Category Archives: Plastic Surgery

PUBLISHED: Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars

Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars
Robert Dabek, MD1Harrison McUmber2Branko Bojovic, MD1,3
1Massachusetts General Hospital
2Tufts University School of Medicine
3Shriners Hospitals for Children – Boston

Burn injuries are often devastating accidents that result in long-term physical and psychosocial consequences and the formation of hypertrophic scars. Laser treatment is a low risk minimally invasive approach to treating such burn scars.

This video discusses the pulsed dye laser (PDL) and fractional ablative CO2 laser, and demonstrates their use in treating the scars on a pediatric patient who suffered from burn injuries 7 years ago in Vietnam.

PUBLISHED: Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion

Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion
Ryan P. Boyle1Jonah Poster2Jonathan Friedstat, MD3
1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
2Icahn School of Medicine at Mount Sinai
3Shriners Hospitals for Children – Boston

The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns.

Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity.

Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.

PUBLISHED: Local Tissue Advancement: Reconstructing Superior Helical Rim Defect and Exposed Ear Cartilage After Mohs Surgery

Local Tissue Advancement: Reconstructing Superior Helical Rim Defect and Exposed Ear Cartilage After Mohs Surgery
Cheryl Yu, MD1Derek Sheen, MD2Katherine M. Yu, MD1Sarah Debs, MD1Peter Kwak, MD1Kevin J. Quinn, MD3Thomas Lee, MD, FACS1
1Virginia Commonwealth University Medical Center
2University of Texas Southwestern Medical Center
3Mass Eye and Ear/Harvard Medical School

Reconstruction of external ear defects often poses various challenges due to the complex anatomy of the ear and its significant role in overall facial aesthetics. The location of the defect independently impacts the repair as various locations present distinct, additional factors to consider during planning. Specifically, defects of the superior auricle complicate the reconstructive process, due to the role of the helical root and superior rim in providing mechanical support for facial accessories such as glasses or hearing aids. The approach to reconstruction must be systematic while also being individually tailored in order to appropriately restore both optimal cosmesis and function.

The featured case involves the reconstruction of a full-thickness superior helix and auricular defect in a patient who wears eyeglasses with a cochlear implant on the same side. The discussion highlights the complexity of superior auricular reconstruction as well as the various surgical options used and challenges encountered.

PUBLISHED: Integra Scalp Reconstruction: Addressing a Full-Thickness Scalp Defect with Exposed Calvarium Along Vertex in an Elderly Immunocompromised Patient

Integra Scalp Reconstruction: Addressing a Full-Thickness Scalp Defect with Exposed Calvarium Along Vertex in an Elderly Immunocompromised Patient
Cheryl Yu, MD1Derek Sheen, MD2Katherine M. Yu, MD1Alyssa N. Calder, MD1Christopher J. Kandl, MD1Thomas Lee, MD, FACS1
1Virginia Commonwealth University Medical Center
2University of Texas Southwestern Medical Center

Reconstruction of full-thickness scalp defects often poses various challenges depending on the complexity and characteristics of the wound as well as independent patient health factors. Despite a range of reconstructive options ranging from primary closure, adjacent tissue transfer, and autografts to free flap reconstruction, there is no universally adopted decision algorithm.

Integra, an acellular matrix composed of crosslinked bovine collagen and glycosaminoglycan covered by a silicone membrane, is widely used for scalp reconstruction and has been shown to produce excellent functional and cosmetic results.

The featured case involves staged scalp reconstruction utilizing the Integra bilayer matrix wound dressing for an elderly immunocompromised patient presenting with two adjacent full-thickness scalp defects resulting in exposed calvarial bone over the vertex. The discussion centers on determining the most optimal scalp reconstructive option and exploring the treatment algorithm used at our institution. Furthermore, application of Integra for calvarial bone coverage will be discussed.

PUBLISHED: Blepharoplasty for Bilateral Upper Eyelids

Blepharoplasty for Bilateral Upper Eyelids
Lilit Arzumanian, MD1Alexander Martin, OD2John Lee, MD2
1Vardanants Center for Innovative Medicine
2Boston Vision

Upper blepharoplasty is one of the most commonly performed oculoplastic procedures. It is aimed at correcting the involutional changes of the upper eyelids, characterized by loose, excess eyelid skin (dermatochalasis) and preaponeurotic fat herniation (steatoblepharon) as well as some cases of ptosis. These conditions could result in functional symptoms, such as reduced visual fields, as well as cosmetic concerns and perceived body dysmorphia.

In this case, the patient underwent upper blepharoplasty for cosmetic improvement and to remove xanthomatous lesions. This article discusses and demonstrates the preoperative assessment of the patient, the preparation, the surgical technique, and possible complications.

