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PubMed1993

Rapidly converging iterative reconstruction algorithms in single-photon emission computed tomography.

Iterative reconstruction algorithms with markedly different convergence rates have been proposed in single-photon emission computed tomography (SPECT). Several new iterative reconstruction methods are described in this investigation. Differences between the methods include whether a ramp filter was used during backprojection, the type of backprojection weighting and whether camera and collimator blur were employed in the projection step. Simulated and real cylindrical phantoms with rod inserts were used to compare the properties of convergence and resolution following reconstruction by maximum likelihood (ML), iterative-Chang and the newly proposed reconstruction methods. Resolution was assessed after kernel-sieve regularization to achieve the same signal-to-noise ratio for all methods. Compared with maximum-likelihood reconstruction, methods employing a ramp converged much faster. One such method resulted in images with the same resolution and noise as ML, thus permitting termination of reconstruction at 14 iterations rather than the 1000 iterations required with ML. The major determinants of resolution were found to be use of an accurate model of the gamma camera imaging process in the projection step and inclusion of attenuation weighting and depth-dependent blur in the backprojection step. In summary, a new iterative reconstruction method was developed incorporating attenuation and blur and using a ramp filter that achieved results comparable to maximum-likelihood reconstruction in a fraction of the time.

Algorithms↗

PubMed1993

Unilateral microtia reconstruction: is the position symmetrical?

A method of analyzing the head position of the reconstructed unilateral microtic ear relative to the normal side was developed and applied in the assessment of 78 microtic ear reconstructions. Two groups of patients were assessed. Group I included 58 unilateral microtia patients, some with no clinical evidence of lateral facial dysplasia and others with mild to moderate lateral facial dysplasia, as judged by three experienced clinical observers. Group II included 20 unilateral microtia patients with severe lateral facial dysplasia involvement. Of special interest was evidence of lateral facial dysplasia in 88 percent of the patients reviewed. A reproducible technique was developed to assess the position of the reconstructed ear. Three slides showing the normal ear, reconstructed ear, and anteroposterior views of each patient were projected onto a centimeter grid to provide life-size (5-cm) proportions. The normal side served as the control. Length, angulation, and height were compared between normal and reconstructed ears by using a clear film rhomboid pattern designed by choosing specific reproducible landmarks. In group I, the reconstructed ear was of acceptable length and angulation in 91 and 95 percent of the patients, respectively, and of proper height in 88 percent. The corresponding values in group II were 90, 95, and 90 percent. Efforts should be made at the time of original surgery to ensure that the reconstructed ear is not only aesthetically pleasing but also positioned correctly. The technique used by us is one example of an attempt to evaluate the resultant ear position in microtia reconstruction.

Ear, External↗

PubMed1995

[Biomechanical study on the optimal running route for anterior cruciate ligament reconstruction].

The purpose of this study was to determine the isometric points for anterior cruciate ligament (ACL) reconstruction and to investigate notch impingement with isometric reconstruction. The length pattern of ACL was assessed by three-dimensional bi-plane X-ray photogrammetry for determining the isometric point for ACL reconstruction. The isometric points were studied in six fresh cadaveric knees with no injury in any ligament. Five femoral and four tibial attachment sites were selected for intra-articular reconstruction. In each knee, 20 different combinations were studied. For extra-articular reconstruction, three femoral and three tibial sites were selected. In these knees, nine different combinations were studied. One isometric point for intra-articular ACL reconstruction was a combination of the 5-mm superior posterior point from the femoral attachment of the ACL and the center point of the tibial attachment. The other was a combination of the anterior-proximal edge of the femoral attachment and anterior edge of the tibial attachment. There were no isometric points for extra-articular ACL reconstruction. To investigate notch impingement, eight cadaveric knees were studied. One femoral and three tibial attachment sites were selected. For the reconstructed ligaments, 8-mm and 10-mm cables were used. In each cadaveric knee, six different conditions were studied. When the tibial hole was positioned in the center of the attachment of ACL with an 8-mm graft, then notch impingement did not occur. When the tibial drill holes were positioned in a more anterior position, then notch impingement occurred in all the cadaveric knees in which an 8-mm graft was used. With the 10-mm grafts, notch impingement occurred in all three bony tunnel conditions. In these conditions, notch impingement occurred widely from the medial side of the roof to the wall of the lateral femoral condyle. Thus, if the graft diameter is greater than 8 mm, adequate notch plasty must be performed.

