Aesthetic Plastic Surgery

Source:  Aesthetic Plastic Surgery    Tag:  aponeurotic ptosis

Aesthetic Plastic Surgery

Effect of Antiadhesion Barrier Solution and Fibrin on Capsular Formation After Silicone Implant Insertion in a White Rat Model

Abstract

Introduction

One of the most serious complications of breast reconstruction and augmentation using silicone implants is capsular contracture. Several preventive treatments, including vitamin E, steroids, antibiotics, and cysteinyl leukotriene inhibitors, have been studied, and their clinical effects have been reported. However, the problem of capsular contracture has not yet been completely resolved. This study was performed to compare anti-adhesion barrier solution (AABS) and fibrin in their ability to prevent fibrotic capsule formation and simultaneously evaluated their effect when used in combination by capsular thickness analysis and quantitative analysis of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and type I collagen within the fibrous capsule.

Materials and Methods

This study used female six-week-old Sprague-Dawley rats. Eighty rats were equally subdivided into the four following groups: AABS-treated, fibrin-treated, AABS and fibrin combined-treated, and untreated control groups. Each rat received two silicone chips under the panniculus carnosus muscle layer. The test materials were applied around the silicon chips. Four weeks later, the implantation sites including the skin and muscle were excised to avoid the risk of losing the fibrous capsule around the implants. The capsular thickness was analyzed by Masson’s trichrome stain. Quantitative analysis of type I collagen, MMPs, and TIMPs was performed by real-time PCR, Western blot, and zymography.

Results

The mean capsular thickness was 668.10 ± 275.12 μm in the control group, 356.97 ± 112.11 μm in the AABS-treated group, 525.96 ± 130.97 μm in the fibrin-treated group, and 389.24 ± 130.51 μm in the AABS and fibrin combined-treated group. Capsular thickness was significantly decreased in all experimental groups ( p < 0.05). Capsular thickness was greater in the fibrin-treated group than in the AABS-treated group ( p < 0.05). There was no statistically significant difference in capsular thickness between the AABS and fibrin combined-treated group and the AABS- or fibrin-treated group ( p > 0.05). Compared to the control group, the experimental groups had significantly lower expressions of type I collagen and MMP-1 ( p < 0.05), but there was no statistically significant difference in expressions of type I collagen and MMP-1 between the AABS-, fibrin-, and AABS and fibrin combined-treated groups ( p > 0.05). The expressions of MMP-2 and TIMP-2 were not significantly different between the control and the experimental groups ( p > 0.05).

Conclusion

AABS is more effective in reducing capsular thickness compared with fibrin treatment in a white rat model.

No Level Assigned

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

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Classification of the Aging Lips: A Foundation for an Integrated Approach to Perioral Rejuvenation

Abstract

Background

Although perioral aging is highly individual with several distinct processes taking part simultaneously, there is scarce systematic information which helps to indicate the right rejuvenation approach among the multitude of proposed procedures. Existing data about perioral aging has not yet been transformed into a consistent therapeutic concept. The intention of this study was to provide a simple, yet reproducible classification and to offer appropriate rejuvenation approaches.

Methods

To identify reliable and constant landmarks of the ongoing process of perioral aging, 462 perioral photo documentations were morphometrically analyzed. Based upon the identified landmarks a two-dimensional classification was developed. The classification was validated by three plastic surgeons. Inter- and intra-rater reliability was calculated using Cohen’s kappa coefficient.

Results

Perioral aging can be broken down into changes of the lip shape and changes of the lip surface. Both processes can be classified into three stages each: Lip shape according to the shape in profile view, the lip length in relation to the frontal incisors, and the degree of vermilion inversion. Lip surface according to the presence and degree of radial wrinkles and the visibility of the structural elements Cupid’s bow, philtrum, and white roll. Inter-observer reliability was rated very good (kappa values between 0.819 and 0.963) and perfect for intra-observer reliability (1.0).

Conclusion

A better understanding of perioral aging leads to a simple classification for the aging lips. Using the classification helps to tailor an appropriate treatment to the individual patient and aids to achieve a natural rejuvenation result.

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.

