The Value of Ultrasound in the Evaluation of the Integrity of Silicone Breast Implants.

Background and Objective: Breast implant surgery for cosmetic purposes is the most popular plastic surgery and it has been performed for over 100 years. Rupture of silicone gel-filled breast implants usually is asymptomatic and is one of the more dangerous complications due to free silicone migration. The aim of our study was to evaluate the diagnostic value of ultrasound (US) in the evaluation of the integrity of silicone breast implants and identify the main sign of intact and ruptured breast implants. Patients and Methods: In this retrospective study, the medical documentation of women who underwent breast implant surgery and US checkups at Tautrimas Astrauskas Clinic in Kaunas, Lithuania, during 2015-2020 was analyzed. The patients were divided into two groups: patients with intact and ruptured breast implants. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as well as the signs of implant integrity of US examination were evaluated. Results: In this study, 76 women with bilateral breast implants (n = 152) were reviewed. On a US examination, ruptured implants were found in 41.1% (n = 61) of the cases; of them, 78.7% (n = 48) of the cases had ≥2 US signs of a ruptured implant, and in all these cases, implant rupture was confirmed at surgery. Overall, one US sign of a ruptured implant was found in 21.3% (n = 13) of the cases. Of them, inhomogeneous content in all cases (n = 3) was found in the intact implant group, and an abnormal implant shell was documented more often in the ruptured implant group, not intact one (n = 9, 90% vs. n = 1, 10%). US had a diagnostic accuracy of 94.7%, sensitivity of 98.3%, specificity of 89.2%, PPV of 93.4%, and NPV of 97.1% in the evaluation of implant integrity. Conclusions: Our results show that US is a very reliable alternative in evaluating breast implant integrity and could be the investigation of choice for implant rupture, while MRI could be advocated only in inconclusive cases. Uneven implant shell was found to be the most important US sign of breast implant rupture. Based on the findings, we recommend performing US examination after breast augmentation surgery with silicone gel-filled implants annually.

Comparison of otoplasty outcomes using different types of suture materials.

Prominent ears are the most common congenital deformity. Numerous techniques for the correction of this deformity have been described in the literature, but there is no single technique widely accepted by most surgeons. Usually, more attention is focused on sculpturing or suturing techniques but not on suture material. The aim of this study is to evaluate clinical outcomes after otoplasty for surgical correction of prominent ears with different suture materials for the formation of new antihelical fold. During a 3-year period (2006-2008), 133 patients underwent operative correction of protruding ears in a private plastic surgery center. A total of 100 patients came for the follow-up visits, and the data of these patients were included in further analysis. The surgical technique consisted of scoring of the antihelical cartilage, suturing to recreate the fold of the antihelix (in the manner of Nachlas), and conchal setback procedure according to Furnas technique. According to suture material used for formation of new antihelix fold, the patients were divided into three groups: 4/0 Monocryl group (35 patients, 70 ears; Group 1), 4/0 PDS group (27 patients, 54 ears; Group 2), and 4/0 Mersilene group (38 patients, 7 ears; Group 3). Distances from the temporomastoid surface of the skull to the helix border in the upper, middle, and lower parts of the ear were measured before surgery and 6 months following surgery, and these measures were compared among groups. In addition, early and late complications were analyzed. There were 48 men and 52 women, and the median age was 20 years. The groups were matched for age, sex, and protrusion degree. No statistically significant differences were found comparing the groups of different suture material by skull-helical rim distance before operation. Comparison of skull-helical rim distance among groups after surgery showed that this distance in the medial and lower parts of the ear was the same in all groups, but this distance was smaller in the upper part of the ear in the Mersilene group; however, this difference was not statistically significant. Three patients in the Monocryl group (6 ears, 8.57%) and 3 patients in the PDS group (6 ears, 11.11%) had unsatisfactory aesthetic outcome because of recurrence of protrusion in the upper part of the ear. All of them underwent reoperation. In the Mersilene group, no recurrence was documented, but suture extrusion occurred in one patient (2 ears, 2.63%), and the sutures were removed. In our experience, formation of new antihelical fold with a 4/0 Mersilene suture resulted in the lowest rates of late complications. Using this type of suture material, some suture extrusions occurred, but this problem was easily solved by removing sutures. No recurrences of protrusion were documented in this group; therefore, no revision surgeries were necessary.

Endoscopic aesthetic facial surgery: technique and results.

The endoscopic approach to forehead and midface lifting has become popular method of face rejuvenation with minimal incisions. We have performed 67 endoscopic facelift procedures in the last four years. Forehead lifting technique included five small scalp incisions, wide subperiosteal elevation, endoscopic myotomy and forehead tissue fixation with srews, superficial temporal fascia (STF) suture to deep temporal fascia (DTF). Midface lifting technique included temporal 2.5 cm and 1.5 cm vertical intraoral incision, midface subperiosteal undermining and midface elevation with cable sutures Bichat's fat to DTF. Age mediana of patients who underwent endoscopic front lift was 46, patients who had endoscopic front lift and midface lift procedure age mediana was 40. Postoperative complication rate was 7.5% and included frontal branch weakness (n=2), hematoma (n=1), infraorbital nerve paresthesia (n=1) and asymmetrical smile (n=1). The main question is the quality of the results. We have reviewed 49 patients who were followed 6 months or more. Preoperative and postoperative life-size photographs were analyzed. The mean elevation mediana at medial canthus was 2.2 mm, at medial limbus 2.3 mm, at lateral limbus 2.5 mm, at lateral canthus 2.9 mm. Midface - lift effect resulted cheek elevation from 1.07 till 4.71 mm lip corner elevation 1.03 mm to 3.27 mm. We observed cheek elevation, improving nasolabial line, increasing volume of malar region, elevating lip angles in patients after endoscopic midface lift. We have found that important advantage of subperiosteal midface lift, when performed in conjunction with endoscopic brow lift, is its ability to move the cosmetic eye unit, proportionally, leading to a harmonious facial appearance. Endoscopic facelift is effective procedure for face rejuvenation especially for eyebrows and cheek elevation.

[Treatment of multiple lacerated wounds of the face and upper limbs]. / Veido ir ranku dauginiu plestiniu zaizdu gydymas.

We describe a case of severe face and upper extremities injury obtained in accident. 30 cm x 12 cm left arm soft tissue defect covered with thoracodorsal myocutaneous flap after necrectomy. After 10 days a microvascular transplantation of scapular fasciocutaneous flap was performed thus covering a 15.8 cm x 10.5 cm soft tissue defect in face. Eighteen days after trauma autodermoplastica was done in a 35 cm x 11 cm would of the right arm. The patient was discharged after 6 weeks of treatment. October 19, 2000 reconstruction of left ulnar nerve (n. ulnaris) was performed using sural nerve (n. suralis) grafts. Debulking of scapular flap in face was done simultaneously. Eighth months after trauma the patient returned to work. A good esthetic effect was observed.