Postoperative evaluation platform of female breast implant surgery with breast configuration indicator

The purpose of this study is to establish an optimal module of breast configuration, under normal seating state, for postoperative evaluation of a female breast implant surgery. The analytical parameters of breast configuration, such as the breast position, size and shape, can be derived from a three-dimensional (3D), full-sized image process under non-radiation condition. This optimal module converts the breast position, size and shape to the breast configuration indicator consisting of three components or indices-the breast position, volume and breast congruence rate. In conjunction with the continuity analysis, the breast configuration indicator would allow a surgeon to practically grasp the progress during the postsurgery revisits. In addition, the module derived from the proposed computer-aided breast configuration indicator could be of great use as a tool of communication between patients and surgeons.

Closing fasciotomy wounds using plastic bands: an alternative simple and cheap method

Fasciotomy incisions are essential to relieve pressure on the neurovascular structures in the limbs. However, closing such wounds often becomes a challenge to the surgeon. The aim of this study is to describe a simple and cheap method of closing these wounds. Plastic bands were used to gradually close fasciotomy wounds in five patients. All fasciotomy wounds in the five patients closed successfully within 4-12 days. Only two patients developed minimal complications in the form of minor wound infection and a hypertrophic scar. We conclude that the plastic band method used here is cheaper and simpler in comparison to similar techniques using the same device.

The use of buccal flap in the closure of posterior post-palatoplasty fistula

OBJECTIVE

Palatal fistulation is a common complication after cleft palate repair, it could occur at any site along the line of cleft closure. Many techniques have been proposed for its repair. However, the incidence of recurrence after initial fistula closure is high. The aim of this study is to evaluate the efficacy of closure of posterior palatal fistula using buccal myomucosal flap.

METHOD

Fifteen cases with posterior palatal fistulas - after cleft palate repair - were included in this study. Their fistulas were closed in two-layers; an oral mucoperiosteum hinge flap to reconstruct the nasal side and a buccal myomucosal flap from the inner surface of the cheek to reconstruct the oral side. Follow-up was carried out for 1 year.

RESULTS

The fistulas were completely closed in all cases (100%) with no failure or recurrence. This was a single-stage operation in all cases, with no need for further procedure to divide the pedicle of the flap.

CONCLUSIONS

Closure of posterior palatal fistula using buccal myomucosal flap in addition to mucoperiosteal flap is a useful method with high success rate and no morbidity.

Closure of anterior post-palatoplasty fistula using superior lip myomucosal flap

OBJECTIVE

(a) Surgical repair of palatal fistulas are technically difficult due to excessive tissue fibrosis with high failure rate. (b) The aim of this study is to evaluate the efficacy of closure of anterior palatal fistula using myomucosal superior lip flap.

METHODS

33 cases with anterior palatal fistulas after cleft palate repair were subjected to closure in two-layers, the first is the oral mucoperiosteum hinge flap to reconstruct the nasal side and the second is a myomucosal flap from the inner surface of the superior lip to reconstruct the oral side. Follow up was carried out for 12 months.

RESULTS

The fistulas were completely closed in 30 cases (91%) and partially closed in 3 cases (9%) due to necrosis of the tip of the flap.

CONCLUSIONS

Closure of anterior palatal fistula by the use of superior lip myomucosal flap is a useful method with high success rate and no morbidity.

The stable status evaluation for female breast implant surgery by calculating related physics parameters

Cosmetic doctor utilizes the position, size and shapes of female's breast to judge whether the breast is under steady-state condition after breast implant plastic surgery. Since, doctor evaluates the breast condition with the subjective discrimination (such as vision, sense of touch) without using the objective physical parameters auxiliary. This study uses the 3D optics scanner editing 3D image to obtain full-scale 3D female breasts image. The CAD system converts the breast position, size and shapes, as the length of the curve between UBL (upper breast line) and NBL (nipple base line), the length of the curve between NBL and LBL (lower breast line), breast volume and breasts congruence rate. The stability after the breast implant plastic surgery is one of the important successful indexes of plastic surgery, so with the continuity analysis the breast curve length, volume and congruence rate can let the doctor really grasp the stability of the breast after plastic surgery.

Tissue-toxic effects of phosphatidylcholine/deoxycholate after subcutaneous injection for fat dissolution in rats and a human volunteer

BACKGROUND

The safety of the lipodissolution procedure for the cosmetic treatment of fat is unknown.

OBJECTIVES

The objective was to determine the subcutaneous tissue effects of phosphatidylcholine solubilized with deoxycholate (PC/DC) in rats and a human volunteer.

