Augmentation-mastopexy using an autologous parenchymal sling.

BACKGROUND: Mastopexy-augmentation is an important treatment to address breast deflation. Combining these two procedures is technique-sensitive, with a reported high revision rate and propensity for complications. We describe an approach to achieve aesthetic breast correction in an effective, reproducible, and safe manner while minimizing untoward sequela. METHODS: A vertical mastopexy, using a superior dermoglandular pedicle, is coupled with a subpectoral breast implant with the support of a longitudinal autologous sling of breast fascia, termed autologous sling augmentation-mastopexy. RESULTS: Twenty consecutive patients, aged 25-49 years, were treated by this technique, with a follow-up period of at least 1 year. Aesthetic improvement of breast shape, projection, and nipple position were achieved in all patients. No major complications, including infection, necrosis, or implant exposure, occurred. Minor wound-healing deficits at the inferior aspect of the vertical resection occurred in three patients. One patient required implant exchange early postoperatively because of saline leakage. No revisions were necessary to adjust breast symmetry or nipple position. CONCLUSION: We describe a mastopexy-augmentation technique, based on patient selection, mastopexy resection pattern, and implant size and position, to improve breast aesthetics safely and reproducibly while minimizing complications and the need for near-term revision.

Plastic surgery repair of abdominal wall and pelvic floor defects.

Urologists often encounter large perineal and abdominal wall defects, the treatment of which may require close collaboration with the plastic surgeon. These complex defects can be successfully treated using a variety of techniques. Ventral hernias or freshly created abdominal wall defects can be treated with the basic principles of tension-free closure using abdominal wall components separation, synthetic mesh reconstruction, and, more recently, biosynthetic acellular dermis reconstruction. Pelvic floor defects often require flap reconstruction using gracilis flaps, vertical rectus abdominis myocutaneous flaps, or local fasciocutaneous flap. In this article, we seek to familiarize the urologists with the most common techniques used by plastic and reconstructive surgeons in the treatment of these complicated pelvic floor and abdominal wall defects.

Microsurgical reconstruction of posttraumatic high-energy maxillary defects: establishing the effectiveness of early reconstruction.

BACKGROUND: Posttraumatic, high-energy defects of the midface can be challenging to reconstruct because they involve extensive composite tissue loss and result in significant permanent functional and cosmetic deformity. These injuries require replacement of the bony framework, external soft tissue, and intraoral mucosa. Local skin flaps and nonvascularized bone grafts have been used for reconstruction, but bony resorption and the associated soft-tissue collapse limit long-term viability. The authors present a classification of maxillary defects following high-energy trauma and a treatment algorithm using vascularized bone flaps. METHODS: Fourteen patients with significant maxillary loss from high-energy trauma underwent reconstruction with composite vascularized bone flaps. Eight patients had fibula flaps and six had iliac crest flaps. There were five women and nine men, with a mean age of 36.3 years (range, 21 to 48 years) and a mean follow-up of 18 months (range, 5 to 54 months). RESULTS: Thirteen of the 14 flaps survived. Nine patients had additional procedures. Nine patients had oronasal fistulas and eight were dependent on gastrostomy tubes preoperatively. All patients were able to feed orally without nasal regurgitation postoperatively. All patients achieved stable restoration of the midfacial architecture. CONCLUSIONS: The classification scheme presented centers on the missing maxillary subunits. The reconstructive algorithm is based on the type of defect, tissue requirement, and donor tissues necessary to restore facial projection and prosthodontic rehabilitation. Iliac crest and fibula bone free flaps are ideal for restoring a variety of traumatic maxillary defects. The authors advocate early reconstructive intervention using vascularized bone flaps to achieve superior functional and cosmetic outcomes.