Decreasing waist circumference has become an essential feature in modern body contouring surgery owing to the attractiveness of hourglass body shapes. Traditionally, this can be achieved through lipomodeling and abdominal musculature strengthening techniques. An adjunctive procedure for ideal shaping of the waistline is resection of the 11th and 12th ribs, referred to as floating ribs. This study aimed to report and analyze clinical outcomes and self-reported patient satisfaction after "ant waist" surgery (floating rib removal) for aesthetic reasons. We retrospectively reviewed the medical records of five patients who had undergone bilateral 11th and 12th rib resections at a single institute in Taiwan in an outpatient setting. The mean lengths of the resected left and right 11th ribs were 9.1 and 9.5 cm, respectively. The mean lengths of the resected left and right 12th ribs were 6.3 and 6.4 cm, respectively. The mean waist-to-hip ratio decreased from 0.78 preoperatively to 0.72 postoperatively, with a mean decrease of 7.7%. No adverse events were reported. Generally, all patients reported being satisfied with the operation. Floating rib resection proved useful and effective in decreasing the waistto-hip ratio using a safe, simple, and reproducible technique without significant complications. Although preliminarily, the authors' comprehensive demonstration of this ant waist surgery supports further studies focusing on waistline contouring.
Background: The most widely used method for breast reconstruction in Taiwan is alloplastic breast reconstruction, and traditionally, it can be categorized into immediate or delayed, single-stage or 2-stage procedures. We evaluated clinical outcomes and analyzed patients' self-reported satisfaction and quality of life after alloplastic breast reconstruction based on a previous preliminary study. Patient and Methods: The patients who underwent primary alloplastic breast reconstruction after mastectomy were recruited in 2006 to 2020 at a single institute in Taiwan. The assessment of clinical outcomes was conducted by retrospective chart review and risk analysis. The patients also completed the BREAST-Q, a conditionspecific patient-reported outcome measure, at least 6 months after treatment. Results: A total of 237 patients with 247 reconstructed breasts were enrolled in this study. The demographics showed that 205 (83%) were reconstructed using a 2-stage tissue expander-based procedure and 42 (17%) were 1-stage direct-toimplant reconstructions. The mean follow-up time was 79.5 months. The clinical assessment revealed that the overall complication rate was 34%, with infection being the most common (21 patients; 8%). According to risk analysis, smoking (odds ratio, 7.626; 95% confidence interval, 1.56-37.30; P = 0.012), and nipple-sparing mastectomy (odds ratio, 3.281; 95% confidence interval, 1.54-6.99; P = 0.002) were significant risk factors for overall complications. The questionnaire response rate was 38% (94 of 247), at least 6 months after treatment. The total mean score was 69.78. Conclusions: At a single institute in Taiwan from 2006 to 2020, alloplastic breast reconstruction, either single-or 2-stage, have acceptable complication rate and good postoperative satisfaction based on patient-reported outcomes. Both patientand surgery-related factors presented as significant risk factors. Precise patient selection and comprehensive discussion between the patient and physician may play the important role to achieve optimal aesthetic outcomes.
The mortality rate from firearm injuries in the United States has decreased from 30.3 per 100,000 people in 1990 to 20.6 in 2010, likely because of improvement in treatments. However, the incidence of gunshot wounds continues to increase, including the number of mass shootings, even though the definition of which is still unclear. According to Gun Violence Archives, there were 346 mass shootings in the United States, defined as 4 or more injuries in a single incident, in 2017, with 437 deaths and 1803 injured. This article briefly reviews the ballistics of firearms pertinent for maxillofacial surgeons and summarizes the lessons learned from caring for patients with ballistic injuries to the craniofacial region based on the available peer-reviewed publications and the authors' combined experience of more than six decades. Specifically, we discuss in details the roles of plastic surgeons as a member of the multidisciplinary trauma team in the following three phases: damage control, definitive treatment, and long-term rehabilitation.
Summary: The keystone design perforator island flap has been gaining popularity for reconstructing large cutaneous defects with sufficient soft tissue laxity. However, for a defect with insufficient local tissue and tense laxity such as upper to mid-back, a single keystone flap may not be so suitable for advancement and mobilization. Instead of an additional flap or double-opposite-designed keystone flaps, we attempted to apply the vessel loop shoelace technique for external expansion before proceeding with only one keystone flap reconstruction for a 15 × 15 cm skin and soft tissue defect on the mid-back. The outcome was a viable flap, with no ischemic flap edge, wound dehiscence, or infection. In our opinion, external expansion with vessel loops followed by a keystone flap might yield fairly good results for the reconstruction of mid-back defects; furthermore, this method may be ideal for defects located in regions lacking sufficient skin laxity.
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