1/8. hair-bearing submental artery island flap for reconstruction of mustache and beard.Loss of mustache and beard in the adult male caused by severe burn, trauma, or tumor resection may cause cosmetic and psychological problems for these patients. Reconstruction of the elements of the face presents difficult and often daunting problems for plastic surgeons. The tissue that will be used for this purpose should have the same characteristics as the facial area, consisting of thin, pliable, hair-bearing tissue with a good color match. There is a very limited amount of donor area that has these characteristics. A hair-bearing submental island flap was used successfully for mustache and beard reconstruction in 11 male patients during the last 5 years. The scar was on the mentum in four cases, right cheek in two cases, right half of the upper lip in two cases, left cheek in one case, left half of the upper lip in one case, and both sides of the upper lip in one case. The submental island flap is supplied by the submental artery, a branch of the facial artery. The maximum flap size was 13 x 6 cm and the minimum size was 6 x 3 cm (average, 10 x 4 cm) in this series. Direct closure was achieved at all donor sites. patients were followed up for 6 months to 5 years. No major complication was noted other than one case of temporary palsy of the marginal mandibular branch of the facial nerve. The mean postoperative stay was 7 days. color and texture match were good. hair growth on the flap was normal, and characteristics of the hair were the same as the intact side of the face in all patients. The submental island flap is safe, rapid, and simple to raise and leaves a well-hidden donor-site scar. The authors believe that the submental artery island flap surpasses the other flaps in reconstruction of the mustache and beard in male patients. Application of the technique and results are discussed in this article.- - - - - - - - - - ranking = 1keywords = island (Clic here for more details about this article) |
2/8. Cicatricial eyebrow reconstruction with a dense-packing one- to two-hair grafting technique.Scarring eyebrow loss is usually repaired with a hair-bearing island scalp flap or scalp strip grafting technique. The results, however, are usually not desirable with regard to appearance. In this article, a one- or two-hair graft with a dense-packing technique was developed for cicatricial eyebrow reconstruction. It was carried out by harvesting a scalp strip close to the hairline of the back, then dividing it into a series of one- or two-hair grafts, and finally implanting the grafts into the prepared recipient holes of the eyebrow with a desired hair direction. With the authors' experience in treating 96 patients (154 eyebrows) in cases of burn, skin grafting, traumatic scarring, and chemical peeling scar after tattoo removal, the eyebrows could be restored in only one session. In general, 150 to 200 grafts with 200 to 250 hairs were needed for a complete male eyebrow reconstruction and 100 to 150 grafts with 150 to 200 hairs were needed for a complete female eyebrow reconstruction. The maximal hair density was 91.5 hairs/cm per session. Over a 6-month follow-up period, the mean graft survival rate reached 98.1 percent. All of the patients achieved satisfactory results, with a very natural appearance. These results indicate that the above-mentioned technique could be a practical, effective, and probably ideal method for cicatricial eyebrow reconstruction.- - - - - - - - - - ranking = 0.125keywords = island (Clic here for more details about this article) |
3/8. The buccinator myomucosal island pedicle flap: anatomic study and case report.The buccinator myomucosal island pedicle flap is a useful means of introducing relatively large amounts of vascularized mucosa into the oral cavity. Using cadaver dissections and clinical cases, the anatomy and clinical relevance of this tissue are defined. Emphasis is placed on the technical caveats and pitfalls of the procedure.- - - - - - - - - - ranking = 0.625keywords = island (Clic here for more details about this article) |
4/8. The temporal island scalp flap for management of facial burn scars.Facial burn scars are difficult to conceal and often preclude an aesthetic rehabilitation of the patient. Multistaged scalp and neck flaps have been described to provide hair-bearing skin to resurface burn scars in men. We have been resurfacing the upper lip and cheek in a one-stage procedure using a temporal artery island scalp flap. The temporoparietal fascia has been well described in recent years, and the understanding of this anatomy has facilitated the use of the island scalp flap for more distal transfers.- - - - - - - - - - ranking = 0.75keywords = island (Clic here for more details about this article) |
5/8. Salvage of seeing eyes after avulsion of upper and lower lids.It is often stated that any injury severe enough to avulse both lids will inevitably destroy the globe. Two cases are presented in which the globe was uninjured but exposed, requiring immediate coverage. Local skin flaps placed over mobilized conjunctiva were used for emergency cover. One was eventually made into functioning eyelids; the other remains dormant. First-line options for local flaps may not be available because of regional trauma. The reconstructive surgeon caring for acute trauma patients should be familiar with all available options, including recently described island and myocutaneous flaps.- - - - - - - - - - ranking = 0.125keywords = island (Clic here for more details about this article) |
