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Autologous Fat Grafting as a Last Resort for Unsustainable Pain in a Woman with Multiple Osteochondromas.

Vera Lidwina NEGENBORN ; Esther MOERMAN ; Simon Johannes HAM

Archives of Plastic Surgery.2017;44(2):162-165. doi:10.5999/aps.2017.44.2.162

Multiple osteochondromas (MO) is characterized by the formation of osteochondromas throughout the entire body. Although the evidence regarding its pathogenesis is well understood, no curative treatment for the disorder is available. Patients can be treated symptomatically by surgical removal of painful osteochondromas. Unfortunately, some patients still suffer from severe pain, even after surgery. We report on a case concerning a 48-year-old woman with a history of MO who presented with persistent pain after surgical removal of a symptomatic osteochondroma of the left scapula and multiple symptomatic osteochondromas of the left foot and trochanteric region. Several interventions to reduce the pain did not have any lasting effect. Subsequently, she was treated with autologous fat grafting (AFG). After each session she was pain-free for at least one year and reported only partial recurrence of the pain. This is the first case report describing AFG for the treatment of pain after both surgical removal of an osteochondroma and symptomatic osteochondromas in a patient suffering MO with promising results. The treatment is more effective and clearly continues to remain active longer than injection therapy or pain medication. Future studies are necessary to confirm our results.
Adipose Tissue ; Exostoses, Multiple Hereditary* ; Female ; Femur ; Foot ; Health Resorts* ; Humans ; Middle Aged ; Osteochondroma ; Pain Management ; Recurrence ; Scapula ; Transplants*

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Photo Epilation with Intense Pulsed Light for Thinning of Anterior Hairline after Hairline Correction Surgery in East Asians.

Jae Hyun PARK ; Seung Yong LEE ; Seung Hyun YOU ; Na Rae KIM

Archives of Plastic Surgery.2017;44(2):157-161. doi:10.5999/aps.2017.44.2.157

BACKGROUND: Thin hairs are critical to achieve natural result in female hairline correction surgery. However, there are few studies on the usefulness of hair thinning by intense pulsed light (IPL) after hairline correction surgery in East Asian females. METHODS: Hair thinning using IPL was performed in 54 women who had complained about thick hairs along the frontal hairline after hairline correction surgery. Patient mean age was 31.2 years old and patients were an average of 2.1 years post-hairline correction surgery. Initial treatment used 10 J, while second and third sessions were conducted with 10 to 15 J according to responsiveness to treatment. RESULTS: Mean thickness of individual hairs assessed before the procedure was 78.86 µm. The mean number of procedures was 1.6 per patient. Forty of 54 subjects (74%) achieved satisfactory hair thinning with only one procedure from 78.01 to 66.14 µm after treatment. The measured thickness was 66.43 µm at the end of the first year in patients who were satisfied after one procedure. Thirteen cases achieved satisfactory hair thinning after two sessions. Mean thickness was 74.44 µm and 67.51 µm, before and after the second session. One case required a third session with 15J, thinning from 89.00 to 66.50 µm. CONCLUSIONS: Hair thinning by IPL is a very useful method to provide a natural look after hairline correction surgery in East Asians, who have naturally thick hair.
Asian Continental Ancestry Group* ; Female ; Hair ; Hair Follicle ; Hair Removal* ; Humans ; Laser Therapy ; Methods

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Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate.

Oscar J MANRIQUE ; Pedro CIUDAD ; Matthew DOSCHER ; Federico Lo TORTO ; Ralph LIEBLING ; Ricardo GALAN

Archives of Plastic Surgery.2017;44(2):150-156. doi:10.5999/aps.2017.44.2.150

BACKGROUND: Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. METHODS: A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. RESULTS: Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. CONCLUSIONS: When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.
Amputation ; Anti-Bacterial Agents ; Arm ; Cellulitis ; Fingers* ; Follow-Up Studies ; Hand ; Humans ; Occupations ; Osseointegration ; Postoperative Period ; Prostheses and Implants* ; Retrospective Studies ; Shoulder ; Titanium* ; Upper Extremity ; Visual Analog Scale

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Analysis of Pediatric Tendon Injuries in the Hand in Comparison with Adults.

