Temporal Fascia Free Flap for Thumb Coverage in Electrical Burn Injuries: A Case Series Analysis With DASH Score Outcomes Evaluation.

Electrical burns pose unique challenges in reconstructive surgery due to the extensive tissue damage they cause. The thumb is particularly susceptible to electrical burns, leading to severe functional impairment. This case series introduces the use of the temporal fascia free flap for thumb coverage in patients with electrical burn injuries. The study aims to assess the functional outcomes of this approach using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Six male patients underwent thumb reconstruction using temporal fascia free flaps following electrical burn injuries. The extent of the injury was assessed, and necrotic tissue was debrided. Functional outcomes were evaluated using the DASH questionnaire 6 months postoperation. All procedures were conducted in accordance with ethical guidelines, and informed consent was obtained from all patients. All patients achieved successful transplants using temporal fascia free flaps. The average DASH score at the 6-month follow-up indicated satisfactory functional recovery. Patients reported improvements in thumb mobility and functionality, and the cosmetic appearance of the thumb was acceptable. The appearance of the scar in the donor area was well-received. The temporal fascia free flap proved to be an effective method for thumb reconstruction following electrical burn injuries. Its thin and flexible nature allows for optimal contouring and improved range of motion. Although one case of partial flap loss was observed, overall functional and aesthetic outcomes were satisfactory. Further research with larger sample sizes is warranted to optimize surgical techniques and postoperative care for better outcomes.

Pedicle stabilization with fibrin sealant in DIEP flap breast reconstruction.

Microsurgical procedures are nowadays routinely performed worldwide in reconstructive surgery. The deep inferior epigastric artery perforator (DIEP) flap has become the gold standard in breast reconstruction due to its excellent outcomes and lower donor site morbidity. However, complications, including flap failure, still occur in DIEP flap breast reconstruction. Often, according to our experience, these complications result from pedicle disorders, which can be attributed to postoperative mobilization. In the present study, we evaluated the efficacy and safety of using a fibrin sealant as a method for pedicle stabilization to prevent pedicle mobilization in the postoperative period. With our technique, after the flap insetting and microsurgical anastomosis, the pedicle was stabilized by applying a fibrin sealant (TISSEEL™) around and over the entire pedicle. Our study included a homogeneous series of 70 patients who received a delayed DIEP flap breast reconstruction. A retrospective study was conducted to evaluate this novel technique compared to the conventional method. In our experience, the fibrin glue allowed us to reduce the strain for correct pedicle positioning and all subsequent efforts to avoid displacements in the postoperative period. Our preliminary results suggest that this method may lead to a reduction in overall complications attributable to pedicle disorders.

A before and after evaluation of patient reported outcomes assessed by Breast Q following LICAP turnover flap in breast conservative therapy.

Chest-wall perforator-based techniques to replace volume for breast conservative therapy allow excision of large breast areas with minimal sequalae, such as the nipple-areolar complex displacement, parenchymal indentation or contour deformity. Furthermore, chest wall perforator flaps facilitate the maintenance of breast symmetry, hence decreasing the need for contralateral surgery. Lateral intercostal flap was described in numerous variants among which the most famous are the propeller flap and the turnover version. The turnover version is the easiest and fastest version that allows the replacement of large amount of volume. In this paper, we evaluate patients reported outcomes, before and after surgery, collected through the Breast Q. This study was conducted on 21 patients who were admitted to the plastic surgery department. A prospectively maintained database was used to identify the patients and their records were assessed retrospectively. The pre/post operative patients data were collected. The Breast-Q questionnaire was administered before the surgery and at least 1 year after. No major surgical complications were reported. Mean Breast-Q scores were evaluated at least 1 year after surgery and radiotherapy and compared with pre-surgical scores. Among all the modules, no significant differences between the pre-surgical and post-surgical Breast-Q scores were observed. Until now, the lateral intercostal artery perforator flap has not been widely used, due to a difficult dissection and a challenging preoperative planning. According to the reported surgical technique, the execution is easy. This technique provides the same breast-related quality of life compared to preoperative values, reduces the mastectomy rate and increases the overall survival.

