Abdominal desmoid tumors. A new reconstructive approach.

INTRODUCTION: Desmoid tumors are rare soft tissue tumors derived from musculoaponeurotic structures of the abdominal wall musculature. Although they are considered benign tumors because they don't metastasize to other parts of the body, they are clinically considered as malignant for their high tendency on infiltrative growth with local invasion and trend to recurrence after local excision. Several reconstructive techniques are proposed in the literature. METHODS: Nine female patients with abdominal desmoid tumors underwent the removal of a mass of tissue running from the skin to peritoneum near the tumor with a safety margin in macroscopically normal tissue at least of 5 centimeters from the edge of the tumor. After wide excision, a polypropylene mesh was placed in the rear muscular pocket without anchoring suture (sliding mesh sutureless hernioplasty) RESULTS: No patients had perioperative complications or abdominal wall weakness or an incisional hernia in the following 5 years. CONCLUSIONS: We consider this technique of abdominal wall reconstruction after desmoid tumor removal a simple procedure that reduces relapsing events and recurrences of abdominal hernia, reducing tension and pain caused by the traditional suture repair technique. LEVEL OF EVIDENCE: IV.

A new technique of upper eyelid blepharoplasty using the orbicularis muscle flap.

BACKGROUND: Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. The orbicularis muscle flap technique provides good results for patients with atonic skin and an atonic orbicularis muscle when there is excessive fullness in the lateral aspect of the upper lid. This flap also can be used to contain a prominent lacrimal gland or retro-orbicularis oculi fat (ROOF) without dangerous removal of the last one. METHODS: A total of 30 patients underwent upper lid blepharoplasty through a supratarsal incision approach. Dissection of the orbicularis muscle flap was made 5-8 mm above the supratarsal fold. Before the muscle flap suspension, the excess skin and fat pad were removed. The flap suspension was achieved with its rotation and motion of a tunnel in the suborbicularis plane, which anchored it on the periosteum of the orbital lateral rim of the frontal bone with a permanent suture. RESULTS: This technique restores the sharp and crisp tarsal folds and pretarsal show with deepening of the orbitopalpebral sulcus. The orbicularis muscle flap also can be proposed for cases with a ptosis of the lateral upper lid. The authors believe this technique reduces the risk for "rounding" of the eyelid and produces better contact of the lid with the ocular globe. CONCLUSIONS: The orbicularis muscle flap procedure is a feasible technique that can be used reliably to reshape the lateral upper lid. It would be a useful addition to the armamentarium of the plastic surgeon who is called on to perform upper blepharoplasty.