In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.

• Klíčová slova
• amputation, dog bite injury, flap ischemia, forehead replantation, replantation,
• MeSH
• čelo * chirurgie   MeSH
• kousnutí a bodnutí chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrochirurgie * metody   MeSH
• psi MeSH
• replantace * metody   MeSH
• zvířata MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• psi MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Scalp necrosis following a cranioplasty and subsequent exposure of the implant is a dreaded complication and needs to be treated promptly. Conventionally, implant removal is often advised to prevent delayed infection. We present a case of a scalp necrosis following cranioplasty using a titanium mesh for a patient who had undergone glioma excision and radiation therapy. Using a latissimus dorsi free muscle flap, we salvaged the implant. Patient had a persistent dural leak which was addressed by a pedicled extended forehead flap and suction drain under the latissimus dorsi flap. We successfully stopped the cerebrospinal fluid leak and covered the defect adequately concluding that muscle flaps are very useful to salvage exposed implants.

• MeSH
• čelo chirurgie   MeSH
• chirurgické laloky MeSH
• lidé MeSH
• mamoplastika * MeSH
• nekróza chirurgie   MeSH
• skalp chirurgie   MeSH
• zákroky plastické chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Although syringoma is a common benign tumour of the sudoriferous gland, there is also an extremely rare malignant form known as syringoid eccrine carcinoma (SEC). SEC usually exhibits slow growth with deep invasion and a frequent tendency to relapse. The treatment of choice is radical wide resection, which poses a difficult reconstructive problem, especially when the tumour is located in the centre of the face. CASE PRESENTATION: In this case, a 70-year-old man was diagnosed with an SEC at the same location as a benign syringoma of the upper lip and nasal base that had undergone primary excision 7 years prior. Primary radical resection was performed with immediate Abbé flap reconstruction. Nevertheless, histology revealed positive margins, and 3 additional re-excisions were needed to achieve clear margins. Four months after the initial resection, the patient had undergone an innovative reconstruction technique including not only the Abbé flap but also a turbinate flap harvested with functional endonasal surgery and a three-stage forehead flap. CONCLUSION: To the best of our knowledge, this is the first case report of a suspect malignant transformation of a benign syringoma after 7 years. In addition, from oncoplastic and reconstructive points of view, the bilateral use of the turbinate flap for reconstructing the intranasal lining of the alar base is unusual, and the use of functional endonasal surgery in nasal reconstruction for reducing the risk of damaging the vascular supply of the flap is innovative.

• Klíčová slova
• Functional endonasal surgery, Head and neck malignancy, Nasal reconstruction, Syringoid eccrine carcinoma, Turbinate flap,
• MeSH
• čelo chirurgie   MeSH
• karcinom * chirurgie   MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• nádory kožních adnex MeSH
• nádory kůže MeSH
• nádory potních žláz * chirurgie   MeSH
• nosní skořepy chirurgie   MeSH
• ret chirurgie   MeSH
• senioři MeSH
• syringom * chirurgie   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Nasal basal cell carcinomas are the most common malignant tumors of the facial skin, which predilectively affect areas exposed to sunlight, including the nasal area. After their radical removal, there is a variable complex defect of the affected area (defect of all 3 layers of the nose) or even a composite defect (it also occupies the adjacent soft tissues around the nose), which are usually used to reconstruct this area. A 73-year-old female patient with recurrent infiltrative basal cell carcinoma of the left nasal ala underwent four re-excisions before histologically verified free margins without the presence of the tumor. The result was a composite defect that occupied the top of the dome of the right nostril, the entire left half of the soft nose, including the base of the wing, part of the upper lip, and a defect of the adjacent face area of 9 × 5cm. In the first phase, the left cheek and upper lip were reconstructed by advancement French plasty and coverage of the two residual skin defects with full-thickness skin graft. One month later, during the second phase of reconstruction, the flap was re-elevated, shifted and rotated, and a three-stage nasal reconstruction was started using a composite septal pivotal flap and left turbinate flap for inner lining reconstruction, and the nasal skeleton was reconstructed with a cartilaginous L-graft from the 6th rib, septal and conchal cartilages. The skin cover of the nose was reconstructed with the left paramedian forehead flap, which was thinned during the second stage with the simultaneous widening of the bottom of the left nostril by the transposition flap, during the third stage the flap pedicle was removed. In the reconstruction of a complex defect of the nose and its surroundings, it is first necessary to create a stable platform on which the reconstruction of the nose itself will be performed. To achieve an excellent functional and aesthetic result of nose reconstruction, it is appropriate to use a three-stage forehead flap. In this paper, we describe a unique method of nasal reconstruction - a combination of a septal pivotal flap with a turbinate flap to reconstruct the inner lining in conjunction with an L-graft to ensure a stable nasal skeleton and forehead flap to reconstruct the skin cover.

