Superior Medial-Based Breast Reduction with Inverted T Incision: A Precise Description of Our Refined Preoperative Marking and Operative Technique.

The purpose of this paper was to compile a thoroughly elaborated step-by-step guide for the preoperative marking and operative technique for superior medial pedicle inverted T breast reduction based on our long experience and technical refinements. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The treatment of composite defect of bone and soft tissues with a combined latissimus dorsi and serratus anterior and rib free flap.

BACKGROUND: Composite defects of bone and soft tissues represent a reconstructive challenge. Several techniques have been described in the medical literature; however, extensive composite defects should be reconstructed with microvascular free tissue transfer. The purpose of this report is to present the use of a composite latissimus dorsi and serratus anterior and rib free flap (LD-SA/rib) as an alternative procedure in patients who cannot undergo more commonly used vascularized bone-containing free flap reconstruction. METHODS: Since January 2009, 12 patients have undergone bone and soft tissues reconstruction with a composite LD-SA/rib flap. In this case series, indications for LD-SA/rib reconstruction were large mandibular defects after oral cancer ablation, scalp defects, and lower extremity defects. RESULTS: All flaps survived entirely. With reference to postoperative complications, haematoma occurred in four patients, scar contractures in three cases, lower lip incontinence in one patient, and local infection in one patient. Skin graft revision was performed in two cases and secondary debulking procedure in three patients. Flap viability was consistent during the 2-year follow-up. CONCLUSIONS: LD-SA/rib free flap should be regarded as an effective procedure for reconstruction of composite tissue defects in patients who are not candidates for more commonly used vascularized bone-containing free flaps.

Influence of Incision Site on Postoperative Outcome in Skin-/Nipple-Sparing Mastectomy: Is There a Difference between Radial and Inframammary Incision?

BACKGROUND: The aim of this study was to determine whether there is a difference in results between the radial and the inframammary approach in nipple-/skin-sparing mastectomy and immediate reconstruction. METHODS: The patients were divided into two groups (group 1: radial incision; group 2: inframammary fold incision [IMF]), each consisting of two subgroups for direct-to-implant reconstruction (1a, 2a) and expander reconstruction (1b, 2b). The patients were operated on between March 2012 and May 2017. Preoperative tumor parameters, reconstruction parameters, postoperative tumor parameters, and immediate and late complications were assessed. Postoperative photographs were evaluated by the patients and 8 plastic surgeons by means of grading (1-5) and the visual analog scale (VAS; 1-10). RESULTS: Enrolled in this study were 28 patients, namely, 7 patients in each subgroup. The median age was 46 years, and the median follow-up period was 40 months. No immediate complications occurred. Three patients had late complications, but there was no case of evident capsular fibrosis. Twenty-seven patients (96.42%) evaluated the postoperative result as excellent/good. The postoperative evaluation by the plastic surgeons was excellent/good for a median of 18 patients (64.28%). Group 1 showed a median VAS score of 7.63 (expander group: 7.50; direct-to-implant group: 7.75); the median VAS score for group 2 was 8.25 (expander group: 8.75; direct-to-implant group: 7.50). CONCLUSIONS: Our study shows good results for implant breast reconstruction in both groups, with minimally better results for the IMF group. In the direct-to-implant subgroups, the radial group showed slightly better results.

[Concerning the Wrist-to-Forearm-Ratio of the Median nerve ultrasound is not a suitable method for assessing the success of a carpal tunnel release]. / Betreffend der Wrist-to-Forearm-Ratio des N. medianus ist die Sonographie zur Verlaufskontrolle nach Operation eines Karpaltunnelsyndroms ungeeignet.

PURPOSE: The primary aim of the study was to analyze whether there is and - if so - how far a correlation between the clinical findings after carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) and the Wrist-to-Forearm-Ratio (WFR) of the median nerve in ultrasound to answer is question whether the WFR can be used in controlling the operative result. PATIENTS AND METHODS: In a prospective study the clinical, electrophysiological, and sonographic data of 40 patients with CTR for CTS were collected preoperative and 3 and 9 months postoperative. The data of 21 patients with 23 operated hands completing the study were analyzed. There were 5 men and 16 women with an average age of 58 years. RESULTS: Neither a correlation between the clinical findings postoperative and the WFR nor the electrophysiological findings postoperative was found. CONCLUSION: Concerning the Wrist-to-Forearm-Ration of the Median nerve ultrasound is not a suitable method for assessing the success of a carpal tunnel release.

