Otoplasty with Combined and Cartilage Sparing Techniques

Описаните в литературата техники за хирургично лечение на отоклизиса могат да се разглеждат в две главни категории: съхраняващи хрущяла и отслабващи хрущяла чрез надрязване или изпиляване. Стремежът и при двете групи е корекция на антихеликса и издадената конха. Съчетаването на елементи от двата метода цели да се избегнат недостатъците на всеки един от тях. Настоящата статия представя опита ни от приложението на комбинирана и съхраняваща хрущяла техники за корекция на проминиращи уши при 72 пациенти на възраст от 6 до 45 години. Билатерална отопластика е извършена при 67 от случаите и унилатерална в 5 случая. Техника, съхраняваща хрущяла, е приложена при 48 от пациентите. Комбиниран метод е използван при 24 пациенти. Разпределението на получените резултати е както следва: отлични – 67 (93.05%) от случаите, много добри – 2 (2.78%) и незадоволителен – 3 (4.17%) пациенти. Обсъждат се постигнатите резултати и се дискутират предимствата и недостатъците на различните методи.The techniques described in literature for the surgical treatment of otoclysis can be considered in two main categories: cartilage sparing and cartilage weakening by snipping or rasping. The aim in both groups is the antihelix and the protruding concha correction. The purpose of combining elements of both methods is to avoid the disadvantages of each procedure. This article presents our experience with the application of cartilage sparing and combined technique for correction of protruding ears in 72 patients aged 6 to 45 years. Otoplasty is performed bilaterally in 67 cases and unilaterally in 5 cases. Preserving cartilage technique was applied in 48 patients.Combined method was used in 24 patients. The distribution ofthe results is as follows: excellent – 67 (93.05%) of the cases, very good – 2 (2.78%) and unsatisfactory – 3 (4.17%) patients. The obtained results and the advantages and disadvantages of different methods are being discussed

Relative distribution of breast asymmetry in patients requesting aesthetic mammoplasty

PURPOSE: Primary breast asymmetries are quite common. They can affect breast volume and shape, position of inframammary fold, position and size of breast base as well as nipple-areola complex. The aim of this study is to investigate the relative distribution of primary breast asymmetries in patients requesting aesthetic mammaplasty and to analyze the obtained results.MATERIAL AND METHODS: The study covered 360 female patients at a mean age 31.29±6.05 years who were admitted to the hospital for aesthetic breast surgery over a period of 10 years. Various asymmetries such as in the volume, shape, position and size of the mammary gland base, nipple-areola complex and inframammary fold were described, diagnosed and analyzed. Clinical observation, photo-analysis, anthropomorphic measurements and scanner (in case of skeletal deformities) were applied.RESULTS: The results showed a total of 241 patients with breast asymmetry or 66.9% of the cases. Bilateral micromastia was registered as the asymmetry with the highest frequency of occurrence or in 65.6% of the cases. Asymmetries in the position of the nipples on the vertical axis were found out in 88% of the women followed by irregularities in the vertical level of the inframammary fold diagnosed in 85.9% of the patients. Tuberous breast deformity was found in 20.3% of the patients. More than one sign of asymmetry was observed in 93.8% of the cases.CONCLUSION: Breast asymmetry is commonly identified in patients requesting aesthetic mammaplasty. Careful preoperative examination and assessment of these abnormalities underlie the correct planning and ensure the positive outcome of the surgical procedure.Scripta Scientifica Medica 2013; 45(2): 81-85

Reconstruction of deep burns of the knee using gastrocnemius flap

PURPOSE: The objective of this paper was to share our surgical experience and discuss the application of the gastrocnemius flap in the reconstruction of deep burns of the knee.MATERIAL AND METHODS: We reported a reconstructive work using gastrocnemius flap in six patients with deep burns of the knee joint. The application of flap surgery was determined by the size and the depth of the defect without considering the etiology of the burn. Five patients were treated with the medial head and the sixth one was treated with the lateral head of the gastrocnemius muscle.RESULTS: Complete tissue coverage of the wounds was obtained. In one patient, partial split-thickness skin graft was lost, however, secondary healing of the wound occurred. Primary healing occurred in the donor areas. Full mobility and good aesthetic results were obtained in all the patients.CONCLUSION: The gastrocnemius flap is a valuable surgical method in the reconstruction of the deep burns of the knee joint. The final functional and aesthetic outcome is very good. Having considered the advantages of the technique, we believe that its application is appropriate in many cases of deep burns of the knee presenting with exposed bone and tendon.Scripta Scientifica Medica 2013; 45(4): 71-76

