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The Cleft Palate-craniofacial Journal :... Sep 2023One of the most common complications of total auricular reconstruction is exposure of the ear framework. Various reconstruction methods have been reported depending on...
One of the most common complications of total auricular reconstruction is exposure of the ear framework. Various reconstruction methods have been reported depending on the location and size of exposed cartilage. This report describes a safe reconstruction method for each exposed part of the grafted ear framework. From January 2019 to August 2021, 2 cases (4 areas) of framework exposure were observed following autologous microtia reconstruction. The first case developed 2 small areas of skin necrosis on the anterior helix and lower antihelix to concha. The former was reconstructed with a temporal fascia flap and the latter with a local transposition flap. The second case also developed 2 small areas of skin necrosis on the posterior helix and lower antihelix to concha. The former was sutured directly and the latter with a local transposition flap. However, both wounds recurred due to flap necrosis and the cartilage was exposed again. The 3rd operation was performed by covering both wounds with a posterior auricular turnover flap and skin graft. In both cases, the exposed framework was completely covered with the flaps, and the reconstructed ears showed well-defined convolutions. Covering exposed cartilage with a local flap with a random pattern of blood circulation is convenient because no additional skin grafts are required. However, the blood circulation of the flaps is inadequate when an elongated flap is required; consequently, flap necrosis may occur. On the other hand, a temporal fascia flap and posterior auricular flap, which have axillary pattern blood circulation, are considered to be safer. We believe that it is safe to use a temporal fascia flap for cartilage exposure in the upper half of the auricle, and a posterior auricular turnover flap for the lower half.
Topics: Humans; Congenital Microtia; Surgical Flaps; Ear, External; Skin Transplantation; Postoperative Complications; Necrosis
PubMed: 35450440
DOI: 10.1177/10556656221095389 -
Revista Clinica Espanola Feb 2023Retinal vein occlusion (RVO) and nonvalvular atrial fibrillation (NVAF) are associated with vascular risk factors (VRF) and aging. The aim of this study is to analyze...
INTRODUCTION AND OBJECTIVES
Retinal vein occlusion (RVO) and nonvalvular atrial fibrillation (NVAF) are associated with vascular risk factors (VRF) and aging. The aim of this study is to analyze differences in the prevalence of VRF, vascular events, glaucoma, and anticoagulant treatment in patients with NVAF and RVO compared to a control group of the general population from the same geographic area.
METHODS
This is a prospective, single-center, case-control study. All patients diagnosed with RVO from December 2008 to March 2020 as well as a control group were included. Clinical, laboratory, electrocardiographic, and carotid ultrasound variables were analyzed.
RESULTS
A total of 386 patients with RVO and 343 controls were studied. Patients with RVO and NVAF were older and more of them had hypertension, a history of vascular events, and carotid atheromatosis than subjects with RVO without NVAF. In patients with NVAF who were on anticoagulants, those who had RVO differed from the controls with NVAF in that they had a higher prevalence of glaucoma (32 vs. 5.3%; p<0.034), with no significant differences regarding age, VRF, vascular events, or type of anticoagulant therapy (acenocumarol or direct-acting oral anticoagulants).
CONCLUSIONS
Patients with RVO and NVAF were older and had a higher prevalence of hypertension and carotid atheromatosis than subjects with RVO without NVAF. Patients with NVAF and RVO had higher prevalence of glaucoma than subjects with NVAF without RVO. In patients with NVAF, it is recommended to optimized VRF treatment and glaucoma control to prevent the development of RVO.
Topics: Humans; Atrial Fibrillation; Case-Control Studies; Prospective Studies; Retinal Vein Occlusion; Anticoagulants; Risk Factors; Hypertension; Carotid Artery Diseases; Glaucoma
PubMed: 36669741
DOI: 10.1016/j.rceng.2022.11.005 -
Pacing and Clinical Electrophysiology :... Feb 2019Transcutaneous stimulation of the auricular branch of the vagus nerve (AB-VNS) is a potentially noninvasive, inexpensive, and safe approach for vagus nerve stimulation...
BACKGROUND
Transcutaneous stimulation of the auricular branch of the vagus nerve (AB-VNS) is a potentially noninvasive, inexpensive, and safe approach for vagus nerve stimulation that suppresses the induction and duration of atrial fibrillation and reduces sympathetic nerve outflow in healthy humans. Researchers have not determined whether AB-VNS affects ventricular arrhythmias.
OBJECTIVE
To evaluate the antiarrhythmic effects of noninvasive AB-VNS on ventricular arrhythmias induced by myocardial infarction (MI).