METHODS

Rats were treated subcutaneously three times with 50, 300, or 600 microL of PC/DC formula on the abdomen in a chronic study (30 days). A human volunteer undergoing elective liposuction was similarly treated. Cell membrane lysis, cell viability, and histologic status were determined on fresh biopsies of subcutaneous fat from the injection sites.

RESULTS

PC/DC dose-dependently reduced membrane integrity and cell viability. Histologic alterations induced by PC/DC included fibroplasia, bandlike fibrosis in the region of the cutaneous muscle, and partial muscle loss. The highest dose caused widespread fat necrosis, fat cyst formation, and necrotic changes of the walls of small blood vessels. Histologic sections of subcutaneous tissue from the human volunteer showed dose-dependent panniculitis, fat cysts, and vessel necrosis. DC (2.5%), tested for comparison in the rat, exerted membrane and histologic effects similar to those of PC/DC. Solvent controls caused negligible alterations.

CONCLUSIONS

Injection lipolysis with PC/DC causes tissue fibrosis and necrosis of adipose and vascular tissues in rat and man, making the long-term safety of PC/DC for nonsurgical treatment of subcutaneous fat deposits uncertain.

Soft tissue defects of the heel: a surgical reconstruction algorithm based on a retrospective cohort study

The hindfoot is a special anatomical location, requiring unique forms of reconstruction of the thick, durable heel pad, the underlying calcaneus, and the Achilles tendon and its thin, pliable soft tissue envelope. Perhaps more than in any other region of the foot, the heel poses a reconstructive challenge to the surgeon who must consider both form and function when repairing wounds in this location. There are many possible reconstructive options, including local, distant, and free flaps. These flaps could be of muscular, myocutaneous or fasciocutaneous tissues. We reconstructed heel defects in 46 consecutive patients using several reconstructive options, and reviewed the results. Patients were classified according to preoperative demographic variables, including size, depth, site, etiology, age, vascularity, sensation, Achilles tendon condition, bone exposure or bone loss, and the patient's functional needs. Neither partial nor total flap losses were observed; the reconstructions were evaluated and considered satisfactory both by surgeons and patients if they fulfilled certain criteria, namely complete coverage, durability upon weight bearing and walking, sensation, donor site morbidity, and cosmetic appearance. No recurrences of the defects were observed during the follow-up period. Heel reconstruction is a challenging task for foot and ankle reconstructive surgeons. Every step should be taken to avoid recurrences and ulcerations. In this article we present a surgical reconstruction algorithm that may allow easy and reliable decision making based on the preoperative assessment of the defect and other clinical features.

LEVEL OF CLINICAL EVIDENCE

2.

Radial artery coursing behind the biceps brachii tendon: significance for the transradial catheterization and a clinically oriented classification of the radial artery variations

In routine clinical practice the variations of the radial artery are the main reason for technical failure during transradial catheterization. If these variations are well documented, however, they do not represent a problem in the transradial approach. Therefore, we report here a rare case of the radial artery which is very strange but potentially valuable for the clinical practice: it arises at a right angle from the brachial artery and passes behind the biceps brachii tendon. Based on our findings and on an extensive literature review, we propose for the first time a clinically oriented classification of the variations of the radial artery. This classification is related to the catheterization success at the usual access site of the radial artery at the wrist.

Burn injuries and pregnancy

Although burn injuries during pregnancy are considered relatively rare, the exact incidence is not known. Multiple factors influence morbidity and mortality resulting from burn injuries during pregnancy. These factors include the depth and size of the burn, the woman's underlying health and age, and the estimated gestational age of the fetus. Associated inhalation injury and development of other significant secondary complications also influence maternal and fetal outcomes. Successful burn care requires a team approach in which almost every healthcare discipline is represented. Initial care is almost always provided by a specially trained emergency medical team in an out-of-hospital setting. During this phase, the ability of the team to communicate with emergency hospital personnel facilitates appropriate clinical management at the scene. In addition, continued communication regarding the woman's status and responses to treatment allows critical care specialists within the hospital to ensure that necessary personnel and resources are available when the patient arrives. From the time the pregnant woman is admitted to a hospital for additional acute and critical care through the extensive process of rehabilitation from burn injuries, providing care often evokes strong emotions and requires specialized skills to achieve the most positive outcomes.

Injection lipolysis for reduction of saddlebag trochanteric bulges--half-side controlled pilot study

BACKGROUND

Phosphatidylcholine, a lecithin extracted from soybeans can reduce serum cholesterol to some extent. Intravenous use may prevent fat embolism in polytrauma patients. When injected intralesionally in a formulation containing also deoxycholate and ethanol it is supposed to act as "fat burner" to reduce undesired fat deposits; there is little evidence-based scientific support for this indication.

