Surgeons_and_Clinics RSS : Gourt

Permanent Plastic Surgery Job in Wilkes Barre Pennsylvania with Community Health Systems

Wilkes-Barre General Hospital is seeking a board eligible/board certified plastic surgeon. Contact: Joyce Y. McCuller Email: joyce_mcculler@chs.net Phone: 888-373-9600, x7451 Fax: 615-373-9798 Web:

Permanent Plastic Surgery Job in Temple Texas with Scott & White Health Clinic

CENTRAL TEXAS Plastic Surgery Scott & White and Texas A&M College of Medicine Department of Surgery are seeking BC/BE Plastic Surgeons to join our established Division at our main campus Temple. The

Permanent Plastic Surgery Job in Williamsport Pennsylvania with Susquehanna Health

Susquehanna Health is seeking a BC/BE fellowship trained Plastic Surgeon to join one (1) other in our practice and one (1) other that is in private practice here in Williamsport, Pennsylvania. Be part

Permanent PLASTIC SURGERY Job in Southern Illinois Opportunity Illinois with Enterprise Medical Service

Exciting opportunity for a Plastic Surgeon to join rapidly growing physician group with expanding specialty clinic. Competitive salary with comprehensive benefits package. Contact: Neal Fenster Email:

Permanent Plastic Surgery Job in Charlotte Area North Carolina with Medical Search International

A busy hospital in the Charlotte area is seeking a BC/BE Plastic Surgeon State license is preferred but eligibility is acceptable. Residents and fellows are welcomed!! Excellent support staff and coverage.

Locum Tenens Plastic Surgery Job in Plastic Surgeons needed in several locations for a 1 day assignment!! Florida with LocumTenens.com

Plastic Surgeons needed in several locations for a 1 day assignment!! Locations ***Must be Licensed in the state for the assignment*** Saturday July 18th - Miami, FL Saturday September 12th - Philly,

Permanent Plastic Surgery Job in 100% Cosmetic Ohio with IMED Staffing

Cosmetic plastic surgeon seeking to add an associate. Cosmetic fellowship or significant cosmetic experience preferred as the practice is 100% cosmetic. Guaranteed base salary with incentive. AAAASF

Permanent Plastic Surgery Job in Raliegh/Durham North Carolina with IMED Staffing

Plastic Surgeon wants to transfer well-organized established private practice. 90% Cosmetic with over 3000 patient charts. Excellent area of Raliegh/Durham. Turn-key operation with excellent, well trained

Permanent Plastic Surgery Job in Attractive Area Virginia with IMED Staffing

Partner track position in a beautiful mid-sized city in the foothills of the Blue Ridge. In-office surgical suite and skin care center highlight this four physician practice. Solid community ties for

Permanent Plastic Surgery Job in Dodge City Kansas with Job Job Recruiting

Physician - Plastic Surgery Great Practice Opportunity and Great Quality of Life Immediate need for a Plastic Surgeon to join our family friendly Community. Be part of a multispecialty group or solo

Permanent Plastic Surgery Job in Greenville North Carolina with Job Job Recruiting

Academic Plastic Surgery Specialty: Plastic & Reconstructive Surgery Job Description: The Division of Plastic Surgery at the School of Medicine at our Carolina University in Greenville, NC is seeking

Permanent Plastic Surgery Job in Metro Area Plastic Surgery with Hand (30%) Opportunity Iowa with CompHealth Inc

Job 6511909 Hospital based surgery group seeks a plastic surgeon Unbeatable location ? the best that Iowa offers Must be Board Eligible or Board Certified Plastic Surgeon with Hand training or experience

Permanent Plastic Surgery Job in Close to the Coast South Carolina with CompHealth Inc

Job 6511321 Hospital employed position Generous salary Large referral base Mix of Cosmetic and Reconstructive (high volume of referrals from in house Cancer Center) Paid Malpractice Close to major metro

Permanent Plastic Surgery Job in Full Service Plastic Surgery Practice Opportunity - Southeastern Pennsylvania Pennsylvania with CompHealth Inc

Job 6511477 Board Certified or Board Eligible Plastic Surgeon willing to do a mix of cosmetic and reconstructive plastic surgery. Hand trained is a plus, but, not required (no one is doing hand in the

Permanent Plastic Surgery Job in Fantastic Plastic Surgery Opportunity With Group of Three Surgeons Pennsylvania with CompHealth Inc

Job 658071 Busy Plastic Surgery group is recruiting an experienced Plastic Surgeon to join them Top Salary and benefits for the right candidate Call 1:4 No competition in local region Located in a wonderful

Permanent Plastic Surgery Job in Call for Information Illinois with Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

Permanent Plastic Surgery Job in Call for Information North Carolina with Inhouse Physician Recruiters Network

Permanent Plastic Surgery Job in Call for Information North Dakota with Inhouse Physician Recruiters Network

ABOUT THIS JOURNAL: About This Journal

HIGHLIGHTS OF ARCHIVES OF FACIAL PLASTIC SURGERY: Highlights of Archives of Facial Plastic Surgery

ORIGINAL ARTICLE: Effect of Midfacial Asymmetry on Nasal Axis Deviation: Indications for Use of the Subalar Graft

Objective To test the hypothesis that midfacial asymmetry specifically relevant to nasal tip deviation will be reflected in the measured soft-tissue attachments of the ala to the face. Design Retrospective photographic analysis of 35 consecutive patients seeking functional or aesthetic nasal surgery regardless of cause. Results Nasal axis had a significant correlation with the alar-facial angle on base view photographs (P < .001) irrespective of cause (traumatic vs congenital). However, there was no significant correlation between alar facial angle on anteroposterior view (frontal) with nasal axis and no correlation between frontal and basal angles. Conclusion Soft-tissue analysis demonstrates a relationship between nasal axis deviation and lower midfacial asymmetry or hypoplasia.

ORIGINAL ARTICLE: Facial Fractures in Motor Vehicle Collisions: Epidemiological Trends and Risk Factors

Objectives To analyze epidemiological trends in facial fractures sustained in motor vehicle collisions and to identify the effects of occupant and crash-specific characteristics on the likelihood of injury. Methods A retrospective cohort analysis of vehicle occupants with facial fractures following a motor vehicle crash was performed using the population-based 1993-2005 National Automotive Sampling System Crashworthiness Data System database. Injury trends were analyzed by calendar year and vehicle model year. A multivariate analysis was performed on biomechanical, demographic, and safety restraint data, with the calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Results The incidence of facial fractures was found to be decreasing (P < .01), along with a declining probability of injury with newer car models (P < .01). Seat belts with frontal air bag use were associated with a significantly decreased probability of facial fracture (OR, 0.14; 95% CI, 0.09-0.22). Air bags alone were not associated with a reduced probability of injury (OR, 0.78; 95% CI, 0.58-1.06). Side impacts (OR, 1.81; 95% CI, 1.14-2.86) and mismatch in the sizes of the crash vehicles (OR, 1.99; 95% CI, 1.27-3.12) were associated with increased risk of facial fractures. Conclusions The probability of facial fractures from motor vehicle collisions is decreasing. This finding may be due to design improvements implicitly related to vehicle model year. Restraint use continues to be important for injury prevention, while factors such as changes in vehicle fleet composition may alter injury trends.

ANNOUNCEMENT: References

ORIGINAL ARTICLE: Free Tissue Reconstruction Following Excision of Head and Neck Arteriovenous Malformations

Objective To evaluate free tissue transfer (FTT) as a safe and effective reconstructive technique to treat arteriovenous malformations. Vascular lesions that present a significant clinical challenge to the head and neck reconstructive surgeon are often difficult to treat and can leave large, complex defects. Methods Retrospective, single-institution case series. Results We describe 8 patients treated for extensive lesions in various parts of the head and neck reconstructed with free flaps. These malformations have a tendency to recur, which was the case in 75% of our patients (6 of 8) during a mean follow-up period of 5 years. Revision procedures are expected at a mean rate of 6.75 per person in our series. Conclusions Arteriovenous malformations are uncommon and challenging lesions. Use of FTT can ameliorate the large defects resulting from excision of these lesions.

ORIGINAL ARTICLE: Thread-lift for Facial Rejuvenation: Assessment of Long-term Results

Objective To evaluate the long-term success of the thread-lift procedure for facial rejuvenation. Methods Thirty-three patients underwent a thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Ten patients underwent thread-lifts only, and 23 had thread-lifts with other procedures. Ten additional patients having had non–thread-lift rejuvenation procedures, including lipotransfer, chemical peels, and rhytidectomies, were randomly designated as controls. The mean follow-up period was 21 months (range, 12-31 months). Photodocumentation was obtained at each visit. Long-term aesthetic results were evaluated by 4 independent, blinded, and board-certified facial plastic surgeons. Each result was graded on a scale of 0 to 3, with 0 indicating no change; 1, minimal improvement; 2, moderate improvement; and 3, considerable improvement. The population was divided into 3 groups for comparison. Two-tailed t test (P = .05) was used for statistical analysis of aesthetic outcomes. Results Although aesthetic improvement was noted in all groups at 1 month, measurable results persisted to the end of the study for all but the group that underwent the thread-lift procedure only. Aesthetic improvement scores of the non–thread-lift control group were better than the group that underwent thread-lift only. Similarly, when the thread-lift was combined with other procedures, scores were better than when thread-lift was used alone. Statistical significance was demonstrated in both of these comparisons (P < .01). Conclusions The thread-lift provides only limited short-term improvement that may be largely attributed to postprocedural edema and inflammation. Our results objectively demonstrate the poor long-term sustainability of the thread-lift procedure. Given these findings, as well as the measurable risk of adverse events and patient discomfort, we cannot justify further use of this procedure for facial rejuvenation.

ANNOUNCEMENT: Topic Collections

ORIGINAL ARTICLE: Nitrogen Plasma Skin Regeneration and Aesthetic Facial Surgery: Multicenter Evaluation of Concurrent Treatment

Objective To evaluate the safety and efficacy of aesthetic facial surgery with concurrent nitrogen plasma skin regeneration. Methods During a 28-month period, we independently completed 272 concurrent procedures in 95 patients aged 42 to 80 years in whom nitrogen plasma skin regeneration was performed immediately on completion of various aesthetic procedures, including brow-lift, blepharoplasty, lateral canthoplasty, midface-lift, rhytidectomy, cheek augmentation, lip vermillion advancement, filler injections, and augmentation mentoplasty. The treatment variables evaluated included nitrogen plasma pulse energy, pass number, and pulse count, and outcomes monitored included complications and subjective aesthetic improvement. Results The various treatment combinations were well tolerated at all anatomical sites. Rhytidectomy flap treatment included escalation of single-pass low-energy to high-energy nitrogen plasma treatment. Although perioperative complications did not otherwise negatively affect results, they included erythema with acneiform eruption (in 2 patients) and presumed herpes simplex virus infection, brief healing delay, and postinflammatory hyperpigmentation (in 1 patient each). In general, the treatment combinations were synergistic. Conclusions Combining nitrogen plasma skin regeneration with aesthetic facial surgery enhances outcomes for procedures in the forehead and in the periorbital, midface, and perioral regions. It does not seem to increase the risk of dermatologic or surgical complications for the procedures described herein.

ANNOUNCEMENT: Full-text Online Access

ORIGINAL ARTICLE: Domal Stabilization Suture in Tip Rhinoplasty

Objective To investigate use of the domal stabilization suture as a complementary suture modification technique for refining and securing the nasal tip. Methods A single permanent or absorbable suture is placed via an open or cartilage delivery approach. The suture is placed along the cephalic borders of the domes at the medial third of the lateral crura bilaterally just posterior to the junction of the intermediate and lateral crura as a final step in tip rhinoplasty. Results The domal stabilization suture provided a means to help maintain dome symmetry in the setting of variable healing and scarring forces with no complications and no effect on tip rotation or projection. Conclusion Use of the domal stabilization suture enables correction of subtle changes in mild tip asymmetry and irregularities in domal height and provides subtle narrowing of the interdomal distance.

ORIGINAL ARTICLE: Impact of Rhinoplasty on Objective Measurement and Psychophysical Appreciation of Facial Symmetry

Objectives To determine the impact of rhinoplasty on the objective measurement and subjective appreciation of facial symmetry and to investigate whether perceptual shifts are correlated with objective changes in facial proportions. Design Frontal view photographs were used to measure bilateral symmetry ratios of the medial and lateral canthi, tragus, ala, and oral commissure in 100 patients before and 6 months after rhinoplasty. Gestalt dichotomous impressions of facial symmetry were also obtained in all cases. Paired t tests and 2 tests were used to compare facial proportions and the proportion of faces perceived as symmetrical, respectively, before and after surgery. The receiver operating characteristic and analysis of variance were used to assess whether perceptual shifts in symmetry could be correlated with objectively measurable changes in facial proportion. Results The number of faces perceived as symmetrical increased from 42 to 62 after rhinoplasty (P < .001, 2 test). Objectively, midline-to-ala symmetry increased from an average of 91.1% (5.5%) (mean [SD]) to 93.8% (4.5%) after rhinoplasty (P < .001, paired t test). Other facial proportions did not change significantly (P > .10). The degree of change in midline-to-ala symmetry was the only objective measure that was significantly associated with the subjective perception of the face as symmetrical or asymmetrical (P < .01, 1-way analysis of variance). Most positive perceptual shifts were associated with an objective improvement in nasal symmetry that was greater than 2%. Conversely, most negative perceptual shifts were associated with minimal postoperative improvement or loss of nasal symmetry. Conclusion Rhinoplasty leads to objectively measurable changes in nasal symmetry that correspond with psychophysical modifications in the perception of a face as symmetrical or asymmetrical.

