Fascial suspension mastopexy combined with augmentation mammaplasty.

BACKGROUND: We have modified our technique of fascial suspension mastopexy to be used in combination with augmentation mammaplasty. This study aimed to assess the results of the combined procedure in our first consecutive 10 patients. The surgery aims to maximize long-term upper-pole fullness as well as optimal projection and shape in volume-depleted ptotic breasts. METHODS: A retrospective case notes review was carried out, with details of patient demographics, indications, operative detail, and postoperative assessment recorded. In addition, patients were directly questioned to gain their opinion of the procedure. RESULTS: Nineteen breasts were operated on in ten patients. On preoperative assessment two women (20%) had grade 3 ptosis and the rest had grade 2 (83%). The majority of women had had children and had breast-fed (70%). The mean follow-up period was 33 months (range = 4-55) and overall patient satisfaction was high despite six of the 10 patients undergoing minor scar revisions for dog-ears under local anesthetic and two undergoing implant exchange to correct minor asymmetries. There were no major postoperative complications in this series. All patients demonstrated good projection and upper-pole fullness at postoperative review. CONCLUSION: The combined technique of fascial suspension mastopexy and breast augmentation with implants is a safe and reliable method to correct ptosis in volume-depleted breasts. Patients should be counseled on the possible need for minor revisional procedures. Importantly, the technique achieves excellent upper-pole fullness and the projected and rejuvenated breast has an overall pleasing result.

Dynamic arteries of the hand.

BACKGROUND: We investigated the previously undescribed phenomenon of ulnar artery occlusion on clenching to make a fist, following the presentation of a patient to our unit with idiopathic ulnar-sided hand pain. This led us to study this unusual finding in a cohort of asymptomatic patients. METHODS: Ninety-one radial and ulnar arteries were studied in 23 volunteers by color duplex ultrasonography. The subjects were all asymptomatic, their ages ranged from 18 to 78 years, and included 10 males and 13 females. RESULTS: Twenty-two percent of ulnar arteries occluded on clenching a fist, resulting in the hand relying on in-flow solely from the radial artery. All arteries opened up following fist release allowing anterograde flow. Furthermore, 11% of superficial palmar branches of radial arteries occluded on fist-making. The pattern of flow on making a fist showed an initial burst of reverse flow followed by reduced or occluded flow and subsequently an increase in antegrade flow after release of the fist. No subject could occlude both radial and ulnar arteries simultaneously. CONCLUSIONS: We discuss these findings in view of the potential clinical implications in terms of Raynaud's phenomenon, scleroderma, and importantly, the potential for false-positive findings of pathological ulnar artery occlusion on ultrasonography.

Epidermoid inclusion cysts After APTOS thread insertion: case report with clinicopathologic correlates.

The APTOS threading procedure is a relatively new method in antifacial ptosis surgery. The reported cases present a small percentage of minor complications. A 57-year-old woman experienced scarring after APTOS threading. Scar biopsy showed an epidermoid inclusion cyst. Epidermoid inclusion cysts are a potential complication of APTOS threading. Proper surgical technique may reduce their likelihood.

Lacrimal fistula 10 years after closed cosmetic rhinoplasty: case report.

Lateral osteotomies performed during cosmetic rhinoplasty can be associated with several complications. Due to the proximity of the lacrimal drainage system to the site of lateral osteotomies, the lacrimal system may be injured during this procedure. This type of injury is very rare, with few reports in the literature. The authors describe a 31-year-old woman who underwent a cosmetic rhinoplasty and experienced postoperative recurrent conjunctivitis with purulent discharge and epiphora. A lacrimal fistula developed 10 years after the procedure.

Expanded reverse abdominoplasty for reconstruction of burns in the epigastric region and the inframammary fold in female patients.

We report the use of expanded reverse abdominoplasty in three female patients with postburn scars involving the entire epigastric region in which the inframammary folds were effaced, resulting in distortion of breast contour. In two of the patients, tissue expanders were used, and subsequently, reverse abdominoplasty was performed, thus re-creating the inframammary fold. The third patient reported to be pregnant after expanders were placed; therefore, smaller volumes of inflation for tissue expansion were necessary. We believe that this procedure is an optimal solution, both aesthetically and functionally, in respect to other reconstructive techniques in female patients with normal skin inferior to epigastric burns. The surgical technique and results are discussed.

