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Cleft Palate Craniofac J 2018 Dec 13:1055665618817669. Epub 2018 Dec 13.

4 American Craniofacial Associates, Athens, Greece.

Introduction:: Skeletal reconstruction in severe grades of hemifacial microsomia (HFM) continues to be challenging. Traditional techniques of autografts and osseous distraction for reconstruction of the glenoid fossa, condyle, and ramus can fall short of expectations and can create new problems. This intercontinental study analyzes the role of alloplastic skeletal rehabilitation in severe HFM. Read More

Plast Reconstr Surg 2018 Dec 27. Epub 2018 Dec 27.

Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Heidelberglaan 100 3584 CX Utrecht Cedars Sinai Hospital, Los Angeles, CA Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Background: The temporoparietal fascia (TPF) flap is frequently used in ear reconstruction. When the TPF is unavailable, options for primary or secondary salvage reconstruction are limited. In these patients, an inferiorly based occipital artery fascia (OCF) transpositional flap is a good alternative for soft tissue coverage over a framework. Read More

Arch Plast Surg 2017 Nov 27;44(6):554-558. Epub 2017 Oct 27.

Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

In many cases of complete ear amputation, microvascular surgery is required for tissue perfusion and organ survival. However, microvascular reconstruction is not always feasible in the absence of suitable vessels. Here, we present the case of a 76-year-old man who underwent complete amputation of the left ear after a collapse at home because of cardiogenic syncope. Read More

Laryngoscope 2018 04 8;128(4):812-817. Epub 2017 Oct 8.

Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.

Objectives/hypothesis: To assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps.

Study Design: Retrospective single-institution study, April 2015 to March 2017.

Methods: Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. Read More

Am J Otolaryngol 2017 Mar - Apr;38(2):254-256. Epub 2016 Nov 25.

Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

Introduction: PCF is the most common major complication after salvage total laryngectomy (TL), especially for previously irradiated patients with laryngeal or hypopharyngeal cancer.

Methods/results: A 65-year-old woman presented with recurrent bilateral supraglottic SCC requiring salvage TL 5.5years after initial T1N0M0 epiglottic SCC resection. Read More

Laryngoscope 2017 03 18;127(3):642-644. Epub 2016 Oct 18.

Department of Otolaryngology, Massachussetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Microvascular free tissue transfer is essential in complex head and neck reconstruction. The mainstay of microvascular anastomosis has classically been the suture technique, but the coupling device has emerged as a valuable alternative. Couplers are commonly used for venous anastomoses, but most head and neck reconstructive surgeons do not routinely couple arteries. Read More

Eur J Surg Oncol 2017 Jan 27;43(1):175-180. Epub 2016 May 27.

Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.

We reviewed the oncological and functional outcomes of patients treated for a primary sarcoma possibly involving the knee joint and present an algorithm to guide treatment. The records of 76 patients who had a primary bone or soft tissue sarcoma possibly invading the knee between 1996 and 2012 were identified. Mean age and follow-up was 32 years (9-74) and 64 months (12-195), respectively. Read More

Ann Plast Surg 2017 Feb;78(2):178-183

From the *Bona Microtia and Aesthetic Ear Surgery Clinic; †Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul; and ‡Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Ilsan, South Korea.

Background: One of the most common complications of total auricular reconstruction is delayed wound healing, which results in skin necrosis and exposure of the ear framework. Various options exist for salvage of the exposed ear framework.

Methods: From January 2009 to May 2014, 149 patients underwent total auricular reconstruction using an autogenous cartilage framework or porous polyethylene framework (Medpor; Stryker, USA). Read More

JAMA Otolaryngol Head Neck Surg 2015 Sep;141(9):797-803

Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland.

Importance: The optimal reconstruction of total glossectomy defects with or without total laryngectomy is controversial. Various pedicled and free tissue flaps have been advocated, but long-term data on functional outcomes are not available to date.

Objectives: To compare various total glossectomy defect reconstructive techniques used by multiple institutions and to identify factors that may lead to improved long-term speech and swallowing function. Read More

World J Gastroenterol 2015 Jul;21(28):8723-9

Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.

Esophagectomy with extended lymphadenectomy and gastric conduit reconstruction is a radical procedure for the treatment of esophageal cancer that is associated with a high morbidity rate. Gastric conduit necrosis is a fatal complication that occurs in 2% of patients. Conventionally, two-stage salvage surgery consisting of removal of the necrotic gastric conduit followed by reconstruction has been performed; however, this procedure has a high morbidity rate. Read More

Otolaryngol Head Neck Surg 2015 Aug 2;153(2):225-30. Epub 2015 Jun 2.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA

Objective: To determine oncological and neuromorbidity outcomes in patients with advanced head and neck cancer (stage IVB) requiring sacrifice and reconstruction of the carotid artery.

