Laser-assisted lipolysis is a safe and efficacious procedure that may possess advantages over conventional liposuction. Lipolysis occurs in a dose-response relationship. No advantage over tumescent liposuction has been demonstrated. A specific laser wavelength may prove superior for each clinical application, but more studies are needed.
Reconstruction of extensive defects after radical resection of soft-tissue sarcomas of the extremities has become an essential part of the limb salvage approach to the management of these tumors. The authors describe the successful use of a paraumbilical transverse rectus abdominis musculocutaneous flap with the pedicle based on the inferior epigastric artery for reconstruction of a 24- x 22-cm soft-tissue and skin defect of the anterior thigh after wide local excision of a recurrent malignant fibrous histiocytoma. The ability to mobilize a large amount of well-vascularized soft tissue from an acceptable donor site, the versatility of flap design, the extensive arc of rotation, and the dependability of the inferior epigastric vascular pedicle are all distinct advantages of using this flap in the reconstruction of massive defects of the thigh.
Introduction:
Conventional body contouring techniques such as liposuction, although now far less invasive, still require extended periods of recuperation and the use of compression garments. Several noninvasive techniques for soft tissue, adipose, and dermal treatment have been reported in the literature as also producing circumferential measurement reductions in patients. These results can now be correlated to evidence-based scientific methodology versus anecdotal reports.
Materials and Methods:
Patients were treated using the VASER Shape (Sound Surgical Technologies, Louisville, Colo) as part of routine practice. Circumferential measurements were made before and after treatments.
Results:
Two hundred and four patients were treated in 741 treatment sessions at 12 centers in the United States beginning in June 2010. When measured immediately after treatment, the patients experienced a 0.8-in circumferential reduction in the abdomen and a 0.5-in reduction on the thighs. Circumferential reduction continued over the course of treatments, resulting in reductions of more than 2-in and 1-in, respectively, in the abdomen and thighs. In no cases were any analgesics or anesthesia provided to patients before or during treatment. In general, the patients reported that the treatment was pleasant and felt warm but not uncomfortable. After treatment, patients were able to continue with their normal daily routines. Patients reacted positively to the procedure and the immediacy of results, and many reported that their clothes fit better when they dressed after treatment. In addition to circumferential measurement changes, patients also reported the sensation of feeling tighter in the treated area and that the treated areas had smoother skin.
Conclusions:
The VASER Shape system presents a novel approach to achieving immediate circumferential measurement reduction noninvasively with no patient downtime.
Locally advanced, node-positive recurrence of malignant melanoma is a harbinger of distant metastases and signifies poor prognosis. However, the clinical course may vary due to the unpredictable biology of malignant melanoma. The presented patient developed a recurrent melanoma of the scalp that eroded through the skull and involved regional lymph nodes with extracapsular extension. He was treated with wide local excision of the recurrence, bilateral posterolateral neck dissection, and immediate microvascular reconstruction followed by adjuvant radiation therapy. The patient remains free of disease at 12 years. This case illustrates that an aggressive resection should be considered for the operable patients with locally advanced recurrent melanoma to render them disease free surgically.
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