Sepsis With Multiple Abscesses After Massive Autologous Fat Grafting for Augmentation Mammoplasty: A Case Report

Background  

Autologous fat grafting to the breast for breast reconstruction and cosmetic breast augmentation has gained much attention recently. However, its efficacy and the severities of its associated complications are of concern. The authors experienced one case of multiple breast abscesses after augmentation mammoplasty by autologous fat grafting.     

Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon

Background  

Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres), tendon augmentation is required.     

Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

Background  

Addressing bone loss in revision TKA is challenging despite the array of options to reconstruct the deficient bone. Biologic reconstruction using morselized loosely-packed bone graft potentially allows for augmentation of residual bone stock while offering physiologic load transfer. However it is unclear whether the reconstructions are durable.     

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

Background  

Residual laxity remains after ACL reconstruction in patients with combined chronic ACL and medial instability. The question arises whether to correct medial capsular and ligament injuries when Grade II and III medial laxity is present.     

Treatment outcome of enchondroma by simple curettage without augmentation

Background  

Simple curettage for enchondroma without augmentation, known to lead to spontaneous bone consolidation at the curettage site, is a potential standard treatment for this condition. However, few detailed data comparing the results of this technique with conventional methods including reconstruction are available, and the relation between the postoperative completion period for bone consolidation and preoperative independent variables is not known.     

Bilateral Calf Augmentation for Aesthetic Purposes

Background  

The shape of the calf is determined by the development of the soleus and gastrocnemius muscles, the length and orientation of the crural bones, and the distribution of subcutaneous fat. Some people have a naturally thin or underdeveloped calf that remains small despite exercise. Calf augmentation is indicated for cosmetic reasons or for reconstruction of a shrunken lower leg resulting from injury, illness, or congenital disability.     

Maximizing aesthetic outcome in autologous breast reconstruction with implants and lipofilling

Background

Free flap breast reconstruction is an option widely sought in postmastectomy breast reconstruction. However, the volume of autologous tissue from the patient is often not sufficient for symmetrical reconstruction. In these cases, flaps can be used in combination with implants or autologous fat injections to augment volume and achieve shape, symmetry, and contour.

Methods

A retrospective chart review was performed on patients who underwent postmastectomy free flap reconstruction with secondary augmentation using autologous fat grafting or implant from 2008 to 2011.

Results

Twenty-four patients (39 breasts) received further augmentation of autologous tissue reconstruction during this period. Sixteen patients (26 breasts) had fat graft augmentation only, four patients (eight breasts) had implant augmentation only, and three patients (five breasts) had both procedures. Among patients who had fat grafting, operative intervention was required twice for fat necrosis. Contrastingly, of patients who received implants, one patient required operative intervention for implant malpositioning. These differences were not significant (P?=?0.57). The group with both fat grafting and implant augmentation had significantly higher aesthetic scores regarding overall appearance, contour, and volume, but not projection, than the group with fat grafting only and the group with implant only.

Conclusions

Autologous fat grafting offers several contouring aesthetic advantages, including selectively augmenting areas of hollowness to improve contour and maximize symmetry. However, implant augmentation generally allows for a larger increase in projection in a single procedure, with similar rates of postaugmentation complications. Use of both autologous fat grafting and implant augmentation may allow for superior aesthetic results. Level of Evidence: Level IV, therapeutic study.     

Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience

Purpose  

Biliary injury is a severe complication of cholecystectomy. The Hepp–Couinaud reconstruction with the hepatic duct confluence and the left duct may offer best long-term outcome as long as the confluence remains intact (Bismuth I–III). Complex liver surgery is usually indicated in most proximal (Bismuth IV) injuries in non-cirrhotic patients. The aim of this study was to evaluate the surgical treatment and outcome of bile duct injuries managed in a referral hepatobiliary unit.     

Surgical Technique: When to Arthroscopically Repair the Torn Posterior Cruciate Ligament

Background  

Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2–3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can be amenable to repair, the described techniques have been associated with some difficulties attaching the avulsed ligament.     

Functional outcome of ulnar nerve fascicle transfer for restoration of elbow flexion in upper brachial plexus injury

Introduction  

Upper part brachial plexus injuries result in paralysis of Biceps and inability of active elbow flexion. If repair of damaged nerves proves to be impossible, reconstruction surgery will be indicated. Oberlin procedure is a reconstructive method for restoration of elbow flexion in which, posteromedial fascicle of ulnar nerve is transferred to the motor nerve of Biceps. In this article, we evaluated the results of this procedure in 10 patients in whom treatment was performed relatively late.     

Strategies in the management of post-burn breast deformities

Background

Burn injuries to the chest area may end up with severe breast deformity and asymmetry. They are frequently complex and unique to each case, affecting parenchymal development, breast implantation on chest wall, nipple areola complex position, infra-mammary fold definition, and skin envelope. Furthermore, contractures affecting adjacent territories may occur and add to the deformity. Surgical correction should address all the deformity components. Thus, a structured reconstructive plan that recruits different mammaplasty techniques and deals with adjacent territories is needed. This work presents different strategies used in treating severe post-burn breast deformities. Elaborate analyses of the deformities, surgical techniques, and outcomes are presented and a structured reconstructive plan is proposed.

Methods

Sixteen deformed breasts in 11 patients (mean age, 22 years) were managed. The techniques used included a variety of mastopexy techniques, prosthesis-based endoscopic breast reconstruction, and autologous breast augmentation with fat grafting or local flaps in some hypoplastic cases. Ancillary procedures to the neck, axilla, and abdomen were carried out to release the breast when tethered by their contractures.

