Preparation of harvested skin using the Versajet Hydrosurgery System in full-thickness skin grafts

During a full-thickness skin graft procedure, the thickness of the harvested donor skin is adjusted based on the location of the recipient site and the judgment of the surgeon. Conventionally, the thickness of the harvested skin is roughly adjusted using surgical instruments such as scalpels and scissors. However, this method is not only time-consuming, but also requires effort to obtain both the desired thickness of the harvested skin and a smooth surface of that skin. Moreover, there is a possibility of skin perforation. Hence, the authors devised a method of adjusting harvested skin thickness using the Versajet Hydrosurgery System. The Versajet device is a handheld hydrosurgical tool that delivers a high-speed jet stream of saline solution, which enables the precise debridement of tissue. This method makes it easier and faster for the surgeon to obtain the desired thickness of harvested skin. In addition, by obtaining a smooth surface and an even thickness of harvested donor skin, this technique may lead to improved graft viability.

Limited retromuscular fibrofatty tissue resection in upper blepharoplasty for senile patients

BACKGROUND: Studies of eyelid anatomy suggest an absence of supratarsal folds and a redundancy of retromuscular tissue in many Asians. Aggressive retromuscular tissue resection during senile blepharoplasty can lead to complications such as hematoma and extra fold formation. A thin fold is considered aesthetically pleasing, but upper eyelid hollowness is undesirable. Therefore, senile blepharoplasty allows relatively little room for retromuscular resection. METHODS: Between January 2016 and March 2019, blepharoplasty without a brow procedure was performed in 48 patients aged 55 years and older. In some patients with thin eyelids, the upper retromuscular tissue was explored, and the surgeon decided intraoperatively whether to perform resection. In total, 36 of 48 patients underwent retromuscular tissue resection, which was confined to the central and lateral aspects of the eyelid within 7–10 mm from the incision in the superior direction to create a crisp, thin fold without hollowness. The skin was closed, with the closure including the levator palpebrae superioris (levator) muscle, to create a weak, natural-looking, and dynamic fold instead of the buried dermo-levator suture typically created during double eyelid surgery. RESULTS: In the 72 eyelids that underwent resection, hematoma or extra fold formation was absent. In all cases, thin folds were achieved without an increase in the hollowness of the upper eyelid. Most patients were satisfied with their natural-looking postoperative appearance. CONCLUSIONS: When indicated, limited retromuscular resection is recommended in cases of senile blepharoplasty. The resection should be confined to the central and the lateral aspects of the eyelid, within 7–10 mm in the superior direction from the incision, to create a crisp thin fold without hollowness.

Treatment of an abscess after massive autologous fat transplantation for breast augmentation with real-time ultrasonography-guided liposuction

Many studies have demonstrated that an autologous fat graft (AFG) can be a successful alternative to prosthetic breast augmentation; however, with the increasing use of this method, there are also increasing reports of complications. We report a case of severe infection after augmentation mammoplasty with a massive AFG. A 23-year-old woman had undergone primary AFG for breast augmentation. The remaining fat was reused for secondary graft 46 days after the primary transplantation. The patient was referred to our hospital with infectious signs on both breasts. Antibiotics were administered according to the bacterial culture result of the abscess aspirated with ultrasonography (US) guidance. During antibiotic treatment, two US-guided abscess aspirations were performed. Although follow-up magnetic resonance imaging demonstrated reduced abscess and fluid collection after aspiration, the skin of the lower pole of the right breast was perforated. We performed liposuction with real-time US guidance for abscess localization. The abscess and necrotic fat tissue were removed through liposuction. Thereafter, the symptoms, signs, and laboratory and radiologic findings demonstrated complete improvement. The patient was successfully treated while maintaining the breast contour through localized abscess removal, with a much smaller liposuction scar than would have resulted from aggressive excision or drainage.