Study Design: Case series with chart review.

Setting: Tertiary care referral center. Read More

Laryngoscope 2015 Aug 30;125(8):1979-82. Epub 2015 Jan 30.

Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.

Prefabricated composite free flaps for complex airway reconstruction have been described for an adult series at our institution. We extended this approach to a pediatric patient with lifelong subglottic stenosis who had failed previous open airway reconstructions. A staged procedure was utilized in which a composite graft was created using conchal cartilages and a radial forearm free flap. Read More

Br J Hosp Med (Lond) 2014 Dec;75(12):708-10

FY1 in the Department of Ear, Nose and Throat Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH.

Aim: To consider the financial benefit to the authors' trust of omitting a preoperative group and save in enhanced recovery arthroplasty patients, and to estimate the scope for national savings. Patient safety was considered to determine acceptability for routine practice.

Methods: A total of 121 patients receiving a total knee replacement or total hip replacement on the authors' enhanced recovery protocol were selected. Read More

Surg Clin North Am 2014 Aug 16;94(4):817-37. Epub 2014 Jun 16.

Plastic Surgery Transplantation, Burn Center, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

This article describes a practical, clinically based approach to classification of postburn deformities. Burn scar contractures are of either the broad diffuse type or linear band-like type. The former generally respond well to release and insertion of a skin graft or substitute, whereas the latter are generally repaired using a simple or modified Z-plasty or a transpositional flap technique. Read More

Laryngoscope 2014 Aug 15;124(8):1777-82. Epub 2014 Jan 15.

Massachusetts Eye and Ear Infirmary, Head and Neck Division; Harvard Medical School, Department of Otology and Laryngology, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: Report on the successful use of the supraclavicular flap for reconstruction following total laryngectomy and highlight the utility and versatility of the supraclavicular flap for reconstruction after total laryngectomy.

Study Design: Retrospective review of a single institution experience.

Methods: A single institution database was reviewed to identify patients undergoing total laryngectomy and supraclavicular flap reconstruction. Read More

Otol Neurotol 2014 Jan;35(1):84-90

Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.

Objective: To describe a contemporary, pragmatic approach to managing cholesteatoma in the only hearing ear.

Study Design: Retrospective case series.

Setting: Single tertiary referral center. Read More

Microsurgery 2013 Jul 2;33(5):396-400. Epub 2013 May 2.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.

Microvascular replantation, when possible, is the treatment of choice for total ear amputations. Both arterial and venous reconstruction should be attempted. The present case report describes a successful total ear replantation in a 45-year-old woman whose ear was amputated due to a horse accident. Read More

Ann Plast Surg 2014 Jan;72(1):56-8

From the *Shriner's Hospital for Children, Boston, MA; †Harvard Medical School, Boston, MA; and ‡Tufts Medical Center, Boston, MA.

Costochondral grafts have been the gold standard for ear reconstruction in cases of microtia repair for decades. Microtia repair has been traditionally associated with a low complication rate, yet little exists in the literature regarding the management of complications when they do occur. Postoperative infections of costochondral grafts have traditionally resulted in complete graft loss, necessitating additional surgery or leaving the patient with continued physical disfigurement and the accompanying psychological and emotional distress. Read More

J Am Acad Audiol 2012 Apr;23(4):241-8

Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, MO, USA.

This case study summarizes findings in an adult male, aged 57, who presented to the Adult Audiology Clinic with aural atresia in the right ear resulting in a conductive hearing loss and a sudden sensorineural hearing loss in the left ear. Treatment options included reconstruction surgery in the right ear, bone anchored hearing aid in the right ear to overcome the conductive hearing loss, bone anchored hearing aid in the left ear for single sided deafness, and intratympanic steroid injections in the left ear to salvage hearing. This case study highlights that when a patient is educated on all available options the patient is then able to make a decision comfortable to him and to help improve his hearing. Read More

J Craniofac Surg 2011 May;22(3):805-8

Department of Plastic & Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Republic of Korea.

Introduction: This study was intended to present methods for salvage perforation and infection of an expended skin flap in total ear reconstruction with autogenous costal cartilage.

Methods: Between March 2008 and March 2009, 5 patients experienced complications (perforation and infection) after total ear reconstruction. The skin perforations were noted between 29 and 100 days after inflation. Read More

Eur J Vasc Endovasc Surg 2011 Jun 16;41(6):748-57. Epub 2011 Mar 16.

Department of Vascular Surgery, University of Nice Sophia-Antipolis, France.

Purpose: Evaluate the results of the two modalities used for the treatment of Secondary Aorto-Enteric Fistula (SAEF): In situ Reconstruction (ISR) and Extra-Anatomic Reconstruction (EAR). The primary endpoints of this study were early standard 30-day mortality and reinfection (RI). Secondary endpoints were perioperative morbidity, late mortality, primary graft patency, and major amputation rates. Read More

J Trauma 2010 Oct;69(4):E15-9

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.

