Indian Journal of Plastic Surgery最新文献

Background  The conventional methods of dorsal hump reduction planning and execution are prone to errors. The amount to be lowered is usually subject to surgeon's judgment and errors are possible due to differential skin thickness of envelope. Objectives  We propose a hump reduction technique that includes a method to precisely plan the amount of excision based on real surface measurements and our postage stamp technique of hump reduction. Materials and Methods  A prospective study was done in 25 patients requiring dorsal hump reduction. The planning of hump reduction includes precisely plotting the extent of the hump from fixed landmarks on the skin and recreating these distances on the framework after raising the envelope. In contrast to the traditional continuous bony cut in caudocranial direction, we used serial perforations along the proposed profile line. These postage stamp cuts are made using 2 mm osteotome and are converted into a continuous cut using the double-guarded osteotome. Results  All 20 patients were followed till 1 year. There was no major complication and all patients were satisfied with the appearance. Conclusion  Our technique negates the errors in planning and execution. It also helps in reducing the learning curve associated with the control of osteotome making it beneficial for a novice plastic surgeon. It is particularly useful for small humps, and can be used both in open and closed rhinoplasty making it a very good alternative to conventional hump reduction techniques.

Introduction: Hematoma is a common and concerning complication following facelift surgery. To mitigate this risk, hemostatic nets can be applied either externally or internally. In patients with Fitzpatrick skin type of or greater than III, chances of dyspigmentation after external sutures are high for which internal quilting sutures (IQS) have emerged as a promising tool. There is lack of evidence on the use of IQS in darker skin types. Here, we aim to demonstrate its technique and efficacy.

Materials and methods: Forty-one individuals with Indian/Middle Eastern ethnicity, Fitzpatrick skin type ≥III underwent facelift surgery between February 2019 and October 2024. The platysma superficial musculoaponeurotic system plication facelift procedure was performed. IQS were then applied using 4-0 Vicryl, between subcutaneous tissue and skin. Patient demographic data, details of the procedure, early complications including hematoma, necrosis, bruising, nerve palsy, and late complications like skin dimpling, seroma, and sialorrhea were recorded.

Results: The patient cohort comprised 6 males and 35 females (mean age: 55 years), among which 13 patients were of Mediterranean/Middle Eastern ethnicity and 28 were Asian. Fitzpatrick skin type III was present in 17 patients, type IV in 20 patients, and type V in 4 patients. The mean follow-up duration was 37.2 months. No cases of hematoma or seroma were recorded. There was one case of dehiscence in a smoker patient with diabetes. Transient dimpling was observed in seven patients, and two patients developed dog-ears; both resolved conservatively.

Conclusion: In the external hemostatic net, visibility of sutures and increased risk of dyspigmentation at needle puncture sites can be distressing. IQS maintain the benefits of external hemostatic nets-such as reducing skin tension and enhancing redraping-without its disadvantages, resulting in more natural and lasting outcomes, especially for patients with thicker skin and higher Fitzpatrick skin types.

Background: Long-standing burn contractures of limb joints are resistant to complete surgical release and have been addressed earlier by serial casting, and more recently, distraction with a distractor, mostly limited to small joints of the hand. This retrospective study of patients with long-standing burn contracture was done to evaluate the efficacy of external skeletal distractors in securing complete release of various affected joints.

Materials and methods: In our series, complete release was achieved through gradual manual distraction using skeletal uni- and multiplanar frameworks across the affected limbs after incisional release. The resultant wound after complete release was skin grafted or covered with flaps.

Results: Thirty-one limbs in 27 young patients (average age: 19 years) with long-standing contractures (18.5 years) due to burns underwent manual soft tissue distraction in order to achieve complete release (50-95 degrees across various joints). All patients achieved complete release of contractures with minimal complications.

Conclusion: Gradual manual soft tissue distraction through external skeletal distractors of restricting soft tissue ("stretch as you go") after incisional release in long-standing burn contracture of limb joints achieves complete release without exposure of vital structures.

Introduction: Secondary lymphedema negatively impacts the quality of life. Lympho-venous anastomosis (LVA) has shown to attenuate lymphedema symptoms.

Objective: The aim of the study is to evaluate the efficacy, patient satisfaction, and quality of life following LVA for breast cancer-related lymphedema (BCRL) in the Indian setup.

Materials and methods: We conducted a prospective, nonrandomized, feasibility study at a single institute. Sixteen patients with BCRL undergoing secondary LVA between May 2020 and December 2021 were included in the study. Volumetry was done preoperatively and then 6, 12, and 18 months postoperatively. The Indian limb lymphedema scoring (ILLS) system questionnaire and satisfaction scoring were done 1 year postoperatively.

Results: Sixteen patients undergoing secondary LVA for BCRL were included in the study. The preoperative mean difference in limb circumference volume was 804.41 ± 472.01. This was reduced to 471.81 ± 292.216 mL at the 6-month follow-up ( t  = -6.6323; p ≤ 0.00001), 448.58 ± 255.93 ( t  = -5.5295; p  = 0.00006) at 12 months, and 445.25 ± 345.78 ( t  = -6.8957; p ≤ 0.00001) at 18 months of follow-up. The mean volume difference between the two limbs at 12 months post-LVA was 515.3144 ± 284.2007 mL ( t  = 1.9972; p  = 0.1250) and 362.7957 ± 201.9709 mL ( t  = 0.1221; p  = 0.4522). The number of LVAs did not show a statistically significant difference in outcome with a volume difference of 515.3144 ± 284.2007 and 362.7957 ± 201.9709 mL in groups with less than four and more than four anastomosis and a p -value of 0.1250 and 0.4522, respectively. Similarly, body mass index (BMI) and duration of lymphedema did not show a statistically significant difference in outcome ( p  = 0.2648 and 0.2281, respectively). The mean total ILLS were 31.35 and 13.66 pre- and postoperatively, respectively, showing a statistically significant improvement in the quality of life, with a p -value of 0.00023.

