Expanded Paramedian Forehead Flaps for Nasal Defects: Beyond Aesthetic Subunits.

BACKGROUND: Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. METHODS: Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10. RESULTS: The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse. CONCLUSIONS: The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.

[Comparison study of clinical effect and complications between subfascial and submammary breast augmentation].

OBJECTIVE: To compare the clinical effect and complications of subfascial breast augmentation and submammary breast augmentation. METHOD: From Sept. 2009 to May 2012 , 25 patients with subfascial breast augmentation and 31 patients with submammary breast augmentation were observed. The postoperative results including visible implant edge or ripple, upper pole of the implant and long-term implant ptosis were compared respectively. The complications including hematoma, infection and capsular contraction were also recorded. RESULTS: 56 cases were followed up for 2 months to 26 months. The incidence rate of visible implant edge or ripple was 4.0% (1/25 ) in the subfascial group and 29.0% (9/31) in the submammary group, showing a significant difference between them ( PC 0.05). The incidence rate of convex upper pole of the implant was 8.0% (2/25) in the subfascial group and 35.5% (11/31) in the submammary group, showing a significant difference between them ( P < 0.05). Long-term implant ptosis was not found in the two groups. The incidence rate of hematoma was 4.0% (1/25) in the subfascial group and 6.5% (2/31) in the submammary group, infection was not found. The incidence rate of capsular contraction was 8.0% (2/25) in the subfascial group and 12.9% (4/31) in the submammary group, showing no statistical difference between them ( P > 0.05 ). CONCLUSIONS: Subfascial breast augmentation has more clinical advantages compared with submammary breast augmentation, but no evident difference was found in the common complication rate, such as capsular contraction.

[Reduction mammaplasty with central gland pedicle based on Würinger's horizontal septum].

OBJECTIVE: To investigate the method and efficacy of reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum in the treatment of female breast hypertrophy. METHODS: From Mar. 2009 to Sept. 2011, a series of 21 consecutive patients with mild and moderate hypermastia underwent reduction mammaplasty with central gland pedicle. Only the mammary gland located at cranial portion of septum was resected and the mammary gland located at caudal portion of septum was preserved. RESULTS: In our series, the mean resection weight per breast was (327.8 +/- 148.6) g, the mean nipple-to clavicle midpoint was 20.0 cm (range, 18.0-22.0 cm) and the mean nipple-to-sternal-notch distance was 21.0 cm (range, 19.5-22.5 cm) postoperatively. Nipple was moved upward 6.5 cm on average (range, 4.0-10.0 cm). There was no hematoma and nipple-areolar complex (NAC) necrosis. Minimal wound dehiscence occurred in one case and healed by dressing change. 17 cases were followed up for 3 months to 2 years. Satisfactory breast shape was achieved with good NAC sensibility. CONCLUSIONS: The reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum is a safe and reliable technique for mild and moderate hypermastia. Satisfactory breast contour, as well as NAC viability and sensibility, could be achieved with lower occurrence of hematoma or seroma.

[Correction of mild and moderate breast ptosis with glandular flap combined with dermal flap suspension].

OBJECTIVE: To investigate the therapeutic effect of glandular flap combined with dermal flap suspension for correction of mild and moderate breast ptosis. METHODS: The dermal flap was formed according to the breast ptosis and dissection was performed between the skin and gland. The superior-lateral gland was partially resected or cut vertically only to form the lateral glandular flap. Then the glandular flap was rotated medially and fixed to shrink the glandular base area. Then the breast was up-positioned and fixed with dermal flap to remodel the breast shape. RESULTS: From Mar. 2006 to Mar. 2010, 46 cases were treated with satisfactory result. There was no severe complication, except for 2 cases of unilateral hematoma. 40 cases were followed up for 6 months to 4 years with good breast shape. No secondary ptosis, breast flatten and NAC sensation disorder was happened. CONCLUSIONS: Glandular flap combined with dermal flap suspension is a good method for mild and moderate breast ptosis with reliable long-term results. The breasts have busty appearance and good projection with inconspicuous scar.