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RESEARCH LETTERS: Correction of the Secondary Bilateral Cleft Lip Deformity Encountered in Guatemala

RESEARCH LETTERS: An Objective Comparison of 35-mm Film and Digital Camera Image Quality: A New Gold Standard

RESEARCH LETTERS: Rhinobase: A Comprehensive Database, Facial Analysis, and Picture-Archiving Software for Rhinoplasty

ABSTRACTS: IN OTHER ARCHIVES JOURNALS: Abstracts: In Other Archives Journals

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BEAUTY: Edouard Manet's Le Repos

A Novel Nostril Retainer Designed by a Patient

A Novel Nostril Retainer Designed by a Patient Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9385-1Authors Ömer Sağlam, İstanbul Kasımpaşa Military Hospital Department of Otolaryngology İstanbul TurkeySamet Vasfi Kuvat, İstanbul Kasımpaşa Military Hospital Department of Plastic and Reconstructive Surgery İstanbul Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Upper-Lip Augmentation by Graft of Preseptal Orbicularis Oculi Muscle Through Blepharoplasty

Abstract Background Upper-lip augmentation is used to enhance a thin upper lip or correct lip deficiencies or senile hypotrophy. We describe an easy, effective, and reproducible technique. Methods We use two preseptal orbicularis oculi muscle grafts that provide a reliable option for soft-tissue upper-lip augmentation, with improved vertical lip height and lateral lip projection and reappearance of the Cupid’s bow. Muscle grafts are harvested from a blepharoplasty done at the same time. Results The advantages of this procedure include the creation of an anatomically natural upper lip through preserving the continuity and function of the labial structure, good augmentation, no donor-site morbidity, no visible scars on the vermilion, and successful rejuvenation with the associated blepharoplasty. Conclusion Both patients and surgeons were satisfied with the results because the muscle grafts produce a youthful appearance by adding natural, soft roundness and fullness to the upper lip without an artificial look or the use of synthetic material, providing long-term augmentation. Content Type Journal ArticleCategory Innovative TechniqueDOI 10.1007/s00266-009-9383-3Authors Mauro Tarallo, La Sapienza University of Rome Department of Plastic and Reconstructive Surgery Rome ItalyCristiano Monarca, La Sapienza University of Rome Department of Plastic and Reconstructive Surgery Rome ItalyMaria Ida Rizzo, La Sapienza University of Rome Department of Plastic and Reconstructive Surgery Rome ItalyNicolò Scuderi, La Sapienza University of Rome Department of Plastic and Reconstructive Surgery Rome Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

One-Stage Augmentation-Mastopexy with Wise Pattern and Inverted-T Scar

One-Stage Augmentation-Mastopexy with Wise Pattern and Inverted-T Scar Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9352-xAuthors Ali Barutcu, Dokuz Eylul University Department of Plastic and Reconstructive Surgery Izmir TurkeyCaghan Baytekin, Adnan Menderes University Department of Plastic and Reconstructive Surgery ADU Týp Fak. Plastik cer. AD 09100 Aydin Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

A Double-Blind, Randomized, Placebo-Controlled, Two-Dose Comparative Study of Botulinum Toxin Type A for Treating Glabellar Lines in Japanese Subjects: What If Sample Size and Statistical Tests Mattered?

A Double-Blind, Randomized, Placebo-Controlled, Two-Dose Comparative Study of Botulinum Toxin Type A for Treating Glabellar Lines in Japanese Subjects: What If Sample Size and Statistical Tests Mattered? Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9381-5Authors Alberto Mangano, Vita-Salute San Raffaele University School of Medicine - IRCCS San Raffaele Milan ItalyAndrea Albertin, IRCCS Multimedica, Sesto San Giovanni Department of Anesthesiology Milan ItalyLuca La Colla, Vita-Salute San Raffaele University School of Medicine - IRCCS San Raffaele Department of Anesthesiology Via Olgettina 60 20132 Milan Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

A New Approach for Adipose Tissue Treatment and Body Contouring Using Radiofrequency-Assisted Liposuction

Abstract A new liposuction technology for adipocyte lipolysis and uniform three-dimensional tissue heating and contraction is presented. The technology is based on bipolar radiofrequency energy applied to the subcutaneous adipose tissue and subdermal skin surface. Preliminary clinical results, thermal monitoring, and histologic biopsies of the treated tissue demonstrate rapid preaspiration liquefaction of adipose tissue, coagulation of subcutaneous blood vessels, and uniform sustained heating of tissue. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9342-zAuthors Malcolm Paul, Aesthetic Plastic Surgery Institute, University of California Irvine CA 92660 USARobert Stephen Mulholland, SpaMedica Canada Private Aesthetic Plastic Surgery Practice 66 Avenue Rd., Suite 4 Toronto ON M5R 3N8 Canada Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Treatment of Upper- and Lower-Extremity Vitiligo with Epidermal Grafts After CO2 Laser Resurfacing with Systemic and Topical Steroids

Abstract Vitiligo is an acquired condition that presents as sharply demarcated white macules. It affects 1–2% of people of all races, regardless of gender or age. Although the disease does not have any systemic complications, it is of great concern, particularly in darker-skinned individuals. We treated 14 patients with vitiligo involving the upper and lower extremities. Surgical therapies were used in conjunction with medical therapy to achieve repigmentation after the disease was stabilized. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9376-2Authors Safwat M. El Hoseny, Rashid Hospital Department of Health and Medical Service of Dubai Dubai United Arab Emirates Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Periorbital Rejuvenation: A Safe Subcutaneous Approach to Forehead, Eyebrow, and Orbicularis Oculis Muscle Mobilization

Abstract Background Periorbital rejuvenation constitutes a common and much demanded claim. With aging face, fascial attachments and ligamentous supports become attenuated, and therefore, skin, orbicular muscle, malar fat and lateral eyebrow descend in middle-age women. Conventional facelift and standard blepharoplasty does not give an effective periorbital rejuvenation. Methods This technique was applied in 142 patients from 1999 to 2006 to treat periorbital aging. All patients were 35 to 55 years old, and 94.5% were female. Through an incision located in the hair line or inside the temporal portion of scalp, a wide subcutaneous dissection of temporal, forehead and eyelid areas was done. This allows undermining and suspension of the orbicularis oculis muscle with partial denervation and the concomitant treatment of crow’s feet, lateral muscular cantoplasty, elevation of the malar fat, superolateral traction of the eyebrow and resection of excess skin. Blepharoplasty or a conventional facelift was included if necessary. Results A total of 130 patients (91%) presented satisfactory results. In 16 patients (11 %) , partial infection of the temporal wound was detected; in other 12 (9 %), asymmetry of eyebrows was present, of which 9 (75%) corrected spontaneously after 3 months and in other 3 (25 %), a reoperation was necessary. No major complications were observed. Conclusions This technique allows a rational correction of all affected periorbital tissues, including forehead, eyebrow, eyelids, canthal ligaments, orbicularis muscle, malar fat and both periorbital and cheek skin with superior and superolateral vectors of traction. This is a safe and easy technique. Content Type Journal ArticleCategory Innovative TechniquesDOI 10.1007/s00266-009-9356-6Authors Jorge Orlando Guerrissi, Argerich Hospital Department of Plastic Surgery Pi y Margall 750, Ciudad Autónoma de Buenos Aires Buenos Aires Argentina Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Gynecomastia and Tuberous Breast: Assessment and Surgical Approach

Gynecomastia and Tuberous Breast: Assessment and Surgical Approach Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9378-0Authors Marco Klinger, Università degli Studi di Milano, U.O. Chirurgia Plastica 2, IRCCS Istituto Clinico Humanitas Cattedra di Chirurgia Plastica Via Manzoni 56 20089 Rozzano, Milano ItalyFabio Caviggioli, Università degli Studi di Milano, U.O. Chirurgia Plastica 2, IRCCS Istituto Clinico Humanitas Cattedra di Chirurgia Plastica Via Manzoni 56 20089 Rozzano, Milano ItalyFederico Villani, Università degli Studi di Milano, U.O. Chirurgia Plastica 2, IRCCS Istituto Clinico Humanitas Cattedra di Chirurgia Plastica Via Manzoni 56 20089 Rozzano, Milano ItalyDavide Forcellini, Università degli Studi di Milano, U.O. Chirurgia Plastica 2, IRCCS Istituto Clinico Humanitas Cattedra di Chirurgia Plastica Via Manzoni 56 20089 Rozzano, Milano ItalyFrancesco Klinger, Università degli Studi di Milano, U.O. Chirurgia Plastica 2, IRCCS Istituto Clinico Humanitas Cattedra di Chirurgia Plastica Via Manzoni 56 20089 Rozzano, Milano Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Esophageal Stricture and Metaplasia Following Abdominoplasty

Abstract Numerous complications have been reported following abdominoplasty. In this report, the case of a 48-year-old woman who developed an esophageal stricture, and subsequently Barrett’s esophagus, secondary to increased intra-abdominal pressure following abdominoplasty is presented. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9380-6Authors Sabrina Cugno, Centre Hospitalier de l’Université de Montréal (CHUM) Service of Plastic and Reconstructive Surgery, Hôpital Notre-Dame 1560 Sherbrooke Street East Montréal QC H2L 4M1 CanadaDemetrios Rizis, Centre Hospitalier de l’Université de Montréal (CHUM) Service of Plastic and Reconstructive Surgery, Hôpital Notre-Dame 1560 Sherbrooke Street East Montréal QC H2L 4M1 CanadaAndreas Nikolis, Centre Hospitalier de l’Université de Montréal (CHUM) Service of Plastic and Reconstructive Surgery, Hôpital Notre-Dame 1560 Sherbrooke Street East Montréal QC H2L 4M1 CanadaJean-Paul Brutus, Centre Hospitalier de l’Université de Montréal (CHUM) Service of Plastic and Reconstructive Surgery, Hôpital Notre-Dame 1560 Sherbrooke Street East Montréal QC H2L 4M1 CanadaCarlos Cordoba, Centre Hospitalier de l’Université de Montréal (CHUM) Service of Plastic and Reconstructive Surgery, Hôpital Notre-Dame 1560 Sherbrooke Street East Montréal QC H2L 4M1 Canada Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Statements on the Safety of Permanent Soft Tissue Fillers in Europe

Abstract Increasing reported complications associated with permanent soft tissue fillers have led the national medical societies and governmental institutes in Europe to send out warnings regarding their use. Regulation and legislation for the introduction of new products and the use of existing products are necessary to guarantee patient safety. Content Type Journal ArticleCategory EditorialDOI 10.1007/s00266-009-9369-1Authors Daphne van Dam, Medical Centre Leeuwarden Henri Dunantplein 2 8901 BR Leeuwarden The NetherlandsBerend van der Lei, University Medical Centre Groningen Hanzeplein 1 9700 RB Groningen The NetherlandsMichel Cromheecke, Centrallasarettet Västerås Department of Plastic Surgery 72189 Västerås Sweden Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Nipple Reconstruction with Bipedicled Dermal Flap: A New and Easy Technique

Abstract Background Nipple reconstruction is the last step in breast reconstruction. An entirely satisfying breast reconstruction can be achieved only with a symmetrically placed and ideally shaped nipple-areola complex. Several techniques and modifications have been described for nipple-areola reconstruction but long-term projection loss is still a problem in nipple reconstruction. Methods Between January 2005 and October 2008, 13 female patients underwent 19 nipple reconstructions in our department. Among these patients, seven underwent breast reconstruction with a DIEP flap following unilateral mastectomy, and six were diagnosed with gigantomasty and underwent bilateral breast reduction with a modification of free nipple grafting. Our method for nipple reconstruction relies on a vertically oriented bipedicled flap with horizontally oriented extensions from the mid-portion. Results Nineteen nipple reconstructions in 13 patients were evaluated and the mean follow-up period was 15 months. We did not see any necrosis or any significant projection loss in our cases. Patients’ satisfaction was noted as high and the results were evaluated as pleasing. Conclusion We present a new technique that uses a bipedicled flap, oriented vertically. A rich blood supply to the flap may be the principal cause for long-lasting nipple projection. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9368-2Authors Gursel Turgut, Sisli Etfal State Hospital for Research and Training 19 Mayıs Mah. Celal Atik Sokak, Oguz apt. B Blok D21 Sisli-İstanbul TurkeyBulent Sacak, Sisli Etfal State Hospital for Research and Training 19 Mayıs Mah. Celal Atik Sokak, Oguz apt. B Blok D21 Sisli-İstanbul TurkeyTahsin Görgülü, Sisli Etfal State Hospital for Research and Training 19 Mayıs Mah. Celal Atik Sokak, Oguz apt. B Blok D21 Sisli-İstanbul TurkeyAysin K. Yesilada, Sisli Etfal State Hospital for Research and Training 19 Mayıs Mah. Celal Atik Sokak, Oguz apt. B Blok D21 Sisli-İstanbul TurkeyLutfu Bas, Sisli Etfal State Hospital for Research and Training 19 Mayıs Mah. Celal Atik Sokak, Oguz apt. B Blok D21 Sisli-İstanbul Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Autologous Fat Transplantation and Delayed Silicone Implant Insertion in a Case of Mycobacterium avium Breast Infection

