Platelet gel sealant use in rhytidectomy.

BACKGROUND: A prospective study was used to evaluate the efficacy of a commercially available platelet gel product as a sealant to decrease postsurgical drain fluid rates and volumes in patients who have undergone rhytidectomy procedures. Quantitative assessments of postoperative drain fluid outputs were compared in subjects who did and did not receive platelet gel treatment. METHODS: Autologous platelet concentrate was prepared from each subject (n = 19), combined with bovine thrombin to form a platelet gel, and applied during the rhytidectomy procedure. Surgical drains were placed and effluent was collected postoperatively at 8-hour intervals for 24 hours and the volumes were recorded. A retrospective examination of surgical drain output over time in subjects (n = 14) who did not receive platelet gel treatment was performed; this group served as the control group. RESULTS: Subjects who received the platelet gel sealant treatment had significantly decreased surgical drain fluid levels over 24 hours [109 +/- 8.5 ml (mean +/- SEM)] compared with subjects who did not receive the platelet gel sealant (78 +/- 7.5 ml) (p < 0.02). From 0 to 8 hours postoperatively, platelet gel-treated subjects had a mean 35 percent decrease in fluid levels compared with the controls (p < 0.03). No difference in surgical drain outputs was observed from 8 to 16 hours between the two experimental groups. From 16 to 24 hours, the control group had increased mean fluid levels (20 percent) and the platelet gel sealant group output levels decreased (50 percent). CONCLUSIONS: Platelet gel sealant treatment was associated with decreased surgical fluid drain output in the first 24 hours postoperatively.

In search of improved fat transfer viability: a quantitative analysis of the role of centrifugation and harvest site.

Fat grafting is an unpredictable procedure that continues to challenge the field of plastic surgery due to irregular resorption. Applications for this procedure are broad in both reconstructive and cosmetic plastic surgery. Fat grafts are carefully obtained and manipulated to obtain better graft takes and results, yet there is no universal agreement on what constitutes an ideal methodology. The present study examines adipocyte viability from four commonly used donor sites in five subjects. No statistical differences in adipocyte viability were demonstrated among abdominal fat, thigh fat, flank fat, or knee fat donor sites that were immediately removed and untreated (p < 0.225). In addition, no differences were observed in representative tissue samples that were removed and centrifuged (thigh, p = 0.508; knee, p = 0.302; flank, p = 0.088; abdomen, p = 0.533). On the basis of these quantitative data, neither harvest location nor centrifugation demonstrated any advantage in terms of lipocyte viability. Fat tissue transfers from these common sites may be considered equal, and centrifugation does not appear to enhance immediate fat tissue viability before implantation.

Is the umbilicus truly midline? Clinical and medicolegal implications.

A common misconception is that the umbilicus is a midline structure. To date, an anatomical survey examining whether the umbilicus is located at the midline has not been reported. This study measured the position of the umbilicus among 136 subjects, in two separate experiments. The results demonstrated that the umbilicus was not at the midline for nearly 100 percent of subjects and was more than 2 percent from the midline for more than 50 percent of subjects. This finding is of great importance for patient counseling in preoperative and postoperative settings. Because the discerning eye has repeatedly been demonstrated to be able to detect smaller asymmetries, these findings are significant and should be discussed with patients undergoing cosmetic abdominoplasty or reconstructive procedures, for preoperative informed consent. Education and preoperative demonstration can help prevent medicolegal ramifications. The umbilicus is rarely midline and, when critically analyzed, is located lateral to the midline axis more often than not.

Recurrent mammary hyperplasia: current concepts.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the factors leading to undesirable long-term reduction mammaplasty results. 2. Delineate the differential diagnosis of recurrent hypermastia. 3. Understand the significance of preoperative counseling, particularly with regard to expected postoperative outcome. 4. Understand short-term and long-term expected and undesirable postoperative results. 5. Understand safe and effective surgical planning for revision reduction mammaplasty. A large majority of patients who undergo reduction mammaplasty are satisfied with their aesthetic outcome and resolution of preoperative symptoms. Occasionally, patients present with postoperative concerns; these are usually aesthetic in nature and caused by breast scarring, breast asymmetry, and/or breast shape. Inadequate excision and recurrent hypermastia are more complex concerns, which require careful evaluation and treatment. Analysis of both the presenting deformity and the original surgical approach is critical in determining an operative plan. This article discusses the safe approach to revision reduction mammaplasty. Current concepts are discussed and presented. An algorithm for decision-making is presented and discussed.