The Effect of Botox on the Implant Stabilization and Capsular Formation: An Experimental Study.

BACKGROUND: Breast augmentation is one of the most common esthetic procedures with increasing frequency throughout the past years. The most demanding complications involving esthetic and reconstructive breast surgery are the malpositioning of the implant and capsular contracture. The etiology, prevention, and management remain to be fully explained. Botulinum toxin (BTX) administration has anti-inflammatory effects that can possibly decrease capsular contracture, and chemical denervation of the pectoral muscle theoretically may decrease incidence of malrotation. In our literature search, we found only 1 clinical study using BTX A for capsular contraction, and there were no experimental studies about the implant stabilization and capsular contracture. Therefore, we have studied the effect of BTX A on the prevention of breast implant malrotation and capsular contracture in a rabbit model. METHODS: Sixteen smooth-surfaced cohesive gel implants were implanted in 8 New Zealand white rabbits. The backs of the rabbits were divided into 2 groups. After skin incision, the exposed latissimus dorsi muscle was elevated, and a submuscular pocket was made. In the experimental group, Botox was injected in the muscle overlying the implant. In the control group, the implants were placed under the muscle, and saline was injected into the muscle. At the end of 3 months, the rabbits were imaged and evaluated by ultrasonography and x-ray to examine capsule formations and the movement of the implants. The animals were killed, and the implants with peri-implant capsule were excised. We evaluated collagen pattern and capsule thickness on ventral, lateral, and dorsal aspects. RESULTS: The Botox group showed less infiltration of inflammatory cells at the third month (P < 0.05). Statistically significant differences in capsular thickness were observed on histopathological examination and ultrasonographic imaging. The capsule was thinner on all aspects and the collagen pattern had a more parallel alignment at low density in the experimental group compared with the control group. With x-ray, we observed an increased lateral movement of the implants in the control group. CONCLUSIONS: The use of Botox effectively decreased implant movement and capsular formation at 12 weeks. More experimental and clinical studies will be required to determine whether this is a durable result that can be reproduced in humans.

Penile strangulation and necrosis due to condom catheter.

Condom catheters are often used in the management of male urinary incontinence, and are considered to be safe. As condom catheters are placed on the male genitalia, sometimes adequate care is not taken after placement owing to poor medical care of debilitated patients and feelings of embarrassment and shame. Similarly, sometimes the correct size of penile sheath is not used. Strangulation of penis due to condom catheter is a rare condition; only few such cases have been reported in the literature. Proper application and routine care of condom catheters are important in preventing this devastating complication especially in a neurologically debilitated population. We present a case of penile necrosis due to condom catheter. We will also discuss proper catheter care and treatment of possible complications.

The effects of botulinum toxin A on the wound and skin graft contraction.

OBJECTIVE: In the current study, we investigated the efficiency of botulinum toxin-A (BTX-A) on wound and skin graft contractions. METHODS: Thirty adult female Wistar rats weighing 150 to 200 g were used. The rats were divided into 2 groups. As each rat in these groups underwent 2 different procedures, those groups also were divided into 2 subgroups. Group 1 (n = 15) was assigned as the control group. Pair of full-thickness skin grafts of 40 × 20 mm was harvested from the 2 sides of the dorsal regions of the rats. The full-thickness skin graft harvested from the left side was readapted (Group 1A), and the right side was left as an open wound (Group 1B). The rats in the second group (n = 15) underwent the same procedures and botulinum toxin-A (BTX-A) 0.5-international unit injection to the graft area (Group 2A) and open wound area (Group 2B). RESULTS: A decrease in the amount of the contraction was observed in the groups, which underwent BTX-A injection. In the histologic examination, it was observed that inflammation and collagen amount was higher, and the arrangement of the collagen was different in the groups, which underwent BTX-A injection. CONCLUSIONS: It has been determined that BTX-A injection reduces wound and graft contraction, and also, it is effective on reducing the amount of sebaceous cells and hair follicles.

Versajet hydrosurgery system in the debridement of skin necrosis after Ca gluconate extravasation: report of 9 infantile cases.

OBJECTIVE: The aim of the study was to evaluate the results of debridement with Versajet hydrosurgery system in patients with skin necrosis after ca gluconate extravasation. METHODS: We evaluated nine infants (mean age: 26 days; range: 1 day to 3 months) with calcium gluconate extravasation injury. Site of injury was the foot in 3 cases, the hand and wrist in 5 and the scalp in one. In all patients the skin necrosis was debrided with Versajet hydrosurgery system under general anesthesia without damaging the dermis layer. RESULTS: Following debridement all wounds healed spontaneously by re-epithelization and the mean time of full epithelization was fourteen days. No patient required a second debridement. At a minimum follow-up of 1 year minimal scar formation was noted and there was no hypertrophic scar. CONCLUSION: Versajet hydrosurgery system appears to be effective in the debridement of skin necrosis due to ca gluconate extravasation in pediatric population.

A hydrosurgery system (Versajet) with and without hydrogen peroxide solutions for the debridement of subacute and chronic wounds: a comparative study with hydrodebridement.