Abstract Background Infection after breast augmentation is uncommon, occurring in 1–3% of cases. They are typically caused by bacterial skin flora, specifically Staphylococcus aureus and the coagulase-negative staphylococci. There have been infrequent reports of breast implant infection caused by the atypical mycobacteria. Methods This report summarizes the case of a female patient who was infected by Mycobacterium avium after undergoing augmentation mammoplasty. This is the second case reported in the literature. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until healing of the wound. Salvage methods include one or more of the following: antibiotic therapy, debridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage. Results After removal of the implant and antibiotic therapy, autologous fat transplantation for correction of breast tissue depressions caused by the mycobacterium infection was done. Delayed bilateral breast augmentation by inserting polyurethane-covered silicone implants in subpectoral position and round block mastopexy to resect the periareolar scars were performed. Conclusion Although this kind of complication has significantly compromised the aimed result and has caused frustration to both the patient and the physicians involved, we believe that the combination of autologous fat transplantation and delayed silicone implant insertion can be a safe strategy and can produce an acceptable aesthetic result. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9357-5Authors Luiz Haroldo Pereira, Luiz Haroldo Clinic Department of Plastic Surgery Rua Xavier da Silveira 45/206 22061-010 Rio de Janeiro BrazilAris Sterodimas, Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Postgraduate Medical Institute Department of Plastic Surgery Av. Beira Mar 406 20021-020 Rio de Janeiro Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Autologous Fat Transplantation to the Breast: A Personal Technique with 25 Years of Experience

Abstract Background Over the last 30 years there has been interest in the use of autologous fat transplantation for breast reconstructive and cosmetic purposes. Up until now injection of adipose tissue into the breast has been subject to two limiting factors. First, fat injection into the breast could result in fat necrosis, cyst formation, and indurations that could be mistaken as cancerous calcifications. Second, the degree of reabsorption of the injected adipose tissue is unpredictable. Methods Patients included in the study were candidates for either breast reconstruction after tumor resection or breast augmentation and were divided into three groups. Group I included patients with asymmetry after mastectomy and breast reconstruction; Group II consisted of patients with congenital breast asymmetry; and Group III included patients requesting bilateral breast augmentation. All patients signed a consent form acknowledging potential complications of infiltrating fat into the breast. Results A total of 820 consecutive female patients were operated on between 1983 and 2007. The age distribution of the patients ranged from 19 to 78 years, with a mean of 45.6 years. There were 381 patients in Group I, 54 in Group II, and 385 in Group III. Complications included ecchymosis in 76 patients, striae in 36 patients, 12 hematomas, and 5 infections. Long-term breast asymmetry was observed in 34 cases. Six hundred seventy patients have undergone mammography and ultrasonography 6 months and 1 year after their first intervention under our care. The majority of complications resulting from lipofilling of the breast have been seen in this series during the first 6 months after each session. Breast lesions, including calcifications, cysts, and cancer, that are not apparent in the first year after the final procedure of lipofilling we believe may not be directly associated with the autologous fat grafting to the breast. This has been confirmed by the long-term follow-up of 230 patients (range = 2–25 years, mean = 11.3 years) who have been followed up yearly with mammographic examination. Conclusion In the last 25 years the results of autologous fat transplantation have been predictable and satisfying on the condition that the treatment is performed in stages with small quantities of adipose tissue fat injected in each treatment session. To prevent major complications the final expected result should not be the aim of a single procedure. Mammary lipografting is a procedure that can be offered to patients for breast reconstructive and cosmetic purposes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9377-1Authors Yves Gérard Illouz, Saint Louis Hospital Department of Plastic Surgery Avenue Claude-Vellefaux 75010 Paris FranceAris Sterodimas, 4224 Av Epitacio Pessoa 22471-001 Rio de Janeiro Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Mesotherapy for Benign Symmetric Lipomatosis

Abstract Background Benign symmetric lipomatosis, also known as Madelung disease, is a rare disorder characterized by fat distribution around the shoulders, arms, and neck in the context of chronic alcoholism. Complete excision of nonencapsulated lipomas is difficult. However, reports describing conservative therapeutic measures for lipomatosis are rare. Methods The authors present the case of a 42-year-old man with a diagnosis of benign symmetric lipomatosis who had multiple, large, symmetrical masses in his neck. Multiple phosphatidylcholine injections in the neck were administered 4 weeks apart, a total of seven times to achieve lipolysis. Results The patient’s lipomatosis improved in response to the injections, and he achieved good cosmetic results. Conclusions Intralesional injection, termed mesotherapy, using phosphatidylcholine is a potentially effective therapy for benign symmetric lipomatosis that should be reconsidered as a therapeutic option for this disease. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9374-4Authors Toshio Hasegawa, Juntendo University School of Medicine Department of Dermatology 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421 JapanTomoyuki Matsukura, Matsukura Clinic Division of Plastic Surgery 4-11-6 Jingumae, Shibuya-ku Tokyo 150-0001 JapanShigaku Ikeda, Juntendo University School of Medicine Department of Dermatology 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421 Japan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Selected Abstracts from the “Best of Europe” Sessions of the 1st Congress of the European Association of Societies of Aesthetic Plastic Surgery (EASAPS)

Selected Abstracts from the “Best of Europe” Sessions of the 1st Congress of the European Association of Societies of Aesthetic Plastic Surgery (EASAPS) Content Type Journal ArticleCategory AbstractsDOI 10.1007/s00266-009-9354-8Authors Gilbert Aiach, EASAPS—MADRID 2008 Madrid SpainJ. F. Pascal, EASAPS—MADRID 2008 Madrid SpainC. Le Louarn, EASAPS—MADRID 2008 Madrid SpainBrent Tanner, EASAPS—MADRID 2008 Madrid SpainHusan Bella, EASAPS—MADRID 2008 Madrid SpainPaul Gerachi, EASAPS—MADRID 2008 Madrid SpainDaniel Thornton, EASAPS—MADRID 2008 Madrid SpainHans-Henning Spitalny, EASAPS—MADRID 2008 Madrid SpainHermann Heinrich, EASAPS—MADRID 2008 Madrid SpainMaike Keck, EASAPS—MADRID 2008 Madrid SpainKlaus Ueberreiter, EASAPS—MADRID 2008 Madrid SpainYves Bruehlmann, EASAPS—MADRID 2008 Madrid SpainSerge Lê Huu, EASAPS—MADRID 2008 Madrid SpainU. Rieger, EASAPS—MADRID 2008 Madrid SpainJ. Mesina, EASAPS—MADRID 2008 Madrid SpainA. Trampuz, EASAPS—MADRID 2008 Madrid SpainD. F. Kalbermatten, EASAPS—MADRID 2008 Madrid SpainM. Haug, EASAPS—MADRID 2008 Madrid SpainP. Witt, EASAPS—MADRID 2008 Madrid SpainH. P. Frey, EASAPS—MADRID 2008 Madrid SpainR. Pico, EASAPS—MADRID 2008 Madrid SpainG. Pierer, EASAPS—MADRID 2008 Madrid SpainN. Lüscher, EASAPS—MADRID 2008 Madrid SpainMichele Zocchi, EASAPS—MADRID 2008 Madrid SpainF. Saccomanno, EASAPS—MADRID 2008 Madrid SpainEnrico Robotti, EASAPS—MADRID 2008 Madrid SpainMiguel Chamosa, EASAPS—MADRID 2008 Madrid SpainSalvador Rodríguez-Camps Devis, EASAPS—MADRID 2008 Madrid Spain Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 33 Journal Issue Volume 33, Number 3 / May, 2009

Removal of Accessory Breasts: A Novel Tumescent Liposuction Approach

Abstract Background Accessory breasts, usually with a protuberant appearance, are composed of both the central accessory breast tissue and adjacent fat tissue. They are a palpable convexity and cosmetically unsightly. Consequently, patients often desire cosmetic improvement. The traditional general surgical treatment for accessory breasts is removal of the accessory breast tissue, fat tissue, and covering skin as a whole unit. A rather long ugly scar often is left after this operation. A minimally invasive method frequently used by the plastic surgeon is to “dig out” the accessory breast tissue. A central depression appearance often is left due to the adjacent fat tissue remnant. From the cosmetic point of view, neither a long scar nor a bulge is acceptable. Methods A minimal incision is made, and the tumescent liposuction technique is used to aspirate out both the central accessory breast tissue and adjacent fat tissue. If there is an areola or nipple in the accessory breast, either the areola or nipple is excised after liposuction during the same operation. For patients who have too much extra skin in the accessory breast area, a small fusiform incision is made to remove the extra skin after the accessory breast tissue and fat tissue have been aspirated out. Results From August 2003 to January 2008, 51 patients underwent surgery using the described technique. All were satisfied with their appearance after their initial surgery except for two patients with minimal associated morbidity. Conclusions This report describes a new approach for treating accessory breasts that results in minimal scarring and a better appearance than can be achieved with traditional methods. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9373-5Authors Jufeng Fan, Capital Medical University Plastic Surgery Department, Beijing Chao-yang Hospital #8 Baijiazhuang Road, Chao Yang District Beijing 100020 China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Laser-Assisted Cartilage Reshaping (LACR) for Treating Ear Protrusions: A Clinical Study in 24 Patients

Abstract Background Protruding ears are the most common congenital ear deformity, with a frequency of 13.5%. Since 1845 and the first works of Dieffenbach, over 170 classical surgical methods have been proposed to correct it. We introduced laser-assisted cartilage reshaping (LACR) in 2004 as an alternative to invasive surgical otoplasty. Methods Between January 2008 and June 2008, 24 patients underwent LACR for treatment of bilateral ear protrusion. Fourteen adults and ten children were treated (mean age = 16.0 years, range = 6–45 years). No anesthesia was used. Both sides of the entire helix and the concha were irradiated using a 1540-nm laser connected to a 4-mm spot handpiece with integrated cooling. Fluences varying from 70 up to 84 J/cm2 were applied. Immediately after the irradiation, silicone elastomer was inserted inside the helix to give it the desired shape. After 3 minutes a solid mold was obtained. Patients were asked to keep this mold in place at all times with a bandage wrapped around the head for the first 3 weeks and then for an additional 3 weeks only during the night. A non-steroidal anti-inflammatory drug (NSAID) was prescribed to the patients for 3 days. At 1, 30, 60, and 90 days after the procedure, ears were checked and photographs were taken. Clinical follow-up at 1 year was obtained via direct patient contact or over the telephone. Results The treatment was well tolerated. No hematomas or skin necrosis occurred. Contact dermatitis was observed in four children and two adults as a result of inappropriate mold design. These patients stopped wearing the mold and the shape of their ear did not improve. For the remaining 18 patients (6 children and 9 adults), the expected ear reshaping was obtained (fluence was 84 J/cm2). For three other adults, incomplete reshaping of the ears was observed and can be correlated to a lower fluence (70 J/cm2). Conclusion LACR, performed without any anesthesia, is a safe and less morbid approach to surgical otoplasty. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9353-9Authors Franck M. P. Leclère, Lille University Hospital INSERM U703, Pavillon Vancostenobel 59037 Lille Cedex FranceIoannis Petropoulos, 404 Military Hospital ENT Department Larissa GreeceSerge Mordon, Lille University Hospital INSERM U703, Pavillon Vancostenobel 59037 Lille Cedex France Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Round Gel Breast Implants or Anatomic Gel Breast Implants: Which is the Best Choice?