Purpose: The purpose of this study is to present our experience with patients who underwent traumatic ear amputation.

Methods: Between January 1988 and April 2002, 10 patients sustained ear amputations. Of these, six patients underwent microvascular replantation (arterial anastomosis only and arterial and venous anastomosis in three patients each), and replantation was attempted in one patient. Read More

Ear Nose Throat J 2010 Apr;89(4):177-9

Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA.

We describe what is, to the best of our knowledge, the first use of a double bilobed radial forearm free flap in reconstructive surgery of the tongue and floor of the mouth following bilateral tumor resection. Our patient was a 78-year-old man who had experienced tumor recurrence in the anterior floor of the mouth after previous resection and radiotherapy. Eleven weeks postoperatively, the patient could extend his tongue to his hard palate and past his mandibular alveolus anteriorly. Read More

J Plast Reconstr Aesthet Surg 2010 Nov 23;63(11):1917-20. Epub 2010 Mar 23.

Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.

Case report of a salvaged total scalp, forehead, ear and cheek en-bloc replantation following an industrial avulsion injury with a warm ischaemia time of over 12 h. One arterial and two venous anastomoses using an interposed arterial graft instead of a vein graft was sufficient to produce a successful result. The patient was followed up for a two-year period. Read More

J Craniofac Surg 2010 Mar;21(2):375-8

Department of Plastic, Reconstructive and Aesthetic Surgery, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.

Background: Ear reconstruction with autologous tissues and creating a natural-appearing ear is a difficult, multistage surgical procedure. Problems, such as a thick skin or an inadequate cartilage-flap relationship, may cause obliteration of the framework details. A nonsurgical technique to improve auricular definition is described. Read More

J Egypt Natl Canc Inst 2009 Sep;21(3):249-63

The Department of Surgical Oncology, National Cancer Institute, Cairo University.

Purpose: The aim of this study was to reevaluate the role and effectiveness of pedicled myocutanous and myofascial flaps in reconstruction after resection of head and neck cancer.

Patients And Methods: This study represents the authors own experience using pedicled myocutanous and myofascial flaps in reconstruction after resection of malignant tumors of different sites in the head and neck. The study included 121 patients with head and neck cancer operated upon at the National Cancer Institute, Cairo University and Alminia Cancer Center over 3 years duration, between July 2005 and the end of July 2008. Read More

J Plast Reconstr Aesthet Surg 2008 9;61 Suppl 1:S110-3. Epub 2007 Mar 9.

Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.

One of the common complications of microtia reconstruction with cartilage grafting is exposure of the framework. Recently, we used a mastoid fascial flap for salvage operations in two microtia patients, who had partial skin necrosis with resultant exposure of the cartilage framework. Following the excision of the necrotic skin, the anteriorly based mastoid fascial flap was elevated and transferred as a hinge flap on to the portion of the exposed framework. Read More

Plast Reconstr Surg 2006 Aug;118(2):374-82

Seoul Center for Developmental Ear Anomalies, South Korea.

Background: The authors propose an expanded technique of the temporoparietal facial flap of sufficient size to provide complete coverage in a single-stage procedure for the projected three-dimensional autogenous cartilage framework, including the tragus or lobule.

Methods: A temporoparietal fascial flap measuring 9 x 9 cm was prepared and wrapped around an expander. The expander was gradually infused with saline solution. Read More

Ear Nose Throat J 2005 Oct;84(10):634

Head and Neck Cancer Center, Cedars-Sinai Medical Center, Los Angeles, USA.

Otolaryngol Head Neck Surg 2004 Dec;131(6):934-9

Department of Otolaryngology--Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822, USA.

Background: Medicinal leeches have been demonstrated to be extremely useful and safe in the salvage of venous outflow compromised tissue, particularly in digit replants and various forms of flaps.

Objective: To demonstrate the utility of medicinal leeches in the salvage of venous outflow-compromised traumatic soft tissue avulsions in key facial structures.

Methods: A retrospective review of 4 cases involving the external ear, nose, lip, and scalp in which apparent venous outflow compromise was present. Read More

Plast Reconstr Surg 2004 Aug;114(2):339-50

Department of Plastic and Reconstructive Surgery, Sişli Etfal State Hospital, Istanbul, Turkey.

