Supero-Septum Pedicle Mammaplasty: A New Modification for Reduction Mammaplasty.

BACKGROUND: Many techniques have been introduced for reduction mammaplasty and are utilized in diverse frequencies by different surgeons according to patient needs. Each technique is evaluated based on the aesthetic result, longevity, complication rate, and preservation of the nipple-areola complex (NAC) sensation. OBJECTIVES: The authors sought to introduce the new modified technique of supero-septum pedicle mammaplasty (SSPM) that utilizes both the septum and superior pedicle and is suitable for macromastia and gigantomastia cases. METHODS: Between 2015 and 2018, 60 women who underwent SSPM were evaluated in a prospective study after undergoing superior pedicle deepithelialization and resection of the inferior, lateral, and medial segments. In the lateral pillar, a tongue of tissue was preserved for fixation to the medial pectoral fascia through a window created in the superior pedicle at the third intercostal space. Finally, septum pedicle was sutured to the fascia and muscle at the upper border of the sixth rib somewhat medially. Patients were followed up for a minimum of 13 months. RESULTS: The mean nipple-to-sternal notch (N-SN) distance was 33.05 cm, and the mean NAC elevation was 10.92 cm. Breast reductions varied from 270 to 2800 g per breast. Complications included wound dehiscence (5%), wound infection (2.5%), and partial NAC necrosis (2.5%). At 6 months postoperation, the NAC sensation was significantly better compared with preoperative values (P < 0.005). CONCLUSIONS: SSPM is a relatively safe method of reduction mammaplasty, even for very large breasts, that leads to good aesthetic form along with preserving circulation and sensation of the NAC.

Lateral crural transposition flap in tip correction: Tehran retrospective rhinoplasty experience.

PURPOSE: This study aims to review the authors' experience with the lower lateral crura (LLC) transposition flap in an attempt to highlight its advantages, indications, and limitations. MATERIALS AND METHODS: A retrospective study of 37 rhinoplasties (29 primary cases, 7 secondary cases, and 1 tertiary case) was performed. In all of these, an LLC transposition flap was used by inserting the cephalic portion of the LLCs into a subperichondrial pocket between the medial aspect of the remaining rim strip and the vestibular skin, based on the posterior pedicle. RESULTS: The most prevalent symptom among our patients was nasal external valve dysfunction. Concavity of the LLCs was very common. The LLC transposition flap can correct the LLC deformities with a high rate of patient satisfaction and no need for revision operations. CONCLUSIONS: The LLC transposition flap can overcome the common irregularities of the LLCs and could be applied to primary and secondary rhinoplasties, as well as ethnic noses.

Diced ear cartilage with perichondrial attachment in rhinoplasty: a new concept.

BACKGROUND: Diced cartilage is a valuable material that has recently been added to the graft options in rhinoplasty. Shaping, fixation, and resorption are the main concerns with this material. Perichondrially attached diced conchal cartilage may be a new possibility to solve some of these problems. OBJECTIVES: The authors evaluate the outcome of perichondrially attached diced cartilage in a rabbit model and compare the results with injectable cartilage grafting. METHODS: Ear cartilage was removed from 1 auricle in each of the 16 rabbits included in this study; samples were divided in 2 pieces. After precise weighing, both segments were diced. The perichondrium was left attached to 1 of the pieces. Both segments were inserted in 2 separate pockets in the dorsum of the animal. After a 3-month period, both samples were removed and measured for growth/resorption. RESULTS: At the beginning of this study, the difference in weight between groups was statistically insignificant (P = .213), but 3 months after insertion, significant growth was observed in the perichondrial group (P = .019). CONCLUSIONS: The vascularization and significant growth in weight of the perichondrially attached diced cartilage samples are evidence of the viability of this material. The structural integrity and solid framework afforded by this option suggest that the material should be used more frequently in nasoskeletal augmentation.

Repair of Large Lip Vermilion defects with Mutual Cross Lip Musculomucosal Flaps.

BACKGROUND: Vermilion irregularities are common secondary deformities after cleft lip repair, regressed or resected hemangiomas, trauma and tumor surgeries. Vermilion deficiency attracts considerable attention and detracts from an otherwise excellent lip repair. Minor and moderate vermilion defects can be corrected with upper lip advancement, rotation flaps, tongue flaps or grafts. Major defects defy correction with local flaps. A technique is described for correction of large absolute tissue defects of the vermilion using Mutual Cross-Lip Musculomucosal Flaps (MCLMF) Or Ahmad-Ali's flaps. METHODS: This technique was applied in eight patients with major vermilion defects secondary to hemangioma regression, neoplasia, and trauma. Reconstruction with MCLMF led to create a balanced donor and recipient lips appearance and function. RESULTS: There were no postoperative complications. Surgical results were satisfactory in all patients, and sufficient lip mobility with adequate bulk was maintained. One patient demonstrated minimal transient lip tightening. CONCLUSION: Use of Ahmad-Ali's flaps in selected patients resulted in successful reconstruction of severe vermilion defects.

Actinomycosis: a rare soft tissue infection.

Actinomycosis is a chronic and suppurative infection caused by an endogenous Gram-positive bacterium. The usual sites of infection are the head and neck, thorax, and abdomen. Primary cutaneous actinomycosis is very rare and usually associated with external trauma and local ischemia. We report on the case of a primary cutaneous actinomycosis of the thigh in a 34-year-old man. The patient was treated successfully with surgical resection and combined antibiotic therapy, and eventually cutaneous reconstructive surgical procedure.