Plastic & Reconstructive Surgery最新文献

{"title":"Histologic Analysis of Sensory and Motor Axons in Branches of the Human Brachial Plexus.","authors":"Lauren M Mioton, G. Dumanian, M. De la Garza, J. Ko","doi":"10.1097/PRS.0000000000006278","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006278","url":null,"abstract":"BACKGROUND\u0000The topographic distribution through histologic analysis of motor and sensory axons within peripheral nerves at the brachial plexus level is not clearly defined, as there has previously been little need to appreciate this microanatomy. A desire to better understand the topography of fascicle groups developed with the introduction of targeted muscle reinnervation.\u0000\u0000\u0000METHODS\u0000Fourteen bilateral brachial plexus specimens from seven fresh human cadavers were harvested at the time of organ donation, and immunofluorescent staining of motor and sensory nerves with choline acetyltransferase and Neurofilament 200 was performed to determine whether a consistent somatotopic orientation exists at the brachial plexus level.\u0000\u0000\u0000RESULTS\u0000There was significant variability in the number of fascicles at the level of the brachial plexus. Qualitative analysis of choline acetyltransferase staining demonstrated that although motor axons tended to be grouped in clusters, there were high degrees of variability in somatotopic orientation across specimens. The radial nerve demonstrated the highest number of total myelinated axons, whereas the median nerve exhibited the greatest number of motor axons. The ulnar nerve contained only 13 percent motor axons, which was significantly lower than the median, radial, and musculocutaneous nerves.\u0000\u0000\u0000CONCLUSIONS\u0000There was no consistent somatotopic organization of motor and sensory axons of the mixed major nerves of the arm just distal to the brachial plexus, but clustering of motor axons may facilitate the splitting of nerves into primarily \"motor\" and \"sensory\" fascicles.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78282663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composite Buttock Augmentation: The Next Frontier in Gluteal Aesthetic Surgery.","authors":"Alexander A. Aslani, D. D. Del Vecchio","doi":"10.1097/PRS.0000000000006244","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006244","url":null,"abstract":"BACKGROUND\u0000Despite rapid growth, gluteal fat transplantation has a dismal safety record and often results in inadequate domal projection. Implants alone for gluteal augmentation have also been reported to be less than ideal, with significant complication rates. The idea of combining both implants and fat, as has been described in the breast, was therefore applied to surgery of the buttocks.\u0000\u0000\u0000METHODS\u0000One hundred forty-seven consecutive cases of buttock augmentation were reviewed. Average follow-up was 18 months. The technique of composite buttock augmentation used progressive instrument dissection to precisely define the correct intramuscular plane of the implant pocket with a minimum amount of pocket access dissection.\u0000\u0000\u0000RESULTS\u0000Operating times averaged 1 hour 55 minutes. The average volume of fat inserted was 380 cc. The average implant volume was 300 cc. Complications included implant displacements and implant pocket infections requiring surgical intervention. There were no cases of pulmonary thromboembolism, fat embolism, or death.\u0000\u0000\u0000CONCLUSIONS\u0000Taking a lesson from composite breast augmentation, composite buttock augmentation is a new method for gluteal reshaping that seeks to use the best of both worlds: the reliable core projection of an implant combined with the natural appearance and feel of fat. Progressive instrument dissection seeks to minimize unnecessary dissection and to accurately and safely define the intramuscular pocket. The intramuscular placement of implants instead of fat should eliminate the risk of fatal fat pulmonary embolism in these patients.\u0000\u0000\u0000CLINICAL QUESTION/LEVEL OF EVIDENCE\u0000Therapeutic, IV.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78672539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Satisfaction and Quality of Life in Obese Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients.","authors":"G. Kamel, Karan Mehta, David Nash, J. Jacobson, Robin Berk, Amanda M. Rizzo, Nicolas Greige, T. Benacquista, E. Garfein, K. Weichman","doi":"10.1097/PRS.0000000000006201","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006201","url":null,"abstract":"BACKGROUND\u0000Patients undergoing autologous breast reconstruction have higher rates of patient-reported satisfaction compared to patients undergoing prosthetic reconstruction. Obesity has been shown to increase postoperative complications in both microsurgical and implant reconstructions. The authors evaluated the effects of microsurgical breast reconstruction and prosthetic breast reconstruction on patient-reported outcomes and quality of life in obese patients.\u0000\u0000\u0000METHODS\u0000A retrospective review of obese patients who underwent breast reconstruction from January of 2009 to December of 2017 was conducted. Patients were divided into two cohorts: microsurgical and two-stage tissue expander/implant-based reconstruction. BREAST-Q survey response, demographic information, complications, and need for revision procedures were analyzed.