A comparison between CO2 laser surgery with and without lateral fold vaporization for ingrowing toenails.

BACKGROUND: An ingrowing toenail is an excessive lateral nail growth into the nail fold. It acts as a foreign body and exerts a local pressure sore-like effect, which may result in inflammation and granulation. Several treatment modalities exist, including chemical ablation and different surgical procedures. Here we describe and compare a simple and effective method of partial matricectomy using the CO2 laser (group A) versus a similar method with the addition of lateral nail fold vaporization (group B). OBJECTIVE: Outcome evaluation of a modified laser treatment modality for ingrowing toenails and determination of the role of lateral fold vaporization in reducing the recurrence of symptoms. METHODS: Forty patients (mean age 32.45 years) were treated with CO2 laser ablation of toenails between 1999 and 2005 by four physicians. One physician implemented a method that includes lateral nail fold vaporization and resection of the nail segment with its nail bed from 1999 to 2005. Three physicians implemented a similar technique but without lateral fold vaporization between 1999 and 2003, and added lateral fold vaporization to the performed procedure starting in 2004. RESULTS: The recurrence rate was 37.5% in group A and 6.2% in group B. The overall average disease-free follow-up period was 42.2 months. CONCLUSION: The use of CO2 laser in the treatment of ingrowing toenails offers an effective modality. We demonstrate the importance of lateral fold vaporization with the CO2 laser both in improving efficacy and in decreasing recurrence rates over a long follow-up period.

A new modality in the treatment of actinic cheilitis using the Er:YAG laser.

BACKGROUND: Cheilitis is a precancerous skin lesion most often affecting the lower lip. We describe a technique in which this disorder can be treated using Er:YAG laser vaporization. The Er:YAG laser wavelength at 2940 nm lies in a very strong water absorption peak; tissue interaction results mainly in vaporization with minimal heat conduction to adjacent tissue. OBJECTIVE: To evaluate the efficacy and outcome of a new modality in the treatment of actinic cheilitis with the Er:YAG laser. METHODS: Between 2002 and 2005, 12 patients with actinic cheilitis were treated at our institute with the Er:YAG laser. All patients were cured with no recurrence to date, and none suffered postoperative complications. RESULTS: Patients were men and women aged between 37 and 71 years. The healing duration varied from 7 to 30 days (mean 22.33+/-6.91 days) and the follow-up ranged from 8 months to 3 years (mean 23.16+/-9.48 months). No recurrences were detected in our study. CONCLUSION: Using the Er:YAG laser provides accurate tissue ablation, giving a very satisfactory cosmetic result, with a short healing period, no lip deformity and no sensation loss.

Late-onset facial abscess formation after cosmetic soft tissue augmentation with bio-alcamid.

Bio-Alcamid (BA) (polyalkylimide) was introduced in Europe in 2001. It is a nonresorbable injectable filler for soft tissue augmentation, indicated for a wide variety of clinical applications in reconstructive and cosmetic surgery in conditions where subcutaneous volumetric compensation is required. Although BA biocompatibility was approved by a European Union Certificate (CE), the substance is not a natural component of biologic tissues, and thus inflammation and infection are still potential risks. The authors present a case of BA infection after minor trauma 3 years after bilateral injections to the malar regions in a 43-year-old woman, causing an abscess that required surgical drainage and parenteral antibiotics.

Terror-inflicted thermal injury: A retrospective analysis of burns in the Israeli-Palestinian conflict between the years 1997 and 2003.