• Klíčová slova
• composite septal pivotal flap, forehead flap, nasal reconstruction, turbinate flap,
• MeSH
• čelo chirurgie   MeSH
• chirurgické laloky MeSH
• lidé MeSH
• nádory kůže * chirurgie   MeSH
• nádory nosu * chirurgie   MeSH
• nosní skořepy MeSH
• rinoplastika * MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Third degree burn trauma of the head and neck requires an interdisciplinary approach. After emergency care and hemodynamic stabilization of the patient the focus lies on the reconstruction of the damaged tissue. The options of reconstruction are influenced by the general condition of the patient and by the condition of the surrounding tissues. The deep defects of the head are dangerous for a high risk of wound infection and possible fatal complications. In particular cases the first methods of choice for closure of the defect may be ineffective and a free flap transfer should be considered. We present a case report of a 62-year-old woman who suffered third degree burn trauma of the head and neck leading to a deep defect of the forehead reaching behind the hairline. On the bottom there was an exposed bone with no healing tendency. Due to surrounding fragile scarred tissue we chose a free flap transfer using serratus anterior muscle as a method of closure. The flap was fully healed and provided good aesthetic and functional outcome.

• Klíčová slova
• deep burn trauma, free flap, reconstruction surgery,
• MeSH
• čelo zranění   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• popálení komplikace   chirurgie   MeSH
• poranění krku etiologie   chirurgie   MeSH
• poranění obličeje etiologie   chirurgie   MeSH
• volné tkáňové laloky * MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Basal cell carcinoma (BCC) is the most prevalent malignancy, with rising incidence worldwide. Despite its naturally slow growth and initially low metastatic potential, it can cause significant morbidity and mortality when unrecognized, inadequately treated or poorly followed up. Authors present the case of a 61-year-old male with a 7-year history of multiple incomplete excisions of a “simple” BCC on the forehead. A CT scan of the head revealed an invasive mass (5.2 cm laterolateral x 4.0 cm craniocaudal) in the frontal area. There was no evidence of metastasis. Complete resection of the lesion and reconstruction was achieved in three stages. Final reconstruction was achieved using a left frontal fasciocutaneous flap. The secondary defect was closed with an advancement flap of the scalp and donor sites were covered using a split-thickness skin graft from the upper limb. This case demonstrates the necessity for vigilance in the approach to, diagnosis, treatment and follow-up of these skin neoplasms. The development of giant BCCs should be avoided at all costs. Increased size of BCCs corresponds with increased recurrence rate, metastatic rate, morbidity, mortality, treatment difficulties and overall costs.

