Cranial base hemorrhage. A technique for controlling the uncontrollable.

In the management of trauma, control of life-threatening hemorrhage must be accomplished expeditiously if morbidity is to be decreased and mortality prevented. Hemorrhage from the inaccessible cranial base, especially when transected vessel stumps are not available for direct control, can be the most demanding, life-threatening, surgical emergency. We present our experience in utilizing an autologous bone grafting technique to successfully control severe hemorrhage from the base of the skull. In our review of the literature to date, we have been unable to ascertain whether this modality has been previously used.

Inferior pedicle reduction technique for larger forms of gynecomastia.

The treatment of larger types of gynecomastia is significantly different than that of less severe gynecomastias. Special concerns of the former include areola enlargement, nipple-areola ptosis, and redundant skin. Many procedures have been described to address these issues, none of which is completely satisfactory; these are reviewed here. Unsatisfactory results may be due to residual breast hypertrophy, skin redundancy, complications related to nipple-areola placement, form and viability, and cosmetically unacceptable scars. We describe a new technique that uses an inferior pedicle to reposition the nipple-areola complex and to maintain its neurovascular integrity and form. A superiorly based chest wall flap in conjunction with suction-assisted lipectomy maximizes chest wall contour. There are no breast mound scars, only a periareolar and inframammary scar.

Comparison of autologous fat transfer in fresh, refrigerated, and frozen specimens: an animal model.

The rising popularity of autologous fat transfer (AFT) has raised the questions whether cryopreserved adipocytes are a suitable substrate for soft-tissue augmentation, and which storage techniques may be most suitable for a maximally successful surgical result. An animal model of AFT was conceived using isogeneic Sprague-Dawley rats. Suction harvesting of fat and subcutaneous implantation was performed with specimens stored at -16 degrees C or 1 degrees C for a period of 1 or 2 weeks, as well as a group that underwent immediate implantation. A histological comparison of the experimental and control groups clearly demonstrated a decrease in viable adipocytes and an increase in signs of inflammation and fat cell necrosis in those animals that received stored fat instead of immediate fat implantation. These changes became more severe with increased length of storage and the use of refrigeration over freezing. The authors conclude that the practice of storing harvested adipocytes for later injection is not supported by the experimental evidence and should be avoided.