Aumento de pantorrillas con implantes subfascial

Objetivo: El objetivo del presente estudio es analizar las cirugías de aumento de pantorrillas realizadas por el autor principal describiendo características clínicas de los pacientes, tipos de implantes utilizados y detalles de la técnica quirúrgica con bolsillo subfascial. Material y Método: Estudio de tipo observacional retrospectivo de una serie de 19 pacientes que se realizaron aumento de pantorrilla bilateral por motivos estéticos en una clínica privada en el periodo 2009-2018. Resultados: Todos los pacientes consultaron por piernas delgadas de carácter estético y se les realizó aumento gemelar interno con implantes bilaterales subfascial. En 78% de los casos se utilizó implante de base simétrica y 22% implante de base asimétrica. Hubo 2 complicaciones menores. Discusión: Es necesario contar con mayor variedad de implantes que combinen diferentes medidas de longitud, ancho y proyección que se adecuen a las variables anatomías particulares de cada paciente. Conclusiones: La técnica de implantes de silicona en bolsillo subfascial es satisfactoria con pocas complicaciones. Su éxito depende del correcto balance entre bolsillo e implante. Debería existir mayor variedad de implantes ajustables para cada paciente.

Objective: The objective of the present study is to analyze the calf augmentation surgeries performed by the main author, describing patients' clinical characteristics, types of implants used and details of the surgical technique with subfascial pocket. Materials and Method: A retrospective observational study of a series of 19 patients who underwent bilateral calf augmentation for cosmetic reasons in a private clinic in the period 2009-2018. Results: All patients consulted for slim cosmetic legs, an internal calf augmentation was performed with bilateral implants. In 78% of cases, a symmetrical based implant was used and 22% asymmetric based implant. There were 2 minor complications. Discussion: It is necessary to have a greater variety of implants that combine different measures of length, width and projection that are adapted to the variable anatomies of each patient. Conclusions: Subfascial pocket silicone implant technique is satisfactory with good results and few complications. Its success depends on the correct balance between pocket and implant. It seems that there is not yet a variety of adjustable implants for each patient on the market.

Frontal augmentation as an adjunct to orthognathic or facial contouring surgery / 대한악안면성형재건외과학회지

BACKGROUND: The dimensions and shape of the forehead determine the esthetics of the upper third of the face. Korean young people consider a broad and smooth, rounded forehead more attractive. As a result, frontal augmentation becomes more popular in patients with dentofacial deformities. Various surgical procedures and materials have been used in frontal augmentation surgery, with associated advantages and disadvantages. Silicone is a good candidate for frontal augmentation. The author presents two cases of esthetic frontal augmentation with a prefabricated silicone implant in female patients with dentofacial deformities. CASE PRESENTATION: In case 1, a 24-year-old female patient underwent frontal augmentation surgery with simultaneous maxillomandibular and zygomatic osteotomies to correct facial asymmetry. A silicone implant was fabricated preoperatively using a positive template stone mold of her forehead. In case 2, a 23-year-old female patient underwent total facial contouring surgery including frontal augmentation for improved facial esthetics. A computed tomography (CT)-guided rapid prototype (RP) model was used to make the silicone implants. The operative procedure was safe and simple, and the silicone implants were reliable for a larger degree of frontal augmentation. Six months later, both patients had recovered from the surgery and were satisfied with their frontal shape and projection. CONCLUSIONS: Frontal augmentation with silicone implants can be an effective adjuvant strategy to improve facial esthetics in patients with a flat and narrow forehead who undergo orthognathic reconstruction or total facial contouring surgery.

Medialization thyroplasty using a pocket and silicone implant technique

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To describe a new method of medialization thyroplasty using a modified preformed nasal silicone implant.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Surgical Innovation<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Participants:</strong> Four patients underwent medialization thyroplasty using a pocket and nasal implant technique performed by the senior co-author. The indication for medialization thyroplasty for these patients was hoarseness secondary to unilateral vocal fold paralysis of more than 6 months duration, and documented by flexible fiberoptic laryngoscopy. The outcomes were described with comparison of pre- and post-operative subjective voice assessment. <br /><strong>RESULTS:</strong> Operative time was 15-30 minutes. Postoperative subjective improvement of voice quality was evident. Scars were minimal and aesthetically acceptable. The procedure could be done on an outpatient basis.<br /><strong>CONCLUSION:</strong> Medialization thyroplasty via a pocket and silicone implant technique is initially effective and may be a worthwhile alternative to the usual window technique.</p>

