Eplasty

BACKGROUND: Soft tissue reconstruction of the leg should be relatively easy to perform, utilize viable tissues similar in skin texture and thickness to those lost, leave the most inconspicuous donor-site defect possible, and be performed without compromising other body parts. Evolution in flap surgery has enabled fasciocutaneous, adipofascial, and super-thin flaps to be harvested for the purpose of reconstruction, thereby minimizing morbidity from muscle inclusion into the flap. The authors present their experience with propeller flaps for reconstruction of soft tissue defects in the lower third of the leg...

BACKGROUND: Pressure injuries (PIs) are a challenging problem in health care affecting 2.5 million people per year in the US, with 60,000 deaths directly attributed to PIs annually. Surgical closure is the treatment of choice for stage 3 and 4 PIs, but with complication rates of 59% to 73%, less invasive and more effective treatments are needed. Autologous heterogeneous skin construct (AHSC) is a novel autograft made from a small full-thickness harvest of healthy skin. This single-center retrospective cohort study sought to determine the effectiveness of AHSC in the treatment of recalcitrant stage 4 pressure injuries...

BACKGROUND: Soft tissue masses of the hand are common and mostly benign, including ganglion cysts, glomus tumors, lipomas, and giant cell tumors of the tendon sheath. Schwannomas are benign nerve sheath tumors but are rarely found on the distal parts of the digits. The authors present a case of a schwannoma located at the tip of the finger. METHODS: An otherwise healthy 26-year-old man presented because of a 10-year history of a slowly growing mass on the tip of his right little finger that significantly interfered with his right hand function...

BACKGROUND: Wide palatal defects remain a challenge to the plastic surgeon. The authors present a new method for closure of a wide Veau class II cleft palate in which anterior palatal closure was achieved by use of a bipedicled mucoperiosteal anterior palatal flap. METHODS: Two patients with wide Veau class II cleft palatal defects underwent palatoplasty with difficulty in closing the anterior palate. A novel technique was employed for tension-free closure. RESULTS: A tension-free closure in the midline was achieved with a bipedicled mucoperiosteal anterior palatal flap...

BACKGROUND: Previous studies have shown that patients suffering from endocrine orbitopathy (EO) seem to present with profound asymmetry in proptosis. As asymmetry might pose a major problem in planning decompression surgery, information on the amount of variation between sides and a concise evaluation method should be available. Therefore, a study based on a concise 3D cephalometric analysis was conceived to evaluate globe position. METHODS: A 3D-cephalometric analysis was performed on computed tomography (CT) data from 52 orbitopathy and 54 control data sets...

BACKGROUND: Injury to the neurological pathway that enables ankle dorsiflexion is likely to cause foot drop. This pathway includes the motor cortex; lumbosacral plexus; and the sciatic, tibial, and peroneal nerves. Nerve damage typically occurs due to compression, entrapment, traction, or direct trauma to the nerve due to several etiologies. However, there are limited reports on the incidence, etiology, and factors associated with foot drop. METHODS: The authors reviewed their clinic's data from 1022 patients with foot drop from 2004 to present to determine the incidence, causes, and risk factors of foot drop...

BACKGROUND: Surgical site complications (SSCs) are not uncommon in plastic surgery procedures due to characteristics of the incisions and the patients undergoing such procedures. Closed incision negative pressure therapy (ciNPT) has been used to manage surgical incisions across surgical specialties. This systematic review and meta-analysis examined the impact of ciNPT on risk of SSCs following plastic surgery. METHODS: A systematic review was conducted to identify studies published between January 2005 and July 2021 comparing ciNPT versus traditional standard of care (SOC) dressings for patients undergoing plastic surgery...

BACKGROUND: The rise in Botox, fillers, and chemical peel procedures demands transparent online information that discloses all relevant risks and complications. This study assesses the quality of complication disclosure on the most popular cosmetic sites. METHODS: The top 50 Google search results for "Botox," "fillers," and "chemical peel" were analyzed for their reporting on relevant complications. Websites were categorized based on their origin. An overall complication, prevention, management, prevalence, and disclaimer score were assigned to each site...

Background. Plantar fibromatosis, or Ledderhose disease, presents as plantar fascia nodules caused by hyperactive proliferating fibroblasts. These benign tumorous growths can persist causing pain as well as reduced mobility and quality of life. Plantar fibromatosis may not respond to conservative nonsurgical treatment resulting in surgical intervention, including wide excision of the affected tissue and subsequent reconstruction. Reconstruction of the full-thickness plantar defect is challenging given the location, and recurrence rates are relatively high...