Anterior Cruciate Ligament↗

PubMed1996

Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques.

One hundred and twenty-seven patients who had a rupture of the anterior cruciate ligament agreed to participate in a prospective, randomized study of three arthroscopically assisted reconstruction techniques. One hundred and twenty-five patients (125 reconstructions) were evaluated after a mean duration of follow-up of forty-two months (range, two to five years). Group I included forty patients who had a two-incision reconstruction with use of an autogenous semitendinosus-gracilis graft, group II consisted of forty patients who had a two-incision reconstruction with use of an autogenous patellar-ligament graft, and group III included forty-five patients who had a single-incision reconstruction (endoscopic technique) with use of an autogenous patellar-ligament graft. The male-female ratio, age range, level of athletic activity, interval between the injury and the reconstruction, previous operative procedures, and associated injuries were similar in all three groups. The same postoperative rehabilitation protocol was followed for all patients. Testing with a KT-2000 arthrometer at maximum manual force was done at the follow-up evaluation; the difference in laxity between the involved knee and the contralateral knee was three millimeters or less in thirty-three patients (83 per cent) in group I, thirty-seven patients (93 per cent) in group II, and thirty-nine patients (87 per cent) in group III. A difference of two millimeters or less was found in thirty patients (75 per cent) in group I, thirty-one patients (78 per cent) in group II, and thirty-five patients (78 per cent) in group III. Thirty-five patients (88 per cent) in group I, thirty-eight patients (95 per cent) in group II, and forty patients (89 per cent) in group III returned to at least the same level of athletic activity. Four grafts (two in group I and two in group II) failed as a result of trauma. There was one additional failure in groups I and III, as evidenced by a difference of nine and seven millimeters, respectively, on instrumented testing of laxity. The significant findings were that no knee was rated D according to the system of the International Knee Documentation Committee (p < 0.002, 94 per cent confidence level) and that fewer additional operative procedures were done on patients in group III (p < 0.08). Also, it was found that the patients in group II returned to a greater level of athletic activity (p < 0.02) and that a higher percentage of the patients in this group had a difference of three millimeters or less on testing with the KT-2000 arthrometer than in the other two groups (p < 0.08). However, with the numbers available, there were no significant differences in the over-all outcome among the three groups (p > 0.1). Importantly, the rate of failure was not greater and the outcomes were not less satisfactory for the late reconstructions than they were for the acute reconstructions (those performed less than three weeks after the injury), including those done with an autogenous semitendinosus-gracilis graft in a chronically unstable knee.

Adolescent↗

PubMed1997

[Reconstruction using pedicle and free flaps in partial or total resections of the hypopharyngeal-esophageal tract].

Modern surgical treatment of cancer of the hypopharyngo-esophageal cannot be conditioned by the reconstructive procedures. Reconstructive options are based on the size and position of the defect in this important anatomical region. Currently the reconstruction of the hypopharyngo-esophageal tract allows a rapid and suitable restoration of the vital functions, a low morbidity and shortened hospital stay. The purpose of this study was to compare the various reconstructive approaches in terms of morbidity and functional results. Between January 1990 and June 1994, 17 patients with hypopharyngo-esophageal tract malignancies and one with a stenosis received treatment. The reconstructive procedures included 19 flaps: five myocutaneous pectoralis major flaps, one myocutaneous trapezius flap, five deltopectoral flaps, one radial forearm free flap and seven free jejunal grafts. There were six complications: one total necrosis and two stenosis in the free jejunal grafts group, one partial necrosis and one dehiscence in two myocutaneous pectoralis major flaps and one stenosis in a deltopectoral flap. Based on our studies, we believe that the free jejunal graft is the first choice for total reconstruction of the hypopharyngo and cervical esophageal tract. However the radial forearm free flap is certainly a valid solution for subtotal hypopharyngo-esophageal reconstruction. Pedicled flaps and particularly the myocutaneous pectoralis major flaps are a good alternatives for limited reconstructions (< 50%) of the hypopharyngo-esophageal tract.