\u0000\u0000\u0000RESULTS\u0000One hundred fifty-five patients met the inclusion criteria: 75 (48.4 percent) underwent microsurgical breast reconstruction and 80 (51.6 percent) underwent implant-based reconstruction. Cohorts were similar in body mass index, mean mastectomy specimen weight, laterality, indication for surgery, smoking status, and postoperative complications. Microsurgical reconstruction patients were younger (49.0 years versus 53.0 years; p = 0.02) and more likely to have delayed reconstruction [n = 70 (64.2 percent) versus n = 0 (0.0 percent); p = 0.0001]. BREAST-Q responses showed that microsurgery patients were more satisfied with their breasts (Q-Score of 63.4 ± 6.9 versus 50.8 ± 12.8; p = 0.0001), overall outcome (Q-Score 70.5 ± 13.0 versus 60.3 ± 10.8; p = 0.0001), and chest physical well-being (Q-Score of 69.1 ± 10.9 versus 63.8 ± 8.2; p = 0.01).\u0000\u0000\u0000CONCLUSIONS\u0000Microsurgical breast reconstruction in obese patients yields higher satisfaction with breasts, overall outcomes, and chest physical well-being than implant-based reconstruction. Despite increased postoperative complications associated with obesity, microsurgical breast reconstruction appears to be a good choice for women who understand its risks and benefits and choose to proceed with it.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77660773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: Cranioorbital Morphology Caused by Coronal Ring Suture Synostosis.","authors":"R. Hopper","doi":"10.1097/PRS.0000000000006258","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006258","url":null,"abstract":"","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80716491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis.","authors":"W. Powcharoen, Wei-fa Yang, Kar Yan Li, Wang-yong Zhu, Yu-xiong Su","doi":"10.1097/PRS.0000000000006261","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006261","url":null,"abstract":"BACKGROUND\u0000Computer-assisted mandibular reconstruction facilitates preoperative surgery simulation and transfers the virtual plan to a real operation. This systematic review and meta-analysis aimed to compare the accuracy, efficiency, postoperative complications, and economic viability between computer-assisted mandibular reconstruction and conventional freehand mandibular reconstruction.\u0000\u0000\u0000METHODS\u0000The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched up to November of 2018. The accuracy, efficiency, postoperative complications, and economic viability of computer-assisted mandibular reconstruction compared to conventional freehand mandibular reconstruction were systematically reviewed. Continuous and dichotomous data were pooled in mean difference (or standardized mean difference if necessary) and odds ratio, subsequently, with 95 percent confidence interval.\u0000\u0000\u0000RESULTS\u0000A total of 12 studies were included in the systematic review, and data extracted from 11 of them were combined in meta-analysis. The accuracy of computer-assisted mandibular reconstruction was better than or equal to that of conventional freehand mandibular reconstruction according to qualitative analysis, although the quantitative comparison from meta-analysis was excluded because of the diversity of measurements. As for efficiency, computer-assisted mandibular reconstruction, when compared to conventional freehand mandibular reconstruction, revealed a shorter ischemic time, reconstructive time, total operative time, and length of stay. There was no difference in postoperative complication rate.\u0000\u0000\u0000CONCLUSIONS\u0000Computer-assisted mandibular reconstruction showed increased efficiency considering the reduced ischemic time, total operative time, reconstructive time, and length of stay. However, the accuracy, reconstruction outcomes, and perioperative cost should be further elucidated because of diverse measurements and the lack of included studies.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74274315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topography of the Central Retinal Artery Relevant to Retrobulbar Reperfusion in Filler Complications.","authors":"Shin-Hyo Lee, Tae-Jun Ha, Je-Sung Lee, K. Koh, Wu-Chul Song","doi":"10.1097/PRS.0000000000006205","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006205","url":null,"abstract":"BACKGROUND\u0000Vision loss caused by retrograde occlusion of the central retinal artery is a serious complication of cosmetic filler injections. Salvage methods that involve applying hyaluronidases in the retrobulbar space to degrade filler materials have been proposed recently for rescuing the retinal circulation in an ophthalmic emergency.\u0000\u0000\u0000METHODS\u0000Sixty-six eyeballs and orbital contents were extracted from formalin-embalmed cadavers and dissected carefully to examine the topographic relationship of the central retinal artery and optic nerve. To observe the three-dimensional course of a central retinal artery that invaginates into the optic nerve, serial sections reconstructed at 100-μm intervals using software were visualized in 11 specimens.\u0000\u0000\u0000RESULTS\u0000The central retinal artery ramified from the ophthalmic artery and entered the optic nerve inferiorly at 8.7 ± 1.7 mm (mean ± SD) from the posterior margin of the eyeball. The intraneural course of a central retinal artery changed acutely between the periorbital environment of the fibrous optic nerve sheath, intermediate subarachnoid spaces, and center of the optic nerve stroma.