"Abdominoplasty with "En block" removal of the skin island: a safe and fast approach".

The aim of abdominoplasty is to restore a normal abdominal contour, with minimal signs of the surgery. The purpose of this study was to determine the feasibility, safety, and advantages of en block removal of a skin island before upper abdominal dissection during abdominoplasty. Five hundred-forty female patients who underwent abdominoplasties between January 2004 and December 2018 were retrospectively analyzed. In these cases, the planned skin resection was initially made en block, as done with an elliptic skin excision. In this way, symmetric skin removal is achieved. After the removal of this skin, epigastric skin undermining was easily achieved. The mean age of the patients was 41.4 y, and the mean body mass of index was 27.3 kg/m2. The mean operative time for abdominoplasty only was 98 min. Eight patients had minor skin problems, 22 patients needed aspiration for seroma formation, and 7 patients needed scar revision surgery. There was only one hematoma postoperatively. The final position of the scar from the upper vulvar commissure was 8.9 cm. The results obtained were comparable to those of classical abdominoplasty, suggesting that en block removal of the skin before upper flap dissection is a safe maneuver. En block removal of skin island at the start of the surgery has the added advantage of a reduced operative time and acceptable aesthetic outcome, without an increase in complication rates. In cases of planned abdominoplasties, we suggest that removal of the abdominal skin at the beginning of the operation is a safe and feasible procedure.Abbreviation: PDS: polydioxanone.

The Use of Platelet-Rich Plasma for Storage of Surplus Harvested Skin Grafts.

BACKGROUND: There is a need for improved methods and storage media to sustain the tissue viability of autologous skin grafts. OBJECTIVE: To compare histological changes in human skin grafts stored in platelet-rich plasma (PRP) with those of grafts stored in saline. METHODS: Eight circular, 3-mm full-thickness skin graft samples were harvested from the abdominal skin of each of 5 patients scheduled to undergo an abdominoplasty procedure. Four of these graft samples were stored in saline, and the other 4 were stored in saline mixed with PRP prepared from the patient's own venous blood. Histological assessment of the microscopic appearance of the samples was performed on days 5, 8, 11, and 14. The integrity of the epidermal-dermal junction, number of keratinocytes with perinuclear halos, collagen organization, and number of fibroblasts per field were assessed. The cellular apoptosis rate was also measured on these same days. RESULTS: On day 5, significant differences were observed microscopically between the PRP- and saline-stored grafts (P < .05). The grafts preserved in saline exhibited early marked cellular and nuclear swelling with pleomorphism, as well as early nuclear halo formation. The cell viability rate of the PRP group was significantly higher than that of the saline-stored group on day 8 (P < .05). CONCLUSION: Platelet-rich plasma and its inherent growth factors supported longer graft survival; however, its effect lasted only until day 8. Platelet-rich plasma may be beneficial if grafts need to be stored for delayed application(s).

HISTORIQUE: Il faut améliorer les méthodes et les milieux de conservation pour maintenir la viabilité des greffons autologues de peau. OBJECTIF: Comparer les changements histologiques des greffons de peau humaine conservés dans du plasma riche en plaquettes (PRP) à ceux des greffons conservés dans un soluté physiologique. MÉTHODOLOGIE: Les chercheurs ont prélevé huit échantillons de greffons circulaires de trois millimètres de peau pleine épaisseur sur la peau de l'abdomen de chacun des cinq patients qui devaient subir une abdominoplastie. Quatre d'entre eux ont été conservés dans un soluté physiologique et les quatre autres, dans un soluté physiologique mélangé à du PRP préparé à partir du propre sang veineux du patient. Les chercheurs ont procédé à l'évaluation histologique de l'aspect microscopique des échantillons les cinquième, huitième, onzième et quatorzième jours après le prélèvement. Ils ont examiné l'intégrité de la jonction dermoépidermique, le nombre de kératinocytes dotés de halos périnucléaires, l'organisation du collagène et le nombre de fibroblastes par champ. Les mêmes jours, ils ont mesuré le taux d'apoptose cellulaire. RÉSULTATS: Le cinquième jour, les chercheurs ont observé des différences microscopiques significatives entre les greffons conservés dans le PRP et ceux conservés dans un soluté physiologique (P<0,05). Les greffons conservés dans le soluté physiologique présentaient une hypertrophie cellulaire et nucléaire précoce marquée accompagnée de pléomorphisme ainsi que la formation précoce de halos nucléaires. Le huitième jour, le taux de viabilité des cellules du groupe de PRP était considérablement plus élevé que celui des cellules du groupe de soluté physiologique (P<0,05). CONCLUSION: Le plasma riche en plaquettes et les facteurs de croissance inhérents favorisaient une plus longue survie, mais seulement jusqu'au huitième jour. Le plasma riche en plaquettes peut être bénéfique si les greffes doivent être conservées en vue d'être utilisées plus tard.

