Effect of Reduction Mammoplasty on Insulin and Lipid Metabolism in the Postoperative Third month: Compensatory Hip Enlargement.

BACKGROUNDS: The positive effects of reduction mammoplasty on metabolic profile have been shown in a limited number of studies. This study objective to reveal the effects of reduction mammoplasty on metabolic profile and anthropometric measurements. SUBJECTS AND METHOD: The study was prospectively conducted on 42 patients who were operated between April 2019 and March 2020. Fasting plasma glucose, fasting plasma insulin, total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein cholesterol, HgA1c, homeostasis model assessment scores, adiponectin, leptin, and resistin levels were evaluated. In addition, age, height, weight, body mass index; breast, chest, waist, hip circumference; waist-hip ratio, and bilateral breast resection tissue weights were recorded. Data and blood samples were collected one hour before the operation, 6 and 12 weeks after the operation. RESULT: The patients' mean age was 43.14±10.24, and their average height was 159.42±4.96 cm. The excised bilateral dermo fatty tissue weight was 1435.85±721.16 g. At the postoperative 40th day a decrease in leptin (p = 0.001), resistin (p =0.008), glucose (p = 0.021) and insulin resistance values (p=0.013) stated. There was an increase in adiponectin (p < 0.001) and HDL (p = 0.013) levels at the postoperative 40th day. In the postoperative third month, these data returned to the previous levels that were measured before operations. However, an increase in hip circumference (p = 0.034) and a decrease in waist-hip ratio (p < 0.001) was detected in third month. Also, there was no difference in body mass index and weight compared to pre-operation. CONCLUSION: After reduction mammoplasty, compensatory fat growth in the hip area, an increase in the hip circumference, and a decrease in the waist-hip ratio were observed in the postoperative third month. LEVEL OF EVIDENCE: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Perivascular Injections of Botulinum Toxin Type A Versus Low Concentration of Ethanol.

BACKGROUND: This study aimed to investigate the effect of low concentration ethanol in increasing flap viability by perioperative perivascular application and compared it with that of botulinum toxin type A (BTX-A). MATERIALS AND METHODS: Twenty-seven Wistar albino rats weighing 300-350 g were used in this study. The subjects were randomly divided into three equal groups: group E (ethanol, n = 9), group B (BTX-A, n = 9), and group S (saline, n = 9). In rats, the dorsal multi-territory perforator flap was elevated, and the agents were injected. In postoperative 1 wk, flap viability and vascular endothelial growth factor levels were evaluated. Also, blood flow, microvascular density, and inflammation degree of both choke zones were assessed. RESULTS: The mean flap survival area and vascular endothelial growth factor level were significantly higher in group E than in group B and S (P < 0.001). Similarly, blood flow (first choke zone, P < 0.012, and second choke zone, P < 0.001) and microvascular density (first choke zone and second choke zone, P < 0.001) were found to be higher in Group E compared to Group B and S in the evaluation performed from both choke zones. Also, significant inflammation was detected in the ethanol group. CONCLUSIONS: The positive effects of BTX-A on flap viability were achieved with a low concentration of ethanol. The fact that a low concentration of ethanol increases blood flow, angiogenesis, and flap viability more than BTX-A in the first postoperative week indicates that it can be an alternative agent for perioperative use.

The Effects of Vasonatrin Peptide on Fat Graft Viability: An Experimental Study.

