2017-18 HSC Section 4 Green Book

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Plastic and Reconstructive Problems

Home Study Course

Hsc Home Study Course

Section 4 April 2018

© 2018 American Academy of Otolaryngology—Head and Neck Surgery Foundation Empowering otolaryngologist-head and neck surgeons to deliver the best patient care

THE HOME STUDY COURSE IN OTOLARYNGOLOGY -- HEAD AND NECK SURGERY

SECTION 4

Plastic and Reconstructive Problems

April 2018

SECTION FACULTY:

J. Randall Jordan, MD, FACS** Eunice E. Park, MD MPH ** C.W. David Chang, MD Waleed Ezzat, MD Andrea Jarchow Garcia, MD P. Daniel Ward, MD, MS, FACS

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Section 4 suggested exam deadline: June 11, 2018 Expiration Date: August 7, 2018; CME credit not available after that date

Introduction The Home Study Course (HSC) is designed to provide relevant and timely clinical information for physicians in training and current practitioners in otolaryngology - head and neck surgery. The course, spanning four sections, allows participants the opportunity to explore current and cutting-edge perspectives within each of the core specialty areas of otolaryngology. The Selected Recent Material represents primary fundamentals, evidence-based research, and state of the art technologies in plastic and reconstructive problems. The scientific literature included in this activity forms the basis of the assessment examination. The number and length of articles selected are limited by editorial production schedules and copyright permission issues and should not be considered an exhaustive compilation of knowledge on plastic and reconstructive problems. The Additional Reference Material is provided as an educational supplement to guide individual learning. This material is not included in the course examination and reprints are not provided. Needs Assessment AAO-HNSF’s education activities are designed to improve healthcare provider competence through lifelong learning. The Foundation focuses its education activities on the needs of providers within the specialized scope of practice of otolaryngologists. Emphasis is placed on practice gaps and education needs identified within eight subspecialties. The Home Study Course selects content that addresses these gaps and needs within all subspecialties. Target Audience The primary audience for this activity is physicians and physicians-in-training who specialize in otolaryngology-head and neck surgery. 1. Discuss the available evidence for the use of platelet rich plasma in skin regeneration. 2. Explain the expected rates of revision surgery in cosmetic rhinoplasty with prospective patients. 3. Recommend to patients the different types of available devices for energy-based facial rejuvenation. 4. Review the anatomic areas of the face at risk for vascular complications of injectable fillers. 5. Recognize the factors that affect litigation risk in rhytidectomy surgery and methods to potentially avoid litigation when performing rhytidectomy. 6. Discuss the prevalence of body dysmorphic disorder and methods to diagnose this in prospective patients. 7. Integrate the use of an objective measurement of functional success in rhinoplasty in their practice utilizing the NOSE score. 8. Recommend the adjunctive use of radiation therapy to keloid patients. 9. Apply the use of botulinum toxin injections to improve outcomes in facial paralysis patients with synkinesis or hyperkinesis. 10. Describe less invasive approaches to the management of frontal sinus fractures. 11. Integrate a protocol for molding of the malformed infant ear using commercially available systems. Outcome Objectives The participant who has successfully completed this section should be able to:

Medium Used The Home Study Course is available in electronic or print format. The activity includes a review of outcome objectives, selected scientific literature, and a self-assessment examination. Method of Physician Participation in the Learning Process The physician learner will read the selected scientific literature, reflect on what they have read, and complete the self-assessment exam. After completing this section, participants should have a greater understanding of plastic and reconstructive problems as they affect the head and neck area, as well as useful information for clinical application. Accreditation Statement The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit Designation The AAO-HNSF designates this enduring material for a maximum of 40.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim credit commensurate with the extent of their participation in the activity. ALL PARTICIPANTS must achieve a post-test score of 70% or higher for a passing completion to be recorded and a transcript to be produced. Residents’ results will be provided to the Training Program Director. PHYSICIANS ONLY : a post-test score of 70% or higher is required to receive Credit for this activity. Two retest opportunities will automatically be available if a minimum of 70% is not achieved. Disclosure The American Academy of Otolaryngology Head and Neck Surgery/Foundation (AAO-HNS/F) supports fair and unbiased participation of our volunteers in Academy/Foundation activities. All individuals who may be in a position to control an activity’s content must disclose all relevant financial relationships or disclose that no relevant financial relationships exist. All relevant financial relationships with commercial interests 1 that directly impact and/or might conflict with Academy/Foundation activities must be disclosed. Any real or potential conflicts of interest 2 must be identified, managed, and disclosed to the learners. In addition, disclosure must be made of presentations on drugs or devices or uses of drugs or devices that have not been approved by the Food and Drug Administration. This policy is intended to openly identify any potential conflict so that participants in an activity are able to form their own judgments about the presentation. [1] A “Commercial interest” is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. 2 “Conflict of interest” is defined as any real or potential situation that has competing professional or personal interests that would make it difficult to be unbiased. Conflicts of interest occur when an individual has an opportunity to affect education content about products or services of a commercial interest with which they have a financial relationship. A conflict of interest depends on the situation and not on the character of the individual. Estimated time to complete this activity: 40.0 hours

