Male Lower Extremity Sculpting.

BACKGROUND: The muscular sculpture (MS) is a new technique of male body contouring to achieve: tight skin that very well reveals muscular bulk, a male muscular and athletic body, minimal observable scars and even patients who are not, nor have been in. With this study, we describe the new technique for sculpting of lower extremities. In literature are not described techniques to accomplish a sound aesthetic result in sculpting surgery about lower extremities. METHODS: For this surgical procedure, we illustrate the technique that was obtained from 5 male patients (principles outlined in the Declaration of Helsinki have been followed). We describe this surgery with six steps: defatting step; MS; internal scar removal; irregularity removal; dermal grasping; last residues of fat removing. RESULTS: We obtain a high satisfaction rate as high as 100% for short and long term. Compared to the complications more described in literature (infection, hematoma, seroma, wound dehiscence, hypertrophic scars, sensory nerve injury and recurrent skin laxity, Monarca and Rizzo in Aesthetic Plast Surg 39(2):199-202, 2015), we have not had complications. We had no major complications. We observed, with our other studies, a direct relationship between complications and smoking habit. Successful body-contouring surgery requires a patient to embrace positive lifestyle habits: exercise, a proper diet and other positive lifestyle changes (Monarca et al. in Plast Reconstr Surg 123(5):1637-1638, 2009), and a high compliance and to avoid all the excesses. CONCLUSIONS: We obtain amazing aesthetic results with total patient satisfaction without complications. There are not enough studies in the literature about body sculpting, and is necessary to deepen this technique in order to obtain increasingly encouraging results. LEVEL OF EVIDENCE V: Sculpting surgery, Body contouring, 41 leg surgery, adipose tissue. 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 .

Optimal care for eyelid contraction after radiotherapy: case report and literature review.

Radiotherapy represents a major problem in facial surgery. Orbital and periorbital radiation therapy causes a contraction of the soft tissues. Scarring with ectropion is the most severe complication, with shrinking of the anterior lamella, skin dystrophy, muscle atrophy, and alteration of the remaining soft tissues. Goals for reconstruction include correction of distorted orbitofacial tissues and the restoration of orbital structures. The management of these patients is not standardized. We suggest systematically using a combined approach of surgery and lipofilling to restore the orbital deformity and dystrophy, respectively. For this purpose, we present the case of a 65-year-old woman with asymmetry of the orbital regions and severe lower eyelid cicatricial ectropion due to multiple radiation treatments in childhood for an extensive cavernous hemangioma of the right side of the face. We performed a reconstructive procedure using a tarsal strip technique in association with contralateral upper eyelid graft to correct the extensive retraction of the right lower eyelid and lid asymmetry. Subsequently, the patient underwent lipofilling to correct the post-radiotherapy dystrophy. Skin texture, softness, and elasticity greatly improved with further symmetrization. The combined treatment with surgery and lipofilling can significantly improve the functional and cosmetic outcome of shortened and dystrophic eyelids with a successful result with regard to post-radiotherapy retraction.

Island pedicle and bilobed flaps in ala and back nose reconstruction: a prospective comparative analysis.

BACKGROUND: Reconstruction of face deformities resulting from skin cancer includes reconstructing the area with similar tissue. This prospective study aimed to compare the functional and aesthetic outcomes between two types of local flaps (the island pedicle flap vs the bilobed flap) used in reconstruction of the ala and back nose. METHODS: In this study, 120 patients with skin cancer of the nose underwent ala and back reconstruction: 60 patients using the island flap (IF group) and 60 patients using the bilobed flap (BF group). The two groups were homogeneous for sex, age, and anatomic area. Complications, scarring according to the scale of Vancouver, cosmetic appearance, and disorders of sensations were analyzed, and statistical analysis was performed using Chi-square and analysis of variance (ANOVA). RESULTS: Early complications were more common in the BF group than in the IF group (p < 0.005). The Vancouver Scar Scale scores were significantly better for the IF patients (p < 0,005), who also showed better results in the analysis of cosmetic outcomes (p < 0.005). CONCLUSION: The study showed that the island flap used for ala and back nose reconstruction provides better functional and cosmetic results than the bilobed flap, from both functional and aesthetic points of view. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article.