Adult↗

PubMed1997

Immediate breast reconstruction. A review.

In summary, immediate breast reconstruction has many advantages to the patients and to the surgeons who perform breast reconstruction. For the patients, it is less expensive, psychologically easier, and more convenient. For the surgeons, it facilitates the reconstruction and improves the aesthetic results. Oncologically, there is no reason not to perform immediate breast reconstruction unless the patient does not want it or the prognosis is so poor that any breast reconstruction is unwarranted. We generally offer immediate breast reconstruction to all patients with in situ, T1, or T2 breast cancers who are appropriate surgical candidates. We also offer it to selected patients with T3 breast cancers if the patients are good surgical candidates and are anxious to undergo immediate reconstruction. Skin-sparing mastectomy combined with immediate breast reconstruction has improved the quality of our results and the quality of our patients' lives. By helping our patients in this manner, it has increased the amount of pride we can take in our work and therefore the quality of our own lives as well.

Adult↗

PubMed1997

Bladder exstrophy: evaluation of factors leading to continence with spontaneous voiding after staged reconstruction.

PURPOSE: We performed a long-term retrospective review of patients with bladder exstrophy to evaluate the results of staged surgical reconstruction in regard to urinary continence, spontaneous voiding and preservation of the upper urinary tract. MATERIALS AND METHODS: We reviewed the charts of 42 boys and 15 girls treated at Hôpital St. Joseph for bladder exstrophy between 1965 and 1995. All patients underwent staged repair, including bladder augmentation in 7 (12%) and secondary urinary diversion in 13 (23%). Criteria for good outcome in terms of continence are defined and factors influencing outcomes are reviewed. RESULTS: A total of 38 patients (67%) achieved good or acceptable urinary continence (22 or 39% and 16 or 28%, respectively). Outcome was poor in 19 patients, including 13 (23%) who underwent secondary urinary diversion. Bladder stones, which developed in 13 patients (23%), were the most common long-term complication of bladder exstrophy reconstruction. Ten patients who underwent pelvic osteotomies ultimately had better continence and 9 are dry. Bladder neck reconstruction was performed at a later age overall (mean 10 years). Repeat bladder neck reconstruction was generally associated with poor results. The technique of bladder neck reconstruction did not appear to influence outcome. CONCLUSIONS: A carefully planned surgical reconstruction for bladder exstrophy can lead to satisfactory long-term urinary continence in most patients. Factors contributing to successful results include early bladder closure, pelvic osteotomy, adequate bladder neck reconstruction with bladder neck suspension in girls, and a motivated child and family. Alternatives to surgical reconstruction should be discussed. Ultimate predictors of outcome in bladder exstrophy repair are difficult to ascertain.

Adolescent↗

PubMed1997

Free flap breast reconstruction: the LSU experience (1984-1996).

From 1984 through 1996 the section of Plastic and Reconstructive Surgery at Louisiana State Medical Center has performed over 330 breast reconstructive procedures with free flaps. Seven types of reconstructive procedures have been used during this time span, each with its specific salient positive and negative points. The breast reconstruction techniques included the use of (1) Superior Gluteal Myocutaneous Free Flap, (2) Superficial Inferior Epigastric Artery Flap, (3) Transverse Rectus Abdominis Myocutaneous Free Flap, (4) Deep Inferior Epigastric Perforator Flap, (5) Superior Gluteal Artery Perforator Flap, (6) Inferior Gluteal Artery Perforator Flap, and (7) Lateral Thigh Perforator Flap. The experience with these different methods of breast reconstruction has led us to believe that the ideal material for breast reconstruction is skin and fat, rather than muscle or prosthetic devices. At our institution we have evolved from the myocutaneous flap to the use of perforator flaps for breast reconstruction: the donor site morbidity is less, the 99% success rate is superior, and it allows more options with the perforator free flaps than ever realized with the myocutaneous free flap technique. We feel that, in the future, these perforator techniques will become the standard for autogenous breast reconstruction.