Results

Considerable improvement and reasonable symmetry were achieved in most cases. All patients were satisfied with the results, tolerated the need for multiple procedures, and accepted residual minor asymmetries.

Conclusions

A post-burn breast deformity has a complex nature that may be addressed on multiple stages with different techniques of mastopexy, augmentation, and reconstruction. Ancillary procedures to a contracted adjacent territory may be needed to release the breast if tethered. Adopting a structured reconstructive plan may help obtain reproducible constant results. Level of Evidence: Level IV, therapeutic study.     

How to Perform Breast Augmentation Safely for a Pectus Excavatum Patient

Background  

Pectus excavatum is the most common chest wall deformity. Women with pectus excavatum may have associated hypoplastic breasts and often desire breast augmentation. This report describes how to perform breast augmentation safely for a pectus excavatum patient.     

Blasenaugmentation und -ersatz bei Kindern und Jugendlichen

Background

In children and adolescents, the indication for continent urinary diversion or bladder augmentation is rare. Today, for most patients with a neurogenic bladder, conservative treatment (clean intermittent catheterization [CIC] and pharmacotherapy) is the method of choice, while for patients with bladder exstrophy-epispadias complex (BEEC), primary reconstruction is recommended. Only after failure of conservative treatment or primary reconstruction should bladder augmentation or urinary diversion be considered. Other rare indications include patients with malignant tumor involving the lower urinary tract (e.?g., rhabdomyosarcoma).

Discussion

In patients with a hyperreflexive, small capacity, and/or low compliance bladder with a normal upper urinary tract, bladder augmentation (bowel segments/ureter) is an option. For those unable to perform CIC via the urethra, a continent cutaneous stoma should be offered. In patients with irreparable sphincter defects and normal renal function, a continent cutaneous diversion is an option and in those with a competent anal sphincter the rectosigmoid pouch can be offered.

Conclusion

In this review, surgical options with their advantages and disadvantages are discussed.

     

Intraoperative dreidimensionale Bildgebung – nützlich oder notwendig?

Background

With reference to two large retrospective studies we would like to make a contribution to the discussion whether intraoperative 3-dimensional imaging is only a helpful tool or state of the art for some special indications.

Methods

To answer this question the intraoperative revision rates of syndesmotic injuries and calcaneal fractures were analyzed over a period of 10 years and 8 years, respectively. Additionally, the clinical outcome was evaluated depending on the restoration of the joint reconstruction.

Results

Intraoperative revision rates of 32.7 % of 251 syndesmotic injuries and 40.3 % of 377 calcaneal fractures were found. The mutivariate analysis showed that residual joint incongruity leads to significantly worse clinical and radiological outcome of calcaneal fractures.

Conclusions

Correct assessment of alignment and joint line reconstruction are not possible by means of fluoroscopy in every case of syndesmotic injuries and calcaneal fractures. Therefore, intraoperative 3-dimensional imaging should be used in the treatment of these injuries due to the high intraoperative revision rates and the clinical relevance.     

Bilateral V–Y rotation advancement flap for fingertip amputations

Background  

Fingertip amputation is the most common type of injury in the upper limb. Goals in fingertip amputation reconstruction are covering the defect, establishing maximum tactile gnosis, keeping the length of the finger, protecting the joint function, acquiring a well-padded pulp tissue, providing a bed for growing nail, obtaining a satisfactory cosmetic appearance and allowing the patient to return to work as soon as possible. Adjacent skin and soft tissue are the best covers for fingertip injuries. However, local homodigital flaps lack enough tissue to cover the defect. To solve this problem, we used V–Y rotation advancement flap bilaterally in fingertip amputations which meets all the reconstruction goals. Rotation besides advancement makes this flap more mobile and easier to cover larger defects in all amputation planes.     

Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution

BACKGROUND:

In 2008, the authors’ institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions.

OBJECTIVE:

To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data.

METHODS:

Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room.

RESULTS:

The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55).

CONCLUSION:

In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.     

What are Predictors of Mortality in Patients with Pelvic Fractures?

Background  

Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information.     

Chemical injuries of the oesophagus: aetiopathological issues in Nigeria

Background  

Chemical injuries of the oesophagus occur worldwide. There is paucity of information on aetiopathological profile of chemical injuries of the oesophagus in Nigeria.     

Vertical Scar Mastopexy with a Cat’s Tail Extension for Prevention of Skin Redundancy: An Experience with 17 Consecutive Cases After Mastopexy and Mastopexy with Breast Augmentation

Background  

Mastopexy with or without augmentation is a commonly performed procedure. Marking, orientation of the flap and, in simultaneous augmentation, pockets for the implants can be selected in any combination. Vertical scar mastopexy, with or without augmentation, is commonly performed, with a high revision rate for skin redundancy. A new technique called the “cat’s tail” extension of the vertical scar is a simple modification developed to avoid this complication.     

Breast Augmentation, Antibiotic Prophylaxis, and Infection: Comparative Analysis of 1,628 Primary Augmentation Mammoplasties Assessing the Role and Efficacy of Antibiotics Prophylaxis Duration

Background  

Infections after augmentation mammoplasty are not uncommon, and prophylactic antibiotics are routinely administered to minimize infection. However, there is paucity of information on the relationship between the length of prophylaxis cover and its benefits in primary augmentation mammoplasty. A retrospective analysis of different antibiotic cover regimens, their effectiveness in preventing infections, and the management of infection in established cases is reviewed.