In surgical treatment of head and neck cancer, when local tumor recurrence or failure of the previous reconstruction method occurs, reoperation for reconstruction of complicated soft-tissue defects can become a challenge for the plastic surgeon. This article describes the authors' experience with the extended vertical trapezius myocutaneous flap for head and neck complicated soft-tissue defects in nine patients ranging in age from 17 to 72 years. The causes of the defects were squamous cell carcinoma of the external ear (n = 2), lip (n = 2), larynx (n = 1), and oral cavity floor (n = 1); congenital hemifacial atrophy-temporomandibular joint ankylosis (n = 1); synovial sarcoma at the mandibular ramus (n = 1); and malignant fibrous histiocytoma at the posterior cranial fossa (n = 1). Read More

Ann Plast Surg 2000 Apr;44(4):435-9

Department of Surgery, The Mount Sinai Medical Center, New York, NY 10029, USA.

The authors report a case involving a 46-year-old man who sustained a traumatic amputation of approximately 60% of his ear from a human bite. The ear was replanted microsurgically without the benefit of venous anastomosis. Blood transfusion was not required despite the use of leech therapy and systemic anticoagulation. Read More

Plast Reconstr Surg 1995 Dec;96(7):1698-701

Institute of Plastic Surgery, University of Padua, Italy.

After amputation of an ear, the best results are attained through the use of microvascular replantation. The literature reports very few examples of the successful replantation of a whole ear when compared with the vast number of attempts. We report the case of a 17-year-old boy with a recurrence of a voluminous arteriovenous malformation in the right temporoparietal area. Read More

Plast Reconstr Surg 1994 Apr;93(5):967-79

Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, Misericordia Hospital, Edmonton, Alberta, Canada.

Fifty-five patients with major ear deformities were reconstructed during the period 1982-1993 with autogenous tissue. Fourteen patients were reconstructed with osseointegrated auricular prostheses during the period 1989-1993. Both procedures were done at the same institution by the same surgeon. Read More

J Laryngol Otol 1993 Oct;107(10):892-4

University Department of Otorhinolaryngology, University College Hospital, Galway, Republic of Ireland.

This retrospective study compares the tympanoplasty success rate when using a xenograft (Zenoderm) or an autograft (temporalis fascia). Fifty-three ears were operated on over a three-year period. All the tympanoplasty operations were performed by the same surgeon. Read More

Arch Otolaryngol Head Neck Surg 1993 Mar;119(3):313-9

Division of Otolaryngology, Head and Neck Surgery, Stanford University, CA.

A previously described rabbit ear model was used to address the following issues: (1) the role of surgical delay in composite tissue transfer, (2) optimal enhancement of graft survival using the corticosteroid methylprednisolone, (3) pharmacologic salvage of the failing composite graft, and (4) efficacy of a nonsteroidal dual cyclooxygenase/lipooxygenase inhibitor (SK&F 86002) in enhancing graft survival. Preoperative and immediate postoperative steroid treatment groups exhibited a significant improvement in graft survival area compared with the untreated control group. Preoperative initiation of steroid therapy was more effective than a strictly postoperative regimen. Read More

J Burn Care Rehabil 1991 Jul-Aug;12(4):339-43

Division of Plastic Surgery, University of California, Irvine.

Three cases in which the temporoparietal fascial flap was used to salvage denuded ear cartilage during the acute period after burn injury are reported. Patients' burns ranged from 30% to 75% total body surface area. The full-thickness burn was acutely excised, exposing the auricular cartilage. Read More

J Reconstr Microsurg 1990 Jul;6(3):223-7

Plastic Surgery Section, Indiana University Medical Center, Indianapolis 46202-5200.

A case of successful replantation of a total scalp avulsion, including both ears and one eyebrow, is presented with bilateral anastomoses to the superficial temporal vessels. While over 90 percent of the replant survived, partial loss of occipital and posterior neck skin and the inferior half of the left ear occurred. The patient subsequently required additional procedures, including skin grafting, scar revisions, and staged ear reconstructions. Read More

Ann Plast Surg 1988 Oct;21(4):378-81

Mecom Microsurgical Institute, Baylor College of Medicine, Houston, TX.

Successful restoration of the auricle following amputation using microsurgical techniques for reimplantation remains the best reconstructive alternative. In many cases of partial amputation, however, this option may not be technically feasible. Deepithelialization of the amputated part followed by coverage of the ear cartilage using an ipsilateral temporoparietal fascia turn-down flap may allow a single-stage salvage procedure that provides an acceptable final result. Read More

Plast Reconstr Surg 1987 Apr;79(4):535-41

At a time when microsurgical reattachment of amputated limbs is commonplace, successful reattachment of total ear amputations is rare. Avulsed vessels, small diameters (0.3 to 0. Read More

Otolaryngol Clin North Am 1982 Feb;15(1):225-39

Clin Plast Surg 1978 Jul;5(3):427-35

Salvage of the ear in major acute trauma has been refined over the years. When severed parts were merely discarded, patients had to accept the defect or seek correction by secondary reconstruction. As primary reconstruction improved, the severed parts were reattached minimizing late deformities. Read More