The Internal Negative-Pressure Wound Control System: A Paradigm Shift for Promoting Deep Space Healing in Complex Surgically Created Wounds.

This article introduces a new technology to minimize seroma and promote more predictable healing in surgically created deep space wounds. Its novel design internalizes the delivery of a continuously generated high negative pressure (-125 mmHg) throughout the surgically created space by means of a multibranched Manifold. In a small prospective cohort case study of 24 patients undergoing full abdominoplasty, all patients underwent placement of this device, which was removed 7 days postoperatively.

Evidenced-Based Approach to Abdominoplasty Update.

The following publication was compiled as an evidence-based update for plastic surgeons performing abdominoplasty from a review of the published literature on that subject between January 2014 and February 2017. It is an overview of various aspects of abdominoplasty including preoperative patient assessment, variations and advances in both surgical and anesthetic technique, patient safety, and outcomes. It is intended to serve as an adjunct to previously published evidence-based reviews of abdominoplasty.

Components Separation for Abdominal Wall Reconstruction in the Recalcitrant, High-Comorbidity Patient: A Review of 311 Single-Surgeon Cases.

Purpose: Components separation of the abdominal musculature remains a mainstay for closure of complicated midline and paramedian abdominal wall defects. The authors critically analyzed their experience with this technique to identify prognosticators affecting long-term clinical outcomes.

Methods: A retrospective review was performed of patients undergoing components separation by a single senior surgeon (J.

Assessing Risk and Avoiding Complications in Breast Reduction.

Assessing risk and avoiding complications in breast reduction requires a meticulous history, systematic physical examination, management of expectations, and careful consideration and execution of operative technique. Attention should be paid to comorbidities. Shape, symmetry, contours, scar location, skin quality, nipple-areolar complex (NAC) shape, NAC position relative to inframammary fold, and NAC position relative to the volume of the breast should be evaluated.

Breast Reduction.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify the anatomy of both the vascular supply and the innervation to the breast to design the appropriate pedicle in breast reduction. 2.

The extended abdominoplasty.

This article illustrates the author's approach of directly excising adipose tissue excess in the lateral and posterior hip region by extending the lateral extent of the horizontal incision in a full abdominoplasty toward the posterior axillary line to produce a superior contour in this region. It is most applicable in patients with a significant adipose tissue excess in the lateral hip area that produces an outward convexity seen in the frontal, posterior, or oblique view. Such an excess represents a soft tissue "dog ear" composed of skin, and adipose tissue both deep and superficial to the superficial fascial system.

Acellular dermal matrix inlays to correct significant implant malposition in patients with compromised local tissues.

Breast implant malposition is an increasingly recognized complication of breast augmentation and implant-based breast reconstruction. Etiologic factors include technical imprecision during surgery with overdissection or inadequate dissection of the pocket, inappropriately large implant selection, and the compromise of the local breast tissues, which produces an inability of a patient's natural tissues to support an implant in the placed position. In this article, the author describes a series of 19 patients with significant breast implant malposition following staged implant breast reconstruction in the setting of locally compromised tissues.

Short scar abdominoplasty update.

Techniques for abdominal contouring have proliferated and evolved over the past 2 decades. Now more than ever, aesthetic operations are tailored to fit the anatomic features and aesthetic goals of each individual patient, stressing the absolute importance of patient selection. This short scar procedure relies on a combination of liposuction and modified skin resection and muscle tightening in the lower abdomen.

The double opposing periareola flap: a novel concept for nipple-areola reconstruction.

Background: This report describes the authors' currently favored method of nipple reconstruction that has been developed and used by the senior author over the past 26 months.

Methods: A pull-out flap is derived as the lead edge of one of two opposing skin flaps contained in a circular design approximating the areola complex of the opposite breast. The larger flap gives rise to the nipple construct, a derivative of the skate flap design.

Biomechanical properties of the superficial fascial system.

Background: Surgical repair of the superficial fascial system (SFS) has been claimed to both increase wound strength and enhance surgical outcome through anchoring of deeper tissues.

Objective: The authors assessed the biomechanical properties of the SFS to determine whether repair of the SFS layer improved early and long-term postoperative wound strength.

Methods: Four complementary studies were conducted to study the dermis and SFS junctional architecture and connective tissue content: gross dissection using a dehydrating agent (Pen-Fix; Richard-Allan Scientific, Kalamazoo, MI), a histologic study with hemotoxylin and eosin staining, soft tissue radiography, and immunofluorescence staining.

Separation of anatomic components method of abdominal wall reconstruction--clinical outcome analysis and an update of surgical modifications using the technique.

This article describes some of the benefits and complications of the components separation technique. It additionally highlights some of the modifications that have been made to the technique over the years.

Assessment of TRAM aesthetics: the importance of subunit integration.

Background: Characterization of optimal aesthetics in transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a challenge that even the most experienced breast surgeon faces. Aesthetic assessment in breast surgery has attempted to evaluate the reconstructed breast either as one cohesive entity or as a sum of its parts. The authors propose that the most advantageous assessment involves looking at the reconstructions in terms of aesthetic components, not necessarily in visual subunits.

"Marriage" abdominoplasty: body contouring with limited scars combining mini-abdominoplasty and liposuction.

The "marriage" or union of aggressive truncal liposuction with modified abdominoplasty techniques has been applied by the authors to treat patients with abdominal deformities marked by lower abdominal skin excess, abdominal muscle laxity, and excess adipose tissue on the abdominal wall and in adjacent contours. In the appropriately selected patient this form of "mini-abdominoplasty" has resulted in excellent contour improvement and a more rapid return to life activities than is seen with "full" abdominoplasty. In the authors' experience, it is applicable to the majority of patients (over 50%) presenting for abdominal contour improvement.

Assessment of long-term nipple projection: a comparison of three techniques.

Nipple-areola reconstruction represents the final stage of breast reconstruction, whereby a reconstructed breast mound is transformed into a breast facsimile that more closely resembles the original breast. Although numerous nipple reconstruction techniques are available, all have been plagued by eventual loss of long-term projection. In this report, the authors present a comparative assessment of nipple and areola projection after reconstruction using either a bell flap, a modified star flap, or a skate flap and full-thickness skin graft for areola reconstruction.

A potential role for mast cells in the of bFGF from normal myocytes during angiogenesis in vivo.

Basic fibroblast growth factor (bFGF) is a potent angiogenic factor produced by cells of mesodermal and neuroectodermal origin. Despite numerous advances, the precise mechanism of bFGF release from cells still remains unknown. Upon release from cells, the protein is stored and protected in the extracellular matrix by binding to heparan sulfate proteoglycans.

"Marriage" abdominoplasty: a short scar technique.

Short scar abdominoplasty-that is, a marriage of aggressive superwet lipoplasty, rectus abdominis muscle plication, and excision of lower abdominal skin and excess adipose tissue-can be used as an alternative to conventional abdominoplasty in properly selected patients. According to the authors, this technique offers the advantages of less invasive surgery, decreased pain, and faster return to work. (Aesthetic Surg J 2002;22:294-301.