Autologous Fat Grafting in Young Patients: A Simple and Effective Way to Achieve Facial Balance.

Goals/purpose: Rhinoplasty is the most common procedure seen in the teenage population. Many of these patients have facial imbalance both recognized and unrecognized by the individual and family. Most often it involves chin or midface deficiency.

Hip Asymmetry: Implications in Body Contouring Surgery.

Background: Asymmetry of the hips and its implication in body contouring procedures has not yet been reported. Hip asymmetry is common in the general population and may account for uneven abdominoplasty scar and the apparent discrepancies in volume following liposuction of the hips and flanks. The goal of this study was to determine the presence of hip asymmetry in women presenting for abdominal contouring surgery.

Predictive Factors for Preoperative Percutaneous Endoscopic Gastrostomy Placement: Novel Screening Tools for Head and Neck Reconstruction.

Objective: The treatment of head and neck cancer has varying impact on postoperative recovery and return of swallowing function. The authors aim to establish screening tools to assist in preoperatively determining the need for gastrostomy tube placement.

Methods: The authors prospectively assessed all patients undergoing complex head and neck reconstructive surgery during a 1-year study period.

Bariatric surgery in patients with liver cirrhosis.

Background: Data regarding the management of bariatric patients with cirrhosis are scarce, and there is no strong evidence that supports a specific approach for this group of patients. The aim of this study was to review our experience with cirrhotic patients undergoing bariatric surgery.

Methods: A prospectively maintained database was reviewed to assess the outcomes of bariatric surgery for patients with known cirrhosis and for patients with cirrhosis discovered at surgery (unknown cirrhosis).

The free descending branch muscle-sparing latissimus dorsi flap: vascular anatomy and clinical applications.

Background: Increasing focus on reducing morbidity from latissimus dorsi flaps has led to the evolution of muscle-sparing variants and perforator-based flaps. This study aimed to investigate the vascular anatomy of the muscle-sparing variant and to describe its application as a free flap based on the descending branch of the thoracodorsal artery.

Methods: Twelve fresh cadavers underwent anatomical dissection and angiographic injection studies of the thoracodorsal arterial system.

Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass.

Background: Limited data are available regarding early postoperative small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of the present study was to review our experience with early SBO after LRYGB. The setting was a tertiary referral bariatric center.

The short- and ultrashort-pedicle deep inferior epigastric artery perforator flap in breast reconstruction.

Background: Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is becoming more common and can help reduce donor site morbidity. The authors proposed that dissection of the deep inferior epigastric artery (DIEA) and vein (DIEV) to their external iliac source may not be required for safe flap transfer.

Methods: Sixteen whole fresh cadaveric hemiabdomens were used to dissect transverse abdominal-based flaps.

Modifications to extend the transverse upper gracilis flap in breast reconstruction: clinical series and results.

Background: The transverse myocutaneous gracilis flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the flap with two types of modifications to increase flap volume: an extended and a vertical extended flap. In this article, they discuss the different operative techniques and present a clinical series of both flap types.

The low transverse extended latissimus dorsi flap based on fat compartments of the back for breast reconstruction: anatomical study and clinical results.

Background: Despite many modifications to the extended latissimus dorsi flap, its use in autologous breast reconstruction remains limited because of insufficient volume and donor-site morbidity. Through a detailed analysis of the deposition of back fat, this study describes a low transverse extended latissimus dorsi flap harvest technique that increases flap volumes and improves donor-site aesthetics.

Methods: Eight fresh cadaver hemibacks were used to identify the anatomical location of the fat compartments.

Secondary techniques in breast reconstruction refinement: the periareolar advancement flap.

Background: Techniques in breast reconstruction have vastly improved with natural feeling, aesthetically pleasing breasts created through transfer of free or pedicled tissue. Traditional flap designs incorporate a skin paddle that leaves a "patch," which can be fairly large on the nouveau breast, clearly delineating the boundaries between the reconstruction and the native skin. In this article, the authors discuss the operative technique and present a clinical series of patients undergoing the periareolar advancement flap procedure.

Dermolipectomy of the lateral thoracic fat compartment in secondary breast reconstruction revision: Anatomical and clinical results.

Unlabelled: Fullness in the lateral thoracic area following breast reconstruction can be a source of concern for patients. This redundant tissue creates disharmony between the newly reconstructed breast, the lateral mammary fold, and the lateral thoracic compartment. In this article we present the results of our anatomical/histological study, discuss the operative technique and present a clinical series of patients who underwent this procedure.

Aesthetic subunit of the breast: an analysis of women's preference and clinical implications.

Patient satisfaction in breast surgery is dependent on achieving a balance among all aesthetic subunits. The purpose of this study is to identify which subunit of the breast women consider important and correlate this clinically to improve patient satisfaction following breast surgery. A total of 313 subjects (ages, 20-80) were surveyed using a 25-point survey instrument collected via a telemedicine form.

Postoperative Pain Management in DIEP Flap Breast Reconstruction: Identification of Patients With Poor Pain Control.

Objective: Adequate control of postoperative pain directly improves patient satisfaction and outcomes, and timely identification of patients with poorly controlled pain is essential. Pain management protocols are best studied in patients recovering from the same operation. In our institution, the postoperative pain regimen for patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction is standardized using patient-controlled analgesia (PCA) followed by conversion to oral narcotics.

Breast reconstruction with the latissimus dorsi flap: women's preference for scar location.

Background: Refinements made in latissimus dorsi breast reconstruction have improved the aesthetic appearance of the breast without changing the donor-site location. The optimal location for donor-site placement, from a patient's perspective, is still unknown. The purpose of this study was to assess women's preference for the latissimus dorsi donor-site location; the reasons for donor-site choice; and the correlation between donor-site location preference and factors such as, age, body mass index, body image, and clothing options.

Effect of tamoxifen on arterial microvascular anastomosis.

Breast reconstruction after cancer treatment is based on the circulation of pedicle and microvascular flaps. This article aimed to verify the effect of tamoxifen (TMX) pretreatment in arterial anastomosis in rats. Twenty female Wistar rats were equally divided into two groups.