Use of the Z-plasty technique in nasal skin cancers. Two clinical cases.

Basal cell carcinoma (BCC) is the most common type of cancer in Europe, Australia and the U.S.A. After nasal skin cancer excision, especially if it is less than 1-2 cm in diameter, several surgical techniques can be used to reconstruct the lack of substance.In the management of our two patients we have chosen to utilize, instead, a well-known plastic surgery technique, Z-plasty, which is both easy to perform that effective to achieve excellent cosmetic results. As shown by our two clinical cases, the use of Z-plasty for lack of substance of the nose tip and bridge can be extremely effective in terms of cosmetic results. In comparison with the other reconstructive techniques, in fact, it is very easy to perform and allows to avoid or minimize the distortion of the nasal tip and wing, to orient the incision along the skin tension lines and, finally, to replace the lack with very similar structures regarding color, thickness and tissue architecture to those removed.

Lateral canthoplasty by the Micro-Mitek Anchor System: 10-year review of 96 patients.

PURPOSE: Lateral canthoplasty is useful to correct lower eyelid malposition, restore eyelid function, and protect the ocular surface. An effective method for fixation of soft tissue in the face, such as the lateral canthus, using the Micro-Mitek Anchor System is presented. PATIENTS AND METHODS: We report our experience in 96 patients who underwent lateral canthoplasty by Micro-Mitek Anchor. One hundred twenty-four lateral canthoplasties were performed, including, senile ectropion, tumors, trauma, cicatricial retraction, and lower eyelid malposition after blepharoplasty. RESULTS: The insertion of a bone anchor requires a limited dissection, and the insertion area can be determined accurately. Using the bone anchor to fixate the lateral canthus to the facial skeleton is an effective way to prevent drooping of the canthus due to gravitational forces. CONCLUSIONS: Lateral canthoplasty using the Mitek Anchor System has the advantage of being an easy technique with accurate placement of the anchor, reducing operating time.

Upper-lip augmentation by graft of preseptal orbicularis oculi muscle through blepharoplasty.

BACKGROUND: Upper-lip augmentation is used to enhance a thin upper lip or correct lip deficiencies or senile hypotrophy. We describe an easy, effective, and reproducible technique. METHODS: We use two preseptal orbicularis oculi muscle grafts that provide a reliable option for soft-tissue upper-lip augmentation, with improved vertical lip height and lateral lip projection and reappearance of the Cupid's bow. Muscle grafts are harvested from a blepharoplasty done at the same time. RESULTS: The advantages of this procedure include the creation of an anatomically natural upper lip through preserving the continuity and function of the labial structure, good augmentation, no donor-site morbidity, no visible scars on the vermilion, and successful rejuvenation with the associated blepharoplasty. CONCLUSION: Both patients and surgeons were satisfied with the results because the muscle grafts produce a youthful appearance by adding natural, soft roundness and fullness to the upper lip without an artificial look or the use of synthetic material, providing long-term augmentation.

Custom-made Reduction Mammaplasty.

BACKGROUND: Macromastia is a health problem that requires the coordination of surgical and medical specialists. Goals of reduction mammaplasty are to alleviate physical, emotional and psychosocial discomforts and to restore a conical-shaped breast, maintaining scars as short as possible. We report our approach for reduction mammaplasty with superior pedicle. MATERIALS AND METHODS: Our method combines advantages of round block with vertical scar, using a dermal flap that is fixed to the new mammary crease. We analyzed skin and glandular resection customizing the mammaplasty. RESULTS: The dermal flap works against the weight of residual tissue, maintaining the crease at the desired position with a natural result. Benefits are an excellent projection, short scar, suitable reshaping and patient satisfaction. CONCLUSION: This technique can be used for mild to severe hypertrophy with various degrees of ptosis. It results in a successful aesthetic outcome with minimal scarring, suitable breast remodeling and natural long-lasting projection.

Hemipelvectomy and reconstruction in a patient with advanced Marjolin's ulcer: a case report.

