"Reduction mammaplasty with superomedial pedicle technique: A literature review and retrospective analysis of 938 consecutive breast reductions".

BACKGROUND: The superomedial pedicle reduction mammaplasty has been noted in the literature to provide superior aesthetic results and longevity as well as shorter operative times. However, the inferior pedicle continues to be the most commonly utilized technique in the United States. There is a lack of large-volume outcome studies examining how the superomedial pedicle technique compares against more established reduction methods. METHODS: A retrospective review of 938 reduction mammaplasties was performed at a single institution over a 10-year period. A literature review of superomedial and inferior pedicle complication rates were performed. Study variables were compared against overall mean complication rates for the two techniques. Logistic regression, paired student T-Tests, and Chi-square analyses were used to calculate adjusted odds ratios and to compare continuous and categorical variables. RESULTS: Mean reduction weight was 730 g per breast, ranging from 100 to 4700 g. Overall complication rate was 16%, of which 10% were minor complications related to delayed wound healing. No cases of skin flap necrosis occurred. Increased complications were highly correlated with a BMI > 30, breast reduction weights > 831 g, and sternal notch to nipple distances > 35.5 cm. CONCLUSIONS: The superomedial pedicle reduction mammaplasty technique is safe and reliable with a complication rate lower than the inferior pedicle technique. Based on our findings we propose that residents should be exposed to this method of reduction mammaplasty as part of a compilation of techniques learned in residency and that practicing surgeons would benefit from becoming familiar with its applications.

Pedicled Breast Flap for Soft Tissue Coverage of a Forearm Blast Injury.

This article presents the case of a 35-year-old woman who sustained a shotgun blast injury to the left forearm and chest wall causing significant soft tissue loss of the extensor compartment. The patient suffered a Gustilo IIIB open radial shaft fracture requiring orthopedic stabilization and plastic surgery intervention. As a result, the patient eventually was reconstructed with the use of a pedicled breast flap. Because of the patient's macromastia and her large forearm wound and morbid obesity, an individualized approach was developed such that a breast flap was designed because of its proximity to the upper extremity. The advantage of this type of reconstruction is a more natural contour to the forearm with minimal donor site morbidity. Before creation of the flap, the patient expressed interest in a reduction mammaplasty because of her symptomatic macromastia. Overall, this was a 2-step operation whereby first the breast flap was created, and then a few weeks later, once the arm healed, the reduction mammaplasty was performed. Other types of flaps for upper extremity reconstruction include the rectus abdominis myocutaneous, transverse rectus abdominis myocutaneous, vertical rectus abdominis myocutaneous, groin, and latissumus dorsi. The pedicled breast flap is an innovative approach to upper extremity soft tissue coverage and can be tailored to the specific needs of patients similar to our case presentation.

Three-Dimensional Printing in Plastic and Reconstructive Surgery: A Systematic Review.

BACKGROUND: Increasingly affordable three-dimensional (3D) printing technologies now make it possible for surgeons to create highly customizable patient-tailored products. This process provides the potential to produce individualized artificial and biologic implants, regenerative scaffolds, and cell-specific replacement tissue and organs. The combination of accurate volumetric analysis and production of 3D printed biologic materials are evolving techniques that demonstrate great promise in achieving an accurate and naturally appearing anthropomorphic reconstruction. This systematic review summarizes the current published literature and known ongoing research on 3D printing in the field of plastic and reconstructive surgery (PRS). METHODS: Three medical databases (PubMed, Ovid MEDLINE, and Google Scholar) as well as recent news articles and university websites were searched using PRS and industry-related search terms. Inclusion criteria consisted of any publication or reputable news or academic article in electronic or printed media directly studying or commenting on the use of 3D printing technology in relation to PRS. The current literature was critically appraised, and quality of selected articles was assessed and manually filtered for relevance by 2 reviewers. RESULTS: A total of 1092 articles were identified from the aforementioned sources discussing 3D printing in medicine. The 3D printing in relation to biologic and surgical applications was discussed in 226 articles. Within this subset, 103 articles were included in the review. Of those selected, 5 were pertinent to surgical planning, training, and patient education; 4 to upper extremity and hand prosthetics; 24 to bone and craniomaxillofacial (CMF) reconstruction; 10 to breast reconstruction; 20 to nose, ear, and cartilage reconstruction; 20 to skin; and finally 20 involving overlapping general topics in 3D printing and PRS. CONCLUSIONS: The 3D printing provides the ability to construct complex individualized implants that not only improve patient outcomes but also increase economic feasibility. The technology offers a potential level of accessibility that is paramount for remote and resource-limited locations where health care is most often limited. The 3D printing-based technologies will have an immense impact on the reconstruction of traumatic injuries, facial and limb prosthetic development, as well as advancements in biologic and synthetic implants.

The sentinel placement of an open abdomen negative pressure unit.

The open abdomen is a common condition after a trauma necessitating celiotomy with the inability to close the fascia either due to damage control surgery or abdominal compartment syndrome. Traditionally the open abdomen has been approached with the use of the open abdomen temporary abdominal closure (Barker Vacuum Pack Dressing). More recently there has been the addition of the ABThera™ open abdomen negative pressure unit introduced by KCI. Our case report is based on the first patient to have placement of the ABThera™ device.