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Facial Reconstruction Surgery: Clinical Obstacles and Challenges
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Facial Reconstruction Surgery: Clinical Obstacles and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: closed (15 August 2023) | Viewed by 6939

Special Issue Editors

Dr. Adriana C. Panayi

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Guest Editor
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Interests: tissue reconstruction; biomaterial engineering; surgical outcomes; wound healing; scarring; fibrosis; virtual surgical planning; vascularized composite allotransplantation; facial transplantation; plastic and reconstructive surgery
Dr. Gabriel Hundeshagen

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Guest Editor
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Interests: burns; burn surgery; wound healing; plastic and reconstructive surgery; microsurgery
Dr. Valentin Haug

E-Mail Website
Guest Editor
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Interests: plastic and reconstructive surgery; facial transplantation; tissue preservation; microsurgery; vascularized composite allotransplantation

Special Issue Information

Dear Colleagues,

Disfiguring facial injuries, which can range from superficial damage to the skin to the complete loss of adipose, muscle, and bone tissue, present surgeons with a significant reconstructive challenge while negatively impacting patient quality of life.

Extensive strides in biomedical engineering and surgical technology and techniques, particularly in the the last couple of decades, have revolutionized the field of facial reconstructive surgery. Such advancements have included the use of autologous free tissue transplantation and the optimization of the free tissue transfer method to minimize donor and recipient site morbidity, the use of novel biomedical materials to fill soft tissue and bone defects, the introduction of virtual surgical planning and three-dimensional printing to develop customized implants, and complete facial transplantation, arguably one of the greatest surgical developments in recent decades. These principles and techniques are continually undergoing refinement, with each novel development not only advancing the progress of facial reconstruction techniques, but simultaneously presenting novel challenges. The ultimate goal of the facial reconstruction surgeon is the re-establishment of the anatomy and function of the face as closely as possible to its pre-injury state.

The present Special Issue on “Facial Reconstruction Surgery: Clinical Obstacles and Challenges“ invites experts in the field to submit reviews and original scientific articles reflecting on the history of reconstructive methods, outlining the status at present of the technologies available for facial reconstruction, and providing insights into the future of this ever-changing field.

Dr. Adriana C. Panayi
Dr. Gabriel Hundeshagen
Dr. Valentin Haug
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tissue engineering
  • biomaterials
  • microsurgery
  • vascularized composite allotransplantation
  • facial transplantation
  • free tissue transfer
  • virtual surgical planning
  • patient-specific implants
  • reconstructive surgery

Published Papers (3 papers)

