The fibula-free flap is commonly used to reconstruct mandibular defects, in part due to the abundant bone available. Most of the defects encountered result from head and neck cancer resections. As a result, many patients requiring mandibular reconstruction may have peripheral vascular disease significant enough to preclude use of a fibula-free flap. Most reconstructive surgeons have considered occlusion of 1 of the tibial vessels to be a contraindication for fibula-free flap harvest since the lower extremity would rely on a single vessel after the peroneal artery is harvested. Lance Oxford, MD, and Yadranko Ducic, MD, FRCSC, describe their experience with fibula-free tissue transfer when only 1 of the tibial vessels is patent. In their series, there were no wound complications or incidents of foot ischemia when carefully selected patients had fibula-free flaps harvested with 2-vessel runoff. This interesting approach could increase the number of patients who can undergo reconstruction with a fibula-free flap but stands in contrast to much of the current literature.
Forehead and midface-lifts are commonly performed endoscopically. Michael E. Villano, MD, and colleagues note that the endoscopic midface-lift clinically improved lower eyelid tone and tension. They prospectively studied changes in lower eyelid tension before and after the midface-lift. The data demonstrate that the midface-lift significantly increased lower eyelid tension 2 to 3 times at 4- to 6-month follow-up. The tension declined over time but remained elevated at 1-year follow-up. This study contributes to our understanding of the effects of midface-lifts and holds promise for addressing lower eyelid malposition from multiple cases.
Nathan Monhian, MD, and colleagues investigated the role of matrix metalloproteinases (MMPs) in the locally aggressive behavior of basal cell carcinomas. This class of enzymes provides a mechanism for tumor spread and invasion. In this study, Monhian et al compared enzyme levels in peritumoral tissue with postauricular skin in the same individual. Statistically significant elevations in MMP levels are found in peritumoral tissue in contrast to postauricular sites uninvolved with tumor. Previous studies by these investigators demonstrated differences between normal tissue and tumor tissue MMP levels but were less conclusive because the control tissue and tumor tissue were taken from different individuals.
The nasal septum plays an important role in both aesthetic and functional aspects of rhinoplasty. Deviations after significant trauma or rhinoplasty may result in a paucity of usable septal cartilage. Significant septal cartilage disruption presents a dilemma for surgeons, and creating a straight septum in situ may not be feasible. One option is the extracorporeal septoplasty in which the remaining septum is removed, reconstructed, and reimplanted. Wolfgang Gubisch, MD, presents his experience with extracorporeal septoplasty in more than 2000 patients. The technique involves creation of straight dorsal and caudal strut grafts with the available cartilage. These are then secured with suture fixation to the nasal spine and upper lateral cartilage layers. The use of spreader and dorsal onlay grafts are recommended to maintain straightness and eliminate dorsal irregularities. The author reports a low complication rate. He thoroughly describes the technique, with numerous recommendations to assist surgeons who perform difficult septal surgery.
La Donna della Finestra by Dante Gabriel Rossetti (1828-1882).Article
This issue’s Highlights were written by DeWayne Bradley, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2005;7(4):217. doi:10.1001/archfaci.7.4.217