Possibilities for more accurate prediction of thermal injury severity and determination of its impact on the body using the Abbreviated Burn Severity Index

INTRODUCTION: During the last decades, the chances of survival in burn patients have been progressively increasing, but the issue of prognosis of death after such injuries is still of great ethical, social, medical, and forensic interest.AIM: The purpose of our study was to examine and confirm the accuracy of the ABSI (Abbreviated Burn Severity Index) system in predicting the risk of death in thermal trauma by comparing its values with the actual risk reported.MATERIALS AND METHODS: In order to achieve this purpose, the medical records of burn patients admitted to the Clinic of Thermal Trauma, Plastic, Reconstructive and Aesthetic Surgery at the Naval Hospital of Varna for a five-year period (2011-2015) were studied and the death cases were analyzed. The mortality rate predicted by ABSI was compared to the actual death rate reported in the medical records.RESULTS: There was a significant difference in the mean values of ABSI in survivors and deceased: 4.65 and 11, respectively. All with an ABSI value less than 3 survived. For ABSI values up to 10, a slightly lower mortality was reported than the predicted. For the values ≥11 they matched. Despite these discrepancies, we believe that ABSI is suitable for calculating the risk of death in thermal trauma, especially in more severe burns, where the threat to life is higher.CONCLUSION: Three groups were differentiated with a sharp increase in the percentage of actually reported mortality. Their respective ABSI values can be taken as a reference for forensic medical practitioners in the classification of bodily injuries due to burns

Application of the pedicled m. latissimus dorsi flap for trunk reconstructions

PURPOSE: M. latissimus dorsi flap is one of the most commonly used pedicled flaps in plastic surgery. It can be based either on the dominant thoracodorsal vessels, or, as a reverse flap, on its secondary segmental pedicles. The purpose of this paper is to evaluate our experience with pedicled flaps from m. latissimus dorsi for trunk reconstructions.MATERIAL AND METHODS: In the present study, we applied eight flaps on 7 patients: four flaps for breast reconstruction, one flap for postmastectomy radiation wound treatment, one flap to cover a defect on the anterior thoracic wall caused by toxic skin necrosis, one flap to correct axillary skin contracture after deep burn injury, and one for lumbar reconstruction after malignant melanoma radical excision.RESULTS: In the present paper, two cases with application of this flap were reported to illustrate the stages of the surgical technique. All the flaps were vital and adapted normally. Narrow partial skin necrosis and donor scar depression were observed in the largest skin-muscle flap only.CONCLUSION: M. latissimus dorsi pedicled flaps are reliable source for trunk reconstructions. They may transfer abundant plastic material to compensate tissue deficit of different etiology. The risk of complications is insignificant, whereas the patients' quality of life is considerably improved.Scripta Scientifica Medica 2013; 45(2): 86-90

DEVELOPMENT AND RESULTS OF MEDICATIONS OF THE BURNS

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Aesthetic Rhynoplasty In Patients With Deviated Septum

Въведение: Девиация на септума, съчетана с обструкция на горните дихателни пътища е често срещана при пациенти желаещи естетична ринопластика. Анатомична основа на отклонението могат да бъдат свързани аномалии с костните структури, хрущялната част от носната преграда, или комбинация от двете. Етиологично изкривяването на септума може да бъде вродено или придобито от предишна травма или операция.Целта на тази статия е да споделим нашия опит относно естетичната ринопластика при пациенти с девиация на септума и да се дискутират хирургичните техники за естетична и функционална корекция.Материал и методи: От общо 91 пациенти с естетична ринопластика 16 (17,58%) на възраст от 21 до 38 години са били с девиация на септума. Всички пациенти са били и с функционални проблеми. Принципите на корекция включват широка експозиция чрез отворен достъп, освобождаване на всички тъкани деформиращи септума, изправяне на преградата и осигуряване на адекватна дорзална и каудална опора, възстановяване на дългосрочна подкрепа, намаляване и латерализиране на хипертрофиралите долни конхи, извършване на контролирани остеотомии.Резултати: Отлични резултати са отчетени при 12 (75%) пациента. В три от случаите резултатите са много добри. Реоперация се наложи при един пациент.Заключение: Независимо, че девиацията на септума прави оперативната намеса значително по-трудна, най-добре е тя да бъде коригирана едновременно с естетичната ринопластика.---------------------------------------------------------------Introduction: Patients requesting aesthetic rhinoplasty  quite often suffer from deviation of the septum and airway obstruction. The anatomic basis of the deviation may be related to bone pyramid abnormalities, septal cartilage deformity, or a combination of the two. The etiology may be congenital or acquired due to previous trauma or surgery.The aim of this article is to share our experience concerning the treatment of deviated nose and discuss surgical techniques for aesthetic and functional correction.Material and methods: From of total 91 cases with aesthetic rhinoplasty, 16 (17,58%) patients aged 21 – 38, were with deviated septum. All of them had nasal deviation and functional problems. The principles of correction include wide exposure through the open approach, release of all deforming forces to the septum, straightening of the septum while maintaining an adequate dorsal and caudal strut, restoring long-term support, reducing and lateralizing the hypertrophied turbinates, and performing controlled osteotomies.Results: Excellent results were obtained with 12 (75%) patients. In three cases the results were very good. We had to perform secondary rhinoplasty on one patient.Conclusions: The deviation of the septum makes surgery much more difficult, but it is best that it be adjusted simultaneously whit aesthetic rhinoplasty