\u0000\u0000\u0000CONCLUSION\u0000When applying a retrobulbar approach for central retinal artery reperfusion with hyaluronidases, the reliable access route is suggested to be at a depth of 3.0 to 3.5 cm from the border of the inferolateral orbital rim, based on consideration of the entry point of the central retinal artery into the optic nerve.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75463229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fat Grafting for the Treatment of Scleroderma.","authors":"A. Strong, J. Rubin, Jeffrey H. Kozlow, P. Cederna","doi":"10.1097/PRS.0000000000006291","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006291","url":null,"abstract":"BACKGROUND\u0000Scleroderma is a chronic connective tissue disease that results in fibrosis of the skin and internal organs. Although internal organ involvement corresponds with poor prognosis, systemic agents are effective at improving the effects of scleroderma on internal organs. In contrast, skin manifestations are universally present in all patients diagnosed with scleroderma, yet no systemic agents have been shown to be successful. Fat grafting has been shown to improve skin quality and improve contour irregularities and may be helpful in the treatment of patients with scleroderma.\u0000\u0000\u0000METHODS\u0000The authors performed a thorough review of the pathophysiology of scleroderma and the current treatment options for scleroderma. The efficacy of fat grafting for the treatment of scleroderma and the mechanism by which fat grafting improves outcomes was also discussed.\u0000\u0000\u0000RESULTS\u0000Scleroderma is characterized by chronic inflammation and vascular compromise that leads to fibrosis of the skin and internal organs. Fat grafting has recently been the focus of significant basic science research. It has been shown to reduce inflammation, reduce fibrosis by limiting extracellular matrix proteins and increasing collagenase activity, and provide structural support through stem cell proliferation and differentiation. The adipocytes, adipose stem cells, endothelial cells, and vascular smooth muscle cells in the processed fat likely contribute to the effectiveness of this treatment.\u0000\u0000\u0000CONCLUSIONS\u0000Fat grafting in scleroderma patients likely improves skin manifestations by recreating fullness, correcting contour deformities, and improving skin quality. The injected fat provides a mixture of cells that influences the recipient site, resulting in improved outcomes.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90152888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polydioxanone Threads for Facial Rejuvenation: Analysis of Quality Variation in the Market.","authors":"Matthias M Aitzetmueller, Carolina Centeno Cerdas, Phillipp Nessbach, P. Foehr, Elizabeth Brett, Dominik Thor, H. Machens, R. Burgkart, D. Duscher","doi":"10.1097/PRS.0000000000006289","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006289","url":null,"abstract":"BACKGROUND\u0000Beside botulinum-toxin injections and hyaluronic acid fillers, thread lifts have established themselves as the third column of minimally invasive facial rejuvenation. Most commonly, barbed threads for this approach are made out of polydioxanone, a material known for decades from application in resorbable sutures. The clinical efficacy and the putative material safety of polydioxanone have fueled the popularity of thread lifts.\u0000\u0000\u0000METHODS\u0000The present study highlights significant variation among six commercially available threads in microstructure, tensile strength, elasticity, anchoring capacity in human tissue, and biocompatibility.\u0000\u0000\u0000RESULTS\u0000Despite their license to be marketed and sold in the European Union, some products performed significantly worse than others on material testing, and even displayed cytotoxic characteristics.\u0000\u0000\u0000CONCLUSION\u0000The results of this study are highly relevant for clinicians and may be linked to various typical side effects of polydioxanone threads for facial rejuvenation.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78333802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: Mechanical Signals Induce Dedifferentiation of Mature Adipocytes and Increase the Retention Rate of Fat Grafts.","authors":"A. Strong, P. Cederna","doi":"10.1097/PRS.0000000000006273","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006273","url":null,"abstract":"www.PRSJournal.com 1334 F grafting has become one of the most commonly performed operations in plastic and reconstructive surgery. However, the technique has been plagued by variable graft take and resorption rates that reduce the efficacy of each treatment. Basic science and clinical studies have demonstrated resorption rates of 25 to 50 percent, which can lead to the requirement for multiple fat grafting procedures and ultimate patient frustration. Significant ongoing research is currently being conducted to improve fat graft take and reduce resorption rates. Harvest site, harvest method, processing method, site of delivery, and delivery method have all been demonstrated to affect fat grafting results. Each step in the process introduces variability that can impact the overall fat grafting retention rate, and optimization of the ideal methodology for this technique has yet to be determined. In the current article, the authors should be commended for their exploration of pretreating