Cosmetic and reconstructive breast surgery.
(41/220)
This fifteenth and final article in our series on breast disease provides general practitioners with information that will allow them to give their patients a balanced view about issues related to cosmetic breast surgery. As well as breast augmentation and breast reduction surgery, the latest on the breast implant 'silicone controversy' and other procedures such as breast reconstruction following mastectomy are discussed. (+info)
Porcine vesical acellular matrix graft of tunica albuginea for penile reconstruction.
(42/220)
AIM: To characterize the feasibility of the surgical replacement of the penile tunica albuginea (TA) and to evaluate the value of a porcine bladder acellular matrix (BAM) graft. METHODS: Acellular matrices were constructed from pigs' bladders by cell lysis, and then examined by scanning electron microscopy (SEM). Expression levels of the mRNA of the vascular endothelial growth factor (VEGF) receptor, fibroblast growth factor (FGF)-1 receptor, neuregulin, and brain-derived neurotrophic factor (BDNF) in the acellular matrix and submucosa of the pigs'bladders were determined through the reverse transcription-polymerase chain reaction (PCR). A 5 mm X 5 mm square was excised from the penile TA of nine rabbits. The defective TA was then covered in porcine BAM. Equal numbers of animals were sacrificed and histochemically examined at 2, 4 and 6 months after implantation. RESULTS: SEM of the BAM showed collagen fibers with many pores. VEGF receptor, FGF-1 receptor and neuregulin mRNA were expressed in the porcine BAM; BDNF mRNA was not detected. Two months after implantation, the graft sites exhibited excellent healing without contracture, and the fusion between the graft and the neighboring normal TA appeared to be well established. There were no significant histological differences between the implanted tunica and the normal control tunica at 6 months after implantation. CONCLUSION: The porcine BAM graft resulted in a structure which was sufficiently like that of the normal TA. This implantation might be considered applicable to the reconstruction of the TA in conditions such as trauma or Peyronie's disease. (+info)
Plastic surgery made easy - simple techniques for closing skin defects and improving cosmetic results.
(43/220)
BACKGROUND: Although meticulous technique cannot guarantee a superior cosmetic result when repairing skin wounds or excising skin lesions, a well planned and executed repair reduces the risk of unsatisfactory scarring. OBJECTIVE: This article discusses sound plastic surgery principles that every doctor operating on the skin can apply. Common suture techniques and simple flap techniques and their indications are also discussed. DISCUSSION: Principles of effective wound repair include: good lighting and equipment, atraumatic tissue handling, early repair of traumatic wounds, thorough wound debridement and lavage, avoiding healing by secondary intention, judicious antibiotic prophylaxis, appropriate planning of incisions, carefully executed incisions, avoiding wound repair under tension, layered wound repair, use of appropriate suture size and needle, everted wound edges, use of adjuncts such as skin tapes and soft tissue adhesives, and early suture removal. Useful suture techniques include deep dermal sutures with buried knots, simple interrupted sutures, vertical mattress, horizontal mattress, subcuticular sutures, continuous over-and-over sutures and far-near near-far pulley sutures. Rotation, transposition, advancement and island flaps can be useful to close defects in situations where skin grafting is not possible or desirable. (+info)
Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy.
(44/220)
BACKGROUND: Treatment for metabolic and morphologic alterations in HIV-related lipodystrophy include medical therapy, physical exercise, and surgical interventions. METHOD: We assessed the efficacy and safety of a comprehensive multidisciplinary approach for treating morphological and metabolic alterations of the lipodystrophy syndrome in consecutive patients attending the Metabolic Clinic (MC) of the University of Modena and Reggio Emilia who had at least 2 evaluations over a 48-week period. 245 patients were evaluated: 143 (62.4%) were men, 74 (36.1%) presented with lipoatrophy, 10 (4.9%) with fat accumulation, 93 (45%) with mixed forms, 24 (11.3%) had hypercholesterolemia (LDL >160 mg/dL), 87 (38%) had hypertriglyceridemia (TG >150 mg/dL), 13 (5.7%) had diabetes (glucose >126 mg/dL), and 78 (44%) had insulin resistance (HOMA-IR >4). RESULTS: At follow-up, a significant improvement was observed in both objective and subjective variables. Anthropometric improvement was observed in waist to hip ratio, waist circumference, and right and left cheek dermal thickness measurements. A nonsignificant improvement was observed in fat and lean regional mass by DEXA; CT showed improvement in visceral and subcutaneous adipose tissue. Glucose, HOMA-IR, total cholesterol, and APO B improved. Subjective variables improved in aesthetic satisfaction. CONCLUSION: We conclude that the medical and surgical interventions proposed in this multidisciplinary therapeutic approach are efficacious and safe in the management of lipodystrophy. (+info)
Evaluation of craniofacial surgery in the treatment of facial deformities.
