BackgroundThe thin and pliable skin of the neck is a region with multidirectional activity, and postburn scar contractures tend to form there easily. The supraclavicular flap is used to correct neck scar contractures. Its main vascular supply is the supraclavicular artery, and it can be harvested as either a skin pedicle flap or an island flap (vascular pedicle flap).ObjectiveIn this article, a total of 41 flaps are studied retrospectively and their efficacy in reconstruction of post-burn neck scar contractures is discussed. Also donor-site morbidity, patient satisfaction, and complications were evaluated.Patients and MethodsBetween November of 2004 and January of 2009, 41 supraclavicular flaps were used for reconstructions in 32 patients at the authors’ hospital. Twenty-four of these flaps were skin pedicle flaps, and 17 were island flaps. The range of flap size was 18 ± 6 cm in length, and 9 ± 3 cm in width. Pre-expansion was performed in 14 flaps. Primary closure of donor site was performed in 35 flaps.ResultsThirty-seven of the 41 flaps survived completely, but there were three cases of distal necrosis (10-30%), and one case of complete flap necrosis. Twenty-nine of the 32 patients were satisfied with both the functional and aesthetic results.ConclusionsScarring of the neck produces problems with function, and appearance. In our view, the supraclavicular flap, a thin flap of good texture, is an excellent and highly reliable flap for covering defects of the anterior neck. This flap is easy to harvest, with good functional and aesthetic results.

Background: Aesthetic and functional concerns, especially after multiple revision rhinoplasties, continue to provide a challenge even for the experienced surgeon. Objective: This study aimed to report the results in terms of “secondary rhinoplasty,” performed by the senior author after previous rhinoplasty. Methods: This descriptive prospective study was carried on 150 patients with surgical indication of secondary rhinoplasty and they were asked to fill out the questionnaire divided into 3 parts: overall epidemiological questions, questions of patients’ aesthetic and functional complaints, and objective evaluation by the surgeon. The nasal problems in the upper and middle regions were divided into high or low, broad or narrow, crooked, irregularity of nasal bridge, or other alterations. The patients included in the study had surgical programming of secondary rhinoplasty, with mandatory aesthetic and optional functional purposes, having previous rhinoplasty with the same or different surgeon. Results: There were 136 females and 14 males with the mean age of 31.52 (6.36) years. The most common complaints were related to the nose tip with 123 cases included deviated tip and pinched (bilateral) with 25.3%, 30.7%, and 25.3%, middle nose with 78 cases included mid vault deviation, inverted V, and polly beak with 31.3%, 18%, and 9.3%, and upper nasal region with 69 cases included dorsum irregularity and wide dorsum with the rates of 22.7% and 16.7%, respectively; respiratory problem was reported in 13 cases. Conclusion: Unilateral or bilateral twisting at the nasal tip had the highest percentages, and the lowest incidence was in relation to the complaints of the upper nasal part.

BACKGROUND Rib cartilage is an outstanding material in reconstructive septorhinoplasty, especially in revision surgery with a low rate of complications compared to other materials. In this study, the results of oblique splitting of rib grafts were evaluated in 25 patients operated for primary and secondary septorhinoplasty. METHODS The prospective case series were undertaken on 25 patients of saddle or crooked nose that referred to the senior author’s private office between January 2015 and November 2017. They had primary and secondary septorhinoplasty using autologous costal cartilage carved by the oblique split method (OSM). The postoperative follow-up period ranged from 3 to 36 months (Mean follow up of 19 months). RESULTS The problems seen in patients were saddle-nose deformity in 16 cases, crooked-nose deformity in 3, crooked nose and saddle nose in 3 and implant infection, inverted V-pinch, destruction of septum in 3 more cases. After oblique split rib grafts surgery and 3-36 month follow-up (an average of 19 months), the operative outcomes were successful and no severe resorption, infection, warping or displacement were observed related to graft and patients were also satisfied, and there was no complication of the donor-site. The patients did not have any post-operative complications and no complain of nasal distortion during follow up period. CONCLUSION OSM allowed obtaining large quantities of graft material without the risk of warping due to inclusion of both peripheral and central portions of the rib cartilage.

Background: Rhinoplasty as the most common aesthetic surgical operations aims to correct deformities of the different structures of the nose with each case its own challenges. We aimed to highlight the importance of self-assessment for rhino surgeons. Methods: This retrospective descriptive study was done on 192 patients in Ordibehesht Hospital, Isfahan, Iran from April 2017 to Jun 2021. candidate for secondary rhinoplasty, with mandatory aesthetic and optional functional purposes, having previously undergone rhinoplasty with the same or another surgeon. Patients with initial rhinoplasty by the first author were assigned to group 1 (n=102) and the patients who were operated by the other surgeons were in the group 2 (n=90). Data were collected using an author made checklist divided into three parts: overall demographic questions, questions about the patients’ aesthetic and functional complaints and objective evaluation by the surgeon. Results: The most frequent reported complaints led to their current rhinoplasty were about the nasal tip with 161 cases (83.9%), upper nasal part with 98 cases (51%) and mid-nose (middle nose) with 81 cases (42.2%). Besides, respiratory problem was observed in 58 patients (30.2%). Surgeon’s skill was significantly associated with occurrence of these two complaints; so that these two complaints were more common in group2 than group1 ( P value <0.05). Conclusion: Such assessments resulted to improve the surgical outcomes due to finding the more prevalent problems in own patients than the other surgeons’ patients and determining the reasons that leads to change the techniques with regard to the researches and consulting with the colleagues.