Single-Stage Immediate Breast Reconstruction Using Anatomical Silicone-Based Implant and The Hammock Technique of Dermal-Muscle Flap in Large and Ptotic breasts: A Multicenter Study.

BACKGROUND: This study revisits the previously described technique of inverted-T skin-reducing mastectomy and dermal-muscle pocket as a single-stage breast reconstruction using anatomical implants in large and ptotic breasts. Refinements have been added to enhance the quality of implant coverage, improve aesthetic outcome, and augment the implant volume than previously described in the literature. SUBJECTS AND METHODS: The study was performed in three centers in the UK, Egypt, and Libya. It included patients with large ptotic breasts with a breast cup size of D or larger. The areola-to-inframammary fold distance is of 8 cm or more, and a nipple-sternal notch distance is 25 cm or more. Modification of the dermal-muscle flap was made through dividing the medial and lateral ends of the de-epithelialized flap at a distance of one inch to create wings that could be sutured to the free edge of pectoralis major muscle to act as a hammock. RESULTS: It included 42 patients, and the mean age of the patients was 44.4 years (range 28-62). The mean body mass index was 34.2 (range 24-42). The reconstruction was unilateral in 32 (76.2%) patients and bilateral in ten (23.8%) patients. The average implant volume was 498.5 CC (range 375-650). Seventeen (40.5%) patients had a symmetrizing breast reduction. The average follow-up time was 52 weeks. Major complications were noticed in four (7.7%) breasts: Three breasts had major skin necrosis and one breast had hematoma that necessitated surgical evacuation. There were no reported cases of implant extrusion. Minor complications were recorded in six (11.5%) breasts; two had wound infection, and three had minor skin necrosis. CONCLUSION: The hammock technique of dermal-muscle flap is safe and versatile in large and ptotic breasts. It also creates a natural-looking breast with bigger implants.

Single-stage muscle flap reconstruction of major scrotal defects: report of two cases.

Major scrotal defect with exposed testes and/or spermatic cords are a challenge for the reconstructive surgeon. The bacterial flora of the perineum, difficulty of immobilisation and the contour of the testes make testicular cover a difficult task [Br. J. Plast. Surg. 41 (1988) 190]. Traditional approaches have used simple skin grafts or if not feasible, multi-staged procedures with initial burying of the testes under delayed medial thigh flaps. Better techniques then evolved to permit early single-staged coverage using flaps rather than skin grafts in these usually contaminated and unsuitable wounds to improve the cosmetic outcome of the reconstruction and reduce patient discomfort and hospital stay. Muscle flaps represent an excellent reconstruction option in the contaminated perineum especially in patients with impaired ability to deal with infection such as diabetic or toxic patients. We present two cases of reconstruction of the scrotum using simple, reliable single-stage muscle flap techniques with good aesthetic results and review the literature.

The bi-pedicle post-auricular tube flap for reconstruction of partial ear defects.

Reconstruction of partial ear defects represents a difficult challenge to the plastic surgeon, due to the delicate and intricate architecture of the chondrocutaneous sandwich of the external ear. These defects could be the result of laceration and avulsion injuries, animal and human bites, burns and tumour excision. Since its introduction to the plastic surgery field, by Gillies, in 1917, tube flaps have been successfully used to reconstruct many defects. Although, in the past two decades, tube flaps have been replaced by the more modern single-stage reconstruction techniques, it still represents an excellent tool for reconstruction of partial ear defects. We present three cases of reconstruction of partial ear defects using a modified two-stage post-auricular tube flap technique, which is simple and reliable technique with good aesthetic outcome.