METHODS AND RESULTS
Twelve beagle dogs were randomly divided into the following two groups: a AB-VNS group (coronary artery occlusion and noninvasive AB-VNS) and a control group (coronary artery occlusion but without AB-VNS). We examined spontaneous ventricular arrhythmias, ventricular electrophysiological properties, and cardiac function in conscious dogs. Morphology, fibrosis, and ultrastructures were also assessed. AB-VNS significantly reduced the occurrence of spontaneous ventricular arrhythmias, including isolated premature ventricular complexes, ventricular couplets, ventricular bigeminy, ventricular trigeminy, and ventricular tachycardia. AB-VNS effectively increased ventricular electrical stability, including significantly prolonged ventricular effective refractory periods, decreased the dispersion of effective refractory period, enhanced the ventricular fibrillation threshold, and decreased the maximum slope of the monophasic action potential duration restitution curve. AB-VNS treatments alleviate ventricular interstitial fibrosis after MI. However, cardiac function was not improved, and MI-induced ultrastructural changes in the myocardium were not reversed by 4 weeks of AB-VNS. In addition, AB-VNS for 4 weeks resulted in mild mitochondrial swelling within the neuronal axons of the auricular vagus fiber.
CONCLUSIONS
Noninvasive AB-VNS reduces the occurrence of spontaneous ventricular arrhythmias in conscious dogs with MI. AB-VNS increases ventricular electrical stability and alleviates ventricular interstitial fibrosis induced by MI.
Topics: Animals; Arrhythmias, Cardiac; Dogs; Electrophysiologic Techniques, Cardiac; Female; Male; Myocardial Infarction; Random Allocation; Vagus Nerve Stimulation; Ventricular Function
PubMed: 30552763
DOI: 10.1111/pace.13585 -
Aesthetic Plastic Surgery Jun 2016Hyaluronic acid (HA) injection-induced embolism is a rare but severe complication. This article is aimed to introduce an islanded rabbit auricular skin flap model of HA...
BACKGROUND
Hyaluronic acid (HA) injection-induced embolism is a rare but severe complication. This article is aimed to introduce an islanded rabbit auricular skin flap model of HA injection-induced embolism and to study its pathophysiological progress.
METHODS
An islanded skin flap was elevated based on the proximal central auricular artery/vein. Eighteen rabbits were randomized into three groups. Ten, twenty, and forty microliters of HA were injected into the central auricular artery in each group, respectively. Flap fluorescence angiography was performed. One-way ANOVA was used to compare fluorescence area at different time points and between dose groups. Two rabbits in each group were randomly chosen for histology examination. In addition to regular HE staining, Alcian Blue staining was performed to better show the existence of HA in the vessel lumen.
RESULTS
The mean calculated fluorescence area was 64.41 % on POD 1, 79.77 % on POD 3, 88.20 % on POD 5, and 92.03 % on POD 7 in 10 μl group; 60.51 % on POD 1, 58.84 % on POD 3, 71.20 % on POD 5, and 76.54 % on POD 7 in 20 μl group; 21.60 % on POD 1, 3.08 % on POD 3, 2.91 % on POD 5, and 7.52 % on POD 7 in 40 μl group. In all three groups, infiltration of eosinophilic granulocytes was observed in the muscular layer of both artery and vein.
CONCLUSION
Our study successfully created a rabbit auricular skin necrosis model of HA embolism, which provided a valuable animal model for further investigation of the pathophysiological progress and the efficacy of potential treatments.
NO LEVEL ASSIGNED
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Animals; Biopsy, Needle; Disease Models, Animal; Ear Auricle; Embolism; Graft Rejection; Graft Survival; Hyaluronic Acid; Immunohistochemistry; Male; Necrosis; Rabbits; Random Allocation; Sensitivity and Specificity; Skin; Surgical Flaps
PubMed: 27118463
DOI: 10.1007/s00266-016-0630-0 -
Clinica E Investigacion En... 2022One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known...
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.
Topics: Arteriosclerosis; Cardiovascular Diseases; Heart Disease Risk Factors; Humans; Risk Factors
PubMed: 35090775
DOI: 10.1016/j.arteri.2021.11.003 -
Plastic and Reconstructive Surgery.... Apr 2021Facial thread-lifting has been popular because of its ease and safety with short down time. However, many physicians perform the procedure in cosmetic clinics, which can...
Facial thread-lifting has been popular because of its ease and safety with short down time. However, many physicians perform the procedure in cosmetic clinics, which can result in several complications. This report describes the surgical treatment of iatrogenic superficial temporal artery pseudoaneurysm (STAP) following thread-lifting. A 27-year-old man developed a painless, pulsating soft mass in the pre-auricular region after undergoing a thread-lift in a private cosmetic clinic 3 months before being referred to the authors' hospital. The mass was diagnosed as a STAP, using magnetic resonance imaging. The pseudoaneurysm was resected completely, and the superficial temporal artery was microsurgically reconstructed. Although there are some surgical procedures for treating STAP, such as surgical resection and embolization, the former is considered the first choice. Physicians should be trained before performing thread-lifting and must know the possibility of an iatrogenic STAP appearing after the procedure and the face and neck anatomy to prevent complications.
