Mammoplasty with an L-shaped limited scar and retropectoral dermopexy

In mammoplasty the goal of the surgeon is giving the breast new form and volume and good, durable shape with minimal scarring. This article presents a simple technique of reduction mammoplasty that avoids incisions in the so-called hypertrophic areas of the chest, the medial and the lateral extremities of the submammary fold. The technique is based on nipple transposition on a superior semicircular flap in the new predetermined side, supra-areolar dermopexy. The skin of the inferior pole of the breast is internally de-epithelized to two curvilinear incisions that end near the projection of the anterior axillary line to form an inferior dermal flap for retropectoral dermopexy. The limited residual scar is L-shaped. Ptotic and hypertrophic breasts can be treated with this method.Presented at the XXXIVth National Congress of Italian Society of Plastic Surgery, Bari, 2–5 October 1985     

新型L形剥离子在内窥镜辅助假体隆乳术中的应用研究

目的:探讨新型L形剥离子在内窥镜辅助假体隆乳术中的实用性及临床推广价值。方法:2018年7月-2019年3月4个单位6位医生使用L形剥离子行内窥镜辅助假体隆乳术,共65例患者,按切口设计线切开皮肤,用弯剪钝性剥离至显露胸大肌外侧缘,插入新型L形剥离子从上、内、下、外侧依次剥离,剥离完成后插入内窥镜专用U形拉钩继续剥离腔隙,充分止血,置入假体,调整好位置后放置引流管,缝合切口,加压包扎。结果:所有患者均顺利出院,无术后血肿、包膜挛缩等并发症发生。结论:新型L形剥离子应用于内窥镜辅助假体隆乳术中具有轻巧、操作方便、省时省力等优点,值得临床推广。     

Reduction mammoplasty and mastopexy with limited inversed T scar

Our retrospective study done on 184 cases of hypertrophic mammary gland and ptosis on little, medium, and high grade confirms that we have approached an original technique, giving an inversed T scar, reducing the horizontal part of our scar instead of the original Pitanguy scar.     

Mastectomy scar histopathology of limited clinical value

This study assesses whether the routine submission of mastectomy scars for histologic examination at the time of delayed breast reconstruction is useful. A retrospective review was performed of all delayed breast reconstructions for breast cancer performed by a single surgeon over a 5-year period from January 2000 to December 2004. One hundred eighty-eight patients underwent delayed breast reconstruction during this period, and of these, 133 scars (1 patient had bilateral scars excised) were submitted for histology where the reconstruction was performed by either transversus rectus abdominus muscle flap (TRAM) or latissimus dorsi myocutaneous flap (LDF) +/- implant. Fifty-six patients had reconstruction performed by tissue expander through the inframammary crease where the original mastectomy scar was not excised and were excluded from the study. One mastectomy scar specimen showed a 2-mm suspicious area of invasive ductal carcinoma consistent with same histopathology at the time of mastectomy. This study corroborates evidence that it is questionable whether routine histopathology of mastectomy scar at the time of delayed breast reconstruction should not be a standard practice.     

Spontaneous rupture of an L-shaped kidney

A case of spontaneous renal rupture caused by obstruction due to a ureteral stone in the L-shaped kidney of a young obese, diabetic man is reported. the role of CT beside excretory urography and ultrasound is emphasized in the diagnosis of crossed renal ectopia, and the transabdominal approach is recommended to resolve its complications needing operative management.     

Renal cell carcinoma in an L-shaped kidney

A 64-year-old man with a chief complaint of an asymptomatic abdominal mass was diagnosed as having a renal cell carcinoma in his L-shaped kidney. He was successfully treated with partial nephrectomy following selective embolization of the feeder artery. It is thought to be the first reported case of renal cell carcinoma occurring in an L-shaped kidney.     

隆乳术后哺乳致单侧巨乳患者行改良双环法巨乳缩小术围术期护理

对8例采用聚丙烯酰胺水凝胶(PAHG)注射式隆乳术后哺乳致单侧巨乳患者,行改良双环法巨乳缩小术.结果 8例均手术顺利,切口愈合良好,乳房外形佳.提出术前给予针对性心理护理和完善术前手术区域设计,做好各项准备;术后严密观察引流情况,做好体位护理、伤口包扎护理.并给予详细的功能锻炼指导.可促进患者康复.     

L-shaped cross-fused kidney with stone

L-shaped crossed renal ectopia is a rare congenital anomaly. A unique stone location on plain film and reconstructive computed tomography is demonstrated in a case of renal and ureteral calculi in a 58-year-old woman with right-to-left cross-fused ectopic kidney.     