Abstract Background Since their introduction in 1993, anatomic implants have been popularized by numerous surgeons, but very little literature compares the precise indications, advantages, and disadvantages between round implants and anatomic implants. Methods A retrospective analysis was performed for all the patients who underwent breast implantation by the main author over a 15-year period. The number of implanted patients, the shape of the implants placed, the approach routes, and the placement plane were determined as well as the relationship between the shape of the implant and the approach route. The aesthetic results obtained were analyzed in detail based on the shape of the implant used. Results Over a 15-year period, 932 patients underwent surgery for breast implants. During the first 6 years, only round implants were used, and during the last 9 years, both anatomic and round implants were used. A total of 787 pairs of round implants and 145 pairs of anatomic implants were placed. The indications based on the postoperative aesthetic analysis suggest the use of implants according to their shape. Conclusions The use of anatomic implants is suggested for patients with significant differences in chest height and width measurements, for cases of significant mammary asymmetry, for patients with a small breast volume or a prominent thorax, and for breasts with a significant deficit of inferior mammary volume or significant shortening of the breast. The authors recommend round implants for patients with a superior pole deficit or moderate breast pseudoptosis, for patients who have a breast that will cover the implant, and for patients who present with a small asymmetry. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9370-8Authors Lázaro Cárdenas-Camarena, Instituto Jalisciense de Cirugía Reconstructiva Guadalajara Jalisco MexicoJoel Encinas-Brambila, Instituto Jalisciense de Cirugía Reconstructiva Guadalajara Jalisco Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Safety and Effectiveness of Mentor’s MemoryGel Implants at 6 Years

Safety and Effectiveness of Mentor’s MemoryGel Implants at 6 Years Content Type Journal ArticleCategory ErratumDOI 10.1007/s00266-009-9379-zAuthors Bruce Cunningham, University of Minnesota Medical School Division of Plastic and Reconstructive Surgery Mayo Memorial Bldg., 420 Delaware Street SE Minneapolis MN 55455 USAJonathan McCue, University of Minnesota Medical School Division of Plastic and Reconstructive Surgery Mayo Memorial Bldg., 420 Delaware Street SE Minneapolis MN 55455 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 33 Journal Issue Volume 33, Number 3 / May, 2009

The Serial Free Fat Transfer in Irradiated Prosthetic Breast Reconstructions

Abstract Background This study investigated the effects of lipofilling on both the functional and the aesthetic aspects of breast reconstruction. Methods Sixty-one consecutive patients with irradiated reconstructed breasts (62 breasts) were offered free fat transfer to enhance the results and correct the defects. Twenty patients were enrolled (active branch) and underwent multiple sessions of lipofilling, while the others were considered controls. The fat was harvested by syringe and processed by saline washing only (no centrifugation). Three months after the last session the functional outcome was evaluated using the LENT-SOMA scoring system and the aesthetic outcome was evaluated using a visual 5-point scale. Results A significant improvement in all the LENT-SOMA scores after free fat grafting was observed; the scores after treatment were all significantly lower than those before it and were also significantly lower than those of untreated breasts. These results also were confirmed by comparing homogeneous subgroups of breasts with similar LENT-SOMA ranks before treatment. Similarly, the cosmetic outcomes were significantly enhanced after serial lipofilling. The four cases in the active branch with severe flap thinning resolved with no implant exposure (mean follow-up = 17.6 months), while implant exposure occurred in the two cases with the same problem in the control group. In one case, a Baker 3-4 capsular contracture was downgraded to Baker 1 after only one session of lipofilling. No complications occurred in the treated cases. Conclusion Free fat transfer is a safe and reliable technique in improving the outcomes of irradiated reconstructed breasts with implants. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9366-4Authors Pietro Panettiere, Università degli Studi di Bologna Dipartimento di Scienze Chirurgiche Specialistiche ed Anestesiologiche via Massarenti, 9 40128 Bologna ItalyLucio Marchetti, Ospedale Privato Accreditato “Villa Chiara” Via Porrettana, 170 40033 Casalecchio di Reno (Bo) ItalyDanilo Accorsi, Ospedale Privato Accreditato “Villa Chiara” Via Porrettana, 170 40033 Casalecchio di Reno (Bo) Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Radiation diminishes stem cell function but does not cause ischemia.

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Aquilae non capiunt muscas (eagles don't catch flies).

Related Articles Aquilae non capiunt muscas (eagles don't catch flies). Plast Reconstr Surg. 2009 Jul;124(1):343-4 Authors: Ilango N, Jacob J, Gupta AK PMID: 19568133 [PubMed - in process]

Complications after polymethylmethacrylate injections.

Related Articles Complications after polymethylmethacrylate injections. Plast Reconstr Surg. 2009 Jul;124(1):342-3 Authors: Nácul AM, Valente DS PMID: 19568132 [PubMed - in process]

Povidone-iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. is statistical correctness always pursued?

Related Articles Povidone-iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. is statistical correctness always pursued? Plast Reconstr Surg. 2009 Jul;124(1):340; author reply 340-2 Authors: Mangano A, Albertin A, La Colla L PMID: 19568131 [PubMed - in process]

Aesthetic and effective leech application.

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Aesthetic labia minora and clitoral hood reduction using extended central wedge resection.

Related Articles Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2009 Jul;124(1):337; author reply 337-8 Authors: Hamori CA PMID: 19568126 [PubMed - in process]

Shoulder proprioception after latissimus dorsi breast reconstruction.

Related Articles Shoulder proprioception after latissimus dorsi breast reconstruction. Plast Reconstr Surg. 2009 Jul;124(1):336-7 Authors: Knobloch K, Ipaktchi K, Vogt PM PMID: 19568123 [PubMed - in process]

Versatile uses of abdominoplasty specimen for young trainees.

Related Articles Versatile uses of abdominoplasty specimen for young trainees. Plast Reconstr Surg. 2009 Jul;124(1):335-6; author reply 336 Authors: Ilango N, Jacob J, Gupta AK PMID: 19568122 [PubMed - in process]

Factors that may influence failure of the correction of the musculoaponeurotic deformities of the abdomen.

Related Articles Factors that may influence failure of the correction of the musculoaponeurotic deformities of the abdomen. Plast Reconstr Surg. 2009 Jul;124(1):334; author reply 334-5 Authors: Nahas FX, Barbosa MV, Ferreira LM PMID: 19568121 [PubMed - in process]

Scars: a review of emerging and currently available therapies.

Related Articles Scars: a review of emerging and currently available therapies. Plast Reconstr Surg. 2009 Jul;124(1):330 Authors: Klinger M, Caviggioli F, Forcellini D, Villani F PMID: 19568118 [PubMed - in process]

Progressive tension sutures in the prevention of postabdominoplasty Seroma: a prospective, randomized, double-blind clinical trial. The quest for statistical significance goes through sample size calculation.

Related Articles Progressive tension sutures in the prevention of postabdominoplasty Seroma: a prospective, randomized, double-blind clinical trial. The quest for statistical significance goes through sample size calculation. Plast Reconstr Surg. 2009 Jul;124(1):330-1; author reply 331-4 Authors: La Colla L, Albertin A, Mangano A, Mangano A PMID: 19568117 [PubMed - in process]

The SIEA angiosome: interindividual variability predicted preoperatively.

Related Articles The SIEA angiosome: interindividual variability predicted preoperatively. Plast Reconstr Surg. 2009 Jul;124(1):327-8; author reply 328-30 Authors: Rozen WM, Chubb D, Grinsell D, Ashton MW PMID: 19568115 [PubMed - in process]

Complications after autologous fat injection to the breast.

Related Articles Complications after autologous fat injection to the breast. Plast Reconstr Surg. 2009 Jul;124(1):326-7 Authors: Walden JL PMID: 19568114 [PubMed - in process]

Failure of a "highly cohesive implant": what does it really mean?

Related Articles Failure of a "highly cohesive implant": what does it really mean? Plast Reconstr Surg. 2009 Jul;124(1):323-5; author reply 325-6 Authors: Tebbetts J PMID: 19568111 [PubMed - in process]

The efficacy of prophylactic low-molecular-weight heparin to prevent pulmonary thromboembolism in immediate breast reconstruction using the TRAM flap.

Related Articles The efficacy of prophylactic low-molecular-weight heparin to prevent pulmonary thromboembolism in immediate breast reconstruction using the TRAM flap. Plast Reconstr Surg. 2009 Jul;124(1):322-3; author reply 323 Authors: Handschin AE, Busch K, Vogt PM PMID: 19568110 [PubMed - in process]

Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free tram flap breast reconstruction: are we on the right track?

Related Articles Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free tram flap breast reconstruction: are we on the right track? Plast Reconstr Surg. 2009 Jul;124(1):320-1; author reply 321-2 Authors: La Colla L, Mangano A, Mangano A, Albertin A PMID: 19568108 [PubMed - in process]

Reconstruction of extensive head and neck defects with multiple simultaneous free flaps.

Related Articles Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 2009 Jul;124(1):318 Authors: Chien SH, Hsu H, Lin CM, Chiu CH, Huang CC PMID: 19568106 [PubMed - in process]

Are lexical processing differences in cleft lip and palate subjects inherent or secondary to velopharyngeal insufficiency?

Related Articles Are lexical processing differences in cleft lip and palate subjects inherent or secondary to velopharyngeal insufficiency? Plast Reconstr Surg. 2009 Jul;124(1):318-9; author reply 319-20 Authors: Furlow LT PMID: 19568105 [PubMed - in process]

Late-onset infections and granuloma formation after facial polylactic acid (new-fill) injections in women who are heavy smokers.

Related Articles Late-onset infections and granuloma formation after facial polylactic acid (new-fill) injections in women who are heavy smokers. Plast Reconstr Surg. 2009 Jul;124(1):316-7; author reply 317-8 Authors: Azizzadeh B PMID: 19568103 [PubMed - in process]

Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments.

Related Articles Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg. 2009 Jul;124(1):315-6 Authors: Hatef DA, Hollier LH PMID: 19568101 [PubMed - in process]

Face transplant procurement: a preclinical and clinical study.

Related Articles Face transplant procurement: a preclinical and clinical study. Plast Reconstr Surg. 2009 Jul;124(1):314-5; author reply 315 Authors: Knobloch K, Rennekampff HO, Vogt PM PMID: 19568100 [PubMed - in process]

Regarding comprehensive management of chemosis following cosmetic lower blepharoplasty.

Related Articles Regarding comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg. 2009 Jul;124(1):313-4 Authors: Putterman AM PMID: 19568098 [PubMed - in process]

Temporal hollowing following coronal incision: a prospective, randomized, controlled trial--statistics are crucial for drawing adequate conclusions in plastic surgery.

Related Articles Temporal hollowing following coronal incision: a prospective, randomized, controlled trial--statistics are crucial for drawing adequate conclusions in plastic surgery. Plast Reconstr Surg. 2009 Jul;124(1):312-3; author reply 313 Authors: Mangano A, Albertin A, Mangano A, La Colla L PMID: 19568097 [PubMed - in process]

Discussion. Systematic review of skin graft donor-site dressings.

Related Articles Discussion. Systematic review of skin graft donor-site dressings. Plast Reconstr Surg. 2009 Jul;124(1):307-8 Authors: Chung KC, Ghori AK PMID: 19568093 [PubMed - in process]

Systematic review of skin graft donor-site dressings.

Systematic review of skin graft donor-site dressings. Plast Reconstr Surg. 2009 Jul;124(1):298-306 Authors: Voineskos SH, Ayeni OA, McKnight L, Thoma A BACKGROUND: Debate continues about what split-thickness skin graft donor-site dressing provides the best outcomes for patients at the lowest cost. The goal of this systematic review was to determine which donor-site dressings are associated with the best outcomes for the following: pain, infection rate, healing quality, healing rate, quality of life, and cost. METHODS: A comprehensive literature review and assessment was undertaken by two independent reviewers. Articles were selected using specific inclusion criteria. Split-thickness skin graft donor-site dressings were classified as either moist or nonmoist based on the state of the dressing upon initial application. Methodological quality of randomized controlled trials was assessed using the Jadad scale. RESULTS: Seventy-five relevant articles were included in the final analysis, three of which were review articles. The most commonly measured outcome was healing rate (64 of 72), followed by pain (58 of 72), infection rate (40 of 72), healing quality (40 of 72), and cost (15 of 72). No studies measured quality of life. The majority of articles were randomized controlled trials (35 of 75), followed by observational studies (22 of 75), unsystematic clinical observations (15 of 75), and review articles (three of 75). It was difficult to compare moist and nonmoist dressings in this review because of the methodological heterogeneity of the included articles. The available evidence suggests, however, that moist dressings are superior in terms of pain. CONCLUSIONS: Some weak evidence exists that supports "wet dressings." To determine the best split-thickness skin graft donor-site dressing, more methodologically sound randomized controlled trials are needed. Trials with parallel economic evaluations should be undertaken to answer this question. PMID: 19568092 [PubMed - in process]

Fractional photothermolysis for skin rejuvenation.

