Correction of Areolar Protuberance During Augmentation Mammoplasty in Transfemale Patients.

Augmentation mammoplasty refers to "top surgery" for transfemale patients. Before this surgery, due to the hormonal treatment being taken, it may be encountered that there would be a glandular tissue of breast that seems to be similar to the simple tuberous breast disease, which is one of the diseases in female breast development. The presence of areolar protuberance in transfemale would of course undermine the cosmetic gain after augmentation mammoplasty operation. This situation, which can be difficult to diagnose before surgery especially in transfemale patients, will manifest itself clearly after the end of augmentation mammoplasty. As a precaution, resection of a part of glandular tissue equal to the protruding height of the areola from the posterior wall of the gland is an effective method both in terms of its simple applicability and not to use of an extra skin incision while performing augmentation mammoplasty.

Acellular Dermal Matrix Use in Cleft Palate and Palatal Fistula Repair: A Potential Benefit?

BACKGROUND: In cleft palate repair, anatomically oriented, tension free, atraumatic total closure is the key to achieve a normal speech consecutive to a sufficient velopharyngeal closure and also to prevent postoperative fistula development. In this clinical study, we review our experience with acellular dermal matrix (ADM) which was used as an adjunct to facilitate difficult cleft palate and palatal fistula closure. METHODS: From October 2009 till December 2013, primary cleft palate and fistula repairs in which ADM was used were culled from the cleft surgery files. Acellular dermal matrix was used as an extra layer in between palatal flaps of primary repairs and as a sandwiched sheet separating the flaps used to repair fistulas. In addition to patient, cleft and fistula demographics, records were evaluated for sizes, fistula development, fistula recurrence, extrusion, exposure, and infection. RESULTS: Acellular dermal matrix was used in 35 patients with palatal clefts of mean size 15 ±â€Š4  mm and in 15 palatal fistulas. Two-flap palatoplasty technique was the dominant technique for the palate repair. Fistula rate for the palate repair was 8.5% and fistula recurrence rate was 20%. Mean follow-up for the palate and fistula repair patients was 29 ±â€Š15 months and 32 ±â€Š11 months, respectively. In two cases of palatoplasty group and in four cases of fistula repair group, ADM was exposed resulting in total extrusion in two fistula cases. CONCLUSIONS: In this ongoing experience of application, ADM has been shown to be a simple, safe, and helpful tool to reduce fistula rate mainly in relatively wide and high tension tenuous cleft palate repairs but less favorable in challenging fistula closure attempts particularly along with poorly vascularized surrounding tissues. However, study design and its results are yet far from strongly recommending routine ADM use in cleft palate surgery.

The role of preoperative radiological assessment of vascular injury on surgical decision making in mutilating injuries of the upper extremity.

Preoperative assessment of the extent of vascular injury is important in patients with mutilating injuries of the upper extremity. The aim of this report was to discuss the influence of computed tomography angiography (CTA) and digital subtraction angiography (DSA) on the operating room decision-making in mutilating injuries and limb-salvage procedures of the traumatic upper extremity. Four DSA and 3 CTA were performed in 7 patients with a mean age of 28.3 (range, 4-48) years. The results of the DSA and CTA altered the preoperative planning. In 5 patients, the reconstructive decision of the type of flap was altered, whereas in all 7 patients, either the level or type of anastomosis was changed after radiologic investigations. The mean follow-up period was 37.8 months. During the follow-up period, all patients underwent subsequent procedures such as sensory restoration, tendon reconstruction, or capsulotomy. The effects of radiologic results in which flap selection, target donor vessel, and level and type of anastomosis have changed are discussed in correlation with intraoperative findings.