Functional Improvement with Free Vascularized Toe-to-hand Proximal Interphalangeal (PIP) Joint Transfer.

BACKGROUND: Reconstruction of small joints of fingers is still challenging in hand surgery. Implant arthroplasty and arthrodesis have some limitations in the reconstruction of small finger joints. Free vascularized PIP joint transfer from second toe to finger is a promising autogenous reconstructive alternative. METHODS: In this prospective study, 7 cases of free vascularized PIP joint transfer were analyzed. The measurements for active and passive range of motion (ROM), grip, and pinch strength has been done preoperatively and 1-year postoperatively. The functional change in daily life quality and work-related activities was evaluated with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Mean follow-up period was 20.3 months (12-25). Preoperative mean active and passive ROM values were 3.6° (0-14°) and 11.9° (0-29°), respectively. Postoperative 1-year measurements revealed a mean active ROM of 24.1° and a mean passive ROM of 31.6°. Mean grip and pinch strength increased from 52.1 to 58.6 lbs and from 5.1 to 5.9 lbs, respectively. Mean preoperative and postoperative DASH-scores were 41.3 and 30.3. CONCLUSION: The improvement in ROM, increasing grip strength, and declining DASH scores in our study support that free vascularized joint transfer improves patients' daily life quality and work-related activities via providing a functional joint if performed with appropriate indications, careful planning, and meticulous surgical execution. Free vascularized joint transfer provides an autogenous, painless, mobile, and stable joint. It also has the advantages of composite tissue reconstruction and lacks the disadvantages of arthrodesis and synthetic joint implants.

Effects of laser-assisted lipolysis on nipple-areola complex.

BACKGROUND: Gynecomastia, as a most common benign condition, represents itself as the enlargement of the male breast and also nipple-areola complex as the severity of the condition increases. With this study, we aimed to clarify the effects of 980-nm diode laser on nipple-areola complex (NAC). OBJECTIVES: Although numerous open techniques have been described to correct gynecomastia, nowadays trends have shifted to minimally invasive techniques such as laser-assisted lipolysis (LAL). METHODS: A total of 25 patients with bilateral gynecomastia treated with LAL by using a 980-nm diode laser. RESULTS: The resultant contour and reduced size of the complex were satisfactory. CONCLUSIONS: LAL leads to significant reduction of the size of NAC.

One-Stage Cleft Lip and Palate Repair in an Older Population.

BACKGROUND: In underdeveloped countries one-stage definitive repair of cleft lip and palate is considered for late-presenting patients. MATERIALS AND METHODS: A total of 25 patients with unoperated cleft lip and palate more than 2 years of age were enrolled in this study for one-stage simultaneous repair of cleft lip and palate. According to Veau-Wardill-Kilner push-back technique, 2 flap palatoplasties were performed for palatal repairs; all of the lips were repaired with the Millard II rotation-advancement technique. RESULTS: The authors experienced no perioperative or postoperative life-threatening complications. With respect to the registered operation periods, longer times were required to perform these double operations, but this elongation is shorter than the sum of the periods if the 2 operations had been performed separately. Although the authors were unable to evaluate the late postoperative results because the authors could not follow-up the patients after they were discharged the day after surgery, the early results related to the success of the operation without any surgical complication were prone to meet the parents' and patients' expectations. DISCUSSION: The authors presented their experiences with many volunteer cleft lip and palate trips to third world countries; however the structure of this article is not a new hypothesis and data based to support a scientific study, but observations are objective to get a conclusion. To perform one-stage definitive repair of the cleft lip and palate in late-presented patients was the reality that they had only 1 chance to undergo these operations. According to the terms and conditions of this challenging operation, one-stage simultaneous repair of cleft lip and palate is a more demanding and time-consuming procedure than is isolated cleft lip repair or cleft palate repair. Although technically challenging, single-stage repair of the whole deformity in late-presenting patients is a feasible, reliable, successful, and safe procedure in authors' experience.

Correction of Brassiere Strap Grooves with Fat Injections.

BACKGROUND: The size and weight of hypertrophied breast can cause both physical and psychological problems. Although the majority of these problems can be solved with breast reduction surgery, the particular problem of development of brassiere strap grooves on the shoulders due to the weight of the breasts cannot be corrected with this method. OBJECTIVES: Breast reduction surgery focuses only on the increased dimensions of breasts: fullness of the thoracic wall lateral to the breasts, as well as the appearance of brassiere strap grooves, need to be taken into consideration to obtain a better upper body image. Therefore, we present a series of 10 female patients who were treated with fat injections for the correction of brassiere strap grooves. METHODS: Reduction mammaplasty and fat injections into the brassiere strap grooves were performed during the same session. RESULTS: Dramatic changes are obtained with judicious placement of fat into the bra strap grooves. CONCLUSIONS: A more aesthetic and harmonious look can be obtained with using these combined aesthetic procedures in appropriately selected patients. LEVEL OF EVIDENCE: 4 Therapeautic.

Brassiere strap groove deformity: definition and classification.

UNLABELLED: Brassiere strap grooves develop mostly on the shoulders of women with hypertrophied breasts. Varying degrees of the deformity are observed in such cases. To date, there is no universally accepted definition and classification for brassiere strap groove deformity. In this study, we aimed to define and classify the deformity in order to inform consultants and future surgeons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .