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

APPLICATION OF PEDICLE FLAPS FOR WOUND COVERAGE OF LOWER LEG

This paper presents 11 clinical cases with soft tissue defect of lower leg and foot. The reconstructive surgery of the wounds involves 14 pedicle flaps: five of which are gastrocnemius; nine are sural flaps. The etiology of the defects is various: 6 of the patients are with deep burns of the lower limbs; 3 with deep frostbite; 2 with different trauma. The patients are aged between 27 and 79. The obtained results and the applied reconstructive methods in the treatment of soft tissue defects of the lower extremities are discussed

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

Application of Local Axial Flaps to Scalp Reconstruction

BackgroundScalp defects may be caused by various etiological factors, and they represent a significant surgical and aesthetic concern. Various surgical techniques can be applied for reconstructive work such as primary closure, skin grafting, pedicled or free flaps. In this article, the authors share their clinical experience with scalp operations using the technique of local flaps and discuss the application of this method from the perspective of not only the size of the defect, but also in relation to the anatomical area, quality of surrounding tissue, and patient's condition.MethodsDuring the period from December 2007 to December 2012, 13 patients with various scalp defects, aged 11 to 86 years, underwent reconstruction with local pedicle flaps. The indications were based on the patients' condition (age, sex, quality of surrounding tissue, and comorbidities) and wound parameters. Depending on the size of the defects, they were classified into three groups as follows: large, 20 to 50 cm2; very large, 50 to 100 cm2; extremely large, 100 cm2. The location was defined as peripheral (frontal, temporal, occipital), central, or combined (more than one area). We performed reconstruction with 11 single transposition flaps and 1 bipedicle with a skin graft on the donor area, and 2 advancement flaps in 1 patient.ResultsIn all of the patients, complete tissue coverage was achieved. The recovery was relatively quick, without hematoma, seroma, or infections. The flaps survived entirely.ConclusionsLocal flaps are widely used in scalp reconstruction since they provide healthy, stable, hair-bearing tissue and require a short healing time for the patients

Undiagnosed Long-Lasting Ulcerative Colitis Engaging Transplant after Vaginal Plastic Surgery with Colon: a Case Report

This is the report of a 59-year-old woman suffering from recurrent vaginal pain and bleeding and episodes of anal bleeding. At the age of 16 she underwent vaginal plastic surgery. The case demonstrates the ulcerative engagement of the vaginal transplant

Abstracts Of The Proceedings And The Posters From The Third Scientific Session Of The Medical College Of Varna

October 2-3, 201