Preservation of Exposed Breast Implant for Immediate Breast Reconstruction

PURPOSE: Common complications of immediate breast reconstruction with implant are capsular contracture, malposition of implant, hematoma and seroma. Especially, the most severe complication is implant exposure caused by inflammation or necrosis of skin flap margin of mastectomy site. This article reports the experience of cases of salvage in such an exposure of implant. METHODS: From July, 2002 to Feb., 2009, sixty-five patients who underwent immediate breast reconstruction with implant were retrospectively analyzed. Exposure of implant was happened in 5 of 65 patients and they were treated at out patient district. Two of five patients were reconstructed with saline implnt and all of them underwent the enveloping of the implant with AlloDerm(R) and Serratus muscle flap. Remaning three patients were reconstructed with silicone implant and all of them underwent the enveloping of the implant with AlloDerm(R). RESULTS: In the group of patients who underwent reconstruction with saline implant, implant exposure was found in one patient due to partial necrosis of the margin of skin flap and debridement and primary repair were done. In the other one patient, dressing with antibiotic ointment were done. And debridement and primary repair were proceeded. In the group of patients who underwent reconstruction with silicone implant, implant exposure was found in one patient. After removal of the implant, tissue expansion was done and a new silicone implant was inserted. Implant exposure were found in the other two patients, antibiotics ointment application and primarily repaired. CONCLUSION: It was the common knowledge that the exposed implant should be removed. But salvage of the exposed implants may be possible with proper treatment. Four of five patients (80%) with exposed breast implant were salvaged with conservative management.

Conjunctival Expansion Using a Subtenon's Silicone Implant in New Zealand White Rabbits

PURPOSE: In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant. MATERIALS AND METHODS: We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes. RESULTS: The mean size of the expanded conjunctival tissues was 194.4mm(2). On the third day, we were able to harvest a 223.56mm(2) section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38mm(2) section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues. CONCLUSION: The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.

Correction of the Dorsal Contour Deformity Caused by Scoliosis with Silicone Implant

PURPOSE: Scoliosis is a multifactorial disorder caused by genetic, biochemical, developmental, neuromuscular factors and causes complex deformities which include skeletal deformity, pain, cardiovascular dysfunction, motor function disorder. Until now, the treatment of scoliosis have been focused on orthopedic correction, preservation of cardiopulmonary and neurologic function. But recently, as aesthetic demands increases, the needs for the correction or improvement of the trunk and extremity contour does. So, the correction of soft tissue contour deformity can be a new concept for the treatment of scoliosis. METHODS: We corrected a deformed contour with prefabricated silicone implant in a scoliosis patient who had been operated for orthopedic correction previously. Submuscular pocket was made under trapezius and latissimus dorsi muscle. Silicone implant was placed in the pocket and fixed to thoracolumbar fascia with sutures. RESULTS: We had a satisfactory results for the correction of contour deformity. There was no significant complication. CONCLUSION: Silicone implant is a new trial for the correction of scoliosis contour deformity. This method is simple, safe and brings on satisfactory results.

The Infection after Augmentation Rhinoplasty Using Silicone Implant

Augmentation rhinoplasty using silicone implant is one of the most common cosmetic procedures in Korea, but is not without several complications such as exposure of the implant, its deviation and deformity. Above all, infection and extrusion through the skin is most serious complication. The purpose of this study was to determine the type of microbial colonization on silicone implant removed from symptomatic patients and to prevent from the infection. Over the past 11 years, from February of 1996 to February of 2007, we have done 134 aesthetic rhinoplasties using silicone implant in our clinic, patient ages ranged from 15 to 62 years with an average of 29.2 years. 78 percent of patients (105) were female, and 22 percent (29) were male. Among them, four cases had the local infection. The infection rate was 2.9 percent. Total six cases of implant including the other two case augmented elsewhere having the infection were removed and submitted for Gram stain, standard aerobic and anaerobic bacterial culture, and fungal cultures. Staphylococcus aureus was isolated most frequently (four cases), followed by Pseudomonas aeruginosa (one case) and Proteus mirabilis (one case). No fungal infections were identified. In order to reduce the infection rates after augmentation rhinoplasty using silicone implant, rhinorrhea as a source of bacterial nutrients should thoroughly be managed perioperatively. The hairs of the nostril should appropriately be shaved, and the patient's entire face and internal nares meticulously prepared. The implant should be shaped to be shorter, smaller and thinner, appropriately to the patient's nasal phenotype. Also, subperiosteal implantation rather than subcutaneous or subfascial is better choice.

