Augmentation Rhinoplasty With Silicone Implant Covered With Acellular Dermal Matrix.

BACKGROUND: Alloplastic materials are a mainstay in Asian rhinoplasty. However, the outline of alloplastic implants can become conspicuous over time in rhinoplasty patients, which is a significant cause for revision. In revision rhinoplasty, alloplastic materials can remain a viable and affordable option in Asian patients. The acellular dermal matrices (ADM) are often used to interface between the silicone material and the skin envelope. This study assesses histologic changes following implantation of ADM-covered silicone material in rats. METHODS: To demonstrate differences at the histologic level, silicone blocks with and without ADM were implanted in the subcutaneous plane of 10 rats. These implants were harvested after 9 weeks and examined histologically for capsule thickness and myofibroblast activity. RESULT: In the in vivo study, the presence of ADM was associated with significantly decreased capsule thickness and myofibroblast activity around the implant and maintained the structure of ADM well. CONCLUSION: The authors suggest that using the ADMs to cover silicone implants can be an alternative method for decreasing the visibility of implant contour, by the prevention of capsular contracture and the addition of a soft tissue layer to the dorsal skin envelope.

Donor-Site Morbidity after Partial Second Toe Pulp Free Flap for Fingertip Reconstruction.

BACKGROUND: In this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes. METHODS: A single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance. RESULTS: The review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0-10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients. CONCLUSIONS: The partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.

Does upper blepharoplasty affect frontalis tonicity?

BACKGROUND: Frontalis hypertonicity has long been implicated in patients with significant dermatochalasia or blepharoptosis, as evidenced by eyebrow changes that occur after the resection of redundant skin or after blepharoptosis operation. However, whether upper blepharoplasty affects the forehead muscle has not been reported. Thus, this study investigated electrophysiology of the frontalis muscle and eyebrow morphology in a population of patients undergoing double-eyelid blepharoplasty. METHOD: Patients wishing to undergo upper blepharoplasty were recruited for this prospective study between June 2011 and February 2012. The subjects were excluded for complaints of visual obstruction, trauma history, and for any underlying medical condition that would affect eyebrow height or electromyogram (EMG) findings. Eyebrow morphology was ascertained in a standardized photogrammetric evaluation, and the frontalis muscle activity was recorded with needle EMG. These assessments were carried out at preoperation and at 2 weeks, 3 months, and 6 months. Root-mean-square (RMS) indices of various facial expressions were used to normalize the frontalis activity values across individuals. RESULTS: Thirteen patients with a mean age of 55.5 years were recruited. No statistical significance was observed for eyebrow heights at various assessment points. However, EMG recordings have demonstrated a gradual decrease in the proportional RMS index of the frontalis muscle activity. This difference was statistically significant between preoperation and 6 months postoperation (p < 0.05). CONCLUSION: Upper blepharoplasty was associated with gradual decreases in the frontalis muscle activity. A longer follow-up study is needed to evaluate whether this decreased tonicity results in morphologic changes such as decreased forehead wrinkles and depressed eyebrows. This research indicates that upper blepharoplasty has the potential to interfere with those human-computer interaction designs with facial EMG readings as an input.

Overview of surgical scar prevention and management.

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

Eponymous instruments in plastic surgery.

Surgeons use eponymous instruments daily, yet the stories behind these instruments are often lost in history. The authors have selected eponymous instruments commonly used in plastic surgery and provide a brief biography of the surgeons who invented them. This list represents more than two centuries of surgical history, and the physicians come from a number of disciplines, including general surgery, plastic surgery, ophthalmic surgery, and rural medicine. Remembering the life stories of surgeon inventors enriches our understanding of the history of our profession and allows us to appreciate our instruments instead of taking them for granted.

Patterns of finger amputation and replantation in the setting of a rapidly growing immigrant population.

To determine the incidence of finger amputation and replantation in North Carolina (NC) and to identify patterns of injury by race and immigration status. Finger amputation injury data were obtained from the NC hospital discharge database. Hospital discharge data were linked to 2000 US Census data by zip code of residence to estimate median income, the percentage of Hispanics, and the percent foreign-born. A total of 556 admissions for finger amputations (86% male, 14% female) occurred in NC during 2004-2006. The most common mechanism was industrial machinery (36%). Eighty-nine replantations were performed (16%). Finger amputation is a common work-related injury in NC. The rate of replantation appeared to be higher in zip codes with a higher density of Hispanics and with a higher density of immigrants. More data on injury that includes racial/ethnic, social, and economic information will be critical to understand the true burden of injury on immigrants.