Medial Thigh Contouring After Massive Weight Loss: The Liposuction-Assisted Medial Thigh Lift (LAMeT).

INTRODUCTION: Following massive weight loss (MWL), medial contouring of the thigh is frequently requested to improve the appearance and function. Thigh lifting can be associated with significant complications if the medial thigh excess is removed en bloc. In this article, we describe the Liposuction-Assisted Medial Thigh Lift (LAMeT) and evaluate the outcomes and complications in a retrospective cohort study. MATERIALS AND METHODS: A total of 54 females aged between 25 and 61 years with Grade 2 or 3 of thigh deformity on Pittsburgh Rating Scale (PRS) underwent medial thigh reduction. Vertical thigh lift with fascia suspension was performed in 25 patients with third degree of ptosis on PRS, horizontal thigh lift with fascia suspension was performed in 3 patients with second degree on PRS, LAMeT was performed in 26 patients with second and third degree on PRS. RESULTS: Complications were observed in 35.7% of the patients that underwent the standard technique and in 3.8% patients that underwent the LAMeT. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT group. CONCLUSIONS: Medial thigh lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc because the resection of the excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus, the incidence of postoperative complications is lower and the patients heal faster.

Complex abdominal wall repair using a porcine dermal matrix.

Management of complex abdominal defects remains a significant challenge for many surgeons, especially in contaminated fields. Currently, available biosynthetic grafts include human cadaveric dermis (AlloDerm), porcine dermal (Permacol and Strattice), and submucosal (Surgisis) sources. All these grafts are composed of an acellular collagen scaffold to provide a bridge for tissue incorporation and neovascularization. The authors describe a case report of a woman who required dual mesh explantation and successive reparative surgery using a porcine dermal matrix for a complex and infected abdominal wound. Twelve months postdischarge the patient remains well, she is pain free, and she returned home to full activities with complete wound closure and without any evidence of residual or recurrent hernia. The patient was satisfied with her cosmetic results. In conclusion, the authors' experience shows that the use of Permacol, a porcine dermal matrix, has been successful in treating an infected abdomen and a vast abdominal wall defect.

Use of platelet-rich plasma and hyaluronic acid in the loss of substance with bone exposure.

OBJECTIVE: : In lower-extremity surgery, the complex wound with bone exposure remains a challenging problem for the plastic surgeon. The purpose of this study was to describe a new therapeutic approach to stimulate the regeneration of the lower-extremity complex wounds based on a combined treatment composed of platelet-rich plasma (PRP) and hyaluronic acid (HA) dressing. DESIGN: : Wounds with posttraumatic bone exposure have been treated with HA dressing alone or in combination with PRP. PATIENT: : Fifteen patients affected by lower-extremity wound with posttraumatic bone exposure have been treated at the Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy. RESULTS: : After a single treatment, the authors observed that the mean re-epithelialization time was 8.1 weeks in 73.3% patients treated with PRP and HA dressing versus the 30% patients treated with HA dressing only. CONCLUSION: : These data confirm the evidence of using PRP technology in the healing of both soft- and hard-tissue wounds. Moreover, the satisfaction of the patient confirms the quality of this study's results.

Orbital reconstruction: bone-anchored implants.

The authors present their experience on reconstruction by extraoral bone-anchored implants technique, showing two patients from a total of 13, treated for orbital reconstruction. They were selected from 66 patients treated for reconstruction of orbit, ear and nose using this technique by the staff of the Department of Plastic and Reconstructive Surgery of the University of Tor Vergata, Rome, Italy. They underwent orbital emptying due to cancer pathology. Surgical technique is described in detail; its final purpose being positioning of titanium fixtures on the orbital borders, necessary to anchor the silicone epithesis. The advantages and potential limits of this technique are exposed, exposing the important role of patient's compliance. The importance of preliminary study on the patients is also emphasized and includes clinical evaluation and instrumental examination for surgical planning, completed by a photographic study in the three standard projections.Satisfactory aesthetic results were obtained by the use of this technique and the authors believe it may represent a valid option; complementary to more traditional ones, but is a first choice in patients who cannot endure major surgery or in case of failure of traditional techniques.