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A New Modification of C–V Flap Technique in Nipple Reconstruction: Rolled Triangular Dermal-Fat Flaps

Abstract

In this study, a simple modification of the C–V flap technique designed to maintain the neo-nipple projection performed as the last stage of breast reconstruction is described. The technique was used in seventeen patients who were treated with breast reconstruction using the transverse rectus abdominis flap. Except for one patient with a 2.3 mm decrease in nipple projection, the projection of all neo-nipples was preserved at the end of the mean follow-up period of 19.4 months. According to the results of our study, modifying the C–V flap technique by adding rolled triangular dermal-fat flaps improves the long-term maintenance of neo-nipple projection.

Level of Evidence V

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.

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Wide-Open Dorsal Approach Rhinoplasty for Droopy Noses

Abstract

Background

Because rhinoplastic surgery predominantly deals with the osseocartilaginous skeleton, droopy noses with thick skin remain a problem to be solved. In these noses, neglecting excess skin can impair long-lasting and complete correction of the nasal deformity. As these noses already require redundant dorsal skin resection, surgical manipulations can be executed entirely through the dorsal skin excision window instead of the transcolumellar approach.

Objective

The wide-open dorsal approach rhinoplasty (WoDAR) was developed to allow removal of excess dorsal skin and reconstruction of the nasal osseocartilaginous framework through the excised dorsal skin avoiding a transcolumellar incision.

Materials and Methods

Nine male patients with thick skin and significantly ptotic noses were operated with WoDAR. The cosmetic appearance of the noses was evaluated by the patients before and after the operation using a visual analog scale (VAS). The nasal obstruction symptom evaluation (NOSE) scale was evaluated individually preoperatively and postoperatively. The nasolabial angle (NLA) was measured preoperatively, at the third, twelfth, and twenty-fourth months postoperatively. Dorsal scars were evaluated by means of the Stony Brook’s scar evaluation scale (SBSES).

Results

Patients (mean age: 51.4 ± 4.8 years) were followed for an average duration of 20.6 ± 8.4 months. Cosmetic evaluation revealed that the mean patient preoperative VAS score was 23.3 ± 25.6, whereas the postoperative VAS score was 92.6 ± 14.8. Preoperative and postoperative NOSE scores were 79.5 ± 16.5 and 11.5 ± 11.5, respectively. The mean preoperative NLA was 72.9 ± 2.9° and at the third and twelfth month postoperatively was 92 ± 6.5 and 91 ± 5.4. The NLA measurements of all four patients followed for 24 months revealed less than 2° derotation compared to third postoperative month. The mean SBSES score was 4.1 ± 0.8 out of 5.

Conclusion

WoDAR allowed esthetically and functionally pleasing outcomes. This advantageous technique can be regarded as a surgical alternative for carefully selected aged patients with severely ptotic, thick-skinned noses who might otherwise end up with unsatisfying results both for surgeon and patients.

Level of Evidence V

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.

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Concepts in Navel Aesthetic: A Comprehensive Surface Anatomy Analysis

Abstract

Introduction

The navel contributes to abdominal surface identity and beauty. In Western societies, the display of the navel in women’s fashion has grown and, nowadays, women are much more concerned about its shape and position. Despite this, few studies are available on navel surface anatomy and there is no standardization regarding its proper placement in cosmetic abdominoplasty.

Materials and Methods

In this observational study, we analyzed navel shape and position on 81 high quality pictures, having been chosen as top 2013 bikini models by editors of mass media. An on-line survey on navel shape and position has been made via facebook.com, involving 1,682 people.

Results

The analysis revealed that navel position is quite variable based on the proportions analyzed with an acceptable narrow data spread of the xiphoid–umbilicus:umbilicus-abdominal mean crease ratio of 1.62 ± 0.16. The data dispersion for the other three ratios was wider, making them less reliable as references. The most appreciated navel shape was the vertical oval with superior hooding (82 %), and the less appreciated ones were the horizontal oval (29 %) and the protruding shape (47 %). When comparing navel position on the same body, the majority of participants choose the one with the navel relocated according to the golden ratio (i.e., 1.618)

Conclusion

The most attractive navel position is located at the xiphoid–umbilicus:umbilicus-abdominal crease golden ratio. Bony landmarks seem to be not reliable as references for proper navel positioning. The use of the Fibonacci (golden mean) caliper intraoperatively might aid in proper positioning of the navel in abdominoplasty.

