Faculty Bibliography

Upper extremity reconstruction is most often encountered in trauma patients. Although the rate of complications from elective orthopedic procedures remains relatively low, these complications are oftentimes in the form of open joints or joint infections that can be devastating. Classically, wounds of the shoulder girdle have been treated with large muscles such as the pectoralis major, pectoralis minor, and latissimus dorsi. Flaps more local to the area including the deltoid muscle flap have been overlooked due to their small size. Despite its size, the anterior deltoid can be used for shoulder girdle reconstruction with minimal functional deficit and allows for reconstruction of the glenohumeral joint without sacrifice of the larger muscles of the upper trunk. This study reports a case of a chronic shoulder girdle wound and successful management with the use of an anterior deltoid muscle flap.

SUMMARY/CONCLUSIONS:Congenital carpal coalitions are rare conditions that arise from a failure or an incomplete cavitation of a common cartilaginous precursor of the carpal bones between the fourth and eighth week of intrauterine life. The incidence of coalitions has been estimated to occur in about 0.1% of the population and up to 1.6% in people of African descent. This study reports a case of trans-scaphoid trans-lunotriquetral perilunate dislocation with a lunotriquetral coalition and successful management with closed reduction, percutaneous fixation, and a thumb spica cast.

Facial allotransplantation is a clinical reality, proposed to provide improved functional and aesthetic outcomes to conventional methods of facial reconstruction. Multidisciplinary efforts are needed in addressing not just the surgical and immunological issues but the psychological and sociological aspects as well. In view of this, an international survey was designed and conducted to demonstrate that attitudes toward facial allotransplantation are highly influenced by cultural background. Of all countries surveyed, France had the highest percentage of respondents willing to donate their faces (59%) and Iraq had the lowest (19%). A higher percentage of respondents were willing to accepting a face transplant (68%) than donate their face after death (41%). Countries with a dominant Western population show greater percentages of willingness to accept a face transplant, as they exhibit more positive variables, that is, (1) acceptance of plastic surgery for disfigurement and for cosmetic reasons and (2) awareness to the world's first face transplant. Countries with a dominant Western population also show greater percentages of willingness to donate their faces after death, as they exhibit more positive variables, that is, (1) positive attitude to organ donation by being an organ donor themselves, (2) acceptance of plastic surgery if disfigured, and (3) awareness to the world's first face transplant. Although religion was sometimes cited as a reason for not donating their faces, data analysis has shown religion not to be a strong associating factor to willingness to donate a face after death.

Frontonasal dysplasia is a severe malformation composed of cranial, ophthalmic, nasal, upper lip, and palatal deformities. Reconstruction in these patients requires complex craniofacial efforts. A 19-year-old woman with frontonasal dysplasia was treated at our institution where she had undergone multiple prior reconstructive surgeries including facial bipartition and cantilevered calvarial bone graft for nasal reconstruction. She later presented with a palpable bone graft prominence, associated contour deformity, and an area of overlying paper-thin skin at the nasal tip. Although there was no ulceration, the threat of graft extrusion required immediate attention. The prominent bone graft tip was debrided, and the overlying soft tissue envelope was augmented using acellular dermal matrix. No surgical complication was encountered. The patient had successful salvage of the bone graft and a pleasing aesthetic outcome at 9 months of follow-up. The use of acellular dermal matrix has proven to be beneficial in the correction of nasal contour deformities given its soft, natural appearance, availability, affordability, and safety. Its use also avoids further donor site morbidity. We suggest acellular dermal matrix as a graft material in revision rhinoplasties for cases of acquired nasal contour deformity and threatened bone graft extrusion. This is the first report known to the authors using acellular dermal matrix during staged nasal reconstruction in a patient experiencing frontonasal dysplasia.

Excess skin and soft tissue of the thighs after massive weight loss (MWL) can present with varying degrees of severity. The classic medial thigh lift has considerable limitations in the postbariatric population, inspiring the quest for safer and more effective technical solutions. In this study, the circumferential thigh lift (CTL), and CTL with vertical extension, predicated on a theoretical and technical approach that improves safety and aesthetics in thighplasty after MWL, is described and evaluated. Nine patients were treated; all patients experienced MWL and all had previously undergone first-stage contouring with circumferential abdominal dermolipectomy. Patients were treated with a prone-to-supine approach with concomitant suction-assisted lipectomy (SAL). Lumbar and lateral thigh and infragluteal skin and fat were excised to the midaxillary lines and medial thigh meridians. Direct excision of anterolateral thigh skin was carried in a superficial plane into the medial thigh to confluence with the posterior excision. No direct undermining of any skin margin was performed. When soft-tissue excess is limited to the proximal third of the thigh, a horizontal excision pattern is used; with middle and lower one-third thigh excess, a vertical extension is employed. The medial superficial fascial system is anchored to the superficial perineal fascia. Data were reviewed retrospectively. In the 9 procedures performed, 3 achieved MWL by nonsurgical means, and 6 underwent bariatric surgery (bypass or band). Three patients were treated with CTL, and 6 with CTL with vertical extension. There were 3 seromas (33%) treated with percutaneous aspiration. There was 1 case of cellulitis (11%) treated successfully with in-office incision and drainage, and oral antibiotics. There were no hematomas, skin loss, wound dehiscences, lymphedema, or vulvar distortions. The circumferential excision of thigh excess without direct undermining allows for the maintenance of a rich blood supply to skin margins, and concomitant SAL improves thigh contour while providing discontinuous thigh undermining. Anchoring of the superficial fascial system to superficial perineal fascia reinforces the medial lift and prevents scar migration. CTL with or without vertical extension can be combined with SAL to maximize safety and aesthetic results after MWL.