Gynecomastia Management: An Evolution and Refinement in Technique at UT Southwestern Medical Center.

Gynecomastia is a benign proliferation of male breast glandular tissue. Gynecomastia can affect men at any stage of life. Traditional treatment options involved excisional surgeries with periareolar or T-shaped scars, which can leave more visible scars on the chest.

Lateral Abdominal Wall Defects: The Importance of Anatomy and Technique for a Successful Repair.

Flank and lateral abdominal wall defects can be an extremely challenging phenomenon for surgeons to undertake. Their rarity and specific idiosyncrasies in regard to embryologic and anatomical characteristics must be taken into consideration when formulating an operative plan. We will discuss these cardinal points including technical recommendations by notable experts in the field to gain a better understanding in the diagnosis and treatment of this infrequent but morbid occurrence.

An Evidence-Based Model for the Successful Treatment of Flank and Lateral Abdominal Wall Hernias.

Background: Lateral abdominal wall defects are a significant contributor to patient morbidity and mortality in the United States. Reconstruction involving flank hernias and bulges is relatively scarce in the literature despite its serious consequences. The authors aim to identify an objective approach for the evaluation and successful repair of defects of the lateral abdominal wall.

Changing role of hyaluronidase in plastic surgery.

Soft-tissue augmentation has become an increasingly popular option for facial rejuvenation. Hyaluronic acid fillers are part of the most rapidly expanding segment of this market, largely because of their safe drug profile and temporary nature. Despite their good safety profile, they can and do have complications ranging from superficial placement, uneven placement, granulomatous reactions, and skin necrosis.

Clostridium difficile enteritis: A report of two cases and systematic literature review.

Clostridium difficile (C. difficile) is the most common cause of healthcare associated infectious diarrhea. In the last decade, the incidence of C.

The use of non-invasive instruments in characterizing human facial and abdominal skin.

Background And Objective: The skin is highly variable. This variation, although helpful for function, causes inconsistencies when assessed using subjective scales. The purpose of this study is to measure differences in skin on the face and abdomen using non-invasive, objective devices as a method to eliminate subjective error and help reduce intra- and inter-observer variability in clinical analysis.

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.

Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients.

Background: Venous thromboembolism is a major patient safety issue. The Plastic Surgery Foundation-sponsored Venous Thromboembolism Prevention Study examined whether postoperative enoxaparin prevents symptomatic venous thromboembolism in adult plastic surgery patients.

Methods: In 2009, four sites uniformly adopted a clinical protocol.

The effect of postoperative enoxaparin on risk for reoperative hematoma.

Background: The risk of postoperative bleeding is the chief concern expressed by plastic surgeons who do not use pharmacologic prophylaxis against venous thromboembolism. The Plastic Surgery Foundation-funded Venous Thromboembolism Prevention Study examined whether receipt of postoperative enoxaparin prophylaxis changed 60-day reoperative hematoma rates.

Methods: In 2009, the study's network sites uniformly adopted a "best practice" clinical protocol to provide postoperative enoxaparin to adult plastic surgery patients at risk for perioperative venous thromboembolism.

The dorsal metacarpal artery perforator flap: a case report utilizing a quaba flap harvested from a previously skin-grafted area for dorsal 5th digit coverage.

Burns to the hand are common in burn victims. These burns often leave complex wounds that require local flaps for coverage. Local flaps are often excluded because they lie within the zone of thermal injury.

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.

Latissimus dorsi donor-site morbidity: the combination of quilting and fibrin sealant reduce length of drain placement and seroma rate.

Seroma formation has been shown to be a multifactorial process in part due to dead space and the formation of raw surfaces, which produce large quantities of serous exudate. The purpose of this study is to evaluate the effect of quilting/progressive tension sutures (to reduce dead space) and fibrin sealant (to seal the raw surface) in combination on the seroma rate and length of drain placement in patients undergoing latissimus dorsi breast reconstruction. A retrospective review of 43 patients undergoing latissimus dorsi flap breast reconstruction was performed.

The extended transverse musculocutaneous gracilis flap: vascular anatomy and clinical implications.

Background: The transverse musculocutaneous gracilis (TMG) flap has been used in autologous breast reconstruction, but disadvantages include a small flap volume; therefore, it is only used in small-to-moderate breast reconstructions. We investigated the vascular territory of this flap and the possibility of extending its dimensions.

Methods: Ten circumferential thigh adipocutaneous flaps attached to the gracilis muscle were harvested from adult cadavers.

An intra-individual quantitative assessment of acute laser injury patterns in facial versus abdominal skin.

Introduction: Clinical laser settings have traditionally been calibrated on abdominal skin to predict and anticipate patterns of injuries in facial skin. This experimental approach has limitations as facial skin and abdominal skin have differences that may influence the depth of laser injury.

Objective: The primary objective of this study is to analyze the acute pattern of laser injury in abdominal skin and facial skin samples from the same subject and detail the anatomical and biophysical properties that can influence the laser tissue interaction.

Etiology, prevention, and treatment of dermal filler complications.

The availability of dermal fillers for multiple cosmetic indications has led to a dramatic increase in their application. Although fillers are generally regarded as safe tools for soft tissue augmentation, complications can occur. Therefore, to describe and review the complications associated with the currently-available dermal filling agents, the authors conducted a literature review in peer-reviewed journals and present the reported complication rates.

Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients.

Background: The Venous Thromboembolism Prevention Study (VTEPS) Network is a consortium of 5 tertiary referral centers established to examine venous thromboembolism (VTE) in plastic surgery patients. We report our midterm analyses of the study's control group to evaluate the incidence of VTE in patients who receive no chemoprophylaxis, and validate the Caprini Risk Assessment Model (RAM) in plastic surgery patients.

Study Design: Medical record review was performed at VTEPS centers for all eligible plastic surgery patients between March 2006 and June 2009.

The single dominant medial row perforator DIEP flap in breast reconstruction: three-dimensional perforasome and clinical results.

Background: Successful outcomes with the deep inferior epigastric artery perforator (DIEP) flap are heavily dependent on identifying the largest perforators. The purpose of this study was to describe the vascular anatomy (location, size, zones of perfusion, and variations) of the single most dominant deep inferior epigastric artery perforator and to report a clinical series based on this flap.

Methods: Eleven abdominal flaps were harvested from fresh adult cadavers, and measurements were combined with clinical measurements from 16 patients.

Perforasomes of the DIEP flap: vascular anatomy of the lateral versus medial row perforators and clinical implications.

Background: Regarding the perfusion of a deep inferior epigastric perforator (DIEP) flap, the classic Hartrampf zones II and III were demonstrated by Holm et al. to be reversed using fluorescent perfusion techniques, implying that blood flow from the pedicle travels to the ipsilateral side before crossing the midline. The authors' hypothesis is that the zones of perfusion and the vascular anatomy differ greatly between lateral row and medial row perforators.