No Level Assigned

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

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Readability Assessment of Online Patient Abdominoplasty Resources

Abstract

Background

Limited functional health literacy is recognized as an important contributor to health disparities in the United States. As internet access becomes more universal, there is increasing concern about whether patients with poor or marginal literacy can access understandable healthcare information. As such, the National Institutes of Health and American Medical Association recommend that patient information be written at a sixth grade level. This study identifies the most popular online resources for patient information about abdominoplasty and evaluates their readability in the context of average American literacy.

Methods

The two largest internet search engines were queried for “tummy tuck surgery” to simulate a patient search in lay terms. The ten most popular sites common to both search engines were identified, and all relevant articles from the main sites were downloaded. Sponsored results were excluded. Readability analysis of the articles was performed using ten established tests.

Results

Online information about abdominoplasty from the ten most popular publically available websites had an overall average readability of 12th grade. Mean reading grade level scores among tests were: Coleman–Liau 11.9, Flesch–Kincaid 11.4, FORCAST 11.1, Fry 13, Gunning Fog 13.5, New Dale–Chall 11.8, New Fog Count 9.9, Raygor Estimate 12, and SMOG 13.4; Flesch Reading Ease index score was 46.

Conclusions

Online patient resources about abdominoplasty are uniformly above the recommended target readability level and are likely too difficult for many patients to understand. A range of readability identified among websites could allow surgeons to guide patients to more appropriate resources for their literacy skills.

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.

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Achieving Symmetry in Unilateral DIEP Flap Breast Reconstruction: An Analysis of 126 Cases over 3 Years

Abstract

Many patients who prefer breast reconstruction by a deep inferior epigastric artery perforator (DIEP) flap often lack skin laxity at the lower abdomen. Recreating a symmetrical breast with various degrees of ptosis is one of the most difficult procedures. In this report, varied DIEP flap shapes were precisely designed on the basis of normal breast ptosis. The reconstructive outcomes were quantitatively evaluated for asymmetry of footprint, volume, breast projection, and nipple position by a 3-dimensional scanning system. One hundred twenty-six cases of unilateral DIEP flap breast reconstruction were successfully performed from January 2009 to July 2012. The maximal flap width ranged from 7.5 to 10.5 cm (mean, 9.0 cm), and the flap length ranged from 28 to 38 cm (mean, 32.5 cm). The discrepancy of the footprint and nipple position did not differ significantly between the reconstructed and normal breasts. However, the reconstructed side had significantly higher breast volume and projection. For patients with a relatively tight abdomen, the flap design and shaping approach we propose achieves a maximal symmetrical outcome and should be considered as a good and reliable option.

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.

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Mesotherapy with an Intradermal Hyaluronic Acid Formulation for Skin Rejuvenation: An Intrapatient, Placebo-Controlled, Long-Term Trial Using High-Frequency Ultrasound

Abstract

Mesotherapy with hyaluronic acid (HA) is a treatment approach currently used for skin rejuvenation. High-frequency ultrasound (20–100 MHz) is a non-invasive technique that has been used to evaluate age-related dermal changes. The presence and the degree of a typical subepidermal low-echogenic band (SLEB) are photoaging related: the lower the SLEB echogenicity, the higher the photoaging. The aim of this trial was to evaluate, through ultrasound imaging, the long-term effects of microinjections of HA on SLEB echogenicity. Twenty-two women with clinical and ultrasound signs of moderate photoaging were enrolled in the study. Treatment consisted of multiple microinjections of HA salts of biotechnological origin on the dorsum of one hand, once weekly for 4 weeks and, successively, once monthly for 4 months (group A) or 9 months (group B). The dorsum of the other hand of each subject was injected with saline solution and used as a control. In all subjects, high-frequency ultrasound (22 MHz) was performed to evaluate SLEB echogenicity changes during treatment. Eighteen out of 22 patients completed the study. At the end of 4 weeks, an ultrasound increase of dermal echogenicity was observed in 13 subjects (seven of group A and six of group B), which we considered as “responders”. In these patients, the Student’s  t-test showed a significant increase from baseline of SLEB pixel numbers of +24 % ( P < 0.01) versus +6 % with placebo. In the same subjects, after an additional 4 months of monthly injections, the mean increase was +18 % ( P < 0.05) versus +4 % with placebo. In patients from group B that completed 10 months of treatment, the increase from baseline of SLEB pixel numbers was +18 % ( P < 0.05) versus 0 % with placebo. Our study suggests that mesotherapy with HA may effectively improve skin aging and photoaging, as supported by quantifiable ultrasound data showing significant changes in SLEB density over time.

