Complications of reduction mammaplasty: comparison of nipple-areolar graft and pedicle.

A retrospective study of breast reductions in 268 patients by two plastic surgeons was performed. Particular attention was paid to those patients treated by inferior pedicle techniques; these patients were compared with those treated by free nipple grafts. According to our findings, patients with skin loss were heavier and had longer suprasternal notch-to-nipple distances. Patients who had free nipple grafts were older and heavier and had larger specimen weights and longer suprasternal notch-to-nipple distances. Fifty-four of the original 268 patients were included in a substudy of larger breasts, defined as those with a specimen weight of over 700 g. Nineteen patients underwent free nipple grafts, and 35 underwent inferior pedicle techniques. None of the 19 patients having free nipple grafts developed complications, whereas 6 of the 35 undergoing inferior pedicle techniques sustained significant complications. We conclude that free nipple grafts should be considered over inferior pedicles in heavier patients with breast ptosis.

A new method of perineal reconstruction following vulvectomy.

We propose a method in which vulvar reconstruction could be accomplished at the time of vluvectomy. A full-thickness pedicle flap is rotated from the vaginal vault to the area of excision, providing excellent coverage without subsequent contracture, and obviating the need for clitorectomy. This technique may also aid in palliating the psychological trauma induced by genital disfigurement.

Electromyographic verification of viable muscle tissue following a double-pendulum flap procedure for surgical repair of bilateral cleft lip.

Five patients were seen in an electromyographic study of the double pendulum flap method of bilateral cleft lip repair. All five patients displayed active orbicularis oris muscle tissue. By bringing lateral lip segments to the center of the cleft, the double pendulum flap method restores muscular function and improves cosmetic appearance. This surgical procedure may be modified to be performed on other anomalies resulting from a discontinuity of muscular tissue.

Transverse pharyngeal flaps: a dynamic repair for velopharyngeal insufficiency.

During the past three years, forty-eight patients, ranging from five to thirty years of age, have undergone bilateral transverse pharyngeal pedicles to the palate. Thirty-nine patients had not had pharyngeal flaps prior to this procedure and the remaining nine patients had failure of production of acceptable speech after undergoing inferiorly or superiorly based flap operations. One patient suffered separation of the suture line. Dramatic improvement in speech has been noted in the remaining forty-seven patients. While it is difficult to compare the speech results to other procedures, a significant finding has been achievement of satisfactory speech in all nine patients referred for correction after failure with superiorly or inferiorly based flaps. Muscle survival, as evidenced by consistent electromyograph studies, demonstrated functioning double pharyngeal sphincters to control airway shunting during rapid spontaneous speech. The use of transverse pharyngeal flaps offers an obturator effect and the added benefit of active muscle for airstream control in speech function to correct nasality in cleft palate patients. Preservation of the integrity of the neuromuscular component of these pedicles assures survival of the tissue mass for its obturator effect. A modified procedure has been adapted for patients with failure of production of acceptable speech, after using inferiorly or superiorly based flaps.