OBJECTIVE: The aim of this study was to evaluate the efficacy of hydrosurgery prepared with or without hydrogen peroxide for the management of subacute and chronic wounds. METHODS: This is a retrospective study on patients with infected subacute and chronic wounds. The wounds were debrided using hydrosurgery prepared with (the study group) or without hydrogen peroxide before grafting the wound (the control group). RESULTS: There were 60 patients in the study group and 70 patients in the control group. The hospital stay (mean, 7.83 [SD, 2.16] vs 9.86 [SD, 3.41] days; P < .001) and graft viability (mean, 3 [2-3] vs 2 [2-3]; P = .001) were significantly better in the study group than in the control group. The difference of hemoglobin levels after surgery was also significantly lower in the study group (0.1 [0-0.48] vs 0.45 [0-1]; P = .004). CONCLUSIONS: Encouraging results were obtained with the use of the hydrosurgery system prepared with hydrogen peroxide for infected subacute and chronic wounds. This method decreased hospital stay and bleeding, thus providing better contact of the skin graft with the wound bed, allowing early rehabilitation. The findings of the authors' study need to be substantiated in large-scale randomized controlled trials.

Unusual burn injury due to application of white vinegar and aspirin mixture.

Traditional medicine remedies are believed to provide relief from pain; nevertheless, it can be a risky procedure if these remedies are prepared inappropriately. Here, we describe a patient who suffered from a split-thickness leg burn after applying a self-inflicted mixture consisting of white vinegar and aspirin prepared for knee pain. This case report highlights a rare cause of a chemical burn that could become more common with increasing use of traditional remedies worldwide.

Using bilaterally fascioperichondrial flaps with a distal and a proximal base combined with conventional otoplasty.

Prominent ears are the most common aesthetic abnormality of the external ear. Mustardè sutures and conchal setback are usually used for otoplasty, additional various cartilage-manipulation methods are also presented. One adjunctive technique that is often used involves the elevation of a fascial flap beneath which is sutured for additional cover, potentially reducing the risk of complications and recurrence. In the literature, this flap is traditionally raised with a proximal or distal base but it can be raised both distally and proximally with a number of advantages as we demonstrate. This article presents a technique to raise the fascioperichondrial flap with both a proximal and a distal base as an addition to conventional otoplasty. One hundred consecutive patients, followed up for at least 12 months, have been reviewed. One hundred ninety otoplasties were performed in 100 patients (10 unilateral), 65 women and 35 men. The mean age was 20.6 years, and the mean follow-up time was 16.3 months, respectively. No patient has developed skin necrosis or suture extrusion. In two patients (One bilateral and one unilateral for a total of three ears) a further procedure has been required to improve symmetry (1.5%). Using the retro auricular fascioperichondrial flap combined with other techniques offers good results and can be used as a standard procedure in the surgical treatment of prominent ears.

Rare complication after VAC therapy in the treatment of tissue defect due to surgical excision of pilonidal sinus.

BACKGROUND: Pilonidal sinus is frequently managed with surgical incision. If the wound is left open to heal by secondary intention, negative pressure wound therapy (NPWT) is often used to promote healing. CASE: We describe the case of a 60-year-old patient referred after excision of a pilonidal sinus, which was managed postoperatively with NPWT. Unfortunately, the patient developed squamous cell carcinoma, which was undetected postoperatively, as the dressing was left in place for 5 days. CONCLUSION: Guidelines for the use of NPWT should be followed, with dressing intervals at 2 to 3 days. Wounds managed by NPWT should be monitored carefully for malignancy at the time of dressing changes.

2-octyl-cyanoacrylate glue for fixation of STSG in genitourinary tissue defects due to Fournier gangrene: a preliminary trial.

BACKGROUND: In these reported cases, we observed the outcomes of skin take and wound healing using 2-octyl-cyanoacrylate glue, which was used as tissue glue in the reconstruction of complex genital skin loss due to fournier gangrene. METHODS: Fifteen patients with Fournier's gangrene were treated in this study. After initial surgical debridement, all defects were repaired using STSG. In this method a thin layer of 2-octyl-cyanoacrylate was dripped on the recipient site immediately before graft application. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Patient and physician satisfaction were also determined. RESULTS: Grafts were completely accepted in all fifteen patients. None of the patients had wound infection, seroma, hematoma, or other complications. CONCLUSION: Use of 2-octyl-cyanoacrylate glue (Glueseal) for STSG fixation in complex genital skin defects after Fournier gangrene may be an acceptable alternative to conventional surgical closure with a good cosmetic outcome. Further studies are needed to confirm our initial success with this approach.

Comparing reduction mammaplasty specimens between superior and central pedicle techniques: a retrospective study.

UNLABELLED: The aim of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens in two retrospective series of patients operated using superior and central pedicle mammaplasties. Between November 2000 and December 2011, 60 consecutive patients (120 breasts) underwent breast reduction using the superior pedicle technique with a vertical scar (Lejour's technique). These patients were compared with another series of 80 patients (150 breasts) who underwent breast reduction using a vertical scar mammaplasty with a central pedicle (Copcu's technique). The characteristics of the patients were statistically similar between the two groups. Therefore, 140 patients who had undergone reduction mammaplasty were analyzed with respect to their histologic diagnoses, age, and specimen's weight. In the superior pedicle technique, we found that 30% of these women had pathologic alterations in at least one of their breasts, whereas the pathologic changes in patients who underwent Copcu's technique were 35%. In terms of tumor diagnosis, the upper quadrant excision technique (e.g. Copcu's method) may be safer. If there is no other special condition, it is better to use the pedicle technique in which the upper lateral and upper medial pole is removed. LEVEL OF EVIDENCE: Level I, therapeutic study.