Therapeutic, IV.

Summary: For more precise and rapid notification of free flap status between staff members after surgery, the authors used a smartphone and mobile messenger application including multimedia during the initial postoperative period and analyzed the influence of this method for the re-exploration time and survival rate of the flap before and after use. From April of 2010 to September of 2011, 123 consecutive free flaps were reviewed. The authors increased the flap survival rate from 96.2 to 100 percent and increased the threatened flap salvage rate from 50 to 100 percent with this method. The time interval between the first notification of flap compromise and the start of re-exploration was significantly shortened (4.0 versus 1.4 hours). This method not only provided better communication and comprehensive information but also allowed early diagnosis of flap compromise to be actualized at early re-exploration, ultimately increasing flap survival. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The purpose of this study was to compare the volumetric and histologic changes of the acellular cadaveric dermis, lyophilized bovine pericardium, irradiated bovine tendon, and autologous cartilage transplanted subcutaneously in the rats. Four different kinds of implants were placed in subcutaneous pockets of the dorsum of 40 Wister rats. The implants with the subcutaneous pockets were retrieved in the first, fourth, eighth, and 12th weeks after implantation. The size and histologic change of each implant were observed. The xiphoid cartilage showed the peak survival (71.0%, P = 0.247) on the 12th week, but part of the cartilage was absorbed irregularly and its shape changed unpredictably. The lyophilized bovine pericardium had a high survival rate as well (64.4%, P = 0.016). However, the size decreased significantly in the first through 12th weeks. A survival of acellular cadaveric dermis was lower (38.8%, P = 0.036) than the cartilage and pericardium, but it sustained the structure for 12 weeks and changed peripherally into the neocollagen. Irradiated bovine tendon disclosed the lowest survival rate (31.4%, P = 0.008). The structure was gradually distorted and replaced entirely by neocollagen in the 12th week after implantation. Autologous cartilage is the best choice for soft tissue and nasal tip augmentation. Although other implants than the cartilage showed significant diminution of its volume in 12 weeks, lyophilized bovine pericardium could be the next substitute to the cartilage in soft tissue augmentation.