A different strategy in the surgical treatment of capsular contracture: leave capsule intact.

The authors present their experience with the surgical treatment of capsular contracture to achieve better results in a safe, predictable, and practical way, and discuss the possible treatment modalities. They simply advise leaving the capsule intact, even if it is calcified, and create another pocket, rarely in the front or, more typically, at the back of the capsule. If the breast tissue is also ptotic, a mastopexy procedure may be added to the procedure, in addition to augmentation, with a rather small prosthesis placed in the new pocket or, occasionally, in the old one. External, forceable massage is not advisable to treat the capsule. Open capsulotomy and/or partial capsulectomy can be applied to release the capsule. However, it is not advisable since recurrence is usually inevitable. The purpose of this paper is to present a series of surgical procedures to avoid the problems created by the capsule and present different cases with good results.

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple.

A method of repair is described for correction of abnormally enlarged nipple-areola complex following both periareolar mastopexy and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control the enlargement of nipple-areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast, especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy or reduction mammoplasty cases resulting in enlarged nipple-areola complexes, the size of the areola can also be corrected by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision, the shape of the breast is more acceptable and the size of the areola does not enlarge with time.

Innervated dorsal adipofascial turnover flap for fingertip amputations.

Traumatic or thermal injury to the fingertip may result in composite tissue loss. Exposed tendon, bone, or joint surface is best treated by flap coverage. The authors present their experience with a new technique that provides coverage for fingertip defects using the innervated dorsal adipofascial turnover flap, which consists of adipofascial tissue only and relies on the arterial anastomotic network of this tissue layer to sustain its vascularization. Eight digital amputations between the distal phalanx proximal to the nail matrix and midportion of the middle phalanx were resurfaced successfully with the innervated dorsal adipofascial turnover flap. The flaps survived completely; the mean follow-up was 9 months. This technique seems to be a relatively simple way of achieving early recovery. It does not require the use of distant flap immobilization of adjacent digits, nor does it require the use of homodigital flaps, which may jeopardize an already injured finger. The main advantages of the innervated dorsal adipofascial turnover flap are its ready availability from the local tissue, its sensation, and the absence of functional and aesthetic disturbance at the donor site.

Tangentially split gluteus maximus myocutaneous island flap based on perforator arteries for the reconstruction of pressure sores.

From 1995 to 1997, the authors used tangentially split gluteus maximus myocutaneous island flaps based on the musculocutaneous perforator arteries for the reconstruction of pressure sores located in the trochanteric, sacral, and ischial regions of 30 ambulatory and paraplegic patients. The postoperative follow-up period was 18 months. Postoperative electromyograms were performed on the ambulatory patients to compare the function of the gluteus maximus muscles on each side. There were one major and two minor postoperative complications. There was no total flap loss. The major advantage of this technique is the preservation of most of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. The tangentially split gluteus maximus myocutaneous island flap is recommended as the procedure of choice for closure of sacral, ischial, and trochanteric ulcers in both the ambulatory and nonambulatory patient.

Prophylactic antibiotics in plastic and reconstructive surgery.

There is no consensus in the literature on the use of prophylactic antibiotics to prevent postoperative infection. This study was performed to investigate whether the use of prophylactic antibiotics has an effect on postoperative infection rates. A total of 1400 patients were classified into four groups based on their diagnosis. During the induction of anesthesia, half of each group received 2 g of a sulbactam-ampicillin combination and the other half received a placebo (saline solution) intravenously. Wound infection rates were observed in the postoperative period. Age, sex, and operative site of the patients with the same diagnosis were comparable in each group. The white blood cell count and the body temperature reading of each patient were recorded postoperatively. Wounds were observed daily in the postoperative period and graded according to a predetermined scale. Bacteriologic specimens were obtained from patients who had wound infections. According to our clinical experience, antibiotic prophylaxis is not necessary in plastic surgery. At the end of our 6-year study, a significant difference could not be found between the antibiotic prophylaxis and placebo groups.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face.

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Septo-orbitoperiostoplasty for the treatment of palpebral bags: a 10-year experience.

The orbital region is sensitive to the undesirable effects of any surgical intervention, because of its anatomical location and the importance of the eyelids in facial sign language. The procedures performed for correction of baggy eyelids may have remarkable undesired results. In recent years, we have made a special effort to analyze the causes, to minimize these undesirable effects, and to be able to offer patients more natural and safer results. We have designed a new technique called septo-orbitoperiostoplasty for the treatment of baggy eyelids, based on preservation of orbital fat and correction of the supportive layer. This technique consists of placing the orbital fat back into the orbital cavity and its retention by suturing the lax septum to the periosteum of the orbital rim. Neither an incision on the orbital septum nor an excision of the orbital fat is performed. It can be performed for both upper and lower eyelids. This paper describes the surgical procedure and shows the results obtained from 74 patients who had been treated with this technique over a 10-year period. All patients were followed up for an average of 5 years.

A new approach for the treatment of recurrent large abdominal hernias: the overlap flap.

In this article we report a new technique for the treatment of recurrent large abdominal hernias and skin laxity: the overlap flap. This technique combines abdominoplasty with hernia repair. Obese patients with recurrent large abdominal hernias and skin laxity could benefit from this operation. This operation could not be performed in patients with a wide absence of the abdominal wall. A total of six patients were treated with this technique in our clinic. Follow-up of the patients has ranged from 1 to 4 years. Cosmetic results were excellent in all patients. No recurrence of the hernias has been observed in any of the patients. Two flaps are prepared; the lower one is deepithelialized, and it is used as an autogenous mesh in place of a prosthetic material to reinforce the abdominal wall, and the upper flap is prepared and overlapped on this lower one.

A new technique for distal hypospadias repair: advancement of a distally deepithelialized urethrocutaneous flap.

We report on a new modification technique and the latest results of a procedure for treating cases of distal hypospadias with minimal or no chordee called advancement of a distally deepithelialized urethrocutaneous flap. This procedure incorporates correction of chordee, mobilization of the urethrocutaneous flap, and advancement of the flap through a tunnel until it reaches the tip of the glans. A total of 30 children underwent treatment using this procedure in our clinic. Follow-up of the patients ranged from 2 months to 3 years. Cosmetic results were excellent in all the patients. Fistula formation has been observed in only one patient, possibly due to a surgical accident. This technique may only be applied in distal hypospadias patients with minimal or no chordee in whom the meatus is localized to the coronal level or 0.5 cm proximal to it. Patients with a short urethra or in whom the meatus is distally localized but with severe chordee are not candidates for this technique. In general, this technique is not applicable in patients with ventral penile curvature. We would like to emphasize that this repair technique allows for simple and safe dissection of the distal urethra composed of only mucosa without corpus spongiosum around it. This kind of distal urethra can be advanced easily to the tip of the glans penis with the help of the dermal component.