Modified McKissock's Breast Reduction Technique: A Case Series and Description of Our Technique Modification.

Background: The modified McKissock breast reduction technique uses upper and lower vascular pedicles to reduce breast size and reshape the breasts. This technique has gained significant interest in recent years because of its potential to minimize surgical complications. The current study aims to report our experience and results with our refined version of the McKissock technique. Methods: We conducted a prospective cohort study on patients with breast hypertrophy between 2022 and 2023 to evaluate the modified McKissock breast reduction technique. Two main alterations were made to the original McKissock technique. First, the superior pedicle was modified to create a superomedial pedicle. Second, the inferior pedicle was thinned to form a dermoseptal pedicle with a 4 cm wide base. Results: A total of 13 patients underwent surgery using the modified McKissock breast reduction technique. The average age of the patients was 37.2 years. For the right breast, the weight of tissue resected during reduction ranged from 189 g to 695 g (average 379 g). For the left breast, the resection weight range was 160 g to 608 g (average 370 g). There were no complications except one patient who developed partial nipple necrosis on the left side. All patients expressed satisfaction with the outcomes. Conclusion: Our modified McKissock breast reduction technique shows promise as a method for reducing breast size. It offers several potential advantages, including improved preservation of the nipple and areola complex, more precise breast shaping, contouring capabilities, and reduced risk of complications. Although the early results of this technique are encouraging, further research is required to evaluate its long-term benefits and risks fully.

Biometría del músculo grácil: pedículos vasculares e inervación en un grupo de individuos brasileños / Biometric characteristics of the gracilis muscle: vascular pedicles and innervation in a group of Brazilian individuals

El músculo grácil (MG) está ubicado en la cara medial del muslo, medial y posterior al aductor largo en su parte proximal. Se origina a nivel del pubis y se inserta en la cara medial de la tibia, en su parte superior. Como colgajo libre funcional ha sido uno de los injertos más utilizados en reconstrucciones diversas, tales como pene, perineo, vagina, pierna, plexo braquial, parálisis facial, lesiones rectales, entre otras. Basado en lo anterior, el objetivo de este estudio fue complementar la anatomía del MG tanto en sus dimensiones como en sus pedículos vasculares e inervación, estableciendo las relaciones biométricas existentes, contribuyendo a la anatomía quirúrgica, en su uso como injerto. Para ello, se utilizaron 30 miembros inferiores de 20 cadáveres de individuos adultos, brasileños, de sexo masculino, 14 derechos y 16 izquierdos; 17 fijados en formol y 13 en glicerina. Se dividió al muslo en 4 cuartiles enumerados de proximal a distal como C1,C2,C3 y C4. Se contabilizó el número de pedículos y se nombraron como pedículo principal (PP), pedículo menor 1 (Pm1), pedículo menor 2 (Pm2) y pedículo menor 3 (Pm3). La longitud media del GM fue de 42,25 cm ± 2,35 cm y su ancho promedio de 32,90 ± 4,86 mm. Con respecto a los pedículos vasculares se encontró un pedículo en 10/30 casos (33,3 %); un pedículo principal y uno menor en 10/30 (33,3 %); un pedículo principal y dos menores en 8/30 (26,7 %) y un pedículo principal y tres menores en 2/30 (6,7 %). Su inervación siempre procedió del ramo anterior del nervio obturador (RaNO). El punto motor se encontró a una distancia promedio de 7,94 mm proximal al ingreso del pedículo principal en el MG. Los registros biométricos están expresados en tablas. Los resultados obtenidos aportarán al conocimiento anatómico, pudiendo ser utilizados como soporte morfológico a los procedimientos quirúrgicos que involucren al músculo grácil.

The gracilis muscle (GM) is located in the medial aspect of the thigh, medial and posterior to the long adductor in its proximal part. It originates at the pubic level and is inserted in the medial face of the tibia, in its upper part. As a functional free flap, it has been one of the most co mmonly used grafts in various reconstructions, such as penis, perineum, vagina, leg, brachial plexus, facial paralysis, rectal lesions, among others. Based on the above, the objective of this study was to complement the anatomy of the GM both in its dimensions and in its vascular pedicles and innervation, establishing the existing biometric relationships, contributing to the surgical anatomy, in its use as a graft. For this, 30 lower limbs of 20 bodies of adult, Brazilian, male, 14 right and 16 left individuals were used; 17 fixed in formaldehyde and 13 in glycerin. The thigh was divided into 4 quartiles listed from proximal to distal such as C1, C2, C3 and C4. The number of pedicles was counted and they were named as principal pedicle (PP), minor pedicle 1 (mP1), minor pedicle 2 (mP2) and minor pedicle 3 (mP3). The average length of the GM was 42.25 cm ± 2.35 cm and its average width was 32.90 ± 4.86 mm. With respect to vascular pedicles, a pedicle was found in 10/30 cases (33.3 %); one PP and one mP in 10/30 (33.3 %); one PP and two mP in 8/30 (26.7 %) and one PP and three mP in 2/30 (6.7 %). Its innervation always came from the anterior branch of the obturator nerve (aBON). The motor point was found at an average distance of 7.94 mm proximal to the entry of the PP in the GM. Biometric records are expressed in tables. The results obtained will contribute to anatomical knowledge, and can be used as morphological support for surgical procedures that involve the GM.

Vascular Pedicle and Microchannels: Simple Methods Toward Effective In Vivo Vascularization of 3D Scaffolds.

Poor vascularization remains a key limiting factor in translating advances in tissue engineering to clinical applications. Vascular pedicles (large arteries and veins) isolated in plastic chambers are known to sprout an extensive capillary network. This study examined the effect vascular pedicles and scaffold architecture have on vascularization and tissue integration of implanted silk scaffolds. Porous silk scaffolds with or without microchannels are manufactured to support implantation of a central vascular pedicle, without a chamber, implanted in the groin of Sprague Dawley rats, and assessed morphologically and morphometrically at 2 and 6 weeks. At both time points, blood vessels, connective tissue, and an inflammatory response infiltrate all scaffold pores externally, and centrally when a vascular pedicle is implanted. At week 2, vascular pedicles significantly increase the degree of scaffold tissue infiltration, and both the pedicle and the scaffold microchannels significantly increase vascular volume and vascular density. Interestingly, microchannels contribute to increased scaffold vascularity without affecting overall tissue infiltration, suggesting a direct effect of biomaterial architecture on vascularization. The inclusion of pedicles and microchannels are simple and effective proangiogenic techniques for engineering thick tissue constructs as both increase the speed of construct vascularization in the early weeks post in vivo implantation.

Free jejunal flap transfer with multiple vascular pedicles for safe and reliable pharyngoesophageal reconstruction.

BACKGROUND: In pharyngoesophageal reconstruction, we transferred a long jejunum flap containing multiple pedicles to achieve a 100% flap survival rate, and used the redundant mesentery to cover important tissues and fill in the dead space to reduce common postoperative complications, such as surgical site infections and fistula formation. METHODS: A total of 243 jejunal flap transfers with multiple vascular anastomoses were reviewed to examine flap survival and rates of early postoperative complications, such as surgical site infections and fistula formation, perioperative mortality, and donor site morbidity. RESULTS: All 243 jejunal flaps survived without any partial necrosis. The surgical site infections occurred in 15 cases (6.2%) and fistula formation in 9 cases (3.7%). The perioperative mortality rate was 0.4%. There were 7 cases (2.9%) with donor site morbidity. CONCLUSION: Although our procedure requires extra operating time for additional vessel anastomoses, it could be performed safely and reliably with a high success rate.