Indian Journal of Plastic Surgery最新文献

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome involves vaginal agenesis and variable uterine development, often accompanied by renal, skeletal, and auditory anomalies. The primary objective of treatment is to reconstruct a neovagina that closely resembles the natural anatomy, enabling normal sexual function. This study evaluates various vaginoplasty techniques performed at our institution and their outcomes.

Materials and methods: This retrospective study, conducted from January 2012 to January 2024, includes patients who underwent different types of vaginoplasty, including the McIndoe, Singapore flap, islanded pudendal flap, labia minora flap, and horseshoe modification of the labia minora flap. Procedures were chosen based on clinical examination. Outcomes were assessed using an institutional scoring system evaluating vaginal length, introitus diameter, neovaginal skin quality, and pain during intercourse.

Results: Twenty patients of primary vaginal agenesis (aged 18-27) diagnosed clinically and confirmed with pelvic MRI underwent vaginoplasty by the same surgical team. One (14.28%) patient of the McIndoe procedure experienced graft contracture, which was released and regrafted, while another (14.28%) had partial graft loss managed conservatively. No significant complications occurred in the remaining patients. All used a postoperative vaginal mould for three months. The average follow-up period was 18 months, with neovaginal length ranging from 6 to 10 cm.

Conclusion: The horseshoe modification of the labia minora flap offers a reliable, effective approach for vaginal reconstruction in cases of MRKH syndrome. This technique fulfils the basic tenets of plastic surgery, namely the restoration of form and function. The simplicity of the procedure and relatively short learning curve render it an attractive flap option even for the novice plastic surgeon.

Background: Safe subcutaneous buttock augmentation (SSBA) offers a safer alternative to traditional gluteal fat grafting, addressing concerns of complications such as fat embolism. This study aims to establish the safety and efficacy of SSBA in an Indian cohort.

Materials and methods: A retrospective analysis was conducted on 293 patients (287 females, 6 males) who underwent SSBA between January 2017 and September 2024. Fat was harvested using ultrasound-assisted liposuction and power-assisted liposuction, followed by grafting into the subcutaneous plane using a power-assisted device with a 5-mm blunt cannula.

Results: The mean fat grafting volume for females was 557 mL and 341.6 mL for males. There were no reported mortalities, and complications were minimal. For females, the mean waist-to-hip ratio improved significantly from 0.81 to 0.72 ( p  < 0.001), demonstrating notable aesthetic enhancement.

Conclusion: SSBA is a safe and effective procedure for buttock enhancement, showing significant improvement in body contour and minimal risk of complications. These results reinforce the importance of technique precision and safety protocol adherence.

Introduction: A study was conducted to reveal the anatomy of the perforators and stations of anastomosis of the lateral supramalleolar artery (LSMA) axis and to analyze the outcome of various avatars of the flap based on the LSMA axis.

Materials and methods: Ten cadaveric dissections were performed to study the anatomy of the LSMA axis. Twenty patients with distal third leg, ankle, and dorsum of foot defects underwent reconstruction using the various avatars of the LSMA axis flaps. At the end of the follow-up, they were all assessed using the Institutional Functional and Aesthetic Outcome Assessment scoring system by two independent observers.

Results: The cadaveric study showed consistent anatomical details of superficial peroneal nerve artery-LSMA-descending branch of ramus perforans anastomotic axis and their perforators. In the clinical study, the average size of the primary defect was 63.6 cm ² . The average follow-up period was 12.5 months. Three (15%) noncritical complications were reported in our study, which were all managed conservatively. Fifty-five percent ( n  = 11) of patients had a good/excellent final computed institutional assessment score ( p  = 0.025). The rest of the patients (45% [ n  = 9]) had a fair outcome score.

Conclusion: Reconstructing soft tissue defects in the distal third of leg, ankle, and foot presents a considerable challenge. The LSMA flap and its various avatars may be a useful addendum in the reconstructive armamentarium for coverage of distal third leg, ankle, and dorsum foot defects.

Introduction: The rising use of orofacial harmonization highlights the importance of the lip area, closely linked to the orbicularis oris muscle. This longitudinal study assessed the electromyographic (EMG) activity of the upper and lower orbicularis oris muscle in adult women following hyaluronic acid lip filling.

Materials and methods: Twenty-two adult women, with a mean age of 35.4 ± 12.3 years, were included. EMG was measured during rest, cheek inflation tasks (concurrently and alternately), lip protrusion and compression, and before, 30, and 60 days after lip filling. Differences were significant using t -test and repeated measures analysis of variance with Bonferroni correction ( p  < 0.05).

Results: Significant EMG differences were found in the upper orbicularis oris muscle (before vs. 30 days, p  = 0.04) and lower orbicularis oris muscle (before vs. 30 days, p  = 0.0006) during bilateral cheek inflation, and in the upper orbicularis oris muscle (30 vs. 60 days, p  = 0.05) during rest. At 30 days, EMG of both upper and lower orbicularis oris muscle decreased in all tasks. By 60 days, the upper muscle's EMG increased in most tasks, while the lower muscle's EMG decreased during cheek inflation tasks. The lower orbicularis oris muscle had significantly higher EMG than the upper in nearly all tasks ( p  = 0.000).