PUBLISHED: Basal Cell Carcinoma Excision from the Lower Lip with Versatile Keystone Flap for Vascularized Skin Replacement

Basal Cell Carcinoma Excision from the Lower Lip with Versatile Keystone Flap for Vascularized Skin Replacement
Geoffrey G. Hallock, MD
Sacred Heart Campus, St. Luke’s Hospital

Maintenance of intact skin throughout the body is essential to prevent dehydration, to act as a barrier to infection, to allow unrestricted movement, and to provide a normal appearance. A flap is a piece of body tissue, usually skin and fat, that always has its own blood supply. Therefore, a flap can be moved anywhere it can reach without worrying about the circulation present at the place that needs it, which is called the recipient site. When compared with all other possible choices, a flap best meets all the requirements for any area needing skin replacement.

The keystone type flap as one such option is so named because its design has the shape of the keystone of a Roman arch. If taken from loose tissues adjacent to a defect, it can be simply cut and advanced for any necessary skin coverage. Direct closure of the donor site where this flap comes from is possible so that usually a quite good overall cosmetic result is also obtained. These virtues are shown as an overview in this video where a keystone flap is transferred after removal of a common basal cell skin cancer from the lower lip.

PUBLISHED: Local Tissue Rearrangement for Hypertrophic Chemical Burn: Z-Plasty and VY-Plasty

Local Tissue Rearrangement for Hypertrophic Chemical Burn: Z-Plasty and VY-Plasty
Daniel N. Driscoll, MD, FACS¹; Lisa Gfrerer, MD, PhD²; Robert Dabek, MD³; Aleia M. Boccardi*
¹Shriners Hospitals for Children – Boston
²Harvard Plastic Surgery Combined Residency Program
³Massachusetts General Hospital
*Touro University College of Osteopathic Medicine

Hypertrophic scarring following burn injuries has been shown to occur in up to 70% of patients, potentially causing both long-term psychological and physical morbidity. Increased rates of depression and anxiety are seen to arise from aesthetic dissatisfaction, affecting patient rehabilitation and subsequent societal interaction. Mobility is jeopardized from contractures that develop within the damaged tissue, leading to decreased range of motion and function of the area. Both sequelae leave the patient with an overall decreased quality of life.

Surgical techniques involving local tissue rearrangement, including Z-plasty and VY-plasty can be employed to improve both the function and cosmetic effects of burn scars. Essentially, these techniques illicit a decrease in tension through a lengthening of contracted tissue of up to 50–70%, allowing for better static alignment and increased mobility over joint surfaces. This video depicts the combination of both tissue rearrangement techniques as applied to hypertrophic scar contractures resulting from prior burn injuries. These techniques are an invaluable part of a reconstructive surgeons’ armamentarium when approaching scar revision.

PUBLISHED: Reconstruction of a Large Nasal Cutaneous Defect Using Nasolabial and Rhomboid Flaps

Reconstruction of a Large Nasal Cutaneous Defect Using Nasolabial and Rhomboid Flaps
Ajaipal S. Kang, MD, FACS
UPMC Hamot

Resection of cutaneous malignancies may result in substantial skin defects. Often, skin grafting is a first-line option for reconstruction of such defects but may be limited by poor cosmetic outcomes and incomplete graft acceptance. Accordingly, skin flaps, tissue rearrangement techniques, and more complex procedures may be needed. This case report presents the successful use of a combination of nasolabial flap and rhomboid flap for reconstruction of a 3-cm × 2-cm left nasal sidewall and ala skin defect that remained following a basal cell cancer Mohs resection. The flaps were quickly and easily fashioned, did not require any special instruments, and resulted in a good cosmetic outcome. There were no wound complications and the flaps healed completely with excellent contour, texture, thickness, color match, and complete patient satisfaction. This case is an example of the technical aspects of successful planning, elevation, and inset of a nasolabial flap and rhomboid flap.

PUBLISHED: Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Jonah Poster
Shriners Hospitals for Children – Boston

Jonathan Friedstat, MD
Shriners Hospitals for Children – Boston
Massachusetts General Hospital

Burn scar contracture of the dorsal foot causes metatarsophalangeal joint hyperextension and interphalangeal joint hyperextension. In children, these issues only intensify over time as a child grows. Here, Dr. Friedstat at Shriners Hospitals for Children in Boston presents the case of a young boy who suffered a 32% total body surface area flame burn to his lower back, bilateral buttocks, legs, and feet. This patient had previously undergone a bilateral contracture release of the dorsum of the foot. Because the contractures recurred, another bilateral dorsal foot scar contracture release was performed using a split-thickness 1:1 meshed skin graft harvested from the anterior left thigh.

Preprint Release: Bilobed Nasolabial and Rhomboid Flaps for Repair of a Left Nasal Ala Defect Following Basal Cell Cancer Excision

Bilobed Nasolabial and Rhomboid Flaps for Repair of a Left Nasal Ala Defect Following Basal Cell Cancer Excision
UPMC Hamot

Ajaipal S. Kang, MD
Cosmetic, Plastic & Reconstructive Surgery Specialist
UPMC Hamot

In this case, Dr. Ajaipal Kang at UPMC Hamot performs a bilobed nasolabial flap and a rhomboid flap to close a left nasal ala defect that remained following an excision of a basal cell cancer.