use of progressive tension sutures in abdominoplasty for fewer complications and a speedy recovery

Abdominoplasty is one of the commonest plastic surgery procedures done worldwide, however, it is plagued by a number of local complications including; hematoma and seroma formation, flap necrosis and hypertrophic scars. To avoid these complications, suction drainage and limitation of postoperative ambulation are widely used by most surgeons. The use of progressive tension sutures [PTS] has been introduced in plastic surgery in various operations to ease the advancement of various skin flaps. The basic concept of their use in abdominoplasty is to control redrapping of the abdominal flap eliminating dead space and nullifying the need for drains. It also avoids tension on the terminal suture lines by dividing flap tension over many successive points thus minimizing the possibility of flap edge necrosis and allowing early postoperative ambulation. Progressive tension sutures were used in 15 cases. No drains were used and early ambulation was allowed in all cases. The incidence of complications was very low [0. 13%], minimal seroma was encountered in one case [6.65%] and was managed conservatively and superficial flap necrosis in another case [6.65%] which was managed by repeated dressings. The average duration of operation was 2.4 hours and the average postoperative hospital stay was 2.6 days. These results suggest that the use of progressive tension sutures in abdominoplasty reduces the risk of local complications, ease the early postoperative period without adding significant operative time or hospital stay

Postpartum involutional hypomastia: management by augmentation mammaplasty with submuscular textured saline-filled implants

One of the most common indications for augmentation mammaplasty is postpartum involutional hypomastia, with or without a varying degree of ptosis. The goal is to achieve a good and lasting aesthetically pleasing result, to preserve nipple sensation, and to avoid the most distressing and difficult to remedy complication capsular contracture around the implant, To achieve these goals, several factors should be taken into consideration; the biochemical nature of the implant, the surface of implant envelope, the plane of implantation, the use of povidone-iodine irrigation, the use of postoperative compression and the prevention of early hematoma formation and infection. 20 cases of postpartum involutional hypomastia were managed by submuscular implantation of textured saline filled implant. The aesthetic result was satisfactory in 95% of cases, Inframammary approach allowed adequate medial pectoral fibre release in 39 sides [97.5%] with only one case needing correction of unilateral implant migration by adhesive strapping. The nipple sensation was preserved in all cases. There were no incidents of capsular contracture or - late implant failure over a 1-year follow up period The results suggest that the use of the submuscular plane, the textured surface and the saline filled nature of the implant greatly minimizes the risk of capsular contracture development and that the use of inframammary approach makes operation easier, allowing adequate pocket dissection and muscle medial release and under vision Hemostasis. it also allows preservation of lateral thoracic nerve responsible for nipple sensation

Intraoperative lymphatic mapping and sentinal node biopsy predicts axillary nodal involvement and avoids negative axillary dissections in [N0] breast cancer

The status of the axillary nodes is the strongest known prognostic variable in patients with breast cancer, and is routineely used in planning postoperative therapy. Conventional axillary dissection is limited by sampling error and potential morbidity With new wide scale regimens of screening and growing consensus of early diagnosis of breast cancer increasing numbers of negative axillary nodal dissections are encountered. Sentinel node biopsy techniques have revolutionized the management of axillary nodes. Accurate identification and focused histologic evaluation of the sentinel node allow accurate prediction of the status of other axillary nodes, thereby avoiding the morbidity and expense of a complete axillay dissection in node negative patients. In 26 cases of breast cancer, SLN intraoperative mapping was done following preoperative subcutaneous dye injection over breast mass. SLN detection success rate was 76.92%. Pathological examination of detected SLN[s] and comparison with the rest of axillary nodes revealed an accuracy rule of 90% in detection of axillury status with negative predictive value of 80%. With further evaluation and growing experience with the technique it can be a useful method to decide when to procced with formal axillary dissection in cases with no clinically detected nodes