Reconstrucción mamaria post-mastectomía con colgajo miocútaneo de latísimo dorsal más prótesis de silicón / Post-mastectomy breast reconstruction with flap miocutaneo of latisimo dorsal more protesis of silicion

La glándula mamaria es una parte importante de la morfología femenina y su desarrollo constituye una de las características más destacadas de la diferenciación sexual. Cada día aumenta el número de pacientes sometidas a mastectomía por un diagnóstico cada vez más temprano de cáncer de mama y aunque el porcentaje es bajo, ahora son más las pacientes que deciden optar por el procedimiento, incrementándose nuestra experiencia en la técnica practicada en el Servicio de Cirugía Plástica y Unidad Nacional de Quemados del Hospital San Juan de Dios, con un agresivo programa de reconstrucción mamaria, específicamente con el colgajo músculo-cutáneo de Latísimo Dorsal, dorsal ancho, y prótesis de silicón. Hubo 78 pacientes que se sometieron a reconstrucción mamaria con la técnica de colgajo músculo-cutáneo de dorsal ancho, más prótesis de silicón. Estos casos fueron aportados por los médicos del servicio, las pacientes mismas y posteriormente, en su gran mayoría por la CCSS, la cual asumió el programa en su totalidad. Todas las prótesis fueron rellenas con silicón cohesivo o altamente cohesivo y de perfil alto o muy alto. Se reconstruyeron 78 mamas entre enero de 1999 y julio del 2003, por la técnica acá descrita en igual número de pacientes, quienes habían sido sometidas a mastectomía a causa de cáncer del seno...

The female breast is an important part of the woman and its development is one of the most remarkable characteristics on the sex differential. Every day more patients are mastectomized due to a good and early diagnosis of breast cancer. Eventhough the percentage is low, there are more patients looking for a breast reconstruction. This situation increment the experience of the plastic surgery department and the national burn unit of the Hospital San Juan de Dios, with a very aggressive program of breast reconstruction,specifically, using the technic of the Latissimus Dorsi Moycutaneos Flap and Silastic Gell Filled rosthesis. A total of 78 patients underwent breast reconstruction with the Latissimus Dorsi Flap and Silastic Gel Filled Prosthesis. The staff physician performed all of these and all the patients are from the Caja Costarricense de Seguro Social (CCSS). All of the 78 patients underwent breast reconstruction with the method described here between january of 1999 and july 2003. The medium age was 48.55 years. The surgical time was about 2 hours with 30 minutes in the patients were discharged in the first 24 hours in the 95% of the cases. The mastectomy affected the couple relationship; more than 50% of the woman lost her partner. No evidence of cancer recurrence was found on the chest wall. Patients and physicians are very satisfied with the reconstruction technic. The results and our experience are increasing every year. In our country breast cancer is early diagnosed, treated and reconstruction is following mastectomy. The prime interest of plastic surgeons is to developed a good program for reconstruction eventhough only 10% resort to this operation. We are sure that in the near future more patients will undergo this procedure (breast reconstruction) due to our excellent results, and for the anatomical and personal satisfaction obtained y the patient.

Augmentation Rhinoplasty Minimizing Change of Nasion Level: A Simple Method

Nasions are flat and located more caudally in Asian than in Caucasian. Implant insertions in rhinoplasties are apt to move nasions more cephallic, which can cause unsatisfactory results in Asian. The purpose of this study is introducing a simple technique in rhinoplasty avoiding unnatural nasion in augmentation rhinoplasty in Asian patients. Multiple radiating incisions were made at nasion level on inner side of silicone implant to fit it into the curvature around the nasion. Between October 2001 and October 2003, 27 patients underwent augmentation rhinoplasties using this technique and results were evaluated. Preoperative and postoperative photographs of patients were used to measure the levels of nasion from medial canthus. The mean nasion level from medial canthus of preopertive patients were 3.46+/-0.87 mm and postoprative patient was 4.98+/-0.96 mm. The mean difference between preoperative nasion level and postoperative nasion level was 1.52 mm. There was no complication such as extrusion, displacement or infection. This technique of radiating incisions on inner side of the silicon implant can minimize cephalic migration of the nasion level in augmentation rhinoplasty in Asian.

