ABSTRACT
Valoramos por ecografía y estadísticamente la eficacia de la liposucción láser-asistida en casos de ginecomastia, teniendo en cuenta la respuesta de retracción de la piel, la rapidez de la recuperación del paciente, y el grado de satisfacción que originan los resultados. Presentamos un estudio prospectivo de 28 pacientes con ginecomastia de diferente grado, tratados mediante liposucción asistida por láser de Diodo de 1470 nm, previa sedación y con anestesia tumescente. El láser se programó a 15 Watios (W) en emisión continua y se administraron 8 a 12 kilojulios (kJ) por cada mama. No se realizaron escisiones de piel ni se emplearon drenajes. Se realizó valoración objetiva y subjetiva empleando la misma escala visual analógica (VAS) completada por médicos y pacientes. Se tomaron fotografías antes y 6 meses después de la intervención, y se realizaron mediciones del perímetro torácico y del diámetro de las areolas. El seguimiento ecográfico de las áreas tratadas fue comparativo antes y 6 meses después del tratamiento. Para el estudio estadístico se empleó t de Student como test de contraste. No observamos complicaciones, como signos de isquemia o quemaduras cutáneas. La disminución del perímetro torácico y del diámetro de las areolas fue estadísticamente significativa. Tanto la valoración objetiva como la subjetiva alcanzaron resultados superiores al 90 %. Mediante la ecografía también se demostró disminución, estadísticamente significativa, de la banda de tejido graso subcutáneo (p < 0,05) al comparar las imágenes de antes y 6 meses después del tratamiento. La recuperación laboral se realizó en un promedio de 3 días. En conclusión, creemos que la liposucción láser-asistida es un método eficaz y reproducible, comprobado ecográfica y estadísticamente, que alcanza buenos resultados con menos trauma quirúrgico, lo que conlleva un alto grado de satisfacción por parte de los pacientes (AU)
We evaluate efficacy of laser-assisted liposuction in gynecomastia by means of ultrasonography and statistical study, taking into account skin retraction, patients time recovery and satisfaction index with results of surgery. A prospective study on 28 patients suffering from gynecomastia, were treated by means of liposuction assisted by 1470 nm Diode laser lipolysis. Surgery was carried out under sedation and tumescent anesthesia. Laser was programmed at 15 W, 8 a 12 kJ total cumulative energy per breast. Neither skin resection nor drainages were used. Doctors and patients evaluated results objective and subjectively with the same Visual Analogue Scale. For scoring results, pictures took before and 6 months after were used. Measures of chest and areola diameter of before and after surgery were taken for comparative statistical analysis. Ultrasonography follow up was done to determine the width of subcutaneous fat layer eliminated. T Student was use as contrast test to examine results achieved. No complications were observed such ischemia or skin burns. Chest and areolas diameter decrease in dimension were statically significant. Objective and subjective evaluations gave results greater than 90 %. Ultrasonography demonstrated decreasing, statically significant, in subcutaneous fatty tissue (p < 0,05), by comparing images before and 6 months after treatment. Laser-assisted liposuction is an efficacious procedure and reproducible. Ultrasonography controls and the statically study demonstrated good results and limited surgical trauma that imply patients' high satisfaction with the surgery outcome (AU)
Subject(s)
Humans , Male , Gynecomastia/surgery , Lipectomy/methods , Surgery, Computer-Assisted/methods , Lasers, Semiconductor/therapeutic use , UltrasonographyABSTRACT
Gynecomastia is the most common breast pathology. Numerous excisions and liposuction techniques have been described to correct bilateral male breast enlargement. Recently, there has been a shift from the open approach to minimally invasive techniques. This article reports a 5-year experience using laser-assisted lipolysis (LAL) to treat gynecomastia, and describes the surgical technique. Between January 2006 and December 2010, a total of 28 patients with bilateral gynecomastia were treated with LAL. Patients had a mean age of 36.5 years (range 24 to 56 years). LAL was performed with a 980-nm diode laser (continuous emission, 15 W power, 8-12 kJ total energy per breast) after tumescent anesthetic infiltration. The breast was evaluated objectively by two physicians who compared chest circumference and photographs. Patients were also asked to score the results using a visual analogue scale: 75 to 100 (very good), 50-74 (good), 25 to 49 (fair) and 0 to 24 (poor). The postoperative period for all patients was incident-free. After 6 months, 18 patients (64.3%) scored the results as "very good", 6 as "good" (21.4%), 3 as "fair" (10.7%) and 1 "poor" (3.6%). Mean chest circumferences pre- and postoperatively were, respectively, 117.4 ± 11.1 cm and 103.3 ± 7.5 cm (p < 0.001), corresponding to a mean difference of 14.1 cm. Physicians scored the photographs as "very good" in 22 patients (78.6%), as "good" in five patients (17.9%), and as "fair" in one patient (3.6%). LAL in gynecomastia is safe and produces significant effects on fatty tissue, with a reduction in breast volume, together with significant skin tightening. Provided an appropriate amount of energy is delivered by an experienced operator, the results are both significant and consistent.
Subject(s)
Gynecomastia/surgery , Laser Therapy/methods , Lipectomy/methods , Adult , Female , Humans , Laser Therapy/instrumentation , Lasers, Semiconductor , Lipectomy/instrumentation , Male , Mammaplasty/methods , Middle Aged , Patient Satisfaction , Postoperative Care , Postoperative Complications/etiology , Postoperative Period , Prospective Studies , Young AdultABSTRACT
The development of a prefabricated free flap that could have potential for tracheal reconstruction has been investigated in the goat model. Through a staged procedure, a composite cutaneous-chondromucosal premolded, prevascularized flap was obtained by prefabrication techniques. The procedure comprised three surgical stages. In the first stage, on day 0, the cartilaginous frame-work was constructed, along with the vascular pedicle (implantation of an arteriovenous fistula as a vascular carrier). In the second stage, on day 50, the inner surface of the neotrachea was lined with nasal mucosa. In the third stage, on day 60, the flap was elevated and free transferred to reconstruct a 15-cm circumferential defect in the cervical trachea. Ten animals were operated on, and the results were one infection, three early deaths, one free-flap failure with early tracheal stenosis, and five long-term survivors without significant stenosis. The structure of the neotracheal flap closely resembled that of the native trachea: internal respiratory epithelial lining, cartilage rings, and fibrovascular tissue. Fiberoptic bronchoscopy was done to all the animals at 10 and 60 days, revealing no significant stenosis in the long-term survivors.
Subject(s)
Surgical Flaps/methods , Trachea/surgery , Animals , Female , Goats , Graft Survival , Postoperative ComplicationsABSTRACT
We report a case of severe injury of the scalp and skull caused by high tension electric current. The patient developed tetraplegia. The surgical steps undertaken are also described. We used two consecutive free flaps which failed 5 days after each operation. We discuss the possible causes for flap failure, which we think was due to damaged receptor vessels. The wound was closed after expanding the adjacent scalp. Scalp expansion was an uneventful procedure, however infection of the cavity developed. We overcame this problem by an aggressive approach (cavity irrigation, daily expansion and systemic antibiotherapy). The use of a synthetic mesh to avoid cerebral herniation through the bone defect is also described.
