360 Genital Fat Transfer.

BACKGROUND: This study was designed to evaluate utility of transferring autologous adipose-derived mesenchymal stem cells with high regenerative capacity and adipose tissue derived-stromal vascular fraction, so-called 360 Vaginal Beautification technique, in labia majora augmentation and vaginal tightening operation. METHODS: A total of 97 female patients who underwent labia majora augmentation and vaginal tightening operation with 360 Vaginal Beautification technique were included. Post-discharge early (3rd and 7th postoperative day) and late (1st and 3rd postoperative month) surgical complications were assessed , while the Female Genital Self-Image Scale (FGSIS) was applied before surgery and also during postoperative 6-12 months. RESULTS: All complications noted on postoperative 3rd day (ecchymosis of labia majus, ecchymosis of clitoral hood, tenderness in the pubic area and pain at the vaginal entrance points) regressed on postoperative 7th day with no infection, edema, lipoma or granuloma formation in any patient. Total mean FGSIS score was 17.7 ± 1.6 in the pre-operative period, and increased significantly to 20.9 ± 1.4 and 22.2 ± 1.8 in the postoperative 6th month (p < 0.001) and 12th month (p = 0.013), respectively. CONCLUSIONS: The use of autologous fat, called 360 vaginal beautification, in the labia majora augmentation and vaginal tightening appears to be a safe technique due to use of autologous tissue transfer and to be associated with high satisfaction rate and an advantage of being more minimally invasive than surgical labia majora augmentation and vaginal tightening. LEVEL OF EVIDENCE IV: 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Fournier Gangrene: Association of Mortality with the Complete Blood Count Parameters.

BACKGROUND: The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis. METHODS: Records of patients diagnosed with Fournier gangrene were analyzed retrospectively. RESULTS: Seventy-four patients (49 men and 25 women) with a mean age of 57.60 ± 15.34 years (range, 20 to 95 years) were included. Sixty-eight participants were discharged and six died during follow-up. In the discharged group, during hospitalization, there was a trend downward in neutrophil-to-lymphocyte ratio and mean platelet volume values, whereas platelet count increased significantly. In the nonsurvivor group, the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement and at the end of hospitalization were significantly higher; platelet counts at admission, after the first débridement, and at the end of hospitalization were significantly lower compared with the survivor group (p < 0.05). In correlation analysis, mortality rate was negatively correlated with platelet count at admission and after first débridement and positively correlated with the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement. Regarding the receiver operating characteristic curve analyses, a platelet count of 188,500/µl at admission and 196,000/µl after the first débridement, a neutrophil-to-lymphocyte ratio of 13.71, and a mean platelet volume of 9.25 fl after the first débridement were defined as the cutoff levels having the best sensitivities and specificities. CONCLUSIONS: This study suggests that platelet count at admission and platelet count, mean platelet volume, and neutrophil-to-lymphocyte ratio after first débridement and during discharge may be included among the prognostic scores of Fournier gangrene. The authors defined some threshold values that can be used during patient follow-up. Larger prospective studies are warranted to determine the exact role of those parameters in the prognosis of Fournier gangrene. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.