Three-Flap Mastopexy with Reduction or Augmentation.

BACKGROUND: Many authors have studied breast ptosis and made contributions to the search for a procedure that allows its correction with long-lasting results and minimal scars. Collective evolution has allowed us to reach the point where we are today and will allow us to continue improving techniques in the future. OBJECTIVES: The mastopexy procedure that we have used for the last 11 years, resulting from our surgical practice and countless observations at conferences, is a versatile procedure, applicable to different types of breasts and mastopexies with and without reduction or augmentation. METHODS: Analysis and the clinical review of the patients and the records of the mastopexy cases that we operated on using the technique from January 2009 to March, 2020, are presented here. Using a periareolar approach for grade I ptosis and an inverted "T" approach for more severe ptosis, the excess skin is removed, and three flaps of breast tissue, superior, medial and lateral, are carved. A retromammary dissection is performed to anchor the end of the flaps, medial and lateral, to the pectoral aponeurosis, followed by invagination of these flaps to concentrate the breast tissue in the upper and central area of the breast. Closure of the wound is then performed, transforming its excess length into a short horizontal one, into the inframammary grove. RESULTS: Sixty-seven female patients, between 36 and 59 years old, underwent this procedure. Complications included hematoma (4%), overcorrection (4%), dehiscence (3.3%), residual ptosis (2.7%), pathological scarring (2.7%) and rotation folds (2%). Maximum follow-up was 8 years 2 months, mean follow-up 2 years 9 months, with satisfactory results for the patients and surgeon. CONCLUSIONS: The mastopexy procedure that we present here is a versatile technique, which can be applied to most cases requiring correction of ptosis. It provides the breast with proper shape, size and location with fewer scars. It is a logical, safe, efficient, reproducible procedure, which is easy to learn. 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.

Linfedema escrotal masivo: Reporte de caso y revisión de la literatura / Massive scrotal lymphedema: case report and literature review

El lindefema masivo localizado es una condición rara pero su incidencia se encuentra en aumento. El linfedema puede ser primario o secundario a infecciones, radioterapia, cirugías, cáncer, enfermedades del sistema inmune o a compresión. Algunos autores han sugerido un incremento en su incidencia debido a la epidemia de obesidad. El linfedema escrotal produce una morbilidad importante debido a mala higiene, infecciones, incontinencia urinaria, disfunción sexual, pérdida de la libido e inclusive limitación en la deambulación. Las opciones de tratamiento no quirúrgico de la linfedema incluyen el drenaje linfático manual, prendas de compresión, terapia física y ejercicio. Usualmente, el tratamiento conservador falla debido a la dificultad anatómica que presenta la región genital para la aplicación de dichas terapias. El tratamiento quirúrgico puede ser efectivo en casos graves y moderados. Existen diferentes variantes a la técnica quirúrgica, pero la resección del tejido afectado y la reconstrucción con tejido sano es primordial. El pronóstico de esta patología tiende a ser bueno; sin embargo, se reporta una alta tasa de recidiva.

Massive localized lymphedema is a rare but rising condition that could be primary in nature or secondary to infections, radiation, surgery, malignancies, autoimmune or compression. Some authors have suggested and increased incidence due to the raising epidemic of obesity. Scrotal lymphedema causes significant morbidity such as poor hygiene, infections, urinary incontinence, sexual dysfunction, loss of libido and a limited ambulation. Although non operative treatment options for lymphedema include manual lymph drainage, compression garments, exercises, sequential gradient pump. Usually, non-operative techniques fail due to the difficult in the anatomic area. Surgical treatment can be effective in moderate to severe cases of giant scrotal lymphedema. There are many variations of the surgical technique, however, resection of the affected tissue and reconstruction with healthy skin is primordial. The prognosis tends to be good, although there is reported a significant amount of relapse, mostly dependent on the weight lost and diet of the patients

Abordaje quirúrgico temprano de la trigonocefalia / Early quirurgic management of trigonocephaly