2018 Section 4 PLASTIC AND RECONSTRUCTIVE PROBLEMS

** Co-Chairs: J. Randall Jordan, MD, FACS, Professor and Vice-Chair, Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS. Disclosure: No relationships to disclose Eunice E. Park, MD MPH, Clinical Assistant Professor, Department of Otolaryngology- Head & Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY and Facial Plastic Surgeon, Prohealth Care Associates, Lake Success, NY. Disclosure: No relationships to disclose Faculty: C. W. David Chang, MD, FACS, Associate Professor of Clinical Otolaryngology, Department of Otolaryngology—Head and Neck Surgery, University of Missouri, Columbia, MO. Disclosure: Leadership Role: President, Missouri Society of Otolaryngology Co-chair, Patient Safety and Quality Improvement Committee Residency Program Director, University of Missouri Waleed H. Ezzat, MD, FACS , Director, Division of Facial Plastic and Reconstructive Surgery, Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, Boston, MA. Disclosure: Leadership Role: Board Member, Massachusetts Society of Otolaryngology Research Funding: Stryker, CMF, Inc Andrea Jarchow Garcia, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC; Private practice, Dilworth Facial Plastic Surgery, Charlotte, NC. Disclosure: No relationships to disclose. P. Daniel Ward, MD, MS, FACS, Adjunct Associate Professor, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of Utah, Salt Lake City, UT. Disclosure: No relationships to disclose

Planner(s): Linda Lee, AAO─HNSF Education Program Manager Stephanie Wilson, Stephanie Wilson Consulting, LLC; Production Manager Richard V. Smith, MD, chair, AAO-HNSF Education Steering

No relationships to disclose No relationships to disclose

Expert Witness: various

Committee

legal firms

Scott B. Roofe, MD, chair, AAO-HNSF Facial Plastic &

No relationships to disclose

Reconstructive Surgery Education Committee

This 2017-18 Home Study Course Section includes discussion of the following drugs and devices that have not been approved by the United States Food and Drug Administration:

Name of drug or device

Nature of off-label discussion

Botulinum toxin

Use for facial synkinesis, hyperkinesis, and hyperlacrimation

Disclaimer The information contained in this activity represents the views of those who created it and does not necessarily represent the official view or recommendations of the American Academy of Otolaryngology – Head and Neck Surgery Foundation. June 11, 2018: Section 4 suggested exam submission deadline. August 7, 2018, midnight EST: deadline for all 2017-18 HSC exams to be submitted. EVIDENCE BASED MEDICINE The AAO-HNSF Education Advisory Committee approved the assignment of the appropriate level of evidence to support each clinical and/or scientific journal reference used to authenticate a continuing medical education activity. Noted at the end of each reference, the level of evidence is displayed in this format: [EBM Level 3] .

Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001) Level 1

Randomized 1 controlled trials 2 or a systematic review 3 (meta-analysis 4 ) of randomized controlled trials 5 . Prospective (cohort 6 or outcomes) study 7 with an internal control group or a systematic review of prospective, controlled trials. Retrospective (case-control 8 ) study 9 with an internal control group or a systematic review of retrospective, controlled trials. Case series 10 without an internal control group (retrospective reviews; uncontrolled cohort or outcome studies).

Level 2

Level 3

Level 4

Expert opinion without explicit critical appraisal, or recommendation based on physiology/bench research.

Level 5

Two additional ratings to be used for articles that do not fall into the above scale. Articles that are informational only can be rated N/A , and articles that are a review of an article can be rated as Review. All definitions adapted from Glossary of Terms, Evidence Based Emergency Medicine at New York Academy of Medicine at www.ebem.org . 1 A technique which gives every patient an equal chance of being assigned to any particular arm of a controlled clinical trial. 2 Any study which compares two groups by virtue of different therapies or exposures fulfills this definition. 3 A formal review of a focused clinical question based on a comprehensive search strategy and structure critical appraisal. 4 A review of a focused clinical question following rigorous methodological criteria and employing statistical techniques to combine data from independently performed studies on that question. 5 A controlled clinical trial in which the study groups are created through randomizations. 6 This design follows a group of patients, called a “cohort”, over time to determine general outcomes as well as outcomes of different subgroups. 7 Any study done forward in time. This is particularly important in studies on therapy, prognosis or harm, where retrospective studies make hidden biases very likely. 8 This might be considered a randomized controlled trial played backwards. People who get sick or have a bad outcome are identified and “matched” with people who did better. Then, the effects of the therapy or harmful

exposure which might have been administered at the start of the trial are evaluated. 9 Any study in which the outcomes have already occurred before the study has begun. 10 This includes single case reports and published case series.

OUTLINE

April 2018 Section 4

PLASTIC & RECONSTRUCTIVE PROBLEMS

I.

COSMETIC A. Tissue engineering and related topics for cosmetic applications

B. Cosmetic rhinoplasty

C. Laser therapy for rejuvenation

D. Fillers and chemodenervation

E. Rhytidectomy

F. Blepharoplasty

II.

RECONSTRUCTION A. Functional rhinoplasty

B. Treatment of hypertrophic scars and keloids

C. Flaps and grafts

D. Facial paralysis

E. Facial fractures

III.

CONGENITAL A. Craniofacial deformities

TABLE OF CONTENTS Selected Recent Materials - Reproduced in this Study Guide

April 2018 Section 4: PLASTIC & RECONSTRUCTIVE PROBLEMS

Additional Reference Material.................................................................................................i - iii Cycle 2017-2018 Index........................................................................................................I-1 – I-9

I.

