• The technique for using the temporoparietal fascial flap in head and neck reconstruction is described. The advantages and applications of this flap are discussed and illustrated with case reports. Donor site morbidity is discussed, and the details of flap harvesting are reviewed. We have found the flap to be useful in the reconstruction of a variety of defects that require thin, vascular, and durable coverage. ( Arch Otolaryngol Head Neck Surg. 1993;119:618-623)

The temporoparietal fascial flap in head and neck reconstruction

Upper Extremity Burn Contractures

Background: A failed ear reattachment tends to complicate subsequent reconstruction with autogenous rib cartilage. The various reattachment methods differ in technical demand, in the secondary damage of periauricular tissue, and in aesthetic outcome. In the past 25 years, the microsurgical method has proven to be especially successful. The aim of this work was to assess case reports of auricular trauma since the first microsurgical ear replantation by Pennington. Methods: An extensive review of the literature of acute ear trauma published between 1980 and 2004 was performed. For a better comparison, the type of damage, the reattachment technique, and the final outcome were categorized. Representative cases of traumatic auricular lesions, which were reconstructed with rib or conchal cartilage at the authors' hospital, were included. Results: Seventy-four cases in 56 publications were analyzed. The microsurgical replantation showed excellent aesthetic results but demanded an intensive perioperative and postoperative treatment. Pocket methods were used mainly in partial amputations. Repairs with periauricular tissue flaps made a quite inconsistent impression. Direct reattachments, such as composite grafts, were indicated only in extended lacerations. Conclusions: To replant an avulsed auricle is still a challenge for surgeons. Microsurgically reanastomosed ear replantation appears to be the best method because a superior outcome can be achieved without jeopardizing a subsequent ear reconstruction with rib cartilage in case of failure. The pocket method and periauricular skin or fascia flaps should be abandoned. They rarely achieve such a consistently good aesthetic outcome as a secondary reconstruction with rib cartilage.

A comparison of ear reattachment methods: a review of 25 years since Pennington.

Reconstruction of the auricle

Reconstruction of the axilla with a posterior arm fasciocutaneous flap.

A fasciocutaneous flap raised on the inner surface of the upper arm has been used to release 16 burn scar contractures of the anterior axillary fold. It is a relatively quick and simple procedure that adequately corrects the contracture and does not have to followed by prolonged splinting.

The inner arm fasciocutaneous flap.

Primary ear reconstruction following avulsion using a temporoparietal fascial island flap based on the superficial temporal vessels is presented as a modification of an existing technique for the acute treatment of this difficult problem, offering a further alternative to established traditional nonmicrosurgical procedures.

Primary nonmicrosurgical reconstruction following ear avulsion using the temporoparietal fascial island flap.

Ambulation using axillary crutches (AC) is associated with increased energy expenditure (EE) and decreased gait speed compared to unassisted walking. A hands-free crutch (HFC) may represent an alternative to AC to decrease EE for those requiring assistive devices. Therefore, the PURPOSE of this randomized order, crossover-design study was to determine the differences in EE between AC and HFC ambulation. METHODS: To date, five healthy (BMI < 30 kg/m2) male and female adults (mean ± SD: age: 21 ± 1 years; height: 171.9 ± 10.4 cm; weight: 74.16 ± 10.46 kg) completed a 6-minute walk at 50 m/min, an activities of daily living (ADL) course, and a two-flight stair climb with AC, HFC, and unassisted walking. The order of trial conditions was randomized. EE during each condition was obtained through indirect calorimetry utilizing the COSMED K4b2 portable metabolic system. Unpaired t-tests were performed to compare EE between the assistive devices and unassisted walking. RESULTS: For the 50 m/min paced 6-minute walk, EE for unassisted walking (3.06 ± 0.37 kcal/min) was significantly (p < 0.05) lower than EE for HFC (5.33 ± 1.27 kcal/min) and AC (7.35 ± 0.80 Kcal/min). Additionally, EE for the 50 m/min walk was significantly (p = 0.03) lower for HFC than AC. EE for unassisted stair climbing (3.30 ± 1.07 kcal/min) was significantly (p = 0.049) lower than EE for AC stair climbing (4.74 ± 0.61 kcal/min), but not statistically different (p = 0.47) for HFC stair climbing (3.83 ± 1.09 Kcal/min). EE for the unassisted (3.46 ± 0.41 kcal/min) ADL course was significantly lower than EE for AC (5.31 ± 0.64 kcal/min) and HFC (5.11 ± 0.34 kcal/min) during the ADL course. CONCLUSIONS: These preliminary findings suggest that HFC may offer a more energy efficient alternative to AC during ambulation. For ADLs, no conclusive differences were found between AC and HFC for EE with these data. Continued recruitment and testing of 20 participants will permit stronger conclusions. 

Timothy Finucan

Papers

The inner arm fasciocutaneous flap.

Primary nonmicrosurgical reconstruction following ear avulsion using the temporoparietal fascial island flap.

Metabolic energy expenditure during ambulation using axillary crutches and a hands-free crutch.