Related Articles Fractional photothermolysis for skin rejuvenation. Plast Reconstr Surg. 2009 Jul;124(1):281-90 Authors: Cohen SR, Henssler C, Johnston J BACKGROUND: Fractional photothermolysis has become an important laser modality in management of a number of skin conditions and photoaging. The authors describe the scientific basis of fractional photothermolysis, report on most of the available devices, discuss their clinical uses and techniques, and attempt to decipher their relative efficacy. METHODS: The authors reviewed as best as possible all fractional lasers currently approved by the Food and Drug Administration for distribution into the United States. Laser wavelength, means of delivery, depth of penetration, and special features were collated. RESULTS: Nine fractional lasers were evaluated. Main differences in outcome were related to type of laser wavelength. In general, scanning technologies are faster and more precise. Deeper injuries result in more collagen remodeling. Variations in laser wavelengths, depth of injury, type of delivery system, consumables, and architecture of the fractionated laser light are important considerations when evaluating fractional lasers. Little scientific research comparing the injury, healing, and outcomes of the various fractional lasers is available. CONCLUSIONS: Fractional photothermolysis represents a breakthrough in laser treatment for a wide array of skin problems. The safety profile has been improved over conventional ablative lasers, and the range of skin types and treatment areas have been expanded. Unlike full-surface flat beam resurfacing, fractional resurfacing damages specific microtreatment zones within the target area. Nonablative fractionals do not achieve results similar to those of the fractional ablative lasers, but certain conditions may respond better to nonablative fractional treatments. More data are needed on the comparative effects of the various types of lasers and their best indications. PMID: 19568091 [PubMed - in process]

The anatomy and clinical implications of perioral submuscular fat.

Related Articles The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg. 2009 Jul;124(1):266-71 Authors: Rohrich RJ, Pessa JE BACKGROUND: One of the goals of lip augmentation is to recreate the natural shape and contour of the lips. The literature describes numerous fillers and multiple techniques for this procedure. However, there is a paucity of information regarding the anatomy of the fat layers of the upper and lower lips. While prosecting cadavers, the authors noted the presence of fat deep to the orbicularis muscle of the lip and a separate fat compartment deep to the mentalis muscle. This anatomy has not been previously described. METHODS: The authors dissected a total of 10 cadaver specimens. Dissection of the upper and lower lips and chin was performed. Latex injection of the arterial circuit aided the identification of boundaries. Histologic examination was performed on full-thickness specimens using hematoxylin and eosin stains. RESULTS: Fat was noted deep to the orbicularis oris and mentalis muscles. This fat is distinct from the more superficial fat of the cutaneous lip. The wet-dry border of the lip appears to be the most anterior boundary of the submuscular lip fat. The lateral boundary is the zygomaticus muscle. Histologic examination confirms this macroscopic anatomy. CONCLUSIONS: If volume loss is a significant component of facial aging, it becomes important for the clinician to know the precise anatomy of the subcutaneous tissue. Greater precision is possible in rejuvenating specific characteristics of aging. Augmentation at the vermilion cutaneous junction defines the vermilion border and improves perioral rhytides. Deep fat augmentation of the vermilion restores volume, shape, and lip eversion. Augmentation of submuscular fat beneath the cutaneous lip improves the convex shape. Submentalis fat augmentation specifically reduces the depth of the labiomental hollow. These findings are in agreement with previous observations that volume loss of deep fat--temporal, buccal, and sub-orbicularis oculi fat --contributes to the aging process. Knowledge of this anatomy and site-specific augmentation make it possible for the clinician to approach perioral rejuvenation in an algorithmic fashion. PMID: 19568090 [PubMed - in process]

Insights into patient and clinician concerns about scar appearance: semiquantitative structured surveys.

Related Articles Insights into patient and clinician concerns about scar appearance: semiquantitative structured surveys. Plast Reconstr Surg. 2009 Jul;124(1):256-65 Authors: Young VL, Hutchison J BACKGROUND: Few data are available regarding the psychological impact of scars arising from routine elective/aesthetic surgical procedures. To gain insight into both patients' and clinicians' concerns, the authors have undertaken structured semiquantitative surveys of (1) patients who had recently undergone a routine surgical procedure and (2) a cohort of plastic and aesthetic dermatological surgeons. METHODS: All selected patients had undergone a surgical procedure within 6 to 24 months before survey and had a scar(s) that caused concern. Participants completed a previously validated Self Completion Form that aimed to investigate their concerns. Clinicians were surveyed via telephone interviews using a similar format of questionnaire but with questions tailored to clinicians. RESULTS: Ninety-seven patients and 24 clinicians were interviewed. Patients were dissatisfied with scars resulting from surgery, irrespective of gender, age, ethnicity, or geographical location, and 91 percent would value even small improvements in scarring. Patients had scar(s) that they wished were less noticeable over a wide range of body sites (both "visible" and "nonvisible"). Male and female respondents had similar rates of dissatisfaction about their own scars. The survey revealed issues in the communication between patients and clinicians regarding scars; 71 percent of patients felt that they were more concerned than their surgeon about the scar resulting from a recent surgical procedure. CONCLUSIONS: This preliminary study indicates that patients are highly concerned about scarring following routine surgery, with most patients valuing any improvement in scarring. These data also show that there are disparities in patient-clinician communication regarding expectations following surgery. PMID: 19568089 [PubMed - in process]

Use of the harmonic blade in face lifting: a report based on 420 operations.

Related Articles Use of the harmonic blade in face lifting: a report based on 420 operations. Plast Reconstr Surg. 2009 Jul;124(1):245-55 Authors: Firmin FO, Marchac AC, Lotz NC BACKGROUND: An important concern for patients who undergo a face lift is the recovery time. Use of the Harmonic blade (Ethicon Endo-Surgery, Cincinnati, Ohio) for surgical dissection and hemostasis in face lift has improved recovery time and greatly reduced the risk of hematomas in the senior author's practice. METHODS: A retrospective study evaluated the complication rate using the Harmonic blade in face and neck lifting (n = 420) between 2001 and 2007. A prospective study was conducted on 100 cases (October of 2006 to May of 2008) to evaluate the mean operative time, drainage, and recovery time. Results at day 8 were evaluated using on a scale of 1 to 4 (1 = nil tracking to 4 = marked tracking). RESULTS: The complication rate in 420 cases was low and decreased with experience. Complications included hematoma (n = 5), temporary facial paresis (n = 4), submental lipolysis (n = 3), skin perforation (n = 1), minor skin burn (n = 1), skin necrosis (n = 0), and hair loss (n = 0). Mean operative time for face lift with a superficial musculoaponeurotic system procedure and anterior platysmaplasty was 180 minutes (range, 140 to 210 minutes). Drainage at day 1 was 20 cc (range, 0 to 30 cc). Average return to normal social life was by day 8 (range, 5 to 20 days). Results at day 8 were graded 1 for edema and ecchymosis. CONCLUSIONS: The beneficial effects of the Harmonic blade are obvious objectively and subjectively to both the surgeon and the patients. Understanding the key technical details involved with its use will improve the learning curve for the surgeon as this technology becomes an asset in face lifting. PMID: 19568088 [PubMed - in process]

Supplement: advances in pediatric plastic surgery. Preface.

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Supplement: advances in pediatric plastic surgery. Foreword.

Related Articles Supplement: advances in pediatric plastic surgery. Foreword. Plast Reconstr Surg. 2009 Jul;124(1):227-8 Authors: Rohrich RJ PMID: 19568086 [PubMed - in process]

Closed mallet thumb injury: a review of the literature and case study of the use of magnetic resonance imaging in deciding treatment.

Related Articles Closed mallet thumb injury: a review of the literature and case study of the use of magnetic resonance imaging in deciding treatment. Plast Reconstr Surg. 2009 Jul;124(1):222-6 Authors: Tabbal GN, Bastidas N, Sharma S SUMMARY: At present, the literature dedicated to closed mallet thumb injury offers conflicting evidence between conservative and operative approaches. Although conservative treatment is often successful, retraction of the extensor pollicis tendon may lead to improper reattachment and continued deformity. This discussion and case report serve to highlight the use of magnetic resonance imaging as an adjunct in selecting the proper treatment strategy for this injury at initial presentation. PMID: 19568085 [PubMed - in process]

Reconstruction of postburn thenar contractures using the free thoracodorsal artery perforator flap.

Related Articles Reconstruction of postburn thenar contractures using the free thoracodorsal artery perforator flap. Plast Reconstr Surg. 2009 Jul;124(1):217-21 Authors: Uygur F, Kulahci Y, Sever C, Duman H PMID: 19568084 [PubMed - in process]

Long-term results of surgical treatment for hypothenar hammer syndrome.

Related Articles Long-term results of surgical treatment for hypothenar hammer syndrome. Plast Reconstr Surg. 2009 Jul;124(1):210-6 Authors: Lifchez SD, Higgins JP BACKGROUND: Ulnar artery occlusion at the wrist and proximal palm can cause debilitating pain and tissue loss. There is disagreement in the literature as to whether the diseased ulnar artery needs to be reconstructed or merely resected. The authors report the long-term outcomes of patients treated surgically with reconstruction of the ulnar artery. METHODS: The long-term outcomes of 14 patients treated for this condition were evaluated. Comparisons of late postoperative to preoperative and early postoperative measurements were performed for digital brachial index. Subjective symptoms and function impairment were compared for preoperative and postoperative states using validated questionnaires. Comparisons were also made based on ulnar artery patency versus occlusion at late postoperative measurement. RESULTS: Two patients underwent excision of the thrombosed segment and direct ulnar artery repair. All reconstructions were performed using vein grafts. Eight reconstructions remained patent at a mean 52 months postoperatively. All patients had a mean improvement in digital brachial index (0.82 versus 0.70), decrease in pain and dysesthesia symptoms, and decrease in cold intolerance compared with preoperatively. Patients with ulnar artery occlusion at final measurement had more improvement in digital brachial index (0.19 versus 0.03) and tended to have better subjective improvement in symptoms and function than those whose ulnar artery remained patent. CONCLUSIONS: Ulnar artery reconstruction in the setting of hypothenar hammer syndrome results in immediate and long-term improvement of commonly used objective and subjective measurements of digital blood flow. Interestingly, long-term follow-up demonstrates superior endpoints in those reconstructions that occluded. A proposed mechanism to explain this phenomenon is presented. PMID: 19568083 [PubMed - in process]

Chemoprotection of flexor tendon repairs using botulinum toxin.

Related Articles Chemoprotection of flexor tendon repairs using botulinum toxin. Plast Reconstr Surg. 2009 Jul;124(1):201-9 Authors: De Aguiar G, Chait LA, Schultz D, Bleloch S, Theron A, Snijman CN, Ching V BACKGROUND: After flexor tendon repair, tendon gapping or rupture may be replaced by joint stiffness and poor function. After surgical repair of injured flexor tendons, botulinum toxin type A was injected into the forearm flexor muscles. This selectively decreased the force of muscle contraction. During this period of partial muscle denervation, patients could generate enough force to allow for early active mobilization (with its attendant benefits) but insufficient force to induce gapping or rupture of the repaired tendon. METHODS: Eighteen adult patients with zone 2 flexor tendon injuries (34 digits) were studied prospectively for up to 3 years. Tendons were repaired using the modified Kessler technique and marked with stainless steel wire. Botulinum toxin was injected into the appropriate proximal flexor muscle belly under localizing electromyographic control. A matched cohort consisted of 53 patients (104 digits). RESULTS: Results were assessed according to range of joint motion (Kleinert and Verdan criteria) and electromyographic and radiologic studies. Ninety-four percent had excellent results and 6 percent of digits had good results. There were no patients with fair or poor results. Average active range of motion was 244 degrees at 18 months. No gapping or ruptures occurred and no tenolyses were required. The control group of matched controls (modified Kessler repair; no botulinum injection) showed that 81 percent of digits had excellent results, 6 percent had good results, 8 percent had fair results, and 6 percent had poor results. CONCLUSIONS: Botulinum toxin injection statistically significantly improves the results of flexor tendon repair. The authors have termed this technique "chemoprotection" of flexor tendon repairs. PMID: 19568082 [PubMed - in process]

Efficacy of using sutures treated with povidone-iodine or chlorhexidine for preventing growth of Staphylococcus and Escherichia coli.

Related Articles Efficacy of using sutures treated with povidone-iodine or chlorhexidine for preventing growth of Staphylococcus and Escherichia coli. Plast Reconstr Surg. 2009 Jul;124(1):191e-3e Authors: Walker G, Rude M, Cirillo SL, Cirillo JD PMID: 19568081 [PubMed - in process]

Botox therapy for ischemic digits.