Reduction of the Areolar Diameter After Ultrasound-Assisted Liposuction for Gynecomastia.

BACKGROUND: One of the clinical aspects characterizing gynecomastia is the enlargement of the nipple-areolar complex (NAC) due to hypertrophic breast glands, and the excessive fatty tissue underneath. OBJECTIVE: The purpose of this study was to quantify the reduction of the areolar diameter after ultrasound-assisted liposuction (UAL) of the male breast. METHODS: The horizontal diameters of the NACs of 30 men who underwent UAL were measured before surgery, 1 month after surgery and 6 months after surgery in a standard fashion. Those patients with surgical gland removals of any kind were not included in this study. RESULTS: The mean age of the patients was 27.9 years, and all of the patients had bilateral grade I, II, or III gynecomastia. The mean diameter of the NACs before surgery was 35.36 mm (range, 26-55 mm), and after surgery, the mean diameter of the NACs was initially reduced to 28.8 mm (range, 23-44 mm) and later to 28.57 mm (range, 23-42 mm). The mean volume of breast tissue aspirated was 382 mL per breast, and the percentage of reduction was 17.3%. The reduction of areola diameter was statistically significant after first month. A significant positive correlation was identified between the liposuction volume and areolar diameter reduction. CONCLUSIONS: In cases of gynecomastia, the removal of the glandular and fatty tissue underneath the areola releases the expanding forces and pressure that enlarge it. In many cases of gynecomastia, UAL alone is effective in reducing the size of the NAC and allows the surgeon to avoid placing scars on the breast.

Exposure to Tumescent Solution Significantly Increases Phosphorylation of Perilipin in Adipocytes.

BACKGROUND: Lidocaine and epinephrine could potentially decrease adipocyte viability, but these effects have not been substantiated. The phosphorylation status of perilipin in adipocytes may be predictive of cell viability. Perilipin coats lipid droplets and restricts access of lipases; phospho-perilipin lacks this protective function. OBJECTIVES: The authors investigated the effects of tumescent solution containing lidocaine and epinephrine on the phosphorylation status of perilipin in adipocytes. METHODS: In this in vitro study, lipoaspirates were collected before and after tumescence from 15 women who underwent abdominoplasty. Fat samples were fixed, sectioned, and stained for histologic and immunohistochemical analyses. Relative phosphorylation of perilipin was inferred from pixel intensities of immunostained adipocytes observed with confocal microscopy. RESULTS: For adipocytes collected before tumescent infiltration, 10.08% of total perilipin was phosphorylated. In contrast, 30.62% of total perilipin was phosphorylated for adipocytes collected from tumescent tissue (P < .01). CONCLUSIONS: The tumescent technique increases the relative phosphorylation of perilipin in adipocytes, making these cells more vulnerable to lipolysis. Tumescent solution applied for analgesia or hemostasis of the donor site should contain the lowest possible concentrations of lidocaine and epinephrine. LEVEL OF EVIDENCE 5.

Stepwise positional-orientational order and the multicritical-multistructural global phase diagram of the s=3/2 Ising model from renormalization-group theory.

The spin-3/2 Ising model, with nearest-neighbor interactions only, is the prototypical system with two different ordering species, with concentrations regulated by a chemical potential. Its global phase diagram, obtained in d=3 by renormalization-group theory in the Migdal-Kadanoff approximation or equivalently as an exact solution of a d=3 hierarchical lattice, with flows subtended by 40 different fixed points, presents a very rich structure containing eight different ordered and disordered phases, with more than 14 different types of phase diagrams in temperature and chemical potential. It exhibits phases with orientational and/or positional order. It also exhibits quintuple phase transition reentrances. Universality of critical exponents is conserved across different renormalization-group flow basins via redundant fixed points. One of the phase diagrams contains a plastic crystal sequence, with positional and orientational ordering encountered consecutively as temperature is lowered. The global phase diagram also contains double critical points, first-order and critical lines between two ordered phases, critical end points, usual and unusual (inverted) bicritical points, tricritical points, multiple tetracritical points, and zero-temperature criticality and bicriticality. The four-state Potts permutation-symmetric subspace is contained in this model.

