Degloving injuries of trunk and limbs: comparison of outcomes of early versus delayed assessment by the plastic surgery team.

OBJECTIVE: to analyze cases of degloving of the trunk and limbs, comparing outcomes of early versus delayed assessment by the plastic surgery team. METHODS: we conducted a retrospective analysis of medical charts. Patients comprised two groups: Group I - early assessment, performed within 12 hours post trauma; and Group II - delayed assessment, performed more than 12 hours post trauma. We defined primary grafting as the use of skin from the traumatized skin flap. We excluded cases involving hands, feet or genitalia. RESULTS: there were 47 patients treated with degloving injuries between 2002 and 2010. The mean body surface area affected was 8.2%. Lower limbs were the most frequently affected site (95.7%), whether alone or in association with lesions to other sites. Delayed assessment by the plastic surgery team occurred in 25 cases. Mean hospital stay was 36.1 days for Group I and 57.1 days for Group II (p=0.026). Regarding the number of surgical operations (skin grafts), Group I received a mean of 1.3, while Group II underwent 1.6 (p=0.034). CONCLUSION: based on length of hospital stay and number of operations in trauma patients with degloving of the trunk and limbs, plastic surgery assessment should be carried out early.

Local complications after industrial liquid silicone injection: case series.

OBJECTIVE: To analyze a case series of patients who underwent injection of industrial liquid silicone in a clandestine manner and by unauthorized persons. METHODS: We conducted a retrospective analysis of medical records of patients treated between September 2003 and December 2010. Data regarding gender, age, location and volume of silicone injected, time between application and clinical manifestations, complications, treatment and outcome were collected. Early manifestations were defined as occurring within 30 days of injection and late manifestations, the ones arising after this period. RESULTS: We treated 12 patients, eight were male, seven transsexuals. The volume injected ranged from 5 ml to 2000 ml, being unknown in three cases. The most often used injected sites were the thighs and buttocks. Eight patients had early manifestations, with inflammation and/or infection. Surgical debridement was necessary in five cases. Three patients with a history of injection in the breast region underwent adenomastectomy. There was one death due to refractory septic shock. CONCLUSION: The use of industrial liquid silicone should be completely contraindicated as a filling material and modification of body contouring, and may have serious complications, even death.

Increased survival of free fat grafts with platelet-rich plasma in rabbits.

BACKGROUND: Numerous applications of autogenous platelet-rich plasma (PRP) have been studied so far; however, its property of enhancing the survival of free fat grafts has not been defined yet. In the literature, many reports are anecdotal and few include controls to definitely determine the role played by PRP in these grafts. OBJECTIVE: PRP was investigated to study its effect in free fat grafts' survival in a rabbit model. MATERIAL AND METHOD: A total of 30 New Zealand male rabbits aged 6 months received 0.8 g fat tissue (harvested by scissors dissection from the scapular area of the own animal) in the ears and were randomised into two groups. Group 1 (PRP group) was given the combination of 0.8 g of free fat graft and 1 ml of PRP. Group 2 (control group) received 0.8 g of free fat graft and 1 ml of saline solution. The rabbits were followed up for a period of 6 months after the procedure and then euthanised. The grafted tissue was stained with haematoxylin-eosin and submitted to microscopical evaluation. Graft histopathology was investigated for adipocyte viability, number of blood vessels and the presence of necrosis and fibrosis. All data were statistically analysed by the differences between the study groups. RESULTS: Three major effects of the addition of PRP in the free fat graft were observed. Group 1 showed a significantly higher fat survival weight as compared with the control group (P<0.05). Histopathological investigations revealed that the number of viable adipocytes and blood vessels was higher in group 1, and still, a larger number of necrotic areas and fibrosis were detected between group 2 (P<0.05). CONCLUSION: Application of autogenous PRP can enhance free fat graft survival in rabbits.

Sutureless closure of the upper eyelids in blepharoplasty: use of octyl-2-cyanoacrylate.