PubMed: 33868876
DOI: 10.1097/GOX.0000000000003524 -
Zhongguo Zhen Jiu = Chinese Acupuncture... Feb 2018To evaluate the effect and clinical value of auricular point sticking for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effect and clinical value of auricular point sticking for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture, including radial artery spasm (RAS) and coronary artery spasm (CAS).
METHODS
A total of 480 patients were randomized into an observation group (224 cases) and a control group (256 cases). Percutaneous coronary intervention and usual care in perioperative period were used in the control group. Auricular point sticking was began to apply 12 h before percutaneous coronary intervention in the observation group at Jiaogan (AH), Shenmen (TF), Pizhixia (AT), Neifenmi (CO), Xin (CO), Shen (CO), Shenshangxian (TG), 1 min a time every point, once every 2 h, 12 h before and after operation. The incidences of vasospasm and vagus reflex during piercing process were compared, and the usage ratios of vasoactive agent were recorded, including glyceryl trinitrate, dopamine and atropine injections.
RESULTS
The incidence of angiospasm was 4.9% (11/224) in the observation group, which was lower than 13.3% (34/256) in the control group (<0.01). The incidence of vagal reflex of the observation group was 7.1% (16/224), which was lower than 19.5% (50/256) of the control group (<0.01). The usage ratios of glyceryl trinitrate, atropine and dopamine injections were 3.6% (8/224), 7.1% (16/224), 6.3% (14/224) respectively in the observation group, which were lower than 14.8% (38/256), 15.6% (40/256), 15.2% (39/256) in the control group (all <0.01). .
CONCLUSION
Auricular point sticking achieves effect for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture.
Topics: Acupuncture Points; Acupuncture, Ear; Humans; Punctures; Radial Artery; Reflex; Vagus Nerve; Vasospasm, Intracranial
PubMed: 29473355
DOI: 10.13703/j.0255-2930.2018.02.007 -
Laryngoscope Investigative... Oct 2022In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when...
BACKGROUND
In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice.
METHODS
For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow-up.
RESULTS
PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%.
CONCLUSION
The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy.
PubMed: 36258872
DOI: 10.1002/lio2.894 -
International Journal of Oral and... Nov 2021Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the...
Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the superficial temporal artery is an ideal option for a full-thickness nasal alar defect. However, the pedicle length and the discrepancy in artery diameter between the recipient vessel and flap pedicle continue to be major problems for free auricular composite tissue transfer. Considering that the angular artery is occasionally absent and the course of the infraorbital segment of the facial vein is constant, there are often no suitable vessels around the recipient site for anastomoses to the short pedicle of the flap. In the absence of a suitable recipient artery, an infraorbital segment of the facial vein measuring 2.5cm in length was taken as a graft for the anastomosis of the superficial temporal artery and superior labial artery. End-to-end anastomosis was performed easily. The flap was inset to reconstruct the contralateral ala. The facial vein graft for anastomosis of the superficial temporal artery and branch of the facial artery is a reliable and easy method to resolve the problem of a short pedicle and large artery discrepancy for nasal ala reconstruction with a vascularized composite helical rim flap.
Topics: Anastomosis, Surgical; Humans; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Surgical Flaps; Veins
PubMed: 33678491
DOI: 10.1016/j.ijom.2021.02.022 -
Plastic and Reconstructive Surgery.... Dec 2017Microtia is a congenital auricular deformity that occurs in 1:5,000-10,000 births. It can cause severe impairment to the patient's self-esteem and problems regarding...
BACKGROUND
Microtia is a congenital auricular deformity that occurs in 1:5,000-10,000 births. It can cause severe impairment to the patient's self-esteem and problems regarding social integration. Multiple measures have been described in attempt to better operative outcomes of these patients. We used computed tomography (CT) angiography to analyze the vascular pattern of the auricular region before surgery.
METHODS
Fourteen patients with unilateral microtia were included. All underwent CT angiogram plus tridimensional reconstruction. Both healthy and microtic auricles were analyzed descriptively in terms of main arterial supply, pattern, diameter of subbranches, and angulation. The sample was divided in 2 age groups for better understanding of the data.
RESULTS
Blood supply to the auricle was found to depend on 2 main vessels: temporal superficial artery (TSA) and its subbranches (superior, middle, and lower branch) and posterior auricular (PA) artery. In the microtic group, TSA was the dominant artery in 13 of 14 cases (92%). Superior, middle, and inferior branches were present in 4, 3, and 0 cases, respectively. Three of the microtic auricles presented supply from PA artery, from which in 1 case, it represented the only supply to the region.
CONCLUSIONS
There is wide variability in the blood supply of both healthy and microtic auricles; however, we were able to identify some tendencies in our sample. Further research is needed to prove the benefit of a preoperative imaging study in these patients. Still, in our experience, we found it useful as a complement for surgical planning.
PubMed: 29632773
DOI: 10.1097/GOX.0000000000001594