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3. A Treatment Strategy for Postburn Neck Reconstruction

Author

Caroline Messmer, Detlev Erdmann, Jun Yang, Danru Wang, Yixin Zhang, Brian S. Coan, Yunliang Qian, L. Scott Levin, Keith E. Follmar, and Yee Siang Ong

Subjects
Adult, Male, medicine.medical_specialty, Contracture, Adolescent, Free flap, Genioplasty, Surgical Flaps, Neck Injuries, Cicatrix, Young Adult, Neck Muscles, Recurrence, medicine, Humans, Child, Muscle contracture, business.industry, Soft tissue, Skin Transplantation, Middle Aged, Plastic Surgery Procedures, Chin, Surgery, Plastic surgery, medicine.anatomical_structure, Platysmaplasty, Female, Burns, business, Neck
Abstract

The authors describe an algorithm for reconstruction of both the soft tissue and skeletal components of severe postburn neck deformities. The critical functional and aesthetic importance of the cervicomental angle is emphasized. The neck is subdivided into 3 anatomic subunits: (1) lower lip/chin subunit, (2) submental subunit, and (3) anterior neck subunit. After release of contractures, platysmaplasty is performed to prevent recurrence and to deepen the cervicomental angle. In cases where chin retrusion is present, sliding genioplasty is performed. The 3 subunits are resurfaced individually by skin grafts and free flaps. The combined scapular and parascapular bilobed free flap is an ideal flap for cases involving 2 subunits. Fifty patients with severe postburns neck contractures were treated. After excision and release of scar, 47 (94%) patients underwent platysmaplasty, and 12 (24%) patients underwent sliding genioplasty. Defects were covered with skin grafts alone in 20 (40%) patients, with free flaps only in 22 (44%) patients, and with a combination of skin grafts and free flaps in 8 (16%) patients.

Published
2010
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5. Contributors