Conclusion: Hyaluronic acid lip filling initially relaxed the orbicularis oris muscle at 30 days. By 60 days, the upper muscle's activity increased, indicating adaptation, while the lower muscle remained less active during cheek inflation, showing distinct functional changes after 60 days.

Background: Ophthalmic bimatoprost has been used worldwide for treatment of glaucoma, and enhanced eyelash growth has been reported with such use. Dermal application of prevalent bimatoprost preparations for eyelash enhancement has been reported with adverse effects.

Objective: This article assesses if revised formulation (Trulush) of bimatoprost 0.03% provides effective as well as safe eyelash enhancement in Indian population.

Materials and methods: Prospective split-face study was conducted for 12 weeks in willing subjects for their eyelash rejuvenation. Subjects completed the pre- and post-study questionnaires for subjective evaluation. Bimatoprost (Trulush) was applied on the upper eyelid margin once a day. Adverse events were also assessed. Objective evaluation was done using available digital scale and pre- and post-study photographs at 12 weeks.

Results: All Subjects reported improvement in length, darkness, and density. Objective assessment corresponded with the subjective assessments. No significant adverse effects were reported by the subjects.

Conclusion: Bimatoprost 0.03%, in the available formulation (Trulush), is found to be effective for topical application and eyelash rejuvenation by their increase in length, darkness, and density. There are no significant side effects.

Prolonged cocaine use can severely damage the osteocartilaginous structures of the midface region. Involvement of the nose, sinuses, and palate has been grouped into a syndrome called cocaine-induced midline destructive lesions. These lesions may resemble other necrotizing conditions, often complicating diagnosis and treatment. A complex nasal reconstruction is introduced in a 54-year-old woman with extensive midfacial destruction after 15 years of cocaine abuse. Total nasal reconstruction was performed using a medial femoral condyle free flap (MFCFF) for internal lining and bone support in combination with a paramedian forehead flap for external coverage. The MFCFF proved to be effective in recreating the anatomy of the nasal dorsum with minimal donor site morbidity, while the paramedian forehead flap improved the aesthetic results. Despite the need for multiple surgical interventions, this approach showed satisfactory functional and aesthetic long-term results.

Introduction: This is a study to assess versatility of the supraclavicular artery island flap (SCAIF) for reconstruction of head and neck defects. This study has also evaluated complications of SCAIF and their correlation with flap dimensions.

Materials and methods: This is a prospective study done at a single institute for 1-year duration. A total of 30 patients with head and neck cancer were included in the study. SCAIF was used in all patients for reconstruction of defect after carcinoma resection. Postoperative follow-up was done for 3 weeks. The study variables were location of defect, length and width of flap, time taken for flap harvest, and complications.

Results: Flap-related early complications were observed in 6 (20%) patients. These early complications were distal margin necrosis in four patients, partial flap loss in one patient, and wound infection and development of orocutaneous fistula in one patient. Stiffness in neck and shoulder movements (late complication) was noted in two patients. Among patients who developed complications, the mean flap length was 16.38 cm when compared with 15.68 cm among those who did not develop complications. Difference in mean flap length was found to be statistically significant ( p -value = 0.019).

Conclusion: SCAIF provides a skin paddle which is hairless, thin, pliable, and color-matched with the recipient site in the head and neck region. However, its limited reach and smaller volume should be kept in mind while planning reconstruction. The safe length of SCAIF is 16 to 17 cm (up to lower third of deltoid muscle), which makes it a suitable choice for defect of lower third of the head and neck region.

Background: Large posterior trunk defects due to radical sarcoma excisions conventionally mandate a free flap, needing vein grafts for pedicle length and skin grafts for donor site. Conventional options like skin grafting or local (fasciocutaneous or myocutaneous) flaps are either unsuitable due to paucity of tissues or ill-advised in view of adjuvant radiotherapy. Perforator flaps are now an established option for back defects, and the use of single flap is quite common and widely reported. Larger defects can be dealt with by planning two such flaps on separate perforators.

Materials and methods: Retrospective analysis of consecutive double perforator flaps was done for indication of resection, size of defects, size of flaps, perforator origin, complications, and tolerance for radiation. Flaps were planned in freestyle manner, committed after visualization and dissection of the selected perforators through the defect, to enable best possible design for tissue recruitment and primary closure of donor sites.

Results: Twenty-four flaps were performed in 12 patients. Average defect size was 168.5 cm ² . One flap was lost to an arterial issue. Two flaps had venous insufficiency that resolved with release of sutures but needed secondary suturing and second flap respectively for marginal necrosis. Three cases needed skin grafts at remnant defects and site of suture dehiscence. Postoperative radiation was tolerated well.

Conclusion: Double perforator flaps are viable alternative to free flaps for large posterior trunk defects. The native perforator-based supply and abundant skin of the back and neighboring trunk are well utilized to this effect. Primary donor site closure keeps morbidity to minimum.