilateral), surgeon, sex, ASA classification, continuous smoking, pathological N-stage, age, defect size, flap ischemic time, and postoperative radiotherapy. Proportional hazards regression was used to test the effect on the time between reconstruction and intervention. RESULTS: Sixty-nine (87%) of the 79 fibula flaps were successful at the last follow-up. Forty-eight major recipient site complications occurred in 41 reconstructions. Nineteen complications required surgical intervention within six weeks and were mostly vascular problems, necessitating immediate intervention. These early complications were associated with defects crossing the midline, with an estimated relative risk of 5.3 (CI 1.1-20, P = 0.01). Twenty-nine complications required surgical intervention more than 6 weeks after the reconstruction. These late complications generally occurred after months or years, and were associated with smoking, with an estimated relative risk of 2.8 (CI 1.0-8.3, P = 0.05). CONCLUSIONS: Fibula flaps crossing the midline have a higher risk of early major recipient site complications than unilateral reconstructions. Smoking increases the risk of late complications.

Literature Review of Criteria for Defining Recipient-Site Infection after Oral Oncologic Surgery with Simultaneous Reconstruction.

BACKGROUND: The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction. METHODS: A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infection-head neck," "surgical site infection-oral cancer," "antibiotic prophylaxis-head neck," and "surgical site infection-oral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded. RESULTS: The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection. CONCLUSION: Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery.

Surgical Therapies for Vitiligo.

Surgical management is a safe and effective treatment modality for select patients with vitiligo. Many techniques of vitiligo surgery exist, each with unique advantages and disadvantages. Preoperative screening for appropriate candidates, selection of surgical technique, and postoperative management are all key elements in enabling patients to achieve maximal repigmentation.

Outcomes of one-side versus two-sides recipient vessels for bilateral breast reconstructions with bilateral DIEP flaps.

BACKGROUND: This study was to compare the use of one-side versus two-sides recipient vessels in either bilateral breast reconstructions or unilateral breast reconstruction with contralateral augmentation using bilateral DIEP flaps. PATIENTS AND METHODS: A retrospective review including all cases of bilateral breast reconstructions and unilateral reconstruction with contralateral augmentation with DIEP flaps was performed. Patient's demographics, surgical variables, and outcome were collected. Two distinct cohorts based on the recipient vessel techniques, one-side versus two-sides, were compared. RESULTS: A total of 25 patients with 50 split-DIEP flaps were included, with one-side recipient vessels used in 19 patients and two-sides recipient vessels in 6 patients. Ischemia time was significantly reduced in one-side recipient group compared to two-sides recipient vessels group (62.4 ± 21.3 vs. 105.9 ± 32.5, P < 0.001). There was no statistic difference in venous congestion, partial flap loss, or fat necrosis in both groups. CONCLUSIONS: Using one-side recipient vessels for bilateral breast reconstructions with unilateral breast reconstruction with contralateral augmentation using differentially split DIEP flaps presents a high success rate, acceptable ischemia time, and minimal complications for small to medium volume breast reconstructions. Utilizing this method can reduce the ischemia time and spare one side internal mammary vessels. J. Surg. Oncol. 2016;114:5-10. © 2016 Wiley Periodicals, Inc.

Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo.

Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below.