L型复合假体隆鼻术

为探讨一种预防和治疗手术后出现鼻尖假体轮廓外显和鼻尖外露的方法。应用鼻尖部覆盖自体耳软骨的Ｌ型硅胶假体隆鼻术，即在Ｌ型假体的鼻尖部覆盖取自耳甲腔软骨（０．８ｃｍ×１．０ｃｍ），共施术３６例。其中Ｌ型硅胶取出后鼻尖部凹陷４例，隆鼻术后鼻尖歪斜６例，鼻尖皮肤组织肥厚修薄后５例，鼻部皮肤细薄９例，均取得良好效果，未发现并发症。本手术具有方法简便，术中鼻尖易于调整。术后鼻尖柔软稳定，防止鼻尖外露的优点。尤其适用于隆鼻术后鼻尖皮肤变薄，鼻尖假体轮廓外显，瘢痕凹陷和鼻尖部皮肤较薄的病人。     

一种增生性瘢痕动物模型的建立

目的　建立兔耳瘢痕动物模型 ,观察兔耳腹侧创面在伤后不同时间瘢痕增生的情况。方法　于 32只新西兰白兔的 6 0只兔耳腹面手术切除 2cm× 5cm全层皮肤 ,创面用 1%磺胺嘧啶银冷霜外敷包扎至愈合 ,换药 1次 /周。未作手术的 4只兔耳作对照。 (1)术后连续 12个月观察兔耳创面自然愈合情况。 (2 )用光镜、透射电镜观察兔耳创面瘢痕增生情况。 (3)用计算机图像分析系统测定 1～ 6个月的瘢痕指数。　结果　兔耳创面上皮化后其色泽、厚度和质地均经历从瘢痕形成、成熟到退化的演变过程 ;1～ 2个月的瘢痕指数 2 .2 9± 0 .74较 3～ 4个月 (2 .82± 0 .36 )和 5～ 6个月 (2 .90± 0 .84 )低 (P <0.0 5),其变化与瘢痕增生程度的消长趋势吻合。　结论　兔耳腹面全层皮肤缺损经自然愈合后形成的增生性瘢痕与人体增生性瘢痕相似 ,该模型是研究增生性瘢痕的发生机制及评估其治疗方法的较好的动物模型之一     

Mammoplasty using liposuction and the periareolar incision

The major dilemma of reduction mammoplasty and mastopexy has been the difficult choice between a procedure that yields an ideal shape of the breast versus the size of the scar. With our technique, selected breasts can now be reduced through liposuction and the mastopexy performed through a periareolar incision, resulting in virtually imperceptible scarring.     

Local melanoma recurrences in the scar after limited surgery for primary tumor

The clinical and histologic records of 46 consecutive patients were reviewed who during the period 1980–1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted about 50% of all patients admitted with local recurrence from melanoma during this period. At reexamination of the primary tumors, 16 were found to be malignant melanomas and 9 were nevi (four atypical and five benign). Twenty-one specimens were missing, 11 of which had never been sent for histologic examination. The median thickness of nine measurable melanomas was 0.66 mm. The recurrences in scar consisted of 34 primary melanomas: 18 superficial spreading, 4 nodular, 3 lentigo malignant, and 9 unclassified. Twelve tumors were dermal melanoma metastases. The median thickness of the 25 measurable melanomas was 0.78 mm. The 5-year overall survival was 69%. At the closing date of the study 15 patients had died, 13 of them because of disseminated melanoma. A comparison of the survival curves from this study with those from other series of melanomas with comparable tumor thickness indicates a considerably worse prognosis than is expected with such thin tumors. We believe that the considerable number of local recurrences in the form of a new primary in a scar following limited surgery supports the theory of limited field change around a primary melanoma. Furthermore, limited procedures for primary melanoma, if followed by a recurrence in the scar, worsen the prognosis.

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Resumen Se revisaron los archivos clínicos e histológicos de 46 pacientes consecutivos que tuvieron recurrencia de melanoma en la cicatriz luego de cirugía limitada, en el período 1980 a 1993. Este subgrupo constituyó alrededor del 50% de la totalidad de los pacientes hospitalizados con recurrencia local de un melanoma en tal período. En el nuevo análisis de los tumores primarios, 16 probaron ser melanomas malignos y 9 fueron nevus (4 atípicos y 5 benignos). Faltaron 21 especímenes y de éstos, 11 nunca fueron enviados para examen histológico. El promedio de espesor de 9 melanomas medibles fue 0.66 mm. Treinta y cuatro melanomas primarios presentaron recurrencia en la cicatriz; 18 eran del tipo de extensión superficial, 4 nodulares, 3 léntigo-maligna y 9 no clasificados. Doce tumores fueron metástasis dérmicas del melanoma. El promedio de espesor de los 25 melanomas medibles fue 0.78 mm. La tasa de sobrevida a cinco años fue 69%. Al cierre del estudio 15 pacientes habían muerto, 13 de ellos por enfermedad diseminada. Al comparar las curvas de sobrevida del estudio con las diferentes series de melanomas de espesor comparable, aparece un pronóstico considerablemente peor que el que se esperaría en pacientes con estos tumores delgados. Concluimos que el considerable número de recurrencias locales en forma de un nuevo tumor primario en la cicatriz luego de cirugía limitada como soporte a la teoría de un cambio en un campo definido alrededor del melanoma primario. Además, que los procedimientos limitados, si son seguidos de recurrencia en la cicatriz, empeoran el pronóstico.