OBJECTIVE

To evaluate the capability of phosphatidylcholine + deoxycholate + ethanol (PPC/DC/E) to reduce body fat with a half-side pilot study for the reduction of saddlebag trochanteric bulges.

METHODS

PPC/DC/E was injected into the right posterior trochanteric areas three times at weeks 0, 3 and 6. Treatment areas and the same regions of the contralateral side as a control were evaluated by sonography. Tape measurements were taken and the thickness of the subcutaneous adipose tissue (SAT) was measured with an optical device (Lipometer) at baseline and at week 8 and week 20 (2 and 14 weeks after completing therapy).

RESULTS

In this half-side trial, no significant reduction of subcutaneous fat was achieved after three treatments with PPC/DC/E when compared to the untreated side.Transient inflammatory reactions occurred in all patients.

LIMITATIONS

Only the commercially available formulation containing the three components was tested.

CONCLUSION

The off-label use of PPC/DC/E as a "fat burner" did not produce measurable reduction of undesired trochanteric fat deposits.

Giant cutaneous horn in an African woman: a case report

Introduction

A cutaneous horn is a conical projection of hyperkeratotic epidermis. Though grossly resembling an animal horn, it lacks a bony core. These lesions have been well described in Caucasian patients, as well as in a number of Arabic and Asian patients.

Case presentation

A young female presented with a large 'horn' of five-year duration, arising from a burn scar. Excision and scalp reconstruction were performed. Histology was reported as verrucoid epidermal hyperplasia with cutaneous horn.

Conclusion

This may be the first documentation of this lesion in a black African. Although likely rare, it should be considered in the differential diagnosis of dermatologic lesions. Up to 40% of cutaneous horns occur as part of a premalignant or malignant lesion, and surgical extirpation with histological examination is thus more important than the curiosity surrounding these lesions.

Commissuroplasty for macrostomia

Macrostomia is a rare facial malformation caused by failure of mesodermal migration merging to obliterate the embryonic grooves between the maxillary and mandibular processes during the early phase of gestation. This kind of malformation may require the use of several surgical techniques to repair the facial structure. Bibliographic studies concerning the repair of this malformation are focused on the description of mucosa, muscle, and skin flaps disconnected between them. This article presents a description of a unique myomucosal flap from vermillion for the correction of the existing malformation in the oral commissure.

Head and Neck Keloid: Treatment by Core Excision and Delayed Intralesional Injection of Steroid

PURPOSE

This report aims to describe a technique used by the author for the management of head and neck keloid.

PATIENTS AND METHODS

This is a clinical review of patients presenting with new and recurrent keloid of the head and neck to the Maxillofacial Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. The surgical technique involved the intralesional excision of the bulk of the keloid. Primary closure of the ensuring defect was achieved at operation. At the time of suture removal between 10 and 14 days postoperative, 40 mg triamcinolone was injected into the residual lesion. The injection was repeated on 2 more occasions at monthly intervals. All patients were followed up for at least 2 years.

RESULTS

Eighteen patients were successfully treated with no sign of recurrence in any of them. The main complication was hypo-pigmentation at the site of the original lesion.

CONCLUSION

The technique was found to be effective for the treatment of moderately sized new and recurrent keloid scars of the head and neck and is therefore recommended.

Congenital Malformations of the Oral Cavity

Congenital malformations of the oral cavity may involve the lips, jaws, hard palate, floor of mouth, and anterior two thirds of the tongue. These malformations may be the product of errors in embryogenesis or the result of intrauterine events disturbing embryonic and fetal growth. This article begins with a review of the pertinent embryologic development of these structures. After reviewing the normal embryology, specific malformations are described. Recommended management follows the brief description of each malformation. An attempt is made to point out where these malformations deviate from normal development. Finally, management recommendations are based on traditional methods and recent advances described in the literature.

A rare anatomic variant: the lateral position of the external carotid artery

During educational dissections a rare anatomic variant was encountered at the level of the right carotid triangle of a human adult male specimen. The variant was unilateral. On that side the common carotid artery bifurcated slightly above the level of the upper border of the thyroid cartilage, but the external carotid artery was posterolateral to the internal carotid artery and the anterior branches of the external carotid artery (superior thyroid, lingual and facial arteries) initially crossed over the internal carotid artery before continuing with a normal anatomical course. The possibility of an inversed disposition of the internal and external carotid arteries must be held in mind when performing arterial ligatures in the carotid triangle, to avoid damage to the internal carotid artery or haemorrhagic accidents.