Breast augmentation: A geographical comparison.

OBJECTIVE: To describe and compare physical characteristics and implant details of women undergoing primary cosmetic breast augmentation in different geographical locations. METHODS: Three cohorts of 100 consecutive breast augmentation cases in university settings were retrospectively reviewed for patient demographic and implant information in Kelowna (British Columbia), Loma Linda (California, USA) and Temple (Texas, USA). Statistical analysis was performed with a Kruskal-Wallis test without normality assumption (P<0.05 was considered to be significant). Pearson correlation coefficients were also determined for body mass index (BMI) versus implant volume at each of the sites. RESULTS: The three group medians were significantly different for weight, BMI and implant volume. Kelowna's average patient was 33 years of age, had a BMI of 20.8 kg/m(2) and an implant volume of 389 mL. Loma Linda's average patient was 32 years of age, had a BMI of 21.6 kg/m(2) and an implant volume of 385 mL. Temple's average patient was 36 years of age, had a BMI of 22.6 kg/m(2) and an implant volume of 335 mL. Pearson correlations for BMI versus implant volume were statistically significant in the Loma Linda and Temple groups. CONCLUSION: Patients from different geographical locations undergoing breast augmentation were similar in age, height and parity, but varied in weight, BMI and implant volume. A positive linear correlation between BMI and implant volume was found in the American cohorts.

An objective comparison of holding, slippage, and pull-out tensions for eight suspension sutures in the malar fat pads of fresh-frozen human cadavers.

BACKGROUND: In recent years, a number of designed suspension sutures have been rapidly introduced into clinical practice. OBJECTIVE: This study compares the holding tension, slippage tension, and pull-out tension for each of 8 suspension suture systems randomly positioned in the midface soft tissue in 4 fresh-frozen cadaver heads. METHODS: For each suture suspension system, a suture was positioned and set within the soft tissue of the cheek adjacent to the nasolabial line and attached to a tensiometer. A reference point was marked on the skin at the point where the suture first engaged the tissue. Holding tension was defined as the ounces of tension required to obtain a 5-mm superolateral displacement of the reference point. Slippage tension was determined by pulling further until the suture experienced its first slippage. Pull-out tension was defined as the ounces of tension required to pull the entire suture from its exit site. Photomicrographs of the fixation sites on the extracted sutures were examined and compared to their preinsertion state. RESULTS: Holding tension was statistically higher for the expanded polytetrafluoroethylene (ePTFE) knotted looped suture (W.L. Gore & Associates, Flagstaff, AZ) than for other systems. Slippage tension was greatest for the ePTFE suture; among other sutures, the tension profiles for the Silhouette (Kolster Methods, Inc., Corona, CA) and Woffles suture technique were higher than the others. In 3 of 5 cases, the ePTFE sutures demonstrated the highest pull-out tension, followed by the Silhouette and Woffles sutures. About 50% of barbs or cogs of polypropylene and polydioxanone sutures demonstrated bending, curling, or stripping away from the suture body after extraction. No morphologic flaws were found for suture knots, free-standing cones, or anchor pulleys. CONCLUSIONS: The various suture suspension systems currently available have differing efficacy and safety profiles. The results of this cadaver study clarify our understanding of the safety, benefits, and limitations of these systems. The higher ounces of tension for the ePTFE and Woffles sutures were to be expected, because these systems employ double suture strands that grasp a wider area than single-suture systems. Limitations of the study include the small number of samples, possible departures from clinical technique, and the inherent differences of the elastic and suture-holding properties between fresh-frozen cadaveric versus living tissue.

Artificial dermis as an alternative for coverage of complex scalp defects following excision of malignant tumors.

BACKGROUND: Artificial dermis has been used successfully for coverage of full-thickness wounds with a well-vascularized surgical bed. However, the use of artificial dermis in the reconstruction of partial- and full-thickness scalp defects has not been well documented. METHODS: Seven patients (six men and one woman; mean age, 70 +/- 14 years) with partial-thickness (three patients) and full-thickness (four patients) soft-tissue defects of the scalp (mean defect area, 97 +/- 58 cm) following resection of recurrent malignant tumors and/or previous failed reconstructions underwent staged scalp reconstruction with a bilaminate skin substitute (Integra). After adequate debridement of scalp wounds, including burring the outer table of the calvaria down to bleeding bone for full-thickness defects, Integra was scored and applied unexpanded. A split-thickness skin graft (0.011 +/- 0.0 inch in thickness) was placed on the operative site at postoperative day 36 +/- 15 after removal of the silicone layer of the artificial dermis. Two patients required repeated applications of artificial dermis to compensate for contour deficits before skin grafting. RESULTS: Clinically, all reconstructed areas showed well-vascularized neodermis before skin grafting. There was a 100 percent take of the skin grafts, with no infections or other complications noted. All reconstructive procedures were performed in less than 3 hours of combined operative time, with the last stage performed on an outpatient basis. CONCLUSIONS: Artificial dermis can be used successfully for reconstruction of complex scalp defects following oncologic resection, offering minimal donor-site morbidity, expedient operative time, and when needed, temporary quality closure until final pathologic results are known. Integra skin may offer another option for definitive management of extensive full-thickness scalp defects.

Intraosseous ganglion of the lunate.

Intraosseous ganglia are occasionally found affecting the carpal bones of the hand and should be considered in the differential diagnosis of chronic wrist pain. They have characteristic radiographic findings of a cyst with a thin sclerotic rim. This case report illustrates an unusual presentation of a cyst in the lunate with successful treatment. Standard of care includes curettage and bone grafting with minimal recurrence reported.