Conclusion: LVA significantly improves the quality of life and reduces limb volume, with stabilization occurring at 18 months, and the number of anastomoses, patient's BMI, and lymphedema duration did not affect volume reduction in our set of patients.

Glomus tumors are benign mesenchymal neoplasms arising from the glomus body. The most common site of presentation of a glomus tumor is the subungual region, followed by the fingertip and foot. Facial glomus tumors are extremely rare and constitute less than 1% of all glomus tumors. We report a case of facial glomus tumor that presented with a small painful nodule on the face. Following its excision, the diagnosis of glomus tumor came as a histopathological surprise.

We present a case report of a 6-month-old infant with a giant congenital melanocytic nevus (GCMN) covering 50% of the face. The treatment of choice was a serial resection with skin grafting. The first surgery encompassed excision from the nose and the right and left infraorbital areas. Full-thickness skin graft (FTSG) harvested from the left inner arm was engrafted. During the second surgery, the GCMN was excised from the left cheek, which was reconstructed with a fasciocervical advancement flap elevated in a superomedial direction. The third surgery encompassed excision from the forehead, left temporal region, right cheek, and left lower eyelid. The area was covered with an FTSG from the right inner brachium. At the age of 3 years, resection from the left eyelid, skin grafting, and temporal tarsorrhaphy were performed. The orbicularis oculi were released 1.5 years later and the lower eyelid was reconstructed with a fragment of a cartilage graft from the auricular conchae. Following the patient's complete healing, their quality of life was evaluated through Pediatric Quality of Life Inventory report for toddlers. A pleasant aesthetic result was achieved, satisfying both parents and the child.

Rhinoplasty is one of the most performed procedures by plastic surgeons worldwide, for both functional and cosmetic indications. The demand for aesthetic rhinoplasty in India has been on the rise over the past decade. Despite this rise in demand, rhinoplasty is still considered one of the most technically demanding procedures in plastic surgery. Complications following rhinoplasty are reported to be 4 to 18.8%, with dorsal skin necrosis being a rare complication that occurs in less than 1% cases. Out of a total of 244 rhinoplasties performed by a single surgeon at our institution, 2 cases of dorsal skin necrosis were encountered (0.8%). Currently, there is no literature describing dorsal skin necrosis following rhinoplasty among the Indian population. We present two patients who experienced dorsal nasal skin necrosis following open rhinoplasty while on topical 0.05% tretinoin treatment and highlight our management approach.

High-riding nipple-areolar complex (NAC) due to postoperative malposition following breast reduction surgery is a very serious aesthetic problem for the patients and a very difficult one for surgeons to correct. Reduction surgeries aim to elevate the NAC, and the best course of action for avoiding a high-riding NAC is prevention of over-elevation, taking care of marking the appropriate distance between the NAC and the inferior mammary fold. Its correction poses a very difficult challenge due to the limited skin between the upper edge of the NAC and the sternal notch and the concern for avoiding scars that lie above the nipple in the superior pole of the breast. There are various techniques described for repositioning the NAC to an acceptable position, but most of them come with the drawback of unsatisfactory correction of bottoming out, additional scars, and multiple stages. A technique of mastopexy called "two-flap technique" including repositioning of the NAC as well as elevation of inferior breast mound (or correction of bottoming out), without any additional scars, is described in this article.

Background: Complex nasal reconstructions traditionally use staged flaps, with skin grafts reserved for smaller defects.

Objective: This study evaluates single-stage full-thickness skin grafting (FTSG) for wide nasal defects postcancer resection.

Materials and methods: A retrospective analysis included 52 patients with nasal malignant lesions limited to the skin, reconstructed in a single stage immediately after cancer resections. Defects were intentionally over- or downsized to align with the esthetic unit concept. Templates of the defects were used to harvest FTSG. All donor areas were closed primarily. The graft was carefully sutured to fit the defect, and bolsters were applied for 5 to 12 days. Postoperative taping was used for 4 months. Postoperative photographs were assessed by 92 independent raters using a visual analog scale evaluating five parameters: skin color matching, surface regularity, symmetry, perimetral contours, and overall nasal appearance. Results and complications were analyzed for statistical associations.

Results: On average, 3.5 of 9 nasal units per patient were reconstructed, covering 55.5% of the nasal surface. Local anesthesia was used in 90.4% of cases. Periclavicular and retroauricular donor sites were used in 61.5 and 34.6% of cases, respectively. Evaluators rated the outcomes at an average of 7.1/10 (range 5.1-8.8). The complication rate was 15.4%. No significant correlations were found between the outcomes and the analyzed factors.

Conclusion: FTSG effectively reconstructs wide nasal defects in a single stage, predominantly under local anesthesia, with satisfactory outcomes. This approach signifies a descent down the reconstruction ladder, shifting from complex, flap-staged methods to a single-stage solution.