Acellular dermal matrix and bone cement sandwich technique for chest wall reconstruction

The authors performed rigid reconstruction using the sandwich technique for full-thickness chest wall defects by using two layers of acellular dermal matrix and bone cement. We assessed six patients who underwent chest wall reconstruction. Reconstruction was performed by sandwiching bone cement between two layers of acellular dermal matrix. In all patients, there was no defect of the overlying soft tissue, and primary closure was performed for external wounds. The average follow-up period was 4 years (range, 2–8 years). No major complications were noted. The sandwich technique can serve as an efficient and safe option for chest wall reconstruction.

Treatment of chronic bronchopleural fistula and recurrent empyema using a latissimus dorsi myocutaneous flap: a case report and literature review

Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.

Treatment of chronic bronchopleural fistula and recurrent empyema using a latissimus dorsi myocutaneous flap: a case report and literature review

Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.

Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

Reduction mammoplasty is a popular operation worldwide. Early complications include bleeding, wound dehiscence, and nipple-areolar complex (NAC) ischemia. Although uncommon, NAC ischemia can lead to necrosis of the NAC. NAC congestion is usually recognized intraoperatively or within a few hours of the operation. A 21-year-old woman with severe macromastia received bilateral reduction mammoplasty using a Wise-pattern reduction with a superomedial pedicle. NAC congestion of the left breast was identified 40 hours after the operation. Delayed venous congestion of the NAC after reduction mammoplasty has not been previously reported; in this case, delayed congestion may have been caused by partial venous obstruction aggravated by the progression of tissue edema near the pedicle. Through use of the delayed suture technique, application of nitroglycerin cream, intravenous administration of prostaglandin E1, and use of a portable negative-pressure wound therapy device, the patient’s NAC was salvaged with satisfactory nipple projection and minimal scarring.

BellaGel breast implant: 6-Year results of a prospective cohort study

Background@#This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. @*Methods@#This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. @*Results@#At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. @*Conclusions@#The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.

Finite element analysis of long-term changes of the breast after augmentation mammoplasty: Implications for implant design

The development of breast implant technology continues to evolve over time, but changes in breast shape after implantation have not been fully elucidated. Thus, we performed computerized finite element analysis in order to better understand the trajectory of changes and stress variation after breast implantation. The finite element analysis of changes in breast shape involved two components: a static analysis of the position where the implant is inserted, and a dynamic analysis of the downward pressure applied in the direction of gravity during physical activity. Through this finite element analysis, in terms of extrinsic changes, it was found that the dimensions of the breast implant and the position of the top-point did not directly correspond to the trajectory of changes in the breast after implantation. In addition, in terms of internal changes, static and dynamic analysis showed that implants with a lower top-point led to an increased amount of stress applied to the lower thorax. The maximum stress values were 1.6 to 2 times larger in the dynamic analysis than in the static analysis. This finding has important implications for plastic surgeons who are concerned with long-term changes or side effects, such as bottoming-out, after anatomic implant placement.

Detergent Solution-induced Alkaline Burn of Hand: A Case Report and Review of Literature

We present an interesting case of arbitrary chemical burn resulting from exposure to an undiluted detergent solution as a folk remedy. A 59-year-old woman came to the emergency department presenting chemical burn on her hand. She was affected by housewife's eczema on her left hand and wanted to cure the lesion. So three days before she came to hospital, she had put her hand into an undiluted detergent solution for an hour as a folk remedy for eczema. The patient was treated with foam dressing while the wound was demarcated. After three weeks, she underwent full-thickness skin graft on her 4(th) finger only. On postoperative day 14, the grafted skin was well-taken and on postoperative day 32, the wound was healed completely with a nail growth. Dish detergent solution has been widely used in kitchen but there is no documented report of chemical burn resulting from a detergent solution. When this patient came to our hospital at first time, the wound was so inflammatory and partial necrosis was combined. So we waited for demarcation preparing even for amputation. But with application of appropriate foam dressing, the patient was healed well and required only partial skin graft. We may encounter the patients suffer from the chemical burns due to usual detergent sometimes. But we do not need to perform surgical treatment immediately. Instead, appropriate dressing will be helpful to minimize operation range.

Neobladder-vaginal Fistula Repair with Modified Martius Bulbocavernosus Fat Pad Flap

PURPOSE: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. METHODS: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. RESULTS: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. CONCLUSION: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.

Small Bowel Strangulation after Free TRAM Breast Reconstruction in Post-hysterectomy Patient: A Case Report

PURPOSE: The rectus abdominis myocutaneous flap is currently the most commonly used donor site of immediate and delayed breast reconstruction surgery, for its versatility and ease of handling, as well as sufficient blood supply. Despite many advantages of rectus abdominis flap, morbidity of donor site is considered as inevitable shortcoming. The authors recently faced a devastating complication, small bowel obstruction that led to strangulation, after delayed breast reconstruction with free transverses rectus abdominis myocutaneous (TRAM) flap. And we would like to report it, because abdominal pain after TRAM flap is a common symptom and can be overlooked easily. METHODS: A 56-year-old female patient who had history of receiving total abdominal hysterectomy 20 years ago underwent delayed breast reconstruction with TRAM flap transfer. She complained abdominal discomfort and pain from third postoperative day, postoperative small bowel obstruction that arose from strangulated bowel and prompt emergency operation was done. RESULTS: After resection of the strangulated bowel and reanastomosis, quickly her symptoms were relieved, and there were no further problems during her hospital stay. 7 days after her emergency operation she was discharged. CONCLUSION: In patients with previous abdominal surgical history, prolonged ileus can lead to bowel strangulation, so surgeons should always consider the possibility, and must be aware of abdominal symptoms in patients who receive free TRAM flap operations.