Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes.

Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.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 .

Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort.

BACKGROUND: Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. OBJECTIVES: The authors evaluated the effect of BCS on QoL and the durability of this effect over time. METHODS: QoL was measured with the Body-QoL® instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instrument's main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. RESULTS: Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 ± 14.1 preoperatively to 85.5 ± 17.5 short-term postoperatively and to 84.4 ± 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 ± 15.6 vs 46.1 ± 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. CONCLUSIONS: QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts.

Manejo quirúrgico de pacientes adultos con anomalías vasculares: serie de casos / Surgical management of adult patients with vascular anomalies: series of cases

Introducción: Las anomalías vasculares son un grupo heterogéneo de patologías, que considera tanto tumores como malformaciones vasculares. Son, habitualmente, de diagnostico y manejo durante la infancia, algunas lesiones persisten hasta la edad adulta. El tratamiento habitual considera terapias poco invasivas, siendo la alternativa resecctiva un opcion infrecuente. Objetivos: El objetivo de este estudio es presentar el manejo quirúrgico de pacientes portadores de anomalías vasculares realizado por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de anomalias vasculares, sometidos a manejo quirúrgico por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Se incluyó todos los pacientes con diagnóstico de anomalías vasculares intervenidos entre los años 2010 ­ 2016. Se realizó una revisión del historial clínico de cada paciente elaborando un análisis descriptivo. Resultados: Serie de 9 pacientes, 6 (66,6%) de sexo femenino, con edad promedio de 34,88 ±15,70 años. De los cuales 6 (66,67%) presentaron malformaciones vasculares y 2 (22,22%) tumores vasculares. Se observo compromiso de cabeza en 6 (66,67%) casos y 2 (22,22,%) genital. Se utilizo colgajos locales de avance en 6 (66,67%) y colgajos de transposición en 2 (22,22%) casos. Conclusiones: El manejo quirúrgico es una alternativa terapéutica segura que ofrece resultados buenos a las lesiones complejas. Y por tanto, creemos que es necesario un trabajo multidisciplinario entre pediatras, dermatólogos, radiólogos fisiatras, psicólogos y cirujanos plásticos para poder ofrecer mejores resultados a nuestros pacientes.

Introduction: Vascular anomalies are a heterogeneous group of pathologies, which considers tumors and vascular malformations. Usually diagnosed and treated during childhood, some lesions persist into adulthood. The usual treatment considers non-invasive therapies, being the respective alternative an uncommon option. Objectives: Present the surgical management of adults patients with vascular anomalies performed by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. Material and methods: Retrospective case series of patients with diagnosis of vascular anomalies submitted to surgical management by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. All patients with diagnosis of vascular anomalies operated between the years 2010 - 2016 were included. A review of the clinical history of each patient was carried out and a descriptive analysis was done. Results: Series of 9 patients, 6 (66.6%) female, with a mean age of 34.88 ± 15.70 years. Of these, 6 (66.67%) had vascular malformations and 2 (22.22%) had vascular tumors. Head involvement was observed in 6 (66.67%) cases and 2 (22.22%) genital. Local flaps were used in 6 (66.67%) and transposition flaps in 2 (22.22%) cases. Conclusions: Surgical management is a safe therapeutic alternative that offers beneficial results to complex lesions. Therefore, we believe a multidisciplinary work between pediatricians, dermatologists, radiologists.

Manejo quirúrgico de pacientes con hidrosadenitis supurativa: experiencia del Hospital Clínico de la Universidad de Chile / Surgical management of patients with hidradenitis suppurativa: experience of the Clinical Hospital of the University of Chile

Introducción: La hidrosadenitis supurativa es una enfermedad crónica de la piel en zonas que contienen glándulas apocrinas. Clásicamente se describe un manejo multimodal. La cirugía es una estrategia reconstructiva eficaz, frecuentemente postergada. No existen reportes sobre la experiencia a nivel nacional en el manejo de este grupo de pacientes. Objetivos: Exponer los resultados de manejo quirúrgico reconstructivo de pacientes con diagnóstico de hidrosadenitis supurativa por parte de un equipo de cirugía plástica de un hospital clínico. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de hidrosadenitis supurativa con manejo quirúrgico. Se realizó una revisión del historial clínico de cada paciente y se elaborando un análisis descriptivo. Resultados: Trece pacientes, 7 (53,8%) de sexo femenino, edad promedio de 30,5±5,9 años. Se realizó manejo quirúrgico de 17 lesiones, siendo las más frecuentes 9 (52,9%)Axilar y 5 (29,4%) Inguino-perianal. Se realizó drenaje­curaciones en 2 (11,8%) y resección-cobertura en 15 (88,2%), 14 (82,3%) con colgajos y 2 (11,8%) injertos. Discusión: El manejo quirúrgico es una alternativa terapéutica eficaz para el control de la hidrosadenitis supurativa, presentando buenos resultados estéticos y funcionales con bajas complicaciones.

