New Surgery Spotlight Now Available

IN THE JULY SURGERY SPOTLIGHT, Greg Borschel, MD, and Ronald Zuker, MD, perform a Segmental Gracilis Muscle Transplant on a 15-year-old boy who has right unilateral acquired facial palsy due to a brain tumor. In preparation for this surgery, the boy has previously had a cross-face sural nerve graft placed.

In this eight-hour case, two teams work simultaneously. One team harvests and prepares the segment of the gracilis muscle, while the second team works at the recipient site, preparing the facial artery and vein for anastomosis, and preparing the previously placed cross-face sural nerve graft for coaptation from the motor nerve to the gracilis muscle.

At the donor site, Dr. Borschel explains the importance and the process of de-bulking and splitting the gracilis muscle and presents a detailed diagram that demonstrates how the graft will be modeled and placed.  At the recipient site, Dr. Zuker demonstrates the movement of the facial muscles in creating a smile before measuring the anatomy inside the face so that the gracilis graft can be appropriately sized.  He then prepares the distal stump of the previously placed sural nerve graft for connection to the new graft.

Dr. Borschel notes that while different teams utilize running sutures and GI staplers to anchor the gracilis transfer, his team’s approach is to use reinforcing mattress sutures and anchoring sutures in an figure 8 pattern in order to create a secure fixation at the level of the oral commissure. After blood supply to the flap is established, Drs. Borschel and Zuker  anchor the graft at the commissure, fan out the muscle to achieve an appropriate level of tension, and the distal end is then sutured in place before closure.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD LibrarySurgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).

Surgery Spotlight Highlights High Wing Le Fort I with Genioplasty

IN THE LATEST Surgery Spotlight, Steven Buchman MD, demonstrates how to correct the effects of a congenital craniofacial syndrome on a young woman by performing a High Wing Le Fort I Osteotomy and accompanying genioplasty. Dr. Buchman describes the importance of preoperative planning for the procedure and utilization of a surgical model based on impressions of the patient’s teeth. The model is marked and then adjusted to demonstrate the desired operative outcome. Measurements can then be taken to determine the amount of movement that must be achieved on the patient during the actual procedure. Dr. Buchman illustrates on the patient the various key points of anatomy while dissecting the maxilla and its four buttresses before cutting and finally down-fracturing the maxilla so that the upper tooth-bearing segment can be moved freely within the mouth. Utilizing a splint that was designed from the surgical model, Dr. Buchman places the upper to the lower mandible into IMF (Intermaxillary fixation; the proper closed bite position), and then demonstrates how to position the maxilla and the zygoma and remove bony and cartilaginous interferences to allow the osteotomized maxillary segment to be secured to the stable facial bones.

Following the successful plating of the Le Fort, Dr. Buchman demonstrates a genioplasty on the patient who has a very thick, vertically long and retrusive chin and demonstrates how removing an interpositional segment of bone from her chin will improve her resulting profile and bring her facial bones into better position and symmetry following the Greek “Golden Rule” of ideal facial proportion. After marking the midline and then removing an interpositional segment of bone, he demonstrates plating the remaining bones of the chin back together.

In the third and final portion of this patient’s combined procedures, Dr. Buchman then demonstrates how to shape the bone excised from the chin so that it can be grafted to the patient’s mid face in order to improve the projection and symmetry of the malar eminence.

Dr. Buchman is a leader in the field of reconstructive craniofacial surgery. He is a Tenured Professor of Surgery in the Section of Plastic & Reconstructive Surgery and holds a joint appointment as a Professor Neurosurgery at the University of Michigan Medical School. Dr. Buchman has won numerous awards for excellence in teaching, research and clinical care.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).

New Surgery Spotlight highlights mandible reconstruction

IN THE NEW SURGERY SPOTLIGHT, Henry C. Vasconez MD, plans the harvest of a fibula osteocutaneous free flap to perform mandible reconstruction on a 21-year-old male with severe craniofacial microsomia and other congenital anomalies. In addition, the patient will also undergo a sagittal split mandibular osteotomy on the contralateral side, as well as a rotational LeFort 1 maxillary advancement in order to obtain improved symmetry and occlusion.

Dr. Henry Vasconez is a board-certified plastic surgeon in Lexington, Kentucky. In addition to private practice, he serves as a professor at the University of Kentucky. His interests include craniofacial surgery, pediatric plastic surgery, breast reconstruction and aesthetic surgery.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).

New Surgery Spotlight highlights Anterior Cranial Vault Reconstruction

In this month’s Surgery Spotlight Robert Havlik, MD performs an anterior cranial vault reconstruction to achieve the normal shape of the head on a 10-month-old infant who was diagnosed with craniosynostosis. Watch Dr. Havlik as he works with pediatric surgeon, Dr. Laurie Ackeman to correct these malformations of the skull to alleviate intracranial pressure. The video is now streaming for free on PSEN, or can be purchased as a part of an online course to receive CME credit.

Dr. Havlik is a recognized surgeon and researcher in cleft palate repair, and maxillofacial and craniofacial disorders. He is the immediate past-president of the American Society of Maxillofacial Surgeons and is past president of the American Society of Craniofacial Surgeons. He currently serves as the Chairman of Plastic Surgery and George J. Korkos, MD Professor in Plastic and Reconstructive Surgery at the Medical College of Wisconsin.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).

ASMS Day at Plastic Surgery The Meeting

The American Society of Maxillofacial Surgeons will host ASMS Day at Plastic Surgery 2012 on Sunday, October 28 in New Orleans. PSEN will once again be on hand to cover the programs, courses and events. Courses include Controversies in Cleft Care I – Cleft Lip, Managing Late Post-Traumatic Nasal Deformities and Putting Your Best Chin Forward. For the full listing of the ASMS Day program, please visit the meeting website. In addition, ASMS will host a special pre-conference program titled ASMS Successful Maxillofacial Surgery in Your Practice on Thursday, October 25. Click here for more information on the full program and how to register.

Last year at Plastic Surgery 2011 The Meeting, ASMS hosted the panel “Innovative Techniques in Head and Neck Reconstruction: The New Frontier” during ASMS Day on Sunday, September 25, 2011 in Denver, Colorado. In the presentation, panelists Matthew Hanasono, MD; Jesse Selber, MD; and Roman Skoracki, MD discussed innovative techniques in microsurgery, such as three-dimensional imaging using AutoCAD software and robotics. To view a recap, including an interview with moderator Geoffrey Robb, MD click here. For an overview of what topics were addressed during ASMS Day 2011 watch the interview video above.

More information and registration for Plastic Surgery 2012, which will be held this October in New Orleans can be found on the meeting website.