RESUMO
INTRODUCTION: Currently, increasingly reconstructive surgeon consider the failure rates of perforator propeller flaps especially in the distal third of the lower leg are too important and prefer to return to the use of free flap at first line option with failure rates frequently lower than 5%. So, we performed a systematic review with meta-analysis comparing free flaps (perforator-based or not) and pedicled-propeller flaps to respond to the question "what is the safest coverage for distal third of the lower limb?" METHODS: This review was conducted according to PRISMA criteria. From 1991 to 2015, MEDLINE®, Pubmed central, Embase and Cochrane Library were searched. The pooled estimations were performed by meta-analysis. The homogeneity Q statistic and the I2 index were computed. RESULTS: We included 36 articles for free flaps (1,226 flaps) and 19 articles for pedicled-propeller flaps (302 flaps). The overall failure rate was 3.9% [95%CI:2.6-5.3] for free flaps and 2.77% [95%CI:0.0-5.6] for pedicled-propeller flaps (P = 0.36). The complication rates were 19.0% for free flaps and 21.4% for pedicled-propeller flaps (P = 0.37). In more detail, we noted for free flaps versus pedicled-propeller flaps: partial necrosis (2.70 vs. 6.88%, P = 0.001%), wound dehiscence (2.38 vs. 0.26%, P = 0.018), infection (4.45 vs. 1.22%, P = 0.009). The coverage failure rate was 5.24% [95%CI:3.68-6.81] versus 2.99% [95%CI:0.38-5.60] without significant difference (P = 0.016). CONCLUSION: In the lower limb the complications are not rare and many teams consider the free flaps to be safer. In this meta-analysis we provide evidence that failure and overall complications rate of perforator propeller flaps are comparable with free flaps. Although, partial necrosis is significantly higher for pedicled-propeller flaps than free flaps, in reality the success of coverage appears similar. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:109-119, 2018.
Assuntos
Retalhos de Tecido Biológico , Traumatismos da Perna/cirurgia , Retalho Perfurante , Procedimentos de Cirurgia Plástica/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Resultado do TratamentoRESUMO
Objective A thorough psychological assessment of patients requesting cosmetic surgery can help to protect them from the risk of postoperative dissatisfaction and the onset and/or aggravation of psychiatric disorders. This study seeks to shed more light on why people desire cosmetic surgery and thus help surgeons, psychiatrists, and psychologists to conduct assessments before surgery. Methods In-depth interviews were conducted with 35 subjects who requested cosmetic surgery. The interviews were recorded and transcribed and then analyzed qualitatively with Grounded Theory. Themes and categories were identified and compared in logical order, to build a consistent theoretical model. Results In each interview, we identified one or more recent events that the subjects considered to be contributing factors in their decisions to have cosmetic surgery. We observed that 33 of 35 patients said they sought cosmetic surgery at a time when they were experiencing, or had just experienced, one or more major changes in their bodies or their relationships. Recent life events triggered or strengthened specific psychological needs in the subjects: to cope with the past and with change, attain a consistent identity, find or regain a positive self-image, alter others' perceptions, define themselves in relation to others, or please themselves or others. Patients said that they chose plastic surgery to fulfill one or more of these needs. Conclusions This study identifies the role of recent events in inciting individuals to resort to cosmetic surgery. This factor provides new perspectives for surgeons to understand those patients and opens new avenues for research.
