This study assesses whether the routine submission of mastectomy scars for histologic examination at the time of delayed breast reconstruction is useful. A retrospective review was performed of all delayed breast reconstructions for breast cancer performed by a single surgeon over a 5-year period from January 2000 to December 2004. One hundred eighty-eight patients underwent delayed breast reconstruction during this period, and of these, 133 scars (1 patient had bilateral scars excised) were submitted for histology where the reconstruction was performed by either transversus rectus abdominus muscle flap (TRAM) or latissimus dorsi myocutaneous flap (LDF) +/- implant. Fifty-six patients had reconstruction performed by tissue expander through the inframammary crease where the original mastectomy scar was not excised and were excluded from the study. One mastectomy scar specimen showed a 2-mm suspicious area of invasive ductal carcinoma consistent with same histopathology at the time of mastectomy. This study corroborates evidence that it is questionable whether routine histopathology of mastectomy scar at the time of delayed breast reconstruction should not be a standard practice.
A 10-week-old, 4.5 kg female Weimaraner dog was referred to the Chonbuk National University, Animal Medical Centre with signs of regurgitation after weaning. The cervical oesophagus was palpable as a flaccid, air-filled cavity. The thoracic radiographs revealed oesophageal dilatation cranial to the heart and constriction at the level of third rib. A presumptive diagnosis was made as persistent right aortic arch (PRAA). A left 4th intercostal thoracotomy was performed and the definitive diagnosis was made as PRAA with left ligamentum arteriosum (LA) and an aberrant left subclavian artery (SA). The oesophagus was found dually compressed and severely necrosed. The corrective surgery comprised of transection of the LA as well as resection and anastomosis of the oesophagus, which resulted in a complete alleviation of the clinical signs.
A two-years-old, intact female, Shih-Tzu dog weighing 5 kg was presented to the Chonbuk Animal Medical Centre, College of Veterinary Medicine, Chonbuk National University, with the history of bone ingestion before two days. The survey radiographs of the thorax revealed a bone at the caudal thoracic oesophagus. An oesophagram was performed which did not reveal any oesophageal leakage or perforation. The left caudolateral thoracotomy was performed and the caudal oesophagus was found partially necrosed, friable and inflamed. The necrosed, friable part was removed and the oesophageal defect was reconstructed using a full-thickness muscle flap collected from the diaphragm. A part of the omentum was mobilized from the abdomen and sutured over the reconstructed site of the oesophagus to aid healing. Oesophagoscopy after nine days postoperatively showed a good adhesion of the diaphragm flap. The patient showed normal activity after 12 days and no complications were observed during a one-year follow up period. The pedicle flap collected from the left hemidiaphragm in addition to the omentum flap can be successfully used to reconstruct the circumferential oesophageal defect.
FIGURE 2. Late appearance of a successful (left), partially failed (center), and totally failed (right) bipedicled free epigastric skin flap. FIGURE 1. Prepared bipedicled epigastric skin flap for free transfer.
Background: Rhinoplasty is the most challenging surgical procedure amongst all the aesthetic/cosmetic operations. As for the challenges with rhinoplasty are great, so the need of minimal invasive techniques, less scarring, quick recovery especially in the asian nose with thick sebaceous nasal tip skin. The aim in beautification rhinoplasty is to improve the aesthetic proportions, volumes, and angles of the nose, adapted to the face as a whole. Frequently the patient desire is to achieve symmetrical, smaller, more attractive nose with better respiration, which require the identification of aesthetic and functional problems to execute the planned operation. Study Period: The author have had performed fifty seven rhinoplasty procedures from July 2014 to July 2017 with almost 6 months follow up period. Material and Methods: The techniques used for almost all rhinoplasty procedures includes T-excision, humpectomy, macidonian technique for lateral digital osteotomy, columellar sliding and nasal tip refinement. Where needed combined with septoplasty, turbinectomy, polypectomy etc additional procedure in nine patients out of fifity seven. Serdev Sutures® in rhinoplasty include: tip rotation, refinement / narrowing of the tip, lower and medial thirds, alar base narrowing and nasal dorsum lifting of concavities and irregularities. Results: With the advancement in minimal invasive techniques, it has become possible to achieve excellent satisfactory results (80 -100 % by using visual analogue scoring system), where indicated combined with ENT Surgery. Conclusion: The correct nose proportions, angles, and volumes guides the appropriate procedure to the surgeon. By using advance minimal invasive techniques provide predictable results for close rhinoplasty, nearly normal “nonoperated appearance” after atraumatic mini-invasive surgery.
Objective / Purpose of the Study: For abdominal reshaping / contouring, patient with excess abdominal skin and redundant fat quite often require abdominoplasty / tummy tuck. Inconsistent results achieved with traditional liposuction especially in the supraumbilical area. This study is to assess the role of abdominal VASER liposelection and if the abdominoplasty can be avoided. Material and Methods: This is retrospective cross sectional observational study conducted at Dundrum Medical Cosmetic Clinic, Dublin 16, Ireland. The study period includes two years from March 2009 to February 2011. In this study total number of consecutive 85 patients, operated by single surgeon were included with type I-IV patient category according to Matarasso classification system (1). There were 10 (11.8%) male and 75 (88.2%) female patient with mean age 42.4 years ± 10.95 years. Results: All of the 85 patients were treated with abdominal VASER liposelection. There were 75 female (88.2%) patients and 10 male (11.8%) patients in this study. Seven (8.2%) female patient require second session of VASER liposelection procedure 3 months after the first procedure and 3 (3.5%) female patient underwent third session to complete the abdominal contouring. None of the total 10 male patient required 2nd or 3rd session of abdominal VASER liposelection. The satisfaction level achieved 90 to 100 % by using visual analogue scoring system for all types I - IV abdomen. No early or late complication was noted in this study. Conclusion: This is a low risk, minimally invasive, scarless ambulatory technique performed under local anaesthetic, highly satisfactory to the patient as well as surgeon and is effective in all the categories of protuberant abdomen avoiding the local and systemic risk of abdominoplasty.
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