Level of Evidence II

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.

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The Inhibitory Effect of Platelet-Rich Plasma on Botulinum Toxin Type-A: An Experimental Study in Rabbits

Abstract

Background

Combination treatments of botulinum toxin type-A and other rejuvenation agents or instruments are gradually becoming more popular. After observing a high incidence of therapy failure following simultaneous applications of botulinum toxin type-A and platelet-rich plasma mesotherapy, we aimed to investigate whether PRP has an inhibitory effect on botulinum toxin type-A.

Methods

Twenty-four New Zealand white rabbits were divided into 4 groups, and the anterior auricular muscle and overlying skin were used for injections. Groups I and II both received onabotulinumtoxinA intramuscular injections. In addition, autologous platelet-rich plasma mesotherapy was performed in Group I while Group II received saline mesotherapy. Group III was designed as the in vitro mixture group in which onabotulinumtoxinA and platelet-rich plasma were mixed and then administered intramuscularly. Group IV received saline within the mixture instead of platelet-rich plasma. The contralateral ears of all the rabbits served as control and were only treated with onabotulinumtoxinA. Visual evaluation of ear positions and electroneuromyographic studies were done prior to all procedures and at day 14. Anterior auricular muscles were harvested at day 14 and were evaluated with quantitative real-time PCR.

Results

Visual and electroneuromyographic studies revealed less onabotulinumtoxinA activity in Groups I and III. When platelet-rich plasma was administered through skin mesotherapy, onabotulinumtoxinA activity failure was more severe in comparison with direct contact. No significant difference in SNAP-25 mRNA expression through quantitative real-time PCR was observed between groups.

Conclusion

Although we could not explain the exact mechanism underlying this interaction, platelet-rich plasma applications result in less onabotulinumtoxinA muscle paralysis activity.

No Level Assigned

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

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Borderline to Moderate Blepharoptosis Correction Using Retrotarsal Tucking of Müller Muscle: Levator Aponeurosis in Asian Eyelids

Abstract

Background

The purpose of this paper is to report the outcome of retrotarsal tucking of Müller muscle-levator aponeurosis for the correction of borderline to moderate ptosis in conjunction with esthetic blepharoplasty in Asian eyelids and to explore the relationship between the extent of advancement and change in the eyelid position (MRD 1).

Methods

The medical records of 290 consecutive patients who underwent retrotarsal tucking of Müller muscle-levator aponeurosis from February 2005 to November 2011 were reviewed. Of those, 26 patients (51 eyelids) were statistically analyzed. The correction was performed through an external upper blepharoplasty approach. Once the orbital septum was opened, the Müller muscle-levator aponeurosis was advanced and tucked under the posterior surface of the tarsus by a single lifting suture. The average follow-up period was 20.6 months, with a range of 3–68 months.

Results

In 26 patients (51 eyelids), satisfactory results were recorded for 49 of 51 eyelids (96.1 %). The margin reflex distance-1 (MRD 1) increased from 1.56 ± 0.70 mm preoperatively to 3.86 ± 0.94 mm postoperatively ( p < 0.001, Wilcoxon signed rank test). When 6.1 mm of advancement was implemented, an average MRD 1 of 1 mm was achieved. For 7.2 and 8.3 mm of advancement, the average MRD 1 achieved was 2 and 3 mm each. A noteworthy complication, although not included in statistical analysis, was one patient who had developed corneal irritation caused by the conjunctival exposure to the non-absorbable suture 3 years after the surgery, which led the subject to have the suture removed.

