Woman with a Painful Rash on Face (FKA 2020-1929) [Case Report]
Incorporating Minimally Invasive Procedures intoÂ an Aesthetic Surgery Practice
Minimally invasive procedures in an aesthetic practice have grown over the past decade. Plastic surgery practices are embracing the incorporation of injectables and lasers as adjuncts to their surgical procedures. The use of botulinum toxin, hyaluronic acid fillers, and lasers has made a significant impact on the authors' practice. The authors describe the important considerations, consultation goals, and procedural steps with injectables and fillers. The novel use of deoxycholic acid injections is also described. The authors strongly think that as options continue to expand, plastic surgeons will benefit from taking an active role in adopting these new innovations.
3D Topographical Surface Changes of the Malar Region in Response to Compartmental Volumization of the Deep Medial and Lateral Cheek
Fat Grafting to the Forehead/Glabella/Radix Complex and Pyriform Aperture: Aesthetic and Anti-Aging Implications
BACKGROUND:Optimal aesthetic outcomes from rhinoplasty are heavily influenced by structures adjacent to the nose. Although the importance of the chin has been emphasized since the inception of rhinoplasty, little attention has been given to the forehead. The forehead/glabella/radix complex represents a vital triad in rhinoplasty, from which the nasofrontal angle is derived. In the present study, the authors sought to determine whether fat grafting to the forehead/glabella/radix complex and pyriform aperture can favorably impact the nasofrontal and nasolabial angles, respectively. METHODS:The authors reviewed pre- and postoperative images (obtained by an independent professional photographer) of patients who underwent autologous fat grafting to the forehead/glabella/radix region and the pyriform aperture, with or without concurrent rhinoplasty. Nasofrontal and nasolabial angles were measured on lateral images. Mean pre- and postoperative values were calculated and compared. A Wilcoxon rank-sum test was used for statistical analysis. RESULTS:Twenty-six patients underwent fat grafting alone (FG group; mean follow-up, 3.3 years), and 19 had fat grafting plus rhinoplasty (FG + R group; mean follow-up, 5.2 years). The mean nasofrontal angle in the FG group decreased by 2.0Â° (P = 0.005), and the mean nasolabial angle increased by 2.3Â° (P = 0.006). The mean nasofrontal angle in the FG + R group decreased by 2.0Â° (P = 0.011), and the mean nasolabial angle increased by 6.0Â° (P = 0.026). CONCLUSIONS:Autologous fat grafting to the forehead/glabella/radix complex and pyriform aperture is a reliable method to favorably influence the nasofrontal and nasolabial angles, respectively. Such treatment optimizes the interplay between the nose and the adjacent facial features, enhancing overall aesthetics.
Ralph Ger, MD: an innovator in reconstructive surgery [Historical Article]
Asymmetric sternotomy and sternal wound complications: assessment using 3-dimensional computed tomography reconstruction
OBJECTIVE:Wound complications after midline sternotomy result in significant morbidity and mortality. Despite many known risk factors, the influence of sternal asymmetry has largely been ignored. The purpose of this study was to assess the utility of 3-dimensional computed tomographic scan reconstructions to assess sternal asymmetry and determine its relationship with sternal wound infection. METHODS:A retrospective chart review was conducted for patients who underwent midline sternotomy and received a postoperative computed tomographic scan between 2009 and 2010. Cases were composed of all patients who had a sternal wound infection after undergoing sternotomy. Controls were randomly selected from patients without poststernotomy wound complications. Sternal asymmetry was defined as the difference between the left and the right sternal halves and was expressed as a percentage of the total sternal volume. RESULTS:Twenty-six cases were identified and 32 controls were selected as described earlier. The patients were similar in baseline characteristics and risk factors including age, sex, smoking status, diabetes, chronic obstructive pulmonary disease, preoperative creatinine, and operative time. Univariate factors associated with sternal wound infection include an asymmetry of 10% or greater, body mass index, and internal mammary artery harvest. In a multivariate logistic regression, independent predictors of sternal wound infection included an asymmetry of 10% or greater (odds ratio, 3.6; P = 0.03) and diabetes (odds ratio, 3.3; P = 0.0442). CONCLUSIONS:Our data suggest an association between asymmetric sternotomy and sternal wound infections. We recommend an assessment of sternal asymmetry to be performed in patients with sternal wound infection and if it is found to be 10% or greater, the surgeon should implement measures that stabilize the sternum.
Arteriovenous fistula following radial forearm free flap [Case Report]
The authors describe the development of a right facial arteriovenous fistula following debulking of a radial forearm free flap for reconstruction of the neck due to a burn contraction scar. The arteriovenous fistula was immediately excised following interventional embolization, without recurrence on postoperative follow-up. The authors report this as being the first arteriovenous fistula following a secondary debulking procedure, likely due to cross-clamping of the vascular pedicle. Thus, the authors recommend that the vascular pedicle be identified and that the artery and vein be selectively ligated during secondary debulking procedure following microvascular free flap reconstruction to avoid communication of the respective vessels potentially predisposing to development of an unintended arteriovenous fistula.