Approccio chirurgico e indicazioni ai trattamenti estetici nel dismorfismo da eccesso

Introduction. Patients with body dysmorphic disorder often go to the plastic surgeon to correct what they consider a physical deformity or defect, although their appearance falls within normal aesthetic standards. The aim of our study was to evaluate the real need for aesthetic treatments in such patients. Patients and methods. We included patients who practised an intense sport activity and believed they had body deformities ascribable to their sport activity. We evaluated whether the deformities described by the patients were real or exaggerated. The patients who did have a deformity underwent surgery to correct it; their level of satisfaction was evaluated at a 6-month follow-up examination. The patients with subjective deformities underwent a psychiatric examination. Results. We enrolled 51 patients who practised an intense sport activity and reported body deformities. Forty-one of these patients were found to have a body deformity upon examination and underwent surgery. Surgery was considered to be unnecessary in the remaining 10 patients. Thirty-two of the 41 patients who did undergo were highly satisfied with the outcome. Discussion. The plastic surgeon often sees patients with minor body deformities that do not require treatment but are a major cause of psychological disorders. A thorough psychiatric examination is necessary in such patients to rule out psychiatric diseases. The plastic surgeon should make every effort to identify patients with subjective body dysmorphic disorder to avoid the negative consequences due to the patient’s insatisfaction for the outcome of surgery

Chapter 17. Imaging and surgical strategies for cutaneous neoplasm of scalp

No abstrac

Melanoma of the Umbilicus: An Incidental Diagnosis During Fat-Harvesting Donor-Site Selection

[No abstract available

Melanoma of the Umbilicus: An Incidental Diagnosis During Fat-Harvesting Donor-Site Selection

[No abstract available

Long-term results of a versatile technique for umbilicoplasty in abdominoplasty

Background: Umbilical repositioning is a main step in performing abdominoplasty. The surgical aims are minimal visible scars and a natural-appearing result. Reported techniques do not completely satisfy the aesthetic targets for all types of patients. A previous study reported a versatile technique for umbilicoplasty based on an elliptical vertical incision of the umbilical skin and a double opposing "Y" incision on the abdominal flap to create a new umbilicus. This report describes the long-term results with this technique. Methods: A total of 111 abdominoplasties were performed. Patient satisfaction and postoperative results were evaluated over a 5-year follow-up period. A modified 5-ml syringe was used to assess the depth and volume of the umbilical stalk. Depth value variations were statistically compared using the Wilcoxon test. Results: For all the patients, a three-dimensional umbilicus with an adequate depression was created. In four cases, deepithelialization of the umbilical skin occurred. After 1 postoperative year, no significant changes in umbilical shape, dimension, depth, or appearance were observed. After 5 years, no significant changes in shape or appearance were observed. The cicatricial umbilical stenosis occurrence was 4.5%. A small significant decrease in umbilical depth was noted. Overall, the results remained satisfying at this writing. Conclusions: The reported technique is easy to learn, simple to perform, and stable over time. It gives a natural depth appearance, ensures optimal position, pulls scars deeply, and allows achievement of different shapes according to the patient's habitus

Reconstruction of anterior auricular conchal defect after malignancy excision: Revolving-door flap versus full-thickness skin graft

Skin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone todelay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p < 0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours. (C) 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons

Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling

A case of Mycobacterium chelonae infection in the buttock after combined liposuction and lipoinjection is presented. The real possibility of contamination from operating room equipment was the potential etiologic factor of this infection. The clinical presentation of the disease was typical. The difficulty confirming the diagnosis was solved by specific culturing techniques. Successful treatment with limited debridement and irrigation combined with prolonged specific antibiotic therapy effected a long-term cure

A Clinical Study of Late Seroma in Breast Implantation Surgery

The use of mammary implants may lead to a variety of early and delayed complications. The most common delayed complications are capsular contracture and implant failure. Late seroma has seldom been reported. In a long-term prospective observational study, cases of late seroma were assessed and recorded. Between March 2005 and November 2009, suspected cases of late seroma in patients who had undergone breast augmentation or reconstruction with textured implants were evaluated clinically and with instrumental analyses. An ultrasound-guided needle aspiration of the fluid was performed. In this study, 13 cases of late seroma (8 augmentations and 5 reconstructions) were observed. The overall incidence of this complication was 1.68%. Chemical analyses confirmed the diagnosis of seroma, which recurred in all the patients within days of evacuation. For 12 patients, a reoperation was performed, during which the implant was removed, a total capsulectomy was performed, and in cases of subglandular breast augmentation, the implant pocket was changed to a submuscular placement before a new prosthesis was inserted. One patient underwent a second ultrasound-guided needle aspiration. No seroma recurrence was observed in any of the patients during the follow-up period. In case of unexpected breast enlargement after prosthesis implantation, the physician should first rule out infection, then investigate possible friction irritation from either a fold in the device or rubbing of a textured implant. According to the authors' experience and another report, this complication occurs in 1% to 2% of cases. The inclusion of this complication in the informed consent form should be considered. Long-term studies designed to investigate the underlying causes of late seroma are warranted for the prevention and treatment of this complication

Treatment of Post Mastectomy Pain Syndrome after mastopexy with botulinum toxin

[No abstract available