• Klíčová slova
• Basal cell carcinoma, giant basal cell carcinoma, local invasion, plastic surgery, reconstructive surgery, recurrence,
• MeSH
• bazocelulární karcinom diagnostické zobrazování   prevence a kontrola   chirurgie   MeSH
• čelo MeSH
• chirurgické laloky MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory kůže diagnostické zobrazování   prevence a kontrola   chirurgie   MeSH
• nádory obličeje diagnostické zobrazování   prevence a kontrola   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Although the short- and long-term effectiveness of abobotulinumtoxinA (Dysport®/Azzalure®) for glabellar line (GL) treatment is well established, reporting of subject satisfaction over repeat treatment cycles is limited. The APPEAL study aimed to assess subject satisfaction with long-term GL treatment with abobotulinumtoxinA in a real-life setting. METHODS: APPEAL was a noninterventional, prospective, longitudinal study in subjects administered ≥ 3 abobotulinumtoxinA injection cycles for moderate-to-severe GL, according to routine clinical practice. Subjects completed a satisfaction questionnaire at 3 weeks (± 7 days) after each cycle. Primary endpoint included subjects' overall satisfaction with GL after three injection cycles. Secondary endpoints included satisfaction after Cycles 1 and 2 and factors associated with satisfaction after each cycle. Physician satisfaction was also assessed after Cycles 1 and 3. RESULTS: Of 150 subjects enrolled, 135 completed the overall subject satisfaction questionnaire after Cycle 3. At 3 weeks after Cycle 3, 99.3% of subjects were 'very satisfied' (74.1%) or 'satisfied' (25.2%) with GL. Levels of subject satisfaction and associated factors after Cycles 1 and 2 were as large and significant as after Cycle 3 (83-100%, depending on question). Physicians' satisfaction with GL appearance, facial expression, and overall satisfaction was almost complete after the first injection (≥ 97.4%) and unanimous after the third (100%). CONCLUSIONS: In the APPEAL study, overall satisfaction was high after three abobotulinumtoxinA injection cycles for GL based on both subjects' (99.3%) and physicians' (100.0%) assessments. High levels of subject satisfaction reported after Cycle 1 were maintained with repeated injections. No new safety signals were observed. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Trial registration NCT02353897.

• Klíčová slova
• AbobotulinumtoxinA, Dysport®, Glabellar lines, Physician satisfaction, Subject satisfaction,
• MeSH
• botulotoxiny typ A aplikace a dávkování   MeSH
• čelo MeSH
• dospělí MeSH
• estetika MeSH
• injekce subkutánní MeSH
• lékaři * MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• mladý dospělý MeSH
• omlazení fyziologie   MeSH
• osobní uspokojení MeSH
• prognóza MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• rozvrh dávkování léků MeSH
• spokojenost pacientů statistika a číselné údaje   MeSH
• stárnutí kůže MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Názvy látek
• abobotulinumtoxinA MeSH Prohlížeč
• botulotoxiny typ A MeSH

OBJECTIVE: Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images. METHODS: 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient. RESULTS: All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries were found between male and female subjects (P > 0.05). Regression analyses demonstrated that the judgement of facial attractiveness was not influenced by absolute regional facial asymmetries when gender, facial width-to-height ratio and type of malocclusion were controlled (P > 0.05). LIMITATIONS: A potential limitation of the study could be that other biologic and cultural factors influencing the perception of facial attractiveness were not controlled for. CONCLUSIONS: A small amount of asymmetry was present in all subjects assessed in this study, and asymmetry of this magnitude may not influence the assessment of facial attractiveness.