(45/220)
Surgical access to the cranial, orbital, and facial areas, as developed by Tessier, has produced not only definitive repair of previously uncorrectable congenital deformities such as orbital hypertelorism and facial stenosis (e.g., Crouzon's, Apert's syndromes) but also has improved markedly the treatment of traumatic and neoplastic defects. The surgical approach allows complete dissection of facial soft tisses including the orbits from the underlying bones followed by corrective osteotomies and fixation. Mobilization of the frontal lobes through a frontal bone flap exposure may be required. The ramifications of this latest intrusion by surgeons into a previously inviolate anatomic area have involved neurosurgeons, ophthalmologists, anesthesiologists, and dental and psycho-social disciplines. The disciplines of genetics and embryology are being influenced by this new field of surgery, much as the study of immunology was influenced by transplantation surgery two decades ago. This report analyzes a 10 year experience with over 100 patients with emphasis on patient selection by disease, age, intellectual status, morbidity, complications, and the psycho-social reactions of patient and family. Procedures initially planned to correct dental and aesthetic defects are proving beneficial for other functions including hearing, taste and smell, articulation and tongue movement, respiratory function, vision, and possibly bone growth. The development of self image, a normal process always in operation, is also strikingly altered. These operations may last as long as 14 to 16 hours. We have had no deaths or postoperative blindness. One postoperative cerebrospinal fluid leak was successfully repaired. Three partial losses of bone grafts and four instances of late cellulitis have occurred. Prevention of infection seems related to avoidance of dead spaces and primary closure of all mucosal, dural, conjunctival and skin surfaces. (+info)
Radical cranio-orbital reconstructive procedures for cloverleaf skull deformity in adult: operative technique for the longest survivor--case report.
(46/220)
Cosmetic cranio-orbital reconstructive surgery was carried out on a 22-year-old male, the longest surviving case of cloverleaf skull syndrome reported. He previously underwent classical linear suturectomy for synostotic sutures and temporal cranioplasty. Fortunately, hydrocephalus became arrested so did not require continuous cerebrospinal fluid drainage through shunt tube. His intelligence quotient was in the 40s. The present problem was mainly of cosmetic cranio-orbital corrections of shallow orbits with resultant exophthalmos, frontal dysgenesis, and marked temporal bossings. Bilateral orbital advance, lateral canthal/pterional reshaping, frontal remodeling, and temporal reduction cranioplasty were performed. The postoperative outcome was satisfactory. The cloverleaf skull deformity is etiologically and pathologically heterogeneous, so radical surgical reconstructive procedures should be planned and designed individually. (+info)
Transplantation of mesenchymal stem cells is an optimal approach for plastic surgery.
(47/220)
Mesenchymal stem cells (MSCs) are able to differentiate into a variety of cell types, offering promising approaches for stem cell-mediated tissue regeneration. Here, we explored the potential of utilizing MSCs to reconstruct orofacial tissue, thereby altering the orofacial appearance. We demonstrated that bone marrow MSCs were capable of generating bone structures and bone-associated marrow elements on the surfaces of the orofacial bone. This resulted in significant recontouring of the facial appearance in mouse and swine. Notably, the newly formed bone and associated marrow tissues integrated with the surfaces of the recipient bones and re-established a functional bone marrow organ-like system. These data suggested that MSC-mediated tissue regeneration led to a body structure extension, with the re-establishment of all functional components necessary for maintaining the bone and associated marrow organ. In addition, we found that the subcutaneous transplantation of another population of MSCs, the human periodontal ligament stem cells (PDLSCs), could form substantial amounts of collagen fibers and improve facial wrinkles in mouse. By contrast, bone marrow MSCs failed to survive at 8 weeks post-transplantation under the conditions used for the PDLSC transplantation. This study suggested that the mutual interactions between donor MSCs and recipient microenvironment determine long-term outcome of the functional tissue regeneration. Disclosure of potential conflicts of interest is found at the end of this article. (+info)
Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction.
(48/220)
BACKGROUND: General surgeons' attitudes toward breast reconstruction may affect referrals to plastic surgeons. The propensity to refer to plastic surgeons prior to surgical treatment decisions for breast cancer varies markedly across general surgeons and is associated with receipt of reconstruction. In this study, the authors used data from a large physician survey to examine factors associated with general surgeons' propensity to refer breast cancer patients to plastic surgeons prior to mastectomy. METHODS: The authors surveyed all attending general surgeons (N=456 surgeons) from a population-based sample of breast cancer patients who were diagnosed in Detroit and Los Angeles during 2002 (N=1844 patients), with a surgeon response rate of 80%. The dependent variable was surgeon report of the percentage of their mastectomy patients in the past 2 years who they referred to plastic surgeons prior to initial surgery (referral propensity). Referral propensity was collapsed into 3 categories (<25%, 25-75%, and >75%) and regressed on the following covariates using logistic regression: Surveillance, Epidemiology, and End Results registry; number of years in clinical practice; surgeons' sex; annual breast surgery volume; and hospital setting. RESULTS: Only 24% of surgeons referred>75% of their patients to plastic surgeons prior to surgery (high referral propensity). High referral propensity was associated independently with surgeons who were women (odds ratio [OR], 2.3; P=.03), high clinical breast surgery volume (OR, 4.1; P<.01), and working in cancer centers (OR, 2.4; P=.01). High-referral surgeons and low-referral surgeons also had different beliefs about women's preferences for reconstruction, with the low-referral surgeons perceiving more access barriers (cost, availability of plastic surgeons) and a lower patient priority for reconstruction. CONCLUSIONS: A large proportion of surgeons do not refer breast cancer patients to plastic surgery at the time of surgical decision-making. Surgeons who have a high referral propensity are more likely to be women, to have a high clinical breast volume, and to work in cancer centers. These data support the importance of comanagement through multidisciplinary care models. Women need more opportunities to discuss reconstructive options to make informed surgical treatment decisions about their breast cancer. (+info)