Patients with squamous cell carcinoma of the lower limb may exhibit locally advanced or metastatic disease. Surgical resection to control the primary tumor is often extensive.The case of a 51-year-old man with squamous cell carcinoma on Marjolin's ulcer affected, rapidly growing, and involving soft and bone tissues is described. Treatment required performing a hemipelvectomy. Immediate reconstruction was chosen as surgical procedure planning the harvest of 4 superficial muscles and 1 deep muscle of the abdomen to protect the pelvic content and to eliminate the dead spaces.The chosen technique minimized postoperative complications, and at 7 years follow-up, the patient is disease free.

Minimally invasive combined treatment for Parry-Romberg syndrome.

BACKGROUND: Facial hemiatrophy, a typical manifestation of Parry-Romberg syndrome, produces massive face asymmetry, causing marked aesthetic damage and severe psychological discomfort, with repercussions to the psychophysical status of the patient. This article presents a successful combined treatment that results in resolution of symptoms and patient satisfaction. METHODS: The authors proposed a clinic-therapeutic management comprising a customized program of bio-lipo-intense pulsed light (IPL) remodeling. RESULTS: In 2007, at a 1-year follow-up visit, the patient presented a stable result. She is satisfied with the augmentation treatment, the new volume and contours of the face, and the resolution of the sclerosis and ochrodermia. CONCLUSION: The authors have succeeded with a minimally invasive reconstructive technique for Romberg disease using a customized therapeutic program of poly-L-lactic acid, lipofilling, and IPL therapy. They report a case of good healing without recurrences and complications, with a good cosmetic result, and with satisfaction of the patient.

Volumetric analysis of cleft lip deformity using 3D stereophotogrammetry.

PURPOSE: To quantify and compare pre-operative and post-operative volumetric adjustments of the upper lip tissues in patients with cleft lip. METHODS: The authors performed an anthropometric study and a quantitative analysis of the differences based on three-dimensional morphology of the nasolabial area. Twenty facial images using the three-dimensional stereophotogrammetry were taken from ten selected subjects on two separate occasions, sitting in natural head position. Facial landmarks were marked and measurements recorded, in order to calculate the volumetric adjustments in the soft tissues of the upper lip, comparing the preoperative and postoperative results. Student test and p-Value were performed for statistical analysis. RESULTS: The analysis of the 3D images showed variability with the pre- and postoperative volumes of the nasolabial area with: an increase of upper lip volume all patients; a complete view of the severity in the preoperative; and an improvement of the appearance in the postoperative. The amount of increase of the upper lip volume was established about 29,7%. For all measurements, the variability between pre- and post-operative was significant (p < 0.01). CONCLUSION: The 3D stereophotogrammetry technique allows a detailed preoperative evaluation and an accurate assessment of the surgical outcomes. The study provides a value of volumetric variation of the upper lip in individuals with cleft lip. KEY WORDS: Cleft lip, Nasolabial area, 3D Morphological Analysis, 3D Stereophotogrammetry, Upper lip volume.

Skin grafting: comparative evaluation of two dressing techniques in selected body areas.

BACKGROUND: Skin grafting is a frequent surgical procedure used to reconstruct a soft-tissue deficit. Tie-over bolster dressing is the traditional technique made to fix the graft to the recipient area. This dressing does not always provide satisfactory results in some difficult body areas, with poor skin graft taking as an outcome. Here, we used a soft "polyurethane sponge" as a compressive tool. MATERIALS AND METHODS: A therapeutic protocol was used to select patients, splitting them into 2 groups: tie-over bolster dressing versus polyurethane sponge. Data analysis and calculation of sample size were performed using the Statistical Package for the Social Sciences Windows version 13.0. RESULTS: Of the 106 patients treated by traditional compressive dressing, 11 had complications, thus achieving a success rate of 89.6%. Of the 106 patients treated by polyurethane sponge dressing, 3 had complications, providing a success rate of 97.1%. CONCLUSION: Compared with the conventional tie-over dressing, the sponge dressing technique was demonstrated to be more successful in graft taking in selected areas.

Double localization of giant cell reparative granuloma of the bone in the same finger. Differential diagnosis and treatment.

