Objective — to determine the feasibility and effectiveness of using custom‑made and 3D‑printed mandibular implants in patients with microgenia, and to investigate their quality of life and satisfaction with aesthetic results during a two‑year follow‑up. Materials and methods. 21 patients participated in the study, with 14 (66.7 %) women and 7 (33.3 %) men. The average age of patients was 23.4 ± 2.3 years. All patients had signs of microgenia. In our study, a CT scan of the skull without contrast enhancement served as the primary diagnostic tool. Polyetheretherketonen (PEEK) was the material of choice for the implants. Results. Among the early postoperative complications were alterations to the sensation of the skin overlying the lower lip, which was restored within 1 — 2 months, and bruising, which had a tendency to spread to the neck. None of the patients had impaired motor innervation of the lower lip. Hematoma and wound suppuration were not detected either. One or two years after surgery, none of the patients had any delayed complications, including implant displacement, bone resorption in the lower jaw, decreased motor activity of the facial muscles, or altered sensation affecting the lower lip. Aesthetic results were assessed after the one‑year follow‑up. In a sample of 21 patients, the aesthetic outcome was excellent in 18 (85.7 %) patients and good in 3 (14.3 %) patients. No patients had bad aesthetic outcomes. Conclusions. The absence of delayed complications and the low risk of early complications, which in 71.4 % of patients only present as a temporary alteration to the sensation affecting the lower lip, indicate the safety of the suggested method. In all patients after mentoplasty with custom‑made implants, the physical and mental components of health improved statistically (with all values p < 0.05). Excellent aesthetic outcomes were observed in almost all patients (85.7 %) after mentoplasty with custom‑made implants.
The aim — to increase the treatment efficacy for patients with cosmetic defects of the anterior abdominal wall by introducing new simultaneous operations techniques in combination with lipoabdominoplasty.Materials and methods. The original procedure was used in 42 patients (the main group). The comparison group included 40 patients. The average age of patients in the main group was 38.2 ± 2.8 years, and 41.1 ± 2.3 years in the comparison group. 35 (83.3 %) of the patients in the main group were either obese or overweight (average BMI 34.2 ± 1.9), the maximal patient’s body weight was 113 kg. In the comparison group, the average BMI was 35.1 ± 1.7, the maximal patient’s body weight was 117 kg. The term of postoperative observation was 12 months.Results and discussion. The average duration of surgical intervention was 129 ± 15 min in the comparison group and 170.2 ± 6.5 minutes in the main group, which was caused by the additional liposuction procedure. The average volumes of liposuction were 1253.6 ± 36.2 ml and ranged 250 — 2750 ml. Volumes over 1000 ml were observed in 30 patients (71.4 %). 6 complications (13.3 %) developed in the main group and in 12 patients from the comparison group (30.0 %).Conclusions. The lower level of postoperative complications in patients with 13.3 % with a potentially high risk compared with traditional abdominoplasty — 30.0 % (p < 0.05), is an important argument in favour of lipoabdominoplasty. When evaluating the result after 12 months, the advantage of an excellent result in the main group was found to be 71.2 %, as opposed to 37.5 % in the comparison group.
