Alar cartilage flap for projection of the nasal tip

Introduction: The nasal tip is a frequent object of study by surgeons, since it is a common reason for pre- and postoperative complaints. Thus, the tip should be thoroughly evaluated to determine the best technique to be used. The objective is to demonstrate an original alar cartilage flap technique for projection of the nasal tip, performed alone or in combination with other procedures for the same purpose. Method: A retrospective cross-sectional study of 22 patients submitted to open rhinoplasty with use of the alar flap to project the nasal tip. Results: A total of 22 open rhinoplasties were performed on primary bulbous, fatty, and under-projected tips. Among the patients in the study, 90% were black and 2% were white; 72.7% reported a high degree of satisfaction with the operation, 18.1% considered the result very good, and 9.2% considered the result acceptable. There were no complications/reoperations. Conclusion: The alar cartilage flap for projection of the nasal tip is simple to perform and can be considered an excellent supplemental method for use in treatment of the black nose

Alternative technique for the treatment of osteonecrosis in breasts: description and results

Introduction: This work describes and presents the results of an alternative technique for treating steatonecrosis by liposuction using a specific cannula, with good physical and imaging results. Steatonecrosis is a complication that frequently occurs during mammary surgeries, especially during mammary reconstructions and in conservative surgery or TRAM. Steatonecrosis is characterized initially by hardening of the tissue that may develop into nodules of different sizes in any mammary region with oily cysts and fibrosis; consequently, steatonecrosis is a constant concern for patients, oncologists, breast cancer specialists, and plastic surgeons due to the possibility of tumor recurrence. Method: A retrospective review of the medical records of the patients undergoing procedures related to the breast, either reconstructive or aesthetic, was performed. Patients who developed steatonecrosis and were treated by liposuction, similar to the bone drilling technique performed by orthopedic surgeons for the treatment of bone necrosis, were included in the study. Results: Eight patients from the study period reviewed were selected. The mean age was 56 years. Most of the patients showed deformity in the affected breast, with oily cysts, reported in 5 patients (62.5%), being the most common deformity. Breast cancer history was reported for 75% of the patients. Conclusion: The individualization of the patient is the key to successful treatment of steatonecrosis and an essential tool to satisfy the expectations and desires of the patient after this complication. Each technique has its indications, advantages and limitations, which should be thoroughly discussed with the patient to obtain the best possible result

Breast reconstruction with a latissimus dorsi myocutaneous flap and implants: evaluation of strategies adopted to improve the results and evaluation of satisfaction by Breast-Q

Introduction: The paper describes a 14-year experience with breast reconstruction using a latissimus dorsi myocutaneous flap (LDMF) and breast implants. The objective was to delineate the experience with LDMF and breast implants, skin island schedules and dissection details, flap transposition and placement of the implant under a double layer, strategies to minimize damage in the donor area, and strategies of breast symmetry and reconstruction of the nipple-areola complex, in association with evaluation using the Breast-Q questionnaire. Methods: A review of medical records was performed between April 2003 and June 2017. Results: In the period, 76 patients with a mean age of 50.09 years underwent reconstruction with a LDMF, which was bilateral in 11, for the right breast in 34, for the left breast in 31, immediate in 41, late in 22, and for rescue in 13. Conclusion: We conclude and verified with the Breast-Q questionnaire that with a precise indication, the proposed reconstruction technique with a double subpectoral plane and coverage with a LDMF is safer with a lower complication rate

Surgical treatment of complications resulting from adjuvant radiotherapy: a case report

INTRODUCTION: Breast cancer is the leading cause of death among malignancies affecting women. Treatment options range from surgical treatment, radiotherapy, chemotherapy and hormone therapy. The immediate breast reconstruction helps to benefit the psychosocial aspects of patients, however, depend on the technique used a number of complications can appear, especially after adjuvant radiotherapy. CASE REPORT: We report a case of a 65-year-old woman, underwent quadrantectomy and radiotherapy in 1988. In 2010, the patient presented an injury on the scar and she was referred to mastectomy with reconstruction of retail large dorsal and adjuvant radiotherapy. Upon examination, we observed flap necrosis with infection on the axillary region, lymphedema, radiodermatitis, fibroses and joint limitation. In 2014, the patient sought our service to perform a new restorative approach. A bipedicled transverse abdominal flap was decided to be adequate to her case. After surgery, the patient reported mild pain in the upper pole that managed with debridement and dressing. Seven months after surgery there was a complete healing of the flap and patient was satisfied with the surgery. CONCLUSION: The knowledge of surgical techniques associated with the correct scaling of steps are essential for surgical success and management of complications that may appear in breast reconstruction of patients undergoing radiotherapy

