Background: Palpable lumps as sequelae of fat necrosis after fat grafting to the breast may not only cause physical or psychological symptoms to patients but also potentially complicate breast cancer screening. In this article, the authors present their experience in management of fat necrosis following fat grafting for breast augmentation. Methods: Over a 5-year period, a total of 685 Asian women (age range, 20 to 58 years) underwent autologous fat transplantation to the breasts. The average volume of fat graft to each breast was 205 ± 45 cc. The preoperative and postoperative photographs and the breast volume were recorded. Detection of fat necrosis was based on clinical examinations and imaging studies. The mean follow-up was 208 ± 36 days. Results: The mean volume increase was 135 ± 20 cc in a single breast, with a mean graft retention rate of 65 percent. Sixty-six patients (9.6 percent) were found to have fat necrosis in the form of solitary or multiple cysts, sclerotic nodules, or calcifications in either one or both breasts postoperatively. The average time before first detection of the breast lump was 108 ± 45 days. Management of fat necrosis included aspiration or excision based on the authors’ treatment algorithm. The symptoms related to fat necrosis such as discomfort on palpation, pain, or possible skin reaction were significantly improved in 54 of 57 patients (94.7 percent). Conclusions: Fat necrosis following autologous fat grafting for breast augmentation can be managed successfully and its related symptoms can be relieved in 94.7 percent of patients. It can be approached safely based on a sound algorithm developed by the authors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The omental free flap is a valuable option for reconstructive efforts in nearly all anatomic regions. This is a result of its inherent anatomy and vascularity, and its angiogenic, immunogenic, and lymphatic properties.

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Lower extremity reconstruction often poses several challenges for the reconstructive surgeon. Because of limited local tissue options, patients who sustain extensive middle to distal third tibia fractures used to be at higher risk of limb loss without adequate soft tissue coverage. The traditional principle of reconstructing middle and distal third leg wounds with free tissue transfer is being challenged by advances in understanding of local muscle flap anatomy and surgical techniques to improve the efficacy of local flaps. In this article, we examine contemporary considerations, developed by the authors, for the appropriate indications of free tissue transfer versus use of local flaps such as the soleus muscle flap. We review the versatility and reliability of the soleus muscle as a local muscle option once the technique is mastered on how to safely and effectively design and execute this flap. We highlight the importance of an algorithmic approach to soft-tissue reconstruction of the lower extremity based on the best surgical option for the patient. This includes factors such as medical history, appropriate surgical candidacy, as well as the size and mechanism of injury to decide the most viable option for lower extremity reconstruction. We show that the medial hemisoleus muscle flap is a reliable local option, both by itself or in conjunction with other local flaps, to reconstruct less extensive wounds in the middle to distal third of the leg. Ultimately, such a local muscle flap must be mastered by the reconstructive surgeon to augment his or her armamentarium to provide a well-rounded reconstructive plan in managing the soft-tissue wound, while minimizing donor-site morbidity and potentially be more cost-effective in nature.

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Inhibitory control dysfunction was considered a universal characteristic of violent offenders. The aim of this study was to examine differences in inhibitory control between two subtypes of violent youth; those displaying predominantly impulsive and those presenting predominantly premeditated aggression (PM). Forty-four juvenile offenders, defined on the basis of the Procedures for the Classification of Aggressive/Violent Acts (Stanford and Barratt, 2001) participated (N = 23: impulsive; N = 21 premeditated). A visual Go/NoGo task was used to compare behavioral responses and event-related potentials (ERPs) between groups. The task contained two letters (W and M), W was the Go stimulus and M the NoGo stimulus. The impulsive youth showed a significantly greater decrease in N2 latency for Go relative to NoGo trials than the premeditated aggressive youth. The differentiation in N2 amplitude between Go and NoGo (N2d) was negatively correlated with impulsivity of aggression. Both groups showed no significant central NoGo P3. Our findings suggest that impulsive violent youth show stronger prepotent responses and impaired conflict monitoring during early inhibitory control processing relative to premeditated aggressive youth. Both impulsive and premeditated violent youth may show impaired response inhibition at the late processing stage of inhibitory control.

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Background Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to transfer soft tissue of a sufficient quality to within the defect while minimizing donor site morbidity. Refinements in scalp reconstruction consist of both improvement in reducing donor site morbidity and enhancing recipient site contour and balance. Furthermore, technical advancements and the vast experience within our field have allowed for preoperative evaluation of recipient vessels that are more favorable in proximity to the scalp. Methods In this review, we aim to describe the contemporary approach to microsurgical scalp reconstruction. This is to include the indications of choosing free flaps as well as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty, recipient vessel selection, operative technique, and reoperations is also reviewed. In addition, our considerations and the nuances within each category are also described. Summary Scalp reconstructions involve the fundamental tenants of plastic surgery and demand application of these principles to each case on an individual basis and a successful reconstruction must consider all aspects, with backup options at the ready. Two workhorse free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps, serve a primary role in the contemporary approach to microsurgical scalp reconstruction. Conclusion We hope this review can lay the foundation for which future plastic surgeons may continue to build and advance the approach to complex microsurgical scalp reconstruction.