Author

Ghada Y. Afifi, Edward Akelman, Louis C. Argenta, Eric Arnaud, Duffield Ashmead, Sherrell J. Aston, Kodi K. Azari, Daniel J. Azurin, Russell Babbitt, Stephen B. Baker, Nabil A. Barakat, Raymond L. Barnhill, David T. Barrall, Scott P. Bartlett, Bruce S. Bauer, Erik M. Bauer, Stephen P. Beals, Michael L. Bentz, Samuel J. Beran, Richard A. Berger, Nada Berry, Walter L. Biffl, Kirby I. Bland, Loren J. Borud, Vincent Boyd, Lynn Breglio, David J. Bryan, Steven R. Buchman, Harry J. Buncke, Rudolf Buntic, Renee Burke, Richard I. Burton, Anthony A. Caldamone, Ryan P. Calfee, Chris A. Campbell, Lois Carlson, Stephanie A. Caterson, Christi M. Cavaliere, Eric I-Yun Chang, Joyce C. Chen, Ben J. Childers, Gloria A. Chin, Simon H. Chin, Niki A. Christopoulos, William G. Cioffi, Brian S. Coan, Marilyn A. Cohen, Mimis Cohen, Stephen Daane, David J. David, Jorge I. de la Torre, Anthony J. DeFranzo, A. Lee Dellon, Jaimie DeRosa, Christine A. DiEdwardo, Joseph J. Disa, Sean T. Doherty, Rudolph F. Dolezal, Raymond G. Dufresne, Christian Dumontier, Raymond M. Dunn, Lee E. Edstrom, W.G. Eshbaugh, Gregory R.D. Evans, Jeffrey A. Fearon, Alvaro A. Figueroa, Jack Fisher, R. Jobe Fix, James W. Fletcher, Robert S. Flowers, Christopher R. Forrest, M. Brandon Freeman, Jack A. Friedland, Karen E. Frye, Brian R. Gastman, Louis A. Gilula, Mark H. Gonzales, James T. Goodrich, Vijay S. Gorantla, Mark Gorney, Mark S. Granick, Arin K. Greene, Joshua A. Greenwald, Joseph S. Gruss, Punita Gupta, Geoffrey C. Gurtner, Mark N. Halikis, Geoffrey G. Hallock, Eric G. Halvorson, Dennis C. Hammond, Rebecca J.B. Hammond, Albert R. Harris, Raymond J. Harshbarger, Robert J. Havlik, Tad R. Heinz, Vincent R. Hentz, Rosemary Hickey, Larry Hollier, Roy W. Hong, Erik A. Hoy, Andrew Hsu, Jennifer Hunter-Yates, Ian T. Jackson, Lisa M. Jacob, Sonu A. Jain, Raymond V. Janevicius, Shao Jiang, Jesse B. Jupiter, Lana Kang, Girish B. Kapur, Joseph Karamikian, Henry K. Kawamoto, Carolyn L. Kerrigan, Christopher Khorsandi, Dana K. Khuthaila, David C. Kim, Jon Kline, Cynthia L. Koudela, Thomas J. Krizek, Matthew D. Kwan, Albert Lam, Howard N. Langstein, Don LaRossa, Donald R. Laub, Jonathan L. Le, Raphael C. Lee, W.P. Andrew Lee, Dennis E. Lenhart, L. Scott Levin, David M. Lichtman, James Lilley, Kant Y. Lin, John William Little, Michael T. Longaker, Matthew S. Loos, Joseph E. Losee, Arnold Luterman, Sheilah A. Lynch, Susan E. Mackinnon, Terry R. Maffi, Eric J. Mahoney, Ahmed Seif Makki, Jeffrey V. Manchio, Ernest K. Manders, Mahesh H. Mankani, Paul N. Manson, Daniel Marchac, Malcolm W. Marks, William J. Martin, Paul A. Martineau, Stephen J. Mathes, G. Patrick Maxwell, Joseph G. McCarthy, William T. McClellan, Michael P. McConnell, Robert M. McFarlane, Mary H. McGrath, Leslie T. McQuiston, Vineet Mehan, Anjali R. Mehta, Julie A. Melchior, Robert M. Menard, Frederick Menick, Martin C. Mihm, D. Ralph Millard, Fernando Molina, Fernando Ortiz Monasterio, Louis Morales, Robert J. Morin, Chaitanya S. Mudgal, John B. Mulliken, Thomas A. Mustoe, Jeffrey N. Myers, Maurice Y. Nahabedian, Michael W. Neumeister, Mary Lynn Newport, Zahid Niazi, Sacha Obaid, Suzanne Olbricht, Osak Omulepu, Sonal Pandya, Marcello Pantaloni, Frank A. Papay, Robert J. Paresi, Amar Patel, Jagruti C. Patel, Wilfred C.G. Peh, Jane A. Petro, John W. Polley, Samuel O. Poore, Julian J. Pribaz, Somayaji Ramamurthy, Sai S. Ramasastry, David L. Ramirez, Oscar M. Ramirez, Peter Randall, Peter D. Ray, W. Bradford Rockwell, Craig M. Rodner, Alan Rosen, Harvey Rosen, Douglas C. Ross, Shai Rozen, Leonard K. Ruby, Jaiyoung Ryu, Justin M. Sacks, Jhonny Salomon, Kenneth E. Salyer, Sven N. Sandeen, Shawkat Sati, Stefan Schneeberger, David P. Schnur, Paul L. Schnur, Richard C. Schultz, David M. Schwartzenfeld, Karl A. Schwarz, Brooke R. Seckel, John T. Seki, Alex Senchenkov, Mark Shashikant, Dan H. Shell, Saleh M. Shenaq, Michele A. Shermak, Prasanna-Kumar Shivapuja, Maria Siemionow, Davinder J. Singh, Sumner A. Slavin, Eugene M. Smith, Erhan Sonmez, Nicholas J. Speziale, Melvin Spira, John L. Spolyar, David A. Staffenberg, Samuel Stal, Eric J. Stelnicki, Mitchell A. Stotland, James W. Strickland, Brent V. Stromberg, Patrick K. Sullivan, Matthew R. Swelstad, Julio Taleisnik, Peter J. Taub, Oren M. Tepper, Julia K. Terzis, Dean M. Toriumi, Bryant A. Toth, Thomas Trumble, Raymond Tse, Raoul Tubiana, Joseph Upton, Luis O. Vásconez, Nicholas B. Vedder, Adam J. Vernadakis, Armand D. Versaci, William F. Wagner, Jennifer L. Walden, Derrick C. Wan, Stephen M. Warren, H. Kirk Watson, Renata V. Weber, Andrew J. Weiland, Adam B. Weinfeld, Jeffrey Weinzweig, Norman Weinzweig, Arnold-Peter C. Weiss, Linton A. Whitaker, Deborah J. White, Lisa Ann Whitty, S. Anthony Wolfe, Ronit Wollstein, Albert S. Woo, R. Christie Wray, Michael J. Yaremchuk, Soheil S. Younai, Jack C. Yu, Eser Yuksel, Alarick Yung, Priya S. Zeikus, and Richard J. Zienowicz

