“T”-osteotomy of the calcaneum

Summary The relative length and height of the lateral and medial walls of the calcaneum probably govern the production and persistence of structural hindfoot deformity, forefoot supination and adduction, and pronation and abduction. Anatomical restoration of the proportions of the calcaneal walls forms the basis of the T-osteotomy of the calcaneum. We have undertaken this operation on 72 feet in 60 patients for cavovarus deformity with forefoot adduction. The calcaneum is approached from the lateral side and the T-shaped osteotomy is performed through the body, the vertical limb being 1 to 1.5 cm behind and parallel to the calcaneo-cuboid joint. The horizontal limb starts from the centre of the vertical cut and ends above the attachment of the tendo achillis. The postero-inferior segment is pushed out correcting the heel varus and at the same time broadening the heel. The forefoot is manipulated downwards and outwards to correct the residual cavus and the adduction and supination of the forefoot. The over-all results, with an average follow-up of 3.7 years, have been satisfactory.Paper presented at Kyoto, Japan, during the XIVth World Congress of SICOT on October 17, 1978     

Surgical remodeling of the silhouette by aspiration lipolysis or selective lipectomy

The author, a pioneer in originating the technique of suction lipectomy, discusses in detail the pathophysiology of the fat cell and fat metabolism. In addition, he describes the surgical means by which, since 1977, he has popularized this innovative new approach to the treatment of unsightly fat deposits in many sites in the body, including the thighs, buttocks, abdomen, hips, arms, ankles, breasts, and submental regions.     

Respecting the aesthetic units in the surgery of palpebral malignancy

Summary The authors, based on their own experience in this field suggest their own therapeutical view which can be described as follows: a much more frequent use of plastic procedures using sliding flaps from the cheek, associated usually with chondromucosal free grafts from the septum, will give not only much better aesthetic results but also a better guarantee against neoplastic recurrence due to the possibility of being able to carry out a much larger ablation.     

118. Diagnostik und chirurgische Behandlung des thoracoabdominalen Aortenaneurysma (TAA)

Zusammenfassung 14 von 21 Patienten mit TAA (40–76 Jahre) wurden mit der ingraft technique nach Crawford operiert. 11 Patienten waren symptomatisch (5 Penetration, 3 progrediente Dissektion, 3 Ruptur) Grundlage der morphologischen Diagnostik bildeten CT und Angiographie. Die Erkrankung reichte von der linken A. subclavia bis zu den Beckenarterien bei 8 Patienten und betraf den distalen thoracoabdominalen Abschnitt in 6 Fällen. Kompensierte Niereninsuffizienz (9 Fälle) mit erheblichem Hypertonus (6 Fälle) waren neben coronarer Herzkrankheit die wesentlichen Risikofaktoren. – 11 Patienten (80%) überlebten den Eingriff, in einem Fall mit Paraplegie. Von den drei Todesfällen waren 2 Patienten über 70 Jahre alt und erlitten eine Paraplegie (gesamt 20 %). Nierenfunktionsstörungen traten in Abhängigkeit von der Ischämiezeit auf, erforderten jedoch nur einmal vorübergehend Hämodialyse. Verbesserte überlebens- und Komplikationsrate ohne Shunt kennzeichnen die Methode.     

A readily available,economic suction cannula

Summary A method of making a fine suction cannula from an intravenous transfusion needle is described. This has been used in general plastic surgery, microsurgery and suturing in the emergency room.     

