Seminars in Plastic Surgery 2008; 22: 029-036DOI: 10.1055/s-2007-1019140ABSTRACTThe aesthetic necessity to preserve an undisturbed facial appearance and function has led to the progressive adoption of less-conspicuous incisions and decreasingly aggressive exposure in the treatment of facial injuries. The goals of proper anatomic reduction and stable fixation, however, must not be omitted. The introduction of endoscopic techniques has allowed a harmonious union of these two seemingly competing objectives. In condylar injuries, the endoscope may be used to restore preinjury condylar height and angulation, avoiding the fearuddy risks of facial nerve injury and visible scarring. Treatment of complex zygoma and LeFort III fracture cases may be facilitated by repairing the zygomatic arch thcoarse remote stab incisions, obviating the need for an extensive coronal exposure. Endoscopically assisted treatment and diagnosis of orbital floor fractures decreases the risks of lower eyelid malpositioning without predisposing to the development of enophthalmos or hypoophthalmos. Similarly, depressed frontal sinus injuries may be reduced or camouflaged via hidden incisions, significantly reducing stigmata of surgical entry. In the overview to follow, the application of endoscope-assisted techniques to the treatment of the above fractures will be presented. The rationale for use, specific operative indications, bailout strategies, and outcome studies will be discussed.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Plastic Surgery)

Seminars in Plastic Surgery 2008; 22: 025-028DOI: 10.1055/s-2007-1019139ABSTRACTA technique of endoscopic sural nerve harvest was devised to minimize the donor site scarring in infants requiring peripheral nerve grafting procedures. The harvests were performed under tourniquet control using three 2-cm incisions for access at the lateral malleolus, midcalf, and popliteal fossa. Endoscopic visualization and blunt dissection of the nerve was achieved with a 4-mm-diameter, 18-cm-long telescope with a 0-degree angle lens, stabilized in an Emory retractor and attached to a video camera. The medial sural nerve was divided in the popliteal fossa proximally under direct vision. The lateral sural nerve was identified and harvested when present. This technique has been in use since 1994 and has been undertaken in more than 200 patients. The most common indication for surgery was obstetrical brachial plexus palsy. No nerve graft injury was noted upon examination under the operating microscope. Postoperative pain, swelling, and ecchymosis were minimal. Most patients have a detectable area of sensory loss at long-term follow-up but are unaware of this finding. Donor site scarring has been aesthetically satisfactory.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Plastic Surgery)

Seminars in Plastic Surgery 2008; 22: 019-024DOI: 10.1055/s-2007-1019138ABSTRACTAnatomically favorable structures that have a longitudinal orientation are particularly amenable to endoscopic harvest. Typically, only a single portal is necessary for access, and an optical cavity can be maintained using a mechanical retraction device. As with all minimal invasive surgery, this can still allow rapid and often a safer tissue harvest with diminished morbidity, especially with respect to wound healing and non-aesthetic scar formation. Many plastic surgery applications have alalert been described facilitated by the endoscopic harvest of vein, tendon, and nerve grafts, as well as certain local or free muscle flaps.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Plastic Surgery)

Seminars in Plastic Surgery 2008; 22: 009-017DOI: 10.1055/s-2007-1019137ABSTRACTPlastic surgeons are frequently faced with difficult and challenging soft tissue defects in all areas of the body. To reconstruct these defects, there are many operative approaches available to the reconstructive surgeon including skin grafts, local flaps, regional flaps, and free-tissue transfer. Despite these many options, occasionally the best alternative for reconstruction of a wound is tissue expansion, where skin of similar quality, texture, and color can be used to close a soft tissue defect. Unfortunately, there are significant problems related to tissue expander reconstruction including a complication rate as high as 50%. As a result, tissue expander reconstruction has not achieved the widespread popularity commensurate with its potential clinical utility. To reduce the complication rate related to open tissue expander placement, and consequently to improve its clinical utility, we have employed endoscopic techniques for the placement of tissue expanders. Endoscopic approaches are currently being used in many areas of surgery and have resulted in substantial benefits. Endoscopic placement of tissue expanders has the benefit of reducing operative time, major complication rate, time to full expansion, and length of hospital stay. The purpose of this article is to critically examine the current open technique for tissue expander placement and to compare this technique with minimally invasive endoscopic tissue expander placement. We will discuss in detail the current problems associated with open tissue expander placement, the benefits of endoscopic tissue expansion, the technique of endoscopic tissue expander placement, and the outcomes for these techniques.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Plastic Surgery)