Female↗

PubMed1997

Improved resolution for PET volume imaging through three-dimensional iterative reconstruction.

UNLABELLED: It has been demonstrated that in two-dimensional iterative reconstruction, a resolution model can improve image resolution while controlling noise. With the lower noise levels of three-dimensional PET volume imaging, these iterative reconstruction advantages may be extended to three dimensions to further improve the reconstructed image resolution. METHODS: We have implemented three-dimensional versions of iterative filtered backprojection (IFBP) and the maximum likelihood by expectation maximization (ML-EM) reconstruction algorithms and applied them to three-dimensional PET volume datasets. The results were compared to images obtained using the standard three-dimensional reprojection reconstruction (3DRP) algorithm. RESULTS: For IFBP with 15 iterations and no regularization compared to 3DRP, both using a ramp filter, the transaxial resolution improved 52%, and the axial resolution improved 39%. With a strong regularization, the transaxial and axial resolution improvements were reduced to 6% and 5%, respectively. If a Hanning roll-off is applied to the ramp filter in the transaxial direction, the transaxial resolution for IFBP without regularization improved 35% compared to 3DRP; with regularization the improvement dropped to 19%. The axial resolution for IFBP and 3DRP was unaffected by this transaxial smoothing in the reconstruction filter. With the same Hanning roll-off, the noise for IFBP without regularization increased by a factor of 6 compared to 3DRP; with regularization the noise was increased only by a factor of 3. Compared to IFBP, the three-dimensional ML-EM reconstruction produced similar resolution improvements with a much smaller increase in noise and slower convergence. Resolution improvements from both IFBP and ML-EM reconstructions are visually apparent in three-dimensional FDG brain images and result in increased activation signals in a three-dimensional [15O]water functional activation study. CONCLUSION: Our results demonstrate that resolution improvement is possible for IFBP and ML-EM compared to 3DRP with or without noise increase.

Algorithms↗

PubMed1998

The use of bladder for total transplant ureteral reconstruction.

PURPOSE: Although complete necrosis of a transplanted renal allograft ureter is uncommon, it is a difficult complication to manage. Long or multisegment ureteral strictures, most commonly ischemic in nature, are formidable problems for the reconstructive surgeon. We reviewed 655 consecutive renal allografts to determine the incidence of these complex ureteral complications, and the effectiveness and morbidity of complete ureteral reconstruction using bladder alone. MATERIALS AND METHODS: Of 20 patients (3.0%) who required ureteral reconstruction 9 had complete ureteral necrosis and 11 had long (4) or multisegment (7) ureteral strictures. Total ureteral reconstruction was performed using a modified Boari flap in 15 patients and direct pyelovesicostomy in 5. All patients were followed postoperatively with renal ultrasound as well as 99mtechnetium mercaptoacetyltriglycine-3 diuretic renal scans. Mean followup was 28 months. RESULTS: All 20 patients had successful reconstruction of the transplant ureter using bladder for substitution. Four patients had persistent dilatation of the renal collecting system without evidence of obstruction as measured by diuretic renal scan (half-time less than 20 minutes). Reflux into the transplant renal pelvis occurred in 6 patients. Two patients had reversible deterioration in renal function secondary to rejection episodes. Of the group reconstructed via Boari bladder flap prolonged stenting (mean 27 days) and prolonged high volume drain output (mean 22 days) were not uncommon. CONCLUSIONS: Complete ureteral reconstruction is a complex problem in the renal allograft recipient. Using the bladder for reconstruction via Boari flap or direct pyelovesicostomy is an effective technique with minimal morbidity.

