Effects of Fatigue and Sleep Deprivation on Microvascular Anastomoses.

Previous studies have investigated the effects of various human-based factors, such as tremor, exercise, and posture, on microsurgical performance. In this study, the authors investigated the effects of sleep deprivation and fatigue on microsurgery. A total of 48 Wistar Hannover rats were divided into 3 groups (16 anastomoses in each group) to be operated on at 3 different times: in the morning at 08:00 hours (group I), at night on the same day (01:00 h, group II), and the next morning at 09:00 hours (group III) following a night with no sleep. The blindly evaluated parameters were anastomotic times, error score (ES), global rating scale (GRS), autopsy scores (ASs), and patency. There was progressive decrease in the anastomosis times between the groups (P > 0.05). The patency rates were 93% in group I, 81% in group II, and 81% in group III (P > 0.05). The ES (P < 0.01), AS (P < 0.001), and GRS (P < 0.001) revealed significant results. Comparison between the groups showed that other than the anastomosis time, the night group (group II) showed a significant drop when compared with the preceding morning group (group I) (ES P < 0.01, AS P < .001, and GRS P < 0.001). In most of the parameters, the errors occurred with fatigue after the day and reached a maximum at the end of the day (group II). This study provides valuable data that might have significant medicolegal implications for controversial issues. More studies, however, including multiple surgeons with different experience levels, might be required to fully elucidate the overall effects of fatigue and sleep deprivation on microsurgery.

The Use of Dermabrasion to Achieve Natural-Looking Areolas Following Breast Reduction or Mastopexy: A Study of 23 Patients.

BACKGROUND: Although obtaining symmetrical breasts with good projection and a correctly positioned nipple-areola complex are the main objectives after breast reduction (BR) or mastopexy (MP), the importance of areola esthetics should not be underestimated. In this study, the authors discuss the use of dermabrasion for another purpose, which is to achieve a more natural areola with a smooth, natural border and depigmentation. METHODS: Twenty-three patients who had undergone BR surgery (18) or MP (5) between 2012 and 2014 were included in the study. The mean age of the participants was 25.5 (range 19-43). Dermabrasion of the areola was performed using a diamond-type fraise to obtain a smooth transition from the border of the areola to the depigmented areola zones. RESULTS: The patients were followed up for 15 months on average (range 12-18 months). In a survey administered 1 year after surgery, the patients were asked to score their new areola on a scale of 0-10. The mean score was 8.6 (range 4-10). Three patients were re-operated due to the persistence of the sharp border due to insufficient dermabrasion. One patient had a hypertrophic scar and another had hyperpigmentation. CONCLUSIONS: Satisfactory and a more natural areola can be obtained using dermabrasion with few complications in BR or MP patients. Therefore, this technique may be considered a complementary procedure for motivated and voluntary patients ready to accept the disadvantages of a secondary procedure.

Transaxillary totally subfascial breast augmentation with anatomical breast implants: review of 27 cases.

BACKGROUND: The transaxillary route is a popular method of breast augmentation because it is associated with inconspicuous scars. The subfascial plane carries the advantages and decreases the disadvantages of subglandular and submuscular planes. In the technique described, the authors placed the implant totally subfascially to strengthen the advantages of the traditional subfascial plane. METHODS: Twenty-seven patients (50 breasts) were included in the study from 2009 to 2012. The mean patient age was 27.3 years (range, 19 to 32 years). An axillary incision was performed and the pectoralis major fascia was opened initially. With endoscopic assistance, the dissection continued craniocaudally underneath the fasciae of the pectoralis, serratus, and rectus abdominis muscles. Patients were followed up in terms of rippling, implant visibility, capsular contracture, and asymmetry. RESULTS: Patients were followed up for an average of 21 months (range, 7 to 28 months). Anatomical, textured, and cohesive gel implants were used, with a mean implant size of 235 cc (range, 180 to 300 cc). In terms of the Baker classification, only 16 percent of the patients had grade II capsular contractures. There were no cases of malpositions, wrinkling, or rippling. Overall satisfaction was quite high (96 percent), and none of the patients required an implant removal or change. CONCLUSIONS: A modification of the subfascial plane was demonstrated where the implants have been placed totally subfascially, in contrast to the traditional subfacial techniques. Satisfactory results have been obtained in terms of breast shape, nipple sensitivity, capsular contracture, and implant visibility. However, more long-term results are needed to evaluate the exact effect of total fascial coverage. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.