Subject(s)
Aspirin/therapeutic use , No-Reflow Phenomenon/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Complications/drug therapy , Salvage Therapy/methods , Surgical Flaps/blood supply , Ticlopidine/analogs & derivatives , Clopidogrel , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Mammaplasty/methods , Middle Aged , No-Reflow Phenomenon/etiology , Surgical Flaps/transplantation , Ticlopidine/therapeutic useABSTRACT
Defect closure on the nasal tip subunit still remains challenging. Full-thickness skin transplantation still is used despite its poor outcome in terms of the nasal tip contour caused by lack of dermal tissue. To avoid subsidence deformities associated with nasal tip reconstruction with skin transplants, this study analyzed methods using combined epidermal and dermal replacement. For 30 consecutive patients with a nasal tip defect, a retrospective comparison was made between conventional full-thickness skin transplantation, retroauricular perichondrodermal composite grafts, and skin transplantation supplemented with the collagen-elastin matrix, Matriderm, used as a dermal substitute (n = 10 per study group).The postoperative results were evaluated in a randomized and blind manner by external facial surgeons using the Manchester Scar Scale. The findings showed a marked improvement in nasal tip contour with combined epidermal/dermal replacement without any deterioration in other graft qualities, justifying the additional effort involved in this procedure. Two patients developed fistulae after Matriderm-aided skin transplantation. Therefore, the authors do not consider this a suitable method for nasal tip reconstruction.
Subject(s)
Nose Neoplasms/surgery , Nose/surgery , Rhinoplasty/methods , Skin Transplantation , Adult , Aged , Aged, 80 and over , Collagen , Elastin , Female , Humans , Male , Middle Aged , Retrospective Studies , Skin, ArtificialABSTRACT
BACKGROUND: Seroma is one of the most troubling complications after abdominoplasty; incidence rates of up to 25% have been reported. If it is correct that shearing forces between the two separated abdominal layers play a key role in the development of seroma, postoperative immobilization of the patient until the layers are sufficiently adhered may be a solution to the problem. OBJECTIVE: The authors examine the association between length of immobilization and the development of seroma. METHODS: This retrospective study included 60 patients; half were immobilized for 24 hours (group 1) and the other half were immobilized for at least 48 hours (group 2). For thromboembolism prophylaxis, all patients received low molecular weight heparin and compression stockings. Postoperative follow-up for detection of seroma continued for at least three months. RESULTS: Mobilization after 24 hours led to a seroma rate of 13%, whereas immobilization of at least 48 hours decreased the seroma rate to 0%. CONCLUSIONS: For abdominoplasty patients with a low or moderate thromboembolic risk, the data suggest that immobilization for at least 48 hours with chemical and mechanical thromboembolism prophylaxis significantly reduces the risk of seroma.
