Biologically Enhanced Hamstring Tendon Transfer for Treatment of Acute Rupture of Posterior Tibialis Tendon in an Athlete: Case Report.

We report the case of a 32-year-old basketball player who presented with an acute flatfoot deformity after performing a unipodal power jump. Rupture of the posterior tibial tendon within the foot was diagnosed and then treated by hamstring tendon transfer combined with application of autologous biologic preparations. The functional outcome at 18 months was good. To our knowledge, this is the first reported case of posterior tibial tendon rupture treated by hamstring tendon transfer.

Radiographic findings after breast augmentation by autologous fat transfer.

BACKGROUND: Fat transfer to healthy breasts, that is, in women with no history of breast disease, particularly breast cancer, is becoming increasingly popular. The main issue remains whether the transfer of fat cells to the native breast hampers breast imaging. This pilot study aimed to assess the effectiveness of radiographic evaluation after breast lipomodeling and to propose objective elements for the detection of mammographic signs, and for postoperative evaluation of breast density and Breast Imaging Reporting and Data System (American College of Radiology) classification. METHODS: The authors retrospectively reviewed the radiographic findings of patients undergoing breast lipomodeling between 2000 and 2008. A descriptive semiologic analysis was conducted. Then, the authors compared breast tissue density and Breast Imaging Reporting and Data System categorization in 20 patients with preoperative and postoperative images available for review. RESULTS: The descriptive analysis identified 16 percent of mammograms with microcalcifications, 9 percent with macrocalcifications, 25 percent with clear well-focused images of cystic lesions, and 12 percent with tissue remodeling. The comparative study showed no statistically significant difference between breast density findings before and after fat injection, whether using the American College of Radiology classification or a personalized rating system. Similarly, no significant difference was observed using the American College of Radiology Breast Imaging Reporting and Data System categorization before and after fat grafting. CONCLUSIONS: Radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure. However, the authors' preliminary results should be confirmed in larger series, and the radiographic follow-up of women undergoing breast lipomodeling should be standardized to ensure reproducibility and improve patient safety.

Breast reduction in gigantomastia using the posterosuperior pedicle: an alternative technique, based on preservation of the anterior intercostal artery perforators.

BACKGROUND: The purpose of this study was to describe and evaluate the outcomes of breast reduction in cases of gigantomastia using a posterosuperior pedicle. METHODS: Four hundred thirty-one breast reductions were performed between 2004 and 2007. Fifty patients of 431 (11.6 percent) responded to the inclusion criteria (>1000 g of tissue removed per breast (100 breasts). The mean age was 33.2 years (range, 17 to 58 years). The average notch-to-nipple distance was 37.9 cm (range, 35 to 46 cm). The mean body mass index was 27 (range, 22 to 35 cm). The technique of the posterosuperior pedicle was used, in which the perforators from fourth anterior intercostal arteries are preserved (posterior pedicle). Results were evaluated by means of self-evaluation at 1 year postoperatively. RESULTS: The average weight resected was 1231 g (range, 1000 to 2500 g). The length of hospital stay was 2.3 days (range 2 to 4 days). Thirty seven patients evaluated their results as "very good" (74 percent), nine as "good" (18 percent), and four as "acceptable" (8 percent). There were no "poor" results. The chief complaint was insufficient breast reduction (four patients), despite the considerable improvement in their daily life (8 percent). Back pain totally resolved in 46 percent and partially (with significant improvement) in 54 percent of cases. One major and seven minor complications were recorded. CONCLUSIONS: The posterosuperior pedicle for breast reduction is a reproducible and versatile technique. The preservation of the anterior intercostal artery perforators enhances the reliability of the vascular supply to the superior pedicle.