Combining Preservation and Structured Rhinoplasty: Septal Extension Grafts and the Interdomal Hanger.

Preservation rhinoplasty is a new philosophy in the field of rhinoplasty, focusing on preserving and reshaping nasal structures. However, the authors suggest some patients are not good candidates for preservation rhinoplasty. Patients with underprojected noses and thick skin need a septal extension graft for tip support and to achieve maximum tip definition. In this article, we describe a new technique to combine septal extension graft with the preservation of tip ligaments, called interdomal hanger. It allows the surgeon to benefit from increased tip support in rotation and projection. The technique consists of the preservation of the interdomal ligament, which is then stabilized above the septal extension graft working as a suspensory sling. With this technique, the surgeon can mix important steps of preservation rhinoplasty and benefit from the support of the septal extension grafts.

[Preoperative embolization of abdominal paraganglioma: case report]. / Embolização pré operatória no tratamento de paraganglioma abdominal: relato de caso.

Paragangliomas is a pheochromocytoma of extra adrenal localization. The case report is a male, 55 years old who presented symptoms of adrenergic hyperstimulation associated to an abdominal mass diagnosed as paraganglioma by a biopsy. Because of its size, localization and vascularization, an aortography with embolization of the nutrient branches of the tumor was done pre-operatively. Four days later, a surgical ressection was performed, and the tumor was adhered to the duodenum, infra-renal aorta and inferior vena cava. We believe that an angiographic study pre-operatively with embolization makes possible an analysis of the anastomosis and arterial supplement, making the ressecability of the tumor safer, although it seems the surgical intervention should have been done earlier.

Plication of the brachial fascia: an important step in dermolipectomy procedures of the arm.

BACKGROUND: Both the aging process and postobesity deformities of the upper extremities are associated with lipodystrophy, loss of muscular mass, weakening of the fascia, and skin laxity. Many different surgical procedures have been described to correct these deformities, but most of them have limitations, particularly with respect to postsurgical scarring. OBJECTIVES: The authors present a technique in which plication of the brachial fascia is performed before dermolipectomy in order to obtain greater flap advancement and limit tension on the final scars, thereby diminishing postoperative complications. METHODS: From 1997 to 2007, the authors retrospectively followed 41 female patients who had undergone brachial dermolipectomy procedures associated with plication of the fascia on the internal aspect of the arm. This technique permitted greater advancement of the entire thickness of the flap, creating a better support for the flap with larger skin resection. The distance between the two incisions was also shortened, reducing dead space between the two planes, the incidence of seromas, and tension on the suture line. RESULTS: The scarring complications caused by tension on the skin were eliminated. Therefore, our complication rate was low, with only three cases of small foci of dehiscence, two cases of seroma, and four cases of hypertrophic scars in certain areas. The mean follow-up period was seven years, during which 92% of the patients were pleased with their outcomes. CONCLUSIONS: The described surgical approach provided excellent overall extremity contour with favorable scars while simultaneously addressing axillary contour and forearm deformities when present.

Embolização pré operatória no tratamento de paraganglioma abdominal: relato de caso / Pré-operative embolization of abdominal paraganglioma: case report

Paragangliomas is a pheochromocytoma of extra adrenal localization. The case report is a male, 55 years old who presented symptoms of adrenergic hyperstimulation associated to an abdominal mass diagnosed as paraganglioma by a biopsy. Because of its size, localization and vascularization, an aortography with embolization of the nutrient branches of the tumor was done pre-operatively. Four days later, a surgical ressection was performed, and the tumor was adhered to the duodenum, infra-renal aorta and inferior vena cava. We believe that an angiographic study pre-operatively with embolization makes possible an analysis of the anastomosis and arterial supplement, making the ressecability of the tumor safer, although it seems the surgical intervention should have been done earlier.

