Fat embolism syndrome after lower extremity replantation associated with tibia fracture: case report.

We report a patient who was diagnosed as fat embolism syndrome after replantation surgery of left amputated foot. This diagnosis was based on the presence of a long bone fracture with an amputation of a major extremity, supported by the signs of pulmonary and cerebral dysfunction and confirmed by the demonstration of arterial hypoxemia in the absence of other disorders.

Vertical reduction mammaplasty: preventing skin redundancy at the vertical scar in women with large breasts or poor skin elasticity.

The authors describe a vertical reduction mammaplasty technique for avoiding skin excess at the vertical scar. Conical projection of the breast is achieved by cranial to caudal gland-shaping sutures. Excision of redundant skin is performed in a triangular pattern, creating bilateral dog ears. Resection of these dog ears results in a short, symmetrical horizontal scar located at the new submammary line.

[An alternative method for the correction of enophthalmos: deep lateral orbital approach]. / Enoftalminin düzeltilmesi için alternatif bir yaklasim: Derin lateral orbita girisimi.

Both increased orbital volume due to inadequate orbital floor reconstruction and loss of orbital volume may result in enophthalmos. Enophthalmos, vertical dystopia, and "lateral scleral show" deformity were detected in a 33-year-old female patient who presented with periorbital deformities after three operations for the correction of traumatic zygomatic fracture. First, vertical dystopia was repaired by reinforcing the orbital base with cranial bone grafting. Since enophthalmos was not successfully corrected, orbital volume augmentation was performed using the deep lateral wall through an upper eyelid crease incision. The only postoperative complaint was edema which was controlled by application of ice.

Evaluation of the effects of tip-binding sutures and cartilaginous grafts on tip projection and rotation.

BACKGROUND: Numerous approaches and techniques have been described to achieve a desired result in tip surgery, but there are few studies that define or analyze the changes that occur after surgery. Therefore, the authors planned a study to document changes in nasal tip projection, crural and lobular lengths of the columella, columellar length, and proportional relationships of tip projection and columella with dorsal length. METHODS: Analysis was based on data collected from preoperative and 1-year postoperative lateral views of 18 patients who were randomly chosen. The tip-binding suture group included nine patients and the cartilaginous graft group included nine patients. The measurements were obtained using the parameters regarding tip projection and rotation on standardized photographs. The values were statistically analyzed with paired and unpaired t tests. RESULTS: The changes in all parameters except crural length were statistically significant in the tip-binding suture group. In contrast, the statistical analysis of the cartilaginous graft group revealed prominent dimensional changes in tip projection and especially in crural and lobular segments. CONCLUSIONS: The authors believe that cartilaginous grafts should be considered if the dimensional changes have priority in the preoperative plan. The columellar strut graft provides satisfactory structural tip support and dimensional changes in crural length. Shield grafting causes augmentation in the lobular segment. If minor dimensional changes with more rotational alterations are planned, tip suture techniques should be preferred.

A new simple method used to prepare fat for injection.

Various clinical and experimental studies on harvesting techniques, donor sites, preparation, and preservation of fat for injection imply that there is no universal agreement on an ideal methodology. Unpredictable and irregular resorption of fat leads to uncertainty about volume maintenance of the transplanted fat necessitating repeat procedures. In this report, the authors present their 5-year clinical experience with facial fat grafting by isolated and combined procedures using a simple method that they developed for fat preparation. This technique includes fat harvesting with syringe aspiration and filtration of the fat aspirate instead of centrifugation. The idea for filtration was inspired by a yogurt concentration method used in Anatolia. The authors also aimed to increase fat survival by using multiple fat injections of minimal amounts into different levels.

An unusual case of self-injected bovine fat in liquid form to the face for cosmetic reasons.

A 45-year-old woman injected bovine fat in liquid form in to her periorbital area and nasolabial folds near the lip margin and glabellar area to look younger. She was influenced by a TV program about fat augmentation of the aging face and collagen injection to the wrinkles. Major depression had been diagnosed for this woman 5 years previously, after which she used antidepressants and hypnotics irregularly. The prolonged edema of her face subsided within 3 months, along with the erythema, itching, and firmness at the injection sites. No liposuction of the injected material was planned because it had changed to solid form as soon as it was injected. Additionally, it was thought that surgical excision of the fat would not be effective and could harm the facial nerve branches because magnetic resonance imaging showed diffuse enlargement of subcutaneous tissue. Therefore, a conservative approach, such as medical treatment with close follow-up evaluation was preferred. The reported case is presented not only to add an interesting self-injection case to the literature, but also to show that patients with psychological problems may harm themselves by using inappropriate methods for cosmetic reasons under the effect of inaccurate information obtained from TV programs, press, family, and friends.

