Meridian pedicle-based breast shaping in reduction mammaplasty: a technical modification.

BACKGROUND: We present a technical modification of vertical reduction mammaplasty which provides a reliable pedicle that can be used in large and highly ptotic breasts with confidence when compared to vertical mammaplasty techniques without sacrificing conical breast shape and projection, in contrast to Wise pattern reduction techniques. METHODS: Thirty-two patients under general anesthesia were operated on using this modification between 2008 and 2012. The surgical technique is as follows: after general anesthesia induction and local anesthetic infiltration, skin incisions are made according to preoperative drawings. The breast meridian is prepared by superior and inferior plication of the vertical pedicle, including two dermal and one central attachment to the chest wall. Lateral and medial tissue resections are performed, thus preparing medial and lateral pillars after skin undermining. The pillars are sutured to the meridian to reconstruct a projectile conical breast shape. Inverted-T scar (87.5%, n=28) and vertical scar (12.5%, n=4) were used for closure. RESULTS: All patients were satisfied with the outcome regarding breast projection, shape, and size at 12 (n=30) and 24 months (n=15) after surgery except for 12 cases that needed reoperations: 2 cases for bottoming out and lower pole deformity, 2 cases needed more reduction by liposuction or re-excision, and 8 scar revisions. CONCLUSION: Early and late results (up to 2 years) regarding breast shape and projection were found to be satisfactory while providing a reliable pedicle with less postoperative drainage. LEVEL OF EVIDENCE V: 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 .

Reconstruction of coup de sabre deformity (linear localized scleroderma) by using galeal frontalis muscle flap and demineralized bone matrix combination.

In this clinical report, we are presenting the combination of demineralized bone matrix combined with bilateral galea frontalis flaps. Based on our 6-month results, this seems to be a reasonable combination to accomplish long-lasting restoration of forehead defects related to en coup de sabre linear localized scleroderma.

Hypertrophic frontal sinus reduction by using anterior wall internalization and galeal frontalis flap obliteration.

In this article, we are introducing the use of galeal-frontalis flap to reduce hypertrophic sinus based on 1 case: a 25-year-old amateur boxer who had prominent frontal area due to hypertrophic frontal sinus. Three-dimensional reformatted computed tomography scans were obtained for evaluation of the hypertrophy and the morphology of the frontal sinus. Reduction of the hypertrophic frontal sinus was performed by resection and shaping of the anterior wall and obliteration of the frontal sinus by right-side galeal-frontalis flap excision via bicoronal approach. The trimmed anterior wall was inserted into the frontal sinus and secured with three 3.0 PDS sutures to the bone edges, and the incision was closed. The outcome was satisfactory without any complications during 1-year follow-up, and sixth-month computed tomography scans revealed no bone resorption. Here we are introducing a novel technique to reduce hypertrophic sinus based on a clinical report.

Use of dental mirror in microsurgical practice.

In this article, we introduce the use of dental mirror during microsurgery. We have been using no. 4 dental mirror during microvascular anastomoses and nerve coaptations for the last 6 months successfully and found that, as a cheap and easily obtainable instrument, it has facilitated our practice. We are strongly recommending the use of dental mirrors in microsurgical practice and inclusion to every microsurgery instrument set.