COSMETIC A. Tissue engineering and related topics for cosmetic applications Banyard DA, Bourgeois JM, Widgerow AD, Evans GR. Regenerative biomaterials: a review. Plast Reconstr Surg . 2015; 135(6):1740-1748. EBM level 4..................................................................................................................1-9 Summary : The authors present a review of biomaterials and biodegradable synthetics and their clinical applications in burn reconstruction and wound healing, craniofacial repair, and cosmetic surgery. Fabi S, Sundaram H. The potential of topical and injectable growth factors and cytokines for skin rejuvenation. Facial Plast Surg . 2014; 30(2):157-171. EBM level 3..............................................................................................................10-24 Summary : This article reviews the available evidence for the role of topical and injectable growth factors contained in autologous platelet-rich plasma (PRP) in skin regeneration. It presents data from recent studies and includes safety considerations. Evidence gaps that currently exist between experimental observations regarding growth factors and their proven clinical benefits are discussed. B. Cosmetic rhinoplasty Rohrich RJ, Dauwe PB, Pulikkottil BJ, Pezeshk RA. The importance of the anterior septal angle in the open dorsal approach to rhinoplasty. Plast Reconstr Surg . 2017; 139(3):604-612. EBM level 5....................................................25-33

Summary : This paper describes the importance of the anterior septal angle as a reference for successful rhinoplasty in both primary and revision cases.

Spataro E, Piccirillo JF, Kallogjeri D, et al. Revision rates and risk factors of 175 842 patients undergoing septorhinoplasty. JAMA Facial Plast Surg . 2016; 18(3):212-219. EBM level 3...........................................................................34-41

Summary : This paper utilizes a large database to determine the rate of revision for rhinoplasty.

C. Laser therapy for rejuvenation Britt CJ, Marcus B. Energy-based facial rejuvenation: advances in diagnosis and treatment. JAMA Facial Plast Surg . 2017; 19(1):64-71. EBM level 5........42-49 Summary : This article provides an overview of the current literature on all energy-based facial rejuvenation therapies with an emphasis on the expanding role of nonsurgical options. It gives a detailed description of the current uses and the advantages and the limitations of each modality. Wu DC, Fitzpatrick RE. Facial rejuvenation via the sequential combined use of multiple laser modalities: safety and efficacy. Lasers Surg Med . 2016; 48(6):577-583. EBM level 4...........................................................................50-56 Summary : This article discusses the combined use of ablative and nonablative laser therapies in a single treatment session. The authors emphasize the ability of this technique to address a multitude of facial aging signs including telangiectasia, dyschromia, superficial to moderate rhytids, and textural abnormalities. Furthermore, the article suggests increased patient satisfaction without prolonged recovery using this method. D. Fillers and chemodenervation Al-Haddab M, Abduljabbar A, Al-Somaily A. The sterility of partially used hyaluronic acid fillers after long storage. Dermatol Surg . 2017; 43(7):967-970. EBM level 4.....................................................................................................57-60 Beleznay K, Carruthers JD, Humphrey S, Jones D. Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg . 2015; 41(10):1097-1117. EBM level 4.....................................................................61-81 Summary : This paper extensively reviews all the published cases to date of blindness associated with filler administration and examines the key points related to avoidance and management. Scheuer JF 3rd, Sieber DA, Pezeshk RA, et al. Anatomy of the facial danger zones: maximizing safety during soft-tissue filler injections. Plast Reconstr Surg . 2017; 139(1):50e-58e. EBM level 4....................................................82-90 Summary : A detailed description of the facial vascular anatomy is provided in this article as it relates to the six most dangerous areas for filler injection. Technique principles in these “danger zones” are also reviewed in an effort to minimize devastating complications after filler injection. Summary : This paper examines the microbiological profile of partially used syringes of hyaluronic acid filler and offers recommendations for best practices.

Wilson AJ, Chang B, Taglienti AJ, et al. A quantitative analysis of onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA: a randomized, double-blind, prospective clinical trial of comparative dynamic strain reduction. Plast Reconstr Surg . 2016; 137(5):1424-1433. EBM level 2............................................................................................................91-100 Summary : The aim of this study was to perform a direct comparison of the three FDA-approved type A neurotoxins for glabellar motion via a quantitative analysis of strain reduction. The authors cite that direct comparison studies in the literature are limited in many instances to static photography that may be more subjective in nature. Furthermore, the authors suggest that relying upon subjective data may limit our true understanding on how to clinically apply each neurotoxin to a specific area for maximal patient outcomes. E. Rhytidectomy Antell DE, May JM, Bonnano MJ, Lee NY. A comparison of the full and short- scar face-lift incision techniques in multiple sets of identical twins. Plast Reconstr Surg . 2016; 137(6):1707-1714. EBM level 2..............................101-108 Jacono AA, Malone MH, Talei B. Three-dimensional analysis of long-term midface volume change after vertical vector deep-plane rhytidectomy. Aesthet Surg J. 2015; 35(5):491-503. EBM level 4...............................................109-121 Summary : This article establishes vertical vector deep-plane rhytidectomy as an effective means to restoring mid-facial volume loss. Using three-dimensional analysis via the Vectra 3D imaging software, mid-facial volume changes pre- facelift and post-facelift are examined. Also, the surgical anatomy of the cheek fat compartments and operative technique are described. Kandinov A, Mutchnick S, Nangia V, et al. Analysis of factors associated with rhytidectomy malpractice litigation cases. JAMA Facial Plast Surg . 2017; 19(4):255-259. EBM level 5.......................................................................122-126 Summary : This study reviews common reasons for litigation following rhytidectomy. It details the most common judgements in favor of the defendant as well as those in favor of the plaintiff. Insight is given to the surgeon on possible means to avoid litigation. Killion EA, Hyman CH, Hatef DA, et al. A systematic examination of the effect of tissue glues on rhytidectomy complications. Aesthet Surg J . 2015; 35(3):229- 234. EBM level 3........................................................................................127-132 Summary : This meta-analysis reviews the utility of fibrin glue in preventing hematoma after facelift surgery. Previous studies to date, including a meta- analysis, determined minimal benefit likely due to a small sample size. With a much larger patient pool, these authors conclude that fibrin glue may indeed be beneficial in preventing postoperative hematoma but determine no effect on postoperative seroma or ecchymosis. Summary : This study compares the outcomes of short-scar and full-incision facelifts at 1 and 5 years.