Jin Sung KIM ; Seung Je SUNG ; Young Joon KIM ; Young Woong CHOI

Archives of Plastic Surgery.2017;44(2):144-149. doi:10.5999/aps.2017.44.2.144

BACKGROUND: The purpose of this study was to identify the epidemiologic characteristics of hand tendon injuries in children and to compare these with those of adults. METHODS: This retrospective study was conducted on acute traumatic tendon injuries of the hand treated at our institution from 2005 to 2013, based on medical records and X-ray findings. Age, sex, hand injured, mechanism of injury, tendons and zones injured, number of affected digits, and comorbidities and complications were analyzed. Patients were divided into 2 groups: a pediatric group (≤15 years) and an adult group (>15 years). RESULTS: Over the 9-year study period, 533 patients were surgically treated for acute traumatic tendon injuries of the hand. In the pediatric group (n=76), being male, the right hand, the extensor tendon, complete rupture, the middle finger, and glass injury predominated in hand tendon injuries. In the adult group (n=457), results were similar, but injury to the index finger and knife injury were the most common. An accompanying fracture was more common in the adult group and complication rates were non-significantly different. CONCLUSIONS: This comparative analysis revealed no significant epidemiologic intergroup differences. The belief that pediatric tendon injuries tend to be less severe is misplaced, and careful physical examination and exploration should be conducted in pediatric cases of hand injury.
Adult* ; Child ; Comorbidity ; Epidemiologic Studies ; Fingers ; Glass ; Hand Injuries ; Hand* ; Humans ; Male ; Medical Records ; Physical Examination ; Retrospective Studies ; Rupture ; Tendon Injuries* ; Tendons* ; Wounds and Injuries

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Peroneal Flap: Clinical Application and Cadaveric Study.

Yooseok HA ; Kwan Koo YEO ; Yibo PIAO ; Sang Ha OH

Archives of Plastic Surgery.2017;44(2):136-143. doi:10.5999/aps.2017.44.2.136

BACKGROUND: The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps. METHODS: The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients. RESULTS: We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size ranged from 2.0 cm×4.5 cm to 8.0 cm×8.0 cm. All the flaps survived. Five flaps developed partial skin necrosis. In 2 cases, a split-thickness skin graft was performed, and the other 3 cases were treated without any additional procedures. CONCLUSIONS: The peroneal artery perforator flap is a good alternative for the reconstruction of soft tissue defects, with a constant and reliable vascular pedicle, thin and pliable skin, and the possibility of creating a composite tissue flap.
Arteries ; Cadaver* ; Humans ; Leg ; Necrosis ; Perforator Flap ; Skin ; Surgical Flaps ; Tibia ; Transplants

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Systematic Review and Comparative Meta-Analysis of Outcomes Following Pedicled Muscle versus Fasciocutaneous Flap Coverage for Complex Periprosthetic Wounds in Patients with Total Knee Arthroplasty.

James M ECONOMIDES ; Michael V DEFAZIO ; Kayvon GOLSHANI ; Mark CINQUE ; Ersilia L ANGHEL ; Christopher E ATTINGER ; Karen Kim EVANS

Archives of Plastic Surgery.2017;44(2):124-135. doi:10.5999/aps.2017.44.2.124

BACKGROUND: In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. METHODS: A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. RESULTS: A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. CONCLUSIONS: Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.
Arthroplasty, Replacement, Knee* ; Athletes ; Cohort Studies ; Consensus ; Extremities ; Humans ; Knee ; Knee Prosthesis ; Limb Salvage ; Surgical Flaps ; Walking ; Wounds and Injuries*

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Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity.