Avoiding Extended Scar in Skin Expansion: Alagoz Technique.

The principal aim of skin expansion is to provide additional donor tissue without extra donor-site morbidity. Most of the reports about tissue expansion are focused on the properties of expander. Donor-site decision is usually underestimated. Here, we offer to use the defect area and surrounding healthy tissue as the donor site.In 4 cases, expanders were placed just under the defect in a fashion to extend 1 to 2 cm more laterally toward the encircling healthy tissue. The expanded tissue was not mobilized for longer distances; thus, there was no loss in flap gain. The resulting final scar was linear or crescentic. In the Alagoz technique, tissue gain similar in size to the defect is sufficient for reconstruction. The simpler the flap, the best the resulting scar.

[Using pedicled rectus abdominis musculocutaneous flaps in thigh and lumber defects]. / Pediküllü rektus abdominis kas deri flebinin uyluk ve sirt defektlerinde kullanimi

BACKGROUND: A series of previously described but rarely used variations of the pedicled, extended or vertical rectus abdominis musculocutaneous flap (Extended RAM, VRAM) were reviewed. METHODS: Skin paddle dimensions, ranged 8 to 28 cm in width and 10 to 35 cm in length, were used in five consecutive patients. Four flaps were placed deep to the inguinal ligament to repair the thigh as proximal to the knee region; the remaining one flap was passed transabdominally to cover the defect of the lumbar region. RESULTS: No flaps necrosis were seen and in one case wound healing problems required minimal operative intervention. Successful transfer of the VRAM and extended RAM with low rate of complication for the thigh and lumbar region defects were demonstrated to be safe and reasonable options of flap reconstruction. DISCUSSION: The flaps had the advantages of being robust and well-vascularized, easy and fast to harvest, and not requiring microsurgery experience.

Necessity of suction drains in gynecomastia surgery.

BACKGROUND: The aim of gynecomastia surgery is to restore a normal chest contour with minimal signs of breast surgery. OBJECTIVE: The authors examine the rate of complications in gynecomastia surgery when no closed-suction drains are placed. METHODS: One hundred thirty-eight consecutive male patients who underwent gynecomastia surgery without drains were retrospectively analyzed to determine whether the absence of drains adversely affected patient outcomes. Patients were managed by ultrasonic-assisted liposuction both with and without the pull-through technique. RESULTS: The mean age of the patients was 29 years, and the mean volume of breast tissue aspirated was 350 mL per beast. Pull-through was needed in 23 cases. There was only 1 postoperative hematoma. CONCLUSIONS: These results are comparable with previously published data for gynecomastia surgery in which drains were placed, suggesting that the absence of drains does not adversely affect postoperative recovery. Routine closed-suction drainage after gynecomastia surgery is unnecessary, and it may be appropriate to omit drains after gynecomastia surgery.

Management of neglected periorbital squamous cell carcinoma requiring orbital exenteration.

With its perineural invasion capacity, periorbital squamous cell carcinoma (SCC) may easily invade orbital structures. When SCC invades the orbital musculature or the orbit itself, orbital exenteration, one of the most disfiguring operations on the face, is required. We reviewed elderly patients with periorbitally localized SCC requiring orbital exenteration to evaluate reconstructive options and survival. A chart review of patients' records was conducted to identify all patients older than 65 years with periorbital malignancy requiring orbital exenteration from 2006 to 2011. A total of 9 patients who met the criteria were included in the study. The mean age at surgery was 77 ± 6.7 years, and the mean defect size was 74.2 cm2. All patients had a similar history of late presentation to a doctor because of hesitation to undergo surgery. The temporoparietal fascia flap, galeal flap, free gracilis flap, and free vastus lateralis musculocutaneous flap were the treatment options for reconstruction of the defects. All patients died during follow-up, and the mean survival was 15.7 months (range, 6-36 months). Only 2 of them had relapse before the death. Our small series suggest that elderly patients with periorbital SCC requiring orbital exenteration may not have enough survival to relapse because of the death from different causes without relapse or any sign of spreading cancer. Also, prolonged surgery with free flap reconstruction may increase the risk of postoperative intensive care unit requirement. Because local flaps may work very well for reconstructing the orbital exenteration defects, free flap option should be kept for selected cases.