the cells to be harvested before isolation for fat grafting.1 The concept of manipulating cells with mechanical forces before harvesting to induce a more robust population of cells for delivery is based on sound foundational principles. In developmental biology, cells and their local microenvironment, or niche, communicate through mechanical cues to regulate cell fate and cell behavior.2 In adult stem cells, the mechanical and physical interactions of cells with the extracellular matrix regulate proliferation, self-renewal, differentiation, and multipotency.2 In response to increased stiffness or load, mature cells have been shown to secrete matrix components or proteases that enhance or diminish adhesive interactions, stiffen or soften the extracellular matrix, and alter downstream signaling pathways.3 The interactions between the harvested cells and the environment may produce more robust cells that survive the fat grafting process. Although the sheer number of cells that may survive through pretreatment with various mechanical stressors can improve fat graft retention, additional signaling pathways are likely to be up-regulated through the mechanical induction and contribute to improved retention. New vascular networks are critical in the survival of the engrafted fat, as they provide nutrients to the cells. Studies have shown that neovascular network formation and growth are regulated by mechanical conditions, and changes in the surrounding matrix alter vessel formation and remodeling.4 Thus, mechanical stimulation of cells before harvest has the potential to generate an angiogenic response and promote the survival of fat grafts through the formation of new vascular networks. Although many new innovations have been described in the literature in the past decade, it remains to be determined which novel technique translates into improved fat retention in patients. Animal studies are essential as a first step to describe new techniques and to obtain histologic analy","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86818530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: Neurotized Platysma Graft: A New Technique for Functional Reanimation of the Eye Sphincter in Longstanding Facial Paralysis.","authors":"S. Rozen","doi":"10.1097/PRS.0000000000006297","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006297","url":null,"abstract":"www.PRSJournal.com 1071e C protection is one of the highest priorities in longstanding flaccid facial paralysis patients. The inability to close the palpebral aperture secondary to a paralyzed orbicularis oculi muscle increases the risk of keratoconjunctivitis, ulcerations and, in severe cases, blindness. The orbicularis oculi muscle is a unique muscle. It is extremely thin, as it lies under the thinnest skin in the body—the upper and lower eyelids. Also, its circular shape combined with medial and lateral anchoring allows it a very distinctive sphincter action, enabling palpebral aperture closure in a cranial-to-caudal direction with minimal medialto-lateral vector. In addition, its proper tone and function are essential in periorbital aesthetics. Even when midface palsy reconstruction is optimal, patients with suboptimal aesthetic periorbital reconstruction will always carry the stigmata of facial paralysis. Static upper and lower eyelid procedures provide some corneal protection during sleeping hours but are limited during awake hours when normal blink reflex and voluntary palpebral closure are vital. Although orbicularis oculi muscle neurotization is feasible in the acute and subacute phase, longstanding palsy patients need a new neuromuscular unit. This has previously been attempted by either muscle transfers or functional muscle transplants.1 Both are imperfect. The former often suffer from lateral-to-medial action, sometimes providing closure but nearly always creating distortion. The latter demand very high technical proficiency2 and are frequently bulky. This is where the work by Drs. Nassif and Chia is unique.3 Although free muscle grafts were described as early as 1970 by Tamai et al.,4 they were inherently unreliable because of muscle ischemia, especially in thicker muscles. Nevertheless, the periorbital area needs an extremely thin muscle and, as demonstrated in regenerative peripheral nerve interface studies, small muscle grafts without axial blood supply may survive in wellvascularized wound beds and available early neurotization.5 Nassif and Chia took advantage of this approach and of the similar embryologic, histologic, architectural, and fine motor unit arrangement properties of the platysma and orbicularis oculi muscle. They transplanted two very thin platysma muscle grafts to the upper and lower eyelids after preparing the recipient bed with respective cross-facial nerve grafts. The premise is that these thin muscle grafts survive because of early vascularization and neurotization. By no means is this procedure portrayed as simple, but its beauty is its simplicity. It may seem that Nassif and Chia have provided the holy grail of periorbital reconstruction in longstanding paralyzed patients, addressing the most difficult challenges by providing a reproducible, functional, aesthetic and thin, sphincter-like reconstruction. Nevertheless, a discussion must point out limitations and encourage further development; thus, the followin","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87600133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}