Recognition and repair of an incidental umbilical hernia repair during abdominoplasty.

Introduction: Umbilical hernias are found in 2% of the American adult population with increasing prevalence in overweight and multiparous women. A mesh repair is considered to be a suitable option for those desiring non-cosmetic surgical repair. Despite the mesh plug's reported value in reduction of the recurrence of umbilical hernia from 11% to 1%, there is an increased risk in de-vascularizing the umbilicus with its use. Presentation of Case: We present a case which avoids fascial incisions near the umbilicus, thus preserving the blood supply employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication. Discussion of Case: Hernia repair can be associated with a host of issues, minor and major, including regional tissue ischemia and the distortion of natural anatomy, likely due to ischemia of the epigastric vessels. Abdominoplasty is a suitable option for patients with redundancy of the abdominal skin and laxity abdominal wall musculature. Abdominoplasty has excellent exposure and correction of abdominal wall hernias. This "anatomic repair" employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication can be used in place of a mesh overlay for the purposes of umbilical hernia repair especially when the hernia may be asymptomatic. Conclusion: Abdominoplasty uniquely allows for an open hernia repair when anticipated or discovered at the time of surgery and is considered a true anatomical repair of an umbilical hernia which does not necessitates the use of foreign materials.

Safety of a Protective Funnel in Primary Breast Augmentation: A Retrospective Analysis of 380 Multicenter Cases in the United States.

BACKGROUND: Protective funnel devices are commonly used to deliver implants in primary breast augmentation (BA) yet there is a paucity of evidence-based data describing their safety in the literature. OBJECTIVES: The purpose of this study was to assess the safety of protective funnels in primary BA within the first 30 days postoperatively. METHODS: This multicenter, Level 3 study retrospectively reviewed the surgical records of 380 consecutive patients (760 breasts) who underwent primary BA by 9 board-certified plastic surgeons using the iNPLANT Funnel (Proximate Concepts LLC, Allendale, NJ) for implant delivery between November 2019 and December 2020. Data were collected pertaining to demographics, implant information, surgery details, and postoperative complications. RESULTS: The mean patient age was 33 years and 76% of patients had a BMI <25 kg/m2. Of this cohort, 11.4% were smokers, 0.8% had diabetes, and 83% were ASA Class 1. All patients received smooth implants with a median volume of 375 cc. A total of 8 (2.1%) complications were reported, including 3 hematomas (0.79%), 1 seroma (0.26%), and 1 superficial infection (0.26%). No patient required explantation. We identified ASA class, BMI, surgery duration, and implant size as potential risk factors. CONCLUSIONS: The data suggest that the use of protective funnels, such as the iNPLANT Funnel, in primary BA is a safe option when these are utilized according to the manufacturer's Instructions for Use. The use of this device led to a low infection rate (0.26%) and a complication rate of (2.1%) consistent with the average reported in the literature (2%-2.5%).1 Implications for clinical practice are encouraging and future research will include a prospective analysis with a larger case series and potentially a control group.

Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck.

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

Large extended abdominoplasty-dispelling the myths of prohibitively high BMI's: a case report.

Abdominoplasty is one of the most highly requested cosmetic procedures in the USA. Although it is famed for its cosmetic value, there are few reports that discuss its therapeutic potential. Furthermore, few abdominoplasties are completed in patients over the body mass index (BMI) of 30 due to fears of increased complications. A 63-year-old male presented due to development of a large pannus following weight loss postgastric bypass. Unfortunately, because of this pannus, the patient began experiencing significant physical and emotional distress. The patient had difficult urinating, ambulating and could no longer engage in sexual activity. The patient underwent abdominoplasty for removal of the pannus. At the 5-month follow-up, patient exhibited resolution of his symptoms. Abdominoplasty should not be limited to cosmetic procedures. It holds therapeutic value, and the BMI should not be listed as a firm contraindication to the procedure.

Abdominoplasty for treatment of abdominal gun-shot wound sequalae - A case report.

