Buried penis release in adults with suction lipectomy and abdominoplasty.

The buried penis in adults who had substantial weight gain was treated with a combination of suction lipectomy of the abdomen and pubic area and the release of the suspensory ligament of the penis and with abdominoplasty with suture anchoring of the pubic and penile skin base dermis to the rectus fascia superiorly. This procedure was performed in 11 patients over the past 10 years with satisfactory results. One patient required additional excess skin excision from the side of the pubic and scrotal area to improve the results.

Treatment of alar cartilage malposition using the cartilage disc graft technique.

Patients with a bifid, cephalically rotated, contour-deformed, bulky, overprojected, pinched-tip, alar-dislocated, and/or alar-tethered nose had primary and secondary rhinoplasties using complete lateral alar cartilage mobilization, modification, and repositioning and the cartilage disc tip-graft technique. This technique avoids the pitfalls of classic in situ subtraction rhinoplasty and provides a better way to correct the nasal shape without causing airway obstruction. This technique was performed in 30 patients in the past 6 years who had primary or secondary rhinoplasties, with satisfactory results.

The modified cartilage disc tip graft in primary rhinoplasty.

The cartilage disc graft technique with new modifications has been used in primary rhinoplasty during the past 6 years on 51 patients. The technique can be done through closed or open rhinoplasty with other modifications of the tip cartilages or premaxilla. This technique is simple and reliable, and the results are consistently reproducible.

Treatment of thrombosed thumb artery aneurysm: a report of four cases.

Acute thrombosis of a thumb ulnar digital artery aneurysm is painful and associated with varying degrees of ischemia. Treatment of 4 patients with this condition by resection of thrombosed aneurysm and microsurgical vein graft reconstruction of the involved artery is discussed. Complete relief of symptoms, including healing of ulcerations and reversal of cold intolerance, were achieved. The authors recommend resection of the thrombosed thumb ulnar digital artery aneurysm and re-establishment of arterial flow by an interpositional vein graft.

A new technique for nasal tip cartilage graft in primary rhinoplasty.

Inadequate tip projection in traditional rhinoplasty led to postrhinoplasty deformity, which with time got worse. Sheen's vertical shield and Peck's horizontal multiple rectangular stacked cartilage graft have been used to reduce postrhinoplasty tip projection loss. The new two fixed column disk cartilage graft technique at the tip-defining points is designed to combine the advantages of both techniques. This technique can be used in both open and closed rhinoplasty, and the amount of projection can be adjusted to fit the dorsum with relative ease. This technique has been used in 38 primary rhinoplasties with satisfactory results.

Free vascularized temporal parietal flap in hand surgery.

Free vascularized temporo-parietal fascia (TPF) flap is a flap of thin, pliable and vascularized tissue which can cover an area measuring up to 12 cm x 14 cm. The flap is harvested based on temporal vessels, which provide a smooth, gliding surface for tendon function and eliminates the need for secondary procedures usually required by the pedicled or bulky free vascularized myocutaneous flaps. The donor pedicle is long and consistent with an average diameter of 3 mm in adults. This flap is versatile. In 12 resurfacings for traumatic wounds of hand and wrist, no flaps were lost. Donor site morbidity, except for a transient sideburn hair loss in one case, was not encountered. We recommend this flap as a viable one-stage procedure for coverage of complex hand wounds.

Metallic plate stabilisation of bone grafts in craniofacial surgery.

The use of Champy miniplates to stabilise bone grafts in osseous defects following craniofacial and orbital osteotomies is discussed. The advantages of these methods are decrease in operating time, accurate fit of the bone graft and the fixation of the bone graft in the plane of the plate, thus placing it exactly into the correct position in relation to the osteotomy. Total stability is obtained and, in maxillary advancement, intermaxillary fixation may not be necessary. This is useful in children and at all ages adds to the postoperative safety. There may be less relapse with this rigid internal fixation. Long term follow-up will be required to determine whether this statement is true. Although the plates are expensive, it is felt that the reduction in operating time outweighs this.