“Tear-Drop Augmentation Mastopexy”: A Technique to Augment Superior Pole Hollow

Breast ptosis classification systems focus on the inferior descent of the nipple, as well as the descent and distribution of the breast parenchyma below the inframammary fold. Common problems, such as development of a superior pole hollow and an excessive width of the superior pole, extending into the axilla, are not addressed. Few procedures specifically address these deficiencies, and even less information is available in terms of preventative maneuvers when augmentation is desired as an adjunct. Round implants worsen the problem by creating a superior pole shelf, and anatomic implants are unreliable alternatives. Here, we present a technique—tear-drop augmentation mastopexy—that addresses superior pole hollow, excess superior pole width, as well as breast ptosis and hypomastia. Patients with moderate to severe breast ptosis (Regnaults classification), tubular breast deformity, and deformities secondary to previous breast surgery are included in the study. Skin is deepithelialized through a circumareolar incision, and a skin-fat flap is elevated completely encircling the breast. A 2-cm area of parenchyma is left attached to the skin in the lower half of the breast. Breast parenchyma in the superior half of the breast is then advanced and plicated in a superiomedial direction to move the nipple areolar complex to the desired new position. Care is taken to redefine the pectoralis major muscle at its axillary border. A 3-cm incision is then placed in the inferior part of the parenchyma at the 6 oclock position to create a subpectoral pocket for placement of the implant. The tunnel is then closed to separate the implant pocket from the subcutaneous dissection. Residual dermal flap is used to define, and add durability to the parenchyma reshaping procedure. A 3-0 mersiline (Ethicon, Somerville, NJ) blocking suture is used for a uniform circumareolar skin closure. Patients (n:35), ages 17–48, underwent tear-drop augmentation mastopexy between January 1999 and September 2002 for correction of the breast ptosis, tubular breast deformity, and deformities secondary to previous aesthetic breast surgery. The average follow-up was 2 years. All patients displayed type 1 or 2 (Baker classification) capsules. One subcutaneous hematoma and one subcutaneous seroma were seen, which were both treated by percutaneous aspiration. No submuscular hematomas, infections, skin or nipple losses, or hypertrophic scars were noted. Patient satisfaction was high. A more natural tear-drop breast shape was created with an improvement in the superior pole hollow and narrowing of the superior breast. The smallest breasts did not benefit from this technique for elimination of the superior pole shelf, as correction was proportional to the amount of breast tissue available for superior advancement. The tear-drop augmentation mastopexy is a novel technique for correction of the breast ptosis with augmentation, avoiding problematic development of superior pole hollow and excess superior width. This technique is also well applied to tubular breast deformity as well as to secondary breast procedures. Long-term follow-up demonstrates a safe and reproducible result with high patient satisfaction. This technique may solve several problems associated with breast ptosis surgery, which before were not specifically addressed, and the technique warrants further investigation.     

Patient anxiety and experiences associated with an outpatient “one-stop” “see and treat” hysteroscopy clinic

Background One-stop outpatient hysteroscopy clinics have become well established for the investigation and treatment of women with abnormal uterine bleeding. However, the advantages of these clinics may be offset by patient factors such as anxiety, pain, and dissatisfaction. This study aimed to establish patients views and experiences of outpatient service delivery in the context of a one-stop diagnostic and therapeutic hysteroscopy clinic, to determine the amount of anxiety experienced by these women and compare this with other settings, and to determine any predictors for patient preferences.Methods The 20-item State–Trait Anxiety Inventory was given to 240 women attending a one-stop hysteroscopy clinic: to 73 consecutive women before their appointment in a general gynecology clinic and to 36 consecutive women attending a chronic pelvic pain clinic. The results were compared with published data for the normal female population, for women awaiting major surgery, and for women awaiting a colposcopy clinic appointment. In addition, a questionnaire designed to ascertain patients views and experiences was used. Logistic regression analysis was used to delineate the predictive values of diagnostic or therapeutic hysteroscopy, and to determine their effect on the preference of patients to have the procedure performed under general anesthesia in the future.Results Women attending the hysteroscopy clinic in this study reported significantly higher levels of anxiety than those attending the general gynecology clinic (median, 45 vs 39; p = 0.004), but the levels of anxiety were comparable with those of women attending the chronic pelvic pain clinic (median, 45 vs 46; p = 0.8). As compared with the data from the normal female population (mean, 35.7) and those reported for women awaiting major surgery (mean, 41.2), the levels of anxiety experienced before outpatient hysteroscopy clinic treatment were found to be higher (mean, 45.7). Only women awaiting colposcopy (6-item mean score, 51.1 ± 13.3) experienced significantly higher anxiety scores than the women awaiting outpatient hysteroscopy (6-item mean score, 47.3 ± 13.9; p = 0.002). Despite their anxiety, most women are satisfied with the outpatient hysteroscopy see and treat service. High levels of anxiety, particularly concerning pain but not operative intervention, were significant predictors of patients desiring a future procedure to be performed under general anesthesia.Conclusions Outpatient hysteroscopy is associated with significant anxiety, which increases the likelihood of intolerance for the outpatient procedure. However, among those undergoing operative therapeutic procedures, dissatisfaction was not associated with the outpatient setting.     

