Iatrogenic subcutaneous emphysema in aesthetic breast augmentation Medicolegal aspects.

The aim of the present study was to investigate clinical results and medico-legal aspects related to the surgical procedure of mini breast augmentation. In the present case, a 28-year-old young woman with bilateral mammary hypoplasia underwent surgery, under local anesthesia, with the placement of 150 cc breast implants in the sub-glandular plane. We report a case of dramatic isolated subcutaneous emphysema without pneumothorax and pneumomediastinum to be related in terms of a causal link to the surgical procedure which the patient underwent. The plastic surgeon proceeded to replace a breast implant that presumably, represented the vehicle of transmission of the suspected pathogen responsible for the infection, to become a causal role for the infectious manifestation. This case report is an emblematic example of the need for a careful and correct surgical procedure, in order to avoid serious consequences as in the case in question, burdened by the occurrence of unsafe conditions for the patient. Compliance with the guidelines and the technical datasheet of breast implants is essential in order to avoid the concrete hypothesis of professional liability. KEY WORDS: Aesthetic breast augmentation, Breast implant, Iatrogenic subcutaneous emphysema.

Complications after breast augmentation with hyaluronic acid: a case report.

Breast augmentation is a very requested procedure in aesthetic surgery. Over time, various techniques of breast augmentation have been described, both through the use of alloplastic materials and autologous tissues: implants, fat grafting, flap surgery, and injectable fillers. According to the international current trend to perform minimally invasive procedure, injectable fillers have progressively increased their uses and notoriety in aesthetic medicine. Among the various available products, hyaluronic acid is likely to be the most popular synthetic filler all over the world. Nowadays many brands are on the market and this paper focuses on Macrolane which is a NASHA-based (stabilized hyaluronic acid of non-animal origin) filler. However, although highly biocompatible, as any material, foreign to our body, also hyaluronic acid fillers undergo a process of degradation and disposal. In our work, we report the first case in literature of migration of Macrolane in an axillary lymph node in a 45-year-old woman three years after injection for breast augmentation and its related management. The aim of the paper is to discuss and underline further complications and their treatment besides the ones already described in literature in order to provide a deeper knowledge concerning the use and the side effects of injectable fillers in aesthetic medicine.

Modifield musculocutaneous gracilis flap A case report.

A heterogeneous range of malignant pathologies affects vulvar and perineal regions. Today standard radical mutilating surgery for the treatment of invasive vulvar carcinoma is being replaced by a conservative and individualized approach. Defects of the external pelvis and perineal lining are usually reconstructed with local or regional fasciocutaneous flaps. However, in particular situations, the asymmetrical distribution of the defect and its location, close to sources of infec-tion such as the perineal area, may suggest a different approach. This report presents a patient who underwent conservative vulvectomy bilaterally and reconstruction with a unilateral modified gracilis flap. A V shaped incision was designed in the skin paddle of the flap, allowing it to fit the loss of substance around the remaining vulvar skin. Patient was highly satisfied with the result, she had no pain, no problem in defecation or urination nor during deambulation. In case with asymmetrical defect in the vulvo-perineal area the modified gracilis flap can be considered as a valid reconstructive option. KEY WORDS: Modified gracilis flap, Vulvo-perineal reconstruction.