Optimizing Implant Width Selection in Breast Augmentation: Insights from On-Patient Landmark Positioning in 3D Breast Simulation.

The VECTRA® XT 3D simulation program is a valuable tool for implant selection during the decision-making process of breast augmentations. The software allows for the assignment of automatically or manually positioned anatomical landmarks and provides accompanying measurements. This study aimed to present a strategy for standardizing landmark placement on Vectra® images during primary breast augmentations, optimize implant selection, and insure consistency in breast width data collection. We performed a retrospective analysis of patient data wherein breast width measurements were obtained through Clinical Assessment (CA) and the Vectra® program using both automatically (VA) and manually (VM) placed landmarks. Consideration was also given to the thickness of medial and lateral breast tissues. The suggested implant base width from all groups was then compared to the actual implant (AI) used during surgical procedures. Comparing the change rates in relation to the actual implant width revealed that rates in CA measurements were significantly lower than those in VA (p < 0.05), and similarly lower than those in VM (p < 0.05). Furthermore, change rates in VM were significantly lower than in VA (p < 0.05). Each group showed a significant positive correlation with the actual implant width. The Vectra® XT 3D simulation program is a valuable adjunct in breast augmentation. However, relying on it solely may lead to inaccuracies in the assessment of breast dimensions due to automatic landmarking. To achieve standardized measurements, landmarks can be marked on the patient before creating the Vectra® image. Our results underline the superiority of clinical judgment over simulation programs in establishing a reliable surgical plan.

Hybrid Stromal Vascular Fraction (Hybrid-SVF): A New Paradigm in Mechanical Regenerative Cell Processing.

Enzymatic digestion of extracellular matrix (ECM) from lipoaspirate is the conventional form of harvesting stromal vascular fraction (SVF) called enzymatically digested SVF (E-SVF). Mechanical SVF (M-SVF) isolation has emerged as an alternative method, but it has also some limitations in terms of lower cell viability and diminished cell counts. To enhance the SVF qualitatively and quantitatively, we propose a novel concept called "hybrid-SVF," in which we combine M-SVF with the concentrated parts of adipose tissue after centrifugation, which is called stromal vascular matrix (SVM). Methods: Hybrid-SVF injection was applied as an adjunctive therapy to fat grafting in 88 patients and 11 samples were evaluated in the laboratory for cell count, viability and cell activity. Results: Experimental results determined that SVM part showed higher cellular activity. SVM and M-SVF showed higher cellular potency than E-SVF. Clinically, none of the patients required an additional session for fat grafting since there was no significant graft resorption. However, seven patients asked for further volume augmentation due to their individual preferences. No major complication was encountered. Conclusions: The usage of hybrid-SVF has a very high regenerative potential due to the ECM support and exceptionally high cell yield in addition to preserved cell potency. Although there are ongoing studies focusing on optimizing cell counts and further clinical applications, we believe that our preliminary results might create a paradigm shift in the area of regenerative fat grafting.

Comparison of venous repair results using either arterial or vein grafts in a crush-avulsion injury model

Background/aim: Venous insufficiency after replantation or revascularization is one of the most common causes of limb loss in either the short or the long term. The aim of this study was to evaluate the results of a new technique to overcome venous insufficiency. Materials and Methods: A crush-avulsion type of injury was formed in the femoral veins of rats of 3 separate groups. In the control group, primary repair was applied to the damaged veins and the remaining 2 groups were repaired with either an arterial graft or a vein graft. The success rates of anastomosis were then compared. Results: In the control group the patency rate was 25% in the 2nd hour, 12.5% on the 2nd day, and 12.5% on the 10th day. The patency rate in the vein group was 87.5% in the 2nd hour, 50% on the 2nd day, and 37.5% on the 10th day, whereas the patency rates in the artery group were 100% in the 2nd hour, 87.5% on the 2nd day, and 75% on the 10th day. Conclusion: Microsurgery requires experience and patience. It can be considered that the use of arterial grafts for venous repair in replantation after crush-avulsion type amputations can increase the success rate of replantation.

Utilization of arterial grafts in foot replantation.

Our subject is a 36-year-old man who presented to the emergency department with bilateral lower extremity amputation at the level of the distal third of the tibia after a car accident. Surgery was planned for below-knee amputation of the right lower extremity and replantation of the left foot. The arteries dissected from the iatrogenically amputated segment were used as grafts to repair vascular gaps during the replantation. The patient's follow-up had been problem free. We concluded that whenever possible, amputated parts unsuitable for replantation should be examined thoroughly and neurovascular structures that might be used as grafts should be preserved.