Objective To investigate the effectiveness of local skin flaps such as V-Y advancement flap (V-Y plasty) and transposition flap (Z plasty) in the adjustment of reconstructed nasal alars at second stage. Methods Between June 2012 and January 2017, 14 cases of reconstructed nasal alars by nasolabial flap or expanded forehead flap were recruited. There were 9 males and 5 females with an average age of 34.8 years (range, 18-52 years). The interval time between one- and two-stage operations was 1-12 months (mean, 3 months). The type of local skin flap was decided according to the flaws of reconstructed nasal alars. V-Y plasty was used in 5 cases, Z plasty in 2 cases, and V-Y plasty combined with Z plasty in 7 cases. Results All operations were successfully completed. The flaps in 3 cases suffered from epidermal necrosis at the far end and healed by dressing change. The other wounds healed by first intention. All 14 cases were followed up 6-40 months (mean, 12 months). The nasal alars had verisimilar shape and symmetrical appearance. The color and texture of reconstructed nasal alar were closed to peripheral tissues. Conclusion Applying local skin flaps such as V-Y plasty and Z plasty can acquire a better shape in the adjustment of reconstructed nasal alars.
Objective To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder’s syndrome. Methods Between June 2012 and June 2017, 8 cases of Binder’s syndrome were admitted. There were 3 males and 5 females, aged 16-31 years (mean, 22 years). All patients were conformed to the typical manifestations of Binder’s syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder’s syndrome was evaluated. Results All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in 1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation (P<0.05). The difference in nasal dorsum length, nasal tip projection rate, and nasion projection between actual values at 6 months after operation and normal values was no significant (P<0.05). There was significant difference in nasal columella-lobule ratio between actual value at 6 months after operation and normal value (P>0.05). Conclusion Autogenous costal cartilage transplantation in repair of Binder’s syndrome can obviously improve patients’ appearance of the external nose and middle face, and obtain the persistent effectiveness.
ObjectiveTo explore the feasibility and effectiveness of using auricular cartilage multi-point suspension fixed on deep craniofacial fascia in correcting mild to moderate cupped ear malformation.MethodsBetween January 2014 and March 2016, 22 patients (12 males and 10 females) with mild to moderate cupped ear malformation were admitted, aged from 6 to 28 years, with an average age of 15 years. Sixteen cases were unilateral and 6 cases were bilateral. According to Tanzer classification, there were 18 sides of type Ⅰ and 10 sides of type Ⅱ. The otocranial groove incision was selected to expose and release the posterior auricular muscles and ligaments. The abnormal structure of auricle subunits was remolded. The auricle cartilage was suspended and fixed on the deep craniofacial fascia with non absorbable line to remodel the shape and position of auricle.ResultsThe incision healed by first intention, without hematoma, infection, and skin necrosis. All the patients were followed up 3-48 months, with an average of 12 months. In addition to 1 case of slippage of the fixed line knot, the effect was good after being suspended and fixed again, the auricles of the other patients were not drooping and tilted forward, the shape of the outer ear was good, the ear boat was obvious, the shape of the upper and lower feet of the ear wheel and the pair of ears was natural, the bilateral symmetry was good, and the patients and their families were satisfied.ConclusionAuricular cartilage multi-point suspension fixed on deep craniofacial fascia is effective in the treatment of mild to moderate cupped ear malformation.
ObjectiveTo discuss the clinical application and effectiveness of autologous costal cartilage transplantation in the repair of upper lip depression in the secondary repair of cleft lip.MethodsThe clinical data of 10 patients of secondary repair of upper lip depression with cleft lip by autologous costal cartilage transplantation between January 2017 and January 2019 were retrospectively analysed. There were 7 males and 3 females with an average age of 24 years (range, 18-33 years). There were 8 cases of bilateral lip fissure and 2 cases of unilateral lip fissure. All of them underwent early lip repair at the age of 2-3 years old. The change of the profile of the soft tissue profile of the upper lip of the patient was quantitatively analyzed before operation and at immediate after operation, including the soft tissue facial angle (G-Sn-Pg’), the nasolabial angle (Cm-Sn-UL), the mentolabial angle (UL-LL-Pg’), the distance between the most salient point of the upper lip to the aesthetic plane (UL-E), the highest point of the frontal part, the projection distance of the most salient point of the upper lip on the plane of the orbital ear (G-UL), and the upper lip protrusion (ULP).ResultsOne case had incision infection and healed after dressing change, and in the other 9 patients, the incisions healed by first intention, and no acute infection and other complications occurred. The appearance of the lateral morphology of the upper lip at immediate after operation was significantly improved when compared with that before operation. The value of UL-LL-Pg’, UL-E, G-UL, and ULP were significantly increased and G-Sn-Pg’ was significantly decreased when compared with preoperative ones (P<0.05). There was no significant difference in Cm-Sn-UL between pre- and post-operation (t=0.821, P=0.433). All the 10 patients were followed up 6-24 months, with an average of 15 months. During the follow-up, the soft tissue morphology of the upper lip was good. No long-term complications such as cartilage absorption and cartilage displacement were found.ConclusionAutologous costal cartilage transplantation is a safe and effective treatment for upper lip depression in the secondary repair of cleft lip.