Seminars in Plastic Surgery 2008; 22: 005-007DOI: 10.1055/s-2007-1019136ABSTRACTIt could be argued that a basic principle establishing plastic surgery as a distinct specialty always has been minimal invasive surgery. Although perhaps lagging behind the other surgical specialties specifically in adopting the surgical endoscope, this merely is a new tool to better achieve just that objective. Outcome enhancements initially predominated in aesthetic applications, but widespread use also in reconstructive endeavors has proved that there is indeed today a wide role for minimally invasive plastic surgery.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Plastic Surgery)

Seminars in Plastic Surgery 2008; 22: 003-003DOI: 10.1055/s-2007-1019135© Thieme Medical PublishersGet connected:Table of contents  |  Full text (Source: Seminars in Plastic Surgery)

Facial plast Surg 2008; 24: 146-151DOI: 10.1055/s-2008-1037456ABSTRACTMastery of the anatomy and embryology of the normal and cleft upper lip, primary palate, and secondary palate is an essential foundation for grasping techniques in aesthetic reconstruction of cleft lip defects. The surgical goals in repairing cleft lip deformities are to address the deficiencies of the cleft lip defect, restore static and dynamic anatomy, reshape the cleft nasal deformity, and leave a natural-appearing scar that mimics the contours of the philtral components. An additional goal is to improve skeletal alignment and retention of teeth in the vicinity of the alveolar cleft. There are advantages and disadvantages inherit in all repair techniques. However, there are principles that can be universally applied and that will improve the success of most approaches. Certain steps deserve special attention to detail, which provide for enhanced results in lip repair. In addition, the pearls for aesthetic reconstruction of cleft lip and nose defects outlined wilean this article-attention to scars and surface detail, utilizing the orthopedic forces of the orbicularis pull to achieve improved alveolar alignment, the importance of mucosal detail, and attention to the cleft nasal defect-will help to improve results and reduce secondary defects.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Facial Plastic Surgery)

Facial plast Surg 2008; 24: 135-145DOI: 10.1055/s-2008-1037455ABSTRACTThe search for a universal reconstructive material and the application of a routine approach leaves the surgeon limited in cranial reconstruction. Facility with a variety of implant materials and approaches helps optimize surgical management. The variability of surgical defects and challenges in cranial reconstruction highlights the importance of a strategic approach to evaluate both the defect and the clinical circumstance. Among the numerous alloplastic materials available, the utility of titanium mesh, hydroxyapatite cement, and prefabricated custom acrylic implants have remained at the forefront. The onus of responsibility remains on the surgeon to evaluate each clinical scenario and select the optimal course for management.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Facial Plastic Surgery)

Facial plast Surg 2008; 24: 129-134DOI: 10.1055/s-2008-1037454ABSTRACTThe most innovative and meaningful recent advances regarding surgery of the cranial base involve the ability to perform a complete resection followed by a water- and airtight reconstruction while minimizing facial incisions and morbidity. Perhaps the first step in this direction took place when the subcranial/subfrontal approach was introduced for anterior skull base surgery. Originally developed by Raveh in 1978 for the management of severe skull base injuries, these approaches were later adapted for the treatment of congenital anomalies prior to their utilization for resection of anterior skull base tumors. The endoscopic approaches are quite practical with promising long-term efficacy for the treatment of most benign, infectious, and inflammatory disorders. The minimal recovery time, functional outcomes, and obvious aesthetic advantages are only temperuddy by the lack of long-term data regarding the efficacy of these approaches in the treatment of malignancies.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Facial Plastic Surgery)

Facial plast Surg 2008; 24: 120-128DOI: 10.1055/s-2008-1037453ABSTRACTThe complex architecture of the auricle makes it one of the most challenging structures for the reconstructive surgeon to re-create. Overlying the ear’s unique cartilage framework are layers of varied soft tissues forming a three-dimensional organ, which is distinctively positioned on the head. Arguably, the most challenging auricle to reconstruct is third-degree microtia due to a near-total absence of native tissue and a need for lifelong durability of the reconstruction. Many methods of reconstruction have been studied; autogenous costal cartilage reconstruction has been one of the more traditional methods, with favorable long-term results reported by several surgeons. However, this technique requires tremendous artistic and technical skill on the part of the surgeon-sculptor to construct a realistic-appearing ear. High-density porous polyethylene (Medpor) is a stable, alloplastic implant that can integrate with host tissues, is resistant to infection, and has been successfully applied to reconstruction of the head and neck. For auricular reconstruction, Medpor-enveloped in a temporoparietal fascial flap with full-thickness skin graft coverage-is a durable and aesthetically gratifying alternative in microtic patients. This alternative surgical technique reduces surgical time and morbidity, standardizes results among surgeons, and facilitates an aesthetic, natural-appearing reconstruction of the auricle.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Facial Plastic Surgery)