Reilly MJ, Tomsic JA, Fernandez SJ, Davison SP. Effect of facial rejuvenation surgery on perceived attractiveness, femininity, and personality. JAMA Facial Plast Surg . 2015; 17(3):202-207. EBM level 5.........................................133-138 Summary : This study introduces a new way to think about facelift results, beyond simply a more youthful appearance by evaluating the changes in likeability, social skills, attractiveness, and femininity that occur after facelift. F. Blepharoplasty Hashem AM, Couto RA, Waltzman JT, et al. Evidence-based medicine: a graded approach to lower lid blepharoplasty. Plast Reconstr Surg. 2017; 139(1):139e- 150e. EBM level 5......................................................................................139-150 Summary : This review paper provides a concise review of the functional anatomy of the eyelid and the preoperative evaluation of the blepharoplasty candidate. Also discussed in appropriate detail are the differing approaches to the eyelids and lateral canthus. Joseph AW, Ishii L, Joseph SS, et al. Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg. 2017; 19(4):269-274. EBM level NA..............151-156 Summary : The authors present a prospective, multi-centered study that evaluates the prevalence of body dysmorphic disorder (BDD) among the facial plastic and oculoplastic patient populations. A validated screening tool is used to compare objective assessment versus the surgeon's clinical judgment in assessing for BDD. Floyd EM, Ho S, Patel P, et al. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE score. Otolaryngol Head Neck Surg . 2017; 156(5):809-815. EBM level 3.............................157-163 Summary : This article presents a meta-analysis of the available literature relating to outcomes after functional rhinoplasty and provides a great reference for surgeons to do some more investigation of the literature on their own. The data uses objective measures to compare pre- and postoperative outcomes. Surowitz J, Lee MK, Most SP. Anterior septal reconstruction for treatment of severe caudal septal deviation: clinical severity and outcomes. Otolaryngol Head Neck Surg . 2015; 153(1):27-33. EBM level 4...........................................164-170 Summary : The authors share their experience of extracorporeal septoplasty for treatment of severe caudal and dorsal septal deviations. The article shares indications for the procedure as well as operative techniques. Outcomes are reported using NOSE scores. RECONSTRUCTION A. Functional rhinoplasty

II.

Wee JH, Mun SJ, Na WS, et al. Autologous vs irradiated homologous costal cartilage as graft material in rhinoplasty. JAMA Facial Plast Surg . 2017; 19(3):183-188. EBM level 3.......................................................................171-176 Summary : This paper is a retrospective, single-institution study comparing the aesthetic and histological qualities of autologous costal cartilage versus irradiated homologous cartilage. The study shows improved outcomes with the use of autologous cartilage. Yeung A, Hassouneh B, Kim DW. Outcome of nasal valve obstruction after functional and aesthetic-functional rhinoplasty. JAMA Facial Plast Surg . 2016; 18(2):128-134. EBM level 4.......................................................................177-183 Summary : This paper presents a multi-institutional study of functional and aesthetic rhinoplasty patients who were diagnosed with nasal valve insufficiency and underwent corrective surgery. Patients were excluded if the septum or turbinates substantially contributed to nasal obstruction. Outcomes using the NOSE score showed good improvement up to 12 months postoperatively. B. Treatment of hypertrophic scars and keloids Guy WM, Pattisapu P, Ongkasuwan J, Brissett AE. Creation of a head and neck keloid quality of life questionnaire. Laryngoscope. 2015; 125(12):2672-2676. EBM level 4.................................................................................................184-188 Summary : This study focuses on the development of a reliable quality-of-life (QOL) questionnaire for patients with keloids of the head and neck. Previous QOL questionnaires were inclusive of all keloids locations. In contrast to keloids of the body, the authors emphasize the importance of understanding both the physical and psychological impacts of the highly visible keloids of the head and neck. van Leeuwen MC, Stokmans SC, Bulstra AE, et al. High-dose-rate brachytherapy for the treatment of recalcitrant keloids: a unique, effective treatment protocol. Plast Reconstr Surg. 2014; 134(3):527-534. EBM level 4..........................................................................................................189-196 Summary : This study demonstrates a possible therapeutic advantage using high- dose brachytherapy with surgical excision in the treatment of keloids. The authors give a detailed description of the method for treatment using this technique, citing patient convenience and ease in comparison to external-beam radiation and low-dose brachytherapy. The authors also demonstrate a low recurrence rate of 3.1% following the treatment regimen.

