Open Neck Lift: Surgical Technique and A Clinical Classification for Cervical Rejuvenation.

Careful evaluation of the neck and its relationship to the lower third of the face is fundamental to provide appropriate recommendations for procedures. The authors propose a modified Baker "clinical" classification as a more reliable and reproducible evaluative basis for the treatment of the aging neck. A total of 450 patients underwent procedures for cervical rejuvenation between December 2012 and December 2022 by the senior author. These included 9 cases of neck liposuction, 6 isolated neck lifts, 15 minimal access cranial suspension face lifts, 94 face lifts with open neck lifts, and 326 extended R-face and neck lifts. The male-to-female ratio was 1:20. The mean patient age was 59.1 years and the mean follow-up was 14 months (range 11.5-20 months). From the data, a modified Baker clinical classification for the aging neck was formulated along with recommendations for possible solutions. Ninety-four percent of the patients expressed high satisfaction on the Owsley Facelift Satisfaction Survey at 1-year follow-up. The complication rate was 1.78% (8 patients), including 1 hematoma, 1 skin edge necrosis (1 cm), 1 slow healing site (postauricular), 3 limited postauricular/earlobe scar revisions, and 2 mild contour irregularities. Cervical rejuvenation can be achieved by a spectrum of interventions and approaches. A comprehensive preoperative assessment and a clinical neck lift classification are the keys to selecting the correct surgical technique for achieving reliable and consistent results. The authors propose a pragmatic approach for both isolated and integrated neck lift procedures with excellent aesthetic outcomes and minimal complications.

Large Congenital Facial Teratoma Associated With Neurological Migration Disorder (Polymicrogyria) and Absent Corpus Callosum.

BACKGROUND: Herein, the author report a severe case of large facial mixed germ line tumor associated with neuronal migration disorder, polymicrogyria, and corpus callosum agenesis. This specific association has not been reported as yet. METHOD: A 33-year-old primiparous woman at 38th week, delivered 3820 g male baby, via Cesarian section. Postpartum profuse bleeding was noticed from a large, ulcerative, 7 cm exophytic left facial mass, which was controlled nonoperatively. The treatment included surgical excision and 560 g of large facial tumor. Histology results revealed mixed germ line tumor with grade 3, immature teratoma. RESULTS: Four months postoperatively the teratoma recurred in the buccal, tonsillar, and parapharyngeal areas. Fourteen months following the initial surgical excision the patient died from airway obstruction. CONCLUSION: Due to poor initial prognosis further treatment of the facial malignancy was not feasible. However, initial, early postnatal, excisional surgery provided a prolonged and better quality of life for the patient and family.

Full thickness burns caused by cyanoacrylate nail glue: A case series.

Artificial (acrylic) nails are popular cosmetic enhancements that provide the user with the appearance of manicured nails, do not chip or crack, and are generally considered very safe to apply. We report three cases where full thickness thermal burns were sustained from nail glue adhesive (cyanoacrylate) during the application of artificial nails. All three cases underwent surgical debridement and split skin graft reconstruction. We carried out an experiment to characterize the exothermic reaction between nail glue and cotton leggings. The average high temperature produced was 68°C which was sustained for 12.2s which is more than sufficient to cause full thickness burns on skin. We report these cases to increase both professional and public awareness of this serious potential complication associated with the application of artificial nails.

Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques.

BACKGROUND: Widespread adoption of the extended latissimus dorsi myocutaneous flap in breast reconstruction has been limited by donor-site complications. The dissection plane may be either above or below the superficial layer of the thoracolumbar fascia, which may be transferred with the flap or retained on the back skin flaps. The aim of this study was to investigate whether varying the plane of dissection improves donor-site morbidity and complications. METHODS: A comparative analysis of consecutive women treated with extended latissimus dorsi myocutaneous breast reconstruction by a single surgeon (D.F.) between 2006 and 2012 was performed. RESULTS: Eighty patients were reviewed. Between 2006 and 2011, 47 patients were treated with traditional suprafascial harvest (group A); the subsequent 33 patients between 2011 and 2012 had subfascial harvest (group B), retaining the superficial fascia on the back skin flaps. When compared with group A, group B patients showed significant reduction in both mean number of seroma drainage events (p = 0.027) and mean total aspirated seroma volume, which was reduced by half (p = 0.006). Group B patients also reported significant reduction in donor-site pain (p = 0.041) and donor-site scar adherence to the chest wall (p = 0.026). No increases in flap or donor-site dehiscence, partial flap loss, or other minor or major complications were observed. CONCLUSION: The technique of subfascial harvest during autologous latissimus dorsi flap breast reconstruction significantly improves back donor-site morbidity without compromising flap survival. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

A stacked technique of mastopexy: volume redistribution mastopexy with inferior flap and superomedially based pedicle.

BACKGROUND: Many mastopexy techniques focus on lifting the position of the nipple and excising the skin, with less attention paid to redistributing the uplifted volume of the ptotic breast. With the inferior pedicle technique, the onus is placed on skin taking the tension for the whole breast. Skin stretch then may lead to pseudoptosis. METHODS: With the advent of breast suturing, breast volume can be reshaped and lifted with less reliance on skin tension to maintain the lifted breast position. Since 2006, the senior author (G.J.O.) has applied these breast suturing and oncoplastic breast reconstructive techniques to mastopexy. By creating more than one flap/pedicle of the breast tissue, breast parenchyma can be redistributed more successfully towards the upper pole. The authors make no claim to originating this principle, which has been used by many plastic surgeons over the years, but they wish to explain their version of the technique that has evolved over the last 6 years. RESULTS: The authors present their arguments for this technique and discuss the relevance of improving upper-pole fullness and their concepts regarding skin re-draping. CONCLUSION: The key tenet for successful mastopexy is volume redistribution. Excision of skin is the secondary consideration. A natural-appearing breast shape can be achieved with this technique. 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 .

The Role of the Very Long Posterior Tibial Artery Flap following Severe Lower Limb Trauma: Case Series and Literature Review.

SUMMARY: With advancing techniques, knowledge, and training, the decision to salvage a lower limb following severe trauma is becoming ever more popular and successful. However, in cases where amputation is inevitable due to extensive injury or infection, we encourage the use of the very long posterior tibial artery (VLPTA) flap when the sole of the foot and posterior tibial neurovasculature are intact. We report 3 patients who underwent below-knee amputation and reconstruction using the VLPTA flap. A literature review was also performed to identify the outcomes and any complications associated with VLPTA flap.