Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite

BACKGROUND: Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. METHODS: We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. RESULTS AND DISCUSSION: The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed. CONCLUSION: The Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation

Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours

<p>Abstract</p> <p>Background</p> <p>surgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps.</p> <p>Methods</p> <p>Ninety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients.</p> <p>Results</p> <p>Wound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all.</p> <p>Conclusions</p> <p>Immediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.</p

Nasal reconstruction with local flaps: A simple algorithm for management of small defects

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Be familiar with subunits of the nose. 2. Understand various flaps used in nasal reconstruction. 3. Be able to choose a flap for the defect depending on its location, size, shape and orientation. BACKGROUND: Management of small defects in nasal reconstruction can be quite challenging. Location, size, shape, and orientation of the defects are important factors in determining the method used in reconstruction. METHODS: In this article, the authors retrospectively examined 300 cases where local flaps were used to reconstruct small nasal defects. The authors correlated the characteristics of those defects with the techniques used to reconstruct them. RESULTS: The authors found that certain flaps were used predominantly in reconstruction of certain defects. CONCLUSIONS: The authors were able to develop a simple algorithm for management of small nasal defects that may prospectively aid the planning of reconstructive strategy in these cases. Copyright © 2008 by the American Society of Plastic Surgeons

Dynamic Characterisation and Seismic Vulnerability Assessment of Existing Masonry Port Structures

This paper focuses on the dynamic identification and the seismic vulnerability assessment of an existing masonry port structure located in Livorno (Italy), which is a former railway station bombed and reconstructed after WWII. To this end, a historical-critical analysis, and an investigation and testing campaign has been carried out, along with a number of Ambient Vibration Tests (AVT). According to the Operational Modal Analysis (OMA), a Frequency Domain Decomposition (FDD) algorithm has been leveraged for dynamic identification. The severe noise around the harbour area and the poor soil quality make it difficult to identify the modal parameters of the structure, even if specific signal processing techniques were applied to remove the interferences. Although a ground sensor is not needed for output-only identification, it has been useful to identify a local phenomenon that it would have been arduous to figure out without its support. The investigations and the test outputs have been the baseline to create a finite element model, although not reproducing the real structural behaviour of some simplifying assumptions. However, the dynamic Structural Health Monitoring (SHM) outcomes have not been leveraged to calibrate it. A Modal Response Spectrum Analysis (MRSA) and a non-linear static (Pushover) analysis (POA) have been carried out to determine the structure capacity, and thus the Seismic Vulnerability Index (SVI) of the simplified model