The Tuck-in Mastopexy.

BACKGROUND: Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. The aim of this article is to describe a mastopexy technique used for grades 1 to 2 ptosis, "tuck-in" mastopexy technique. METHODS: Keyhole pattern was used for skin markings. All the planned skin excision areas were de-epithelialized. Breast mound was elevated as a 1-piece flap with extensive subglandular dissection. Elevated breast flap was reshaped and repositioned. Skin incisions were sutured in 2 layers. RESULTS: Seventeen patients were operated on with this technique; average follow-up time was 10.1 months. No major complications were seen. The results were pleasing for both the patients and the surgeon. CONCLUSIONS: The "tuck-in" mastopexy technique uses breast mound as 1-piece flap, which has great vascularity from medial, superior, and lateral pedicles. Large areas of de-epithelialization facilitate reshaping and repositioning. It permits simultaneous or secondary breast augmentation with silicone gel implants. This easy-to-do technique has low complication rates and a short learning period.

The lateral crural rein flap: a novel technique for management of tip rotation in primary rhinoplasty.

BACKGROUND: An important consideration in rhinoplasty is maintenance of the applied tip rotation. Different techniques have been proposed to accomplish this. Loss of rotation after surgery not only results in a derotated tip but also can create a supratip deformity. OBJECTIVES: As a supplement to dorsal reconstruction, the authors introduced and applied the lateral crural rein flap technique, whereby cartilage flaps are created from the cephalic portion of the lateral crura to control and stabilize tip rotation. METHODS: Eleven patients underwent primary open-approach rhinoplasty that included the lateral crural rein technique; the mean follow-up time was 18 months. Excess cephalic portions of the lateral crura were prepared as medial crura-based cartilaginous flaps and were incorporated into the nasal dorsum (similar to spreader grafts) and stabilized to achieve the desired tip rotation. RESULTS: The lateral crural rein flap technique provided stability to the nasal tip while minimizing derotation in the postoperative period. Long-term follow-up revealed maintenance of the nasal tip rotation and symmetric dorsal aesthetic lines. CONCLUSIONS: The lateral crural rein flap technique is effective for controlling nasal tip rotation while reducing lateral crural cephalic excess. Longevity of the applied tip rotation is reinforced by secure attachment of the lower nasal cartilage complex to the midvault structures. LEVEL OF EVIDENCE: 4.

Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg.

BACKGROUND: Soft-tissue defects in the knee region are usually complex and require adequate reconstruction with flaps. The aim of this article is to present the authors' experience using the reverse-flow anterolateral thigh perforator flap for the reconstruction of a variety of soft-tissue defects around the knee including the upper third of the leg. METHODS: A total of 17 reverse-flow anterolateral thigh perforator flaps were used for reconstruction of soft-tissue defects around the knee and the upper third of the leg between December 2006 and December 2010. The ages of patients ranged from 26 to 82 years (mean, 64.3). Defect sizes ranged from 6×8 to 10×14 cm. The application of the reverse-flow anterolateral thigh perforator flaps in relation to the variable arterial anatomy was described. RESULTS: The dimensions of the largest flap used for reconstruction were 10×16 cm. The perforators were musculocutaneous in 14 patients and septocutaneous in three patients. The maximal pedicle length was 28 cm. All of the flaps survived. Only two flaps developed partial skin necrosis at the distal end. Good aesthetic and functional results with adequate range of motion were achieved in all cases. CONCLUSION: Despite a variable vascular anatomy that can be challenging for the surgeon, reverse-flow anterolateral thigh perforator flap is a safe and reliable method for reconstruction of the defects around the knee and even the upper third of the leg.