Verhiel S, Piatkowski de Grzymala A, van der Hulst R. Mechanism of action, efficacy, and adverse events of calcium antagonists in hypertrophic scars and keloids: a systematic review. Dermatol Surg . 2015; 41(12):1343-1350. EBM level 4..........................................................................................................197-204 Summary : The authors performed a broad literature review in an attempt to deduce if calcium antagonists should be considered as an additional therapeutic measure for the treatment of keloids and hypertrophic scars. The authors describe the lack of controlled studies in the literature using injectable verapamil versus standard therapies. Although further studies are warranted, they suggest that injectable verapamil may have a lower side effect profile than injectable triamcinolone with similar efficacy. C. Flaps and grafts Ezzat WH, Liu SW. Comparative study of functional nasal reconstruction using structural reinforcement. JAMA Facial Plast Surg . 2017; 19(4):318-322. EBM level 3..........................................................................................................205-209 Summary : This paper presents the first comparative study within the literature comparing functional nasal reconstruction with and without the use of structural support. This represents the highest level of evidence available in the literature for structural reinforcement of the nasal valves. Patel SA, Liu JJ, Murakami CS, et al. Complication rates in delayed reconstruction of the head and neck after Mohs micrographic surgery. JAMA Facial Plast Surg . 2016; 18(5):340-346. EBM level 3.............................210-216 Summary : The authors describe a retrospective study investigating the association of the rate of complication after delayed Mohs reconstructive surgery. They found that reconstruction after 2 days or more was associated with increased complication rates. D. Facial paralysis Albathi M, Oyer S, Ishii LE, et al. Early nerve grafting for facial paralysis after cerebellopontine angle tumor resection with preserved facial nerve continuity. JAMA Facial Plast Surg . 2016; 18(1):54-60. EBM level 3......................217-223 Summary : This manuscript looks into the potential value of performing facial nerve reinnervation procedures within 6 months after paresis induced by vestibular schwannoma surgery. The authors found it acceptable to proceed with nerve grafting within 6 months if electromyelogram and stimulation suggest no reinnervation.

Cabin JA, Massry GG, Azizzadeh B. Botulinum toxin in the management of facial paralysis. Curr Opin Otolaryngol Head Neck Surg . 2015; 23(4):272-280. EBM level 4.................................................................................................224-233 Summary : This manuscript is written as a review of the literature describing the use of botulinum toxin for managing sequelae of facial paresis such as synkinesis, hyperkinesis, and hyperlacrimation. The authors also highlight the possible role of botulinum toxin in the acute paresis phase. The role of physical therapy is stressed. E. Facial fractures Delaney SW. Treatment strategies for frontal sinus anterior table fractures and contour deformities. J Plast Reconstr Aesthet Surg . 2016; 69(8):1037-1045. EBM level 5.................................................................................................234-242 Summary : This article reviews different approaches in the treatment of anterior table frontal sinus fractures. Delayed contour deformity camouflage can be achieved using many different materials. Advancement in endoscopic technology and expertise has created a paradigm shift toward a less invasive approach to the frontal region, with considerably less morbidity than conventional open techniques.

Doerr TD. Evidence-based facial fracture management. Facial Plast Surg Clin North Am . 2015; 23(3):335-345. EBM level 4..........................................243-253

Summary : This article reviews an evidence-based methodology in facial fracture management. It highlights the few areas of facial trauma in which randomized studies and meta-analysis are available. The article examines the future of facial trauma care in which clinical registries and health databases may be better able to answer clinical questions too complex to be addressed by clinical trials.

III.

CONGENITAL A. Craniofacial deformities

Daniali LN, Rezzadeh K, Shell C, et al. Classification of newborn ear malformations and their treatment with the EarWell Infant Ear Correction System. Plast Reconstr Surg . 2017; 139(3):681-691. EBM level 4.........254-264 Summary : This study is a case series reviewing the authors’ experience in treating 303 ears with deformities (prominent, lidding, conchal crus, Stahl, and helical rim deformities) and 175 ears with malformations (constricted ears and cryptotia). Blinded photographic assessment was performed. Doft MA, Goodkind AB, Diamond S, et al. The newborn butterfly project: a shortened treatment protocol for ear molding. Plast Reconstr Surg . 2015; 135(3):577e-583e. EBM level 4.................................................................265-271

Summary : This paper suggests that if earlier molding is adopted, the time required for molding can be decreased to 2 weeks from 6 to 8 weeks.

Pawar SS, Koch CA, Murakami C. Treatment of prominent ears and otoplasty: a contemporary review. JAMA Facial Plast Surg . 2015; 17(6):449-454. EBM level 4..........................................................................................................272-277 Summary : The authors provide a non-systematic review of otoplasty, discussing traditional techniques (cartilage sparing, cartilage cutting) as well as more contemporary issues (incisionless otoplasty, molding).

APRIL 2018 SECTION 4 ADDITIONAL REFERENCES

Baker SR. Diced cartilage augmentation: early experience with the Tasman technique. Arch Facial Plast Surg . 2012; 14(6):451-455.

Bitik O, Uzun H, Kamburoğlu HO, et al. Revisiting the role of columellar strut graft in primary open approach rhinoplasty. Plast Reconstr Surg . 2015; 135(4):987-997.

Braasch DC, Abubaker AO. Management of mandibular angle fracture. Oral Maxillofac Surg Clin North Am . 2013; 25(4):591-600.

Buckmiller LM, Munson PD, Dyamenahalli U, et al. Propranolol for infantile hemangiomas: early experience at a tertiary vascular anomalies center. Laryngoscope . 2010; 120(4):676-681.

Cerrati EW, O TM, Binetter D, et al. Surgical treatment of head and neck port-wine stains by means of a staged zonal approach. Plast Reconstr Surg . 2014; 134(5):1003-1012.

Choi JW, Kim N. Clinical application of three-dimensional printing technology in craniofacial plastic surgery. Arch Plast Surg . 2015; 42(3):267-277. Erratum. Arch Plast Surg . 2015; 45(4):513.