Management of temporomandibular joint ankylosis with temporalis fascia flap and fat graft.

AIM: Temporomandibular joint (TMJ) ankylosis is a serious problem that restricts jaw mobility and causes disturbances in facial and mandibular growth. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis to decrease postoperative complications such as re-ankylosis. MATERIAL AND METHOD: Eleven patients who presented with ankylosis of the TMJ underwent surgical release. After performing gap arthroplasty through a preauricular approach, the temporalis fascia flap was transposed to the gap. An autogenous fat graft was then obtained from the abdomen and used as interpositional material. The follow-up time was 3-5 years. RESULTS: Re-ankylosis did not occur in any of the patients, and all had satisfactory mouth opening. CONCLUSION: Surgical treatment of TMJ ankylosis with gap arthroplasty, interposition of the temporalis fascia flap and fat grafting is an effective and easily procedure for preventing of re-ankylosis. The autogenous nature and close proximity to the joint are the main advantages of the temporalis fascia flap when compared with other interpositional materials, and the fat graft provides additional support by reducing pressure.

Rhabdomyosarcoma in an adult hand.

Rhabdomyosarcoma (RMS) is a malign tumour which arises from cells committed to a skeletal muscle lineage. It constitutes 4%-8% of all childhood malignancies but is rare in adults. The rare pleomorphic subtype occurs almost exclusively in adults and most often involves the extremities. RMS of the hand or foot comprise a minority of extremity cases. An adult patient with rhabdomyosarcoma in the hand, which is very rare, is presented in this article. General characteristics of the tumour and the treatment strategies are discussed.

Nonequilibrium magnetic properties in a two-dimensional kinetic mixed Ising system within the effective-field theory and Glauber-type stochastic dynamics approach.

Nonequilibrium magnetic properties in a two-dimensional kinetic mixed spin-2 and spin-5/2 Ising system in the presence of a time-varying (sinusoidal) magnetic field are studied within the effective-field theory (EFT) with correlations. The time evolution of the system is described by using Glauber-type stochastic dynamics. The dynamic EFT equations are derived by employing the Glauber transition rates for two interpenetrating square lattices. We investigate the time dependence of the magnetizations for different interaction parameter values in order to find the phases in the system. We also study the thermal behavior of the dynamic magnetizations, the hysteresis loop area, and dynamic correlation. The dynamic phase diagrams are presented in the reduced magnetic field amplitude and reduced temperature plane and we observe that the system exhibits dynamic tricritical and reentrant behaviors. Moreover, the system also displays a double critical end point (B), a zero-temperature critical point (Z), a critical end point (E), and a triple point (TP). We also performed a comparison with the mean-field prediction in order to point out the effects of correlations and found that some of the dynamic first-order phase lines, which are artifacts of the mean-field approach, disappeared.

Contact with wet cement: an unrecognized cause of chemical burn.

Chemical burns account for a small percentage of admissions to burn units. Wet cement is a poorly recognized cause of chemical burn. As the construction industry is growing, individuals will likely have more contact with this material and be more prone to its harmful effects. Wet cement can cause severe full-thickness burns with prolonged contact, but this property is not well known among professional users. The lack of information about the potential hazards of wet cement makes it an important problem that must be considered more seriously as a risk factor for chemical burn. Increasing public knowledge of the necessary preventive measures is crucial for avoiding this type of chemical burn injury. Here, we report a case with full-thickness burn that occurred while working with wet cement without proper protection.

Critical lines for an unequal size of molecules in a binary gas-liquid mixture around the van Laar point using the combination of the Tompa model and the van der Waals equation.

We combine the modified Tompa model with the van der Waals equation to study critical lines for an unequal size of molecules in a binary gas-liquid mixture around the van Laar point. The van Laar point is coined by Meijer and it is the only point at which the mathematical double point curve is stable. It is the intersection of the tricritical point and the double critical end point. We calculate the critical lines as a function of χ(1) and χ(2), the density of type I molecules and the density of type II molecules for various values of the system parameters; hence the global phase diagrams are presented and discussed in the density-density plane. We also investigate the connectivity of critical lines at the van Laar point and its vicinity and discuss these connections according to the Scott and van Konynenburg classifications. It is also found that the critical lines and phase behavior are extremely sensitive to small modifications in the system parameters.

