Indian Journal of Plastic Surgery最新文献

Total temporomandibular joint replacement (TMJR) is a surgical intervention employed for the management of advanced temporomandibular joint (TMJ) disorders, particularly when autogenous grafts are not recommended. With stainless steel implant of glenoid fossa attempted for the correction of ankylosis in the 1960s, total TMJR-which minimizes foreign body reaction and consists of highly biocompatible materials such as Cr-Co-Mo alloy, titanium, and ultra-high-molecular-weight polyethylene-began to be applied. These alloplastic prostheses are available in both standardized and customized forms, comprising components for the mandibular condyle and glenoid fossa. The present case report presents India's first TMJR in a 12-year-old female patient with TMJ ankylosis. Total TMJR was done in her with India's first customized TMJ prosthesis (Samsid TMJ prosthesis), which was designed and manufactured by the author for the first time in India. This study presents a 16-year follow-up of customized TMJR, addressing TMJ ankylosis. Our research showcases the long-term success of Samsid TMJ prostheses in improving pain, oral function, diet, and overall quality of life. The case report also highlights the potential of Samsid TMJ prostheses as a valuable solution for TMJ patients, emphasizing the importance of tailored solutions for lasting joint function restoration. The results presented indicate that the Samsid patient-fitted total TMJR system remains a secure, efficient, and dependable long-term treatment option for the particular patient demographic examined in this research.

Resection of advanced oral malignancies often leads to extensive composite tissue defects, which may involve skin, oral mucosa, mandible, and a significant amount of soft tissue. While the free fibula flap remains the primary choice of reconstruction, there are instances where a second flap is necessary for coverage. In such cases, the anterolateral thigh (ALT) flap is commonly employed as a second free flap. We recently utilized a superficial circumflex iliac artery perforator (SCIP) flap in combination with the free fibula flap to reconstruct a large oromandibular defect. This report emphasizes the significance of the SCIP flap and the benefits of combining free flaps, supported by relevant literature.

We present the case of a 36-year-old male patient with a posttraumatic composite defect of the lower two-thirds of the anterior aspect of the left leg with exposed necrotic tibia in an old, neglected type 3b fracture of the tibia of 9-month duration. The options for definitive soft-tissue cover include microvascular free tissue transfer and cross-leg flaps. In trauma cases, the surrounding tissue is usually damaged, and the recipient vessels are frequently implicated, ruling out the use of a microvascular free flap. Cross-leg flaps are unachievable due to large defect sizes and lack of appropriate donor tissue. In this case report, we highlight the use of cross-leg microvascular free anterolateral thigh (ALT) flap cover for the composite leg defect. By presenting our case, we aim to advocate the clinical application of cross-leg free flap surgery in vessel-depleted limbs as a safe and viable option.

Traditionally, burn reconstructions have been performed by the use of skin grafting or local flaps. Recently free flaps are being used with increasing frequency. Although not very common in the head neck region, free flaps are mostly used for secondary reconstructions of cervicofacial contractures. We report the role of free flaps in postburn facial reconstructions, excluding neck and scalp burns. Sixteen free flaps used for postburn facial reconstructions were reviewed retrospectively, during the period between 2003 and 2023. The etiology, indications, timing, location, choice of the flap, type of reconstruction, and outcomes were analyzed. Indications and type of reconstructions were categorized to correlate with flap choice. The age of the patients ranged between 8 and 40 years. The etiology included electrical burns in six cases, flame burns in eight cases, and acid burns in two cases. Nine defects were in the central part of the face including the nose and the chin. Two primary and 14 secondary reconstructions were performed using free flaps from lateral thigh in 11 cases, lateral arm in 2 free flaps cases, radial forearm in 2 free flaps cases, and the posterior auricular flap in 1 case. There were no total flap failures. Secondary procedures were needed in 10 of 13 evaluable patients. Free flaps provide a good and safe option for selective postburn reconstructions in the face. The choice of flap mainly depends on the indication and type of reconstruction needed, apart from the availability of donor tissue and the surgeon's preference. Complex reconstructions may need larger and composite flaps to replace the components. Multiple secondary procedures are needed to achieve the objectives.

