A Novel Ear Cartilage Caudal Septal Extension Graft

Hossam M.T. Foda, Ahmed El Abany

In cases of weak or deficient caudal septum, the caudal septum extension graft (CSEG) is the most commonly used reconstructive method. In the current study the authors introduce a newly-designed conchal cartilage CSEG and evaluate its cosmetic and functional outcomes. The graft has an average length of 3 ± 0.3 cm and composed of a distal double-layered part, which is 3 to 4 mm wide and a proximal single-layered part, which is 1.2 to 1.7 cm wide. The graft design allows the proximal single-layered part to be fixed on either sides of the caudal septum while keeping the distal double-layered segment in the midline. The study included 230 patients, of which 83% were revisions, all patients completed a validated patient-reported outcome measure (PROM) questionnaire pre- and postoperatively. The PROMs used were either the Nasal Obstruction Symptom Evaluation (NOSE) survey or the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). During the mean follow-up period of 18.2 months (range: 9–192 months) no serious complications were encountered and only six cases (2.3%) required minor revisions of the CSEG.

Using the proposed conchal cartilage, CSEG resulted in an improved cosmetic and functional outcome as evidenced by the significant postoperative improvement in the NOSE, SCHNOS-O, and SCHNOS-C scores with a p-value <0.001, <0.05, and <0.0001, respectively. The graft provided adequate tensile strength and support to the nasal tip, which resulted in improved tip projection, rotation, definition, and symmetry, while maintaining a degree of flexibility and elasticity which is much more than that of the rib or even the septum thus resulting in the most natural feel of the nasal tip lobule.

Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review

Esther Goh, Shreya Kulkarni, Francisco Moura, Samuel Norton

Soft-tissue thumb defects are common reconstructive challenges, the main goals being restoration of tactile sensibility, range of movement, pulp padding, length, and cosmesis. The reverse-flow dorsoulnar and dorsoradial collateral artery flaps are homodigital flaps used to cover both distal dorsal and volar thumb defects. These flaps can be used as compound flaps including skin, fat, and/or nerves. As there is no critical analysis of these studies, this study aims to create a synthesized comprehensive systematic review.

Automated Decellularization of the Rodent Epigastric Free Flap: A Comparison of Sodium Dodecyl Sulfate–Based Protocols

Fuat Baris Bengur, Lei Chen, Benjamin K. Schilling, Chiaki Komatsu, Grace M. Figlioli, Kacey G. Marra, Lauren E. Kokai, Mario G. Solari

Free tissue transfer to cover complex wounds with exposed critical structures results in donor-site morbidity. Perfusion decellularization and recellularization of vascularized composite tissues is an active area of research to fabricate complex constructs without a donor site. Sodium dodecyl sulfate (SDS)-based protocols remain the predominant choice for decellularization despite the deleterious effects on tissue ultrastructure and capillary networks. The authors aimed to develop an automated decellularization process and compare different SDS perfusion times to optimize the protocol.

Managing Oromandibular Hardware Failure after Free Flap Surgery

Aaron M. Domack, Dustin A. Silverman, Alice L. Tang, Chad A. Zender, Yash J. Patil

Hardware failure after oromandibular reconstruction using free tissue transfer can delay additional therapies directed at cancer treatment and prevent patients from returning to normal oral function. Understanding and strict adherence to principles of rigid fixation is critical in preventing complications. Early surgical intervention for hardware exposure as well as utilization of locoregional flaps may prevent the need for more extensive revision surgery.