Related Articles Botox therapy for ischemic digits. Plast Reconstr Surg. 2009 Jul;124(1):191-201 Authors: Neumeister MW, Chambers CB, Herron MS, Webb K, Wietfeldt J, Gillespie JN, Bueno RA, Cooney CM BACKGROUND: Treating patients with Raynaud's phenomenon who have chronic pain and ulcerations is extremely challenging. Unrelenting pain can lead to dysfunction and disuse, rendering the patient debilitated and/or chronically depressed. Pharmacologic vasodilators and surgical sympathectomies offer variable benefits. Outcomes of symptomatic patients treated with botulinum toxin type A (Botox) injections for Raynaud's phenomenon are presented. METHODS: A retrospective study focused on patient outcomes was performed on 19 patients diagnosed with Raynaud's phenomenon. Patients suffered from chronic ischemic hand pain. All patients had vascular studies to rule out occlusive disease. Fifty to 100 units of Botox were injected into the palm around each involved neurovascular bundle. Preinjection and postinjection laser Doppler scanning was performed on most patients to measure blood flow. RESULTS: Sixteen of 19 patients (84 percent) reported pain reduction at rest. Thirteen patients reported immediate relief; three reported more gradual pain reduction over 1 to 2 months. Three patients had no or minimal pain relief. Tissue perfusion results demonstrated a marked change in blood flow (-48.15 percent to 425 percent) to the digits. All patients with chronic finger ulcers healed within 60 days. Most patients [n = 12 (63 percent)] remained pain-free (13 to 59 months) with a single-injection schedule. Four patients (21 percent) required repeated injections because of recurrent pain. CONCLUSIONS: Vascular function is abnormal in patients with Raynaud's phenomenon. Although its mechanism is unknown, Botox yielded a distinct improvement in perfusion and reduction in pain in patients failing conservative management. Continued research may lead to more specific and reliable treatment for Raynaud's patients. PMID: 19568080 [PubMed - in process]

The CONSORT statement and plastic surgery.

Related Articles The CONSORT statement and plastic surgery. Plast Reconstr Surg. 2009 Jul;124(1):188e-91e Authors: Prado AS, Danilla S, Andrades P, Parada F PMID: 19568079 [PubMed - in process]

Autologous versus Autogenous.

Related Articles Autologous versus Autogenous. Plast Reconstr Surg. 2009 Jul;124(1):187e-8e Authors: Halvorson EG PMID: 19568078 [PubMed - in process]

Computer and data disposal in plastic surgery: guidelines for health insurance portability and accountability act compliance.

Related Articles Computer and data disposal in plastic surgery: guidelines for health insurance portability and accountability act compliance. Plast Reconstr Surg. 2009 Jul;124(1):186e-7e Authors: Lee BT PMID: 19568077 [PubMed - in process]

Introduction of a new method for repair of widening surface scars by applying the tenon-mortise principle.

Related Articles Introduction of a new method for repair of widening surface scars by applying the tenon-mortise principle. Plast Reconstr Surg. 2009 Jul;124(1):184e-6e Authors: Chen W, Li S, Li Y, Li Q, Tang Y PMID: 19568076 [PubMed - in process]

Preoperative perforator imaging in reconstructive plastic surgery: current practice in Germany.

Related Articles Preoperative perforator imaging in reconstructive plastic surgery: current practice in Germany. Plast Reconstr Surg. 2009 Jul;124(1):183e-4e Authors: Knobloch K, Gohritz A, Reuss E, Redeker J, Spies M, Vogt PM PMID: 19568075 [PubMed - in process]

Intravenous regional anesthesia toxicity in pregnancy.

Related Articles Intravenous regional anesthesia toxicity in pregnancy. Plast Reconstr Surg. 2009 Jul;124(1):182e-3e Authors: Cooper JS, May JW PMID: 19568074 [PubMed - in process]

Panniculus morbidus follow-up.

Related Articles Panniculus morbidus follow-up. Plast Reconstr Surg. 2009 Jul;124(1):181e Authors: Engrav LH PMID: 19568073 [PubMed - in process]

A novel application for repair of skin defects of the penis: anterior scrotal artery flap.

Related Articles A novel application for repair of skin defects of the penis: anterior scrotal artery flap. Plast Reconstr Surg. 2009 Jul;124(1):181e-2e Authors: Isken T, Onyedi M, Sen C, Izmirli H, Yucel E PMID: 19568072 [PubMed - in process]

The vascular anatomy of the tensor fasciae latae perforator flap.

Related Articles The vascular anatomy of the tensor fasciae latae perforator flap. Plast Reconstr Surg. 2009 Jul;124(1):181-9 Authors: Hubmer MG, Schwaiger N, Windisch G, Feigl G, Koch H, Haas FM, Justich I, Scharnagl E BACKGROUND: The purpose of this study was to differentiate between musculocutaneous and septocutaneous perforators of the tensor fasciae latae perforator flap; to evaluate their number, size, and location; and to provide landmarks to facilitate flap dissection. An additional injection study estimated the skin area of the flap. METHODS: The anatomical study was performed on 23 fixed and injected cadavers. The perforators of the tensor fasciae latae were identified and classified as septocutaneous or musculocutaneous. Diameter, location, and numbers were measured and the perforators were dissected up to their origin. The injection study was performed on 10 fresh cadavers. On one side, the ascending branch of the lateral circumflex femoral artery was injected with methylene blue; on the other side, the septocutaneous perforators were injected selectively. The size, location, and borders of the stained skin were measured. RESULTS: Forty-five thighs were included in this study. All perforators emerged from the ascending branch of the lateral circumflex artery. The average number of musculocutaneous perforators was 2.3 (range, 0 to 5), the distance from the anterior superior iliac spine was 10.9 cm (range, 4.5 to 16.1 cm), and the diameter was 0.9 mm (range, 0.2 to 2 mm). Four specimens had no musculocutaneous perforator. The average number of septocutaneous perforators was 1.8 (range, 1 to 3), the distance from the anterior superior iliac spine was 10.9 cm (range, 6.2 to 15.7 cm), and the diameter was 1.5 mm (range, 0.5 to 3 mm). Seventy-six percent of the septocutaneous perforators emerged between 8 and 12 cm from the anterior superior iliac spine. The possible pedicle length of a flap based on these vessels is 8.1 cm (range, 6.5 to 10 cm). In the injection study, the average skin area stained with methylene blue was 19.4 x 13.4 cm (range, 10 to 24 cm x 7 to 17 cm) in the ascending branch group. In the perforator group, the average skin area was 19.2 x 13.7 cm (range, 15 to 22 cm x 12 to 16 cm). CONCLUSIONS: The authors could show that the number of septocutaneous perforators for the tensor fasciae latae flap is more constant and that their diameter is greater than that of musculocutaneous perforators. The location of these perforators on a line extending from the ilium to the greater trochanter facilitates planning and dissection of a flap. PMID: 19568071 [PubMed - in process]

Perioperative interstitial brachytherapy for recurrent keloid scars.

Related Articles Perioperative interstitial brachytherapy for recurrent keloid scars. Plast Reconstr Surg. 2009 Jul;124(1):180e-1e Authors: Rio E, Bardet E, Peuvrel P, Pannier M, Dreno B PMID: 19568070 [PubMed - in process]

Bilobed flap for axillary reconstruction.

Related Articles Bilobed flap for axillary reconstruction. Plast Reconstr Surg. 2009 Jul;124(1):179e-80e Authors: Smith ML, Lee JC PMID: 19568069 [PubMed - in process]

"Oxytocin hand": extravasation and vascular compromise after obstetrical pitocin.

Related Articles "Oxytocin hand": extravasation and vascular compromise after obstetrical pitocin. Plast Reconstr Surg. 2009 Jul;124(1):177e-9e Authors: Pollock RA, Olges JR, Stewart DH PMID: 19568068 [PubMed - in process]

A long-term follow-up and improvement of the repair of incomplete syndactyly by web flap on a subcutaneous tissue pedicle.

Related Articles A long-term follow-up and improvement of the repair of incomplete syndactyly by web flap on a subcutaneous tissue pedicle. Plast Reconstr Surg. 2009 Jul;124(1):176e-7e Authors: Xu JH, Hong XY, Yao JM, Dawreeawo J PMID: 19568067 [PubMed - in process]

Diagnostic dilemma: acellular dermis mimicking a breast mass after immediate tissue expander breast reconstruction.

Related Articles Diagnostic dilemma: acellular dermis mimicking a breast mass after immediate tissue expander breast reconstruction. Plast Reconstr Surg. 2009 Jul;124(1):174e-6e Authors: Buck DW, Heyer K, Wayne JD, Yeldandi A, Kim JY PMID: 19568066 [PubMed - in process]

Toxic shock syndrome after prosthetic breast reconstruction with AlloDerm.

Related Articles Toxic shock syndrome after prosthetic breast reconstruction with AlloDerm. Plast Reconstr Surg. 2009 Jul;124(1):173e-4e Authors: Vendemia N, Rohde C PMID: 19568065 [PubMed - in process]

A peculiar case of oral firework explosion caused by Russian roulette.

Related Articles A peculiar case of oral firework explosion caused by Russian roulette. Plast Reconstr Surg. 2009 Jul;124(1):172e-3e Authors: Di Benedetto GM, Grassetti L, Forlini W, Bertani A PMID: 19568064 [PubMed - in process]

Versatility of the anterolateral thigh flap with vascularized fascia lata for reconstruction of complex soft-tissue defects: clinical experience and functional assessment of the donor site.

Related Articles Versatility of the anterolateral thigh flap with vascularized fascia lata for reconstruction of complex soft-tissue defects: clinical experience and functional assessment of the donor site. Plast Reconstr Surg. 2009 Jul;124(1):171-80 Authors: Kuo YR, Yeh MC, Shih HS, Chen CC, Lin PY, Chiang YC, Jeng SF BACKGROUND: The anterolateral thigh flap is commonly used for reconstruction of various soft-tissue defects. This article presents the authors' approach to one-stage reconstruction of composite soft-tissue defects using an anterolateral thigh flap with a vascularized fascia lata. METHODS: This retrospective review analyzed 973 patients who had undergone anterolateral thigh flap reconstruction for various soft-tissue defects over the past 10 years. Various types of complicated defects in 36 patients were reconstructed with a composite anterolateral thigh flap combined with vascularized fascia lata. The fascia lata component of the flap was used for abdominal wall and fascial defect reconstruction in 12 patients, for lip-cheek defect reconstruction in 15 patients, for reconstruction of composite defects in extremities in nine patients, and for reconstruction of the perineum in one patient. Functional outcomes of donor sites were investigated by using a dynamometer. RESULTS: All flaps except one survived. The overall flap survival rate was 97 percent. Patients achieved satisfactory results without major postoperative complications. The study revealed that vascularized fascia may mimic a fascial sheath but lacks the muscle-synchronized excursion properties. Apart from a mild deficiency in quadriceps femoris muscles contraction in the donor thighs, no difficulties in daily ambulation were reported by the patients. CONCLUSIONS: The anterolateral thigh flap with vascularized fascia lata provides a reliable fascial component for single-stage reconstruction of complex soft-tissue defects. PMID: 19568063 [PubMed - in process]

Botulinum toxin injections for modulation of nasal and facial grimaces in a cleft lip and palate patient.

Related Articles Botulinum toxin injections for modulation of nasal and facial grimaces in a cleft lip and palate patient. Plast Reconstr Surg. 2009 Jul;124(1):170e-2e Authors: Aizenbud D, Nachmani A, Silberstein E, Rosenberg L PMID: 19568062 [PubMed - in process]

Free tissue transfer in a head and neck cancer patient with polycythemia vera.

Related Articles Free tissue transfer in a head and neck cancer patient with polycythemia vera. Plast Reconstr Surg. 2009 Jul;124(1):169e-70e Authors: Lin SJ, Yu P PMID: 19568061 [PubMed - in process]

Reconstruction of acid-injured face with occipitocervicodorsal super-thin flaps.

Related Articles Reconstruction of acid-injured face with occipitocervicodorsal super-thin flaps. Plast Reconstr Surg. 2009 Jul;124(1):167e-9e Authors: Vinh VQ, Van Anh T, Nam L, Hyakusoku H, Ogawa R PMID: 19568060 [PubMed - in process]

V-y modification of a bipedicle perforator flap.

Related Articles V-y modification of a bipedicle perforator flap. Plast Reconstr Surg. 2009 Jul;124(1):167-70 Authors: Hartzell TL, Orgill BD, Chan R, Mathy JA, Orgill DP PMID: 19568059 [PubMed - in process]

Transconjunctival lower blepharoplasty through interrupted incisions.

Related Articles Transconjunctival lower blepharoplasty through interrupted incisions. Plast Reconstr Surg. 2009 Jul;124(1):166e-7e Authors: Pechter EA PMID: 19568058 [PubMed - in process]

Orthodontic dynamic expansion system for treatment of cryptotia.

Related Articles Orthodontic dynamic expansion system for treatment of cryptotia. Plast Reconstr Surg. 2009 Jul;124(1):165e-6e Authors: Staudt CB, Chardot C, La Scala GC PMID: 19568057 [PubMed - in process]

A novel single-flap technique for total penile reconstruction: the pedicled anterolateral thigh flap.

Related Articles A novel single-flap technique for total penile reconstruction: the pedicled anterolateral thigh flap. Plast Reconstr Surg. 2009 Jul;124(1):163-6 Authors: Lee GK, Lim AF, Bird ET PMID: 19568056 [PubMed - in process]

Marjolin's ulcer: a preventable complication of burns?

