The universal dermal mastopexy: a simple way of planning the operation

The objective of mastopexy is improvement of breast form. Mastopexy procedures are therefore more selective than those for reduction mammaplasty. A simple and reliable operative technique for correction of ptotic breasts is presented. The advantage of this technique offers an alternative to augmentation mammaplasty.     

Emerging applications for acellular dermal matrices in mastopexy

This article explores whether some new acellular dermal matrices (ADMs) can be applied to breast augmentation or reconstruction revision, and particularly whether they can withstand the centripetal pull and prevent recurrent stretch deformities following periareolar mastopexy. Acellular dermis use in breast reconstruction and aesthetic breast revision is a fortuitous development, because their original purpose was for burn reconstruction. Although level 1 evidence remains lacking, ADMs have become integral adjuncts in breast reconstruction, complex hernia, and aesthetic breast revision. New applications continue to be explored, although these are in early stages of development and their long-term value remains to be confirmed.     

The dermal pursestring suture: a new technique for a short inframammary scar in reduction mammaplasty and dermal mastopexy

The author hypothesized the possibility of reducing the extent of the scar formed at the inframammary sulcus in reduction mammaplasty and mastopexy by burying the dogear of excess skin in the region of the inframammary sulcus using a pursestring suture after first removing the epithelium. The results of 15 patients with follow-up periods ranging from 20 to 150 days encourage further application of this technique, which leaves a very small, aesthetically satisfactory scar.     

Dormant Pseudomonas aeruginosa infection seven years post-augmentation mastopexy: A case report

Introduction and importanceAround 1% of all complications associated with breast implants are attributable to infection, classified as acute, subacute, or late-onset, with late-onset infections being the rarest. Even when symptoms are not obvious, an infection may still be lingering. Sub-clinical presentations have been implicated in the pathophysiology of breast implant capsular contracture. Organisms can establish dormancy through biofilm formation, and can also be idiopathically activated, and present as a late-onset infection, as has been clearly described in the literature with the infamous Enterococcus avium.Case presentationWe report the case of a 44-year-old woman who underwent bilateral augmentation mastopexy seven years ago complicated by an acute perioperative infection that was resolved with a full course of antibiotics. She presented to the clinic complaining of left breast pain and swelling accompanied by fever for four days. Ultrasonic imaging showed moderate peri-implant fluid positive for Pseudomonas aeruginosa upon aspiration. The patient therefore underwent bilateral breast exploration and capsulectomy.Clinical discussionWe believe that the dormant P. aeruginosa contributed to the capsular contracture and was idiopathically activated, manifesting as a late-onset infection seven years post-augmentation mastopexy.ConclusionTo the best of our knowledge, no previous studies or case reports have described a late-onset infection due to idiopathic activation, where dormant P. aeruginosa is isolated from an implant capsule many years after augmentation mastopexy. More studies are required to examine the role of dormant bacteria in capsular contracture and their idiopathic activation considering the consequences on patient outcomes.     

The minus-plus mastopexy

The minus-plus mastopexy technique is designed for correction of moderate or major breast ptosis where breast volume is adequate but located in the lower quadrants and increased fullness in the upper quadrants is desired. The advantages of this procedure are absence of a medial scar, excellent projection, ensured nipple viability, speed, and flexibility.     

Improving shape and symmetry in mastopexy with autologous or cadaveric dermal slings

Mastopexy and reduction mammaplasty reshape breast parenchyma and restore youthful contour in women with ptotic breasts. However, recurrent ptosis and breast base widening are common. We have been using internal autologous or cadaveric (AlloDerm) dermal slings to circumferentially support and shape the breasts for symmetry or rejuvenation. Ten patients underwent unilateral mastopexy (3), unilateral reduction-mastopexy (1), bilateral mastopexy (5), or bilateral reduction-mastopexy (1) with an internal dermal sling to correct breast reconstruction asymmetry (2), congenital asymmetry (2), or acquired ptosis (6). Three of 6 patients acquired breast ptosis after massive weight loss. Autologous dermis was used in 5 patients, and 5 patients were reconstructed with AlloDerm. Patients have maintained projection and breast base width after 6 months to 3 years. In conclusion, internal dermal slings improve shape, breast projection, and base width in select patients undergoing mastopexy. An algorithm based on quantity and quality of native skin is provided.     

Histomorphological observations on dermal repair in expanded rabbit skin: a preliminary report.

In 11 New Zealand rabbits, small tissue expanders were placed in a pocket between the dermis and the panniculus carnosus and inflated during a period of 10 days. Animals were killed immediately after the inflation procedure (Group I, N = 4), 25 days thereafter (Group II, N = 5), and 35 and 55 days thereafter (Group III, N = 2). Dermal connective tissue architecture was studied by routine light microscopy. Specimens in group I showed a striking disturbance in polarity of the dermal collagen bundles. These changes were accompanied by a clear increase of cellular infiltration. In groups II and III, the collagen polarity showed a tendency to recover to normal, while cellular infiltration was decreased. The current findings indicate that there is a spontaneous repair of the damaged dermal collagen in expanded skin with time.     

Evipal anesthesia: A preliminary report

Evipal affords an easy, rapid and safe method of inducing deep, general anesthesia for a brief period. It is adapted for minor operations upon any part of the body and is not followed by prolonged sleep, nausea or vomiting. As a preliminary to a general inhalation anesthesia, it has a field as yet not fully established.The safety of any anesthetic must be the measure by which its usefulness is judged. Our experience is too meager to allow us to advance any decisive statements. The report of the Anesthetic Committee, Medical Research Council, London, England, is most reassuring. This committee found 25,000 cases of evipal anesthesia reported with but one death attributed to the anesthetic itself.     