AIM: This article reports a case of GCRG seen in a young man with a rare double localization in the same finger and illustrates the degree of diagnostic difficulty and treatment. MATERIAL OF STUDY: A 16-year-old man presented with dull pain and swelling of the left middle finger. Plain radiography of the hand showed expansive and lucent lytic lesions with circumferential cortical destruction in the small bones of the proximal and middle phalanges. He underwent en-bloc resection and reconstruction. RESULTS: Histologic findings were consistent with the radiologic diagnosis of GCRG, although several of the features were considered atypical, including the appearance of the giant cells and the areas of the stroma that more closely resembled a giant cell tumor (GCT). At 6 months postoperatively, the morphologic recovery was complete and he had returned to unrestricted activities. His range of motion at the involved joint was the almost completely recovered, and his grip strength on the third setting of the Jamar scale was 48 and 42 kg for the right and left hands respectively. CONCLUSIONS: GCRG is a rare intraosseous lesion that must be considered in the differential diagnosis of hand and foot lesions, such us giant cell tumor, brown tumor, giant-cell-rich osteosarcoma.

The hundredth case of sclerosing epithelioid fibrosarcoma (SEF).

Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare and distinct variant of low grade fibrosarcoma, found mainly in deep soft tissue of adult extremities. We report a case of Sclerosing Epithelioid Fibrosarcoma of soft tissue, which developed in a 69-year-old woman who presented a tumor involving the fourth finger of her right foot and which has not progressed much in size during the three months prior the surgical excision. Our patient is the hundredth case of Sclerosing Epithelioid Fibrosarcoma reported in literature since 1995, thus confirming the rarity of the tumor. Our experience showed that it is important to make an early diagnosis, in consideration of the clinical aggressiveness of this cancer. Another important aspect concerns the postoperative follow-up. The monitoring of PET-CT technique , although not standardized, could become part of proceedings of therapy and follow-up of tumor, thus allowing oncological radicality and avoid large amputations. To date, 24 months after diagnosis of SEF, our patient feels well, attends our outpatient clinic regularly and shows no evidence of relapse and/or metastasis.

A rare case of postauricular spontaneous keloid in an elderly patient.

Keloid represents an exuberant wound healing response, usually secondary to trauma, inflammation, surgery, or burns. Spontaneous keloid formation is rare and it is controversial whether it is really spontaneous. It usually occurs in young people, and it is rare in elderly. Its main features are the infiltration of surrounding normal tissue, the rare regression and the evolution over time. We report the case of an 81 -year -old man with unexpected spontaneous keloid lesion in the right postauricular region. The diagnosis was hard to be performed because of the patient's age, the anatomical site of the lesion and the absence of skin trauma or injury history. Only the histological examination allowed us to perform the right diagnosis.

Repair of postauricular defects using a new technique: the swallowtail flap.

We describe a case of an 81-year-old patient, where we used a new technique for the reconstruction of postauricular defects (of 3 x 4 cm diameter). The swallowtail flap is an advancement flap that allows getting beyond the repair of the defect, providing an excellent aesthetic result because the scar is masked in the neck and retroauricular folds and does not alter the shape and projection of the ear.

Varioscope M5: a new type of magnification system in anterolateral thigh perforator free-flap surgery.

Free microvascular tissue transfer has become a key procedure for the surgical treatment of large tissue defects that requires specialized practitioners and magnification instruments. The operating microscope traditionally has filled this requirement. A study was performed focusing on the evaluation of a new magnification system, the Varioscope M5 (Life Optics, Vienna, Austria), in reconstructive procedures with a perforator free flap. The device was employed by the same operator during dissection and microvascular anastomosis of 12 anterolateral thigh perforator flaps in head and neck reconstruction. The need to operate in a different way, not provided by an operating microscope, gave us the idea of exploring an alternative to the classical visualization systems. Specific advantages such as reduced cost, freedom of movement, auto focus, minimal upkeep, and a variable range of magnification are some of the reasons that convinced us to try this new type of magnification system. Increasing interest in microsurgery magnification highlights the need for further technical developments in this field. We consider the Varioscope M5 an alternative option for surgical magnification in most free tissue transfers, especially when an operating microscope is not supplied.