MASTOPEXY WITH AUGMENTATION MAMMAPLASTY

Augmentation alone and mastopexy are two different surgical procedures serving different purposes. The indication for simultaneous augmentation with mastopexy is ptosis combined with breast hypotrophy. The aim of this paper is to clarify the application of mastopexy with augmentation in cases of breast ptosis. Mastopexy combined with augmentation was applied in 52 patients with breast ptosis aged 24 to 44 years. The following techniques were used: mastopexy: periareolar (in 44,23%), multiplane (in 28,85%), vertical (in 15,38%), and T-inverted (in 11,54% of the cases). The position of the implant is dual plane in 47 cases (90,38%), subpectoral - in 4 (7,69%), subfastial in one case (192%). Atotal of 104 implants were used. Very good results were obtained in 43 patients (in 82,69%), good - in 5 (in 9,62%), satisfactory - in 3 (in 5,77%), and poor - in one patient (in 1,92% of the cases). The application of augmentation with mastopexy is a relatively complicated surgical procedure. The risk for complications is higher than when the procedures are applied alone. However, the right choice of surgical technique combined with atraumatic tissue dissection definitely leads to good postoperative results

AUGMENTATION MAMMAPLASTY WITH DUAL-PLANE TECHNIQUE

Augmentation alone is one of the most common procedures in aesthetic surgery. It aims at achieving the desired breast shape and volume, and, therefore, in most cases, patient`s level of satisfaction is quite high. The aim of this study is to analyze the specific indications for the application of the dualplane technique for different types of breast. Augmentation alone performed with dual plane technique is used in 262 patients aged 18 to 51 years. Dual plane I is applied in 86 patients (in 32,82%), dual plane II in 24 (in 9,16%), dual plane III - in 78 (in 29,78%), and different dual plane for each breast - in 74 (in 28,24% of the cases). Our results are very good in 232 patients (in 88,55%), good - in 17 (in 6,49%), satisfactory - in 8 (in 3,05%), and poor - in 5 (in 1,91% of the cases). The dual-plane technique can be applied to all types of breast. It allows stable soft tissue coverage and provides good con- tact between the implant, pectoral muscle, and breast tissue

Factors influencing the level of patient`s satisfaction with augmentation mammaplasty

This paper investigated the degree of women`s satisfaction with the outcome of the augmentation mammaplasty and the capacity of clear-cut criteria to judge the postoperative level of satisfaction. The analysis included 96 women aged 20-40 years who had undergone augmentation mammaplasty during the period from 2001 till 2011. The investigation was carried out 6 months after the operation during the postoperative examinations by filling-in a questionnaire about the level of satisfaction with the surgery. The following statistical methods are used: descriptive statistics, testing the internal consistency of the scales with Cronbach`s Alpha, correlation and regression analyses. Data processing was performed by using SPSS-19 statistical package. Some specific interrelations between different parameters that measured the level of satisfaction were determined. The calculated multiple correlation coefficient of independent and dependent variables was of r=0.678 which was a very good result. The proportion of variation in the dependent variable is r 2 =0.522. The assessment of the new appearance after surgery was most strongly influenced by patients improved function in everyday activities such as work, social relationships, leisure, and sex. The multiple correlation coefficient was r=0.686 and the proportion of variation in the dependent variable was r 2 =0.519. This phenomenon could be related to the proactive seeking and receiving feedback, and the assessment of the surgery is mostly determined by that feedback. The analysis of the factors influencing the levels of satisfaction with augmentation mammaplasty provided a valuable feedback for the surgeons. Obviously, the general assessment score of the surgical work is quite high.Scripta Scientifica Medica 2012; 44(2): 79-82