Introduction: Hidradenitis suppurativa is a chronic skin diseases of areas that contain apocrine glands. Classically a multimodal management is described. Surgery is an effective treatment, often postponed. Objectives: Present results of reconstructive surgical management of patients with hidradenitis suppurativa by a plastic surgery team of a clinical hospital. Material and methods: Retrospective case series of patients with hidradenitis suppurativa with surgical management. A review of the clinical history of each patient was carried out and a descriptive analysis was carried out. Results: 13 patients, 7 (53.8%) female, mean age of 30.5 ± 5.9 years. Surgical management of 17 lesions was performed, the most frequent lesions were 9 (52.9%) Axillary and 5 (29.4%) Inguino-perianal. Drainage were performed in 2 (11.8%) and resection-coverage in 15 (88.2%), 14 (82.3%) with flaps and 2 (11.8%) grafts. Discussion: Surgical management is an effective therapeutic alternative for the management of hidradenitis suppurativa, presenting good esthetic and functional results with low complications.

Resultados a largo plazo en calidad de vida en cirugía de contorno corporal: Fase IV en la cohorte Body-Qol® / Long-term outcomes in quality of life after body contouring surgery: Phase IV results in the Body-Qol® cohort

Introducción: La calidad de vida es uno de los resultados en cirugía de contorno corporal más importantes. La evidencia sobre la calidad de vida de estos pacientes a largo plazo es escasa. El objetivo de este estudio fue determinar si la calidad de vida obtenida en el postoperatorio temprano posterior a la cirugía de contorno corporal se mantiene a largo plazo. Métodos: Se diseñó un estudio de cohorte prospectiva compuesta por pacientes postoperados de cirugía de contorno corporal con más de un año de seguimiento. La calidad de vida fue medida con el instrumento Body-Qol®. Se compararon los puntajes preoperatorios, postoperatorios tempranos y postoperatorios tardíos. Se realizó el análisis estadístico con las pruebas de Kruskal-Wallis y Kolmogorov-Smirnov. Resultados: La cohorte se compuso de 112 pacientes con un seguimiento a largo plazo del 75%. En toda la cohorte la calidad de vida mejoró entre el preoperatorio (43,9 ± 14,1 puntos) y ambas mediciones postoperatorias (85,2 ± 16,8 postoperatorio temprano y 83,6 ± 13,5 postoperatorio tardío), siendo estadísticamente significativo (p < 0,0001). Entre el postoperatorio temprano y tardío no existió diferencia (p = 0,112). El análisis por dominios demostró la misma tendencia. Los pacientes con pérdida masiva de peso tuvieron puntajes preoperatorios menores, pero igualaron a la población estética en ambas mediciones postoperatorias. Conclusiones: La calidad de vida mejora significativamente posterior a la cirugía de contorno corporal de forma temprana, y esta mejoría es estable en el tiempo. Esto se observa tanto en los pacientes estéticos como en los posteriores a la pérdida masiva de peso.

Introduction: One of the most important outcomes in patients undergoing body-contouring surgery is quality of life. Data on long-term quality of life is deficient. The main purpose of this study is to determine if short-term QoL after body contouring surgery maintains in the long-term follow up. Methods: A cohort study was designed; patients with at least one-year follow-up from the surgery were included. Quality of life was measured with the Body-Qol© instrument. All patients answered the preoperative Body-Qol© and at least one measurement after one year of follow-up from body contouring surgery. The preoperative scores, short-term scores and long-term follow-up scores were compared. The statistical analysis was made with Kruskal-Wallis y Kolmogorov-Smirnov tests. Results: The cohort was integrated by 112 patients; the long-term follow-up was of 75%. Quality of life improved between the preoperative measure (43.9 ± 14.1 points) and both short-term and long-term measures (85.2 ± 16.8 early postoperative y 83.6 ± 13.5 late postoperative), which was statistically significant (P< .0001). There was no difference between the short-term and long-term measures (P = .112). The domain analysis demonstrated the same tendency. Massive weight loss patients had lower preoperative scores but improved more after BCS, reaching almost cosmetic values. Conclusions: Quality of life improves soon after surgery and is stable over time. This was observed for both massive weight loss and cosmetic patients.