Published
2010
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6. Validation of a cadaveric model for comprehensive physiologic and anatomic evaluation of rhinoplastic techniques

Author

Srinivasan Mukundan, Brian S. Coan, Emma Neff, and Jeffrey R. Marcus

Subjects
Adult, Male, Rhinometry, Acoustic, medicine.medical_specialty, medicine.medical_treatment, Nostril, Sensitivity and Specificity, Rhinoplasty, Acoustic rhinometry, Imaging, Three-Dimensional, Cadaver, otorhinolaryngologic diseases, medicine, Humans, Aged, Probability, Orthodontics, Aged, 80 and over, business.industry, Airway Resistance, Exhalation, Reproducibility of Results, Middle Aged, Rhinomanometry, Surgery, medicine.anatomical_structure, Dilator, Female, Nasal Cavity, Nasal Obstruction, Airway, Cadaveric spasm, business, Tomography, X-Ray Computed
Abstract

Background: The physiologic effects of specific rhinoplasty maneuvers are incompletely understood, largely because of a limited ability to objectively examine such interventions. The purpose of this study was to develop and validate a cadaveric model for rhinoplasty testing. Methods: Ten cadaver heads were methodically prepared to simulate ventilatory conditions. Airway dimensions were measured with three-dimensional computed tomography and acoustic rhinometry. Airflow, pressure, and resistance were measured under conditions of both inhalation and exhalation. Resistance was determined using active anterior rhinomanometry and a continuously variable pressure gradient. Anatomic and physiologic properties were first compared against normative data. Measurements were then taken after application of an adhesive external midvault dilator (BreatheRight; GlaxoSmithKline). Results: The average minimal cross-sectional areas by acoustic rhinometry and by computed tomography were 0.87 cm 2 and 0.84 cm 2 per nostril, respectively (n = 20). The average distance from the nostril to the internal nasal valve was 1.7 cm by acoustic rhinometry and 1.5 cm by computed tomography, consistent with published in vivo normative data at the internal nasal valve. The average resistance with simulated exhalation closely approximated known normative values. With the application of the adhesive nasal dilator, the average area (acoustic rhinometry) increased by 50 percent at the internal nasal valve. During inhalation, the resistance decreased by 21 percent following application of the adhesive dilator. Conclusions: The model provides an accurate representation of nasal anatomy and physiology suitable for objective analysis of rhinoplasty maneuvers. The objective modalities used herein may be applied to rhinoplasty study using this model with accuracy and reproducibility. The external dilator increased area at the internal valve (minimal cross-sectional area) and decreased resistance. (.

Published
2009

7. Early experience with fluorescent angiography in free-tissue transfer reconstruction

Author

Michael R. Zenn, L. Scott Levin, Detlev Erdmann, Brian S. Coan, Jeffrey R. Marcus, and Ivo A. Pestana

Subjects
Adult, Indocyanine Green, Male, medicine.medical_specialty, Reconstructive Surgeon, Adolescent, Coloring agents, Early detection, Free flap, Surgical Flaps, chemistry.chemical_compound, Young Adult, medicine, Humans, Child, Coloring Agents, Aged, Fluorescent Dyes, Intraoperative Care, medicine.diagnostic_test, business.industry, Vascular compromise, Angiography, Middle Aged, Plastic Surgery Procedures, Tissue transfer, Surgery, chemistry, Female, Radiology, business, Indocyanine green
Abstract

Soft-tissue and bony reconstruction with free-tissue transfer is one of the most versatile tools available to the reconstructive surgeon. Determination of flap perfusion and early detection of vascular compromise with prompt correction remain critical in free-tissue transfer success. The aim of this report is to describe the utility of laser-assisted indocyanine green fluorescent dye angiography in free-tissue transfer reconstruction.From October of 2007 to March of 2008, 27 nonrandomized, nonconsecutive patients underwent surgical free flaps in conjunction with intraoperative Novadaq SPY fluorescent angiography.Twenty-seven patients underwent 29 free-tissue transfers. There was one partial flap loss in this group requiring operative revision. No complications attributable to indocyanine green fluorescent dye administration were noted. Imaging procedures (including dye administration) added minimal additional time to the operative time and anesthesia, and assisted in intraoperative decision-making.Novadaq's SPY fluorescent angiography system provides simple and efficient intraoperative real-time surface angiographic imaging. This technology places control of vascular anastomosis evaluation and flap perfusion in the hands of the surgeon intraoperatively in a visual manner that is easy to use and is helpful in surgical decision-making.

Published
2009

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