Maximizing aesthetic results in huge breast reduction using the inferior pedicle technique

Inferior pedicle reduction mammaplasty technique is a reliable technique used in reduction mammaplasty. This technique includes a well-vascularised dermalparenchymal pedicle for safe nipple-areola transposition, but it has been criticised as resulting in a flat breast with inadequate projection after long-term follow-up. Various techniques in which internal shaping of the pedicle are used have demonstrated decreased secondary ptosis. We used internal shaping sutures for the inferior pedicle flap together with lateral and medial sutures hoping for long lasting aesthetic projection and narrow base for the reduced breast. Evaluation by review of the patient charts, photographic analysis and patient-satisfaction questionnaire has revealed acceptable long term results. Inferior pedicle reduction mammoplasty technique with internal shaping sutures is an easy and uncomplicated modification that provides additional advantages for prevention of the secondary ptosis of the reduced breasts in the long term

Pedicled scalp island flap for successful one stage aesthetic eyebrow reconstruction

The use of scalp flap based on frontal branch of superficial temporal artery is one of the famous known methods of eyebrow reconstruction. But to achieve aesthetic eyebrow appearance it is important not only to have viable scalp flap but also normal width, length together with and more importantly the direction of the hairs and lastly the density of hairs. This study included 18 patients, six patients were males and 12 were females with age ranging from 13 to 50 years. The treated patients had unilateral partial or complete brow loss. Management was done for all patients by following some technical considerations to have aesthetic eyebrow shape. during using the scalp island flap based on one of the branches of superficial temporal artery. All cases were done as one stage operation with satisfactory appearance and survival rate [100%]. There was minimal swelling due to the subcutaneous pedicle in the temporal region which needed between 2-3 weeks to subside in all cases. One case of the post-burn alopecia of eye brows suffered partial flap congestion, which improved by conservative measures. The results were satisfactory as regard the eyebrow measurement [width and length], hair direction, but the hair density was higher than the normal density which was clearly noted in partial cases or unilateral reconstruction. And the hair growth also was noted to be faster than normal [they needed frequent shortening]. Scalp island superficial temporal artery flap is an excellent solution for aesthetic eye brow reconstruction. Perfect match with the undamaged eyebrow in partial loss or unilateral cases can be achieved by following some pre-operative and intraoperative important technical considerations

Repair of parastomal hernia associated with incisional hernia and pendulous abdomen

Parastomal hernia [PSH] represents one of the difficult challenges for the surgeon. The association of incisional hernia [laparocele] and parastomal hernia adds to the novel of the issue especially if the abdomen is pendulous. The aim of this study is to evaluate a surgical treatment plan for such complex situations. Seventeen patients with parastomal hernia around a permanent stoma associated with laparocele and pendulous abdomen were selected for the study. They were 11 males and 6 female with a mean age of 53 +/- 9 years. After preoperative assessment, they were subjected to relocation of the stoma plus reinforcement of the laparocele repair and the old stoma site with onlay proparietal polypropylene mesh together with dermolipectomy. The overall complications were encountered in three patients Wound infection was reported in the 3 cases [17.7%], seroma in 2 [11.8%], minimal flap necrosis in 2 [11.8%] sinus formation in one patient [5.9%] and development of PSH at the new site in two patients 11.8%. The association of parastomal hernia, incisional hernia and pendulous abdomen jeopardizes the patient's quality of life and surgery is often indicated. The repair by relocation and reinforcement with onlay polyproplene mesh together with dermolipectomy represents a good solution in terms of low morbidity and an acceptable final outcome