Collar RM, Byrne PJ, Boahene KD. The subzygomatic triangle: rapid, minimally invasive identification of the masseteric nerve for facial reanimation. Plast Reconstr Surg . 2013; 132(1):183-188.

Colletti G, Battista VM, Allevi F, et al. Extraoral approach to mandibular condylar fractures: our experience with 100 cases. J Craniomaxillofac Surg . 2014; 42(5);e186-e194.

Dauwe PB, Pulikkottil BJ, Scheuer JF, et al. Infection in face-lift surgery: an evidence-based approach to infection prevention. Plast Reconstr Surg . 2015; 135(1):58e-66e.

Desai SC, Sand JP, Sharon JD, et al. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg . 2015; 17(1):56-66.

Farnoosh S, Don D, Koempel J, et al. Efficacy of doxycycline and sodium tetradecyl sulfate sclerotherapy in pediatric head and neck lymphatic malformations. Int J Pediatr Otorhinolaryngol . 2015; 79(6):883-887.

Griffin G, Azizzadeh B, Massry GG. New insights into physical findings associated with postblepharoplasty lower eyelid retraction. Aesthet Surg J . 2014; 34(7):995-1004.

Harris GJ. Avoiding complications in the repair of orbital floor fractures. JAMA Facial Plast Surg . 2014; 16(4):290-295.

Hassanein AH, Mulliken JB, Fishman SJ, Greene AK. Evaluation of terminology for vascular anomalies in current literature. Plast Reconstr Surg . 2011; 127(1):347-351.

Holcomb JD. Thermally confined micropulsed 1444-nm Nd:YAG interstitial fiber laser in the aging face and neck: an update. Facial Plast Surg Clin North Am . 2014; 22(2):217-229.

i

Hontanilla B, Marré D. Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system. Plast Reconstr Surg . 2012; 130(5):662e-672e.

Ilhan AE, Saribas B, Caypinar B. Aesthetic and functional results of lateral crural repositioning. JAMA Facial Plast Surg . 2015; 17(4):286-292.

Jacono AA, Malone MH. The effect of midline corset platysmaplasty on degree of face-lift flap elevation during concomitant deep-plane face-lift: a cadaveric study. JAMA Facial Plast Surg . 2016; 18(3):183- 187. Jacono AA, Rousso JJ, Lavin TJ. Comparing rates of distal edge necrosis in deep-plane vs subcutaneous cervicofacial rotation-advancement flaps for facial cutaneous Mohs defects. JAMA Facial Plast Surg . 2014; 16(1):31-35.

Kiang L, Deptula P, Mazhar M, et al. Muscle-sparing blepharoplasty: a prospective left-right comparative study. Arch Plast Surg . 2014; 41(5):576-583.

Lee JW, Baker SR. Correction of caudal septal deviation and deformity using nasal septal bone grafts. JAMA Facial Plast Surg . 2013; 15(2):96-100.

Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated scar management practical guidelines: non- invasive and invasive measures. J Plast Reconstr Aesthet Surg . 2014; 67(8):1017-1025.

Ogawa R, Akaishi S, Dohi T, et al. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method. Plast Reconstr Surg . 2015; 135(3):868- 875.

Palesy T, Pratt E, Mrad N, et al. Airflow and patient-perceived improvement following rhinoplastic correction of external nasal valve dysfunction. JAMA Facial Plast Surg . 2015; 17(2):131-136.

Rajan A, Eubanks E, Edwards S, et al. Optimized cell survival and seeding efficiency for craniofacial tissue engineering using clinical stem cell therapy. Stem Cells Transl Med . 2014; 3(12):1495-1503.

Ribeiro L, Castro E, Ferreira M, et al. The concepts and applications of tissue engineering in otorhinolaryngology. Acta Otorrinolaringol Esp . 2015; 66(1):43-48.

Richter AL, Barrera J, Markus RF, Brissett A. Laser skin treatment in non-Caucasian patients. Facial Plast Surg Clin North Am . 2014; 22(3):439-446.

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Sapthavee A, Munaretto N, Toriumi DM. Skin grafts vs local flaps for reconstruction of nasal defects: a retrospective cohort study. JAMA Facial Plast Surg . 2015; 17(4):270-273.

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Regenerative Medicine Reprinted by permission of Plast Reconstr Surg. 2015; 135(6):1740-1748.

Regenerative Biomaterials: A Review

Derek A. Banyard, M.D., M.B.A. Jenna Martin Bourgeois, M.D. Alan D. Widgerow, M.B.B.Ch., M.Med. Gregory R. D. Evans, M.D. Orange, Calif.

Summary: The authors present a review of biomaterials, substances tradition- ally derived from human or animal tissue or, more recently, biodegradable synthetics modeled after naturally occurring resources. These constructs dif- fer from purely synthetic materials in that they are degraded or incorporat- ed into a host’s tissue. These biomaterials include a diverse array of medical products, such as acellular dermal matrix, bone substitutes, and injectables. In this review, the authors examine various clinical applications, including burn reconstruction and wound healing, breast surgery, complex abdominal wall reconstruction, craniofacial repair, and cosmetic surgery. Biomaterials such as acellular dermal matrix have proven beneficial in difficult-to-treat applications; however, more prospective data are needed to determine their true efficacy and cost-effectiveness.  ( Plast. Reconstr. Surg. 135: 1740, 2015.)