Related Articles Marjolin's ulcer: a preventable complication of burns? Plast Reconstr Surg. 2009 Jul;124(1):156e-64e Authors: Copcu E LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss the clinical features of Marjolin's ulcer. 2. Identify the risk factors for the development of Marjolin's ulcer. 3. Develop a surgical management plan for the treatment of Marjolin's ulcer. SUMMARY: Marjolin's ulcer is a rare and aggressive cutaneous malignancy that arises on previously traumatized and chronically inflamed skin, especially after burns. This clinical condition was first described by Marjolin in 1828. The term "Marjolin's ulcer" has been generally accepted to refer to a long-term malignant complication of the scars resulting from burns. However, vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumor. Clinically, reports suggest that atrophic and unstable scars tend to develop into cancer. Various etiological factors have been implicated in the condition, including toxins released from damaged tissues, immunologic factors, cocarcinogens, and miscellaneous factors such as irritation, poor lymphatic regeneration, antibodies, mutations, and local toxins. The incidence of burn scars undergoing malignant transformation has been reported to be 0.77 to 2 percent. All parts of the body can be affected, but the extremities and the scalp are most frequently affected. There are two variants: acute and chronic. In the former, the carcinoma occurs within 1 year of the injury. The chronic form is more frequent and malignancy tends to develop slowly, with an average time to malignant transformation of 35 years. Although many different cell types can be seen in these lesions, the major histological type is squamous cell carcinoma. Marjolin's ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases; radical excision is the treatment of choice, but there is no consensus on lymph node dissection. Marjolin's ulcer can be insidious and often leads to a poor prognosis, and deaths from Marjolin's ulcer are not uncommon. Meticulous wound care is a crucial step in prevention of these lesions. PMID: 19568055 [PubMed - in process]

The absorbable dermal staple device: a faster, more cost-effective method for incisional closure.

Related Articles The absorbable dermal staple device: a faster, more cost-effective method for incisional closure. Plast Reconstr Surg. 2009 Jul;124(1):156-62 Authors: Cross KJ, Teo EH, Wong SL, Lambe JS, Rohde CH, Grant RT, Ascherman JA BACKGROUND: Closure with dermal sutures is time consuming, may increase the risks of inflammation and infection secondary to foreign body reaction, exposes the surgeon to possible needlestick injuries, and has variable cosmetic outcomes depending on each surgeon's technique. The absorbable INSORB dermal stapler is hypothesized to be faster and more cost effective than sutures for dermal layer closures and provides a safer and more consistent result. METHODS: This is a prospective, randomized, controlled study. Patients undergoing bilateral breast reconstruction with tissue expanders had one incision randomized to dermal closure with absorbable dermal staples. The contralateral side was closed with dermal sutures. During the expansion period, wounds were assessed by a blinded plastic surgeon using the 13-point Vancouver Scar Scale. At the time of implant exchange, both scars were excised and examined for histologic signs of inflammation. RESULTS: Eleven patients (22 incisions) were enrolled in the study. The dermal stapler was four times faster than standard suture closure, reducing closure time by 10.5 minutes (p

Soft-tissue reconstruction of external hemipelvectomy defects.

Related Articles Soft-tissue reconstruction of external hemipelvectomy defects. Plast Reconstr Surg. 2009 Jul;124(1):144-55 Authors: Senchenkov A, Moran SL, Petty PM, Knoetgen J, Tran NV, Clay RP, Bite U, Johnson CH, Barnes SA, Sim FH BACKGROUND: External hemipelvectomy is the ultimate salvage procedure for locally advanced pelvic tumors, infections, and failed revascularizations. It is associated with high wound morbidity requiring surgical management. In this study, the authors analyzed their experience with primary and secondary reconstruction of hemipelvectomy wounds. METHODS: The records of 160 consecutive hemipelvectomy patients from the authors' institution were reviewed to identify the incidence of soft-tissue coverage problems and approaches to their management. RESULTS: At the time of hemipelvectomy, a musculocutaneous hemipelvectomy flap was sufficient for closure in 159 patients, one patient needed a free lower leg fillet flap, and none required pedicle flaps. No hemipelvectomy hernias were observed, although abdominal wall reconstruction was performed in three patients. Wound complications were encountered in 62 patients (39 percent), and 51 patients required operative débridement. Thirty-three patients healed by secondary intention, and 25 underwent delayed reconstruction with local tissue rearrangements (n = 15), split-thickness skin grafting (n = 6), and pedicled flaps (n = 6). All pedicled flaps were contralateral inferiorly based rectus abdominis muscle (n = 2) and musculocutaneous (n = 4) flaps. CONCLUSIONS: Hemipelvectomy is associated with high wound morbidity. When the hemipelvectomy flap has a musculocutaneous design, hernias are exceedingly rare. Although immediate reconstruction is accomplished with a hemipelvectomy flap in the vast majority of cases, secondary reconstructions are often required for management of wound complications. For large defects, a contralateral inferiorly based rectus abdominis muscle or musculocutaneous flap is the reconstruction of choice. The rectus abdominis muscle should therefore always be preserved in hemipelvectomy patients by careful preoperative planning, especially when creation of an ostomy is considered. PMID: 19568053 [PubMed - in process]

Liposuction and lipoinjection treatment for congenital and acquired lipodystrophies in children.

Related Articles Liposuction and lipoinjection treatment for congenital and acquired lipodystrophies in children. Plast Reconstr Surg. 2009 Jul;124(1):134-43 Authors: Giugliano C, Benitez S, Wisnia P, Sorolla JP, Acosta S, Andrades P BACKGROUND: The purpose of this clinical study was to establish liposuction and lipoinjection as a noncosmetic procedure in children to correct lipodystrophies. METHODS: Liposuction, fat injection, or a combination of both was performed on 30 patients between 1994 and 2006 at Roberto del Rio Hospital or Clinica Alemana, Santiago, Chile. Liposuction was indicated in patients with excessive amounts of fatty tissue or tumor-like swelling. Combined liposuction and lipoinjection was performed on patients with deficit and excess in soft tissues. Lipoinjection was used for patients with soft-tissue insufficiencies. Samples of fat obtained by liposuction were submitted to histopathologic examination. Traditional tumescent technique was used for liposuction. The supernatant obtained by simple filtration was used for fat injection. Short- and long-term postoperative follow-up included registration of complications and assessment of aesthetic and functional outcome. The kappa test was used for statistical analysis. RESULTS: Thirty patients, nine boys and 21 girls, were operated on, with an average age of 11 years (range, 4 to 17 years). A total of 43 procedures were performed: 27 liposuctions, 10 lipoinjections, and six combined procedures. Average hospital stay was 1.1 days. Of a total 20 patients who underwent liposuction, six required revision. Histopathologic study showed 19 lipomatoses and one lipoblastomatosis. Cosmetic outcomes based on Strasser scale were as follows: six excellent, 19 good, four mediocre, and one poor. CONCLUSIONS: Liposuction and lipoinjection as sole or combined procedures are safe methods for the pediatric population. They are well tolerated, with a low rate of complications and satisfactory aesthetic results. PMID: 19568052 [PubMed - in process]

Single-stage facial reanimation in the surgical treatment of unilateral established facial paralysis.

Related Articles Single-stage facial reanimation in the surgical treatment of unilateral established facial paralysis. Plast Reconstr Surg. 2009 Jul;124(1):124-33 Authors: Biglioli F, Frigerio A, Rabbiosi D, Brusati R BACKGROUND: Surgical treatment of unilateral long-standing facial paralysis requires transposition of new musculature to restore the function of the atrophied mimetic musculature. Facial reanimation with free neuromuscular flaps is actually the accepted standard treatment. Two-stage procedures have been used for years, with a total flap recovery time of 18 to 24 months. In 1998, Harii proposed single-stage facial reanimation using the latissimus dorsi flap, showing a faster recovery compared with two-stage procedures. The present study evaluated the results of the authors' center applying the single-stage facial reanimation. METHODS: From April of 1999 to April of 2006, 33 patients with unilateral established facial paralysis underwent single-stage facial reanimation via latissimus dorsi free flap transplantation. Time from the onset of paralysis ranged from 20 months to 64 years (mean, 11.6 years). Patients were followed postoperatively for at least 24 months. Results were studied and compared using Terzis and Noah's 1997 classification. RESULTS: Among the 33 patients included in the study, there was an average reinnervation time of 8.9 months. According to Terzis and Noah's classification system, 12 patients (36.3 percent) were considered grade V, 12 (36.3 percent) were grade IV, four (12.2 percent) were grade III, two (6.1 percent) were grade II, and three (9.1 percent) were grade I. CONCLUSIONS: Single-stage facial reanimation with a latissimus dorsi flap achieved morphofunctional results similar to those obtained with the classic two-stage technique. In addition, the authors were able to reduce the morbidity associated with treatment and the time required for recovery. PMID: 19568051 [PubMed - in process]

Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes.

Related Articles Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg. 2009 Jul;124(1):115-23 Authors: Chiu ES, Liu PH, Friedlander PL BACKGROUND: The supraclavicular island flap has been used successfully for difficult facial reconstruction cases, providing acceptable results without using microsurgical techniques. The authors use this regional flap in reconstructing various head and neck oncologic defects that normally require traditional regional or free flaps to repair surgical wounds. METHODS: A pedicled supraclavicular artery flap was used to reconstruct head/neck oncologic defects. Complications and functional outcomes were assessed. RESULTS: Head and neck oncologic patients underwent tumor resection followed by immediate reconstruction using a supraclavicular artery island flap. Ablative defects included neck, tracheal-stomal, mandible, parotid, and pharyngeal walls. All flaps (n = 18) were harvested in less than 1 hour. All ablative wounds and donor sites were closed primarily and did not require additional surgery. Major complications included a complete flap loss when the vascular pedicle was inadvertently divided and pharyngeal leaks. The leaks resolved without surgical intervention, and both patients regained the ability to swallow using their neo-esophagus. Minor complications included donor-site wound dehiscence and cellulitis. None of the patients reported functional donor-site morbidity. CONCLUSIONS: This thin flap is easy and quick to harvest, has a reliable pedicle, and has minimal donor-site morbidity. It is now the authors' flap of choice for many common head and neck reconstructive problems. Early experience using the supraclavicular artery island flap suggests that it is an excellent flap option for head and neck oncologic disease patients. PMID: 19568050 [PubMed - in process]

Analysis of neuropeptides in stretched skin.

Related Articles Analysis of neuropeptides in stretched skin. Plast Reconstr Surg. 2009 Jul;124(1):102-13 Authors: Chin MS, Lancerotto L, Helm DL, Dastouri P, Prsa MJ, Ottensmeyer M, Akaishi S, Orgill DP, Ogawa R BACKGROUND: Mechanical forces modulate wound healing and scar formation through mechanotransduction. In response to mechanical stimulation, neuropeptides are released from peripheral terminals of primary afferent sensory neurons, influencing skin and immune cell functions and increasing vascular permeability, causing neurogenic inflammation. METHODS: A computer-controlled device was used to stretch murine skin. C57Bl6 mice (n = 26) were assigned to a cyclical square-wave tensile stimulation for 4 hours or continuous stimulation for 4 hours. Stretched skin was analyzed for expression of the neuropeptides, substance P and calcitonin gene-related peptide, their receptors (NK1R and calcitonin gene-related peptide receptor component protein), and growth factors (nerve growth factor, transforming growth factor beta1, vascular endothelial growth factor, and epidermal growth factor) using immunohistochemistry and real-time reverse-transcriptase polymerase chain reaction. RESULTS: Cyclical stimulation resulted in a significant increase in expression of neuropeptides and growth factors, whereas the corresponding peptide receptors were down-regulated. Transcription of neuropeptide mRNA was elevated in stretched skin, which proves that neuropeptides are released from not only peripheral terminals of nerve fibers but also resident skin cells. CONCLUSIONS: The authors' results suggest that skin stretching may alter cell physiology by stimulating neuropeptide expression, and that cyclical mechanical force may be more effectively stimulating mechanosensitive nociceptors or mechanoreceptors (mechanosensors) on cells. PMID: 19568049 [PubMed - in process]

The use of acellular dermal matrix to prevent capsule formation around implants in a primate model.