Triangular flap for nipple reconstruction

Introduction: Despite the many published techniques, there are difficulties in satisfactorily achieving a nipple areola complex (NAC) with long-lasting results. The objective is to demonstrate results using the triangular cutaneous flap technique in nipple reconstructions and compare it with previously published techniques. Methods: A prospective study of nipple reconstruction using the triangular cutaneous flap technique from January 1, 2015, to March 1, 2016. Surgical technique: Marking of an equilateral triangle; decortication of the three points of the triangle that are united in the form of an envelope, with the central area adhered to the neo-breast; total skin grafting for construction of the areola. The patients were evaluated and results classified as fully satisfactory, satisfactory, partially satisfactory, or unsatisfactory. Primary type of breast reconstruction, postoperative or neoadjuvant chemo- or radiotherapy complications, comorbidities, and postoperative complications were evaluated. Statistical evaluation was performed using Fisher's exact test, chi-square test, and post hoc analysis (significance p < 0.05). Results: Thirty-one patients underwent nipple reconstruction using the triangular cutaneous flap technique, 17 unilateral and 14 bilateral, totaling 45 reconstructions. Mean age was 50 years, mean body mass index was 24.95 kg/m2, and mean follow-up period was 14 months. Rated: demographic data, complications of patients versus the type of primary breast reconstruction and completion of chemo- and/or radiotherapy, types of breast reconstruction performed, evaluation of the nipples versus reconstruction, evaluation of the nipple reconstruction technique versus satisfaction of evaluators, and nipple complications versus reconstruction technique. Conclusion: The original triangular cutaneous flap technique presents the advantages of easy execution and safety in reconstruction of the NAC

Mastoplasty with inclusion of prosthesis during abdominoplasty in post-bariatric patients

INTRODUCTION: Augmentation mammaplasty during abdominoplasty reduces surgical time and has a better aesthetic effect as it only leaves a single scar. The authors of this study assessed the results obtained in post-bariatric patients undergoing this procedure in the plastic surgery service at Daher Hospital. METHODS: This was a retrospective longitudinal observational study. Of the 161 post-bariatric patients evaluated, 27 had indications for breast augmentation during abdominoplasty. The surgical technique consisted of classical abdominoplasty and creation of tunnels on the upper and middle abdomen for insertion of implants. RESULTS: The age of the patients ranged from 35 to 50 years, with a mean of 42.4 years. The volume of the prosthesis ranged from 285 to 300 ml. The average body mass index was 22.2 kg/m2.The average surgical time period was 2 hours and 35 minutes. None of the following complications were observed: deep vein thrombosis, pulmonary embolism, skin necrosis, hematoma, capsular contracture and/or event. Two patients (7.4%) presented with seroma in the mammary region and one patient developed infection. CONCLUSION: The aesthetic results were satisfactory, as there was only a single scar for these two procedures in post-bariatric patients. Selecting the ideal patient was crucial for good operative success

Evaluation of pressure parameters intra-abdominal and thoracic in patients submitted to abdominoplasty

INTRODUCTION: The abdomen is an important aesthetic and functional segment in the characterization of body contouring. The plication of the rectus abdominis may cause various problems to the patient such as increased intra-abdominal and thoracic pressure. Thus, this study aims to evaluate abdominal pressure and pulmonary parameters in patients undergoing abdominoplasty with liposuction. METHODS: This is a descriptive longitudinal prospective study. All patients underwent the lipoabdominoplasty with liposuction of flanks by the same senior plastic surgeon. The intra-abdominal pressure was measured by a device attached to indwelling urinary catheter of the patient and intra-thoracic pressure was measured by the ventilation device monitor. Measurements were made before and after plication and in Fowler's position. RESULTS: Mean surgery time was 4 hours and 08 minutes. Intra-abdominal pressure before and after plication of the rectus abdominis ranged from 2 to 11 cm H2O and 5-16 cm H2O, respectively. Intra-thoracic pressure before and after plication of the rectus abdominis ranged from 13 to 17 cm H2O and 14-18 cm H2O respectively. The intra-abdominal pressure in Fowler's position ranged from 6 to 23 cm H2O. The intra-thoracic pressure in Fowler's position ranged from 15 to 19 cm H2O. One case of small dehiscence, one case of seroma and one case of respiratory distress were observed. CONCLUSION: The results demonstrate that plication of the rectus abdominis increases intra-abdominal and pulmonary pressure without generating significant systemic changes