Constriction, Pathologic↗

PubMed1997

The success rate of free flaps after preoperative irradiation in head and neck reconstruction.

BACKGROUND AND AIMS: The reconstructive treatment of large head and neck tumours involves serious problems. Preoperative irradiation increases the risk of postoperative complications. Microvascular free flaps offer definite advantages over conventional reconstruction techniques and permit immediate preoperative high-dose radiation therapy. MATERIAL AND METHODS: In 1985-1996, at the Turku University Central Hospital, 101 patients, 61 (60%) men and 40 (40%) women (age range 15-79 years, mean 61 years), with head and neck tumours, underwent microvascular reconstructions, and 90 of them were irradiated before surgery. All irradiated patients underwent primary reconstruction immediately after resection. The total irradiation dose was about 60 Gy, usual range 50 to 65 Gy. The patients were operated on 3 to 5 weeks after discontinuation of irradiation therapy. RESULTS: Of the whole material of 101 free flaps, 89 (88%) were transferred successfully. The success rate in irradiated patients was 88% and in nonirradiated patients 91%. Reoperation had to be performed within twelve hours in three cases, with good results. Only two hernias occurred as donor complications (2%). Two of the patients died postoperatively (2%). Partial flap necrosis occurred in five patients and five patients underwent another reconstruction using a new free flap or with conventional reconstruction techniques. CONCLUSIONS: Free flaps are often the only acceptable choice in extensive head and neck primary reconstructions after irradiation. Microvascular free tissue transfers to the head and neck after preoperative irradiation has become the accepted method of reconstruction as a result of increased success rates with superior aesthetic and functional results.

Adolescent↗

PubMed1998

Autologous pericardial reconstruction of semilunar valves.

BACKGROUND AND AIMS OF THE STUDY: Previous methods for reconstructing semilunar valves have been characterized by lack of precision and reproducibility and, with one exception, the use of unsuitable biomaterial. A new method combines precision with simplicity to reconstruct aortic and pulmonary valves with lightly tanned autologous tissue supported by the annulus of the native valve. Essential components include sizing based on distance between adjacent commissures, cutting a seamless, size-specific trefoil-shaped pattern of tissue with a tricuspid orifice, temporary mounting of the pattern on disposable formers, and suturing with continuous or interrupted monofilament suture to join the autologous tissue pattern with the valve annulus. METHODS: The tissue pattern is cut and mounted on forming devices that enable the implanting surgeon to visualize the orientation clearly, and perform repair accurately and rapidly. One, two or three leaflets can be reconstructed. The forming and cutting devices are discarded when reconstruction is complete. Diseased valves can be reconstructed in no more time than is required for replacement with a prosthesis of any type. Advantages of the method include preservation of full effective orifice area, lack of need for any foreign body other than the sutures used for reconstruction, and the use of non-immunogenic autologous tissue known to be durable and resistant to calcific degeneration. Contraindications include heavily calcified annulus that cannot be satisfactorily debrided, bicuspid anatomy, or a significantly asymmetric annulus. RESULTS: Pulmonary valve reconstructions have been performed in four juvenile sheep by this method. Three animals survived five months; there was one operative death due to non-valve related causes. CONCLUSIONS: Semilunar valve reconstruction with autologous tissue can be simple, precise, and reproducible.

Animals↗

PubMed1998

[Free flaps in the reconstruction of head and neck. Clinical experience].