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Imagem Corporal/psicologia , Entrevista Psicológica , Acontecimentos que Mudam a Vida , Cirurgia Plástica/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
BACKGROUND: Increasing obesity prevalence and development of bariatric surgery have led to the development of skin re-draping techniques. Several contouring techniques have been described for treating the circumferential excess of the lower trunk. MATERIALS AND METHODS: We performed a systematic review to summarize surgical indications, operative techniques, peri-operative management (nutritional supplementation, antibiotic prophylaxis, thrombo-prophylaxis), outcomes, complications, patient satisfaction, and impact on quality of life of circumferential contouring of the lower trunk procedures. A systematic review, based on the PRISMA criteria, was conducted using the Pubmed and Cochrane databases. RESULTS: The review included 42 articles and 1748 operated patients. Two studies only were graded as level of evidence II; the others were graded as levels III to V. The most frequently reported indication was massive weight loss. All the described techniques derived either from belt lipectomy or lower bodylift. Belt lipectomy resulted in a posterior scar situated at the waistline and allowed a better correction of hip back rolls, whereas lower bodylift was more effective on buttock and lateral thigh ptosis. The most reported complication was wound dehiscence. Patient satisfaction and quality of life scores were high in all studies. CONCLUSIONS: This review included a majority of low-level evidence studies that limit extrapolability of the results. Future randomized prospective studies may generate stronger evidence, with a standardization of surgical indications and operative techniques. LEVEL OF EVIDENCE III: 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 .
Assuntos
Abdominoplastia/métodos , Estética , Cirurgia Plástica/métodos , Redução de Peso , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Composição Corporal , Nádegas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Satisfação do Paciente , Cuidados Pós-Operatórios/métodos , Qualidade de Vida , Coxa da Perna/cirurgia , Tronco/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The massive weight loss patient may require a circumferential contouring of the lower trunk. OBJECTIVES: To summarize the complication rates and explore the possibility of predictive risk factors for complications. METHODS: We performed a systematic review using the PubMed and Cochrane databases to identify published articles on the topic. Random effects meta-analyses and meta-regression were conducted to synthesize the data gathered. RESULTS: The analysis included 28 studies and 1380 patients. All but one were retrospective cohorts or case studies. Circumferential contouring of the lower trunk resulted in 37% [95%-CI 30%; 44%] overall complications; 17% [95%-CI 12%; 24%] wound dehiscences; 4% [95%-CI 3%; 5%] skin necrosis; 5% [95%-CI 3%; 9%] infections; 3% [95%-CI 2%; 4%] hematomas; 13% [95%-CI 9%; 18%] seromas; 12% [95%-CI 7%; 21%] scar irregularities; 3% [95%-CI 2%; 5%] thromboembolism; and 5% [95%-CI 3%; 8%] revisions for complications. Lower body lift-related techniques were associated with a higher rate of overall complications than belt lipectomy-related techniques (P = .002). No difference in complication rate was shown when performing a gluteal augmentation with flap. Due to insufficient data reported in the studies, risk factors for postoperative complications could not be assessed. CONCLUSIONS: The whole literature provides very low reliable information. Confusion factors could not be ruled out to explain the increased complications rate for the lower body lift compared to the belt lipectomy. This finding needs to be confirmed in randomized trials. Collaborative efforts must be made to improve the evidence level of our practices and to serve patients in an optimal way. LEVEL OF EVIDENCE: 3 Therapeutic.
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Técnicas Cosméticas/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias/etiologia , Tronco/cirurgia , Redução de Peso , Humanos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: To improve their health and quality of life, obese patients undergo consultation after weight loss. In these patients, the sub-umbilical abdominal and pubic regions are often characterized by redundant skin, creating aesthetic and functional discomfort. Monsplasty is an important step in abdominoplasty or bodylift procedures. We report on an original technique used to correct deformity in the pubic region following weight loss. METHODS: All interventions were performed by the same surgeon between April and December 2015. On stretched skin, we drew two lines 5 cm lateral to the median line on both sides and connected them with the arc of a circle placed 7 cm from the vulvar fork. Then, monsplasty marks extend to abdominal fold. During lower abdominal contouring, we performed monsplasty with three separate stitches between the camper fascia and aponeurosis of the abdominal muscle. The aim was to bring tension to the pubic region without additional surgical procedure. RESULTS: We report on 21 consecutive cases of monsplasty following lower trunk contouring. No reoperation was performed due to complication or aesthetic demand (no under- or over-correction occurred). No complication (e.g. edema, seroma, disturbance of sensibility) was observed in the pubic area. The results were stable 1 year after surgery. CONCLUSIONS: We report on a simple, rapid, and reproducible monsplasty technique for all stages of Pittsburgh classifications, which achieved favorable results with no complication. We recommend performance of this effective technique simultaneously with abdominoplasty or bodylift procedures. LEVEL OF EVIDENCE: IV.