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Research

12 pages, 1611 KiB  
Article
Histomorphometry of the Sural Nerve for Use as a CFNG in Facial Reanimation Procedures
by Andreas Kehrer, Katharina S. Hollmann, Silvan M. Klein, Alexandra M. Anker, Ernst R. Tamm, Lukas Prantl, Simon Engelmann, Samuel Knoedler, Leonard Knoedler and Marc Ruewe
J. Clin. Med. 2023, 12(14), 4627; https://doi.org/10.3390/jcm12144627 - 12 Jul 2023
Cited by 1 | Viewed by 1429
Abstract
Facial palsy (FP) is a debilitating nerve pathology. Cross Face Nerve Grafting (CFNG) describes a surgical technique that uses nerve grafts to reanimate the paralyzed face. The sural nerve has been shown to be a reliable nerve graft with little donor side morbidity. [...] Read more.
Facial palsy (FP) is a debilitating nerve pathology. Cross Face Nerve Grafting (CFNG) describes a surgical technique that uses nerve grafts to reanimate the paralyzed face. The sural nerve has been shown to be a reliable nerve graft with little donor side morbidity. Therefore, we aimed to investigate the microanatomy of the sural nerve. Biopsies were obtained from 15 FP patients who underwent CFNG using sural nerve grafts. Histological cross-sections were fixated, stained with PPD, and digitized. Histomorphometry and a validated software-based axon quantification were conducted. The median age of the operated patients was 37 years (5–62 years). There was a significant difference in axonal capacity decrease towards the periphery when comparing proximal vs. distal biopsies (p = 0.047), while the side of nerve harvest showed no significant differences in nerve caliber (proximal p = 0.253, distal p = 0.506) and axonal capacity for proximal and distal biopsies (proximal p = 0.414, distal p = 0.922). Age did not correlate with axonal capacity (proximal: R = −0.201, p = 0.603; distal: R = 0.317, p = 0.292). These novel insights into the microanatomy of the sural nerve may help refine CFNG techniques and individualize FP patient treatment plans, ultimately improving overall patient outcomes. Full article
(This article belongs to the Special Issue Facial Reconstruction Surgery: Clinical Obstacles and Challenges)
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12 pages, 2333 KiB  
Article
Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience
by Felix Strübing, Fabian Wenz, Nima Etminan, Amir K. Bigdeli, Laura C. Siegwart, Benjamin Thomas, Felix Vollbach, Julian Vogelpohl, Ulrich Kneser and Emre Gazyakan
J. Clin. Med. 2023, 12(8), 2953; https://doi.org/10.3390/jcm12082953 - 19 Apr 2023
Cited by 3 | Viewed by 2788
Abstract
Background: Complex scalp defects are regularly reconstructed using microvascular tissue transfer. The latissimus dorsi free flap is one of the workhorse flaps used in scalp reconstruction. These cases necessitate, particularly in the elderly, a close cooperation between plastic surgeons and neurosurgeons. The purpose [...] Read more.
Background: Complex scalp defects are regularly reconstructed using microvascular tissue transfer. The latissimus dorsi free flap is one of the workhorse flaps used in scalp reconstruction. These cases necessitate, particularly in the elderly, a close cooperation between plastic surgeons and neurosurgeons. The purpose of this study was to evaluate the suitability of the latissimus dorsi free flap for complex scalp reconstructions and to analyze potential risk factors. Methods: A retrospective study identified 43 patients undergoing complex scalp reconstruction using a latissimus dorsi free flap at our department between 2010 and 2022. Results: The mean patient age was 61 ± 18 years. Defects were mostly caused by oncologic tumor resections (n = 23; 55%), exposure to a cranioplasty (n = 10; 23%) or infection (n = 4; 9%). The most frequent recipient vessels were the superficial temporal artery (n = 28; 65%), external carotid artery (n = 12; 28%) and the venae comitantes (n = 28; 65%), external jugular vein (n = 6; 14%). The reconstructive success rate was 97.7%. There was one total flap loss (2%). Partial flap loss occurred in five cases (12%). Follow-up was 8 ± 12 months. Major complications were seen in 13 cases, resulting in a revision rate of 26%. Multivariate logistic regression identified active tobacco use as the only risk factor for major complications (odds ratio 8.9; p = 0.04). Conclusion: Reconstruction of complex scalp defects using the latissimus dorsi free flap yielded high success rates. Among the potential risk factors, active tobacco use seems to affect the outcome of complex scalp reconstructions. Full article
(This article belongs to the Special Issue Facial Reconstruction Surgery: Clinical Obstacles and Challenges)
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17 pages, 540 KiB  
Article
Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database
by Samuel Knoedler, Helena Baecher, Cosima C. Hoch, Doha Obed, Dany Y. Matar, Carsten Rendenbach, Bong-Sung Kim, Leila Harhaus, Martin Kauke-Navarro, Gabriel Hundeshagen, Leonard Knoedler, Dennis P. Orgill and Adriana C. Panayi
J. Clin. Med. 2023, 12(4), 1444; https://doi.org/10.3390/jcm12041444 - 11 Feb 2023
Cited by 3 | Viewed by 2018
Abstract
Background: Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify [...] Read more.
Background: Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008–2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications. Results: The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009). Conclusion: Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations. Full article
(This article belongs to the Special Issue Facial Reconstruction Surgery: Clinical Obstacles and Challenges)
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