9 research outputs found
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Use of Porcine Urinary Bladder Matrix in Socket Reconstruction After Pediatric Orbital Exenteration
Reconstruction options after orbital exenteration can be challenging, time-consuming, and require intensive postoperative care. Engineered dermal acellular matrices offer a quick and easy option for wound healing that has proven to be successful in various settings. Specifically, the porcine urinary bladder matrix has demonstrated success in periocular and orbital wound healing. This report describes a pediatric patient who underwent repair with porcine urinary bladder matrix after orbital exenteration for recurrent alveolar rhabdomyosarcoma. The patient did not require any additional reconstructive procedures. To our knowledge, this is the youngest patient to receive a porcine urinary bladder matrix after exenteration
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Eyelid Reconstruction
The reconstruction of eyelid defects poses a unique challenge to the surgeon due to the eyelids’ highly specialized functions and the critical importance of the eyelids in cosmesis of the face. An understanding of eyelid anatomy and principles of reconstruction unique to the periocular adnexa is key to achieving optimal functional and aesthetic results. In this chapter, we describe techniques for reconstruction of periocular defects with an emphasis on strategies that minimize complications and optimize cosmesis
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Reconstruction of total upper eyelid defects using a myocutaneous advancement flap and a composite contralateral upper eyelid tarsus and hard palate grafts
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"The Platysma Contraction Pattern in Healthy Adults: A Vector Analysis Study."
The platysma muscle's role in lower face dynamics is complex. Multiple insertion points to soft-tissue structures at various levels in the lower face create make for a multi-faceted contraction pattern. To avoid adverse effects in cosmetic procedures when targeting the platysma, its anatomy and physiology must be understood. Clinical observations hint to a bi-directional contraction pattern.
Eighteen healthy volunteers (13 women and 5 men) with a mean age of 44.2 ± 10.1 years were enrolled. Skin displacement vector analysis was used upon maximal platysma contraction to characterize and calculate the movement of the neck and lower-face skin.
In all of the participants a bidirectional movement of the skin was observed: the skin of the lower face and inferior to the jaw-line moved caudally, while the skin of the lower neck moved cephalad. Both movements converged at a line situated at 54±10 percent and 55±8 percent of the length between the clavicle and the inferior base of the ear lobe in men and women respectively (p = 0.70).
The platysma is a bidirectional muscle with a line-of convergence. While the superior portion acts as lip depressor, the lower portion elevates the skin of the upper chest and lower neck. This transition can explain some of the clinically observed adverse effects of neuromodulation of the neck area. It can potentially direct neuromodulation injections to focus above the convergence line to better address lower-face descent
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Lateral Tarsal Strip Complications With and Without Conjunctiva Stripping
PURPOSEThe lateral tarsal strip (LTS) procedure is commonly used to correct eyelid malposition. When performing LTS, some surgeons elect to remove conjunctiva from the tarsal strip, while others do not. It has been hypothesized that without conjunctival stripping, the buried conjunctival tissue can cause complications such as inclusion cysts and granulomas. However, there is limited data comparing LTS cases with and without conjunctiva removal. The authors sought to evaluate whether conjunctival stripping had any impact on complication rates with LTS. METHODSLTS operations for ectropion correction were retrospectively reviewed and were separated into 2 cohorts, Con (conjunctiva not removed) or Coff (conjunctival removed). Charts were reviewed for outcomes and complications including inclusion cyst formation, granuloma formation, wound dehiscence, infection, and focal rim tenderness. RESULTSThe complication rate was 10% versus 8% for Con versus Coff respectively (p = 0.54). The common complications of LTS surgery were granuloma (4%), wound dehiscence (3%), focal rim tenderness (3%), and infection requiring antibiotics (<1%). There was no significant difference in these complications between the Con and Coff cohorts. CONCLUSIONSComplications in both groups were minimal, similar to prior studies, and there was no difference between the 2 cohorts. While it has been suggested that buried conjunctiva may result in increased complication rates, the author's findings suggest that removing the tarsal conjunctiva is a superfluous step in the LTS surgery and does not affect complication rates
Does the histopathological subtype of primary basal cell carcinoma predict the subtype of secondary tumours? What role do genetic mutations play?
Abstract Background Basal cell carcinoma (BCC) is one of the most common malignancies in the world. The frequency of histopathological subtypes and the distribution on the body of BCC has been well documented. Less has been written on the nature of secondary tumours. The genetics of BCC is starting to be understood, particularly with the advent of newer medical treatments (hedgehog inhibitors). Objectives To determine if primary basal cell carcinoma histopathological subtype predicts secondary tumour subtype, as well as their anatomical distribution. Methods A retrospective case series of patients over the age of 18 was performed from 2009 to 2014, with at least two separate diagnoses of BCC. Results In 394 identified patients, a total of 1355 BCCs arose in the cohort over the 6‐year study period. The number of secondary BCCs per patient ranged from 2 to 19 tumours. Nodular BCC was the most likely to reoccur in secondary tumours (53.3%), followed by mixed subtypes (45.7%). Conclusions Within our study, we did find a predisposition for secondary BCCs to be of the same histopathological subtype as the primary, particularly with respect to nodular and mixed tumours. Furthermore, we found that secondary tumours were also more likely to occur on the same anatomical site as the primary tumour. We are only just beginning to under the genetic mutations involved in subtype formation