Sacral dermal sinus: A report of 3 cases

Three cases of sacral dermal sinus are reported. Although none of the patients developed meningitis, the danger of this serious complication and the need for early diagnosis and surgical excision are emphasized. Invasive radiological investigations may be dangerous and are seldom indicated. The relationship of sacral dermal sinus to other dermal lesions in this area is discussed.     

Reduction mammoplasty and mastopexy: A personal technique

Surgical correction of the ptotic or hypertrophic breast is performed with increasing frequency. Many different techniques are widely practiced and give predictably reliable results. Greater consideration needs to be given to the long-term aesthetic results, breast shape, quality of scars, and preservation of nipple sensation. This paper presents a personal technique practiced for the past 10 years in which consideration is given to achieving better nipple projection and less conspicuous scars. In addition, a method of wide tissue overlapping is advocated to maintain better long-term breast contour.     

Dynamic compression nail: A preliminary report

Background

Interlocking nailing, which has become the method of choice for treating fractures of the femoral and tibial shafts, still lacks ability to provide the important contact-compression at the fracture. An intramedullary compression nail is described, which provides axial compression at the fracture site with tightening of the specially designed distal interlocking screw. This uses the same principle as dynamic compression plating.

Methods

The study included 11 femoral and tibial nailings performed for various clinical applications such as acute fractures, non-unions and malunions.

Results

All the fractures attained radiological union, with good skeletal continuity across the fracture, within an average time of 13 weeks in fresh fractures and 18 weeks in non-unions.

Conclusions

Active compression through intramedullary compression nailing has great utility for treating non-unions where it provides greater degree of impaction of its irregular ends. This may prove greatly advantageous to the fracture union through increased stability and the osteogenic potential, particularly when utilized in combination with the small diameter unreamed nails.     

Circular stereotactic callosotomy: A preliminary report

Summary The authors propose a new method for performing Stereotactic callosotomy, which they have named circular callosotomy. The operating device is the original Riechert-Mundinger's string electrode, which can be protruded through a side window and by rotating the probe it is possible to cut the commisural pathways to the extent required. The anatomical results of the operation can be checked using MRI scanning.     

Hang gliding injuries: A preliminary report

Six cases of injury associated with hang gliding are reported. The history and technique of the sport are briefly described. Fractures of the spine and limbs are the commonest injuries encountered in this highrisk activity and many of them could be avoided or reduced in severity by simple safety precautions.     

ISHKS joint registry: A preliminary report

Background:

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are the most widely practiced surgical options for arthritis all over the world and its application is rising in India. Indian Society of Hip and Knee Surgeons (ISHKS) has established a joints registry and has been collecting data for last 6 years.

Materials & Methods:

All members of ISHKS are encouraged to actively participate in the registry. A simple two page knee and hip form can be downloaded from the website www.ishks.com. The information collected includes patient demographics, indication for surgery, implant details and in case of revision arthroplasty: the details of implants removed and the cause of failure of primary arthroplasty. These forms are mailed to the central registry office and the data is fed in computerized registry. Data collection started in October 2006.

Results:

Joint registry is a very important initiative of ISHKS and till date, have data of 34,478 TKAs and 3604 THAs, contributed by 42 surgeons across India. Some important observations have emerged. Data of 34,478 TKAs was assessed: These included 8612 males (25%) and 25,866 females (75%). Average age was 64.4 years (Osteoarthritis range: 45 to 88 years; Rheumatoid arthritis range: 22 to 74 years). Average body mass index was 29.1 (Range: 18.1 to 42.9). The indication for TKA was osteoarthritis in 33,444 (97%) and rheumatoid arthritis in 759 (2.2%). Total of 3604 THA procedures were recorded. These included 2162 (60%) male patients and 1442 (40%) female patients. Average age was 52 years (Range 17 to 85 years) and average BMI was 25.8 (Range: 17.3 to 38.5). The indications for THA was AVN in 49%.

Conclusion:

The registry will become more meaningful in years to come. Active participation of all arthroplasty surgeons across India is vital for the success of the joints registry.     

A preliminary report: cementless trapeziometacarpal arthroplasty

A cementless ball and socket trapeziometacarpal arthroplasty was used for the treatment of Eaton and Littler stage II and III trapeziometacarpal osteoarthritis. Forty-two joints were placed in 36 patients between 1986 and 1992. Five joints in 4 patients required revision. Thirty-four joints in 30 patients were evaluated with a mean follow-up period of 47 months (range, 15-86 months). Of the 33 monitored patients (39 joints), 79% reported good to excellent pain relief and excellent functional improvement and 12% reported poor to fair pain relief and functional improvement. Five joints required revision surgery and constituted 13% of the original arthroplasties. Thirty-three functional tests were graded before and after surgery and improvement was noted in all categories. Dramatic improvement was noted in the typical complaints for trapeziometacarpal joint disease, which are encountered in the activities of daily living. Radiolucent lines were present in 13 of 25 implants (52%), which were radiographically monitored. Radiographic loosening was present in 32%; 12 were around the trapezial component and 1 was around the metacarpal component. Radiographic loosening did not correlate with less satisfactory clinical results. Cementless trapeziometacarpal arthroplasty provides an operative alternative to arthrodesis in properly selected patients with trapeziometacarpal joint osteoarthritis. This joint is not intended to replace excisional or ligament reconstruction tendon interposition arthroplasty in lower demand patients or in those with pantrapezial arthritis. It also is not recommended in patients with rheumatoid arthritis or poor bone stock. It offers the advantages of maintaining excellent motion and stability. The cementless arthroplasty failures can be effectively salvaged by converting them to ligament reconstruction tendon interposition arthroplasty.