Vasonatrin peptide (VNP) is a synthetic peptide that possesses vasodilatory, natriuretic, and anti-inflammatory properties. The authors aimed to analyze the effects of VNP on fat graft survival. Twenty Sprague-Dawley rats are randomly divided into two groups of 10. Fat grafts are harvested from the right inguinal region. After preparation, fat grafts are placed to the interscapular region. The first group of rats were administered VNP after their fat injection, while the second group received tail-vein injections of an equal volume of sterile saline following their fat injection. Experiment and control groups are evaluated according to their level of degeneration of adipocytes, fat necrosis, vacuolization, cyst formation in adipocytes, fibrosis of the fat tissue, capillary density, and CD31 immunohistochemical staining. Degeneration, vacuolization, and cyst formation in adipocytes were lower in the experiment group. Increased capillary density in the experiment group was demonstrated by CD31 antibody staining and by counting capillary density under a microscope. The average percentage of change in weight of the fat grafts in the experiment group was lower than that in the control group. The results indicate that VNP has some beneficial effects on fat graft survival by multiple independent mechanisms that influence both local and systemic homeostasis.

A Novel Basic Training Laboratory Model on Live Subjects for Supermicrosurgery: Mouse Femoral Artery, Vein and Nerve.

BACKGROUND: Increasing success rates of supermicrosurgery operations have increased the importance of developing the ideal training model for super-microsurgery. Working on the model is very important for increasing and continuing microsurgery and supermicrosurgery skills. We aimed to present a standardized, simple and easy to access live training model for supermicrosurgery. METHODS: The experiment was performed in the University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, IDEA, Istanbul, Turkey in 2020. Twelve BALB/c male albino mice weighing 20-45 gr were used in the study. Unilateral femoral artery, vein and nerve diameters of mice were measured. Anastomosis was performed on the bilateral femoral vessels. The surgical procedure times were also recorded. RESULTS: The mean weight of the mice was 36.6 ± 6.09 gr, the length was 15.10 ± 1.10 cm. The mean external diameter of the femoral artery, vein and nerves were 0.31 ± 0.34 mm, 0.48 ± 0.70 mm, 0.38 ± 0.43 mm, respectively. The mean preparation time of neurovascular structures for anastomosis was 15.75 ± 1.54 min, mean femoral artery and vein anastomosis time was 24.91±1.72 and 33.16±1.74 min, respectively. Vascular patency was detected as 100% after all vascular anastomosis procedures. CONCLUSION: Mice femoral neurovascular structures are similar to rats in terms of basic morphology, and they are small enough for super-microsurgery education model. Dissection of mice femoral bundles are easy to perform. In terms of training models, anesthetic requirement and laboratory costs are less for mice, and handling them is much easier compared to rats; thus, making them especially suitable for basic supermicrosurgery training courses.

Management and Treatment of Pressure Ulcers: Clinical Experience.

OBJECTIVES: Pressure ulcers are a common healthcare problem, particularly among hospitalized patients who need long-term treatment; however, preventive medicine can reduce the prevalence. A multidisciplinary approach is fundamental to providing proper care, and the general health status and cooperation of the patient determine treatment modalities. Simple methods can prevent pressure ulcers and their recurrence. The aim of this study was to share clinical experience and evaluate the approach and treatment modalities used for pressure ulcers. METHODS: Fifty-two patients hospitalized with the indication of pressure ulcers were evaluated retrospectively. Age, sex, localization of the decubitus ulcer, treatment method, comorbid diseases, and any postoperative complications were analyzed. RESULTS: Thirty-five patients were male and 17 were female. The mean age was 50.3 years. The most common accompanying disease was diabetes mellitus and the most common etiology was paraplegia. Pressure ulcers were localized on the sacral area in 45 patients, the ischial area in 23, the trochanteric area in 11 patients, and other parts of the body (scapular, lumbar) in 3 patients. Fasciocutaneous rotation flaps, myocutaneous flaps, and perforator flaps were the most used reconstruction techniques. No major complication was observed. CONCLUSION: The most important point with regard to pressure ulcers is prevention. Healthcare system expenses can be significantly reduced by preventing the formation of decubitus ulcers. The progression of pressure ulcers can be easily controlled if the necessary care and treatment are provided in the early period. The role of the plastic surgeon in advanced stages is to perform reconstruction in appropriate cases and to educate patients and their caregivers with the aim of preventing recurrence.