The Fontan operation is a palliative procedure that leads to increased survival of patients with a functional single ventricle (SV). Starting from 1967 when the first operation was performed by Francis Fontan, more and more patients have reached adulthood. Furthermore, it is expected that in the next 20 years, the population with Fontan circulation will reach 150,000 subjects. The absence of right ventricular propulsion and the inability to improve cardiac output because of the low cardiac reserve are the main issues with the Fontan circulation; however, potential complications may also involve multiple organ systems, such as the liver, lungs, brain, bones, and the lymphatic system. As these patients were initially managed mainly by pediatric cardiologists, it was important to assure the appropriate transition to adult care with the involvement of a multidisciplinary team, including adult congenital cardiologists and multiple subspecialists, many of whom are neither yet familiar with the pathophysiology nor the end-organ consequences of the Fontan circulation. Therefore, the aim of our work was to collect all the best available evidence on Fontan's complications management to provide “simple and immediate” information sources for practitioners looking for state of the art evidence to guide their decision-making and work practices. Moreover, we suggest a model of follow-up of patients with Fontan based on a patient-centered multidisciplinary approach.

Objective: Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty. Methods: Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes. Results: All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ: P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time ( P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery. Conclusion: N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.

estoring a natural-appearing nasal tip with optimal projection, rotation, contour, and tactile quality is the conditio sine qua non of revision rhinoplasty. 1,2 Although conventional columellar struts stabilize the nasal tip, 3-7 additional grafting, suturing, or repositioning maneuvers may be necessary to correct contour abnormalities. We describe a versatile Y-columellar strut graft (Y-strut) that is carved from conchal cartilage that reliably achieves favorable nasal tip characteristics (Fig. 1). PATIENTS AND METHODSThis prospective study of patients undergoing Y-strut rhinoplasty was approved by the institutional review board and conducted in accordance with guidelines of the Declaration of Helsinki.Summary: Several techniques have been proposed to modify tip shape and projection, both in congenital and in acquired nasal tip deformities. The authors describe a novel technique, the Y-columellar strut graft (Y-strut), which uses auricular cartilage to increase tip projection and restore contour in primary or revision rhinoplasty. Thirty-seven patients with congenital, acquired, or iatrogenic nasal tip malformation underwent reconstruction with Y-strut using short or long upper limbs ("wings"). The short wing variant was used to increase tip projection in primary rhinoplasty, and the long wing variant was used to corrected iatrogenic deformities of alar cartilages in revision rhinoplasty, improving contour and projection. Frontal, oblique, and lateral views before and after surgery were analyzed in blinded fashion at 1 year for tip shape and projection. Statistical analyses compared demographic characteristics, deformity type, and nasolabial angle before and after surgery to evaluate aesthetic outcome. All patients demonstrated improved nasal tip position. The Y-strut increased the nasolabial angle, reflecting tip rotation, and findings were independent of type or location of deformity (P < 0.00001). No statistically significant differences were observed in comparisons of the short-versus long-wing technique. Three patients with congenital nasal tip malformations showed mild tip deviation at 1-year follow-up, and one had mild dorsal irregularity unrelated to grafting; no negative outcomes were observed in revision rhinoplasty patients. The Y-columellar strut graft is a reliable and versatile rhinoplasty technique using paired, symmetric grafts fashioned from auricular cartilage to correct tip deformities.