Objectives: Scarring alopecia on the head after the removal of a scalp lesion, such as a sebaceous nevus, can be a cosmetic concern. There are several reports on methods used for subgaleal dissection and incision of the galea when using simple sutures, but these methods have not been quantitatively analysed.

Methods: In this small case series, we compared 2 methods for primary wound closure following removal of scalp lesions, one involving only subgaleal dissection (group A) and the other involving both subgaleal dissection and additional galeal incisions (group B).

Results: Fourteen patients were enrolled. The average excision width was 15.0 (range 8-22) mm in group A and 21.8 (range 18-32) mm in group B. The average width of alopecia was 5.6 (range 1-12) mm and 3.1 (range 3-4) mm, respectively.

Conclusions: In this case series, subgaleal dissection and an additional incision to the galea during simple scalp excisions not only expanded the limits of the closable defect width but also reduced the width of the resulting scarring alopecia.

Objectives: This article reports the long-term results of the minimally invasive Earfold™ device.

Methods: Between May 2017 and January 2021, 19 patients (7 men and 12 women) received an Earfold™ implant. Fifteen patients had bilateral implants placed, and among them, 2 received 2 implants per ear. In 4 cases, placement was limited to one ear. In one patient, a concurrent earlobe correction was performed.

Results: Of the 22 patients assessed with Prefold™, 19 chose for this option instead of surgical otoplasty, 2 chose not to undergo any surgery, and one was not found fit for the procedure by the surgeon. Six patients suffered from a complication and had their implants removed. One additional patient requested to have his implants removed as well.

Conclusions: The Earfold™ implant is a promising, minimally invasive alternative for standard otoplasty treatment. Nevertheless, in our series, a notable high complication rate was observed, often necessitating implant removal, particularly in the long term. Despite recognizing a learning curve, the surgeon in this study chose to discontinue the use of Earfold™ implants.

Objectives: Facial wrinkle treatment using botulinum toxin A (BT-A) is an extremely popular aesthetic procedure. Many studies have been conducted on the improvement of the mental states of depressive patients whose glabellar lines were treated with BT-A. It could be caused by afferent effects derived from the proprioception of related facial muscles, which is known as facial feedback hypothesis. This study highlights the impact of BT-A injections into the glabellar region on the emotional states of participants who have specifically no mental disorders.

Methods: A total of 47 Asian participants (42 women and 5 men) without mental disorders completed the Japanese version of the Brief, Momentary Mood Checklist (BMC-J) before and 2 weeks after receiving the treatment for glabellar lines with BT- A injections.

Results: Based on BMC-J scores reported by the participants, their emotional states statistically improved after treatment (P = 0.008), particularly in the concurrent decrease in negative emotions (P = 0.003).

Conclusions: To our knowledge, this is the first study of the statistically significant effect of the BT-A treatment on the emotional state of subjects without mental disorders. The experiences of emotions derived from the motions of the frown muscles, which may be caused by the modulation of the amygdala activity, are not so complicated but extremely primitive, such as pleasure and unpleasure. This might be the reason why our results of BMC-J, which is used to measure basic emotions, indicated more clearly that negative emotions reduced compared with positive ones, in contrast to the finding of previous published reports that measured more complicated emotions such as feelings.

Three cases of total thoracic esophageal re-reconstruction after failed jejunum grafting for esophageal cancer are described. A prefabricated long skin tube formed by a combination of tensor fascia lata and anterolateral thigh flaps was transferred to the ruined anterior chest with vascular anastomosis, with the oral intake achieved in all three patients. The prefabrication reinforced the vascularity of the long conduit by the delay effect. The prefabrication included skin grafting on the resultant raw surface; hence, another free flap to seal the longitudinal suture line of the conduit was avoided. Furthermore, the viability of the conduit was easily monitored with the previously grafted skin. However, if a high-positioned jejunostomy is unavailable, an additional free skin tube might be necessary. Postoperative leakage is quite frequent due to these patients' poor general and local conditions. Therefore, sparing large local flaps or pedicled musculocutaneous flaps around both the oral and anal anastomoses for repairing the fistula is important.

Nipple-areolar complex necrosis following vascular compromise is an infrequent, but devastating complication of reduction mammaplasty. Negative pressure wound therapy has revolutionized wound care since its advent more than 20 years ago and has been used in various surgical settings. Here, we report the novel use of a full-coverage breast-specific incisional negative pressure wound therapy dressing in successfully salvaging nipple-areolar complex compromise in reduction mammaplasty.

We present a case of huge recurrent spindle cell sarcoma in a 3-year-old boy's right temporoparietal scalp, which was initially misdiagnosed as a hemangioma and was primarily excised after an unsuccessful trial of oral propranolol. The tumor recurred and responded to adjuvant chemotherapy. After wide local excision with a frozen section confirming clear margins, a combination of free latissimus dorsi myocutaneous flap, scalp rotational flap, and split-thickness skin graft was used to resurface the extensive postresection defect. However, the patient experienced marginal flap necrosis postoperatively and required multiple operations to achieve adequate soft tissue coverage. His hospitalization was also prolonged because of surgical site infection over the scalp and skin graft donor sites, which required intravenous antibiotics and regular dressing changes. The patient has been disease free after discharge with no remarkable functional deficit. In our opinion, the best tool for reconstruction of extensive scalp defects is free flaps.

Muscle repair can be a frustrating endeavor. When stitches are thrown, surgeons frequently experience tearing through the muscle or tendinous substance, which inadvertently causes more bleeding, injury, and poor tissue hold with more unpredictable scarring and fibrosis. A myriad of suturing techniques has been proposed for muscle repair. However, such techniques can be confusing to replicate and are often strangulating to tissues.

Our institution presents a novel technique that is easily replicable, minimizes tissue strangulation, and provides a good, reliable foothold to place our stitches without tearing through, which will be detailed in the following paper. The described technique has been performed in our institution over a multitude of cases, most prominently in our experience with abdominal wall reconstruction.

Suturing has been a pillar of plastic surgery since its very foundation. From ancient civilizations to modern practices, hair sutures have resurfaced as vital material for wound closure and tissue approximation. This study aimed to explore the historical evolution and application of hair sutures, particularly in facial reconstruction, skin flaps and grafts, peripheral nerve surgery, oral/maxillofacial surgery, and oculoplastic surgery. Notable surgeons and scholars, from Susrata to Sir Harold Gillies, have cited unique properties of horsehair sutures, namely, their pliability, strength, and nonabsorbable nature in various applications. Despite the advent of synthetic materials, recent interest in hair sutures has emerged, driven by their renewable nature and potential for "green" surgical practices. Contemporary studies agree with the historical perspectives, suggesting that hair sutures offer favorable aesthetic outcomes, minimal tissue reaction, and cost-effectiveness. This study illustrates the legacy of hair sutures in plastic and reconstructive surgery.