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1.
World J Plast Surg ; 10(3): 84-89, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34912671

ABSTRACT

BACKGROUND: Macromastia in adolescent girls is a distressing condition. There is an increase in the number of patients opting for reduction mammoplasty in the late teens. The semicircular horizontal method of breast reduction, first described by Passot in 1925 has the advantage of being able to do larger reduction, particularly suitable for pendulous breasts and having a hidden scar in the inframammary fold. METHODS: Eleven patients of adolescent macromastia were included in this study. It was conducted over a period of 4 years (2013-17) at two teaching institutions in Kolkata and Rishikesh, India. The mean age of the patients was 19.2 years. The Passot technique of reduction mammoplasty was performed in each case and the volume of resected breast tissue recorded by weighing the specimen. The aesthetic outcome was assessed by Lowery scale (volume, contour, placement of the breast mound and inframammary fold). Patient satisfaction was assessed after 6 months of follow up on a scale of 1 to 10, where 1-4 was poor, 5-6 fair, 7-8 good and 9-10 excellent. RESULTS: Mean total reduction per breast was 856 gm. Patients reported a mean decrease of cup size by 1.5. The aesthetic outcome was excellent in 6 patients and good in 5 patients. Patient satisfaction was excellent in 9 patients and good in 2 patients. CONCLUSION: Passot technique is a safe and effective technique of reduction mammoplasty and is especially useful in adolescent macromastia where the absence of visible scar on the breasts is very satisfying for the patients.

2.
Breast Dis ; 37(1): 33-37, 2017.
Article in English | MEDLINE | ID: mdl-28598828

ABSTRACT

INTRODUCTION: A "giant" lipoma is defined as a tumor having dimensions greater than 10 cm. Giant lipomas are rare and giant breast lipomas are exceptionally uncommon. Only six cases have been described in world literature till date. Herein we describe a case of giant breast lipoma and discuss its surgical management. CASE REPORT: A 43-year-old lady presented with left sided unilateral gigantomastia. Clinical examination, radiology and histopathology diagnosed lipoma. Excision of the tumor was planned, together with correction of the breast deformity by reduction mammoplasty using McKissok technique. A tumor measuring 19 cm × 16 cm × 10 cm and weighing 1647 grams was removed. The nipple areola complex was set by infolding of the vertical pedicles and the lateral and medial flaps were approximated to create the final breast contour. The patient is doing well on follow up. DISCUSSION: Giant lipomas are rare and of them, giant breast lipomas are extremely uncommon. They can grow to immense proportions and cause significant aesthetic and functional problems. The treatment is excision. But reconstruction of the breast is almost always necessary to achieve a symmetric breast in terms of volume, shape, projection and nipple areola complex symmetry compared to the normal opposite breast. Few authors have used various mammoplasty techniques for reconstruction of the breast after giant lipoma excision. Our case has the following unique features: (i) It is the third largest breast lipoma described in the literature till date, weighing 1647 grams; (ii) The Mckissock technique has been used for parenchymal reshaping which has not been previously described for giant breast lipoma. CONCLUSION: This case demonstrates that reduction mammoplasty after giant lipoma removal is highly rewarding, resulting in a smaller-sized breast that is aesthetically more pleasing, has better symmetry with the contralateral breast, and provides relief from functional mass deficit.


Subject(s)
Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast/abnormalities , Hypertrophy/etiology , Lipoma/complications , Lipoma/surgery , Adult , Breast/surgery , Female , Humans , Hypertrophy/surgery , Mammaplasty
3.
Indian J Dermatol ; 60(5): 521, 2015.
Article in English | MEDLINE | ID: mdl-26538724

ABSTRACT

Angioleiomyomas are benign tumors originating in the vascular smooth muscle. The tumor typically presents as painful, solitary, small (<2 cm), slow growing, subcutaneous nodule. Angioleiomyoma of the knee is rare, and only few cases have been reported so far. We have described herein a giant angioleiomyoma of the knee presenting as a painless ulcer in a 22-year-old man. There was no intra-articular extension of the tumor, and total excision was curative. This is the first case report of giant angioleiomyoma of the knee as well as the first case report of angioleiomyoma presenting as a painless ulcerative lesion.

4.
Plast Surg Int ; 2014: 589068, 2014.
Article in English | MEDLINE | ID: mdl-25478220

ABSTRACT

Background. Skin and nipple areola sparing mastectomy (NASM) has recently gained popularity as the management of breast cancer. This study aims to evaluate the aesthetic outcome, patient satisfaction, and oncological safety of NASM. Methods. The study prospectively analyzes the results of NASM and immediate breast reconstruction in 34 women with breast cancer. The criteria for inclusion were core biopsy-proven, peripherally located breast cancer of any tumor size and with any "N" status, with documented negative intraoperative frozen section biopsy of retroareolar tissue, and distance from the nipple to tumor margin >2 cm on mammography. Results. The median age of the patients was 45 years. The majority had either stage II or stage III breast cancer. The median mammographic distance of tumor from nipple areola complex (NAC) was 3.8 cm. The overall operative morbidity was minimal. The NAC could be preserved in all the patients. There was no local recurrence of tumor at median follow-up of 28.5 months. The aesthetic outcomes were satisfactory. Conclusion. NASM and immediate breast reconstruction can be successfully achieved with minimal morbidity and very low risk of local recurrence in appropriately selected breast cancer patients, with acceptable aesthetic results and good patient satisfaction.