B iomaterials include some of the oldest medical technologies still used in modern clinical practice today. The word “biomate- rial” implies the ability of this active material to become incorporated into native tissue. Today, this term encompasses an ever-growing list of products and categories derived from both human and animal tissue, and synthetic mate- rials derived from naturally occurring organic substances. Because of the sheer scope of the topic, we have created a targeted review on the most relevant and recent clinical studies, with an emphasis on levels of evidence, to highlight the current state of the technology, identify areas where strong clinical data are lacking, and sum- marize recent key findings. BASIC SCIENCE Biomaterials, whether derived from human tissue, animal tissue, or naturally occurring resources, can be distinguished from purely syn- thetic materials by their tendency to become degraded or to be incorporated into a host’s tis- sue. This biocompatibility is thought to result in a minimal foreign body reaction characterized by increased integration and vascularization, release of antiinflammatory cytokines, improved bacte- rial clearance, and improved healing compared From the Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine. Received for publication May 21, 2014; accepted December 16, 2014. Copyright © 2015 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000001272

with synthetic materials. 1 It is the goal of current basic science research to enhance wound healing by optimizing the design of biomaterials. 2 The shared component of acellular dermal matrix and hyaluronic acid–based gels, the two most commonly used biomaterials, is the presence of a three-dimensional collagen matrix. As such, shifts in focus on design elements such as pore size, mechanical integrity, and tension have emerged as critical features for cellular attachment, prolif- eration, and differentiation, and thus altering the wound healing dynamic. 3–5 Autologous donor skin sources are often scarce and skin grafts can fall short in provid- ing stable coverage to restore the structure and function of skin. Evidence indicates that skin replacement requires a dermal layer or structural components that facilitate the generation of a dermal layer to optimize healing and reduce scar- ring and contraction. 4 As a result, a number of synthetic, natural, cellular, and acellular products DERMAL SUBSTITUTES AND BURN WOUNDS

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

A Video Discussion by Geoffrey C. Gurtner, M.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Videos” tab to watch.

www.PRSJournal.com

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Volume 135, Number 6 • Regenerative Materials

have been developed for various uses, includ- ing the treatment of diabetic, chronic, and burn wounds (Table 1). In practical terms, both cellular and acellular biological skin substitutes have proven useful in difficult-to-treat burn reconstructions. 6–8 However, because it only functionally serves to replace the dermal layer, epidermal coverage in the form of a split-thickness skin graft is still needed. Regard- less, numerous studies have demonstrated that the addition of acellular dermal matrix use in this setting results in a faster healing time, 9,10 bet- ter aesthetic outcome with improved skin elastic- ity, and reduced scar contracture 11–19 ; can serve as a temporizing measure to avert the need for emergency surgery 19 ; and allows improved mobil- ity and function of joints that require skin cover- age. 10,12–14,18 Although there are clear benefits to its use, acellular dermal matrix will never serve as a complete replacement for autologous tissue trans- fer in this setting, and more prospective data are needed (Table 2). 6,9–54

Certain techniques, such as meshing of skin substitutes combined with negative-pressure wound therapy, have improved take of these grafts and ensured improved outcomes. The products in Table 3 address acellular dermal matrix types that are used for other diverse soft-tissue applications that include, but are not limited to, abdominal and thoracic wall reconstructions, breast recon- structions, and hernia repair. However, as with all indications with biomaterials, the cost-effective- ness and true benefits over traditional reconstruc- tive options have yet to be clearly defined. 55 ABDOMINAL WALL, BREAST, AND CHEST WALL RECONSTRUCTION Although first introduced as an adjunct for soft-tissue coverage in the setting of full-thick- ness burns, 50 the applications of acellular der- mal matrix have grown tremendously over the past two decades (Table 3). Its advantages over synthetic materials include an exogenous source

Table 1. Skin Substitutes Product Type Cell therapy  CellSpray (Avita Medical, Woburn, Mass.)

Structure

Application

Keratinocytes harvested in proliferating state and sprayed on wound bed

Partial-thickness and donor-site wounds

Cells plus scaffold/carrier  BioSeed-S (BioTissue Technologies, Freiburg, Germany)  Epicel (Genzyme Corp., Cambridge, Mass.)  MySkin (Altrika, Sheffield, United Kingdom)  VivoDerm (ER Squibb and Co., Princeton, N.J.)  Dermagraft (Advanced BioHealing, Inc., LaJolla, Calif.)  Hyalograft 3D (Fidia Advanced Biopolymers, Padova, Italy)  Transcyte (Advanced BioHealing)  Apligraf (Organogenesis, Inc., Canton, Mass.)  OrCel (Ortec International, Inc., New York, N.Y.)  Biobrane (Smith & Nephew, Hull, United Kingdom)  EZ Derm (Genzyme Corp., Cambridge, Mass.)  Integra (Integra LifeSciences Corp., Plainsboro, N.J.)  OASIS Wound Matrix (Cook Medical, Inc., Bloomington, Ind.) Biomaterial alone  AlloDerm (LifeCell Corp., Branchburg, N.J.)