Deformation: Its application to cosmetic facial surgery

The principles of deformation have come to our attention through the study of technical skills in art. It creates emphasis on the motif of a work by transformation and results in the illusionary phenomenon that makes the total appearance more harmonious and impressive. With this artistic technical concept compounded with our surgical experiences, we designed the deformation technique for facial corrective surgery. Introducing some distinctive cases applying this technique, we show its advantages over the see a defect, correct the defect limitations to present surgical techniques and the good effect of the patient's mind and attitudes.Presented at the 17th Annual Meeting of the American Society for Aesthetic Plastic Surgery, Los Angeles, California, April 20, 1983     

Some remarks on breast reduction by the “B” technique

The main disadvantage of the popular techniques for breast reduction are the scars left around the breasts. We present our experience with the B technique for breast reduction, which creates a much smaller size scar that is well hidden under the brassiere. Our conclusion is that the B technique is the method of choice for most breast reductions.     

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Correction of breast ptosis utilizing a “fold over” de-epithelialized lower thoracic fasciocutaneous flap

In the operation described, vascularized dense connective tissues, consisting of two layers of dermis or fascia, are supplied from below the inframammary fold and shaped surgically into a supportive subcutaneous cup. The reconstruction adds to the effect of the dermal mastopexy for the treatment of breast ptosis. This fasciocutaneous type of flap also augments the breast, and a pleasing projection may be achieved without resorting to an implant. The degree of augmentation depends upon the thickness of the subcutis donor site.     

The various etiological factors of “hard capsule” formation in breast augmentations

The use of Silastic implants in breast augmentation has been one of the greatest advances in aesthetic plastic surgery during the past 20 years. This article deals specifically with one of the most important complications, namely, the formation of the hard capsule surrounding the prosthesis. The specific use of a saline-filled Silastic prosthesis with the intra-luminal use of methylprednisolone acetate suspension is discussed, based on experience with 133 patients. Illustrative case histories and photos are shown. The etiology, prevention, and/or total definitive treatment is explained and the conclusion reached is that this management leads to permanent, satisfactory results.     

Arthrolyse «élargie» de la tibio-tarsienne

Résumé A propos de 12 cas de raideur en équin de l'articulation tibio-tarsienne, les auteurs présentent leur technique d'arthrolyse «élargie» qui leur a toujours permis de corriger l'attitude vicieuse du pied. Ils analysent les résultant obtenus et définissent les indications de cette intervention.Ils insistent sur l'intérêt qu'il y a à réorienter sans section osseuse, le secteur de mobilité de la tibio-tarsienne, en conservant les surfaces articulaires.

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Extended arthrolysis of the tibio-tarsal articulation

Summary The authors describe a technique of extended arthrolysis in 12 cases of tibio-tarsal equinus. This has consistently corrected the defective position of the foot. The results are analysed and the indications are defined.The importance of reorientating the sector of the tibio-tarsal mobility without bone section is stressed and the conservation of all articular surfaces.

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Laparoscopic splenectomy

We have now used a new patient position for laparoscopic splenectomy: The patient is placed in right lateral supine position on a bean bag positioning apparatus and the left arm is elevated. The operator is located on the right of the patient; the first assistant is on the same side and the second is on the left.We have a very good view of the spleen which is hung on the diaphragm by the peritoneal attachments, and we can sever successively inferior polar splenic vessels, short gastric vessels, and hilus splenic vessels. With this patient position, it is our opinion that laparoscopic splenectomy is feasible and safe if the spleen volume is not too large. To date, we have performed thirteen splenectomies with this procedure. We have had twelve good results and one conversion to laparotomy.     

A propos of 56 humeral fractures treated with elastic “loop” wires: Preliminary report

Summary Elastic osteosynthesis is suitable for the humerus mainly because it is a non-weight-bearing bone. It is subject to muscular compression which shortens the bone's length. This can result in perforation of the proximal extremity by the K wires with subsequent loss of the reduction. To prevent this major drawback the authors report their experience with an original implant. It seems to preserve efficiently the trophic value of a noninvasive treatment but also to provide secure bone length restoration. These original wires are simple to use and check because no stock of different sizes of implant is necessary.     

Simplified design of the “B” technique mammoplasty

The preoperative design of the B technique mammoplasty is somewhat complicated and less precise than that of other methods of breast reduction. A new maneuver for simplification of the design is presented.     

Hyperhidrosis and its surgical treatment

Summary 111 sections of high thoracic sympathectomies in 60 cases suffering from primary palmar hyperhidrosis are reported. Surgical results and postoperative complications are discussed in detail. Complications were few in number and were of a transitory nature. No mortality occurred in our series. Various surgical and nonsurgical procedures of treatment are reviewed. Surgical intervention remains the treatment of ehoice in essential idiopathic hyperhidrosis.