BACKGROUND: Gun violence is a public health epidemic in the United States with 15,315 non-suicide related deaths reported in 2019 by the Gun Violence Archive. To date, abdominoplasty is primarily a cosmetic procedure, which involves low-lying incision, removal of excess skin, fat, and tissue, and strengthening of the abdominal wall musculature. There currently are limited reports in regard to abdominoplasty as a procedure for scar revision and abdominal deformity repair associated with gunshot related injuries. METHODS: An African American female patient, 38 years of age, presented for correction of a wide healed surgical incision and incisional hernia in the midline abdomen. This resulted from a trauma laparotomy in treatment of multiple gunshot wounds. RESULTS: Patient presented post-operatively with no complications. She had successful reduction of her incisional hernia using an anatomic repair. Her wide hypertrophic abdominal scar was excised and primarily closed. CONCLUSION: In the cases of abdominal hernia and scarring secondary to trauma laparotomies performed for gunshot wounds, abdominoplasty is an option for revision and repair.

Anatomic reconstruction for major tissue loss following abdominoplasty: A case report.

INTRODUCTION: Abdominoplasty is currently one of the most widely requested cosmetic procedures in the United States. There is limited literature describing the corrective measures following skin loss from a flap necrosis due to an abdominoplasty complication. METHODS: A 53-year-old female presented with a large split thickness skin graft due to skin loss as a necrotic complication from an abdominoplasty performed at our center. The patient suffered from emotional stress related to the abdominal deformity, which included a lack of an umbilicus. RESULTS: Patient recovered well post-operatively. She required two procedures - the initial procedure involved excision of the skin graft and closure with the patient's own full-thickness skin and tissue. The second procedure, which occurred six months later, involved the creation of an umbilical stalk from a small cuff of skin. CONCLUSION: Abdominoplasty, although sought for cosmetic purposes, is indeed a major procedure and can result in complications especially from aggressive liposculpture. When complications do occur, revisions are indeed possible with aesthetically pleasing results.

The "sweet science" of reducing periorbital lacerations in mixed martial arts.

The popularity of mixed martial arts competitions and televised events has grown exponentially since its inception, and with the growth of the sport, unique facial injury patterns have surfaced. In particular, upper eyelid and brow lacerations are common and are especially troublesome given the effect of hemorrhage from these areas on the fighter's vision and thus ability to continue. We propose that the convexity of the underlying supraorbital rim is responsible for the high frequency of lacerations in this region after blunt trauma and offer a method of reducing subsequent injury by reducing its prominence.

Reconstruction of long cervical esophageal defects with the radial forearm flap.

The radial forearm flap has been used for reconstruction of the cervical esophagus most often as a patch or for circumferential repair of short defects (less than 5 cm). In the following three cases, the radial forearm flap was used to reconstruct circumferential cervical esophageal defects ranging from 5 to 12 mm in length. These procedures were successfully carried out in three patients in whom the intraoperative defect was unexpectedly large or the intra-abdominal viscera harvest would have been difficult. These patients had reliable esophageal function 8 to 24 months after surgery. We conclude that the radial forearm flap can be used for reconstruction of large circumferential defects of the cervical esophagus.

Effect of vascular endothelial growth factor on rat Achilles tendon healing.

