The use of buflomedil in reduction mammaplasty for a previously irradiated breast: a case report.

In recent years, lumpectomy combined with breast irradiation and chemotherapy, as a part of conservation therapy for breast cancer, has well-established results. Little has been published on reduction mammoplasty for breast-irradiated patients. These patients have increased risks of nipple necrosis, wound complications, and delayed healing. Breast reduction techniques that rely on minimum skin undermining combined with the use of buflomedil may prevent major postoperative complications in breast-irradiated patients. Buflomedil was administered intraoperatively and for 14 days after the procedure. The use of buflomedil in reduction mammaplasty for a previously irradiated breast patient has not been heretofore described. The case of a 58-year-old woman who underwent bilateral breast reduction after breast conservation therapy is reported.

"Train surfers": analysis of 23 cases of electrical burns caused by high tension railway overhead cables.

The term "train surfers" describes a group of adolescents from the outskirts of the city of Rio de Janeiro, who are compelled by the overcrowded railway trains to travel on the roofs of the wagons. Collision with electrical high-tension wires is a relatively frequent occurrence, causing extensive and complex injuries. This study analyzes this clinical and surgical phenomenon which has caused over 100 fatalities in more than 200 registered accidents over the past 10 years.

Contour surgery in the patient with great weight loss.

Obesity can be defined as a chronic disease in which there is excess of body adiposity, leading to severe secondary health problems. This metabolic pathology shortens life-span and is a main cause of diabetes, atherosclerosis, systemic arterial hypertension, and reduction of pulmonary function, among others. The plastic surgeon is involved with the obese patient under two circumstances: either the patient is currently overweight and requests reduction of excess adipose tissue, or has suffered a great weight loss and desires correction of one, or more, contour deformities. In either case, planning demands a close preoperative analysis and careful preparation of the patient, execution of a meticulous surgical routine, and close postoperative follow-up. In this article, various body contour deformities will be addressed, showing the senior author's strategy in treating the obese patient that has achieved the loss of considerable weight.

Numerical modeling of facial aging.

Facial aging is a biological phenomenon. Skin properties change with time, and gravity and facial expressions exert mechanical deformation. Knowledge of these alterations may suggest ways to reverse them by identifying the corresponding distortional forces. The aim of this study was to determine a pattern of change for parameters of the face during the aging process, based on the numerical fitting of measures from a sample of patients. The first aspect of this study was to define adequate facial parameters and means of measuring them. Subsequently, each parameter was defined individually, and these data were analyzed as a set. The sample for the research was restricted to a group of 40 white female patients with a history of limited exposure to the sun, with ages ranging from 25 to 65. The reason for choosing this sample was the availability of frontal pattern photographs at different ages. The parameters for each patient were measured at two different ages. A strong correlation was found between age and behavior of the parameters. This aging model can be verified qualitatively by comparing photographs of a patient with manipulated photographs simulating aging. The quantitative verification of the model was done through the comparison of the measured and the predicted parameters.

Rejuvenation of the brow.

Aging of the upper face is a frequent complaint in patients seeking a more youth appearance. Sometimes muscle dynamics are excessively forceful and cause marked lines of expression relatively early in life. Regardless of chronologic age, it is imperative that the surgeon perform a problem-oriented, detailed analysis of the face and each subunit, so that imperfections can be individually assessed as they apply to the harmonic balance of the whole face. Various factors, such as degree of eyebrow ptosis, vertical dimension of the forehead, preexisting scars, and level of hairline, will determine the best approach to surgical correction of the aging brow. In the authors' opinion treatment of the forehead, when done together with a rhytidectomy, requires previous blocking of the cervicofacial flaps so as not to distort important anatomic landmarks when traction is applied to the frontal flap, respecting the patient's desire for a natural aesthetic result.

Fat grafting of the buttocks and lower limbs.

This article presents the senior author's experience in fat grafting for the treatment of contour deformities of the buttocks and lower limbs. This method has been termed liposculpture and consists in removal of adipose tissue by cannula and syringe and cleaning of the aspirated material with saline. All external contact is thus carefully avoided, preventing contamination. Fat grafting is done in multiple tunnels in a deep plane. Total of 140 patients were treated over the last 5 years and results were considered uniformly satisfactory. Fat absorption was estimated by clinical evaluation to be less than 20% volume. A low rate of complications (less than 3%) supports the authors' opinion that this is an efficient and safe procedure to correct or enhance contour deformities of the lower limbs.

Surgical treatment of hemangiomas of the nose.

The approach to a rapidly growing vascular tumor is determined by a number of objective and subjective factors. As a rule, treatment of a hemangioma in an infant is usually delayed, in the expectation that involution will be complete. While most hemangiomas are harmless vascular marks, some may grow to become large, infiltrating masses. Local factors that influence treatment decision making include volume, ulceration, secondary infection, and bleeding of the tumor. Hemangiomas situated on the nose are distinguished from other locations by a few but important aspects and may demand a more aggressive position from the surgeon. An important consideration is the potential for aplasia of the delicate nasal cartilages that are undergoing development, due to the mass effect of the tumor. Nasal tip hemangiomas are slow to regress, and contour deformities result from the fibrofatty tissue that invariably remains even after total involution. More importantly, hemangiomas of the nasal region are particularly prone to causing great social distress to the parents, who will request prompt treatment for such a visible, deforming lesion. A definite solution that ensures removal of affected tissue and preservation of anatomy seems to be the best treatment for these tumors. In this article, the experience of the senior author (IP) in treating hemangiomas located on the nose is reviewed. The elliptical midline incision over the nasal dorsum described in the text was developed to address three important aspects: an expedient procedure to treat a highly disfiguring disease; an open access to allow for complete resection and, at the same time, allow for the correction of underlying cartilaginous disruption; and placement of a scar in an anatomic location proven to be very satisfactory aesthetically, permitting access for secondary procedures for better definition of nasal contour. Careful patient selection for this surgical procedure is emphasized.

The surgical importance of the dermocartilaginous ligament of the nose.

The dermocartilaginous ligament of the nose, as first described by the senior author, has been shown to influence the equilibrium of the dorsum-tip relationship. In some noses, this is manifested by a residual convexity after routine rhinoplastic management of the osteocartilaginous structures. The anatomic findings are reported, and surgical considerations are analyzed. A system of classification based on the thickness of the ligament has been shown to be helpful in the intraoperative evaluation of this structure.

Body contouring.

Body contour surgery concerns the correction of diverse morphological abnormalities of the body which may occur due to various acquired and congenital etiologies. The concept of surgical body sculpting has achieved widespread recognition and acceptance because it safely alters such deformities yielding functionally aesthetic results. Several factors account for the current popularity of body contouring. Foremost among them, is the considerably increased exposure of the body which is seen in most modem cultures, particularly in warm climates. In no other period in the history of western civilization have men and women been so revealingly attired. In addition, today's competitive society strongly encourages the maintenance of a lean athletic body, as a symbol of good health, youth and vigor. The reality of achieving this physical ideal becomes increasingly less likely because of current sedentary lifestyles and dietary excesses. These factors combine to create a disturbing disequilibrium between an individual's desired condition and his actual state. Regular adherence to proper diet and exercise must be stressed, but unfortunately some of these deformities remain resistant to the most sincere of such efforts. Subsequently, there are increasingly greater numbers of people who seek surgical correction for specific abnormalities. Body contour surgery is also an important reconstructive tool in the correction of extremely lax skin in obese patients who have recently undergone dramatic weight loss.