Direct-to-Implant Retropectoral Dual Plane Approach With Autologous Inferior-Based Dermal Flap: Does SPY-Elite Laser Angiographic System Reduce Complication Rates?

PURPOSE: The study aims to investigate the complications and long-term outcomes associated with retropectoral DTI breast reconstruction with IDF utilizing the SPY-Elite laser angiographic system. MATERIAL AND METHOD: This retrospective study was conducted from June 2017 to January 2023. We examined 52 patients (85 breasts) treated with a direct-to-implant retropectoral dual plane approach with IDF implant coverage. Informed consent was duly obtained from every participant. Inclusion criteria dictated that patients should have medium to large breasts and a second or third degree of ptosis, as per the Regnault ptosis scale. During the intraoperative evaluation, the mastectomy flaps and IDF were assessed with the SPY-Elite laser angiographic system using near-infrared imaging. We recorded patient demographics, characteristic data, and complications. RESULTS: A total of 52 patients, aged 27 to 63, underwent 85 mastectomies using a direct-to-implant retropectoral approach with inferior dermal flap. The average age of the patients was 48, and their average body mass index was 30.8, with a range of 28 to 43. The distance from the nipple to the inframammary fold varied between 14 and 24 cm. The implants used had an average size of 275 cc, ranging from 250 to 650 cc. Textured anatomic implants with either moderate plus or high profile were used in all cases. The sternal notch to nipple distance for these patients ranged from 24 to 38 cm. During the evaluation using the SPY-Elite laser angiographic system, insufficient distal marginal perfusion was detected in five out of 85 inferior dermal flaps, measuring between 2 and 5 cm2. These areas were subsequently debrided, and the reconstructions were successfully completed, representing 5.8% of cases. No instances of necrosis related to IDF have been observed. There have been no failed assessments conducted by SPY ICG. In total, the complication rate was 15.2%, with minor complications occurring in 8.2% of the breasts (7 out of 85) and major ones in 7% (6 out of 85). The subjects were monitored for an average of 14 months, the duration ranging from 12 to 24 months. CONCLUSION: Inferior dermal flaps have considerable advantages, such as a natural autologous blood supply, a more realistic tissue thickness and texture, lower costs, and better tolerance to post-reconstruction radiation. Moreover, using the IDF technique and assessing the perfusion of IDF and mastectomy flaps through the SPY-Elite laser angiographic system appears to be a dependable, efficient way to achieve good cosmetic results in one operation, eliminating the need for additional surgeries. 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 Table of Contents or online Instructions to Authors www.springer.com/00266.

Lipoabdominoplasty: Comparing UAL Versus UAL/PAL Techniques on Complication Profile and Patient Safety.

PURPOSE: This study intends to assess the complications and outcomes related to the use of UAL (LIPO SAVER, LHbiomed Co, Gangnam-gu, Korea) versus a combination of UAL and PAL (Microaire, Charlottesville, VA, USA) within the abdominoplasty procedure. MATERIAL AND METHOD: A retrospective study used patient data and chart reviews in a single surgeon's private cosmetic practice. The study involved patients who underwent the lipoabdominoplasty technique with UAL and a combination of UAL and PAL (UAL/PAL) over 4 years from October 2017 through December 2022. A total of 280 patients (272 female, eight male) who underwent standard (n:258) or fleur-de-lis abdominoplasty (n:22) due to skin excess, musculofascial laxity, and lipodystrophy were included in the study. Patients with illnesses affecting microcirculation, such as diabetes mellitus type I and II, cardiopulmonary diseases, oral contraceptive usage, hereditary bleeding and thrombotic disorders, and those who had undergone revision abdominoplasties were excluded. RESULTS: BMI above 30 kg/m2 was associated with an increased risk of both minor and major complications in the UAL abdominoplasty group (P = 0.005 and 0.001, respectively). On the other hand, BMI over 30 kg/m2 was associated with an increased risk of major complications in the UAL/PAL abdominoplasty group (P = 0.011). BMI over 30 kg/m2 was associated with an overall increased rate of minor and major complications in both the UAL and UAL/PAL groups (P = 0.001 and 0.001, respectively). There was no statistical difference between the UAL and UAL/PAL groups regarding complications, but a slight increase in the overall complication rate was observed in the UAL group (P = 0.061). Additionally, the study unveiled that there was no correlation found between age, gender, duration of surgery, lipoaspirate volumes and combined surgeries with an increased risk of complications between groups. CONCLUSION: BMI over 30 kg/m2 has been shown to have an adverse effect on the profile of complications in both groups, resulting in an increased risk, especially for major and minor complications such as seroma in the UAL group. 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 .

A Case of Nonsyndromic Unilateral Cleft Hand with Central Polydactyly, Syndactyly, and Thumb Hypoplasia: Support for a Common Etiology.

Experimental studies showed that central polydactyly, syndactyly, and cleft hand might appear when the same teratogenic factor acts on embryos at the same developmental stage. These observations and some clinical cases support the concept that a common etiologic mechanism is involved in the development of these malformations. We report a clinical case that demonstrates the association previously observed in experimental studies. Here, a patient with unilateral nonsyndromic cleft hand, central polydactyly, first web syndactyly, osseous syndactyly between the ring and long fingers, and minor thumb hypoplasia was presented.