The aim — to determine the possibility of using Laser Doppler flowmetry (LDF) for the study of blood flow in the vessels of the anterior abdominal wall in order to improve the results and develop new methods of treatment of patients with cosmetic defects of the anterior abdominal wall in patients with obesity I — II stage.Materials and methods. The study of blood flow on the anterior abdominal wall using LDF scan was performed in 132 patients, predominantly females 116 (87.9 %). The average age of patients was 43.4 ± 10.3 years. All patients had obesity of grade I or II. The average body mass index was 32.8 ± 2.7 kg/m2. The patients were divided into two groups: the main group — 64 (48.5 %) patients who underwent abdominoplasty in combination with other simultaneous operations and liposuction (lipoabdominoplasty), and the control group — 68 (51.5 %) patients who underwent abdominoplasty in combination with other simultaneous operations without liposuction. The mean duration of the operation in the main group was 255.3 ± 23.5 min., in the control group — 210.2 ± 21.2 min. Patients were examined in the preoperative period according to the standards of the Ministry of Health of Ukraine. LDF was performed before and during surgery and within 10 days of the postoperative period to determine the microcirculation indices (MI) of the anterior abdominal wall.Results and discussion. The study of MI in the control and main groups prior to the treatment, no statistically significant difference was found between the groups (p = 0.83). Immediately after the operation, the relationship between low‑frequency rhythms, which characterize the active mechanism of microcirculation, and high‑frequency and heart rhythms is disrupted. Normally, the amplitude of vasomotions is 20 — 25 % of the level of the LDF signal, immediately after the operation it decreases to 46 — 55 % at an oscillatiofrequency of 6 — 8 per minute. The average period of recovery of MI to the initial level is 8 days, the maximum is 11 days (for a smoker with type 2 diabetes). A decrease in the level of microcirculation within 1 — 2 days after surgery was 5.2 % bigger in the liposuction group than in the control group. There was no statistically significant difference between the groups in the dynamics of changes in MI during the study period (p = 0.767).Conclusions. The study showed that during lipoabdominoplasty there is no critical reduction in the microcirculation in the flaps compared to the classical abdominoplasty. «Ischemic crisis» in the flaps after lipoabdominoplasty is present during the first 2 days of the postoperative period. In the future, the progressive recovery of microcirculation in the flaps is noted. The safety of simultaneous abdominoplasty with liposuction has been proven. The advantage of lipoabdominoplasty is better mobilization of flaps which reduces the necessary dissection of the flap, preserves the musculo‑dermal perforants, helps to obtain better body contours and reduce the risk of repeated corrections in the postoperative period.
The aim — to determine the possibility of using Doppler blood flow in the vessels of the anterior abdominal wall in order to improve the results and develop new methods for treating patients with cosmetic defects of the anterior abdominal wall during lipoabdominoplasty.Materials and methods. Investigation of the vessels of the anterior abdominal wall using Doppler scan was performed in 58 patients. The average age of patients was 38.2 ± 2.8 years. All patients were either obese with grade I, II or overweight (average body mass index 30.2 ± 1.5). Patients were examined in the preoperative period in accordance with the standards of the Ministry of Health of Ukraine. All patients had primary lipoabdominoplasty. Doppler flowmetry was performed before surgery and on day 14 after lipoabdominoplasty to assess the blood supply to the anterior abdominal wall.Results and discussion. Most muscle‑skin perforators were located at distance of 5.2 ± 0.3 cm from the median line. In the preoperative period in average 6.12 ± 1.31 perforators were detected in one patient. The average diameter of the vessels was 1.55 ± 0.8 mm. In the postoperative period, 3.25 ± 1.27 perforators with a diameter of 1.68 ± 0.75 mm were detected, which confirms the preservation of arterial branches after surgery. The average diameter of the vessels was 1.68 ± 0.75 mm, which confirms the preservation of the arterial branches after the operation. The increase in vessel caliber was statistically significant (p < 0.05). The average blood flow velocity in the vessels increased by 56 % (from 21.8 ml/min before surgery to 34.3 ml/min after surgery, p < 0.05). Vasodilation changes are explained by a decrease in the blood supply to the tissues caused by surgical trauma, a decrease in the total number of perforators and an overload of the residual vessels.Conclusions. Preoperative determination of perforated vessels helps to estimate the possibilities of resection of the flaps, determine the areas of possible dissection and volume of the entire operation. The risk of complications after abdominoplasty can be reduced by a limited flap dissection and the preservation of perforated vessels in the flap. It has been shown that in the course of lipoabdominoplasty perforation vessels with a diameter of more than 1 mm in periumbilical and upper lateral quadrants are not destroyed. During Doppler study in the postoperative period, an increase in the caliber of the arteries (p < 0.05) and the rate of blood flow in them was found to be 56 % (p > 0.05).
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