Long-term quality-of-life improvement in gastric banding patients from body-contouring surgery.

Following my prior study of long-term results after laparoscopic gastric banding concerning operative outcome and complications involving the gastric band itself, I now focus on long-term quality-of-life improvement in the same study group after body-contouring surgery. As determined from our electronic patient data system, 72 patients from the former study group subsequently sought body-contouring surgery at our hospital after successful weight loss. Patients were enrolled in a telephone interview and asked about their expectations and body image before and after postbariatric aesthetic surgery and how it altered their well-being in addition to the weight loss achieved with the gastric band. All patients undergoing postbariatric aesthetic surgery felt extremely uneasy with the hanging skin resulting from weight reduction. Patients cannot imagine the degree of dissatisfaction they will experience from the sagging skin that comes with weight loss. Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and reported an extreme improvement in body image. Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery, because most patients not forewarned suffer greatly from their body image after weight loss.

Three uses of an extra length of jejunum in pharyngo-oesophageal reconstruction with free jejunal flap.

BACKGROUND: The free jejunal flap is a widely spread method of pharyngo-oesophageal reconstruction and can also be used in patients presenting with aspiration tendency following treatment for head and neck cancers or caustic injury of the upper aero-digestive tract to create a separate food pathway, the free jejunal diversionary conduit. METHODS: Sixteen patients, 13 males and 3 females, aged between 32 and 66 years, undergoing pharyngo-oesophageal reconstruction with a free jejunal flap between October 2005 and July 2011, were included in this study. An extra length of jejunum was used in 10 patients for widening of the upper portion of a prefabricated free jejunal flap, in three patients who developed a leak at the jejuno-oesophageal junction during the follow-up for creation of a seromuscular flap that was used to seal off the leak and in three patients with aspiration tendency for simultaneous creation of a free jejunal diversionary conduit and a separate pharyngo-cutaneous fistula. RESULTS: All flaps survived completely. No complication was observed at the pharyngo-jejunal junction during the follow-up in patients reconstructed with the prefabricated free jejunal flap. No recurrence of the leak was observed in patients treated with a seromuscular flap during the follow-up period. Patients with a free jejunal diversionary conduit did not experience episodes of aspiration and no obstruction of the pharyngo-cutaneous fistula was noted in the postoperative period. CONCLUSIONS: We want to encourage the use of an extra length of jejunum in pharyngo-oesophageal reconstruction with a free jejunal flap because it helps to manage postoperative complications, such as leakage and stricture, and it does not increase the morbidity related to the reconstruction. Furthermore, we believe that the creation of a separate pharyngo-cutaneous fistula represents another step forward in the improvement of pharyngo-oesophageal reconstruction with a free jejunal diversionary conduit.

Effects of thermal water on skin regeneration.

An experimental study was carried out in an animal (New Zealand white rabbit) wound model to evaluate any effects of a hypotonic, bicarbonate-calcium-magnesium mineral water (Comano thermal water) on skin regeneration, comparing the healing rate of split-thickness skin graft donor sites treated with the thermal water wet dressing versus a standard petrolatum gauze dressing versus a saline solution wet dressing. The study was performed in two steps; an overall of 22 animals were enrolled in the study. The wound healing progress was evaluated both by the surgeons and by the histologists. Sixty-four punch biopsies were examined in all. The histological samples were examined after staining with haematoxylin and eosin, Masson's and orcein staining and under a transmission electron microscope. The data were statistically analysed. The Comano thermal water proved to improve skin regeneration, not only by increasing keratinocyte proliferation and migration but also favourably modulating the regenerated collagen and elastic fibres in the dermis. We propose that the results of the topical treatment with the thermal water could be due to the favourable combination of a local wet environment with an anti-inflammatory action and that the regenerative properties of Comano thermal water observed in rabbits could also be applied for human use.