Vertical reduction mammaplasty using a superomedial pedicle is a well-accepted technique giving good results in mild to moderate breast hypertrophy. We describe modifications of the vertical reduction technique to achieve safe reductions even for very large breasts and minimize unsightly scarring, skin necrosis and poor shape. Over the past 4 years, 162 patients have undergone bilateral breast reduction using the vertical mammaplasty technique with a superomedial dermoglandular pedicle. We present a retrospective study of 23 cases of gigantomastia (reductions over 1100g) who underwent bilateral reduction mammaplasty, using our technique. The mean age was 49 years, BMIs ranged from 28 to 52 kg/m. The mean suprasternal notch-to-nipple distance was 40.5 cm on the right and 41.4 cm on the left. The average resection weight per breast was 1303 g on the right, and 1245 g on the left side. The suprasternal notch-to-nipple distance was reduced by between 13.2 and 36.0 cm (mean, 16.1 cm). Mean follow-up was 14 months. We observed a superficial infection in 2 patients, a deep hematoma in one patient, partial necrosis of the nipple-areola complex in 1, and 2 patients needed correction surgery due to dog-ear formation. By using the described modifications, the nipple and areola were safely transposed on a superomedial dermoglandular pedicle producing good breast shapes, while scarring and complications in vertical reduction mammaplasty for oversized breasts were effectively minimized.

Previous studies have assessed the effects of changes in microcirculation on wound healing; however, the influence of microcirculation on tissue histomorphology remains widely unknown. Reflectance-mode-confocal microscopy (RMCM) enables in vivo tissue observation on a cellular level. We present RMCM data evaluating the local microcirculation and assess the influence on histomorphology during burn healing. RMCM was performed in 12 patients (aged; 36.2+/-14.2 years, maximum-burn-extent: 4% total body surface area) at times 12, 36, and 72 hours after a superficial burn. The following parameters were assessed: quantitative blood-cell-flow (cbf), epidermal thickness (Emin), basal-layer thickness (tbl), and granular cell-size (Agran). Cbf was found to be 54+/-3.6 cells/minutes (control), increased to 91+/-3.6 cells/minutes (p<0.05) 12 hours postburn; decreased to 71+/-6.1 cells/minutes (p<0.05) (36 hours), and to 63+/-2.3 cells/minutes (p>0.05) 72 hours postburn. Emin was 43.74+/-3.87 mum (control), increased to 51.67+/-4.04 mum (p<0.05) 12 hours, decreased to 48.67+/-3.51 mum (p<0.05) 36 hours, and to 45.33+/-3.21 mum (p>0.05) at 72 hours postburn. Tbl was 14.17+/-0.6 mum (control), increased to 16.93+/-1.15 mum (p<0.05) 12 hours, decreased to 15.93+/-1.20 mum (p<0.05) 32 hours, and to 15.00+/-0.85 mum (p>0.05) 72 hours postburn. Agran was 718+/-56.20 mum(2) (control), increased to 901+/-66.02 mum(2) (p<0.05) 12 hours, decreased to 826+/-56.86 mum(2) 36 hours, and 766+/-65.06 mum(2) at 72 hours postburn. RMCM enables in vivo observation of wound microcirculation and allows direct assessment of vascular effects on cutaneous histomorphology during the healing course of superficial burns.

The effective treatment of severe burns is interdisciplinary, involving general practitioners and emergency physicians as well as plastic surgeons and physicians of other specialties. Knowledge of the basic principles of treatment enables physicians to care for patients with burns appropriately both in the acute setting and in the long term.

The purpose of this study was to assess if the healing course of burn wounds of indeterminate depth can be predicted based on serial in vivo reflectance-mode confocal microscopy (RMCM) analysis. Twenty-four patients (mean age, 33.1+/-11.4 years; mean burn size: 6% TBSA) were investigated at 12, 36, and 72 hours after burn of indeterminate depth and retrospectively grouped into healing group (HG: 16 patients) and nonhealing group (NHG: eight patients). Noninjured skin served as controls. The following parameters were assessed: quantitative blood cell flow (BCF), basal layer thickness (BLT), and inflammatory cells. At 12 hours postburn, BCF increased to 101.67+/-7.64 cells/min in HG vs 85+/-50 cells/min in NHG compared with controls (56.5+/-2.3 cells/min). At 36 and 72 hours, BCF increased to 115+/-10 cells/min and 125+/-50 cells/min in HG vs decreased to 80+/-5 cell/min and 75+/-5 cells/min in NHG (P<.05). At 12 hours postburn, BLT increased to 19.43+/-0.93 microm in HG vs 29+/-1 microm in NHG compared with controls (15.40+/-0.60 microm, P<.05). In HG, further gradual increase of BLT to 20+/-1 microm (36 hours) and 21+/-1 microm (72 hours) was observed, whereas BLT was destroyed after 36 hours in NHG. Qualitative assessment found insignificant amount of IC in controls and low amount in HG until 72 hours postburn, whereas progressive increase in IC from low amount (12 hours) to numerous (36 hours) and massive (72 hours) was observed in NHG. RMCM enables simultaneous evaluation of microcirculation, histomorphology, and inflammatory cell trafficking in burn wounds. RMCM may help to predict whether burns of indeterminate depth have the potential to heal and can be a valuable tool to clinicians to guide early therapeutic decision-making process in burn patients.

No abstract