Neck rejuvenation with mastoid-spanning barbed tensor threads (MST operation).

BACKGROUND: Face rejuvenation with barbed tensor threads has been used in a variety of techniques by many authors focused mainly on cheek rejuvenation. Nevertheless, there is a scarcity of detailed techniques and descriptions of surgical steps in barbed-thread neck rejuvenation. Here we describe our technique and analyze the results of this approach to minimally invasive neck rejuvenation with barbed threads. METHODS: The main aspect of this technique is placement of a mastoid-spanning barbed thread, which deepens the cervicomental angle and provides more tension than other techniques that use barbed threads but that do not cross the neck midline. A retrospective study was conducted on a group of 67 consecutive cases who underwent this technique in a 34-month period starting in August 2009. RESULTS: The patients' average age was 48 years old and the average follow-up was 18 months. Patient satisfaction was high as evidenced by a minimal request for secondary operations. Complications were few and mild, with no cases requiring reoperation for thread removal. CONCLUSIONS: The study showed that neck rejuvenation with barbed threads that cross the neck midline is a powerful minimally invasive rejuvenation technique. The best indication is in patients with initial signs of facial aging. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Progressive tension sutures in the prevention of postabdominoplasty seroma: a prospective, randomized, double-blind clinical trial.

BACKGROUND: The purpose of this study was to evaluate the seroma reduction capabilities of progressive tension sutures and compare them with the conventional use of drains. METHODS: Sixty female patients were randomized into four groups: group 1 (control, no drains, and no progressive tension sutures), group 2 (progressive tension sutures alone), group 3 (drains alone), and group 4 (progressive tension sutures and drains). All patients underwent a classic abdominoplasty and drains were left for 7 days in the corresponding groups. Clinical and ultrasound assessments were performed 2 weeks after the operation by blinded evaluators. Punctures, volumes, nonseroma complications, and aesthetic outcome were also measured. RESULTS: Surgical time was 50 minutes longer in groups 2 and 4. Drain outputs were higher in group 3 than in group 4. The clinical and ultrasound seroma frequency was 35 percent and 90 percent respectively, without significant differences among the groups. The control group was interrupted at 10 patients because of considerably larger seromas and an increased amount of punctures needed for treatment. No differences were found in the other groups. There were no differences with respect to complication rates and aesthetic outcome after follow-up. CONCLUSIONS: Progressive tension sutures increase surgical time, reduce drain outputs, and have the same clinical and ultrasound seroma frequency as the use of drains alone. The combination of both methods simultaneously does not add any advantages. However, complications and interventions increase if at least one of them is not used. The mechanism of action of progressive tension sutures could be the compartmentalization of the fluid collection under the flap facilitating absorption.

Osteosíntesis rígida en cirugía de malformaciones maxilomandibulares / Rigid osteosynthesis in the surgery of maxillomandibullar malformations

Se analiza la primera experiencia, en la aplicación de técnicas de osteosíntesis rígida aplicada a osteotomías maxilofaciales, en nuestro equipo de cirugía plástica. Esta experiencia comenzó en diciembre de 1988 y se operó un grupo de 11 pacientes, en que se efectuó un total de 15 osteotomías correspondientes a 6 sagitales de rama, 4 Le Fort 1 y 5 mentoplastias. Para las fijaciones óseas se utilizaron miniplacas metálicas en maxilar superior y mentón. En la mandibula se utilizaron tornillos solos. El aspecto más destacable fue la no utilización de fijación intermaxilar en el postoperatorio. Los resultados fueron altamente satisfactorio, sin recidivas y con mínimas complicaciones

Reconstrucción faringoesofágica cervical con colgajo libre de yeyuno microvascularizado / Pharyngoesophageal cervical reconstruction with jejunal free microvascular flap

Se presenta un método de reconstrucción faringoesofágica cervical utilizando un injerto de yeyuno revascularizado con microcirugía. Se analiza tres casos clínicos operados con esta técnica, y se describe una modificacion original del procedimiento que consiste en otorgar una conformación en asa tipo omega al colgajo de yeyuno. Los resultados obtenidos en estos tres pacientes fueron altamente satisfactorios destacando su excelente funcionalidad

Experiencia en 201 casos de fisuras labiopalatinas y/o secuelas / Experience in 201 cleft palate cases and/or sequels

Se presenta la experiencia de 201 pacientes con fisuraciones labiopalatinas de la Clínica de Fisurados del Area Sur Metropolitana de Santiago. Casi todos los pacientes eran adultos y en el 60% no habían recibido tratamiento quirúrgico previo. A pesar de ésto, el 25% de éste grupo tenían alteraciones oclusales que requerían corrección quirúrgica. Se incluyeron en la casuística las fístulas residuales y las alteraciones del perfil (sin comunicación oronasal), dado que en éstos 2 grupos necesitaron en un 73% de los casos, corrección quirúrgica de la oclusión. El número de fístulas secundarias a correcciones iniciales (fisuras del paladar primario y/o secundario) aumentó según el tamaño de la comunicación oronasal y el número de reintervenciones