Conclusion

The author concludes that this procedure is one of the most effective surgical options in correcting borderline to moderate blepharoptosis in conjunction with esthetic blepharoplasty. The main advantage of such a method is that once the orbital septum is opened, Müller muscle-levator aponeurosis is easily advanced and tucked under the posterior surface of the tarsal plate without extensive dissection or resection, which is less traumatic and gives a more vertical lifting vector, thus producing excellent cosmetic results and quick recovery.

Level of Evidence V

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.

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An Unexpected Otoplasty Complication: Temporal Nerve Paresis

Abstract

Otoplasty, for prominent ear correction, is the most common aesthetic surgery procedure done in children. While the outcome often has a positive impact on the psychological state of the patient, the procedure itself does have associated complications that must be considered. Common complications include hematomas, infection, necrosis, outer ear canal stenosis, extrusion of sutures, insufficient correction, overcorrection, keloids, and hypertrophic scars. This is the first case report of facial nerve palsy as a complication following otoplasty.

Level of Evidence V

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.

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A New Modified S-plasty for Skin Defect Closure

Abstract

Background

Dog-ear, or standing cone deformity, is a common problem during surgical procedures. Multiple methods have been reported to correct the deformity but most create long scars or excessive normal skin loss.

Methods

We designed a simple and convenient procedure to remove small- and medium-sized skin defects. Based on mathematical calculations, the procedure is an easily designed surgical technique.

Results

All of our patients healed uneventfully with no significant complications. The procedure not only resulted in a shortened surgical incision and preserved a greater amount of healthy skin, but also left a simple “S-shaped” curvilinear scar with favorable esthetic outcomes.

Conclusion

This novel modified S-plasty is a simple tool to successfully remove skin defects, with a low deformity risk.

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.

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Tongue-in-Groove Setback of the Medial Crura to Control Nasal Tip Deprojection in Open Rhinoplasty

Abstract

Background

Overprojection of the nasal tip is a common problem in aesthetic Caucasian and Mediterranean rhinoplasty patients. In these patients, shortening of the conjoined medial crura frequently plays an important part in deprojection of the nasal tip. The combination of vertical incision maneuvers of the medial crura and tongue-in-groove (TIG) allows the surgeon to achieve significant control over projection, rotation and shape of the nasal tip. In this article we present our graduated approach towards nasal tip deprojection in aesthetic Caucasian and Mediterranean rhinoplasty together with a statistical analysis of overall success.

Methods

This retrospective study based on 22 consecutive Caucasian or Mediterranean patients who had aesthetic, open deprojection rhinoplasty combining TIG with either footplate resection or medial crural overlay by one surgeon between 2009 and 2011. Aesthetical success was determined by statistical analysis of change in subjective body image in relation to nasal appearance, scored on five aesthetic 5-point Likert Scale questions and a 10 cm visual analog scale. Change in projection was calculated using a modified Goode method, applied on standardized pre- and postoperative photographs which were also used to measure change in rotation.

Results

Subjective body image in relation to nasal appearance improved from 15.14 to 6.55 ( p < 0.01). The mean aesthetic VAS score improved from 3.32 to 7.91 ( p < 0.01). Substantial deprojection was measured in 19 patients (86.4 %) with a mean deprojection ratio of 0.06 [range 0.02–0.16]. An increased projection ratio of 0.03 was encountered in one patient and in two patients projection was unchanged.

Conclusions

Analysis of objective and subjective aesthetic outcome data suggest that our deprojection algorithm helps to deliver consistently good results in Caucasian and Mediterranean patients who require open deprojection rhinoplasty.

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.

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Aesthetic Labia Minora Reduction with Combined Wedge-edge Resection: A Modified Approach of Labiaplasty

Abstract

Background

Nowadays, the demand for female genital rejuvenation procedures especially for labiaplasty is surging. Labia minora reduction has been the most practiced esthetic procedure for the female genitalia in China. Gynecological plastic surgeons have proposed several methods for labia reduction, but there is no consensus on which one is the best choice. Patients often receive re-operations for inadequate resection and asymmetry with existing methods. Here we present a modified method of labiaplasty combined wedge and edge resection and to discuss the appropriate indications of this method.

