Bryancurry5470

In comminuted facial fractures, peri-operative use of 3D-printed life size models is increasingly a useful adjunct. It allows for preoperative surgical rehearsal and plate bending, to achieve anatomical reduction with reduced operative time and cost. One problem encountered is difficulty contouring the fixation plate whilst maintaining the relative spatial orientation of comminuted fragments. This paper shares an effective method of overcoming this problem.

All comminuted facial fracture patients underwent counselling for 3D printing. Pre-printing thresholding and segmentation of each fragment (as directed by the surgeon) were done by the radiologist and the engineering team, using the multi-slice CT Face DICOM data. Life-size 3D-resin models of the fractures were printed. Fast-acting medium consistency cyanoacrylate glue (Zap-A-Gap

) and miniplates were used to assemble the printed model segments in 'anatomic reduction'. Aerosolized alcohol accelerator facilitated immediate glue curing, providing a stabcost.

The application of medium consistency fast-acting cyanoacrylate glue and miniplates facilitated the creation of the premorbid facial skeletal model and allowed pre-bending of the plates, thus saving operative time and cost.Though the thenar flap has been described since 1926, its use has not been widespread. The main criticisms are donor site morbidity and proximal interphalangeal joint (PIPJ) stiffness. In this paper, we describe a standard design technique for flap design and division to address these two issues. From July 2018 to April 2019, a total of ten patients underwent thenar flap reconstruction of the fingertip. The flap dimensions ranged from 10 mm × 10 mm to 25 mm × 15 mm. All the flaps survived. One patient developed wound infection post division. All donor sites were closed primarily without skin graft. We are using mirror image technique to elevate the flap to ensure that it is inset in the position as we planned without displacement. It largely reduced the chance of rotation and extensive tension when fix the finger to the thenar region. Our technique allows for the flap design to be individually customized based on the orientation of the defect, making it simpler and more replicable. We have also emphasized how care during division of the thenar flap can help prevent complications.

Cancer defects requiring anterior mediastinal tracheostomy (AMT) are complex, often accompanied by tracheo-laryngeal and pharyngeal defects with exposure of the great vessels and mediastinal cavity. The trachea has to be mobilised and exteriorised as an end-tracheostome through the anterior chest. A well-vascularised flap that can resurface skin defects, obliterate dead space and allow maturation of a reliable anterior mediastinal tracheostome is required. We describe a modification of using a centrally fenestrated bipedicled chimeric anterolateral thigh flap (ALT) to address these challenges.

A free chimeric bipedicled ALT flap was designed. The skin defect was resurfaced by a vertically-oriented skin paddle. Two chimeric muscle components were used to partition the mediastinum and the great vessels of the neck from the tracheostome. The mediastinal trachea was mobilised and matured through a centrally-fenestrated opening in the flap. Layered fascial sutures were employed to minimize dehiscence.

Two patients with AMT underwent the modified ALT. No major complications such as flap-tracheostomy dehiscence occurred. AZD1656 One patient had a small peripheral demarcation of the flap which required revision and secondary closure.

The bipedicled design of the modified ALT flap provided robust blood supply to the central fenestration through dual perforators, avoiding flap-tracheostomy separation. The chimeric muscle components obliterate dead space and protect the great vessels of the neck and mediastinum. The thin pliable nature of the anterolateral thigh skin also allowed for tensionless inset of the trachea.

The bipedicled design of the modified ALT flap provided robust blood supply to the central fenestration through dual perforators, avoiding flap-tracheostomy separation. The chimeric muscle components obliterate dead space and protect the great vessels of the neck and mediastinum. The thin pliable nature of the anterolateral thigh skin also allowed for tensionless inset of the trachea.[This corrects the article DOI 10.1016/j.gore.2017.12.006.][This corrects the article DOI 10.1016/j.gore.2020.100603.][This corrects the article DOI 10.1016/j.gore.2019.05.008.][This corrects the article DOI 10.1016/j.gore.2018.05.005.].[This corrects the article DOI 10.1016/j.gore.2019.03.003.][This corrects the article DOI 10.1016/j.gore.2019.100492.][This corrects the article DOI 10.1016/j.gore.2018.03.002.][This corrects the article DOI 10.1016/j.gore.2018.06.009.][This corrects the article DOI 10.1016/j.gore.2020.100611.][This corrects the article DOI 10.1016/j.gore.2020.100556.][This corrects the article DOI 10.1016/j.gore.2018.12.006.][This corrects the article DOI 10.1016/j.gore.2019.02.002.][This corrects the article DOI 10.1016/j.gore.2019.04.006.][This corrects the article DOI 10.1016/j.gore.2019.02.008.][This corrects the article DOI 10.1016/j.gore.2018.12.003.][This corrects the article DOI 10.1016/j.gore.2019.01.001.].[This corrects the article DOI 10.1016/j.gore.2018.03.007.][This corrects the article DOI 10.1016/j.gore.2019.03.005.][This corrects the article DOI 10.1016/j.gore.2020.100554.][This corrects the article DOI 10.1016/j.gore.2019.07.002.][This corrects the article DOI 10.1016/j.gore.2020.100581.][This corrects the article DOI 10.1016/j.gore.2018.07.001.][This corrects the article DOI 10.1016/j.gore.2018.10.009.][This corrects the article DOI 10.1016/j.gore.2019.03.017.][This corrects the article DOI 10.1016/j.gore.2019.07.005.][This corrects the article DOI 10.1016/j.gore.2019.07.010.][This corrects the article DOI 10.1016/j.gore.2018.05.008.][This corrects the article DOI 10.1016/j.gore.2018.05.012.][This corrects the article DOI 10.1016/j.gore.2018.08.004.][This corrects the article DOI 10.1016/j.gore.2020.100597.][This corrects the article DOI 10.1016/j.gore.2020.100598.].