Surgical site infection (SSI) is defined as an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure or within 90 days if prosthetic material is implanted at surgery. Substantial research has been performed to identify the etiological agents, risk factors, and potential treatment options for SSIs. As breast surgery becomes increasingly popular, plastic surgeons are likely to encounter more patients presenting with SSIs. This article summarizes current evidence on pathogens, risk factors, and management strategies for SSIs and highlights further areas of study...

BACKGROUND: Carcinoma cuniculatum is a rare variant of squamous cell carcinoma, mostly affecting the skin but also sparsely reported to occur in the oral cavity. Oral carcinoma cuniculatum (OCC) tends to be misdiagnosed as verrucous carcinoma; this may lead to inadequate treatment and recurrence due to the locally aggressive nature of the tumor. This report presents the case of a 56-year-old man with a progressively enlarging painful OCC at the maxillary right molar region, exhibiting both exophytic (red, soft, nodular mass) and endophytic (superficial ulceration and bone exposure, mimicking nonhealing extraction sockets) growth patterns...

BACKGROUND: Across surgical specialties, tranexamic acid (TXA) is applied to reduce intraoperative and postoperative bleeding. Within plastic surgery, both topical and intravenous routes are used. The application of TXA has yet to be examined in vaginoplasties. METHODS: The authors performed a retrospective chart review of Mayo Clinic patients receiving penile inversion vaginoplasty from January 2017 through July 2021. Incidence of hematoma formation was assessed as the primary outcome...

BACKGROUND: Periprosthetic infections are a debilitating complication of alloplastic breast reconstruction. Local antibiotic delivery for prophylaxis and infection clearance has been used by other surgical specialties but rarely in breast reconstruction. Because local delivery can maintain high antibiotic concentrations with lower toxicity risk, it may be valuable for infection prophylaxis or salvage in breast reconstruction. METHODS: A systematic search of the Embase, PubMed, and Cochrane databases was performed in January 2022...

What are the clinical presentation and potential etiologies of giant lipomas?What is the appropriate imaging procedure for a neck lipoma?What are the differential diagnoses of a giant lipoma?What are the surgical approaches for a giant neck lipoma?

BACKGROUND: Breast reduction is one of the most common procedures performed by plastic surgeons, and the inferior pedicle is a technique frequently used to maintain vascular supply to the nipple areolar complex (NAC). One of the relative contraindications for its use is the presence of a long nipple-to-inframammary fold (IMF) length; however, in the authors' practice, inferior pedicle mammoplasties have been successfully performed for over 10 years on almost all patients. METHODS: The authors performed a retrospective study including patients who underwent bilateral breast reduction with inferior pedicle technique from October 2009 to April 2021 by 2 different surgeons in New Orleans, Louisiana...

BACKGROUND: The pectoralis major musculocutaneous (PMMC) flap is a versatile and commonly used technique for reconstruction of the head and neck in patients at high risk in free tissue transfer procedures. In this report, a "supercharged" PMMC flap, in which the lateral thoracic artery was cut, preserved, and anastomosed to the cervical vessels, was developed to stabilize blood flow. METHODS: The supercharged PMMC flap was introduced in a patient who was at high risk for partial necrosis of the flap and underwent surgery for reconstruction of the tongue...

BACKGROUND: Efficient treatment of extensive skin defects by using skin grafting is a significant challenge because the skin available to use is limited. A mesh graft is usually used; however, the expansion ratio is small (up to 1:6) and inaccurate. The Meek technique is a method of skin grafting that processes the skin into micrografts by cutting. The advantage of the Meek technique is its efficient use of available skin, expanding its area by up to 9 times. In 2020, Japanese insurance companies began to cover treatment using the Meek technique...

BACKGROUND: With the increased adoption of skin-sparing mastectomies, immediate 2-stage breast reconstruction is a common option for breast cancer patients. During the first stage of the procedure with tissue expander placement, higher intraoperative percent fill has been identified as a risk factor for complications. However, the postoperative outcomes of higher intraoperative fill volumes are not well established. The authors sought to evaluate if a higher initial intraoperative tissue expander fill volume is associated with higher complication rates in patients undergoing immediate breast reconstruction with tissue expander placement...

BACKGROUND: Tissue expansion is an effective option for soft tissue reconstruction of the scalp in the pediatric population. Unfortunately, this approach carries a high risk of such complications as infection and expander exposure. While bacterial infection of alloplastic materials is most frequent, when fungal infections occur, the outcomes can be devastating. PURPOSE: To inform the management of fungal tissue expander infections, this report describes a case of expander-based scalp reconstruction complicated by Aspergillus terreus infection in a pediatric patient...

BACKGROUND: In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties...