Long-term changes in nipple-areolar complex position and inferior pole length in superomedial pedicle inverted 't' scar reduction mammaplasty.

BACKGROUND: Proper nipple-areolar complex position in reduction mammoplasty patients is a challenging problem regardless of the preferred technique. Postoperatively, the nipple-areolar complex is often not located at the most projected area of the breast. This retrospective observational study aimed to find the long-term measurements of the nipple-areolar complex position and inferior pole length after inverted T scar-superomedial pedicle reduction mammoplasty. METHODS: Forty-eight female patients (96 breasts) were included in this study. The inclusion criteria were that no previous operation should have been done on any of the breasts and both NAC complexes should be at least 30 cm from the midclavicular point. Preoperatively, the distance from the midclavicular point to the new nipple was recorded. All patients were operated on with the inverted T pattern and superomedial pedicle technique. The resection weights, the distance from the midclavicular point to the nipple distance, and the distance from the NAC lower border to the inframammary fold were evaluated postoperatively with an average of 15-month follow-up. RESULTS: The mean preoperative distance from the midclavicular point to the nipple was 34.21 cm for the right breast and 34.26 cm for the left breast. The mean resection weight per breast was 1035 g for the right breast and 1081 g for the left breast. The descent of the NAC was 1.61 cm for the right breast and 1.79 cm for left breast (mean: 1.7 cm) at the end of the follow-up. Additionally, the inframammary length increased 3.31 cm for the right breast and 3.59 cm for the left breast (mean: 3.45 cm). CONCLUSION: In this study, we found that the new nipple-areolar complex does not go upward but goes downward. However, it was not located at the most projected area of the breast as it was set intra-operatively. This was because the lower pole of the breast sagged more than the nipple: clinically, we observed a nipple superior displacement of 1.75 cm (3.45 - 1.7 = 1.75). According to this calculation, we believe that the new nipple position should be marked at 1.5-1.75 cm below the most projected area of the breast after final shaping so that in the long term, the nipple-areolar complex would be at the proper position. LEVEL OF EVIDENCE V: 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 .

Squamous cell carcinoma of the lower lip: exact location match in siblings.

BACKGROUND: In recent years, genetic contribution to the development of skin cancers is under the magnifying glass of several authors and is now regarded as the main initial etiology in carcinogenesis. OBJECTIVE: Two siblings who had squamous cell carcinoma of the lower lip showing an exact location match are presented. PATIENTS: They did not share common environmental factors, and there was no history of tobacco and/or alcohol abuse. CONCLUSIONS: It would be scientifically deceptive to draw generous conclusions for the cases here, other than being a very interesting and unusual coincidence, because further evaluation could not be done to scientifically prove a possible genetic contribution.

The rate of upper-extremity deep-structure injuries through small penetrating lacerations.

Despite the abundance of epidemiologic studies concerning hand injuries, there is no study that emphasizes the significance of the initial laceration size. The aim of this study is to investigate the incidence of tendon, nerve, and artery injuries that may result from small, penetrating lacerations of the hand and forearm. A total of 226 patients with small lacerations were included in the study. Glass (68.7%) and knife (31.3%) lacerations were the only etiological factors. One hundred thirty-four patients (59.3%) had at least 1 deep-structure injury. One hundred twenty-four patients (92.5%) had at least 1 tendon, 25 patients (18.7%) had at least 1 nerve, and 20 patients (14.9%) had at least 1 artery injury. Extensor tendons were more commonly injured (61.3%). Combination injuries were found in 20 (14.9%) patients. The most-encountered combination was the injury of all 3 structures. Small laceration injuries of the upper extremity have the potential to conceal an underlying deep injury.

Effect of full-thickness skin graft initial dimension on secondary wound contraction: experimental study in rats.

BACKGROUND: The size of a full-thickness skin graft (FTSG) is typically determined using a pattern of the defect usually obtained following excision of a skin lesion. OBJECTIVE: The aim of this experimental study is to investigate the effects of various graft sizes on secondary wound contraction. METHODS: Four 2.5 x 2.5 cm defects were created on the backs of 20 rats. Defect A was left to heal by secondary intention. The graft obtained from defect B (exact size graft) was sutured to its original bed. The wound of defect C (large graft) was patterned, and this was used to obtain a generous graft from the abdomen. A presized 1.5 x 1.5 graft obtained from defect D (small graft) was sutured to its original wound. Graft areas on days 0, 3, 7, 10, 14, 18, and 21 were calculated and converted into a percentage of the original wound size. Analysis of variance was used for statistical comparison. Open wounds reached a final wound size of 5% at day 21. Exact-size grafts showed the least secondary contraction rate (74.19 +/- 4.30 %) (p < .05). CONCLUSION: A graft in the size of a planned excision preserves its original area better than grafts larger or smaller in size in the rodent model. The size of a FTSG is an important factor in preventing secondary wound contraction. However, it should be stressed that the results of this study cannot necessarily be extrapolated to real clinical scenarios without further detailed studies.

The "duck" modification of the tensor fascia lata flap.

Various common locations of pressure sores require specific considerations. The most commonly used flap for the treatment of trochanteric ulcers is the tensor fascia lata (TFL) flap. According to our experience with the original flap, excessive tension and eventual suture separation at the confluence of the donor site flaps and the TFL flap is the most common problem. The purpose of this article is to present a new design for the TFL flap for the coverage of trochanteric pressure sores. An anterior triangular extension is designed exactly at a point where the flaps that will cover the donor site unite after transposition. The desepithelialized proximal part of the flap is folded into the pouch and sutured. The duck flap was applied to 31 trochanteric pressure sores in 27 patients with no major complications. This modification has many advantages: (1) the flap is reliable and easily designed, (2) formation of dead space and cone-shaped dog-ear deformity due to rotation is prevented, (3) better esthetic results are achieved, (4) suture separation is prevented via a tension-free closure, (5) the desepithelialized part produces tight attachment of the flap to the recipient bed, (6) as no muscle tissue is included, the flap is more resistant to pressure.

The medical use of a nonmedical product: melted tar.

The use of hot tar in industry is widespread, and burns caused by this agent remain a problem. Instead of being classified as chemical injuries, these burns compose a unique class of thermal injury because of the difference of mechanisms of injury and the difficulties in removing the agent from the skin. Tar burns usually are occupational in nature and are observed mostly in male patients. This report presents a female burn case that had occurred after she applied hot tar to her skin for the treatment purposes of pain relief.