Formation of osteocartilaginous exostosis resulting from the raising of a lateral supramalleolar flap.

An osteocartilaginous exostosis developed in a 4-year-old boy in whom a distally-based lateral supramalleolar adipofascial flap had been used to cover a defect in the dorsum of the foot. The bony exostosis was first noticed four months after the operation. It was excised with no complications and there has been no recurrence after two years follow-up. The exostosis was thought to result from stripping the perichondrium over the epiphyseal plate while the flap was being raised. This unique complication has not to our knowledge been reported after harvest of a flap before.

Efficacy of bipolar release in neglected congenital muscular torticollis patients.

Surgical correction of the congenital muscular torticollis (CMT) is recommended for patients with unsuccessful conservative treatment. The aim of this study is to evaluate the efficacy of surgical release of congenital muscular torticollis in neglected cases. We retrospectively evaluated the data of our patients in terms of age, sex, clinical presentation, localization of the lesion, diagnostic tests, and additional abnormalities. The age at operation ranged from 6 to 23 years. Complete muscular release as determined by pre-operative and postoperative range of motion measurements was achieved in all of the patients by bipolar release. In this study, neck motion and head tilt showed marked improvement with surgical treatment in cases with CMT who were admitted to the hospital lately. Congenital muscular torticollis patients can benefit from surgical intervention above the age of 5. Bipolar release is an adequate and complication-free method.

Systematic investigation of global phase behavior of polymer mixtures in the pressure-temperature plane.

We investigate the critical lines of polymer mixtures in the presence of their vapor phase at the mathematical double point, where two critical lines meet and exchange branches, and its environment. The model used combines the lattice gas model of Schouten, ten Seldam and Trappeniers with the Flory-Huggins theory. The critical line structure is displayed for various combinations of the chain length and system parameters in the pressure (P)-temperature (T) plane, as is usually done with experimental results. This type of work sheds light on the essential transition mechanism involved in the phase diagram's change of character, such as multi-critical points and mathematical double points, which are of great practical importance in supercritical fluid extraction processes. The P, T diagrams are discussed in accordance with the Scott and van Konynenburg binary phase diagram classification. We found that our P, T plots were in agreement with type II, type III, or type IV phase diagram behaviors. We also found that some of our phase diagrams represent the liquid-liquid equilibria in polymer solutions and mixtures.

Extensor tendon rupture due to cutaneous leichmaniasis: a case report.

Acute cutaneous leishmaniasis is a parasitic infectious disease prevalent in tropical areas. Most doctors in non-endemic countries are not familiar with this disease. Spontaneous tendon ruptures occurring by different mechanisms have been described in the literature but a tendon rupture caused by a skin ulcer secondary to a parasitic infection has not been reported before. In this article clinical and diagnostic features of cutaneous leishmaniasis are reviewed and a case with spontaneous extensor tendon rupture due to cutaneous leishmaniasis is presented.

Preventing negative effects of smoking on microarterial anastomosis.

Although microsurgery has rapid expanded, problems related to microarterial anastomosis continue. Cigarette smoking is one of the major risks for anastomosis by increasing platelet adhesion, and its effects on endothelial cells. Aim of this article is to study the negative effects of cigarettes on microarterial anastomosis line, and to investigate the protective effects of recombinant human erythropoietin (rHuEPO).Ninety-six Sprague-Dawley male rats were divided into 3 groups: group 1 was the control. Rats in groups 2 and 3 were exposed to cigarette smoke starting 21 days prior to surgery for 3 times a day. In group 3, additional 150 IU/kg rHuEPO was given via subcutaneously every 48 hours after microvascular anastomosis, femoral arterial samples, and blood samples were taken for assessment at 1st, 3rd, 5th, and 7th day. Intimae/media ratios were calculated for morphologic analyses.On morphologic analysis of femoral arteries there were statistically significant differences for all 3 groups at 1st, 3rd, 5th, and 7th days (P < 0, 05). The group that made differences was group 2, according to one-way analysis of variance within 3 groups in all days.Smoking decreases endothelial cells healing and causes more thromboses. rHuEPO can prevent these negative effects of smoking.