A different strategy in the surgical treatment of capsular contracture: leave capsule intact.

The authors present their experience with the surgical treatment of capsular contracture to achieve better results in a safe, predictable, and practical way, and discuss the possible treatment modalities. They simply advise leaving the capsule intact, even if it is calcified, and create another pocket, rarely in the front or, more typically, at the back of the capsule. If the breast tissue is also ptotic, a mastopexy procedure may be added to the procedure, in addition to augmentation, with a rather small prosthesis placed in the new pocket or, occasionally, in the old one. External, forceable massage is not advisable to treat the capsule. Open capsulotomy and/or partial capsulectomy can be applied to release the capsule. However, it is not advisable since recurrence is usually inevitable. The purpose of this paper is to present a series of surgical procedures to avoid the problems created by the capsule and present different cases with good results.

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple.

A method of repair is described for correction of abnormally enlarged nipple-areola complex following both periareolar mastopexy and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control the enlargement of nipple-areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast, especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy or reduction mammoplasty cases resulting in enlarged nipple-areola complexes, the size of the areola can also be corrected by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision, the shape of the breast is more acceptable and the size of the areola does not enlarge with time.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face.

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Vascularized double-sided preputial island flap with W flap glanuloplasty for hypospadias repair.

Hypospadias surgery is one of the most challenging surgical interventions that still need further refinements for increased success rates. During the last 5 years, we operated on 26 mid-penile or proximal hypospadias cases by using vascularized double-sided preputial island flap and W flap glanuloplasty to achieve superior functional and aesthetic results. Follow-up period of the patients revealed a 92.3 percent success rate with a single operation. Two cases developed fistula, which was located at the proximal anastomosis site. However, they were repaired in a second sitting without any additional problem. The basic aim in hypospadias surgery is the correction of chordee, reconstruction of urethra, and sufficient ventral penile skin coverage in one stage with minimal complication. The use of vascularized tissue for urethral reconstruction and ventral coverage is believed to have a superior healing capacity with better functional and cosmetic outcome. On the other hand, adding W flap glanuloplasty to this technique avoids the risk of meatal stenosis. We conclude that by combining the two above-mentioned techniques, it is possible to cope better with this devastating congenital deformity.

Delayed effect of denervation on wound contraction in rat skin.

Neuronal supply in soft tissues may be an important part of cutaneous wound healing. In order to observe the effect of denervation on wound contraction, rectangular full-thickness skin defects were created on the dorsum of two groups of Wistar rats. In the experimental group (n = 20), spinal nerves corresponding to the area of the open wound (T11 to L2) were isolated and divided bilaterally. In the control group (n = 20), the same pairs of spinal nerves were dissected but left intact. Limits of denervation were verified by the pinprick test. Wound healing, which is primarily in the form of wound contraction in this model, was evaluated by tracing wound margins onto millimetric paper weekly. Wound contraction was delayed significantly in the experimental group (p < 0.05) at all follow-up periods when compared with the controls. Loss of neuropeptide secretion from the nerve endings in denervated tissues may be responsible for the retarded wound contraction, since neuropeptides are thought to exert trophic effects on skin wound healing.

Vulva reconstruction with a tissue expander.

A patient with exstrophy of the bladder in whom we performed vulva reconstruction using a tissue-expansion technique and local flaps was presented. The ultimate result was in concert with the anatomic characteristics of normal external genitalia with regard to type of skin, pigmentation, hair pattern, quality of circulation, and sensory supply.

Facial resurfacing in xeroderma pigmentosum with monoblock full-thickness skin graft.

A case of xeroderma pigmentosum with multiple skin tumors on the face that was treated with total excision and replacement of face skin except the eyelids with a monoblock full-thickness abdominal skin graft is reported. The quality and tumor-free features of the monoblock full-thickness skin graft in xeroderma pigmentosum are indicated. Despite the increased morbidity of the donor region, the radical surgical approach advocated here has improved the prognosis in the case reported.

A twelve year experience with reduction mammoplasty and abdominoplasty.

In the last 12 years we performed mammoplasty on 191 patients, using the Wise pattern and the Strömbeck technique. In the same 12-year period, we also performed abdominoplasty in 108 patients, using the Pitanguy and the Grazer procedures. In the last four years we performed suction lipectomy in 43 patients, using the Illouz technique. In this article we present our moderate modifications on these techniques and the complications.

A ten-year experience with reduction mammoplasty and abdominoplasty. What is happening in our part of the world?

The authors update their experience with 124 reduction mammoplasties (including mastopexy) and 67 abdominoplasties and discuss their applications of these procedures in Turkey. In almost all cases the Strömbeck procedure for mammoplasty and the Grazer and Pitanguy procedures for abdominoplasty were used. They present problems encountered in performing such operations and their solutions.

Urethral advancement for distal hypospadias repair in circumcised patients.

A new hypospadias repair technique is presented for distal cases. It is a modified form of the old Beck-Hacker technique and applicable only for distal hypospadias patients with minimal or no chordee. It consists of bringing the abnormally localized meatus to the tip of the glans penis by freeing and advancing the distal urethra. Thirty cases were operated on with this technique in the past 2 1/2 years with better results. The advantages of this simple technique can be summarized as follows: (1) it is easy to apply; (2) it can be applied to circumcised patients; (3) it can be done under local anesthesia even in the office; (4) the total length of the urethra is normal in its mucous membrane; (5) stricture formation is minimized by this solo glandular triangular flap; (6) ther is no need for a catheter; and (7) patients urinate freely during the healing process.