This study evaluated the effect of exogenous vascular endothelial growth factor (VEGF) on tendon healing and regulation of other growth factors in a rat Achilles tendon model. Fifty Sprague-Dawley rats were used. In the experimental group, the left Achilles tendon was transected and repaired with the modified Kessler suture technique, and the right Achilles tendon was transected and repaired with resection of plantaris tendon. VEGF, 100 mul (50 mug/ml), was injected into each tendon at the repair site. The same surgical procedures were performed in the control group, with the same volume of saline injected into the repair sites. At intervals of 1, 2, and 4 weeks, the animals were killed and the tendons were harvested and evaluated for tensile strength (1, 2, and 4 weeks) and gene expression (postoperative day 4). At 1 week postoperatively, when plantaris tendon was preserved, the tensile strength of the repaired tendons with VEGF treatment (3.63 +/- 0.62 MPa) was significantly higher than the tensile strength of the repaired tendons with saline treatment (2.20 +/- 0.36 MPa). There was no difference in tensile strength between the two groups without the plantaris tendon support. At 2 weeks postoperatively, the tensile strength was 11.34 +/- 3.89 MPa in the group with VEGF treatment and plantaris tendon preservation, which was significantly higher than the tensile strength in the other groups. There was no significant difference in tensile strength among the groups at 4 weeks postoperatively. The gene expression showed that transforming growth factor-beta in the VEGF-treated tendon was up-regulated in the early stage of tendon healing, whereas expression of platelet-derived growth factor, basic fibroblast growth factor, and insulin-like growth factor-1 was not significantly different among the groups. In conclusion, administration of exogenous VEGF can significantly improve tensile strength early in the course of the rat Achilles tendon healing and was associated with increased expression of transforming growth factor-beta.

Reconsidering the soleus muscle flap for coverage of wounds of the distal third of the leg.

Traditionally, cross-leg flaps and microsurgical flaps have been used to reconstruct defects of the distal third of the leg. In the authors' experience, the soleus muscle has also provided suitable tissue for coverage of these lesions in a notable number of cases. During a 2-year period, the authors treated 28 patients who required flap coverage of defects of the lower third of the leg. In this group, the soleus muscle was used successfully in 8 patients. All of these procedures resulted in healed wounds. The remaining patients underwent reconstruction with microsurgical flaps, fasciocutaneous local flaps, and a gastrocnemius muscle flap. Their experience has demonstrated that the soleus muscle is a valuable tool and should be included in the treatment algorithm for reconstructing lesions of the distal third of the lower extremity.

Effect of hyperbaric oxygen therapy on the tubed pedicle flap survival in a rat model.

The effect of hyperbaric oxygen therapy (HBO) on survival of the distal skin paddle with early pedicle division was studied in a rat tubed pedicle flap model. In part 1, tubed pedicle skin flaps were created on the backs of 14 rats. The pedicle of each skin flap was divided at intervals of 3, 4, 5, and 7 days, and the survival area of each distal skin paddle was measured 5 days after each pedicle was divided. The results showed that the percentages of survival were 0%, 29.9%, 89.9%, and 100% at 3, 4, 5, and 7 days, respectively. In part 2, the tube flaps were created on the backs of 28 rats. The tubed pedicles were divided 4 days after creation. In the experimental group 1 (n = 9), the rats received HBO treatment at 2 atm of pressure twice daily for 3 consecutive days before pedicle division. In the experimental group 2 (n = 9), the rats received HBO treatment after pedicle division twice daily for 3 consecutive days. In the control group (n = 10), the rats received no HBO treatment. The results showed that the mean survival area of the distal skin paddle at 5 days after pedicle division for the groups treated with HBO before and after pedicle division was 6.31 +/- 2.69 cm2 (69.19%) and 6.12 +/- 1.52 cm2 (71.22%), respectively. These survival rates were of statistical significance as compared with the survival rates in the control group of 2.70 +/- 1.89 cm2 (27.9%). These results demonstrate that the administration of HBO therapy to the animal with a tubed pedicle flap can increase flap survival with early division of the tubed pedicle.

Assessment of facial tissue expansion with three-dimensional digitizer scanning.

This article reports a three-dimensional (3D) digital color scanning system used in the measurement of facial soft tissue expansion. This system consists of digital scanning equipment, software for stereolithographical (STL) forms and nonuniform rational B-spline (NURBS) surfaces, and a computer-aided design program. Accurate data for the area of scar excision and the expanded cervicofacial flap were obtained by using this measuring system in a young patient with scar contracture of the face. This technique can accurately model the reconstruction and make plastic surgery planning a truly interactive procedure.