RESUMO
Background: Superior pedicle breast reduction is a very popular technique among plastic surgeons. This technique has had many variations looking for fewer complications and better long-lasting results. The aim of this article is to present a novel technique of breast reduction, making variations in the design of the periareolar incision, using a superior pedicle with a constant vertical incision of 5 cm and a shortened horizontal incision. Methods: The superior pedicle inverted T-mammoplasty with a shortened horizontal scar technique was performed in 1200 patients who underwent surgery between 2010 and 2023; follow-up examination was carried out for an average of 1 year (3 months to 3 years). A patient satisfaction survey was conducted. Results: Patient satisfaction rate was 99%. There were no cases of total necrosis of the areola-nipple complex, 2.7% of the patients presented partial necrosis of the areola-nipple complex, 1.4% of the patients presented local infection, 1.7% presented dehiscence at some point of the vertical or horizontal suture, 4% of the patients presented a widened scar, 8% of the patients presented alteration in the sensibility of the areola-nipple complex, and 0.6% of the patients presented hematoma. With this technique, a rise of the areola-nipple complex of up to 22cm was achieved. Conclusions: The superior pedicle inverted T-mammaplasty with shortened horizontal scar technique showed a lower number of surgical complications compared with other techniques previously used for breast reduction, even when applied in gigantomasty. It provides lasting results and a high rate of patient satisfaction.
RESUMO
Introducción y objetivo: Las lesiones nerviosas en los miembros inferiores son un problema mayor para quienes las padecen porque ocasionan limitaciones funcionales importantes en la extremidad afectada, que pueden ser de carácter sensitivo, motor o ambas. La reconstrucción nerviosa de las extremidades inferiores es un desafío quirúrgico para el cirujano por la dificultad técnica y la gran demanda de conocimiento que requieren. Presentamos la experiencia en reconstrucción nerviosa de los miembros inferiores en el Hospital Universitario Clínica San Rafael en Bogotá (Colombia) y en el Hospital Manuel Gea González en México D.F, (México), y por primera vez, la neurotización sensitiva del nervio safeno interno al nervio tibial posterior Material y método: Recopilamos información de 9 pacientes con lesiones nerviosas de los miembros inferiores, las más representativas según ubicación y etiología, que acudieron a la clínica especializada de nervio periférico, 3 en el Hospital Manuel Gea González y 6 en el Hospital Universitario Clínica San Rafael, y que requirieron reconstrucción nerviosa microquirúrgica. Resultados: En todos los casos hubo recuperación funcional y/o sensitiva de la extremidad afectada. Describimos por primera vez la neurotización sensitiva del nervio safeno interno al tibial para recuperación de sensibilidad de la planta del pie. Conclusiones: Cuanto más proximal es la lesión, más tarda su recuperación. La neurotización sensitiva del nervio safeno interno al nervio tibial es un procedimiento efectivo. El uso de diferentes técnicas quirúrgicas favorece una adecuada reconstrucción nerviosa. Lesiones con evolución menor de 1 año y brechas nerviosas menores de 6 cm son factores de buen pronóstico para la recuperación de los pacientes
Background and objective: Th enerve injuries in the lower limb are a major problem because they cause functional limitation in the affected extremity; these limitations can be sensitive, motor or both. The nerve reconstruction of lower limb is a challenging procedure because it requires huge knowledge of the pathology and surgeon expertise. We present our experience in lower limb nerve reconstruction in the Universitary Hospital Clínica San Rafael in Bogotá (Colombia) and Hospital Manuel Gea González in México D.F. (México). In addition, sensory neurotization of the internal saphenous nerve to the posterior tibial nerve is presented for the first time. Methods: Information was collected from 9 patients with nerve injuries of the lower limbs, the most representative according to location and etiology, who attended the specialized clinic of peripheral nerve, 3 at the Manuel Gea González Hospital and 6 at the Universitary Hospital Clínica San Rafael, and that required microsurgical nerve reconstruction. Results. In all cases, functional and/or sensory recovery of the affected limb was obtained. The sensory neurotization of the internal saphenous nerve to the tibial is described for the first time, to recover the sensation of the sole of the foot. Conclusions: The closer the lesion is, the longer it takes to recover. Sensory neurotization of the internal saphenous nerve to the tibial nerve is an effective procedure. The use of different surgical techniques favors adequate nerve reconstruction. Lesions with evolution less than 1 year and nerve gaps smaller than 6 cm are factors of good prognosis for the recovery of patients