Chronic Boutonniere Deformity: Cross-Lateral Band Technique Using Palmaris Longus Autograft.

PURPOSE: The purpose of this study was to evaluate the outcomes of treatment of chronic boutonniere deformity with a reconstruction technique using palmaris longus autograft. MATERIALS AND METHODS: Seven patients with chronic, posttraumatic, flexible boutonniere deformities referred to our clinic between January 2010 and September 2014 were included in the study. In all 7 patients, the lateral bands were deficient or damaged beyond repair. A novel reconstruction technique for chronic boutonniere deformity utilizing palmaris longus autograft was used. The 2 lateral bands were reconstructed by attaching the palmaris longus tendon grafts from the lateral part of the central slip proximally to the volar aspect of the distal phalanx distally using pull-out sutures. The grafts were positioned so that they crossed over one another at the level of the middle phalanx. The patients were followed for a mean of 14 months (range, 12-16 months). The principal outcome measure was the range of motion of the proximal (PIP) and distal (DIP) interphalangeal joints. RESULTS: Before surgery, the average PIP joint active flexion was 69° (range, 60°-85°). After surgery, the average PIP joint active flexion increased to 92° (range, 90°-100°). Before surgery, the average PIP joint extension deficit was 54° (range, 40°-60°); after surgery, the average deficit was reduced to 7° (range, 5°-15°). Before surgery, the average DIP posture was 9° of hyperextension (range, 5°-12°); after surgery, DIP hyperextension was reduced to 2° (range, 0°-5°). Before surgery, the average DIP active flexion was 40° (range, 35°-55°); after surgery, this increased to 55° (range, 43°-72°). No patients developed a DIP flexion contracture. CONCLUSIONS: In the chronic boutonniere deformity, when the lateral bands are deficient or damaged, our cross-lateral band reconstruction technique using palmaris longus autograft is a treatment option with satisfactory results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Leg ulcer in a patient with Rothmund-Thomson syndrome.

BACKGROUND: Rothmund-Thomson syndrome is a rare genetic condition exhibiting some dermatological, craniofacial, ophthalmological, and central nervous system abnormalities. CASE DESCRIPTION: A 51-year-old male patient, diagnosed with Rothmund-Thomson syndrome, attended to our outpatient clinic with complaint of unhealing wound in lower part of his left leg. Over this period, he had received various local therapies such as creams, wound dressings and hyperbaric oxygen therapy but no progress could be achieved. The wound gradually enlarged. Negative pressure wound therapy was applied at -125 mmHg for 20 days. Wound was finally covered with split-thickness skin graft. DISCUSSION AND EVALUATION: There is only one case of Rothmund-Thomson syndrome with leg ulcer reported in the literature. However, complete closure has not been achieved with non-surgical therapies in this case. Therefore we performed negative pressure wound therapy followed by skin grafting. CONCLUSIONS: It is useful to treat therapy resistant wounds in Rothmund-Thomson syndrome by negative pressure, which can preserve residual vital tissue, and help clear away necrotizing tissue effectively and close the wound promptly.

A classification system for ulnar polydactyly and clinical series.

PURPOSE: To describe a modified classification that includes both complicated ulnar polydactyly and ulnar polydactyly with bifid or duplicated proximal phalanx and to apply it to a clinical series. METHODS: A total of 42 patients with ulnar polydactyly were admitted to our outpatient clinic between January 2004 and January 2014 and were included in the study. Patients' clinical and radiological data were evaluated retrospectively and organized into 5 different subgroups. RESULTS: There were 20 bilateral and 22 unilateral patients with polydactyly. These were composed of 32 supernumerary digits represented as type I, 7 as type II, 9 as type III, 12 as type IV, and 2 as type V. Nine patients had bifid or duplicated proximal phalanges (types IIIA and IIIB) and 2 were of the complicated type (type V). We identified 5 types based on morphology, level of duplication, and other complicating features. CONCLUSIONS: Complicated ulnar polydactyly and ulnar polydactyly with bifid proximal phalanx are 2 important types of ulnar polydactyly with surgical implications, both separately included in the Pritsch classification system and Rayan and Al-Qattan classification systems. None of the current classification systems include both types. We believe our modified classification system will help to better define diagnosis and treatment plans for bifid proximal phalanx and complicated type ulnar polydactyly. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

A rare phenomenon: oculonasal synkinesis.

Oculonasal synkinesis is the simultaneous contraction of the orbicularis oculi and the compressor narium minor muscles. The etiology of this phenomenon is still unclear; congenital and traumatic reasons are considered to be responsible. Here we report a case of oculonasal synkinesis.

Supernumerary nostril: Congenital adrenal hyperplasia with a rare congenital anomaly.

Multiple or supernumerary nostril is a rare congenital anomaly with unknown etiology. The first case was reported by Lindsay as bilateral supernumerary nostrils. Supernumerary nostril cases are mostly unilateral and isolated. They are also reported with other congenital malformations like facial clefts and congenital anomalies like congenital auricular hypoplasia, congenital cataracts, eusophageal atresia and patent ductus arteriosus. Here, we report a case of supernumerary nostril with congenital adrenal hyperplasia.