Chin augmentation can dramatically transform a patient's appearance. Various techniques are in use, each with their specific problems and limitations. We present the first case report from the Indian subcontinent using a custom 3D-printed, bioresorbable polycaprolactone implant. We demonstrate, by appropriate imaging, the replacement of the implant at long-term (22 months) follow-up by patient's own autologous bone formation. An excellent aesthetic result was achieved. Relevant points of technique, as well as pertinent properties of the material, are discussed. This material has been used in neurosurgery and in the management of orbital fractures. Yet, worldwide, very few (3-4) cases of chin implant have been done using this material. We believe this to be a useful and sustainable material, offering several advantages, as set out in the case report.

Objective   To determine the choice of flap cover for patients presenting with bilateral lower limb trauma requiring free flap cover and to derive a step-wise guide to the planning of bilateral lower limb free flaps. Materials and Methods  This was a retrospective study of patients over a 20 year period from 2000 to 2020 who presented with bilateral lower limb defects following trauma and were managed with two free flaps for wound cover, done either simultaneously or sequentially in the same admission. Results  Of the 11 cases with 22 defects, there were 3 re-explorations with 1 flap loss managed with delayed fasciocutaneous flap cover. Donor morbidity was minimal requiring aspiration of seroma for 1 patient and secondary SSG for recipient area graft loss over muscle flap in 2 patients. Conclusion  Use of single donor site ensures economy of time and tissue with the use of skin and muscle chimeric flaps. Harvesting of twin ALT flaps or the use of lattisimus dorsi as one of the flaps requires a 2 stage surgery to avoid prolonged operative time.

Childhood scars can lead to hideous aesthetic and functional deformities in young adults, which can be particularly distressing when involving the face and the breast in a female. Aesthetic restoration requires replacement of the whole or a part of the scarred skin by soft, pliable, and texture-matching skin, which nearly always is in short supply. Dermal regeneration templates (DRTs) can help in skin regeneration that is almost always aesthetically superior to most flaps. Aesthetic demands at the time of final restoration may require the regenerated skin to be moved as a local flap. As regenerated skin from dermal templates is known to match the vascularity of normal native skin, raising it as a flap should follow logically. This, however, has never been attempted to the best of our knowledge after a thorough literature search. We report a case of successfully using DRT-generated skin raised as a flap for aesthetic reconstruction of a postburn scarred breast in a young female. This adds a whole new dimension to the use of DRTs and points to a new field of research in scar management and aesthetic restoration.

Background  Maxillary reconstruction poses unique challenges for the reconstructive surgeon because of the complex three-dimensional (3D) anatomy of the maxilla. Undertaking this endeavor on secondary reconstruction makes it more difficult due to problems in recreating the true defect. This study is an attempt to demonstrate the role of virtual surgical planning (VSP), 3D printing, and mock surgery in reconstructing such defects using free fibula flaps. Materials and Methods  This was a prospective study involving 10 patients of maxillary defects who underwent delayed reconstruction with a free fibula flap. The planning was done preoperatively using computer-aided design and computer-aided manufacturing (CAD-CAM) technology. A mock surgery with 3D printed models was done before the surgery. After the surgery, the accuracy results were obtained by overlapping and measuring fixed point distances between preoperative virtual planning and postoperative computed tomography (CT) scan data. Results and Discussion  Nine patients underwent successful reconstruction and were satisfied with the outcome. One patient had flap loss. The mean shift along the horizontal, vertical, and 3D axes was less than 5 mm between the preoperative virtual planning and postoperative CT scan data, indicating accurate reconstruction. We also suggest strategies for soft-tissue and bony inset including inferolateral pedicle origin, anteriorly facing lateral fibular surface, and two bony struts for the alveolus. Conclusion  VSP and CAD-CAM technology in maxillary reconstructions help achieve an anatomically accurate neo-maxilla. The addition of mock surgery to the routine and the use of cutting guide avoid unpredictability and reduce the need for adaptation activities on the operating table. CAD-CAM technology despite its limitations is invaluable in maxillary reconstruction and is an important tool for a reconstructive plastic surgeon.

Cleft foot is a rare congenital anomaly (syndromic/isolated). Although there have been published reports about this anomaly, none has so far described standardized treatment guidelines. In this case report, we describe the details of operative management of an isolated cleft foot in an 8-year-old girl with a brief review of literature, keeping in mind the aims of the treatment, governed by the local culture and preferred footwear design in the Indian scenario.