The no-drain, no-quilt abdominoplasty: a single-surgeon series of 271 patients.

BACKGROUND: Recent innovations in abdominoplasty include progressive tension "quilting" sutures or Scarpa fascia preservation to limit the risk of seromas and hematomas. No-drain abdominoplasty with progressive tension sutures has been well documented. The authors describe outcomes in patients undergoing abdominoplasty with a modified surgical technique (including sub-Scarpa fascia fat preservation) and no use of drains or progressive tension sutures-the "no-drain, no-quilt" abdominoplasty. METHODS: A retrospective, single-surgeon (A.A.Q.), single-site analysis of all abdominoplasty patients from 2003 to 2012 was performed. Data were extracted from paper case notes. All patients underwent surgery carried out under general anesthesia. The operative technique and postoperative regimen are described. RESULTS: Two hundred seventy-one patients were identified over the 10-year period. Patients had a mean age of 45 years and mean body mass index of 27, and 98 percent were women. Concomitant abdominal liposuction was undertaken in 61 percent of all patients (165 of 271). Twenty-one patients (7.7 percent) had a seroma and five patients (1.8 percent) had a hematoma. Seven patients (2.6 percent) required a return to the operating room to manage complications, and 24 (8.9 percent) required elective revision. Patients were admitted for an average of 1.7 days, and mean follow-up was 6.2 months. CONCLUSIONS: Abdominoplasty can be performed safely without drains or quilting sutures/progressive tension sutures. Benefits are discussed in terms of the potential for reduced intraoperative time (compared with progressive tension sutures), and reduced patient discomfort and inpatient stay (compared with drain use). The authors demonstrate low complication and elective revision rates in their series. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Improving the quality of life in melanoma: the role of the CO(2) laser.

The cutaneous manifestations of late-stage melanoma can be distressing both physically and psychologically. In our department, we are sometimes referred a subgroup of patients where, despite adequate initial treatment, the disease manifests as cutaneous metastases that can be very symptomatic. The referring physician, having deemed other modalities of treatment inappropriate, may direct such patients to us at the regional laser centre for local control. Where no treatment option exists to cure or prolong life, very often, the simplest and safest option is the best. The CO(2) laser can be used to successfully ablate the lesions and be performed on a day-case basis. A worthwhile degree of palliation can be provided. As illustrated by three cases from our department, this form of treatment can be executed as and when required and results in an improved quality of life for these patients.

Lower limb reconstruction using the islanded posterior tibial artery perforator flap.

BACKGROUND: The islanded propeller-design posterior tibial artery perforator flap is a versatile local reconstructive option for defects of the lower leg, ankle, heel, and foot. METHODS: A retrospective review of patients undergoing this procedure from 1989 to 2009 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes. RESULTS: One-hundred six flaps were islanded on a single perforator from the posterior tibial artery in 100 patients (six bilateral). Seventy-two percent of defects were at the lower third of the leg, and 10 percent were at the ankle, heel, or foot. The median angle of rotation about the perforator was 160 degrees (range, 60 to 180 degrees). Eighty-eight percent of flaps had associated fractures, 60 percent were managed using intramedullary nailing, and 44 percent were Gustilo grade IIIb fractures. Five percent of patients subsequently developed osteomyelitis, and the primary nonunion rate was 9 percent. There was an 8.5 percent complete and 12 percent partial flap failure rate, both associated with cigarette smoking, diabetes, and peripheral vascular disease. Limb salvage for complete flap failures included free muscle flap transfer in six cases and below-knee amputation in three cases. CONCLUSION: The islanded propeller-design posterior tibial artery perforator flap provides reliable coverage of lower limb defects, particularly of the lower third.

Sturge-Weber syndrome and dermatomal facial port-wine stains: incidence, association with glaucoma, and pulsed tunable dye laser treatment effectiveness.

BACKGROUND: Laser therapy is the optimal approach for treating port-wine stains, but whether it is effective for patients with facial dermatomal port-wine stains and Sturge-Weber syndrome is undetermined. This project aimed to verify the incidence of Sturge-Weber syndrome and glaucoma within the population, compare the response in syndromic and nonsyndromic patients with facial dermatomal port-wine stains to laser, and determine the treatment response in relation to dermatome and color. METHODS: The authors retrospectively reviewed 874 patients with facial port-wine stains (203 displayed a dermatomal pattern). Pretreatment and posttreatment photographs were assessed clinically and recorded on a statistically reliable percentage gradient. RESULTS: Sturge-Weber syndrome was diagnosed in 30 patients. Twelve patients had glaucoma, with the port-wine stains involving the ophthalmic (V1) division of the trigeminal nerve. The highest proportion of patients with glaucoma came from those with involvement of the maxillary (V2) and/or mandibular (V3) division of the trigeminal nerve. No patients had Sturge-Weber syndrome with V3 port-wine stains alone. After laser therapy, only 45 percent of syndromal patients and 55 percent of nonsyndromic patients had a satisfactory outcome (>50 percent) in color and size reduction of dermatomal port-wine stains. CONCLUSIONS: The incidence of Sturge-Weber syndrome was 3 percent in patients with a facial port-wine stain. There was an increased risk of Sturge-Weber syndrome with involvement of V1 port-wine stains and no risk with involvement of V3 port-wine stains alone. Laser treatment produced unsatisfactory outcomes in patients with facial dermatomal port-wine stains. V3 port-wine stains responded best and V2 worst to laser.

The management of periorbital fat excess in haemangioma involution.

Haemangioma of infancy is a common birthmark. As spontaneous involution is the rule, it is usually treated conservatively. Periorbital haemangiomata may require intervention if symptomatic and this may be early or late, where plastic surgery may be required. It has not previously been recognised that deep periorbital lesions may lead to a baggy appearance of the eyelids because of excess fatty tissue. The management of this condition is described in different clinical presentations illustrated by three female patients with a history of infantile periorbital haemangioma. Two were treated by blepharoplasty, during which an excess of fatty tissue was found, deep to the orbital septum. Birthmark stigmata were eradicated and symmetry was achieved.