Comparison between surgical sutures and Prineo® in terms of esthetic result and scar formation

INTRODUCTION: Wound healing is a well-organized, directed process of tissue repair. The process can be expedited using topical glues and adhesives, which offer a non-invasive, easily removable alternative to suturing. Furthermore, such products have good tensile strength and involve lower application time. In particular, the Prineo® adhesive is applied to a polyester mesh that covers the wound. METHOD: We carried out a retrospective, cross-sectional study, with subsequent statistical analysis , involving 101 surgical procedures in which wound closure was performed using either nylon sutures or Prineo®. All the procedures were performed between 2012 and 2014. RESULTS: Six patients had contact dermatitis after Prineo® was used, with statistical significance (p = 0.042). Furthermore, Prineo® decreased the rate of scar enlargement (p < 0.05) . There was no statistical difference between the Prineo® and suture groups in terms of scar quality (p = 0.068); in both groups, the scar result was mostly excellent (87 %) to good (27%). CONCLUSION: Patients whose wounds were closed using Prineo® a system involving octyl-2-cyanoacrylate and an associated polyester mesh displayed lower rates of scar enlargement, which depended on whether the thickness of the dermis was satisfactory. However, the same patients had higher rates of contact dermatitis than those whose wounds were closed using surgical sutures. Both groups showed excellent to good scar quality, with no significant difference in terms of esthetic scar results

Assessment of immediate symmetrization in breast reconstruction

INTRODUCTION: The surgical treatment of breast cancer frequently results in mutilation. Breast reconstruction in mastectomized women aims to create a new esthetically acceptable breast symmetrical to the contralateral breast. The objective of this study was to assess the feasibility of symmetrization of the contralateral breast simultaneously with breast reconstruction, discuss possible complications, and perform a brief review of the literature. METHODS: A retrospective study was conducted in the Department of Plastic Surgery of Hospital Daher from October 2013 to February 2015. Breast reconstruction outcomes immediately after mastectomy for breast cancer were assessed, and all patients undergoing symmetrization of the contralateral breast in the same surgical stage using the same surgical technique were selected for inclusion and statistical analysis. RESULTS: The study comprised 42 patients within the established criteria, totaling 21 reconstructions with simultaneous symmetrization (Group 1) and 21 symmetrization procedures in two stages (Group 2). The mean age was 53.86 years in Group 1 and 52.62 years in the control group. The groups were comparable in all variables. Data regarding postoperative complications were analyzed. Some of the studied patients did not complete all stages of reconstruction. The group that underwent immediate symmetrization attained more symmetry. The patients aged 45 years and with lower body mass index attained more symmetry in Group 1. CONCLUSION: The implementation of symmetrization procedures at the same stage of unilateral breast reconstruction is associated with low complication rates and revision surgeries. In selected cases, immediate symmetrization may be preferable to the procedure in another surgical stage

Breast reconstruction with creation of upper retropectoral and lower mixed subcutaneous cavities and use of flaps

Introduction: A total of 57,960 new cases of breast cancer were expected in Brazil in 2016 according to data from the National Cancer Institute, corresponding to 25% of cancers in the country (excluding non-melanoma skin tumors). This study aims at presenting a surgical approach for immediate breast reconstructions with upper retropectoral and lower mixed subcutaneous cavities. Methods: The authors performed breast reconstruction using flaps of the pectoral muscle and inferior cutaneous pedicle associated with insertion of silicone breast implants. The medical records of patients operated between 2012 and 2016 at the Plastic Surgery Service of the senior author's private clinic at Daher Hospital and Armed Forces Hospital were retrospectively analyzed. Results: The results were satisfactory, with low complication rates and high patient and author satisfaction. Thirty-six patients, with a mean age of 59 years, underwent breast reconstruction using the described technique. The complications were nipple-areola complex necrosis, dehiscence, seroma, hematoma, liponecrosis, implant displacement, and deep venous thrombosis. No patient needed salvage surgery or had recurrence of mammary neoplasia during the study period. Conclusion: The present technique preserves the skin located at the lower portion of the breast, with a low risk of dehiscence or extrusion of the implant in this region, providing a double protection of the implant, with the pectoralis major muscle in the upper two thirds and the cutaneous-dermis-fat flap in the lower third, characterizing a "dual-plane" positioning