Related Articles The use of acellular dermal matrix to prevent capsule formation around implants in a primate model. Plast Reconstr Surg. 2009 Jul;124(1):82-91 Authors: Stump A, Holton LH, Connor J, Harper JR, Slezak S, Silverman RP BACKGROUND: Implant-based breast reconstruction is a popular option after mastectomy, but capsular contracture may detract from long-term outcomes. The authors have observed that breast implants covered with acellular dermal matrix (AlloDerm) are less likely to develop a capsule in the area where the implant is in direct contact with the acellular matrix. The authors tested this observation experimentally by comparing capsular formation around implants in the presence and absence of AlloDerm in primates. METHODS: Eight smooth-surfaced tissue expanders were implanted into eight African green monkeys. In four experimental animals, a sheet of AlloDerm was draped over the tissue expander so as to cover the implant. Four control animals underwent placement of a tissue expander only. Animals were killed after 10 weeks and specimens underwent histologic and immunohistochemical analysis. RESULTS: Hematoxylin and eosin staining of control specimens revealed the presence of a distinct layer of wavy, parallel arrays of collagen fibers consistent with capsule formation. Immunostaining identified abundant myofibroblasts, a profibrotic cell found in breast capsules. In the AlloDerm-covered specimens, no capsule layer was visible, and specimens stained weakly for myofibroblasts. The difference in myofibroblast staining intensity was statistically significant. CONCLUSIONS: The use of AlloDerm to partially enclose implants effectively prevented formation of a capsule in areas where AlloDerm contacted the implant at 10 weeks. Long-term studies will be required to determine whether this is a durable result that can be reproduced in humans. PMID: 19568048 [PubMed - in process]

A murine model for studying diffusely injected human fat.

Related Articles A murine model for studying diffusely injected human fat. Plast Reconstr Surg. 2009 Jul;124(1):74-81 Authors: Thanik VD, Chang CC, Lerman OZ, Allen RJ, Nguyen PD, Saadeh PB, Warren SM, Levine JP, Coleman SR, Hazen A BACKGROUND: The study of human autologous fat grafting has been primarily anecdotal. In this study, the authors aim to develop a murine model that recapitulates human fat grafting to study the fate of injected fat and the cell populations contained within. METHODS: The authors' method of fat harvesting and refinement has been described previously. The authors injected nude and tie2/lacZ mice with 2 ml of human lipoaspirate placed on the dorsal surface in a multipass, fan-like pattern. Fatty tissue was injected in small volumes of approximately 1/30 ml per withdrawal. The dorsal skin and associated fat was excised at various time points. Sections were stained with hematoxylin and eosin and cytochrome c oxidase IV. Transgenic tie2/lacZ samples were stained with X-galactosidase. At the 8-week time point, volumetric analysis was performed. RESULTS: Volumetric analysis at the 8-week time point showed 82 percent persistence of the original volume. Gross analysis showed it to be healthy, nonfibrotic, and vascularized. Hematoxylin and eosin analysis showed minimal inflammatory or capsular reaction, with viable adipocytes. Fat grafted areas were vascularized with multiple blood vessels. Cytochrome c oxidase IV human-specific stain and beta-galactosidase expression revealed these vessels to be of human origin. CONCLUSIONS: The authors have developed a murine model with which to study the fate of injected lipoaspirate. There is a high level of persistence of the grafted human fat, with minimal inflammatory reaction. The fat is viable and vascularized, demonstrating human-derived vessels in a mouse model. This model provides a platform for studying the populations of progenitor cells known to reside in lipoaspirate. PMID: 19568047 [PubMed - in process]

Tissue harvest by means of suction-assisted or third-generation ultrasound-assisted lipoaspiration has no effect on osteogenic potential of human adipose-derived stromal cells.

Related Articles Tissue harvest by means of suction-assisted or third-generation ultrasound-assisted lipoaspiration has no effect on osteogenic potential of human adipose-derived stromal cells. Plast Reconstr Surg. 2009 Jul;124(1):65-73 Authors: Panetta NJ, Gupta DM, Kwan MD, Wan DC, Commons GW, Longaker MT BACKGROUND: Human adipose-derived stromal cells readily undergo osteogenic differentiation in vitro and in vivo. Thus, interest in their potential role in skeletal tissue engineering continues to escalate. Very little is known regarding the effects that energy delivered by means of third-generation ultrasound-assisted lipoaspiration may have on the osteogenic potential of these cells. The authors investigated whether differences in adipose-derived stromal cell yield, and the in vitro proliferation and osteogenic potential of these cells obtained by suction-assisted lipoaspiration or third-generation ultrasound-assisted lipoaspiration, exist. METHODS: Adipose-derived stromal cells were harvested from lipoaspiration specimens of patients undergoing elective suction-assisted lipoaspiration and third-generation ultrasound-assisted lipoaspiration. Harvested cells were seeded to evaluate proliferative capacity and in vitro osteogenic potential. Alkaline phosphatase and alizarin red staining were performed to evaluate early and terminal osteogenic differentiation, respectively. Quantitative real-time polymerase chain reaction analysis was used to examine osteogenic gene expression patterns of RUNX2/CFBA1 (early differentiation) and osteocalcin (late differentiation). RESULTS: No significant differences in the proliferative capacity (n = 3), alkaline phosphatase staining (n = 3), or extracellular matrix mineralization (n = 3) of suction-assisted lipoaspiration- or third-generation ultrasound-assisted lipoaspiration-derived cells were appreciated. Transcript levels of markers of early and terminal osteogenic differentiation were not significantly different (n = 3). CONCLUSIONS: These findings suggest that exposure of adipose-derived stromal cells to ultrasound energy during tissue harvest by means of third-generation ultrasound-assisted lipoaspiration does not impart a negative consequence toward their proliferative capacity or osteogenic potential. Thus, the cells harvested using third-generation ultrasound-assisted lipoaspiration are comparable to those obtained by means of suction-assisted lipoaspiration for use in the study of osteogenic differentiation and skeletal tissue engineering. PMID: 19568046 [PubMed - in process]

Discussion. Breast reconstruction: a review and rationale for patient selection.

Related Articles Discussion. Breast reconstruction: a review and rationale for patient selection. Plast Reconstr Surg. 2009 Jul;124(1):63-4 Authors: Disa JJ PMID: 19568045 [PubMed - in process]

Discussion. Postmastectomy reconstruction: an approach to patient selection.

Related Articles Discussion. Postmastectomy reconstruction: an approach to patient selection. Plast Reconstr Surg. 2009 Jul;124(1):53-4 Authors: Nahabedian MY PMID: 19568044 [PubMed - in process]

Discussion. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment.

Related Articles Discussion. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment. Plast Reconstr Surg. 2009 Jul;124(1):41-2 Authors: Hammond DC PMID: 19568043 [PubMed - in process]

Discussion. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment.

Related Articles Discussion. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment. Plast Reconstr Surg. 2009 Jul;124(1):39-40 Authors: Nahabedian MY PMID: 19568042 [PubMed - in process]

Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment.

Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment. Plast Reconstr Surg. 2009 Jul;124(1):28-38 Authors: Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K SUMMARY: Of the relatively few studies that exist regarding the cosmetic satisfaction of patients following breast conservation therapy, several indicate significant dissatisfaction in many patients. Breast conservation often results in some of the most challenging and complex reconstructive problems. Indeed, even defining the problem or analyzing the defect can be difficult for the junior surgeon. For the more seasoned reconstructive surgeon, analyzing the problem and applying solutions may be less difficult, but clearly communicating the defects typically seen after an aggressive lumpectomy and radiotherapy can be difficult, especially with trainees or junior surgeons. The goal of this article, the third in a four-part series, is to provide a template for the analysis and surgical reconstruction of defects resulting from breast conservation therapy utilizing a systematic three-step method. Part I of this series described the three main anatomical features of the breast--the footprint, the conus of the breast, and the skin envelope--and how they interact. By systematically analyzing the breast with this three-step method, a "problem list" based in specific anatomic traits of the breast can be generated, allowing the surgeon to then generate an appropriate surgical plan for reconstruction. Surgical approaches based on the percentage of breast parenchyma resected are suggested, with a focus on glandular rearrangement, breast reduction techniques, and locoregional flaps. The three-step method of breast analysis, evaluating the anatomical deformation of the breast footprint, conus, and skin envelope, remains the fundamental "fall-back" principle of this approach. PMID: 19568041 [PubMed - in process]

Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction.

Related Articles Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction. Plast Reconstr Surg. 2009 Jul;124(1):18-27 Authors: Wong C, Saint-Cyr M, Arbique G, Becker S, Brown S, Myers S, Rohrich RJ BACKGROUND: The innovative technique of three- and four-dimensional computed tomographic angiography allows us to analyze the areas of perfusion in commonly used free abdominal flaps in breast reconstruction, such as pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, full TRAMs, muscle-sparing TRAMs, and deep inferior epigastric perforator (DIEP) flaps. The authors compared the vascular territories in these flaps. METHODS: A total of 11 lower abdominal flaps were obtained from nine cadavers and two abdominoplasty procedures. The authors simulated the perfusion of seven pedicled TRAMs, eight full TRAMs, eight muscle-sparing TRAMs, 14 DIEPs, and six superficial inferior epigastric artery flaps. For each simulated flap, the named artery/perforator was injected with Omnipaque contrast using a Harvard precision pump at 0.5 ml/minute, and the flap was subjected to dynamic computed tomographic scanning using a GE Lightspeed 16-slice scanner. Scans were repeated at 0.125-ml increments (every 15 seconds) for the first 1 ml, then at 0.5-ml increments (every 60 seconds) for the next 2 to 3 ml, thus giving progressive computed tomographic images over time. Images were viewed using both General Electrics and TeraRecon systems, allowing analysis of branching patterns and perfusion flow as well as measurements of vascular territory. CONCLUSIONS: This study shows that there are definitive differences in vascular territory based on flap type. The sequences of images also allow us to reappraise the classic Hartrampf zones of perfusion. PMID: 19568040 [PubMed - in process]

The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance.

Related Articles The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance. Plast Reconstr Surg. 2009 Jul;124(1):9-17 Authors: Losken A, Schaefer TG, Newell M, Styblo TM BACKGROUND: Partial breast reconstruction using reduction techniques has recently increased in popularity. Some fear that combining breast conservation therapy with partial breast reconstruction alters the architecture and will affect patterns of local recurrence and make postoperative cancer surveillance more difficult. The purpose of this series was to evaluate long-term postoperative cancer surveillance. METHODS: The authors retrospectively reviewed the charts and mammograms of patients (n = 17; average follow-up, 6.3 years) who underwent the oncoplastic reduction technique before 2004. Mammography sensitivity was determined by measuring breast density, qualitative changes, and time until mammographic stabilization was determined. These data were compared with those of a control group from the same time period who underwent breast conservation therapy alone (n = 17; average follow-up, 5.9 years). RESULTS: Typical mammographic findings, including architectural distortion, cysts, and calcifications, were similar between the two groups. There was no significant difference in breast density scores. The oncoplastic reduction group had longer times to mammographic stabilization (21.2 versus 25.6 months, p = 0.23). There was a trend toward a greater number of postoperative mammograms and ultrasounds in the study group when indexed per follow-up year. The rate of tissue sampling in the study group was significantly higher (53 percent) than that in the control group (18 percent). CONCLUSIONS: The oncoplastic reduction technique remains safe and effective, without significantly affecting postoperative surveillance. Mammographic findings were similar to those observed in patients with breast conservation therapy alone, and sensitivity was not affected. It takes longer to achieve mammographic stability and more patients in the oncoplastic group will require additional diagnostic testing. PMID: 19568039 [PubMed - in process]

Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Perio.

Related Articles Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Perio. Plast Reconstr Surg. 2009 Jul;124(1):1-8 Authors: Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, Alderman AK BACKGROUND: Expander/implant and autogenous tissue breast reconstructions have different aging processes, and the time when these processes stabilize is unclear. The authors' goal was to evaluate long-term patient-reported aesthetic satisfaction with expander/implant and autogenous breast reconstruction. METHODS: The authors surveyed a cross-section of University of Michigan women who underwent postmastectomy breast reconstruction (response rate, 73 percent) between 1988 and 2006 [110 expander/implant and 109 transverse rectus abdominis myocutaneous (TRAM) reconstructions]. Each group was stratified into three postreconstructive periods: short term (8 years). Validated satisfaction items were scored on a 5-point Likert scale; scores were dichotomized into positive and negative responses. Logistic regression assessed satisfaction by procedure, while controlling for sociodemographic and clinical variables. RESULTS: Mean follow-up time after reconstruction was 6.5 years (range, 1 to 18 years). Procedure type had no effect on short-term aesthetic satisfaction. However, in the long term, reconstruction type considerably affected satisfaction. Although satisfaction with TRAM reconstruction remained relatively constant, satisfaction with expander/implants was significantly less among those patients in the long term. Patients who had undergone implant reconstruction more than 8 years earlier, compared with those who undergone implant reconstruction less than 5 years earlier, were significantly less satisfied with breast appearance (odds ratio, 0.10; 95% CI, 0.02 to 0.48), softness (odds ratio, 0.14; 95% CI, 0.03 to 0.64), and size (odds ratio, 0.13; 95% CI, 0.03 to 0.62). CONCLUSIONS: In the long term, TRAM patients, compared with expander/implant patients, appear to have significantly greater aesthetic satisfaction. These long-term data have important implications for women's health in the survivorship period and will help women navigate the complex decision-making process of breast reconstruction. PMID: 19568038 [PubMed - in process]