Methods

From January 2009 to March 2014, we performed 524 labia esthetic surgeries. The methods we used mainly include simple edge resection, wedge resection, modified de-epithelialization, and the combined method discussed in this article. Forty-nine patients aged from 25 to 45 years were selected to receive combined wedge-edge labial resection and were retrospectively reviewed. Patients were required to come back for follow-up assessment at 1 and 6 months.

Results

Twenty-one of forty-nine (42.9 %) patients underwent unilateral labial reduction. The average time for the procedures was 56 min. The mean follow-up was 4.5 months. All the surgeries were successfully performed and 47 patients experienced an uneventful postoperative period. A minor dehiscence occurred in two patients. One of the patients received a revision surgery correcting a postoperative asymmetry malformation. Finally, all the patients were satisfied with the esthetic appearance.

Conclusion

The combined wedge-edge reduction of the labia minora is a simple and safe method associated with high satisfaction and a low complication rate. Therefore, we propose this combined procedure for bi-dimensional and/or unilateral hypertrophied labia minora especially in those who require removal of the dark margin of the labia.

Level of Evidence V

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.

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Quantitative Analysis of Diffusion-Weighted Imaging for Diagnosis of Puerperal Breast Abscess After Polyacrylamide Hydrogel Augmentation Mammoplasty: Compared with Other Conventional Modalities

Abstract

Purpose

Puerperal breast abscess after polyacrylamide hydrogel (PAAG) augmentation mammoplasty can induce breast auto-inflation resulting in serious consequences. Mammography, ultrasound, and conventional MRI are poor at detecting related PAAG abnormality histologically. We evaluated the value of diffusion-weighted imaging (DWI) in the quantitative analysis of puerperal PAAG abscess after augmentation mammoplasty.

Materials and Methods

This was a retrospective study, and a waiver for informed consent was granted. Sixteen puerperal women with breast discomfort underwent conventional breast non-enhanced MRI and axial DWI using a 3T MR scanner. Qualitative analysis of the signal intensity on DWI and conventional sequences was performed. The apparent diffusion coefficient (ADC) values of the affected and contralateral normal PAAG cysts were measured quantitatively. Paired  t test was used to evaluate whether there was significant difference.

Results

Both affected and normal PAAG cysts showed equal signal intensity on conventional T1WI and fat saturation T2WI, which were not helpful in detecting puerperal PAAG abscess. However, the affected PAAG cysts had a significantly decreased ADC value of 1.477 ± 0.332 × 10 −3mm 2/s and showed obvious hypo-intensity on the ADC map and increased signal intensity on DWI compared with the ADC value of 2.775 ± 0.233 × 10 −3mm 2/s of the contralateral normal PAAG cysts.

Conclusion

DWI and quantitative measurement of ADC values are of great value for the diagnosis of puerperal PAAG abscess. Standardized MRI should be suggested to these puerperal women with breast discomfort or just for the purpose of check up. DWI should be selected as the essential MRI sequence.

Level of Evidence III

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.

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Dermo-Fascial Suspension for Better Contouring and Long Lasting Results in Reduction Mammoplasty

Abstract

Background

Recent techniques use the superficial fascia system for anchoring the glandular tissue to the chest wall for minimal tension skin repair in contrast to classic dermal suspension.

Objective

To evaluate the use of dermo-fascial flap in suspension of the breast tissue to the chest wall in reduction mammoplasty to achieve better breast shape, projection, and contour.

Patients and methods

Forty patients who underwent superiomedial reduction mammoplasty were divided into two equal groups. Group I patients underwent classic superior-medial dermo-glandular pedicle (Findlay’s technique) reduction mammoplasty, while in group II, a laterally based dermo-fascial flap was used for suspension of the breast tissue to the chest wall. Preoperative and postoperative measurements of the suprasternal notch-nipple and nipple-inframammary fold distances were recorded and statistically analyzed.

Results

Mild asymmetry occurred in nine cases (5-GI, 4-GII), surgical scar revision was done in seven patients (4-GI, 3-GII), and superficial infection occurred in four patients (2-GI, 2-GII). Group II showed better clinical satisfaction and highly significant statistical differences in postoperative measurements compared to GI ( P < 0.0001).

Conclusion

The use of a dermo-fascial flap to support the glandular pedicle in reduction mammoplasty improves the shape; projection and contour of the breast. It also helps to have long lasting results and reduce recurrent breast ptosis especially in patients with poor skin quality.