• MeSH
• anatomická značka MeSH
• asymetrie obličeje patologie   psychologie   MeSH
• brada patologie   MeSH
• čelo patologie   MeSH
• dospělí MeSH
• estetika stomatologická * MeSH
• fotogrammetrie metody   MeSH
• lidé MeSH
• malokluze patologie   MeSH
• mínění MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nos patologie   MeSH
• obličej patologie   MeSH
• postoj ke zdraví MeSH
• reprodukovatelnost výsledků MeSH
• tvář patologie   MeSH
• zobrazování trojrozměrné metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To evaluate sexual dimorphism of facial form and shape and to describe differences between the average female and male face from 12 to 15 years. SETTING AND SAMPLE POPULATION: Overall 120 facial scans from healthy Caucasian children (17 boys, 13 girls) were longitudinally evaluated over a 4-year period between the ages of 12 and 15 years. MATERIALS AND METHODS: Facial surface scans were obtained using a three-dimensional optical scanner Vectra-3D. Variation in facial shape and form was evaluated using geometric morphometric and statistical methods (DCA, PCA and permutation test). Average faces were superimposed, and the changes were evaluated using colour-coded maps. RESULTS: There were no significant sex differences (p > 0.05) in shape in any age category and no differences in form in the 12- and 13-year-olds, as the female faces were within the area of male variability. From the age of 14, a slight separation occurred, which was statistically confirmed. The differences were mainly associated with size. Generally boys had more prominent eyebrow ridges, more deeply set eyes, a flatter cheek area, and a more prominent nose and chin area. CONCLUSION: The development of facial sexual dimorphism during pubertal growth is connected with ontogenetic allometry.

• Klíčová slova
• 3D imaging, dense correspondence analysis, facial morphology, longitudinal growth, sexual dimorphism,
• MeSH
• analýza hlavních komponent MeSH
• anatomická variace MeSH
• brada anatomie a histologie   MeSH
• čelo anatomie a histologie   MeSH
• dítě MeSH
• fotogrammetrie metody   MeSH
• lidé MeSH
• longitudinální studie MeSH
• mladiství MeSH
• nos anatomie a histologie   MeSH
• obličej anatomie a histologie   MeSH
• obočí anatomie a histologie   MeSH
• oči anatomie a histologie   MeSH
• optické zobrazování metody   MeSH
• pohlavní dimorfismus * MeSH
• puberta fyziologie   MeSH
• ret anatomie a histologie   MeSH
• tvář anatomie a histologie   MeSH
• ústa anatomie a histologie   MeSH
• věkové faktory MeSH
• zobrazování trojrozměrné metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

The accuracy of transcutaneous bilirubin meters has been assessed in newborns from various ethnic backgrounds. However, there are limited data on Greek newborns. Our study examined the accuracy of transcutaneous bilirubin measurements in clinically jaundiced healthy-term Greek newborns, using total serum bilirubin as the reference standard, in order to re-evaluate our local guidelines about neonatal jaundice. Clinically jaundiced newborns requiring total serum bilirubin level estimation were recruited prospectively. 368 pairs of total serum bilirubin/transcutaneous bilirubin measurements were taken in 222 newborns, using a direct spectrophotometric device and the BiliCheck device, respectively. The level of agreement between the obtained transcutaneous bilirubin and total serum bilirubin values was assessed. Our data were analysed using the Stata/SE 12.0 (StataCorp LP, USA) statistical programme. The mean (± SD) TSB was 225.4 ± 25.4 μmol/l and the mean (± SD) TcB was 237.9 ± 21.0 μmol/l. The correlation between the values was poor (Pearson's correlation coefficient 0.439; Lin's concordance coefficient 0.377 [95% CI 0.301 to 0.453]; P<0.001). The Bland-Altman analysis demonstrated that transcutaneous bilirubin measurements tended to overestimate the total serum bilirubin value (mean difference 12.5 ± 24.9 μmol/l), with wide 95% limits of agreement (-36.2 μmol/l to 61.3 μmol/l). Transcutaneous bilirubin values did not correlate well with total serum bilirubin values, being often imprecise in predicting the actual total serum bilirubin levels. This permits us to continue estimating total serum bilirubin in clinically jaundiced newborns according to our local guidelines, in order to safely decide the appropriate care plan.

• MeSH
• bilirubin analýza   metabolismus   MeSH
• čelo MeSH
• lidé MeSH
• novorozenec MeSH
• novorozenecká žloutenka diagnóza   metabolismus   MeSH
• novorozenecký screening přístrojové vybavení   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• srovnávací studie MeSH
• Geografické názvy
• Řecko MeSH
• Názvy látek
• bilirubin MeSH