Use of the galeal frontalis myofascial flap in craniofacial surgery.

The anatomy and the technique of raising the galeal frontalis myofascial flap is described. In 38 patients with various pathologies, congenital anomalies, tumors, and trauma, this technique was employed. There were no extradural infections. The applications and complications of the flap are discussed. It is highly recommended wherever there is a possibility of direct intracranial nasopharyngeal communication.

Louis Ombredanne and the origin of muscle flap use for immediate breast mound reconstruction.

The myocutaneous flaps that are being used for breast reconstruction have a long history, although the techniques of today are more sophisticated than those of the past. Louis Ombredanne was the first to describe the pectoralis muscle flap for immediate breast mound reconstruction in 1906. Mastectomy, as performed by Halstead, is described with some insight into the reasons why breast reconstruction was not encouraged in this country in the early part of this century. Lately, the advances in the myocutaneous flap have made breast reconstruction without a prosthesis possible. The tissue that was transferred to reconstruct a breast using a tubed pedicle flap in multiple stages can now be transferred in a single stage with a better result.

Suction lipectomy--a review of 200 patients over a six-year period and a study of the technique in cadavers.

Suction lipectomy is designed to reduce subcutaneous fat. It is strictly a procedure for the removal of localized fat and body contouring in selected patients and is not a substitute for weight reduction. The technique and the complications associated with the procedure were reviewed in more than 200 patients. Suction lipectomy was performed on fresh cadavers to study the nature of the fibrous tissue and to better understand why the procedure has proved safe.

Surgical correction of the tuberous breast.

Tuberous breasts have been attributed to hypoplasia of the breast with herniation of breast tissue into the nipple and areola. Several procedures have been used to correct the condition. A new method has been designed that reduces breast tissue herniation and areolar size. The surgery is done after subpectoral augmentation, by deepithelialization of a doughnut-shaped piece of skin around the periphery of the areola and excision of four wedges of breast tissue from underneath the new areola. Closure of the gaps results in reduction of both the herniated breast tissue and areola size.

Survey of patients' responses to breast reconstruction.

Patients' responses to single-stage breast reconstruction were evaluated in 100 cases using a questionnaire. The availability of breast reconstruction did not influence the decision to have a mastectomy in 63% of patients but did serve as an incentive in 24%. The reconstruction was acceptable for 92% of patients; increased sexual expressiveness in 45% of patients was another benefit of reconstruction. Multiple-stage reconstruction was acceptable for 65% of patients; however, 56% favored the one-stage operation. Given the same opportunity, 91% of the patients would consider undergoing breast reconstruction.

Anterior periosteal dermal suspension with suction curettage for lateral thigh lipectomy.

The standard excisional approach to lipectomy has now been expanded by the use of suction curettage either as an adjunct or a primary procedure. In severe cases of steatomeria (a term used to designate trochanteric obesity and eliminate the misuse of the term lipodystrophy), curettage serves to prepare and shape the flaps, while excision and "periosteal dermal suspension" are sometimes necessary to achieve adequate contour and lift. Periosteal anchoring ensures adequate permanent suspension and a tension-free closure. Achievement of lateral thigh contouring by an anterior approach is facilitated by the use of the suction curette. Undermining of the superior flap and contouring with suction, as well as overlapping the closure with buried dermal-fat suspension flaps, eliminates bulging above or below the incision. Periosteal dermal suspension decreases the possibility of scar widening and eventual ptosis, provides a fixation technique that permits more lift, and eliminates scarring from the lateral thigh. Lateral thigh suction lipectomy with periosteal dermal suspension has been done alone or in conjunction with buttock reduction or with medial thigh or abdominal lipectomy in 14 patients. The operating time was short, and the results were good with minimal morbidity.

Simple technique for correction of inverted nipple.

The described method for correction of the inverted nipple adds both bulk and structural stability to the nipple. This is done by means of a dermal sling and creation of a narrow base to prevent inversion of the nipple.