Outcomes of Double-Mobility Prosthesis in Trapeziometacarpal Joint Arthritis With a Minimal 3 Years of Follow-Up: An Advantage for Implant Stability.

Background: New generation of total trapeziometacarpal joint prosthesis using double mobility concept has been used for several years. The aim of this study was to evaluate the dislocation rate with this implant after a minimal 3 years of follow-up. Methods: From September 2013 to August 2015, 200 trapeziometacarpal prostheses were implanted in 179 patients. Clinico-radiological follow-up was performed with an average of 48.2 months (36-60 months). Survival rate and dislocation rate were analyzed. Loosening of the implants and other intercurrent events were noticed. Results: Visual analog scale, Quick-DASH, strengths and range of motion improved significantly. We report a survival rate of 97% with only 0.5% of dislocation of prosthesis at 48 months of follow-up. Intercurrent events rate were similar to the ones found in literature or other studies. Conclusions: After a minimal of 3 years of follow-up, prosthesis with double mobility seemed to bring better stability in implant for thumb prosthetic replacement.

The modified serratus anterior fascia flap improves satisfaction and long-term results in immediate implant-based breast reconstruction: A retrospective study.

After immediate implant-based breast reconstruction (IIBR) following skin-sparing mastectomy, postoperative complications such as implant exposure or badly defined mammary folds can occur. Acellular dermal matrix can provide good esthetic outcomes but remain expensive. This study evaluates a new technique of one-stage IIBR by using a modified serratus anterior fascia flap (MSFF group), providing lower implant coverage, as compared to the classical submuscular technique. In this retrospective study, we included all patients who underwent IIBR using either the MSFF technique or the classic technique between November 2012 and February 2015. We collected data regarding demographics, perioperative factors, postoperative complications, patient satisfaction (Breast-Q score), and esthetic outcomes. One hundred twenty-three patients who underwent IIBR, of which 61 breasts (59 patients) using the MSFF and 67 breasts (64 patients) the classical technique, were included. The size of the implants used were significantly higher in the MSFF group (p = 0.036). There were no statistically significant differences between the two groups with regard to the immediate complications rate. After a mean follow-up of 43.9 months, we observed more capsular contractures in the classic group (p < 0.001). In the classic group, patients required more revision surgeries (p = 0.008), more implant changes (p < 0.001), and higher volume of additional lipofilling (p < 0.001). According to the Breast Q scores, patients' satisfaction was better in the MSFF group regarding their breasts (p = 0.001) and the outcomes (p = 0.009). The MSFF is a simple, safe, effective, and inexpensive autologous technique for IIBR, which improves implant coverage with a vascularized flap and provides satisfying outcomes as compared to classic IIBR, with less complications.

Lower rates of lipofilling sessions in latissimus dorsi flap breast reconstruction with initial higher volume transfer by preservation of subfascial fat: A 3D camera-assisted volumetric case series.

Breast reconstruction with latissimus dorsi flap (LDF) is a well-known technique, but the crucial goal is to achieve a satisfying final volume restoration. Our hypothesis is that LDF reconstruction with the preservation of subfascial fat can achieve a higher volume in a one-time procedure than that achieved in a classic LDF harvest. The aim of the study was to quantify the volume resorption in LDF reconstructions with the preservation of subfascial fat. Fifteen breasts were reconstructed with a simple LDF and the remaining 15 with an LDF with the preservation of the subfascial fat between January 2016 and May 2017. Secondly, every patient underwent a lipofilling procedure. A supplemental lipofilling procedure was performed in unsatisfying cases. A Structure-Sensor camera manufactured by OccipitalⓇ was used. Each patient received a 3D measurement during immediate postoperative care and then after 3 and 6 months of follow-up. This study shows no difference in volume retention at follow-up between the 2 techniques. The gain of an immediate and stable fatty layer in LDF + subfascial fat technique leads to breast volume improvement in one surgical step. Breast reconstruction with LDF and subfascial fat can be defined as a reliable solution, which provides an optimal result with a reduced number of surgical interventions when compared with a simple LDF.

