Faculty Bibliography

This study examines the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) in patients undergoing total hip arthroplasty. Eighty-nine patients completed the WOMAC and SF-36 preoperatively and postoperatively. Standardized response means (SRMs) and effect sizes (ES) were used to measure responsiveness. Mean follow-up was 17 months. The SRMs for the WOMAC ranged from -0.93 to -1.49, and the ES ranged from -1.02 to -1.53. The SRMs for the SF-36 ranged from 0.22 to 1.64, and the ES ranged from 0.20 to 1.97. The highest values occurred with the physical functioning, bodily pain, and Physical Component Summary Scales. This study demonstrates a similar level of responsiveness of the WOMAC and several components of the SF-36. This suggests that the isolated use of the SF-36 may be adequate to monitor outcomes after total hip arthroplasty. There may still be a role for the WOMAC when comparing outcomes of specific designs or techniques of total hip arthroplasty.

The long-term projection of nipple reconstruction is a challenge. Fifty-eight consecutive female patients underwent 58 nipple reconstructions with modified top hat flap with cartilage graft following breast reconstruction in 54 autologous tissues and 4 implants, respectively. The average neonipple size was 11.5 mm initially and 8.5 mm at a mean follow-up of 44.9 months (range, 24-65 months), with a mean decrease in projection of 26.1%. Thirty-three patients achieved an excellent result, 20 patients a good result, 3 patients a fair result, and 2 patients a poor result, respectively. The complication rate was 12.1% (7 of 58 cases), and there was no statistically significant difference between the immediate and delayed groups; the revision rate was 8.6% (5 of 58 cases). The modified top hat flap with banked costal cartilage graft provides a sustainable solution to the gradual loss of nipple projection, with few complications.

The authors present a case of late postoperative infection after augmentation gluteoplasty in a 32-year-old pregnant woman. The case is unique in that it is the first documented example of a gluteal implant infection in a pregnant woman and because the infection was not preceded by trauma to the anatomic region.

Restoring volume in the middle and lower portions of the face is becoming an indispensable component of modern facial rejuvenation. Radiesse (BioForm Medical, San Mateo, Calif.) is an injectable filler material composed of synthetic calcium hydroxylapatite microspheres (30 percent) suspended in an aqueous carrier gel (70 percent). At present, Radiesse is indicated in the United States for correction of moderate to deep nasolabial folds and for correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. Its off-label use in other facial aesthetic indications is widely reported in the literature. The ability of Radiesse to provide immediate and durable effects has fueled interest in its use for expanded aesthetic applications, particularly in the middle and lower face. The authors' consensus panel, consisting of a cross-section of experts in plastic surgery, facial plastic surgery, and dermatology, was convened to review the scientific literature and compare clinical experiences regarding the use of calcium hydroxylapatite. This report describes the characteristic effects of aging in the middle and lower face and reviews the composition of calcium hydroxylapatite, its safety and durability, and its appropriate use in a variety of facial applications, including nasolabial folds, correction of human immunodeficiency virus-associated lipoatrophy, augmentation of the malar, submalar, and zygomatic regions, and correction of oral commissure defects, marionette lines, and prejowl sulcus. Recommendations for Radiesse use in each area, including anesthesia, and injection techniques are provided. Measures for enhancing patient comfort, anticipating and minimizing potential complications, and optimizing aesthetic results are also discussed

We present the case of an 18-year-old girl with McCune Albright Syndrome (MAS) and a near total mandibular defect reconstructed with a free fibula flap. There are three reports of mandibular reconstruction in a patient with MAS using the free fibula flap; however this case is unique for two reasons. One, the continuity defect in our patient was much larger than previously reported, representing nearly the entire length of the mandible (21 cm) and required the entire harvestable length of the fibula. Two, the progression of the patient's disease limited options for reconstruction and dictated the use of a fibula with small dysplastic changes.

BACKGROUND: Head and neck anatomy is complex and represents an educational challenge to the student. Conventional two-dimensional illustrations inherently fall short in conveying intricate anatomical relationships that exist in three dimensions. A gratis three-dimensional virtual reality atlas of craniofacial anatomy is presented in an effort to address the paucity of readily accessible and customizable three-dimensional educational material available to the student of head and neck anatomy. METHODS: Three-dimensional model construction was performed in Alias Maya 4.5 and 6.0. A basic three-dimensional skull model was altered to include surgical landmarks and proportions. Some of the soft tissues were adapted from previous work, whereas others were constructed de novo. Texturing was completed with Adobe Photoshop 7.0 and Maya. The Internet application was designed in Viewpoint Enliven 1.0. RESULTS: A three-dimensional computer model of craniofacial anatomy (bone and soft tissue) was completed. The model is compatible with many software packages and can be accessed by means of the Internet or downloaded to a personal computer. As the three-dimensional meshes are publicly available, they can be extensively manipulated by the user, even at the polygonal level. CONCLUSIONS: Three-dimensional computer graphics has yet to be fully exploited for head and neck anatomy education. In this context, the authors present a publicly available computer model of craniofacial anatomy. This model may also find applications beyond clinical medicine. The model can be accessed gratis at the Plastic and Reconstructive Surgery Web site or obtained as a three-dimensional mesh, also gratis, by contacting the authors.

BACKGROUND: The authors studied the effect of midface distraction on maxillary skeletal position and clinical appearance in patients with Crouzon, Pfeiffer, and Apert syndromes, and examined the stability of these changes at 1 year after distraction. METHODS: Fifteen consecutive patients (six male and nine female; average age, 5.9 years) underwent Le Fort III osteotomy with midface advancement using a rigid external distraction device. Six patients had Crouzon, five had Pfeiffer, and four had Apert syndrome. Midface advancement was initiated at the level of the occlusal splint and at the zygomatic/maxillary anchor screws. The device was activated 11 mm on average, at a rate of 1 mm per day. Twenty anatomical landmarks were identified and digitized at three time intervals, and displacement of each landmark was compared with its pretreatment position. RESULTS: By the time of device removal, point A had advanced sagittally along the x axis 15.85 mm and moved downward 1.06 mm along the y axis; the orbitale was moved sagittally along the x axis 12.72 mm and downward 1.99 mm along the y axis. Maximum mean advancement (17.16 mm) was observed at the upper incisal edge. Maxillary and mandibular skeletal discrepancy was significantly decreased, with the ANB angle changing from -5.87 to +13.17 degrees. At 1 year after distraction, point A had advanced an additional 0.81 mm, and the orbitale and upper incisal edge had moved posteriorly 0.07 mm and 1.34 mm, respectively. CONCLUSION: Significant midface advancement can be achieved and maintained with rigid external distraction of the Le Fort III osteotomy segment (up to 24 mm), with excellent stability of the advanced midfacial skeleton