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Abdominoplastia/métodos , Cirurgia Bariátrica/métodos , Segurança do Paciente/estatística & dados numéricos , Qualidade de Vida , Redução de Peso , Adulto , Cirurgia Bariátrica/efeitos adversos , Contorno Corporal/métodos , Estudos de Coortes , Estética , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Posicionamento do Paciente , Satisfação do Paciente/estatística & dados numéricos , Osso Púbico , Estudos Retrospectivos , Cirurgia Plástica/métodosRESUMO
The aim of this study was to evaluate the benefit of using a new slow-setting fibrin sealant compared with staples for adherence of split-thickness skin grafts on the backs of hands and fingers. Staple removal is often painful for patients. Twenty-eight patients were included for a graft total of 34 hands. The authors chose to test this sealant on zones that are often difficult to graft given their varied topographies. Its low concentration of thrombin (4 IU/ml) compared with other sealants provides it with prolonged polymerization time (60 seconds) making it easier to use in this location. All 34 grafts had taken at 5 days postoperatively and no graft required revision surgery. Six of our patients had sealant on one hand and staples on the other hand. All of the patients reported less pain on the sealant hand with a mean visual analog scale inferior to 2.6 times less (Mann-Whitney U test, P = .0035). Eighteen months after treatment, all of the patients had acceptable function and esthetic aspect of their hands with no difference noted between glued or stapled hands. The only notable drawbacks to the use of this sealant are the preparation and application time which is longer than with staples, the need to evacuate small seromas under the graft and obstruction of the drainage points by the sealant. The use of Artiss Sealant enabled us to reduce the amount of care and to decrease the pain because there was no staple removal.
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Queimaduras/terapia , Adesivo Tecidual de Fibrina/uso terapêutico , Retalhos Cirúrgicos , Grampeamento Cirúrgico/métodos , Queimaduras/patologia , Feminino , Humanos , Masculino , Transplante de Pele/métodos , Resultado do TratamentoRESUMO
BACKGROUND: After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo-body lift method. The authors describe their experience with this novel, safe procedure. METHODS: Twenty-five abdominal body-contouring reconstructions following massive weight loss were treated by means of circumferential lipo-body lift. The authors describe the indications for the procedure and their perioperative and postoperative management. RESULTS: The mean patient age was 39.4 years. The mean pre-body lift body mass index was 26.71 kg/m; the average weight loss before surgery was 56.6 kg, with a mean delta body mass index loss of 20.82 kg/m. The average hospital stay was 3.52 days and the drainage duration 3.56 days. No patient experienced any major complication (e.g., hematoma, thromboembolism, bleeding, skin necrosis, or a need for revision surgery to treat complications). Minor complications including wound dehiscence, wound infection, and fat necrosis were reported in 40 percent of patients. The occurrence of complications was associated with smoking status (p = 0.0280), the volume of liposuction (p = 0.0399), and the liposuction volume per unit of body mass index (p = 0.0071). CONCLUSIONS: The authors' novel technique is less invasive than the traditional lower body-lifting method, as shown by the absence of major complications, and allows excellent conservation of connective tissue and vessels; undermining is minimal. As obesity becomes a major problem worldwide, lifting procedures that are safe and effective are important components of reconstructive strategies and should be widely offered to patients who experience massive weight loss. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Abdominoplastia/métodos , Lipectomia/métodos , Obesidade/cirurgia , Redução de Peso , Adulto , Cirurgia Bariátrica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Estudos ProspectivosRESUMO
