Effects of reduction mammoplasty on metabolic profile and body weight.

BACKGROUND: Advanced studies on adipose tissue have established that subcutaneous adipose tissue acts as an endocrine organ to help maintain homeostasis. Based on this information, many plastic surgeons have evaluated the metabolic effects of liposuction because liposuction is the most common surgical procedure in plastic surgery. Liposuction removes a substantial amount of subcutaneous fat from a specific area of the body. Mammoplasty is another procedure that removes a large amount of subcutaneous fat. In this study, the metabolic effects of reduction mammoplasty were evaluated with hemogram, blood glucose, lipid profile, insulin, and insulin resistance tests before and after surgery. METHODS: The study involved 35 patients who underwent reduction mammoplasty between January 2006 and June 2009. All the patients were evaluated with physical examination and their history, height, and weight were obtained. Venous blood samples were collected before, 4 h after, and 3 months after the surgical procedure to evaluate hemogram, blood glucose, insulin, and lipid profiles. The HOMA scores of the patients were calculated. Inferiorly based dermal pedicle, central pedicle, and free nipple graft techniques were used in the operations and all excision materials were sent for histopathological examination. RESULTS: The mean age of the patients was 39.6 ± 11.6 years. The mean excision volume was 2249 ± 1001 g. Body mass indexes were not significantly different before and 3 months after the surgery (p > 0.05). Blood glucose, LDL, HDL, triglyceride, total cholesterol, hemoglobin, and hematocrit values before and 4 h after the surgery were also different (p < 0.05). However, comparisons with the 3-month postoperative test results revealed no statistically significant differences (p > 0.05) and comparisons of all the measurements showed that insulin levels and HOMA scores were not significantly different (p > 0.05). CONCLUSION: The results of the present study showed that reduction mammoplasty operations do not have any positive effects on blood insulin, glucose profile, lipid profile, and body mass index 3 months after the surgery.

Burn and mandible fracture due to pressure cooker explosion.

A burn case of 42-year-old female patient due to pressure cooker explosion associated with mandibular fracture is presented. After early tangential excision of the deep second- and third-degree-burn areas, a split-thickness skin grafting was applied. Open reduction and internal fixation therapy with miniplate system were done for linear symphysis fracture. As much as we know, there was no report in the literature about pressure-cooking burn accompanying mandibular fracture.

Bilobed flap reconstruction in infraorbital skin defects.

BACKGROUND: The infraorbital region is an important subunit for facial aesthetics. Improper closure of skin defects involving this region may lead to deformity in the lower lid and to ectropion. This report presents the authors' experience with 15 patients who had infraorbital skin defects reconstructed with the bilobed flap from the zygomatic and lateral cheek regions. METHODS: Most of the operations were performed under local anesthesia. Pathologic diagnoses included basal cell carcinoma, squamous cell carcinoma, melanoma, and hemangioma. Although we cannot deny that bilobed flaps used in this series were not random flaps, we would like to emphasize that when a flap with a bilobed design is chosen for reconstruction of an infraorbital defect, a superiorly based bilobed flap should be selected to avoid ectropion or any distortion in the middle face. As an adjunct procedure, a glabellar flap was used in some patients who had defects extending medially as well. RESULTS: The results of the repair were satisfactory with respect to color match, texture, and functional properties. CONCLUSION: The superiorly based bilobed flap should be always kept in mind when planning a local flap in the infraorbital region.

Island rat groin flaps with twisted pedicles.

Clinical attempts are made to avoid rotating a flap and twisting the pedicle for fear of perfusion compromise. Torsion of an island rat groin flap pedicle is not a well-recognized experimental entity. The authors describe the results of island flap rotation with pedicle twisting in the rat groin flap model. Forty male Wistar rats were randomly divided into four groups of 10 animals each. In each group, bilateral groin flaps were elevated; one flap was sutured in place without rotation and the contralateral flap was subjected to 180, 270, 360, or 720 degrees of rotation. Blood flow within the flaps was assessed by laser Doppler flowmetry, and flap edema and necrosis were determined 10 days postoperatively. No differences were noted between control flaps and those subjected to 180 and 270 degrees of rotation. Although flaps subjected to 360 degrees of rotation demonstrated a large amount of postoperative edema and congestion of the subcutaneous tissue with some histologic changes, all flaps in this group survived. Measured flap weights at death were different from those of controls. All flaps subjected to 720 degrees of rotation underwent ischemic necrosis. Because of the differences between human skin architecture and rat skin architecture it cannot be concluded that similar results would be observed in any human skin flap. There might be three important points arising from this study of unknowingly twisted island groin flap pedicles in the rat model: (1) twisting of less than 360 degrees has no effect on flap survival; (2) twisting of 720 degrees is always associated with skin flap necrosis; (3) twisting of 360 degrees, although associated with some changes, does not cause skin flap necrosis.

[Rhinophyma treated by excision and full-thickness skin grafting under local analgesia]. / Rinofimanin lokal anestezi altinda deri grefti ile tedavisi.

A seventy-three-year-old man presented with a complaint of enlarged nose. The diagnosis was made as rhinophyma and the mass was excised under local anesthesia. The involved tissues including the columellar, alar, and dorsal nasal skin were removed by preserving the perichondrium and periosteum. A full-thickness skin graft was obtained from the supraclavicular region and transferred to the defect area with a tie-over dressing. An acceptable texture and color adaptation of the skin graft was obtained at the end of one-year follow-up period.