Use of porcine acellular dermal matrix in revisionary cosmetic breast augmentation.

BACKGROUND: Aesthetic breast augmentation can be fraught with postoperative complications, particularly capsular contracture (CC), skin surface irregularities, and implant or inframammary fold malposition. Similar complications have been addressed successfully in reconstructive breast surgery with acellular dermal matrix (ADM) products. OBJECTIVE: The authors present their initial experience with porcine ADM (PADM) in aesthetic breast augmentation. METHODS: Retrospective chart review was performed for 93 consecutive patients (179 breasts) who underwent revisionary cosmetic breast augmentation with or without mastopexy between May 2009 and September 2012. Porcine ADM (Strattice; Lifecell Corp, Branchburg, New Jersey) was placed bilaterally in 74 patients and unilaterally in 19 patients. All patients were operated upon by 1 surgeon (J.N.P.). Product use description and complications were recorded, including infection, extrusion, CC, and implant malposition. RESULTS: Average follow-up was 12 months (range, 1-39 months). There were 2 major complications (1.6% of breasts): an infection in 1 breast that required implant explantation approximately 2 weeks postoperatively and an extrusion that required PADM removal. Two additional patients had high-riding implants resulting from folded PADM that required revision; both cases were corrected by excising the folded PADM segment. Seven other patients required office procedures to correct minor imperfections. Two CC recurrences were suspected (1 patient) in the 76 breasts that underwent capsulectomy and PADM placement. CONCLUSIONS: Porcine ADM demonstrated great utility as an adjunct in revisionary cosmetic breast surgery. The product helped to provide good aesthetic outcomes with low complication rates. Prospective, randomized trials may prove helpful in defining the role of PADM further in these challenging cases.

Management and avoidance of complications in chin augmentation.

Chin augmentation is an extremely rewarding cosmetic operation, particularly when performed as an adjunct to rhinoplasty and rhytidectomy. There has been much debate regarding the ideal surgical approach and whether implant placement or osseous genioplasty is the superior operation. Regardless of the technique, all surgery carries an inherent risk for complications, and it is the surgeon's responsibility to learn which techniques will work best in his or her hands for each patient. Certain complications can be almost unavoidable, but a solid foundation in anatomy and a review of the existing literature can help minimize the risk of certain problems while providing an improved understanding of how to recognize and manage them when they occur. The authors present a comprehensive review of genioplasty and chin implant complications, how they might be avoided, and management methods if they occur.

Wegener's granulomatosis of the pediatric airway: a case demonstrating a conservative management approach.

OBJECTIVE: Subglottic stenosis is found in 10% to 20% of patients with Wegener's granulomatosis, and at times, it may be the only indication of disease. This is particularly a problem in childhood-onset Wegener's granulomatosis, which is complicated 5 times more by subglottic and tracheal stenosis than in adult-onset disease. Because this is a rare disease that is often misdiagnosed as reactive airway disease in childhood, the discovery of subglottic stenosis is delayed until much of the chronic damage has already been done. This report discusses the diagnosis and management of a 12-year-old male with a severe, actively inflamed subglottis and trachea because of Wegener's granulomatosis. METHOD: This study uses a retrospective case review. RESULTS: The study shows a successful symptomatic medical treatment of subglottic stenosis with resolution of tracheal inflammation and subglottic stenosis. CONCLUSION: Treatment of an actively inflamed trachea with subglottic stenosis because of Wegener's granulomatosis should focus on medical therapy, including steroids, before making attempts at surgical intervention.

Granular cell tumors of the larynx: diagnosis and management.

In this case study, a retrospective review of chart and literature was done to discuss the presentation and treatment of granular cell tumors of the larynx. One patient was diagnosed and treated successfully with surgical resection of a laryngeal granular cell tumor. Excellent voice recovery was obtained and there is no evidence of recurrence 6 months after surgery. Granular cell tumors should be considered in the differential diagnosis of laryngeal masses, particularly in the posterior glottis.

Avoiding early revision rhytidectomy: a biomechanical comparison of tissue plication suture techniques.

BACKGROUND: Manipulation and suspension of the superficial musculoaponeurotic system (SMAS) is performed by 74% of rhytidectomy surgeons. Multiple variations in suture techniques are employed in this task, but they have never been evaluated for differences in their ability to withstand stress. OBJECTIVE: To compare the biomechanical properties of two different suture techniques that are used in SMAS plications during rhytidectomy: a double-layered running locking (DRL) stitch and multiple horizontal mattress stitches. METHODS: Fourteen horizontal mattress plications, in rows of six sutures, and comparable lengths of 16 DRL stitch plications of pig skin samples, were stressed using a tensometer with grip displacement increasing at a constant rate of 0.5 cm/Min. The required force to cause plication failure was recorded for each sample at three suture break points. RESULTS: There was no significant difference between the two groups in the force required to cause the initial suture failure. Unlike the horizontal mattress plication, an initial break seemed to cause minimal to no distortion of the DRL tissue plication. When results were normalized by the initial break forces to account for small variations in tissue properties, the force ratio required to cause a second suture break was significantly larger in the DRL group than in the horizontal mattress technique. This is evidenced by the average second to first break force ratios of 1.62 vs. 1.13 for the DRL and horizontal mattress stitches, respectively, with a P-value of .60. The mean ratios of third to first break forces for the DRL and horizontal mattress groups were 2.08 and 0.91, respectively, with a P-value of .08. CONCLUSION: The DRL stitch requires more force than the horizontal mattress stitch to cause significant failure of tissue plication. This technique may enable plastic surgeons to avoid early revision rhytidectomy due to suture failure, and to create a long-lasting, youthful cosmetic result.