Análise do comportamento histopatológico do melanoma fundamental para uma boa prática na cirurgia plástica / Histopathological melanoma behavior analysis fundamental for a good practice

Introdução: O cirurgião plástico trata pacientes com os mais variados tipos de lesões depele, sendo que invariavelmente se defronta com o melanoma, que constitui uma lesãomaligna de pele e mucosas e representa 3% a 4% das neoplasias malignas da pele. É ocarcinoma cutâneo mais agressivo. Método: Foram estudados 116 casos de melanomadiagnosticados no laboratório de patologia. Os dados obtidos em relação a gênero, idade,margens, espessura de Breslow, nível de clark, índice mitótico e presença ou ausência deregressão, e ulceração foram cruzados e analisados estatisticamente. Resultados: No estudo,67,2% dos pacientes correspondiam a mulheres e 32,8%, a homens. A idade média foi de56 anos. Não houve diferença de idade estatisticamente significante entre os sexos. Houvepredominância histológica do tipo difusão superficial com 62,7% e nodular com 18,1%. Nãohouve associação estatisticamente significante entre: regressão e índice BC, sexo e índiceBC, tipo histológico e regressão, tipo histológico e sexo, índice mitótico e tipo histológicodo tumor, invasão angiolinfática, margens livres ou comprometidas ou com presença ouausência de regressão (p > 0,005). Houve forte associação estatisticamente significante entreinvasão angiolinfática e índice Bc, tipo histológico e índice Bc, tipo histológico e invasãoangiolinfática, tipo histológico e ulceração, e na relação índice mitótico e índice Bc (p <0,005). Conclusão: O tratamento desta afecção necessita de um profundo conhecimento deseu comportamento histológico, pois baseado neste conhecimento é planejado o tratamentocirúrgico inicial, sendo possível prever o prognóstico e evolução da doença.

Introduction: The plastic surgeon often treats patients with the most varied types of skininjuries, and, undoubtedly faces the melanoma, which consist a malignancy of skin andmucosa and represents 3% to 4% of the malignant skin neoplasias. It is the most aggressivecutaneous carcinoma. Methods: Were studied 116 diagnosed cases of melanoma atthe pathology laboratory. The collected data concerning gender, age, margins, Breslow’sthickness, Clark’s level, mitotic index and presence or absence of regression, and ulcerationwere statistically analyzed and compared. Results: The patients corresponded 67.2%to women and 32.8% to men. The average age was of 56 years. There was no statisticallysignificant difference between the genders. There was a histological predominance of thesuperficial diffusion type with 62.7% and nodular with 18.1%. There was no statisticallysignificant association between: regression and BC index, sex and BC index, histological typeand regression, histological type and sex, mitotic index and histological type of the tumor,angiolymphatic invasion, free or implicated margins or with either presence or absence ofregression (p > 0.005). There was a statistically significant strong association between angiolymphaticinvasion and BC index, histological type and BC index, histological type andangiolymphatic invasion, histological type and ulceration, and in the relationship mitoticindex and BC index (p < 0.005). Conclusion: The treatment of this pathology demands aprofound knowledge of its histological behavior, as based on this knowledge the initial surgicaltreatment is planned, enabling foreseeing the prognosis and evolution of the disease.

Comparative study of the integration and viability of autonomised and nonautonomised autologous fat tissue grafts--experimental model in rabbits.

BACKGROUND: The free transplant of fatty tissue has gone through several phases of interest over the last 100 years of medical history, having undergone cycles of use and disuse. In the present study we aimed to create, through a delaying process, an improvement in the integration and lower resorption rates of autologous fat grafts. Similar research has not been found in the literature, and this was the motivating factor for the present study. METHODS: Twenty-three New Zealand male rabbits were used. The study consisted of two different modalities of autologous fatty tissue transplants [autonomised graft (A) vs nonautonomised grafts (NA)]. In order to characterise the histological differences that could contribute to the different macroscopic aspects in the samples of the autonomised and nonautonomised groups, three anatomic-pathological criteria were considered: steatonecrosis, viable adipocytes, and fibrous proliferation. For this analysis, the 'point-counting' technique proposed by Gundersen et al. was used, with a reticulum of 100 points and 50 lines. RESULTS: Statistically significant differences were found between the autonomised (A) and nonautonomised (NA) groups in both the macroscopic and microscopic aspects after the 6 month study period (P<0.05). CONCLUSIONS: We conclude that autonomisation of the fatty tissue and its transfer as an autologous implant, in rabbits, is capable of promoting lower rates of resorption and greater integration of the transplanted tissue, characterised by a greater number of viable adipocytes, lower rates of fibrosis and steatonecrosis in comparison with the nonautonomised graft.