A new and serious complication was experienced by patients of three independent surgeons following routine augmentation procedures. In each case reported, double-lumen prostheses had been used. All cases were reoperated with a diagnosis of capsular contracture. However, at surgery it was found that the outer lumen of the prostheses had overfilled with 60-160 cc of interstitial fluid, probably because of an osmotic gradient. The possible causes of this unfortunate complication are considered.
Skin-grafted subcutaneous adipose turnover flaps can be very useful in providing cover of exposed joints especially in critically ill patients. An exposed wrist joint due to a full-thickness electrical burn was successfully covered with a large turnover pure subcutaneous flap harvested from the forearm. Stable cover and good function with minimal donor site morbidity was achieved (22 months follow-up). The planning and the anatomical bases of this useful flap are discussed.A 42-year-old man was admitted 2 days after a severe 20-kV injury. He had extensive deep burns of the left shoulder and left thigh area. In addition, there was an area of full-thickness burn down to the bone, and joint cartilage over the right wrist, right thumb, and little finger were completely carbonized ( Fig. 1). Due to his critical general condition radical ddbridement of the right little finger and thumb amputation was delayed until the 24th postburn day. In addition, extended latissimus dorsi and trapezius musculocutaneous flaps were delayed. Twelve days later the musculocutaneous flaps were used for cover of the thoracic and right shoulder defects, split-thickness skin grafts for that of the thigh, and a subcutaneous turnover flap for that of the right wrist area (Figs. 2, 3). The musculocutaneous flaps healed uneventfully; there was a partial loss of grafts (60% on the thigh and 40% on the turnover subcutaneous flap). Ten days later repeat skin grafting was performed.The patient was discharged 62 days after the admission with a good, relatively pliable, and stable cover of the wrist joint. Fourteen months later a wrist arthrodesis and ulnar head excision reaction were performed for pain and poor wrist function (Fig. 4). A 22-month follow-up shows a satisfactory cover of the metal plate used in the arthrodesis, minimal donor site morbidity and good function of the three remaining fingers (Figs. 4, 5). Planning and surgical technique for the subcutaneous turnover flap over the exposed left wrist jointThe final area of the exposed bone and joint was 7x6 cm (Fig. 2). A K wire was inserted to allow temporary reduction of the displaced ulnar head. The flap was planned with a pedicle of 4x6 cm and a length of 22 cm (4+7 cm). A 15-cm longitudinal incision (4+4+11 cm) was performed along the midline of the flap; this extended just through the dermis (Fig. 2). Under tourniquet two very thin skin flaps were elevated in a plane just under the dermis for 3 cm, and the adipose subcutaneous flap was carefully separated with a scalpel from the muscular fascia, stopping at the limit of the pedicle (about 4 cm from the defect; Fig. 3). The subcutaneous flap was then turned over the wound and skin-grafted; the donor area was closed primari]ly. The thin skin flaps healed without problems, with a very fine scar, while the skin graft over the flap showed a partial loss (40%). A second skin graft 10 days later healed very well, providing good cover for the exposed joint. DiscussionThe main interest of this case is the use of the very large pure subcutaneous...
Several options are currently available for volume augmentation of the lips. Problems with some of these techniques include persistent numbness, partial or complete graft resorption, development of epidermal cysts, and extrusion or migration of the implants. We report our experience with 17 lip augmentation procedures in which we used a latissimus dorsi strip graft as the material to increase lip volume. The technique is simple, safe, and results in long-lasting and well-balanced fullness of the lip vermilion, as evidenced at 1-year follow-up.
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