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In This Issue of JAMA Facial Plastic Surgery
Nov/Dec 2015


JAMA Facial Plast Surg. 2015;17(6):393. doi:10.1001/jamafacial.2014.959

Sharafi and colleagues performed a retrospective analysis of septorhinoplasty patients who had dorsal reductions greater than 3 mm to determine whether a newly designed triangular-shaped flap of upper lateral cartilages can prevent secondary deformity of the nasal dorsum in the keystone area. In the 38 patients who were evaluated, no irregularities were observed in the postoperative photographs or found on digital examination of the keystone area after at least 12 months of follow-up.

Jung and coauthors describe the various techniques that can be used to correct dimpling of the nasal tip caused by complications related to augmentation rhinoplasty techniques in Asian patients. Retrospective analysis demonstrated that the nasal contour and tip symmetry were restored to aesthetic standards with these relatively simple techniques. Eleven patients (39.2%) were treated with unilobed flap, 4 (14.2%) with a bilobed flap, 3 (10.7%) with Z-plasty, 9 (32.1%) with soft-tissue interposition, and 1 (3.5%) with a transposition flap. Twenty-four of the 28 patients (85.7%) were satisfied with their outcomes, and 4 (14.3%) patients were dissatisfied and were given a revision procedure, following which they were satisfied with their outcomes.

Leary and colleagues sought to experimentally simulate how resection of cephalic trim alters the stress distribution within the human nose in response to nasal tip depression (palpation) and to simulate the internal forces generated after cephalic trim that may lead to alar rim retraction cephalically and upward rotation of the nasal tip. Three models were created: a control, a conservative trim, and an aggressive trim. Each simulated model was imported to a software program that performs mechanical simulations, and material properties were assigned. Computerized simulations revealed that the degree of nasal tip rotation and alar rim retraction is dependent on the amount of cartilage that was resected owing to cephalic trim. In an Invited Commentary, Pawar and Rhee discuss the possibilities of computer modeling and simulation.

Invited Commentary

Beckler and coauthors performed a retrospective analysis of patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis. The objective was to assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion. They found that the use of ICGA may reduce the risk of partial skin flap necrosis, especially in those patients requiring large bilobed skin paddles for through-and-through oromandibular reconstruction or in whom the flap skin paddle extends beyond the primary and adjacent angiosomes of the supplying vessel. In an Invited Commentary, Ducic discusses intraoperative free tissue transfer reconstruction.

Invited Commentary