Latissimus Dorsi Musculocutaneous Flap Inset Innovation in Breast Reconstruction.

BACKGROUND: Breast reconstruction is distinct among plastic surgery techniques. This study analysed the results of breast reconstruction with the Latissimus dorsi (LD) myocutaneous flap as a strategy for better coverage and positioning of the implant. METHODS: Twenty patients who underwent surgery between September 2013 and September 2016 were enrolled. Fourteen patients underwent reconstruction with LD and tissue expander (TE) exchanged later with implant. Six patients were reconstructed with LD and implant. The complications, problems, and aesthetic improvement associated with the use of implants placed under LD muscle were assessed. RESULTS: 0ne case required an expander removal because of deflation of TE, also one case had seroma formation due to recurrence of breast cancer and also one case had seroma in donor site. No asymmetry was detected in the inframammary fold (IMF) position between reconstructed and normal regions. After the procedure, 80% of the patients reported that their expectations were met, 95% reported no functional limitations, and 5% reported mild limitations that ameliorated with physiotherapy. The placement of implants (prostheses or expanders) under the muscle with using the LD muscle flap to cover the implant improved the breast contour by softening the inframammary crease and positioning the implants in the upper and medial quadrants of the new breasts. CONCLUSION: Breast reconstruction using silicone implants and the LD muscle flap can have excellent outcomes with low rates of complications. Placing the implant under a layer of muscle improved the harmony of the upper quadrants during breast reconstruction.

Relationship between Hyperactivity of Depressor Septi Nasi Muscle and Changes of Alar Base and Flaring during Smile.

BACKGROUND: Hyperactivity of depressor septi nasi muscle leads to smiling deformity and nasal tip depression. Lateral fascicles of this muscle help in widening the nostrils. The purpose of this study was to evaluate the relationship between the nasal length changes and the alar base and the alar flaring changes during smile. METHODS: Standard photographs are performed in the face and lateral views with forward gaze in the repose and maximum smile. Nasal length, alar base, and alar flaring were measured on the prints of the photographs. To decrease possible errors in the size of the printed photographs, middle face height from glabella to ANS was measured in the lateral view and the interpupil distance in the face view to standardize the measurements. RESULTS: Fifty cases were enrolled in this study. In 39 cases (78%), the nasal length was increased during smile. Forty-six cases (92%) had an increase in alar base diameter during smile. Alar flaring during smile increased in 48 cases (96%). Nasal length and alar base changes during smiling were not significantly correlated. Nasal length and alar flaring changes during smiling were not significantly related too. On the other hand, alar base and alar flaring changes during smile showed correlation. Alar base and alar flaring changes during smile were not significantly different in hyperactive and non-hyperactive cases. CONCLUSION: Nasal length change during smiling and hypertrophy of the medial fascicles of depressor septi nasi were not related to alar base or alar flaring change during smile.

Sentinel node mapping in Marjolin's ulcers: is it feasible?

INTRODUCTION: This study evaluated the feasibility of sentinel node biopsy in Marjolin's ulcers using peritumoral injection of the radiotracer and blue dye. MATERIALS AND METHODS: Ten patients with Marjolin's ulcers (5 male and 5 females) ranging in age from 39-65 years, and who were candidates for surgical removal of their tumors, were included in this study. The patients received 2 mCi technetium 99m (99mTc) antimony sulfide colloid in 2 divided doses subcutaneously in the peritumoral region. Immediately after anesthesia induction, 1 cc patent blue V in 2 divided doses was also injected in the same fashion as the radiotracer. Lymphatic mapping and sentinel node biopsy was performed using a gamma probe. Any hot and/or blue lymph nodes were harvested as a sentinel node. Primary lesions were then excised and wounds grafted with a splitthickness skin graft. RESULTS: A sentinel node could be identified on the lymphoscintigraphy images in only 2 patients. Sentinel node mapping was successful during surgery in these 2 patients. None of the harvested sentinel nodes were blue. CONCLUSION: Lymphatic mapping and sentinel node biopsy do not seem feasible in Marjolin's ulcers located in areas of extensive burn scarring due to a low detection rate. Larger studies are needed to validate the results of this study.