7 research outputs found
Recommended from our members
Breast Reduction
Reduction mammoplasty is one of the most commonly performed reconstructive procedures by plastic surgeons. It also is characterized by the highest patient satisfaction rates. Common indications for surgery include shoulder, neck, or back pain; intertrigus rash; shoulder bra strap grooving; postural problems; difficulty performing exercise; and ulnar paresthesias. This chapter will discuss several nuances in techniques performed in our practice, which have facilitated the steps and perioperative management of these patients. In addition, in our opinion, these helped to decrease common complications of this procedure. We utilize a wise pattern with an inferior dermal pedicle because it is very reliable, reproducible, and a teachable technique. Markings can be reproduced with various breast types and shapes. We believe this gives consistent results with high patient satisfaction. We have incorporated some steps that help standardize and simplify the surgery, while providing reliable results and decreasing complications. This chapter includes some “tricks” we use during our markings, preoperative steps, and intraoperative approaches that help us achieve the goal of more favorable outcomes
Recommended from our members
Gynecomastia: Evaluation and Surgical Tips and Tricks
Gynecomastia, excess development of the male breast, is a common deformity encountered by plastic surgeons. It is the most common breast alteration in males, commonly developing without a pathologic basis during periods of physiologic change such as infancy, puberty, and old age. It may accompany a wide variety of systemic and metabolic diseases, and it may be drug induced. Given the number of pathophysiologic mechanisms, detailed presurgical workup is essential prior to determining whether surgical management is appropriate. This chapter highlights different surgical techniques performed in our practice, along with standardized preoperative evaluation and postoperative care. We believe that a dynamic approach to patients with gynecomastia decreases common complications and increases patient satisfaction in various degrees of gynecomastia. This chapter includes some “tricks” we use during our markings, preoperative steps, and intraoperative approaches that help us optimize patient safety, while maintaining operative efficacy and improving aesthetic outcomes in gynecomastia
Recommended from our members
Prepectoral Direct-to-Implant versus Staged Tissue Expander Breast Reconstruction: A Comparison of Complications
Background: Direct-to-implant (DTI) reconstruction has multiple advantages over a staged tissue expander (TE) approach. However, its use may be limited by concerns of increased complications. This study is the largest series to date comparing postoperative outcomes for DTI versus TE reconstruction in the prepectoral plane. Methods: The authors retrospectively reviewed 348 patients that received 536 total immediate, prepectoral implant-based breast reconstructions between January 2018 and December 2021. The authors compared the presence of risk factors and the rate of six separate complications between patients that received DTI versus TE reconstruction up to one year after surgery. Results: Of 348 patients, 147 (42%) and 201 (58%) underwent TE and DTI reconstruction ( p=0.1813 ), respectively. Overall infection rate was 16.4% ( n=57 ). DTI patients had a significantly greater incidence of wounds ( p<0.0001 ), including minor ( p<0.0011 ) and major wounds ( p<0.0053 ). Significantly greater mastectomy resection weights were found for DTI patients that experienced any complication ( p<0.0076 ), postoperative wounds ( p<0.0001 ), and major wounds specifically ( p<0.0035 ). Compared to medium thickness, extra-thick acellular dermal matrix (ADM) was associated with significantly increased rates of infection ( p<0.0408 ) and wounds ( p<0.0001 ). Conclusions: Prepectoral DTI reconstruction in patients with adequate flap perfusion may have comparable complication rates to staged TE reconstruction apart from a higher incidence of postoperative wounds. Greater mastectomy resection weights and thickness of ADM may specifically contribute to infectious and wound-healing complications. Prepectoral DTI reconstruction is encouraged in the patients with adequate flap perfusion and moderate to low mastectomy resection weights that desire comparable or smaller implant volumes
El control de daños en el trauma cardíaco penetrante
El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico.Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients. © 2021, Facultad de Salud de la Universidad del Valle. All rights reserved