A case in which a growing and painful mass developed in the breast 10 months after fat injection following trochanteric and abdominal liposuction is described. Treatment included lumpectomy and breast reconstruction in a second stage by bilateral subpectoral augmentation mammaplasty with textured gel-filled prostheses. Histologic examination revealed a liponecrotic pseudocyst. The development of pseudocysts and microcalcifications after breast autologous fat injection is a complication that warns against using this technique for breast augmentation.
Infection of a median sternotomy wound is a rare though potentially fatal complication. Despite early diagnosis and proper treatment, prognosis is poor because of the chance of mediastinal spread of the infection and the poor physical state of these patients. Muscle repair is superior to more conservative surgical options such as sternal resuturing with mediastinal irrigation. During the last 10 years, complications--including sternal infections and dehiscences--have been encountered in 172/4725 median sternotomy wounds after cardiac surgery procedures (4%). Thirty-four patients (of whom 30 had acute sternal infections and four chronical sternal infections) underwent aggressive sternal debridement followed by muscle flap closure. Seventy-two muscle flaps were carried out, a pectoralis major bilateral muscle flap being the most common either alone or in combination with a rectus abdominis muscle flap. Five perioperative deaths (15%) were recorded. Of the 29 surviving patients, 25 patients (74%) were free of infection and four (12%) developed recurrence of the infection after a mean follow up of 3 years (range 49 days-8 years). We conclude that although muscle repair is not free of complications, it is reliable in reducing mediastinitis-related morbidity and mortality.
The appearance of psychiatric disorders among plastic surgery patients is well-known, and its frequency is higher than in other surgical branches. There is evidence that these patients may suffer from body dysmorphic disorder (BDD), a mental disorder characterized by excessive concern about some imaginary or slight physical defect, causing significant clinical discomfort, social deterioration, and losses in other important areas of the individuals' activity. We present a typical case of BDD and discuss diagnostic criteria and the proper attitude the plastic surgeon should adopt toward this kind of patient.
A technique of cervical gastrostomy is described. Cervical gastrostomy as an alternative to the use of an indwelling nasogastric tube after cervical oesophagogastrostomy after resection for cancer has been used in six patients and appears to have certain advantages in terms of effective gastric decompression, avoiding discomfort to the patient, and simplification of postoperative nursing. It may play a significant role in reducing postoperative mortality from aspiration pneumonitis and other pulmonary complications.Recent advances in the surgical treatment of oesophageal cancer have led to a higher resectability and reduced postoperative mortality and morbidity rates. Among the most serious and frequent postoperative complications are anastomotic leaks and lung complications. Nowadays, leaks are less frequent as a result of better preoperative preparation, by parenteral feeding, by improved anastomotic techniques and the recent general tendency to perform total oesophagectomy followed by a cervical anastomosis. There are two reasons for this development. First, total oesophageal resection has reduced the incidence of local recurrence of the tumour from submucous longitudinal lymphatic spread. Second, there is the important observation that the mortality rate resulting from a fistula after cervical anastomosis is considerably less than that after an intrathoracic fistula. But postoperative lung complications, chiefly aspiration pneumonitis, also remain a major cause of postoperative difficulties. To a certain extent these can be prevented by better preoperative preparation, intensive pre-and postoperative thoracic physiotherapy and improved anaesthetic techniques,' but in spite of these measures, postoperative lung complications remain a significant cause of death. In a series of cases reported by Belsey, 15% of the operative fatalities resulted from aspiration pneumonitis (Belsey,
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