Large Intraorbital Cyst after Silicone Implant Insertion : A Case Report

PURPOSE: Alloplastic implants, such as methylmethacrylate, Teflon, silicone, Supramid are commonly used to cover the floor defect and to prevent reherniation of the displaced orbital tissue in orbital floor fracture. Silicone implant has been used for reconstruction of orbital wall defects because of pliability, advantage of carving and chemically inert nature. However, silicone implant also has complications including infection, extrusion, pain, dystopia and tissue reaction. Cyst formation around the silicone implant is a very rare complication. According to many reports, cysts around alloplastic implant in an orbital area are mostly hemorrhagic cysts consisted of blood breakdown product with fibrous capsule cell in histologic examination. METHODS: The authors report atypical case and successful treatment of intraorbital hemorrhagic cyst around silicone implant of a 37-year-old male patient. RESULTS: Preoperative symptoms of diplopia, exophthalmos, proptosis, vertical dystopia and ectropion of lower eyelid were resolved after surgical removal of implants with surrounding capsule. CONCLUSION: Clinical suspicion of plastic surgeon is important in diagnosis of intraorbital cyst of patients who have history of silicone implantation and computed tomography is the standard tool of diagnosis. During the operation, caution must be taken on delivering the whole capsule of intraorbital cyst along with silicone implant to prevent recurrence of the cyst.

Clinical Experience of Hyperfibrosis Occurred after Silicone Implant Insertion

Facial depression is not rare conditions caused by soft tissue loss or bone distortion. In such conditions, autogenous bone, cartilage and bioacceptible materials are used for soft tissue augmentation. De Nicola used silicone rubber implant first in 1950. That after, silicone implants are used for bone defect and soft tissue augmentation. We experienced 31-year-old male patient who injured open depressed fracture of right temporal bone. He was operated with autogenous bone graft for bone defect area and silicone implants for soft tissue augmentation. After about 6 years later, mass palpated in right temporal area. There was no inflammatory sign in physical examination and CT finding. So we removed hyperfibrotic tissue totally with previous inserted silicone implants and augmented soft tissue with pored Medpor(R) block. In light microscopic findings, only tissue hyperfibrosis were proved without inflammatory cell, such as giant cell or ephithelioid cell.

Surgical Correction of Cleft Lip and Nose Deformity Associated with Augmentation Rhinoplasty Using Silicone Implant

The correction of secondary cleft lip and nose deformity often presents an extremely difficult plastic surgical problem. The deformity is a complex, three dimensional alteration in nasal anatomy with defects in all tissue layers : skin, cartilage, vestibular lining and bone. The patient who has these kinds of deformities undergoes the aggravation of deformities, as the patient grows older. And the decreased length of maxilla is accompanied by the deficiency of posterior development. As a result, the depression of nose and midface is usually developed and especially the depression of nose is severely noted in an oriental. To correct this secondary cleft lip nose deformity in Oriental patients, alar cartilge mobilization and suspension techniques have been developed. But, these techniques have critical limitations in the suspension vector and power. Oriental people usually have thin alar cartilages and thick skin. So, the suspended, deformed alar cartilage may relapse and pull the normal alar cartilage to the deformed side. To overcome these limitations, we have carried out the augmentation rhinoplasty using a silicone implant with Tajima's inverted U incision and interdomal suturing at the same time, which is inexpensive and easily handled, to twelve patients of secondary cleft lip and nose deformity for recent 2 years. The results were considerably satisfactory, so we report this paper and then can ascertain the further aesthetic benefits, such as the postoperative augmentation of a nose, finer nasal tip and the symmetry of both nostrils.

Endoscopic Transaxillary Silicone Implant Insertion for the Aesthetic Correction of Pectus Excavatum

Scars on anterior chest after operative correction of funnel chest have been the challenging problem despite introduction of refined techiniques by numerous authors. From December 1996 to September 1998, the authors have performed prefabricated silicone implant insertion in eight female patients presenting funnel chest, using transaxillary approaches instead of substernal or inframammary incisions. In two of eight patients, augmentation mammaplasty was performed simultaneously. Except one case of seroma occurred in early stages, all eight cases of pectus excavatum were satisfactorily reconstructed by this technique. All eight patients expressed their satisfaction with the results during the follow-up visits made between 3 months and 3 years. In conclusion, endoscopic transaxillary approach for the scarless anterior chest can be useful technique in aesthetic correction of the funnel chest.