The reconstruction of head and neck defects, due to trauma, tumor resection or other, begins with a careful assessment of the patient and the respective defect. Ideally, it ends with the successful reconstructive procedure that optimally restores form and function to the patient. Free flaps have often been used as a last resort reconstructive option in the head and neck because of the need for added technical skill, a longer operating time and a perception of poor reliability. This study reviews our experience with forty-eight patients submitted to microvascular reconstructive procedures. Twelve different kinds of free flaps have been involved as the preferred choice for free flap reconstruction of a specific defect of the head and neck. The latissimus dorsi flap was used for scalp and skull reconstruction, whereas the serratus anterior or rectus abdominis free flaps were used for the reconstruction of complex defects of the middle third of the face. The radial forearm flap and the free jejunal transfer have become the preferred choices for intraoral and pharyngo-esophageal reconstruction, respectively. Good results were obtained with both functional and social rehabilitation. There were three flap losses probably due to thrombosis of the microvascular anastomosis. There was no surgical mortality. The indications for each free flap are discussed.

Adolescent↗

PubMed1997

[Breast reconstruction using free rectus abdominis myocutaneous flap].

More than 50% of patients who have breast cancer do not need a mastectomy. Since 1976, reconstruction of the breast is suitable. From 1976 to 1995, we have performed 220 breast reconstructions with a pediculed latissimus dorsi and 510 reconstructions with a pediculed transverse rectus abdominis myocutaneous flap (TRAM). So, in all, 1100 immediate breast reconstruction with either a prosthesis or a pediculed flap were performed. The specialised teams aim is to use the TRAM free transplant for immediate breast reconstruction. Between 1990 to 1995 we have performed 5 free TRAM for breast reconstruction for cancer and 6 TURBOTRAM. It is important for the woman to have an abdominal adiposity, to be able to give an excellent breast. Four out of five of the free TRAM reconstructions were successful and one give partial necrosis (4 x 4 cm). All the 6 TURBOTRAM operations were uneventful. There are many advantages with this technique: the free TRAM allows a large resection of the thoracic skin and gives a natural form to the breast, without any prosthesis. The taking of the free TRAM gives only few abdominal hernia and realize an abdominoplasty. Our aim is to perform immediate breast reconstruction with free TRAM flap.

Adult↗

PubMed1998

Facial nerve reconstruction: outcome and failures.

OBJECTIVE: Our study was conducted to assess the outcome of reconstruction of the facial nerve after various resections for parotid neoplasms. METHOD: A 10-year retrospective analysis of 350 primary parotid neoplasms (of which 70 were malignant) and 10 recurrent benign neoplasms involving facial nerve resection in 19 and 2 patients, respectively. Four patients had total resection of the facial nerve and reconstruction with a five-branch assemblage using standard microtechniques. Four patients had reconstruction of the orbital branch only. Twelve patients, of whom three also had a midface branch reconstructed, had reconstruction of the ramus mandibularis. One patient had a direct anastomosis of a partial resection of the main trunk of the nerve. Objective assessment of muscle activity was carried out in the distribution of the reconstructed nerve with a minimum of 18 months follow-up. RESULTS: All four patients with total facial nerve reconstruction had excellent tone in repose. None had purposeful focused movement, and all had mass movement; however, all had good eye closure. None of the patients with mandibular branch grafting alone had useful return of function, but those who had concomitant midface grafting had good return of function of the reconstructed branches. All patients who had orbital grafting had appropriate eye closure. CONCLUSIONS: Facial nerve grafting is effective to rehabilitate gaps in the pes anserinus, even if patients undergo postoperative radiotherapy. Total nerve grafting provides good tone in repose and eye closure, which justifies the procedure. Single-branch grafting is mandatory for the orbital branch, but one can question the use of a single-branch graft for the mandibular branch.

Adult↗

PubMed1998

[Reconstruction of bladder exstrophy: retrospective study of 57 patients with evaluation of criteria in favor of the acquisition of continence].