Autologous keratinocytes in fibrin glue Venous leg ulcers

Cultured autograft of keratinocytes cultured for 3 wk Cultured autograft of keratinocytes

Deep dermal and full-thickness burns

Partial-thickness burns; skin graft sites; diabetic, pressure, and neuropathic ulcers Partial-thickness burns, venous and pressure ulcers Diabetic foot ulcers, epidermolysis bullosa Full- or partial-thickness wounds, scleroderma ulcers Full- and partial-thickness burns Venous, diabetic, and pressure ulcers; pyoderma gangrenosum; vasculitic ulcers; scleroderma; donor sites Split-thickness donor sites, epidermolysis bullosa, and venous and diabetic ulcers Full-thickness wounds, burns, in cosmetic and reconstructive surgery Partial-thickness burns and donor sites Partial-thickness burns; diabetic, pressure, and neuropathic ulcers Deep partial-thickness and full-thickness burns, postsurgical wounds, diabetic ulcers Partial- and full-thickness burns; diabetic, venous, and pressure ulcers

Autologous keratinocytes on hyaluronic acid material Fibroblasts from neonatal skin on biodegradable polyglactin mesh Autologous fibroblasts on hyaluronic acid matrix Allogenic human dermal fibroblasts on nylon mesh of Biobrane Bovine collagen and human keratinocytes from human neonatal foreskin

Neonatal fibroblasts and keratinocytes on cross-linked bovine collagen

Cadaveric acellular dermal matrix

Porcine collagen

Cross-linked porcine collagen

Acellular silicone epidermal substitute over dermal scaffold of collagen and chondroitin-6-sulfate Porcine small intestine submucosa

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Plastic and Reconstructive Surgery • June 2015

Abdominal Wall Complex abdominal wall defects including large hernias and fistulas remain a significant challenge for the reconstructive surgeon. The use of traditional synthetic materials such as polypro- pylene, polyethylene terephthalate, and polytet- rafluoroethylene has lost favor to the lightweight absorbable or partially absorbable materials that include polyglactin (Vicryl; Ethicon, Inc., Somer- ville, N.J.) or poliglecaprone. 56 Unfortunately, none of these materials is particularly well-suited for abdominal wall reconstruction when dealing with a contaminated field where its removal is required in 50 to 90 percent of cases. 45 In addi- tion, complications are extensive and include the risk of visceral adhesions, fistula formation, infection, seroma, and skin breakdown. 44 In this setting, acellular dermal matrix has emerged as a viable alternative. A group in The Netherlands conducted a systematic review of 25 studies on the use of bio- logical grafts in ventral hernia repair and found that the overall recurrence rate was 13.8 percent and depended on the type of wound; however, that number jumped to 23.1 percent if the bio- logical grafts were placed in a contaminated field. Interestingly, of the 15.9 percent of infected grafts encountered, graft removal was required in only 4.9 percent of the cases. 49 Complications are inevitable when deal- ing with complex and contaminated abdominal wounds. There is wide variation reported in the literature, but in one review comparing the out- comes of different biological meshes, Bellows et al. reported an incidence of at least one compli- cation in 87 percent of cases. Unfortunately, this literature review is limited by the lack of a stan- dardized procedure reporting on studies that used varied techniques, including overlay, underlay, sandwich, bridging, and interposition. The most common complications include infection, seroma formation, recurrence, enterocutaneous fistulas, and dehiscence. 47 Currently, there appears to be a trend toward the use of xenograft (animal-derived matrix) over allograft (human-derived matrix) in various complicated settings, with some sug- gesting an observed decrease in the incidence of recurrence and infection. 46–49 Despite these find- ings, it is evident that randomized, prospective trials are needed to reveal the true benefit of a medical device that costs anywhere from $2845 to $5311 per 150 cm 2 . 49 The most comprehensive studies and reviews to date are all composed of Level III evidence (Table 2). The true integrity of acellular dermal matrix (as opposed to synthetic

Table 2. Relevant Studies by Application and Levels of Evidence

Level of Evidence

Reference Chest wall

IV IV III

 Tuggle et al., 2004 20  Von Wattenwyl et al., 2011 21  Lin et al., 2012 22  Rocco et al., 2012 23  Miller et al., 2013 24  Basu et al., 2010 25  Salzberg et al., 2011 26  Hester et al., 2012 30  Kim et al., 2012 31  Ibrahim et al., 2013 32  Cayci et al., 2013 33  Spear et al., 2014 34  Tessler et al., 2014 35  Mesimaki et al., 2009 36  Sherris and Oriel, 2011 37  Meara et al., 2012 38  Shiridharani et al., 2012 39  Yoshioka et al., 2012 40  Jansen and Macadam, 2011 27  Sbitany and Sirletti, 2011 28  Glasberg et al., 2012 29  Gunarajah and Samman, 2013 41

V

III

Breast

III III III III III III III III III IV IV IV IV III III III V III III III III IV IV IV IV IV IV IV V V V IV III V

Craniofacial

 Sandor et al., 2013 42  Fulco et al., 2014 43  Leber et al., 1998 44  Cavallaro et al., 2010 45  Beale et al., 2012 46  Bellows et al., 2013 47  Iacco et al., 2013 48  Slater et al., 2013 49  Lattari et al., 1997 9  Tsai et al., 1999 10  Chen et al., 2008 13  Jiong et al., 2010 14  Yim et al., 2010 18  Askari et al., 2011 6  Pan et al., 2011 15  Tang et al., 2011 17  Chen et al., 2012 11  Chen et al., 2013 12  Pirayesh et al., 2014 16  Zhang et al., 2014 19  Brown et al., 2011 51  Schutz et al., 2012 52   Kølle et al., 2013 53  Ozturk et al., 2013 54

Abdominal wall

Dermal substitutes and burn wounds  Wainwright, 1995 50

V II II

IV

Cosmetic

I

IV

I

IV

of biocompatible tissue when transferable autol- ogous tissue has been exhausted, improved resistance to infection and increased durability when placed in a contaminated field, 2 and the ability of the tissue to integrate and adapt dur- ing remodeling that occurs during the growth phase. Despite these advantages, acellular der- mal matrix is associated with its own set of com- plications and high costs.

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