[3-Dimensional reconstruction of MRI in patients with polyacrylamide hydrogel injection for augmentation mammoplasty].

OBJECTIVE: To investigate the effective diagnostic method for the patients with polyacrylamide hydrogen injection for augmentation mammaplasty. METHODS: MRI scanning (layer thickness 1mm, t2 _ ps3d_ cor alignment) was performed on 23 patients with polyacrylamide hydrogen injection for augmentation mammaplasty. The data were imported into computer and processed. 3D reconstruction and analysis modules were run subsequently to do the volume reconstruction and surface reconstruction to obtain stereoscopic images of the gel and adjacent structures in virtual reality, and to calculate the volume of the hydrogel. RESULTS: Among the 23 patients (46 breasts), the injected hydrogel with integrity capsule existed in retromammary space with no malposition in 5 cases (10 breasts). The capsule was not integrally formed and hydrogel was separately distributed with irregular edge in 6 patients (12 breasts). The pectoris major space, subcutaneous and gland invasion was found in 11 patients (22 breasts). Small amount of hydrogel sparsely distributed in mammary gland and degenerative muscular tissue in 1 patient (2 breasts) who had received extracting surgery before. The volume of hydrogel ranged from 220.309 ml to 372.371 ml (mean: 306.328 ml) in 22 untreated patients (44 breasts). CONCLUSIONS: The volume and distribution of hydrogel can be known clearly by 3D MRI reconstruction technique. This feasible technique is helpful in removing the hydrogel completely.

[Analysis of the complications following the periareolar reduction mammaplasty using polypropylene mesh as suspension device].

OBJECTIVE: To investigate the cause and the prophylactic measures for the complication following the periareolar reduction mammaplasty using polypropylene mesh as suspension device. METHODS: From Dec. 1999 to Dec. 2005, 78 patients who underwent periareolar reduction mammaplasty using polypropylene mesh as suspension device were analysed. Among them, 47 cases were followed-up for 6 months to 5 years, and their long-term effect was evaluated. RESULTS: Early after operation, complications included seroma (3 cases), infection (3 cases), delayed wound healing (3 cases), and paraesthesia of nipple-areolar complex (1 case). The 47 followed-up patients presented abnormal wave-like skin appearance in superior polar of breast (7 cases), palpable cord-like mammary content in peripheral region of breast (3 cases), widening of periareolar scar and secondary ptosis (2 cases) and paraesthesia of nipple-areolar complex (1 case). All other patients acquired good appearance and felt satisfactory. 2 patients could lactate after operation. 5 patients underwent mammary X-ray radiography after operation. No mesh shadow or calcification was revealed. CONCLUSIONS: Although polypropylene mesh is a good suspension device in reduction mammaplasty, the long-term complication is relatively high because of the hardness of the tissue. More soft tissue is necessary as alternative device for clinical application.

[Analysis and treatment of complications induced by polyacrylamide hydrogel injection].

OBJECTIVE: To explore the reasons for the complications of polyacrylamide hydrogel injection. METHODS: 39 patients were included in this study, who had complications after polyacrylamide hydrogel injection in the breasts, nose, temproal area or depressed locus. The clinical manifestations of the complications were analyzed. RESULTS: Postoperative infection occurred in 5 cases, induration in 23, pain in 25, ulceration of the puncture points in 9, displacement in 6, galactostasis in 1, skin necrosis in 1, breast deformation in 3, bilateral asymmetry in 4, aseptic inflammation in 10, and skin-acne-like changes on the face in 4. CONCLUSION: Some complications were caused mainly by incorrect manipulation and others were relative to the injected material. The applications of polyacrylamide hydrogel as a clinical implant material need further investigations. Polyacrylamide hydrogel injection should be cautiously used.