PULMONARY EMBOLISM AFTER ABDOMINOPLASTY - ARE WE REALLY ABLE TO AVOID ALL COMPLICATIONS? CASE REPORTS AND LITERATURE REVIEW.

Pulmonary embolism is a potentially lethal complication in plastic surgery patients. About 34% of the members of American Society of Plastic Surgery have diagnosed pulmonary embolism in their patients, and 7% had experienced at least 1 death due to this complication. The American Society of Plastic Surgeons Executive Committee approved the Venous Thromboembolism Task Force Report. The members agreed that there was not enough evidence to make all-inclusive recommendations for plastic surgery deep vein thrombosis and pulmonary embolism prophylaxis, but released the 2005 Caprini Scale accompanied by the Task Force recommendations for use in plastic surgery. It is generally strongly advised to use appropriate prophylactic measures against venous thromboembolism in all surgical procedures. However, even then we cannot completely avoid this serious complication.

The history and safety of breast implants.

Breast implants are medical devices used for augmentation of the breast, to reconstruct the breast after mastectomy and to correct breast asymmetry. The breast prostheses are likely the most frequently used medical implants. The evolution of modern silicone breast implants was not straightforward and is characterised with a lot of medical, forensic and public attention. Currently it is sufficiently established that implants are safe and can be used for breast reconstruction and aesthetic augmentation. Prosthesis can rupture and produce local symptoms but there is no evidence that silicone breast implants can be of any health hazards for the patients.

Haemophilia - unexpected complication of rhinoplasty.

Authors report a case of unexpected postoperative bleeding after an aesthetic rhinoplasty that was due to previously undiagnosed asymptomatic haemophilia.

Our eight-year experience with breast reconstruction using abdominal advancement flap (207 reconstructions).

There are many possibilities for breast reconstruction after mastectomy. The use of abdominal advancement flap in combination with silicone implant is among the less commonly used methods, although it is simple, fast and leads to excellent results. We started to use this technique at our department eight years ago. Since then we have performed 207 breast reconstructions using abdominal advancement flap in combination with silicone implants. We performed follow-up checks on the patients for between one and six years.

Abnormal scars, management options.

Scar management has always been important but never as much as today. People are now more aware of their scars, given the hype in the media about looking good. They are more likely than ever to seek treatment for scars from the cosmetic point of view. But scars can be problematic, they can itch and be uncomfortable and painful, they can be disfiguring and aesthetically unpleasant, and may cause sleep disturbance, anxiety, depression and disruption of daily activities. If they lay over the bone joint they can limit its function, so we should not always look at scars from the cosmetic point of view. This article aims to provide a physiological overview of wound repair, describing the options of therapy.

Synmastia--an unusual complication of augmentation mammaplasty.

Synmastia is a complication of breast augmentation which is not well known. It is a condition where the implants touch each other above the breast bone. In the article the authors describe not only the mechanism of its origination but also the opportunities for correction and the prospects of prevention. They illustrate formation of synmastia in a young woman with emphasis on probable causes and methods of its effective correction in their own case study.

Epidermal Keratinocytes May Have an Important role in Hypertrophic Scarring Pathogenesis: an Immunohistochemical Study (Using P63 and Ki-67 Staining).

The role of epidermal keratinocytes in the early phase of normal unimpaired wound healing has been extensively studied. However, little is known of the cell biological process in the epidermis and the role of keratinocytes in hypertrophic scar formation. This study investigated the possible role of p63 in the early phase of hypertrophic scarring pathogenesis. Nine skin samples were taken from nine patients during plastic surgery operations, as follows: 1. six samples from patients who on account of thyroid disease or other reasons presented risk factors (RFs) for hypertrophic scarring; 2. one sample from a healthy young person (as control); and 3. one sample from the upper eyelid during blepharoplasty and one sample from an elderly patient during breast reduction. All the patients were women, and were followed up clinically for 12 months. Skin specimens were cultured and sectioned, and analysed by histology and immunohistochemistry. In normal skin, nuclear p63 was abundantly expressed by the basal cells, but expressed by very low levels of transient amplifying (TA) keratinocytes covering the surface. TA keratinocytes, immediately after their withdrawal from the stem cell compartment, reduced p63, even though they possessed a proliferative capacity. In some skin, samples with RFs possessed a high level of p63 expression - not only basal stem cells but also four to five rows of parabasal cells. Four of the six skin samples with RFs showed significant epidermal abnormalities through the expression of both p63 and ki-67. Staining for ki-67, a marker for cell proliferation, revealed more increase in the suprabasal than in the basal keratinocyte proliferation rate. These results suggest that the epidermal keratinocytes may have an important role in hypertrophic scarring pathogenesis, using paracrine or epithelial-mesenchymal signalling. At 3, 6, and 12 months post-operation this finding clinically appeared in four patients with RFs.