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.

Latest Results for European Journal of Plastic Surgery

Orofacial cleft outreach in rural Ghana: any positive impact on the community?

Abstract

Background

Orofacial clefts (OFC) are common congenital malformations in humans. They impact negatively on the life of the affected and often regarded as stigma in the society especially among the rural folks. The aim of this study was to analyze retrospectively the cases managed by a Ghanaian indigenous plastic surgery outreach team and prospectively outline the social impacts on the lives of those treated and their communities.

Methods

The study reviewed the medical records of patients treated during OFC outreaches in rural Ghana from January 2003 to December 2012 (10 years). This involved visiting and interviewing patients and their parents/relatives, as well as the community leaders comprising chiefs, assemblymen, church leaders, etc., using structured pretested questionnaires within 5 days (September 1–5, 2013) in communities in southeast of Ghana.

Results

A total of 32 outreach services were handled over the 10-year period, treating 303 OFC patients (among other pathologies), comprising 175 (57.8 %) males and 128 (42.2 %) females. Out of the 303, 159 (52.5 %) were located and interviewed; also, 65 community/opinion leaders/relatives were interviewed. Sixty-one percent (61 % = 35 patients) of the females and 48 % ( n = 49) of the males got married after the surgery; 83 % ( n = 45) of the school-going-age patients continued and completed basic schools.

Conclusions

OFC outreaches help to restore the lives and dignity of cleft patients and their families improving their quality of life. Stigmatization and psychological effects on them were removed; they were well accepted in their societies and family gatherings.
Level of Evidence: Level III, risk-prognostic study.

Latest Results for European Journal of Plastic Surgery

Melanocytic tumours of uncertain malignant potential (MELTUMPs)—a diagnostic and management dilemma

Abstract

Background

Melanocytic tumours of uncertain malignant potential (MELTUMPs) represent melanocytic proliferations within the dermis and are thereby associated with a potential risk of disease dissemination and metastases. However, there is a paucity of data regarding these lesions, their malignant potential and thus their management.

Methods

This is a retrospective evaluation of all MELTUMPs treated in a single tertiary plastic surgery unit to establish patient demographics, clinical management and outcomes including recurrence and regional and distant metastases.

Results

Forty-two patients were treated for MELTUMPs between 2005 and 2011 in our unit. The mean Breslow thickness was 0.85 mm (range in situ disease to 5 mm). A complete data set was available for 37 of these patients, of whom, 32 (86 %) underwent wider excision with a 1-cm margin and 5 (14 %) with 2-cm margin. The mean follow-up time was 23 months (range 2 to 48 months). One patient developed locally recurrent disease, one patient developed regional metastases and one patient died of metastatic disease.

Conclusions

MELTUMPs present a diagnostic and management dilemma with a paucity of agreed strategies for ongoing patient care. We propose that all MELTUMPs should be treated using a melanoma strategy under the care of a skin cancer multidisciplinary team.
Level of Evidence: Level IV, risk / prognostic study.

Latest Results for European Journal of Plastic Surgery

Giant malignant triton tumor of the scalp

Abstract

Malignant triton tumor is a malignant schwannoma with rhabdomyoblastic differentiation. This tumor is very rare. Case reports and small series have been reported in medical literature. Malignant triton tumor occurs predominantly in the trunk, head, neck, and lower extremities. There is an important relationship with Von Recklinghausen disease. Patients with this tumor have a very poor prognosis, with a rapid and fatal course. We present a clinical case with a giant malignant triton tumor of the scalp.
Level of Evidence: Level V, diagnostic study.

Latest Results for European Journal of Plastic Surgery

Peri-alar hatchet flap for the reconstruction of the columella and nasal tip

Abstract

Reconstruction of the nasolabial columella complex is a technical challenge for which many solutions have been suggested. The peri-alar hatchet pedicle flap, herein described, allows the transposition of a well-matched tissue to reconstruct columellar and nasal tip defects while preserving the alar and nasolabial crease. This procedure did not require a columellar strut or a finishing touch-up procedure for sufficient columellar projection and achieved excellent cosmetic results.
Level of Evidence: Level V, therapeutic study.