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Objective: This paper compares demographic, morphological, functional, and risk factors between isolated and familial forms of microtia in Ecuadorian mestizo patients., Methods: The authors did an epidemiological, and retrospective study with 112 patients divided into isolated microtia (n = 91) and familial microtia (n = 21). Patients with syndromic microtia were not included., Results: In isolated microtia, the mean age was 11.80 ± 16.9, and the most prevalent age group was from 5 to 9 years, with 45.0%; males were 58.2%, and 91.2% of patients were born in a city above 2500 meters about sea level. In familial microtia, the mean age was 15.57 ± 17.2. There were no statistically significant differences between the analyzed variables. In isolated microtia, 41.8% of patients had bilateral involvement, 40.7% had grade 1 microtia in the right ear (RE), and grade 1 in the left ear was 47.3%; external auditory canal atresia of RE was present in 62.6%, and in left ear in 31.6%. External auditory canal atresia sidedness was mostly unilateral in both groups. Most patients did not have tags or pits (78% and 81% in RE and 85.7% and 71.4%). Most patients had moderate hearing loss in both ears., Conclusion: The authors found an association between both microtia forms with external auditory canal atresia in RE; only 20% of patients had unilateral auricular tags or pits in both groups. The authors also found a high incidence (18.75%) of familial microtia, which suggests a distinct pathological genetic component than the more prevalent isolated cases. The authors found a high association of microtia cases from the Ecuadorian highlands above 2500 meters about sea level (over 90%). The presence of "social" intake of alcohol during pregnancy showed over twice the chance of having a child born with microtia., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Head and neck surgery is an important part of general surgery. There is, however, little information about the quality of residents' clinical skills in this important field. In an Objective Structured Clinical Examination (OSCE), residents encounter multiple patients with various clinical problems and are rated by faculty members using objective criteria. This study was undertaken to assess the head and neck surgery skills of a group of general surgical residents. Fifty-one general surgery residents examined the same nine patients with head and neck disease. Faculty members graded each clinical interaction according to preset objective criteria. Both actual (e.g., thyroid nodule, oral cancer follow-up examination) and simulated (e.g., dysphagia) patients were used in the OSCE. The reliability of the examination was assessed by coefficient alpha. The construct validity was determined by a two-way analysis of variance with one repeated measure. The reliability was 0.75 for the clinical examination. Performance varied by level of training: Residents performed at a higher level than interns (p < 0.0001), but overall scores were poor (mean score 55%). Important deficits in skills were identified at all levels of training. It is concluded that more attention should be focused on specific outcome assessments of surgical training programs and on strategies for upgrading the clinical skills of surgical residents.

We describe the treatment of 2 patients with extensive midfacial defects by using a customized composite flap. Autogenous bone was transferred from the iliac crest, revascularized by the rectus muscle, and then transferred as a complete unit by microvascular technique to provide a vascularized bone graft to this area of difficult reconstruction. The bone was shaped and customized to fit the osseous defect. Although the rectus muscle was relatively bulky at the time of harvest, its hearty blood supply permitted trimming and contouring to fit the gap. This technique was based on the principles proposed previously by other authors regarding the vascularization of a free bone graft and its transfer as a composite flap. This technique requires more research and refinement, however this clinical demonstration shows the feasibility of revascularizing a composite flap and the extent to which this technique can be performed.

Thirty-three patients with high-energy gunshot wounds to the face were treated at the University of Kentucky Chandler Medical Center between 1976 and 1993. Wounds were classified according to the mass and velocity of the projectile, and the range from weapon to target. More than half the injuries involved multiple facial regions. Twenty patients underwent immediate definitive reconstructive procedures. Intervals between injury and initial nondefinitive reconstruction for the other patients ranged from 1 day to 1 month. Toward the end of the study period, reconstruction was undertaken earlier and more aggressively, and included more attention to primary bone grafting and free tissue transfer. These patients developed fewer problems with infection, long-term scarring, and contracture, and they required fewer operative procedures. There was no operative mortality and none of the patients with self-inflicted injuries reattempted suicide. We conclude that early aggressive treatment of these wounds can produce better structural, functional, and rehabilitative results.