Reconstruction of Full-Thickness Lower Lid Defects Using Texier's Procedure: Retrospective Assessment of the Indications.

PURPOSE: Lower lid defects involving more than 75% of the lid's length or affecting the cheek are usually reconstructed with a Mustardé rotational cheek flap. This solution often induces postoperative ectropion. The Texier procedure (an upper lid myocutaneous flap and a chondromucosal alar graft) is usually indicated for 1-step reconstruction of full-thickness defects involving less than 50% of the lower lid. This retrospective study evaluated larger indications for the Texier procedure for full-thickness defects of the lower lid, results of lid defects longer than 50 or even 75%, and the use of a chondromucosal nasal septal graft for lid defects longer than 75%. MATERIALS AND METHODS: All lower lid reconstructions using the Texier procedure over a period of 29 months were retrospectively included. Data on postoperative complications and patient satisfaction were collected. RESULTS: Fifteen patients were included; one third had a defect involving no more than 50% of the lower lid, one third presented with a defect of 50 to 75%, and one third had a defect of at least 75%. In this last group, reconstruction included a septal graft. Mean follow-up was 35 months. Transitory palpebral edema was present in 100% of patients and lasted 8 months on average. No postoperative ectropion or nasal alar retraction of the graft donor site was observed. Mean satisfaction score was 2.86 of 3. CONCLUSIONS: The Texier procedure can be used as first-line treatment to reconstruct most full-thickness defects of the lower lid, including subtotal defects.

Impact on Breastfeeding According to Implant Features in Breast Augmentation: A Multicentric Retrospective Study.

BACKGROUND: Exclusive breastfeeding is highly recommended by the World Health Organization during the first 6 months of life. In parallel, breast augmentation with implants is one of the most performed operations in aesthetic surgery. OBJECTIVE: The goal of our study was therefore to analyze the potential impact of aesthetic breast implants on breastfeeding. STUDY DESIGN: A retrospective study was carried out in 3 French university hospitals. The main inclusion criterion was adult women of childbearing age (18-50 years old) with bilateral breast hypoplasia. Some features of the surgery, such as the operative indication, the surgical approach, the implant position against the pectoral muscle, and implants features (material, volume, profile), were collected. We conducted a survey by phone about childbirth after the procedure. If the women had children after surgery, we asked them if they breastfed and the characteristics of breastfeeding. RESULTS: In total, 1316 patients received breast implants in the 3 centers from January 2011 to October 2016 and met our inclusion criteria. We included 1073 patients; 998 women had breast implants with no pregnancy. Among the 75 patients (7%) who gave birth after the surgery, 51 wanted to breastfeed (68%). The patients with a retroglandular implant were significantly less able to breastfeed compared with the patients with retromuscular implants (P = 0.0005). No difference was found for age, the type of surgery, the surgical approach, and the shape or type of implant between the successful breastfeeding group and failed breastfeeding group. CONCLUSION: A woman with aesthetic breast implants has a 75% chance of breastfeeding if desired, regardless of the type and the volume of the implant and the surgical approach. She has an 82% probability of breastfeeding with retromuscular implants and 17% with retroglandular implants.

Efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: A retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases.

To date, the effectiveness of radiological imaging in detecting silicone breast implant rupture is uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture. In this study, 175 patients with 242 breast implants were included, of which 168 and 74 implants were used for breast reconstruction and aesthetic augmentation, respectively. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction were included, regardless of any pre-operative diagnosis of rupture that had been made. The diagnosis of intracapsular rupture was verified intraoperatively and compared to the pre-operative findings. With regard to pre-operative diagnostic imaging methods, we compared magnetic resonance imaging (MRI), mammography, and ultrasonography (US) findings. Among the 242 implants that were explanted, 35 clinical ruptures were confirmed and compared with the related radiological findings. We reported 22 false positives and 15 false negatives. US was the least specific and least accurate method because of its lowest positive predictive value (PPV) and negative predictive value (NPV). Mammography was the most specific and most accurate method, with the highest PPV (96%). Surprisingly, MRI was the most sensitive; however, it was neither the most specific nor the most accurate method despite having the highest NPV (98%). After comparing these three radiological techniques, we conclude that US along with MRI can be useful for young patients. Mammography, which was characterised by high specificity and accuracy, could be useful along with MRI in investigating patients over the age of 40.