6/8. Aesthetic restoration of the severely disfigured face in burn victims: a comprehensive strategy.Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. The strategy of modern facial restoration emphasizes enhancement of aesthetic appearance as significantly as mitigation of functional impairment. Criteria for success are (1) an undistracted "normal" look at conversational distance, (2) facial balance and symmetry, (3) distinct aesthetic units fused by inconspicuous scars, (4) "doughy" skin texture appropriate for corrective makeup, and (5) dynamic facial expression. Since 1985, the author has successfully restored 17 severely disfigured burned faces by replacement of entire aesthetic units with microvascular "prepatterned" composite flaps blended into the facial canvas by cosmetic camouflage techniques. The series includes hemiface (2), neck/jaw (5), chin/lower lip (3), cheek/malar (5), peri-orbital (2), nose (3), upper lip (4), and ear reconstructions (4). Flaps represented are free preauricular (1), radial forearm (6), ulnar forearm (1), free scapular (6), ilio-osteocutaneous (2), temporoparietal (8), vascularized forehead island (3), supraclavicular (1), and SMAS (1). Important to outcome is extensive initial intraoperative "sculpting" to simulate normal planes and contours. Seams are placed at junctions of facial components. Three-dimensional imaging is used to assess architectural asymmetries, and bone grafts are aided by computer-generated acrylic models. Adjunctive procedures include tensor fasciae latae slings, intraoperative tissue expansion, suction-assisted lipectomy, and scar management. After restoration of facial form and texture, flesh color make-up and/or tattooing of beard, lips, scars, eyebrows, etc., aid to hide scars and pigment the skin to harmonize with the rest of the face. In all cases, facial integrity has been aesthetically restored and, in most instances, with makeup, is near normal in social settings at conversational distances. Facial animation is retained and color matches are excellent. One flap was lost early in the series.- - - - - - - - - - ranking = 0.125keywords = island (Clic here for more details about this article) |
7/8. Application of high-tech three-dimensional imaging and computer-generated models in complex facial reconstructions with vascularized bone grafts.We present a series of six patients with eight flaps in whom computer-generated models were used for fabrication of vascularized bone grafts in complex facial restorations. Preoperative CT data, digitalized on tape, were converted by the CEMAX (Santa Clara, Calif.) 1500 Integrated Hardware and software System to a three-dimensional visualization of the bone and soft-tissue deficiencies. These data were transmitted by direct computer link to a CNC milling machine that produced full-size slices "stacked" into a three-dimensional template. The acrylic replica aided selection of appropriate donor sites and intraoperative "carving" of bone transfers. Reconstructions included three zygomas, two maxillae, two mandibles, and one frontal bone. Donor sites were iliac crest, scapula, and outer calvarium. Four were free flaps and four island pedicle flaps. All healed without infection. bone resorption was less than 10 percent. One flap was lost to thrombosis. Other complications included a transient facial palsy in one patient and temporary radial palsy from shoulder traction in another. Computer-generated templates for vascularized grafts are expensive and thus are not indicated or necessary in every patient. The advantages, however, are several. Custom models facilitate preoperative planning, with less guesswork of size, contour, and orientation of the graft, which is especially desirable with vascularized grafts, since the position of the pedicle is critical. anesthesia time is decreased. Grafts can be fitted exactly, without reshaping and "nibbling." Nuances of depth and tapering are directly carved into the bone. By merging high-tech imaging and microsurgery, the best chance of optimal results can be achieved.- - - - - - - - - - ranking = 0.125keywords = island (Clic here for more details about this article) |
8/8. Eyebrow reconstruction in the burn patient.Eyebrow reconstruction in burn patients has been effectively performed in nine eyebrows in six burn patients. The results were excellent in seven of the eyebrows and satisfactory in the remaining two. In the authors' experience, the free hair transplants have had marginal results because of the scarred recipient site, and we recommend the island pedicle graft as an alternative, in selected cases, for facial burn reconstruction. Case summaries, details of the operative procedure, and illustrations are presented.- - - - - - - - - - ranking = 0.125keywords = island (Clic here for more details about this article) |