In order to evaluate the results of staged surgical reconstruction in terms of urinary continence, spontaneous voiding and preservation of the upper urinary tract, we reviewed the charts of 42 boys and 15 girls treated at Hôpital Saint-Joseph for bladder exstrophy between 1965 and 1995. All patients underwent staged repair, associating bladder closure, bladder neck plasty, then genitoplasty, including bladder augmentation in 7 cases (12%). Criteria for good outcome in terms of continence are defined and factors influencing outcomes are reviewed. A total of 38 patients (67%) achieved good or acceptable urinary continence (22 or 39% and 16 or 28%, respectively). Outcome was poor in 19 patients, including 13 (23%) who underwent secondary urinary diversion. Bladder stones, which developed in 13 patients (23%), were the commonest long-term complication of bladder exstrophy reconstruction. Ten patients who underwent pelvic osteotomies ultimately had better continence and 9 are dry. Bladder neck reconstruction was performed at a later age overall (mean 10 years). Repeat bladder neck reconstruction was generally associated with poor results. The technique of bladder neck reconstruction did not appear to influence outcome. This retrospective study confirms that a carefully planned surgical reconstruction for bladder exstrophy can lead to satisfactory long-term urinary continence in most patients. Factors contributing to successful results include early bladder closure, pelvic osteotomy, adequate bladder neck reconstruction with bladder neck suspension in girls, and a motivated child and family. Alternatives to surgical reconstruction should be discussed. Ultimate predictors of outcome in bladder exstrophy repair are difficult to ascertain.

Adolescent↗

PubMedDate not supplied

Irradiated homograft rib cartilage in facial reconstruction.

OBJECTIVE: To evaluate long-term structural, functional, and cosmetic results as well as resorption with the use of irradiated homologous rib cartilage grafts (IHRGs). DESIGN: Cases in which IHRGs were used were reviewed for a long-term follow-up study for nasal and auricular reconstruction, dating back 18 years. A retrospective medical chart review was conducted in the cases in which the patients had returned for clinical examination with photographic documentation. RESULTS: A total of 118 patients who had undergone nasal reconstruction with a mean follow-up of 36 months were identified from our database. There were 12 patients who had undergone auricular reconstruction, with a mean follow-up of 82 months. Resorption with compromise in cosmesis was noted in 11% (11/102) of the grafts used in nasal reconstruction but in 71% (5/7) of those used in auricular reconstruction. Minor resorption without change in form or function was found in 29% (30/102) of the cases. Loss of support, which was related more to graft displacement rather than resorption, was identified in 19% (21/109) of the cases, and loss of support affecting cosmesis was observed in 8% (9/109) of the cases. Maintenance of form and function appeared to be unrelated to the amount of resorption noted for the nasal grafts but was significant for the auricular grafts (P < .01). CONCLUSIONS: The longevity of IHRGs has been favorable for functional, structural, and cosmetic nasal reconstruction, with low levels of resorption identified clinically. The use of IHRGs was associated with an unacceptable rate of graft failure in auricular reconstruction; therefore, they are no longer selected for use in such cases.

Adult↗

PubMed1987

Full-thickness bipedicle flap for total lower eyelid reconstruction.

We describe a technique for total lower eyelid reconstruction utilizing a full-thickness bipedicle flap from the upper eyelid. The levator aponeurosis and Müller's muscle are recessed to avoid upper eyelid retraction. The key to performing this operation is a thorough knowledge of eyelid anatomy and techniques for preserving its microvascular blood supply. The bipedicle flap requires meticulous surgical technique but has many advantages over standard types of total lower eyelid reconstruction, including the following: excellent tissue match and cosmesis are obtained with single-stage reconstruction; distal flaps and grafts are avoided; open palpebral fissure is maintained, resulting in rapid rehabilitation; posterior lamella of tarsus, rather than substitute, is utilized; anterior lamella of functional orbicularis is utilized for support and closure; pedicles suspend and support the eyelid, decreasing lower eyelid retraction, laxity, and ectropion; allows simultaneous reconstruction of canthal defects; and is faster than other forms of total lower eyelid reconstruction. The results of 14 total lower eyelid reconstructions are presented. Minor canthal deformities, the most frequent complication, are easily corrected. This technique should be considered as an alternative to other procedures in cases of total lower eyelid reconstruction.

Aged↗