BACKGROUND: Terror attacks have changed in the past decade, with a growing tendency toward explosives and suicide bombings, which led to a rise in the incidence of thermal injuries among victims. The Israeli-Palestinian conflict of October 2000 marked a turning point when an organized terror campaign commenced. This article presents data of terror-associated burns from the Israeli National Trauma Registry (ITR) during the years 1997 to September 2000 and October 2000 to 2003. METHODS: We analyzed demographic and clinical characteristics of 219 terror-related burn patients and 6,546 other burn patients admitted to hospitals in Israel between 1997 and 2003. Data were obtained from the ITR. RESULTS: Burns contributed about 9% of all terror related trauma and about 5% of all other trauma (p < 0.0001). These percentages have not changed significantly before and after October 2000. Terror-related burns afflict Jewish males more than predicted by their percentage in the population, whereas other burns afflict non-Jewish males more than predicted. Adults and young adults (15-59 years) are the predominant group in terror-related burns (80%), whereas children younger than 15 years are the predominant group in other burns (50%). Large burns (20% to 89% total body surface area) are more common in terror casualties, with greater mortality (6.4% in terror-related versus 3.4% in others; p = 0.0258). CONCLUSION: Although the incidence of burns has risen because of an organized campaign, this change was noticeable in other trauma forms as well in similar proportions. Terror-related burns afflict a targeted population, and generally take on a more severe course with greater mortality rates, thus requiring appropriate medical treatment.

Stensen duct rupture (sialocele) and other complications of the Aptos thread technique.

BACKGROUND: The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. METHODS: Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. RESULTS: The authors present two major complications, a rare case of Stensen's duct laceration and a case of chronic inflammation mandating surgical treatment. CONCLUSIONS: Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.

The use of video capture virtual reality in burn rehabilitation: the possibilities.

We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.

Necrotizing periorbital cellulitis following aesthetic rhinoplasty.

Rhinoplasty is rarely complicated with infection. We present a case of necrotizing periorbital cellulitis that developed in an 18-year-old woman following aesthetic rhinoplasty. The clinical manifestations consisted of swelling of the eyelids and necrosis of the lower eyelid regions, accompanied by high fever. Streptococcus pyogenes was isolated from the wound. The patient responded well to administration of intravenous amoxycillin/clavulanate and conservative local treatment. The infection resolved uneventfully. At 2-year follow-up, the cosmetic result was excellent.

Nonarteritic anterior ischemic optic neuropathy is associated with a specific platelet polymorphism located on the glycoprotein Ibalpha gene.

OBJECTIVE: To evaluate the association between platelet glycoprotein polymorphisms and the risks of single and second eye involvement with nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Case-control study. PARTICIPANTS: Ninety-two consecutive patients with NAION, 26 of whom had second eye involvement, and 145 controls who attended the eye clinic for nonvascular entities. METHODS: Polymerase chain reactions and restriction enzyme analyses were performed for genotyping 5 platelet glycoprotein polymorphisms on DNA extracted from whole blood. MAIN OUTCOME MEASURES: Frequencies of the various platelet polymorphisms. RESULTS: One of the 5 platelet glycoprotein polymorphisms analyzed, the B allele of the glycoprotein Ibalpha variable number of tandem repeats (VNTR), was a significant independent risk factor for NAION, with an odds ratio of 4.25 and a 95% confidence interval of 1.67 to 10.82 (P = 0.0026). All other platelet glycoprotein polymorphisms were similarly distributed in patients and controls. In addition, 9 of 16 patients who bore the VNTR B allele (56.3%) had second eye involvement, whereas among patients not harboring the VNTR B allele only 17 of 72 patients (23.6%) had second eye involvement (P = 0.009). Moreover, second eye involvement occurred earlier in patients who bore the specific polymorphism. CONCLUSIONS: The presence of the VNTR B allele of glycoprotein Ibalpha confers a significant risk for NAION and predisposes affected patients to second eye involvement.

[Ptosis--etiology, diagnosis and management].

Ptosis is a common complaint in patients who refer to ophthalmologists especially oculoplastic surgeons. Occasionally, ptosis may be the presenting sign or symptom of a systemic disease. Therefore, it is of great importance to know the causes of ptosis, its clinical presentation, and the systemic evaluation that one must undergo before going into surgery. This review presents the common causes of ptosis according to age of appearance, systemic diseases that must be ruled out, and the surgical options that exist.