Diathermocoagulation in cutting mode and large flap dissection.

BACKGROUND: The aim of this study was to determine the overall complication rate associated with the use of diathermocoagulation in cutting mode for flap dissection. METHODS: Because of the high rate of complications generally associated with abdominoplasty, a large flap, abdominoplasty, or abdominal dermolipectomy model was chosen. A retrospective review was conducted regarding 647 abdominoplasty procedures, 320 of which were performed with the monopolar diathermocoagulation in the cutting mode and 327 of which were performed with a steel scalpel. The two groups were similar regarding morphologic characteristics, prescriptions, and procedures. In both cases, hemostasis was performed with punctual monopolar coagulation current. Analysis was performed regarding the frequency of major general complications (e.g., deep vein thrombosis and pulmonary embolism), major surgical complications (e.g., acute hemorrhage), and "minor" complications (e.g., postoperative secondary collections or delayed wound healing). RESULTS: In the electrosurgery group, the incidence of noninfectious collections was significantly higher, as was the production of the drains. No difference was seen in terms of reintervention for acute hematoma, postoperative infectious collections, blood loss, hospital stay, or thromboembolic complications. Operations took significantly longer with the steel scalpel. The follow-up was significantly longer in the diathermocoagulation group. CONCLUSIONS: Monopolar diathermocoagulation has already proven its place in the general work of every surgeon. Moreover, this technique remains superior in terms of the rapidity with which surgery can be performed when dissecting large areas. Nevertheless, the higher rate of surgical complications leads to a longer follow-up period that, in part, runs counter to this advantage.

Peninsular conchal axial flap to reconstruct the upper or middle third of the auricle.

BACKGROUND: The reconstruction of partial amputations of the auricle is a continuous subject of publications, in particular, the techniques of ear reconstruction with postauricular flaps. OBJECTIVE: To present in detail the surgical procedure of a new peninsular conchal transposition flap. MATERIALS AND METHODS: This new conchal transposition flap has been used since 1998 to reconstruct seven partial amputations of the upper or middle third of the auricle. If we compare the flap to a tennis racket, the head corresponds to a skin-cartilage-skin flap harvested from the concha and the shaft to a post- and supra-auricular cutaneous and subcutaneous pedicle based around the posterior auricular artery and the superior auricular branch of the superficial temporal artery. The blood supply is reliable because the superior branch of the posterior auricular artery anastomoses with the superior auricular branch of the superficial temporal artery. RESULTS: There have been no significant complications, except one case of partial rim necrosis, which responded well to wound healing by secondary intention. CONCLUSION: Our peninsular flap could be an alternative to more complex procedures involving costal cartilage harvesting, provided that auricle amputations are confined to the upper or middle third of the peripheral structures and spare the concha.