Rupture of a silicone gel mammary prosthesis and amyloidosis: a case report.

There has been a great deal of controversy regarding the safety of silicone breast implants. Silicone gel prostheses older than 10 years have the risk of either leakage or outright rupture. The role of silicone gel in relation to connective tissue disease or amyloidosis has not been proved by current serologic, immunologic, or epidemiologic tests. In this paper, we present a case with renal amyloidosis and a history of untreated silicone implant rupture for five years.

Augmentation mammaplasty by medial periareolar incision.

Various techniques and different types of incisions have been used for breast augmentation, the choice of which depends on regional and physical characteristics of the patient, an indication for the operation, and the decision of the patient and the operator. The periareolar approach is ideal for cases of developmental hypomastia that have adequate skin and glandular tonus and with minimum ptosis. The disadvantages of this method are a hypopigmented scar on the pigmented areola and a decrease in sensitivity of the nipple-areola. This article presents the experiences of the Department of Plastic and Reconstructive Surgery of the University of Istanbul, Faculty of Medicine between 1995 and 1998, on medial periareolar submuscular augmentation approaches to five cases. During this follow-up period we had no major complications.

Ptosis caused by pachydermoperiostosis.

A 39-year-old man with pachydermoperiostosis is presented. He had enlarged, thickened upper eyelids that made it difficult for him to open his eyes. Eyelid correction was performed by resecting the excessive skin and orbicularis muscle in a fusiform shape and shortening the levator aponeurosis by plication. A wedge resection of the lateral third of the upper lid shortened the horizontal width and also changed the unpleasant fan shape to a better shape, with a natural curvature of the lid. The authors also performed a 5-mm transconjunctival tarsectomy. Visual impairment was corrected with a satisfactory aesthetic outcome.

Free nipple reduction mammaplasty with a horizontal scar in high-risk patients.

Women with extremely large and ptotic breasts have many complaints and difficulties during daily life. Conventional reduction mammaplasty techniques are not convenient because the presence of excess tissue beneath and over a long pedicle may cause nipple-areola complex necrosis. These patients mostly have systemic health problems so they benefit from a shorter operative procedure. The amputation method is an option providing rapid surgical operation time and little blood loss but it may lead to a flat, unaesthetic breast with poor projection. In this paper we present an alternative amputation with the use of a backfolded dermoglandular flap and free nipple graft. The inferior pole is amputated. The deepithelialized breast tissue is left on the superior pedicle extending below the 7-cm vertical limb mark. This deepithelialized tissue is tucked to give more central mound projection. The aesthetic outcomes, such as well-rounded breasts with good projection and a hidden scar at the submammary sulcus, have led us to perform this technique, which was first described by the Mansteins in 1997.

The use of the ipsilateral versus contralateral pedicle and vertical versus horizontal flap inset models in TRAM flap breast reconstruction: the aesthetic outcome.

The use of an ipsilateral or a contralateral rectus abdominis muscle as a pedicle and comparison of their advantages and disadvantages in TRAM flap breast reconstruction have been reported in the literature. In our clinical experience with 22 pedicled TRAM flap breast reconstructions, the use of either an ipsilateral or contralateral pedicle was found to be equivocal regarding the flap viability and the aesthetic outcome. Thus, it seems better to decide their use according to the needs of an individual patient. In our series, the contralateral pedicled TRAM flap with a vertical flap inset was preferred in patients with a small opposite breast or in patients with infraclavicular tissue losses (four patients). The ipsilateral pedicled TRAM flap reconstruction with a horizontal flap inset was preferred in patients with a full and attractive opposite breast, unless they received adjuvant radiotherapy (six patients). In patients who received adjuvant radiotherapy the contralateral pedicle was used regardless of the inset model preferred (10 patients). Bilateral TRAM flap breast reconstruction was applied in one of our cases, which is not included in the three categories above mentioned. The aesthetic outcome was determined by analyzing a patient satisfaction questionnaire. Overall satisfaction was achieved in 17 patients. Four patients were dissatisfied. We think that choosing the correct flap inset model is one of the most important factors in achieving a satisfactory aesthetic outcome. Choosing the correct pedicle regarding the type of the flap inset model is equally important to facilitate technical ease during flap transposition and to improve flap survival.