Avulsion Thighplasty: Technique Overview and 6-Year Experience.

UNLABELLED: When choosing a thigh lift operation, the surgeon also chooses which complications he/she will be managing, and the most dreaded after conventional thigh lifting are those of lymphatic origin such as lymphocele or lymphedema. The authors describe avulsion thighplasty, a technique that spares lymphatics by using aggressive liposuction beneath the planned resection area, and thus minimizes lymphatic complications. The technique is outlined and complications are detailed over a 6-year period with long-term follow-up. The risk of major complications is found to be low and the procedure is found to be safe. Patients must be counseled that the risk of minor complications, such as small wound dehiscence or need for a later scar revision, is substantial. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Avulsion brachioplasty: technique overview and 5-year experience.

BACKGROUND: Popularity of arm-contouring procedures, once coveted by the massive weight loss population, has grown among society at large. The technique has evolved with the goal of producing a predictable and thin scar in a location that is acceptable for interpersonal interaction. METHODS: All consecutive brachioplasty patients from May of 2008 to May of 2013 were reviewed retrospectively at a private surgery center. Data collected included age, body mass index, amount of fat removed by liposuction, weight of resected tissue, hematoma or seroma, wound dehiscence, revision procedures, and length of follow-up. RESULTS: The authors reviewed 44 consecutive brachioplasties over 5 years. Average age was 53 years and body mass index was 26. Average amount of liposuctioned fat was 342 ml per arm using 867 ml of tumescent and an average skin specimen weight of 90 g. The follow-up period averaged 446 days. Fourteen patients had wound dehiscence requiring dressing changes. There were no return trips to the operating room for serious concerns such as bleeding or infection. One patient had a seroma. Nine patients underwent scar revision within 1 year. Overall complication rate was 50 percent. Overall revision rate was 21 percent. CONCLUSIONS: Brachioplasty is a rewarding procedure with consistent results and low risk of major complications. The potential for minor complications is substantial, and patients should receive preoperative counseling regarding this risk. In the authors' 5-year study of consecutive patients, 50 percent of patients needed dressing changes for small-wound dehiscence or scar revision within 1 year. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Safety and efficacy of recombinant human bone morphogenetic protein 2 on cranial defect closure in the pediatric population.

BACKGROUND: Traditional reconstructive options for cranial defects include autogenous bone graft, bone substitutes, and synthetic materials. The established standard for repairing cranial defects is autogenous bone. However, young children do not have abundant donor sites for bone harvest, which leads to challenges in closing calvarial defects. Synthetic materials are not ideal alternatives because they require subsequent retrieval and are prone to infection. Their long-term effects on growth of the skull are also not well studied. Bone morphogenetic protein 2 (BMP-2), are shown to positively affect closure of cranial defects in animal models. We present a study comparing the efficacy and safety of closure of cranial defect with bone graft augmented with recombinant human BMP-2 (rhBMP-2) and compared with a series of patients treated with bone graft alone. METHODS: This study is a retrospective multicenter evaluation of 36 patients spanning 5 years. Twenty-one patients undergoing cranial defect closure augmented with rhBMP-2 were compared with 15 patients who underwent cranial defect closure using cranial bone shavings alone. We measured preoperative and postoperative defect size on volumetric computed tomographic scan reconstructions to compare defect sizes. RESULTS: The rhBMP-2 group had slightly increased proportional closure compared with the control group, 86% versus 76% (P < 0.018), respectively. Two patients in the rhBMP-2 group had postoperative fusion of a suture that was known to be patent at the time of cranial defect closure. No instances of brain edema, herniation, airway compromise, or other adverse effects directly attributable to rhBMP-2 were observed. CONCLUSIONS: Bone morphogenetic protein 2 may increase the amplitude and uptake of cranial bone grafts in cranial defect closure. This study shows that defect sizes of up to 16 cm can be reliably closed using this technique. Postoperative fusion of uninvolved sutures in 2 patients indicates that rhBMP-2 may have unreported adverse effects; consideration of this finding should be weighed against the benefit of improved closure of calvarial defects.