Minimizing the Submandibular Incision in Endoscopic Subcondylar Fracture Repair.

Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular incision facilitates reduction in relatively difficult cases and enables clear visualization of posterior border of the mandible to confirm adequate fracture reduction.

Thinning of the medial pedicle in reduction mammoplasty.

BACKGROUND: Modifications of reduction mammoplasty techniques are still evolving. AIM: To evaluate a clinical modification using a thin medial pedicle in reduction mammoplasty. PATIENTS AND METHODS: Thirty-two patients (64 breasts) that underwent ultrathin medial pedicle reduction mammoplasty were included. RESULTS: One patient had nipple areola complex (NAC) necrosis. Partial wound dehiscence occurred in five patients and transient wound pigmentation in two patients. CONCLUSION: The medial pedicle can be used in ultrathin pattern without compromising NAC viability during reduction mammoplasty. This modification adds more flexibility in medial pedicle breast reduction procedure, especially when large reductions are needed in gigantomastia.

Dermo-Fascial Suspension for Better Contouring and Long Lasting Results in Reduction Mammoplasty.

BACKGROUND: Recent techniques use the superficial fascia system for anchoring the glandular tissue to the chest wall for minimal tension skin repair in contrast to classic dermal suspension. OBJECTIVE: To evaluate the use of dermo-fascial flap in suspension of the breast tissue to the chest wall in reduction mammoplasty to achieve better breast shape, projection, and contour. PATIENTS AND METHODS: Forty patients who underwent superiomedial reduction mammoplasty were divided into two equal groups. Group I patients underwent classic superior-medial dermo-glandular pedicle (Findlay's technique) reduction mammoplasty, while in group II, a laterally based dermo-fascial flap was used for suspension of the breast tissue to the chest wall. Preoperative and postoperative measurements of the suprasternal notch-nipple and nipple-inframammary fold distances were recorded and statistically analyzed. RESULTS: Mild asymmetry occurred in nine cases (5-GI, 4-GII), surgical scar revision was done in seven patients (4-GI, 3-GII), and superficial infection occurred in four patients (2-GI, 2-GII). Group II showed better clinical satisfaction and highly significant statistical differences in postoperative measurements compared to GI (P < 0.0001). CONCLUSION: The use of a dermo-fascial flap to support the glandular pedicle in reduction mammoplasty improves the shape; projection and contour of the breast. It also helps to have long lasting results and reduce recurrent breast ptosis especially in patients with poor skin quality.

A Simple Technique to Create Cheek Dimples.

BACKGROUND: Cheek dimple is a commonly requested aesthetic procedure, especially in the Arabian Gulf area. AIM: This work describes the authors' experience in creation of cheek dimples using simple rapid technique. PATIENTS AND METHODS: This study included 116 dimples in 74 patients. The dimple is done through an intraoral stab incision and prolene suture to fix the dermis of the cheek skin to the underlying buccinator muscle. RESULTS: Eighty-six percent of patients had satisfactory results. The most common complications were fading or complete disappearance of the dimple in 14 dimples and infection in 5 patients. CONCLUSIONS: This technique is very simple, very rapid, easy to execute, and gives satisfactory results in up to 86% of patients. This article also highlights the important information that must be discussed with the patients preoperatively.

Concentric double cables fixation as an alternative suspension method for the endoscopic forehead lift.

Fixation of the elevated eyebrow is an important final step in endoscopic forehead lifting. One of the most common methods of fixation includes temporal fasciae sutures for the tail of the eyebrow, and mini-screws for the body of the eyebrow. The concentric cables fixation is an alternative method for elevation of both the tail and the body of the eyebrow. This technique is compared to temporal fasciae suture and mini-screws fixation. Thirty-one patients were included in this study. They were divided into two groups; group I included patients who underwent fixation using fascia sutures and mini-screws, while group II patients underwent concentric cables suspension. Traditional screw and suture technique elevated the eyebrow tail by 7.2, 6.7, 6.3, and 6.0 mm, while the concentric cables resulted in 7.6, 6.8, 6.5, and 6.3 mm elevation at 1, 3, 6, and 12 months postoperatively, respectively. The mean values of brow body elevation were 6.8, 6.4, 6.2, and 5.9 mm for group I, while the mean values of group II were 6, 5.4, 4.8, and 4.7 mm. The concentric cables technique showed a fewer complications rate compared to traditional fixation. The concentric cables fixation offers an alternative inexpensive method to suspend the tail, and to a lesser extent the body, of both eyebrows simultaneously with long-term stability. A fewer complications rate was documented compared to traditional temporal fasciae sutures and mini-screws fixation.

A Simple Method for Proper Placement of the Inframammary Fold Incision in Primary Breast Augmentation.