Zhi Yang NG ; Shaun Shi Yan TAN ; Alexandre Gaston LELLOUCH ; Curtis Lisante CETRULO ; Harvey Wei Ming CHIM

Archives of Plastic Surgery.2017;44(2):117-123. doi:10.5999/aps.2017.44.2.117

BACKGROUND: Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity. METHODS: A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available). RESULTS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation. CONCLUSIONS: With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.
Arm ; Bandages ; Burns ; Classification ; Debridement ; Demography ; Follow-Up Studies ; Forearm ; Hand Transplantation ; Humans ; Reconstructive Surgical Procedures ; Rehabilitation ; Soft Tissue Injuries ; Upper Extremity* ; Wounds and Injuries ; Wrist

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Assessment of Tissue Perfusion Following Conventional Liposuction of Perforator-Based Abdominal Flaps.

Zeynep Deniz AKDENIZ DOĞAN ; Bülent SAÇAK ; Doğuş YALÇIN ; Ozgür PILANCI ; Fatma Betül TUNCER ; Ozhan ÇELEBILER

Archives of Plastic Surgery.2017;44(2):109-116. doi:10.5999/aps.2017.44.2.109

BACKGROUND: The effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser–Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik). METHODS: Nine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively. RESULTS: The measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures. CONCLUSIONS: The liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.
Abdominal Wall ; Abdominoplasty ; Capillaries ; Epigastric Arteries ; Female ; Humans ; Lipectomy* ; Oxygen ; Perforator Flap ; Perfusion* ; Spectrophotometry

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A New Septum in the Female Breast.

Mostafa Abdel Rahman AWAD ; Mahmoud Magdi SHERIF ; Eaman Yahya SADEK ; Hesham Aly HELAL ; Wafaa Raafat Abdel HAMID

Archives of Plastic Surgery.2017;44(2):101-108. doi:10.5999/aps.2017.44.2.101

BACKGROUND: Understanding the female breast fascial system is of paramount importance in breast surgery. Little was written about breast ligaments. Most articles refer to Cooper's work without further anatomical studies. Lately, a horizontal septum has been described conveying nerves and vessels to the nipple areola complex. METHODS: During the surgical dissection of the lower part of the breast, in supero-medial technique for breast reduction operations, a fascial septum between the lower two quadrants was detected. This fibrous septum was studied through anatomic dissection of breast tissues during routine breast reshaping procedures that was done on 30 female patients. Magnetic resonance imaging (MRI) was performed preoperatively in all cases and correlated with the intraoperative findings. In the other five cases, outside the clinical study, the imaging was done during routine investigation for breast swellings. RESULTS: A vertical septum was identified in the lower part of the breast, lying at the breast meridian between the two lower quadrants. It is a tough bi-laminated structure that extends from the middle of the infra-mammary crease caudally to nipple-areola complex cranially and from the pectoral fascia posteriorly to the overlying skin anteriorly. This was proved by MRI findings. CONCLUSIONS: This study describes a new inferior vertical septum which separates the lower half of the breast into two definite anatomical compartments: medial and lateral.
Breast* ; Clinical Study ; Deception ; Fascia ; Female* ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Mammaplasty ; Nipples ; Skin

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Vessel Remodeling after Intima-to-Intima Contact Anastomosis.

Hyeonjung YEO ; Hyodong KIM ; Daegu SON ; Changbae HONG ; Sun Young KWON

Archives of Plastic Surgery.2017;44(2):95-100. doi:10.5999/aps.2017.44.2.95

BACKGROUND: Intima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable. METHODS: Six New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted 90° to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26. RESULTS: All anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely. CONCLUSIONS: Despite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.
Anastomosis, Surgical ; Constriction, Pathologic ; Dilatation ; Jugular Veins ; Microsurgery ; Rabbits ; Regeneration ; Transplants ; Tunica Media ; Ultrasonography ; Vascular Remodeling ; Vascular Surgical Procedures ; Veins

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