Management of keloid and hypertrophic scars.

Scar management for the prevention of excessive scar formation has always been important but never so important as it is today. Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years. However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management have been hampered by confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar - only keloid is listed. Yet the medical and scientific literature distinguishes them as different conditions. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Our experience suggests that there is no single treatment for scars that is adequate and that clinical judgement is very important when considering treatment and balancing the potential benefits of the various treatments available. The goal of treating scars is to restore functionality, provide relief of symptoms, enhance cosmetics, and prevent recurrence. This article is based on our scientific and clinical experiences and focuses on over-the-counter options to manage keloid and hypertrophic scars.

[Breast reconstructions using thoracodorsal flaps according to Holmstrom--a fourteen-year experience]. / Rekonstrukce prsu torakodorzálním lalokem podle Holmströma--ctrnáctileté zkusenosti.

Breast reconstructions after completed mastectomies using fascio-cutaneous flaps in combination with silicone prostheses implantations, are considered routine breast reconstruction procedures. The authors present their fourteen-year experience with the breast reconstructions using the thoracodorsal flaps with the silicone prostheses.

[Giant cell angiofibroma of the lower eyelids]. / Giant cell angiofibrom dolních vícek.

The authors present a rare case of giant cell angiofibroma (GCAF) of the lower eyelids and the possibility of its surgical treatment. They emphasize the basic morphological indicators for assessment of GCAF and its difference from similar entities.

Reconstruction of the lower eyelid after excision of major tumours.

The authors report on a pretentious surgical procedure which is essential after excision of major tumours of the lower eyelid. They describe in detail the reconstruction of the lower lid in case of a 70% loss of the lid. They used Mustard's method during which the tarsoconjunctival defect was replaced by a mucochondral implant from the nasal septum. After suture of the implant the residual skin defect was covered by rotation of a cheek flap. A two-stage reconstruction of the lower lid was used in case of 95% excision of the width of the lid. In the first stage the authors transferred a tarsoconjunctival flap from the upper lid and covered the musculocutaneous part by a transplant of retroauricular skin. In the second stage they released the tarsoconjunctival flap with subsequent plastic surgery of the lower lid. In 100% loss of eyelid the authors used for replacement of the tarsus of the lower lid a mucochondral implant from the nasal septum and to cover the skin defect they used a bridge-shaped myocutaneous flap from the upper lid in the defect of the-lower lid.

Reduction mammaplasty at the Department of Plastic surgery in Prague.

The authors present a review of the history of surgery of hypertrophic breast at the Department of Plastic Surgery in Prague. The period from 1928 to the present time was divided into stages by the dominating surgical technique. The authors emphasize the importance of careful selection of the surgical procedure with regard to the type and grade of the defect.

Our experience with the technique of areolar rotation in reduction mammaplasty.

In the article, the authors present a relatively uncommon method employed for breast reduction and moulding in gigantomastia. They examine the benefits of the surgical technique based on areolar rotation with a wide superior-lateral dermal areolar flap. The authors point out the fact that postoperative blood supply to the areolas is very good while their sensitivity is preserved.

Breast reconstruction in women with Poland's syndrome.

The authors point to the considerable variability in the development of the mammary gland in Poland's syndrome cases. Using computed tomography they draw attention to some other anatomical deviations of the deeper-seated structures of the affected side of the chest. Finally, they discuss various techniques of breast reconstruction for hypoplasia or aplasia.