Tissue expansion is indicated in the reconstruction of various scalp defects when there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It is the most important armamentarium for aesthetic hair-bearing scalp reconstruction in cases of congenital or required defects. This technique was used sequentially without interval to achieve scalp reconstruction for 12 patients with a defect ranging from 30% to 75% of the scalp (average, 55%). For 12 patients, 32 expansion treatments were undertaken between September 1997 and January 2002. The 12 patients included 3 women, 4 men, and 5 children with a mean age of 20 years (range, 45 days to 36 years). All patients had more than one period of treatment. The most common conditions treated were burns (n=7), trauma (n=1), congenital naevi (n=2), and male pattern baldness (n=2). Reconstruction of 12 large scalp defects has been performed with a 3.1% rate of major complications. Results show that tissue expansion is a safe and efficient but time-consuming technique for aesthetic scalp reconstruction, especially in the case of "sideburn" scenario or large defects. There was no significant alteration in ratio of complications although tissue expansions were made sequentially.

Saddle nose reconstruction is based on the use of support grafts to manage aesthetic and functional problems. Bone (calvarial, iliac crest, costal, nasal hump, ulnar, and heterogeneous origin), cartilage (septal, costal, heterogeneous), and synthetic materials (silicon, silastic, polyethylene) were used as support grafts. Three patients have been included in this study to define the surgical management and long-term aesthetic and functional results of patients undergoing rhinoplasty with support grafts for a saddle nose deformity. Open rhinoplasty was employed. Both the lower turbinates were excised and the bone dissected from the soft tissues in two cases and in one case, only mucosa was removed. The amount of support needed was measured by using bone wax. The bone was used shaped in layers, according to the defect, and sutured to each other by vycril suture, and wrapped around by surgicell. The graft was then inserted in its place and fixed with external prolene sutures. Results were satisfactory in both function and aesthetics. Ten to 16-month follow-ups had no complications. Saddle nose surgery basically requires the use of a support graft to repair the nasal dorsum. A lower turbinate bone graft procedure has some advantages: it is cheap and safe, it is ready to use and not time-consuming, there is no donor area and no additional donor site morbidity, and it enlarges the airway and the passage to prevent nasal airway obstruction.

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Saddle nose deformity is characterized by depression of the nasal bone and the cartilage dorsum associated with a collapse in the upper lateral and alar cartilages. Etiopathogenesis usually involves trauma or invasive excision of the bone and cartilage. Surgical treatment for functional and aesthetic recovery relies on the use of grafts. Options for grafting include autogenous tissue such as bone or cartilage and alloplastic augmentation. Nine patients with saddle nose deformity underwent surgical reconstruction with autogenous costal cartilage. The deformity was the result of trauma in seven patients and secondary to surgery in two patients. Cartilage obtained from the sixth and seventh ribs was used as the graft material to compensate for the low nasal dorsum. Cartilage was used as a single unit and shaped to cover the nasal dorsum and the lateral nasal walls completely. The upper lateral cartilages were fixed to shaped cartilage graft. Additional cartilage grafts into the columella and septum were also placed in all patients. Functional and aesthetic outcome was satisfactory in all patients. As a result, using costal cartilage graft, a single unit allowed more predictable and reliable reconstruction of the saddle nose deformity than the conventional dorsal grafts.