Utility of Two Surgical Techniques Using a Lateral Intercostal Artery Perforator Flap after Breast-Conserving Surgery: A Single-Center Retrospective Study.

BACKGROUND: Immediate partial breast reconstruction after breast-conserving surgery has become a new paradigm in treating breast cancer. Among the volume replacement techniques used for small to moderate-sized breasts, the perforator flap method has many advantages. The authors present anatomical studies and two surgical techniques using lateral intercostal artery perforator flaps. METHODS: Data from 40 patients who underwent breast reconstruction using the lateral intercostal artery perforator flap between January of 2011 and June of 2016 were included. The authors conducted comparative analyses of the propeller flap and the turnover flap. They used three-dimensional computed tomography in lateral intercostal artery perforator flap anatomical studies, analyzing the distribution probability of the dominant perforator, the vertical distance from the axillary fold, and the horizontal distance from the anterior border of the latissimus dorsi. RESULTS: The most dominant perforator used for lateral intercostal artery perforator flaps was the sixth lateral intercostal artery perforator (43.6 percent of cases), followed by the seventh lateral intercostal artery perforator (39.1 percent of cases); their mean distances from the latissimus dorsi and the axillary folds were determined and reported. Complications included three cases requiring additional treatment for fat necrosis (propeller method, two cases; turnover method, one case) and venous congestion in only two cases that used the propeller method. Cosmetic satisfaction was 90 percent or greater for both techniques, indicating that results were rated as either excellent or good. CONCLUSION: The authors believe that their study results can broaden the application of partial breast reconstruction by using the lateral intercostal artery perforator flap after breast-conserving surgery, with three-dimensional computed tomography for anatomical studies, and using one of the authors' two described surgical techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Safe delayed procedure of nipple reconstruction in poorly circulated nipple.

Nipple-areolar complex reconstruction represents the final step in breast reconstruction. However, there is no gold standard nipple reconstruction technique that addresses the issue of blood circulation in the flap, which is the most basic complication. Nipple reconstruction was performed in 21 patients. A delayed procedure was performed when a poor outcome was expected due to marginal pinpoint bleeding in the distal tip after flap elevation during nipple reconstruction. The delayed nipple reconstruction can be viewed as a safe and reliable method for improving nipple blood circulation, reducing complications, and enabling long-term nipple projection maintenance in high-risk patients.

A Clinical Photographic Method to Evaluate the Need for Helmet Therapy in Deformational Plagiocephaly.

PURPOSE: With an increase in positional plagiocephaly patients, various therapy methods have been researched and helmet therapy is the most widely used and effective treatment method. To devise a method that would allow medical professionals and patients' parents to more easily identify the shape and outcomes before and after the therapy. METHODS: This study included 399 patients who had helmet therapy from November 2014 to February 2016. Patients wore a cast helmet for more than 20 hours per day. A cranial caliper was used to measure their head before they wore the helmet (prehelmet), once a month during outpatient visits, and 6 months after they stopped wearing the helmet (posthelmet). Clinical photographs were taken on a transparent acrylic sheet with a grid of 5-mm intervals to measure cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and symmetry ration (SR). The patients' photographs were then measured twice: first against the background without the grid and then against the background with the grid. RESULTS: Average age at prehelmet was 20 weeks while their average therapy period was 12 weeks. Patients' prehelmet CVA was 13.3 mm, and their posthelmet CVA was 3.1 mm. Their prehelmet CVAI was 10.1%, and their posthelmet CVAI was 2.1% (P < 0.001). Their overall prehelmet and posthelmet SRs were 0.820 and 0.969, respectively (P < 0.001). In addition, the measurements based on clinical photographs with and without the grid were compared using Fleiss kappa. The results showed κ = 0.847 and 0.956 when the patient was mild, κ = 0.744 and 0.919 when it was moderate, and κ = 0.767 and 0.924 when it was severe (P < 0.001). In all 3 patients, the consistency was higher with the grid. CONCLUSION: Since cast helmet manufacturing for positional plagiocephaly therapy does not require computed tomography scanning, there is no need to administer a sedative, nor does it pose any radiation exposure risk. Since the cast helmet is easier to manufacture and operate and is more cost effective, it could be used to treat more people. In addition, it would be useful for both medical professionals and patients' guardians to use clinical photographs with the acrylic sheet with the grid as a method to analyze shapes and outcomes before and after therapy, along with traditional CVA and CVAI.

Zygomatico-orbital artery: The largest artery in the temporal area.

The zygomatico-orbital artery is the largest artery in the temporal area. With the increasing number of reconstructive and aesthetic surgeries in the area, in-depth understanding of this artery is needed. Thus, the aim of this anatomical study was to determine more information on the zygomatico-orbital artery using contrast-enhanced three-dimensional computer tomography (CT) and color-flow Doppler sonography. On the basis of CT images taken between October 2015 and October 2016 for diagnosing and treating maxillofacial conditions, 50 patients were selected. We examined the patients' morphological classification; anatomical information of the artery, such as the bifurcation points and main course; diameter, depth, and overall length of the artery; and its association with the facial nerve. Doppler sonography was used to determine the presence of a concomitant vein. The zygomatico-orbital artery was classified into three types depending on its bifurcation and relationship with other arteries. The artery bifurcates from the external carotid artery, rises sharply, and crosses the zygomatic arch anterior to the porion. Subsequently, it runs toward the lateral canthus horizontally and transfers to the palpebral and superficial orbital arteries. The mean diameter was 2.52 mm, and the mean depth was 5.61 mm. The average length was 8.50 cm. The artery overlapped with the temporal branch of the facial nerve 1-3 cm posterior to the lateral canthus. No concomitant vein was found. This study provides information on the zygomatico-orbital artery that may be useful in various clinical settings and in the prevention of procedural complications.