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In This Issue of JAMA Facial Plastic Surgery
Mar/Apr 2014


JAMA Facial Plast Surg. 2014;16(2):77. doi:10.1001/jamafacial.2014.75

Prabhat K. Bhama, MD, and colleagues provide a review of 127 patients treated with microvascular free gracilis transfer for smile reanimation over a decade. The authors report quantifiable improvement of smile excursion, angle excursion, and symmetry of the oral commissure at rest and with smiling. Associations are identified between outcome measures and intraoperative measurements. The report advocates that use of gracilis free tissue transfer as a reliable procedure for dynamic reanimation of the paralyzed oral commissure.

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Continuing Medical Education

Scott A. Asher, MD, and colleagues present one of the largest series of patients (n = 115) treated with negative pressure dressings for head and neck wounds. Most patients had poor wound healing risk factors and complex neck wounds, including salivary contamination, bone exposure, great vessel exposure, recent free tissue transfer, and defects near laryngectomy stomas. The average treatment length was 4 days, and all wounds eventually healed. Four adverse reactions were reported, but there were no mortalities. The authors demonstrate the utility and safety of negative pressure wound therapy in patients with complex wounds and compromised wound healing undergoing head and neck surgery.

Marc W. Herr, MD, and colleagues evaluate the use of pedicled fasciocutaneous supraclavicular artery flaps for the reconstruction of head and neck defects in 24 patients. The authors describe their experience using the versatile flap to reconstruct various defects, including the pharyngeal wall, oral cavity, and as far away as the posterolateral skull base. The average size of the defects was 8 × 10 cm, and the largest defect measured 10 × 14 cm. Technical aspects of the flap harvest are highlighted in addition to the assessment of outcomes.

Donald B. Yoo, MD, and colleagues introduce a surgical technique that combines closed canthal suspension and lower eyelid retractor recession to address lower eyelid retraction in the setting of orbicularis weakness. The retrospective review presents outcomes from 29 patients with reduced orbicularis strength and lower eyelid retraction stemming from facial nerve disease, postblepharoplasty, involutional change, or idiopathic etiology. All patients had correction of eyelid malposition postoperatively with an average correction of 1.8 mm. There were no major complications, and patient satisfaction was reported as high. The authors suggest that preserving dynamic lower eyelid muscular support in this population makes attaining satisfactory outcomes more predictable.