Correction of tuberous breast deformity: A retrospective study comparing lipofilling versus breast implant augmentation.

Breast implants and, more recently, autologous fat grafting are the two most common treatments used to correct tuberous breast deformity (TBD). The post-surgical quality of life between the two techniques is not well demonstrated. This study aimed to compare satisfaction and health-related quality of life in patients affected by TBD between these two techniques. All TBD patients operated between January 2008 and May 2015 were retrospectively identified, and only those treated with implants or lipofilling were included. Satisfaction was evaluated at least 6 months after surgery with the postoperative Breast-Q® augmentation module. From January 2008 to May 2015, 62 patients were recruited in our study, and 37 patients were evaluated using a Breast-Q questionnaire after at least 6 months of follow-up. Breast implant-augmented patients were significantly more satisfied concerning the "satisfaction with breasts" module (p = 0.002) and the "satisfaction with outcome" module (p = 0.00008). A question-by-question analysis revealed several interesting and significant differences, showing higher scores in most of the questions in the breast implant group. Patients in the lipofilling group, interestingly, had a mean of 1.6 interventions compared to the mean 1.36 interventions in the implant group (p = 0.23). This reflects the need to perform more surgical sessions in the lipofilling group to achieve a satisfactory result. Our study demonstrated that tuberous breast correction with implants can achieve better satisfaction along with good outcomes than lipofilling usually does.

Coverage of the neurovascular unit of the fingertip using a reverse homodigital dorsal flap.

The exposure of bone, tendons, vessels, and nerves in a digital defect is one of the most frequent and severe problems to solve in hand surgery and current approaches are still disappointing. We show the use of an homodigital adipofascial flap taken from the same finger for covering the pulpar defect in a one-step surgical technique able to preserve the digital artery.

Dermatofibrosarcoma protuberans: Our experience of 59 cases.

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor with intermediate malignancy. It is initially located on the skin from where it is able to infiltrate the deep structures and has a tendency to recur locally following inadequate excision. A t(17;22)(q22;q13) chromosome trans-location is the main cytogenetic alteration responsible for the onset of DFSP. Treatment options include complete surgical excision by performing conventional surgery with wide margins (>3 cm) or Mohs micrographic surgery. A retrospective study was conducted in our Department of Plastic and Reconstructive Surgery and all data were collected from medical records of 59 DFSP patients within this department from 1999 to 2011. A total of 13 of 59 (22%) cases were treated with conventional excision; 3 (5%) cases resulted in tumor-free margins, 8 (14%) cases required surgical revision and 2 (3%) cases lead to recurrence. A total of 46 of 59 (78%) cases were treated with wide excision; 43 (73%) cases resulted in tumor-free margins, 3 (5%) cases required surgical revision and 0 (0%) cases lead to recurrence. In conclusion, the data collected reveal the controversy surrounding the adoption of general guidelines regarding safe margins. Further studies are required to investigate the possibility of obtaining genotypically altered margins from margins that may appear phenotypically healthy.

Breast cancer risk in women treated with augmentation mammoplasty (review).

Surgical implantation of breast prostheses has become increasingly popular while the incidence of breast cancer is increasing each year. There has been no definitive consensus regarding the casual relationship between augmentation mammoplasty and breast cancer incidence, detection, treatment, mortality and survival. This review summarizes the published evidence, including epidemiological studies and case reports. All studies examined state that there is no breast cancer risk in prior augmented women. Moreover, there is also no significant difference in frequency, stage or mean tumor size between augmented and non-augmented women.