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Safe Composite Calf Augmentation: A Staged Procedure.

BACKGROUND: Calf augmentation can be performed using fat grafting, calf implants, or with a combination of both methods (composite augmentation). For safety reasons, we have to be aware of important calf anatomical features, specific physiological considerations and some health conditions can hinder the outcome of each of these procedures.

OBJECTIVES: The authors present their experience in performing composite calf augmentation, its indications, surgical technique and ways of performing it safely.

METHODS: We retrospectively analyzed 63 patients who had had composite calf augmentation for cosmetic and reconstructive surgery in our practice. We reviewed group demographics, complications and results and identified all pitfalls encountered in our cases. Additionally, dissection of the calf regions in fresh cadavers was performed to obtain more accurate anatomy. We also performed measurements of intra-compartmental pressures before and after calf augmentation with implants in 6 cases to determine pressure changes.

RESULTS: All cases had subfascial implant insertion and fat grafting as a delayed procedure. If there is a need for multiple implants, we recommend a staged procedure. Our study showed significant muscle sensitivity to pressure increase after augmentation. That is why, from the standpoint of safety, we advocate subcutaneous fat grafting only. We have had no compartment syndrome.

CONCLUSIONS: Composite calf augmentation surgery is safe, easy to reproduce, with a short recovery period and a low complication rate when done as a staged procedure and respecting specific anatomical and physiological calf features.

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