BACKGROUND: Ulnocarpal impaction syndrome occurs mostly in patients with positive ulnar variance. Ulnar-shortening osteotomy is a commonly used method to correct it, but degenerative changes may appear in the distal radioulnar joint. The authors evaluated outcome after ulnar-shortening osteotomy, particularly the impact of distal radioulnar joint osteoarthritis. METHODS: A 10-year study was performed of patients who underwent ulnar-shortening osteotomy. RESULTS: Forty-six patients were available for clinical examination and radiography. Twenty-nine wrists showed worsening or new osteoarthritis. A difference of preulnar variance and resection was noted: 4.64 mm and 4.48 mm, respectively, in the osteoarthritis group versus 3.50 mm and 3.38 mm in the group without osteoarthitis. Comparison of patients with osteoarthritis revealed a significant limitation of range of motion in flexion-extension (p = 0.009) and pronosupination (p = 0.028): 102 degrees and 138 degrees, respectively, in the osteroarthritis group versus 124 degrees and 155 degreees in the group without osterarthritis. The type of distal radioulnar joint differed significantly (p = 0.038), with a predominance of type I in the osterarthritis group and type II in the group without osterarthritis. Functional outcome was significantly worse in the osterarthritis group versus the group without osteoarthritis concerning the Patient-Rated Wrist Evaluation score (39.07 versus 22.59, p = 0.031), the Quick Disabilities of the Arm, Shoulder, and Hand score (27.38 versus 19.59, p = 0.017), and the modified Gartland-Werley score (76.72 versus 85.14, p = 0.027). CONCLUSIONS: Ulnar-shortening osteotomy modifies the congruence of the distal radioulnar joint, and the type I joint may be at increased risk of arthrosis. Osteoarthritis has a clinical impact, and the amount of ulnar shortening should be limited to what is needed to avoid altering the functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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Osteoartrite/epidemiologia , Osteotomia/efeitos adversos , Amplitude de Movimento Articular/fisiologia , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Feminino , Seguimentos , França , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Osteotomia/métodos , Medição da Dor , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Articulação do Punho/fisiopatologiaRESUMO
INTRODUCTION: The use of a patient's image in plastic surgery is common today. Thus, plastic surgeons should master the use of the image and be aware of the implications of the patients' perception of themselves. The mere-exposure effect is a psychological phenomenon in which a person tends to rate things more positively merely because (s)he is familiar with them. Faces are asymmetric, so faces in photos are different from those observed in mirrors. The main objective of this study was to assess whether patients within a plastic surgery population, particularly those undergoing facial aesthetic surgery, preferred standard photographs or mirror-reversed photographs of themselves. METHOD: A prospective study was conducted in a plastic surgery department, which included women who were admitted to the hospital the day before their procedures. The patients were separated into the following two groups: Group 1 was composed of patients who were undergoing facial aesthetic surgeries, and Group 2 consisted of other patients who presented to the plastic surgery department for surgery. The patients were required to rate their appreciation of their own faces and to choose between standard and mirror-reversed photos of themselves. RESULTS: A total of 214 patients participated. The median age was 47.9 years (interquartile range (IQR): 36.4-60.6), and the median face appreciation was 5 (IQR: 5-7). The preference for the mirror-reversed photograph was significantly different from chance (p < 0.001, binomial (214, 156, 0.5)); 73% of the patients preferred the mirror-reversed photographs. The proportions of patients who preferred the mirror-reversed photograph differed significantly (p = 0.047) between Groups 1 (84%) and 2 (70%). CONCLUSION: Plastic surgery patients have a significant preference for mirror-reversed photographs of themselves over standard photographs. This preference is even more pronounced among patients who are undergoing facial aesthetic surgery. LEVEL OF EVIDENCE: III.
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Emoções , Expressão Facial , Reconhecimento Psicológico/fisiologia , Ritidoplastia/métodos , Ritidoplastia/psicologia , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Fotografação , Estudos ProspectivosRESUMO
BACKGROUND: Resection of cranial tumors involving both bone and scalp tissue may require the recruitment of soft tissue using a flap above the bone reconstruction. When a transposition flap has been chosen, the alopecia zone on the donor site may be difficult to treat afterward. Scalp expansion is the gold standard in these situations, but this has never been described above cranial implants. We report the first case of a patient who underwent a scalp tissue expansion above a custom-made hydroxyapatite cranial implant to correct sequelar alopecia. CASE DESCRIPTION: A 30-year-old man presented with a dermatofibrosarcoma of the scalp with bone invasion. A cranioplasty with a custom-made hydroxyapatite implant and a transposition flap were performed. Although healing was achieved, the donor site of the transposition flap left a 9 × 13 cm sequelar alopecia area on the vertex. To correct it, a rectangular 340-cm3 expander was partially placed above the cranial implant and under the transposition flap. A second 120-cm3 expander was put on the contralateral temporal region. The expansion was successful. No expander infection, cranial implant displacement, or fracture on imaging performed during the follow-up period was detected. The alopecia zone was entirely excised. The patient was very satisfied with the cosmetic result. CONCLUSIONS: Tissue expansion above hydroxyapatite implants may be of concern to the physician because of the risk of infection and rupture of the cranial implant. With this clinical case, we emphasize some precautions to prevent these issues.
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Alopecia/cirurgia , Dermatofibrossarcoma/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias Cranianas/cirurgia , Crânio/cirurgia , Retalhos Cirúrgicos , Expansão de Tecido/métodos , Adulto , Craniotomia , Dermatofibrossarcoma/patologia , Durapatita , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Invasividade Neoplásica , Próteses e Implantes , Implantação de Prótese , Couro Cabeludo/patologia , Neoplasias Cutâneas/patologia , Transplante de Pele , Crânio/patologia , Neoplasias Cranianas/patologiaRESUMO
INTRODUCTION: Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no study on the overall complication or satisfaction rate associated with the various grafting techniques exists. We performed a comprehensive literature review to determine the outcomes and complications of eyelid fat grafting, as well as patient satisfaction. METHODS: A systematic review of the literature using the PRISMA criteria was conducted. This protocol was registered at the Prospective Register of Systematic Reviews at the National Institute for Health Research. RESULTS: Sixteen studies, representing 1,159 patients and published between June 2004 and December 2014, were included. Satisfactory results, judged by clinical examination, were observed in all studies. Few postoperative complications were reported. CONCLUSIONS: We demonstrated that the procedures were easy to perform, and achieved satisfactory and sustainable results with few complications in both reconstructive and cosmetic surgery. However, a wide disparity exists in the various fat harvesting, fat purification, and reinjection techniques. Further studies are required to assess the long-term outcomes. Our conclusions should be accepted cautiously due to the small number of articles and the lack of evidence in published studies.
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Tecido Adiposo/transplante , Pálpebras/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tecido Adiposo/cirurgia , Humanos , Satisfação do Paciente , Estudos Prospectivos , Estudos Retrospectivos , Coleta de Tecidos e Órgãos , Transplante AutólogoRESUMO
BACKGROUND: Brachioplasty frequently offers functional benefits but results in poor aesthetic scars and a relatively high complication rate. The authors describe the complications and risk factors inherent in liposuction-assisted medial brachioplasty and assess patient satisfaction with the functional and aesthetic benefits. METHODS: A 5-year retrospective study was performed that included all patients who underwent liposuction-assisted medial brachioplasty. Complications were reviewed and analyzed by aesthetic and nonaesthetic categories, and patient satisfaction was rated. RESULTS: Sixty-six patients were included (mean age, 44.4 years). The average body mass index was 30.2 kg/m; mean weight reduction was 50.72 kg. Thirty-seven patients (56.1 percent) developed at least one complication, including six (9.1 percent) with a nonaesthetic complication versus 31 (47.0 percent) with an aesthetic complication. Complications were significantly associated with a longer operative time (p = 0.015), 233 minutes in the complication group versus 164 minutes in the no-complication group. Fifty-three patients answered the questionnaire. Forty-six (86.8 percent) stated that they would undergo this intervention again. Overall satisfaction was reported as excellent for 12 patients (22.6 percent) and pleasing for 24 (45.3 percent). All patients rated the functional outcome superior or equal to the aesthetic outcome. Quality of life was estimated to be better after than before the intervention for 41 patients (77.4 percent). CONCLUSIONS: Liposuction-assisted medial brachioplasty is a safe and efficient technique. It offers a functional benefit with a low nonaesthetic complication rate. Despite the inherent scars, the majority of patients would undergo this intervention again because of an important satisfaction rate and improvement in quality of life. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
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Braço/cirurgia , Lipectomia , Procedimentos de Cirurgia Plástica/métodos , Redução de Peso , Adulto , Idoso , Feminino , Humanos , Lipectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Major weight loss causes body deformities. Lower circumferential dermolipectomy with autologous gluteal augmentation by a fat island flap can restore a part of the body contour, but this procedure is associated with a high incidence of complications. The aim of this study was to analyse the benefit/risk ratio and the patients' satisfaction. METHODS: All patients who underwent this procedure at the Nancy University Hospital over a 3-year period (between January 2010 and 2013) were reviewed; the complications were analysed and the patients' satisfaction rated. RESULTS: A total of 55 patients were included with a mean age of 41.0 years. The average body mass index of the patients was 28.2 kg/m² with a mean weight of 76.8 kg at the time of the procedure and a mean weight reduction of 49.6 kg. The mean operative time was 4.85 h. The average hospital stay was 6.1 days. The average haemoglobin loss was 3.0 g/dl, and 12 (21.8%) patients required a blood transfusion. Of the total number of patients, 22 (40%) developed at least one complication, including six (10.9%) major complications. Fifty-two patients answered the questionnaire; 49 (94.2%) patients would go through this procedure again. The overall satisfaction was rated as excellent by 29 (55.8%) patients and as pleasing by 22 (42.3%). The outcome was judged as excellent or pleasing for the abdomen by 29 (55.8%) and 20 (38.35%) patients, respectively, and for the buttocks by 17 (32.7%) and 29 (55.8%) patients, respectively. The quality of life was rated better after than before the intervention by 49 (94.2%) patients. CONCLUSION: Despite a high complication rate, the majority of patients confirmed that they would opt for this procedure again, showing an improvement in their quality of life with an aesthetic and functional benefit. LEVEL OF EVIDENCE: III.
Assuntos
Nádegas/cirurgia , Lipectomia/métodos , Satisfação do Paciente , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos , Redução de Peso , Adulto , Cirurgia Bariátrica , Estética , Feminino , Humanos , Masculino , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
A 20-year-old woman treated with vitamin K antagonist for antiphospholipid syndrome (APS) (pulmonary embolisms at age 15) was admitted for breast reduction after bridging therapy. At 2 days post-surgery haematomas appeared on the surgical site and anticoagulant therapy was withheld. She developed a skin and breast necrosis leading to the diagnosis of catastrophic APS. Despite medical treatment (anticoagulant therapy, corticosteroids and intravenous immunoglobulins) and surgery, necrosis continued. After 2 weeks of negative-pressure wound therapy (V.A.C.(®) Therapy™) the patient improved, mammary tissues were alive, well vascularised and budding. Breast reconstruction was then initiated. Artificial dermis graft (MatriDerm(®) 2 mm) was applied, and 3 weeks later the apposition of split-thickness skin graft on it. Six months later, results of the surgery were good and the patient was satisfied.