This study was undertaken to evaluate the blood supply to the facelift flap by identifying the perforating arteries in the anterior facial region, which is preserved during the undermining of the flap. We have called this medial zone the pedicle area of the flap. Eleven pairs of musculocutaneous perforator arteries supplying the facelift flap were identified, all of them emerging from three main arterial trunks: the facial, the superficial temporal, and the ophthalmic arteries. A rich anastomotic network connected all the vessels; however, we were able to group this network into five basic forms including the ipsilateral and contralateral external and internal carotid arteries. We found these anastomotic links to be constant. We propose that this anatomical feature of the face provides for adequate blood supply even when certain regions have been altered by previous dissection, injury, or congenital deformity. This study confirms previous anatomical findings but also adds specific information regarding the blood supply to the facelift flap that will allow this procedure to be carried out with maximum safety and effectiveness.

A retrospective review of 50 patients who underwent immediate postmastectomy breast reconstruction was performed to determine the effect of reconstruction on the treatment of these patients. The overall complication rate was 50% (25 of 50). Smoking statistically correlated with an increased rate of wound complications (0 = 0.0001). Obese patients had nearly twice as many wound complications; however, this finding was not statistically significant (P = 0.261). Eleven of the 50 patients underwent reconstruction with a prosthesis, with an overall complication rate of 64% (seven of 11) and a 55% (six of 11) rate of prosthesis loss. Thirty-nine of the 50 patients underwent reconstruction with autologous tissue. Forty-six per cent (18 of 39) of the patients in the autologous group developed complications, and eight required emergent reoperation to prevent flap loss. The wound complication rate was significantly lower for bipedicled transverse rectus abdominis muscle (TRAM) flap reconstructions than for other forms of autologous reconstruction (P = 0.040). total operative time (including mastectomy) was 3.11 hours (range, 2-4 hours) for the prosthetic group and 9.4 hours (range, 5-15 hours) for the autologous group. All but two patients undergoing autologous tissue reconstruction required blood transfusions; an average of 2.4 U of blood was transfused per patient (range, 0-7 U). Only two patients in the prosthetic group required a transfusion. The average hospital stay was 5 days (range, 2-7 days) for the prosthetic group and 8.3 days (range, 5-19 days) for the autologous tissue group.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast cancer has reached near epidemic proportions in this country. It is a devastating blow to the patient and her family. Refinements in breast reconstruction have aided greatly in alleviating this harsh attack on the patient's well being and femininity. Many modalities have been used in the past to achieve breast reconstruction but the use of autogenous tissue and immediate reconstruction have permitted the plastic surgeon the opportunity to regain the normal shape of the breast and at times even obtain an improved aesthetic result. We are still not able to obtain a reconstructed breast that has normal sensation and erogenous stimulation. Patients, however, are demanding more and more of their surgeons as they try to better adapt to their conditions. It is hoped that with the advent of new health care reform these patients will not be deprived of the meaningful advances that have been made to date in this field. To paraphrase a saying attributed to Tagliacozzi: "Our objective is not merely to stamp out disease but it is also to buoy the spirit of the afflicted."

We report the case of a 62-year-old man with a huge (25 X 15 cm) dermatofibrosarcoma protuberans of the left flank and abdomen. This is one of the largest dermatofibrosarcoma protuberans lesions reported in the literature. Wide surgical excision of the tumor with 4-cm tumor-free margins created an extensive wound. Wound coverage was performed by transposing an extended rectus abdominis myocutaneous pedicled flap to the defect. Follow-up at 2 years revealed no evidence of local or regional recurrence. We present a brief review of dermatofibrosarcoma protuberans and a discussion of the reconstruction of such large defects.

The goal of reconstructive surgery is to restore anatomy and function. Sexual activity is an important criterion for reconstruction. Wound healing, postoperative rehabilitation, and a positive self-image also can be restored with the creation of a neovagina or neovulva.

The plastic surgeon must frequently deal with the aesthetic repair of cleft earlobe deformities. Many techniques have been described, each claiming to achieve the best results. In this review of the literature, we discuss the various operations for the treatment of this condition. A classification of the traumatic earlobe clefts is proposed, and some basic principles for surgical treatment are suggested.