5.
Asian Spine J ; 8(3): 309-14, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24967044

ABSTRACT

STUDY DESIGN: Case series. PURPOSE: To describe paraspinal transposition flap for coverage of sacral soft tissue defects. OVERVIEW OF LITERATURE: Soft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature. METHODS: The flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cm×5 cm) to extensive (21 cm×10 cm). The median age of the patients was 58 years (range, 16-78 years). RESULTS: There was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores. CONCLUSIONS: The authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.

6.
Burns ; 39(5): 972-7, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23434050

ABSTRACT

INTRODUCTION: Management of post burn contracture can be difficult, particularly for the axilla. Any handicap related to upper limb has a detrimental physical, psycohological, and economical effect. PATIENTS AND METHODS: We have released 20 axillae in 16 patients. These patients had axillary contracture for long duration and 5 had been operated previously by release and skin graft. We used posterior arm fasciocutaneous flaps for coverage of the defect after release of contracture. RESULTS AND CONCLUSION: All the patients had a good post op release. Their range of movement is excellent. No post op splintage was utilised in any of the cases with no incidence of recontracture.


Subject(s)
Axilla/surgery , Burns/complications , Contracture/surgery , Skin Transplantation/methods , Surgical Flaps , Adult , Axilla/injuries , Contracture/etiology , Female , Humans , Male , Middle Aged , Range of Motion, Articular , Young Adult
7.
Can J Plast Surg ; 21(1): 57-61, 2013.
Article in English | MEDLINE | ID: mdl-24431942

ABSTRACT

BACKGROUND: Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. METHODS: The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction. RESULTS: The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required. CONCLUSIONS: This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.


HISTORIQUE: La reconstruction d'importantes anomalies de la lèvre inférieure pose tout un défi. Les auteurs décrivent une nouvelle technique de reconstruction totale de la lève inférieure en une étape, dont l'objectif ultime consiste à obtenir l'équilibre délicat entre une ouverture convenable et une occlusion compétente de la bouche, tout en parvenant à un résultat satisfaisant sur le plan esthétique. MÉTHODOLOGIE: Les auteurs ont mis en application leur nouvelle technique de reconstruction chez un patient ayant une importante anomalie de la lèvre inférieure après l'excision d'un carcinome spinocellulaire. Les chirurgiens ont utilisé des lambeaux prélevés sur la partie nasolabiale inférieure bilatérale pour reconstruire la lèvre inférieure. Pour reconstruire le vermillon, les chirurgiens ont préparé un lambeau mucomusculaire en anse de seauextrait surtout de la partie marginale de l'orbiculaire des lèvres. Par rapport aux techniques déjà décrites, cette intervention est unique pour ce qui est de l'alignement des lambeaux nasolabiaux. De plus, cette technique de reconstruction du vermillon se fait en une étape, s'associe à une morbidité minimale, permet de préserver le pédicule vasculaire et l'innervation et préserve l'orientation de l'orbiculaire des lèvres, ce qui assure la compétence du sphincter oral. En autant que le sachent les auteurs, ce lambeau mucomusculaire de la lèvre supérieure n'a jamais été décrit auparavant et comporte des avantages évidents par rapport aux méthodes de reconstruction du vermillon communément utilisées. RÉSULTATS: Les résultats fonctionnels et esthétiques sont satisfaisants au suivi. Les mouvements et les sensations de la lèvre sont normaux, l'ouverture et la compétence de la bouche sont convenables, la couleur et la texture s'agencent bien avec les tissus adjacents et le vermillon est d'une excellente qualité et d'un volume parfait. Il n'est pas nécessaire de procéder à d'autres chirurgies correctives. CONCLUSIONS: La présente technique, très simple, permet de procéder à une reconstruction totale de la lèvre inférieure en une seule étape, tout en s'associant à une morbidité minime.

8.
Can J Plast Surg ; 20(2): e22-4, 2012.
Article in English | MEDLINE | ID: mdl-23730160

ABSTRACT

BACKGROUND: Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest. OBJECTIVE: To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice. METHODS: The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe. RESULTS: Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area. DISCUSSION: Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite. CONCLUSION: The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.


HISTORIQUE: Les anomalies ou la perte du lobe de l'oreille peuvent être d'origine congénitale ou être acquises en raison d'un traumatisme, de morsures, de brûlures ou d'excision d'une tumeur. Diverses interventions en une ou deux étapes ont été décrites pour reconstruire le lobe de l'oreille. L'intervention de Gavello est l'une des plus anciennes. OBJECTIF: Examiner l'intervention de Gavello compte tenu de la capacité vasculaire du lambeau et exposer la pertinence de cette technique dans la pratique actuelle. MÉTHODOLOGIE: Les auteurs abordent la base vasculaire du lambeau de Gavello et décrivent l'application clinique de l'intervention de Gavello en une étape dans diverses situations, y compris l'absence congénitale de lobe d'oreille, une malformation du lobe de l'oreille après une brûlure et une amputation traumatique du lobe de l'oreille. RÉSULTATS: Les auteurs ont remarqué d'excellents résultats esthétiques dans toutes sortes de situations cliniques, qui permettent de préserver la forme et le volume du lobe de l'oreille ainsi que d'obtenir une bonne correspondance de la couleur et une cicatrice bien cachée au foyer du donneur. EXPOSÉ: L'intervention de Gavello est une intervention simple en une étape qui fait entièrement appel à des tissus locaux pour reconstruire le lobe de l'oreille. Le lambeau a une capacité vasculaire prévisible, la greffe de peau est inutile et l'intervention peut être utilisée pour des anomalies importantes. La région de la mastoïde postauriculaire du donneur doit être intacte. CONCLUSION: L'intervention de Gavello, qui est simple et existe depuis un siècle, est toujours très précieuse pour la reconstruction d'anomalies du lobe de l'oreille d'étiologies variées.

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