Introducción y objetivo. La trigonocefalia, originada por la sinostosis prematura de la sutura metópica, en sus formas más graves presenta mayor restricción del crecimiento lateral de los huesos frontales y temporales, afectando a los rebordes supraorbitarios, limitando el crecimiento y condicionando un hipoteleorbitisimo aparente. Los principales problemas de las técnicas quirúrgicas empleadas para su tratamiento son: falta de corrección del defecto, vaciamiento temporal, daño de suturas no afectadas al hacer transposiciones que producen defectos de crecimiento (sinostosis secundarias), sobrecorrección del hipoteleorbitisimo y defectos óseos. El objetivo de este trabajo es presentar nuestra experiencia en una serie de casos tratados de forma temprana con modificaciones propias a las técnicas abiertas propuestas por Dhellemmes en Francia. Material y método. Entre 2010 y 2018 operamos 7 pacientes con trigonocefalia no sindrómica severa, con una media de 7 meses de edad. Todos fueron estudiados con tomografía computerizada de cráneo con reconstrucción ósea en tres dimensiones (TCC-3D) preoperatoria, postoperatoria inmediata y al año de evolución, electroencefalograma, valoración del neurodesarrollo y por Pediatría y Oftalmología. Resecamos la sutura metópica estenosada y efectuamos craneotomías frontales en forma de alas de escarabajo respetando la sutura coronal. Remodelamos la barra frontoorbitaria con injerto óseo para corregir la angulación y la fijamos con un injerto de hueso. Finalmente practicamos osteotomías radiadas en parietal para modificar la restricción del crecimiento de la bóveda. Resultados. Los resultados funcionales y estéticos fueron excelentes, sin defectos de osificación ni vacío de la fosa temporal, ni morbimortalidad, con cicatriz oculta por el cabello. El desarrollo neurocognitivo de los niños tuvo una mejoría notable de la irritabilidad y de la actividad e interacción con los padres. Conclusiones. En trigonocefalia, la cirugía temprana logra la corrección total del defecto en un solo tiempo quirúrgico, obteniendo una remodelación ósea y un crecimiento armónico del cráneo al respetar el crecimiento del sistema suturario. Las modificaciones a la técnica que proponemos evitan el defecto de vaciamiento temporal y permiten no utilizar material de osteosíntesis

Background and objective. The premature synostosis of the metopic suture in the most severe forms occurs with a restriction of the lateral growth of frontal and temporal bones, affecting the supraorbital rims, which limits its growth and leads to hypoteleorbitism. The triangular shape of the forehead is accentuated by the compensatory growth of the other structures of the skull. The main problem of the handling techniques are: temporal emptying, lack of defect correction, damage of unaffected sutures while making transpositions that will later produce defects in growth and cranial molding. Our aim is to show our surgical experience operated with the variations of the open technique that was conceived by Dhellemmes in France. Methods. Between 2010 and 2018 we operated 7 patients with trigonocephaly; patients' average age was 7 months. They were studied with presurgical and post operatory CBT-3D, electroencephalograms, neurodevelopmental assessment and by Pediatry and Ophthalmology. Stenosed metopic suture was resected and frontal craniotomies shaped like beetle wings were performed out without drying the coronal suture, securing them to the fronto-orbital bar with a discreet progress of the side edges. The medial osteotomy of the orbital toolbar was used to reshape it and correct its angulation fixing it with a bone graft and radiated parietal osteotomy to modify the restriction of frontoparietal growth. Results. Functional and aesthetic results were excellent, without ossification defects or vacuum the temporal fossa, morbidity or mortality, with the scar hidden by hair. Children's neuropsychological development had a noticeable improvement in irritability, activity and interaction with their rents. Conclusions. In trigonocephaly, early surgery achieves total defect correction in a single procedure and a bone remodeling and harmonic skull growth by respecting the sutures system. Our modifications to the technique avoid the temporary emptying defect and don't use osteosynthesis material