Reply: Nasal Reconstruction after Malignant Tumor Resection: An Algorithm for Treatment
Notice bibliographique
Résumé
Sir: We would like to thank Drs. Gurunluoglu and Williams for their comments on our recently published article, “Nasal Reconstruction after Malignant Tumor Resection: An Algorithm for Treatment.”1 Drs. Gurunluoglu and Williams suggest two other local flaps for reconstructing small nasal skin-only defects as an addition to our algorithm. We based our algorithm on our personal clinical experience combined with a literature review, and we realize that our algorithm does not contain all reconstruction options ever published in the literature. We fully agree with Drs. Gurunluoglu and Williams that selection of a particular reconstruction option is at the discretion of the reconstructive surgeon and that it also depends on a variety of other factors such as surgical knowledge and skill. It was never our intention to provide a compulsory algorithm; instead, we attempted to give an overview of which reconstruction options are most appropriate for a given nasal defect, taking into account defect size, shape, location, and tissues involved (i.e., skin only, skin and cartilage, or full thickness). A banner flap, named after its triangular shape, is a monolobed (as opposed to bilobed) flap that is transposed 90 degrees, which often leads to a dog-ear requiring secondary correction. Very mobile and relatively thin skin as in the superior part of the nose is necessary to easily transpose this flap without tension, secondary distortion, or vascular compromise. By basing the flap opposite the defect, the resulting horizontal donor-site scar over the nasal dorsum can have the tendency to create a depressed conspicuous scar. In our opinion, a banner flap is not very useful for closure of nasal tip or alar defects where the skin is sebaceous, thick, and inflexible, leading to difficulties in transposing the flap without tension or vascular compromise. In addition, primary closure of the donor site as shown in Figure 1 will easily lead to upward retraction of the alar rim. Instead, a bilobed flap—where the second vertically oriented lobe of the flap fills the donor defect of the first lobe, which is transposed to the nasal tip defect—would prevent this secondary alar rim distortion and would therefore be a more appropriate option in our opinion. The two triangular V-Y skin flap technique to close infratip skin-only defects is a very useful additional solution for a difficult reconstructive area. However, as is the case for all transposition flap solutions, proper preoperative defect and donor-site analysis is mandatory, because the width of the columella and infratip lobule may not always be sufficient to raise these flaps. In summary, nasal reconstruction can be complex because of its delicate and specific anatomy. There are many appropriate solutions for closure of nasal skin defects, and the flaps suggested by Drs. Gurunluoglu and Williams in addition to our algorithm can without doubt be useful for reconstructing certain small nasal skin-only defects. Sanne E. Moolenburgh, M.D., Ph.D. Linda McLennan, M.D. Department of Plastic and Reconstructive Surgery Erasmus University Medical Center Rotterdam, The Netherlands Peter C. Levendag, M.D., Ph.D. Department of Radiation-Oncology Daniel den Hoed Cancer Center Rotterdam, The Netherlands Kai Munte, M.D., Ph.D. Department of Dermatology Erasmus University Medical Center Rotterdam, The Netherlands Marcel Scholtemeijer, M.D., Ph.D. Department of Oral and Maxillofacial Surgery Erasmus University Medical Center Rotterdam, The Netherlands Stephan O. P. Hofer, M.D., Ph.D. Division of Plastic Surgery University Health Network University of Toronto Toronto, Ontario, Canada Marc A. M. Mureau, M.D., Ph.D. Department of Plastic and Reconstructive Surgery Erasmus University Medical Center Rotterdam, The Netherlands
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».