BACKGROUND: The inframammary incision is a very common access in breast augmentation. The incision must be positioned well to place the resulting scar in the new inframammary fold. AIM: This article presents a simple marking on patients for proper localization of the inframammary incision. MATERIALS AND METHODS: Ninety-six patients who underwent primary breast augmentation were divided into 3 groups according to the volume of the used implants. RESULTS: A total of 90.6% of the patients had excellent postoperative scar location, and 9.4% had good results, with overall 100% patient satisfaction. CONCLUSIONS: Our preoperative markings offer simple, easy, and fixed measurements that facilitate proper postoperative location of the inframammary incision and hide the scar significantly.

Comparison of Blood Loss in Laser Lipolysis vs Traditional Liposuction.

BACKGROUND: Laser-assisted liposuction has been associated with reduced blood loss. However, this clinical finding has not been evaluated objectively. OBJECTIVES: In this study, the authors objectively estimated the blood loss volume associated with laser lipolysis vs traditional liposuction in various anatomic regions. METHODS: In this prospective study, 56 patients underwent equal amounts of traditional and laser-assisted liposuction at 2 contralateral anatomic sites. Blood loss volumes were calculated from the lipoaspirates by measuring hemoglobin and red blood cell content. The data were analyzed statistically with repeated-measures analysis of variance and the Mann-Whitney U test. RESULTS: Laser lipolysis can reduce blood loss by more than 50% compared with traditional liposuction. Laser lipolysis resulted in significant reductions in mean blood loss volumes in the abdomen, flanks, back, and breast. CONCLUSIONS: The authors provide objective evidence that laser lipolysis significantly reduces blood loss compared with traditional liposuction. LEVEL OF EVIDENCE: 3.

The effectiveness and safety of combining laser-assisted liposuction and abdominoplasty.

BACKGROUND: Lipoabdominoplasty is nearly a daily aesthetic procedure. Despite the emergence of laser-assisted liposuction, to date, it has not been clearly evaluated combined with abdominoplasty. This prospective study aimed to evaluate the effectiveness and safety of laser-assisted liposuction relative to traditional liposuction combined with high-lateral-tension abdominoplasty. METHODS: This study investigated 36 consecutive female patients who underwent high-lateral-tension abdominoplasty combined with liposuction of the upper central abdomen and both flanks. The patients were divided into three equal groups based on the technique used for liposuction. Group 1 underwent conventional liposuction with abdominoplasty. Group 2 underwent a mixture of conventional and laser-assisted liposuction with abdominoplasty. Group 3 underwent laser-assisted liposuction with abdominoplasty. RESULTS: The patients in groups 2 and 3 had a better aesthetic outcome than those in group 1 with regard to abdominal contour and skin tightness. No major complications were observed in groups 1 and 2. The patients in group 3 had a higher incidence of complications (3 seromas, 3 central necroses and dehiscence), and one patient underwent secondary sutures. CONCLUSION: Laser-assisted liposuction combined with abdominoplasty in the lateral abdomen seems to be a safe technique with good aesthetic outcomes. Although the combined use of laser-assisted liposuction in the lateral and central abdomen can achieve relatively better aesthetic results, it is associated with significant complications, and its use cannot be supported. Proper laser parameters in the central abdominal area still need further study. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Venous malformations of the head and neck: a diagnostic approach and a proposed management approach based on clinical, radiological, and histopathology findings.

BACKGROUND: There is no easy road map for venous malformations (VMs) of the head and neck according to which treatment modality can be chosen. The purpose of this study was to identify different types of VMs of the head and neck based on clinical, histopathology, MRI, and venography findings that help in specification of different treatment modalities. METHODS: Sixty-nine patients with VMs of the head and neck were included in this study. RESULTS AND CONCLUSION: Our results proposed a diagnostic approach for VMs of the head and neck. MRI, venography, and clinical examination had important impact in decision-making, whereas histopathology had no impact. A management approach has been suggested for each type and its subtypes.

Free tissue transfer and replantation in pediatric patients: technical feasibility and outcome in a series of 28 patients.

Microsurgery in the pediatric population is still challenging because of technical difficulties in the small vessel diameter anastomosis and flaps dissection. The present study reports our experience of microsurgical reconstruction with free tissue transfer and replantation. Twenty-eight pediatric patients under the age of 15 years underwent different microsurgical procedures over a 10-year period. Twenty-one patients (75 %) underwent elective free tissue transfer, while emergency replantation was done in seven patients (25 %). The overall successful microsurgical procedures were 25/28 (89 %). All the 21 free tissue transfers survived (100 %), while three of the seven emergency replantations were lost (57 % survival rate) in this group. Microvascular surgery in children is a feasible, safe, and reliable modality with high survival rate. The indications, success, failure, and complication rates are very near to adults. Over the age of 10 years, procedure is nearly similar to adults. Between the age of 5 and 10 years, successful outcome can be achieved also but with greater challenges in surgical technique. Below the age of 5 years, more challenges could be problematic for successful outcome. Experienced surgical team remains one of the most important factors to obtain good results. Knowledge of multiple reconstructive options and mastering one of them seems essential for satisfactory results.