Therapeutic, IV.

The nose is an important landmark of the face and its shape and beauty is of significant concern. The columella is the subunit between the two nostrils that provides support and projection to the nasal tip and has functional role in nostrils, as well as aesthetic. Ethiology for columellar absence or deficiency is diverse, and it is one of the most complex nasal subunits to reconstruct because of its narrow horizontal dimension, its tenuous vascularity and limited availability of adjacent tissue. We present a patient with columellar, membranous septum and upper lip defect, due to oncological resection. The lip reconstruction was designed using advancement of two upper lip edges with the technique of webster perialar/nasocheek advancement. However, the perialar/nasocheek tissue which is usually discarded was used as inferiorly based skin flaps to reconstruct the membranous septum, columellar skin and nasal vestibule lining. Rib cage cartilage graft was used as columellar strut for support. At 1-year follow-up, the patient has good nasal contour and projection. Scaring of the columella is very subtle. This is a versatile way for successful reconstruction of a columella and large central facial defect in one-stage operation. It is a method which provides very satisfactory aesthetic result with minimum patient morbidity and discomfort.

Aim: Skin grafting is a common clinical practice for plastic surgeons, yet primary contraction of these grafts is a neglected topic. This study was designed to investigate primary contraction and introduce the shape of skin graft as a possible factor that modifies primary contraction behavior, using porcine models. Methods: In the first series, full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs) were compared. In a second series, how the shape of the skin graft affected the degree of contraction was examined. Results: The mean percentage of FTSG shrinkage was 12.04%, and the median was 12.18%. The mean percentage of STSG shrinkage was 6.87%, and the median was 5%. Circle-shaped and square-shaped FTSGs showed mean/median graft shrinkage of 5.83%/6.93% and 4.15%/3.75%, respectively. In STSGs, the circle-shaped and square-shaped grafts had mean/median graft shrinkage of 1.07%/0% and 0.31%/0%, respectively. Conclusion: Our preliminary report revealed an expected greater shrinkage of FTSGs compared with STSGs. Furthermore, in a limited number of specimens, the shape of the skin graft seemed to affect the primary contraction of the STSGs.

Addition of BtxA injection into a muscle immediately after myotomy may interfere with muscle healing and contribute to a more successful long-term result.

Sir, Breast augmentation (BA) remains the most common aesthetical operation performed worldwide [1,2]. It is considered as a simple, reliable procedure with a low complications rate. Early complications such as hematoma, seroma and infection are well known and were referenced in the scientific literature [3]. However, we have not found any published studies regarding early seroma, leaking through the surgical wound (leaking seroma). The goal of this letter is to describe leaking seroma (LS) as an early complication following breast augmentation, to present our thoughts regarding the etiology of LS, patients' risk group, potential treatment and ways to prevent it.We reviewed 350 consecutive patients that underwent breast augmentation by the same surgeon (ABB) in a private medical center during the years 2007-2012. Breast fascial closure was performed with interrupted stitches in 172 patients (49.1 %) and with running interlocking stitches in 178 (50.9 %). Drainage was not used in any of the patients operated in this series. Medical files and operating records were extracted, and all data were statistically analyzed. We defined leaking seroma as a serous exudate discharging from surgical wound, ranging from spots on the dressing to massive fluid leak. Empirically, chosen regimen for treatment of LS, including oral antibiotic, iodine ointment dressing, non-steroidal anti-inflammatory drugs (NSAID), and complete patient rest, was employed.Seventeen patients (4.86 %) showed signs of leaking seroma, in 16 cases unilateral and in one case bilateral. Among 350 patients, two identical female twins were operated and both of them developed LS symptoms. The incidence of LS during the study period gradually decreased as shown in Table 1. Lag time between the operation date and first LS symptoms appearance varied from 5 to 50 days with mean value 15.9±11.6 days. In five patients with massive leak, the fluid from the wound was obtained for bacteriologic examination; in this group all bacterial cultures were sterile.LS treatment regimen included oral antibiotics (usually Ceftin 500 mg×2/day), iodine ointment dressings, non-steroidal anti-inflammatory drugs (NSAID), and rest until the symptoms' cessation. This treatment was successful in 13 out of 17 patients (76.5 %) and duration of their symptoms ranged from 3 to 20 days with mean value 8.6±4.8 days. Patients' postoperative course was uneventful thereafter.The lack of data regarding LS in the plastic surgery literature can be explained by problematic definition of the subject. Usually, breast implant exposure and extrusion are the result of infection. It is very difficult to differentiate leaking seroma from sub-clinical infection. In our cases, the fluid discharge from the wound was serous and pellucid; all wound cultures obtained from patients with massive leak were sterile. Previous antibiotic treatment may have prevented bacterial growth and as a result, may lead to a negative bacterial culture. The lack of data can also be explained by under-reporting of postoperative comp...

Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.