BACKGROUND: Skin adhesives provide an alternative to sutures for skin closure. The use of octyl-2-cyanoacrylate in blepharoplasty has been reported by some authors, but difficulties in applying the product and the real benefits of its use are still controversial. OBJECTIVE: The purpose of this study is to show a simple technique for closing the upper incision in blepharoplasty with octyl-2-cyanoacrylate instead of sutures and to discuss its benefits. METHODS: Eight female patients who underwent blepharoplasty had the upper incision closed with octyl-2-cyanoacrylate, for a total of 16 eyelids studied. Temporary stitches were placed along the incision and pulled by traction to approximate the skin borders. After apposition of the skin borders, high viscosity octyl-2-cyanoacrylate (Dermabond; Johnson & Johnson, New Brunswick, NJ) was used to close the incision. The stitches were removed immediately after glue crust formation, leaving the incision without sutures. The procedure was timed and a Hollander wound scale was used to evaluate the aesthetic results. RESULTS: Approximation of the skin borders with temporary stitches made it easier to apply octyl-2-cianoacrylate. The average gap between the skin borders was 1.0 cm. No major complications were encountered, although minor wound dehiscence occurred in 2 eyelids (12.5%). The closure time averaged 6.9 minutes and the aesthetic results were considered very good or excellent. CONCLUSIONS: Closure of the upper eyelids using octyl-2-cianoacrylate and temporary stitches removed immediately after glue crust formation is a safe and easily reproduced technique, with no differences in aesthetic outcome compared with suture closure.

Surgical complications in hair transplantation: a series of 533 procedures.

BACKGROUND: Surgical complications in hair transplantation can sometimes be a serious matter. Most of the published literature on this issue deals with individual case reports rather than larger series of patients. OBJECTIVE: The authors analyze complications in 425 consecutive patients undergoing 533 hair transplantations. METHODS: Patients with androgenetic alopecia (407 men and 17 women), cicatricial alopecia (9 men and 8 women), and malformations (1 man and 3 women) with a mean age of 36.9 years (standard deviation, 10.4 yrs) underwent hair transplantation between 1995 and 2006 and were followed up postoperatively for at least 1 year. Data on surgical complications were retrospectively analyzed. RESULTS: The overall complication rate in our series was 4.7%, including enlarged scar (1.2%), folliculitis (1.0%), necrosis in the donor area (0.8%), keloids (0.4%), bleeding (0.2%), hiccups (0.2%), infection (0.2%), and pyogenic granuloma (0.2%). The frequency of enlarged scar increased proportionally according to the number of surgical procedures. CONCLUSIONS: The hair transplantation complication rate in this series was 4.7%. Good communication between patient and surgeon, a complete clinical and laboratory assessment of the patient, accurate surgical technique, specific equipment, a trained surgical team, and careful postoperative attention to the patient are crucial for successful hair transplantation and for decreasing complication rates.).

Congenital infiltrating lipomatosis.

The congenital infiltrating lipomatosis (LCI) represents a distinct, clinical and pathological aspect of fat soft-tissue neoplasia; very few cases of which have been described in literature. In 1983, Slavin and Cols described the main characteristics of LCI as:(1) non-encapsulated tumours containing mature adipocites, (2) fat infiltration in muscles and adjacent soft parts, (3) absence of malignant characteristics, (4) absence of lipoblasts, (5) presence of fibrous elements, increased number of vessels and nerves and (6) adjacent bone hypertrophy. In this article, we describe a congenital infiltrating lipomatosis of the face in a child and discuss the diagnoses and the treatment of this disease.

Comparative study of the integration and viability of autonomised and nonautonomised autologous fat tissue grafts--experimental model in rabbits.

BACKGROUND: The free transplant of fatty tissue has gone through several phases of interest over the last 100 years of medical history, having undergone cycles of use and disuse. In the present study we aimed to create, through a delaying process, an improvement in the integration and lower resorption rates of autologous fat grafts. Similar research has not been found in the literature, and this was the motivating factor for the present study. METHODS: Twenty-three New Zealand male rabbits were used. The study consisted of two different modalities of autologous fatty tissue transplants [autonomised graft (A) vs nonautonomised grafts (NA)]. In order to characterise the histological differences that could contribute to the different macroscopic aspects in the samples of the autonomised and nonautonomised groups, three anatomic-pathological criteria were considered: steatonecrosis, viable adipocytes, and fibrous proliferation. For this analysis, the 'point-counting' technique proposed by Gundersen et al. was used, with a reticulum of 100 points and 50 lines. RESULTS: Statistically significant differences were found between the autonomised (A) and nonautonomised (NA) groups in both the macroscopic and microscopic aspects after the 6 month study period (P<0.05). CONCLUSIONS: We conclude that autonomisation of the fatty tissue and its transfer as an autologous implant, in rabbits, is capable of promoting lower rates of resorption and greater integration of the transplanted tissue, characterised by a greater number of viable adipocytes, lower rates of fibrosis and steatonecrosis in comparison with the nonautonomised graft.