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Résumé Les dossiers de 46 patients ayant eu une récidive de mélanome au niveau de leur cicatrice après résection limitée entre 1980 et 1993 et en particulier en ce qui conerne les aspects cliniques et histologiques. Ces patients représentaient à peu près 50% de tous les patients admis pour récidive locale pendant cette même ériode de temps. A la revue de la coupe histologique de la tumeur d'origine, il y avait 16 mélanomes malins et 9 nevi (4 atypiques et 5 bénins). De même, il manquaient 21 pièces et parmi celles, 11 n'avaient jamais fait l'objet d'un examen histologique vrai. L'épaisseur moyenne de neuf mélanomes où ce caratère était mesurable était de 0.66 mm. Les récidives au niveau de la cicatrice concernait 34 mélanome primaires, 18 cas d'extensin superficielle, quatre mélanomes nodulaires, trois lentigos malins et neuf non classifiables. L'épaisseur moyenne des 25 tumeurs mesurables était de 0.78 mm. La survie globale à 5 ans était de 69%. A la période de pointage, il y avait 15 décès, 13 en rapport avec une dissémination du mélanome. En comparant les courbes de survie entre les patients de cette étude avec d'autres études comportant des mélanomes d'épaisseur comparable, le pronostic de ces tumeurs était moins bon qu'attendu. Nous avons retrouvé beaucoup de ces récidives locales sous forme de tumeur primitive dans la cicatrice après excision limitée ce qui est en faveur de la théorie de modifications de champs autour des mélanomes primaires. De même, dès lors que l'exérèse limitée est suivie de récidive, le pronostic est plus mauvais.

     

Anchor enhanced capsulorraphy in bunionectomies using an L-shaped capsulotomy

The objective of this study was to investigate potential benefit of a suture anchor-enhanced capsulorraphy in the early maintenance of correction in bunionectomies. We compared, retrospectively, in successive series, the loss of correction of the Hallux Valgus (HV) and intermetatarsal (IM) angle, in those repaired with an L-shaped capsulorraphy enhanced with anchors to those without. Intraoperative and second week postoperative simulated weightbearing anterior posterior (AP) X-rays were used to evaluate results. By using only intraoperative and early postoperative X-rays, we should have effectively eliminated extraneous factors that might have influenced our results. A Total of 106 cases were investigated, 65 of which were repaired using anchors, the remaining 41 without. In the anchor group, 38 underwent a proximal metatarsal concentric shelf osteotomy (CSO)/modified McBride procedure, while the remaining 27 had a distal Chevron correction. In the without-anchor group, 21 had a CSO/modified McBride procedure while 20 underwent the Chevron procedure. In the without-anchor group, the average HV and IM loss of correction was 4.60 degrees (range, -2 to 21 degrees) and 0.6 degrees (range, -1 to 9 degrees) respectively. In the anchor group, the corresponding loss was 2.8 degrees (range, -3 to 17 degrees) and 0.6 degrees (range, -2 to 14 degrees) respectively. These results, when statistically analyzed, demonstrated that while the IM angle change was not statistically significant, the HV angle change was statistically significant, implying that the anchor plays a significant role in maintaining the surgical correction in both the distal Chevron and CSO/ modified McBride bunionectomies.     

Resection of an L-shaped kidney with renal cell carcinoma using a microwave tissue coagulator

An L-shaped kidney is a type of crossed fused renal ectopia and consists of two moieties which were originally two kidneys. It is an uncommon condition and cases of malignant tumors in such anomalies are exceedingly rare. A case of an L-shaped kidney with renal cell carcinoma is herein reported, in which a separation of both moieties was done in situ in order to perform a tumor resection. A literature review of this topic is also reported and the findings are discussed.     

Augmentation Mammoplasty: Personal Evolution of the Concepts Looking for an Ideal Technique

The purpose of this paper is to report our personal experience in the field of augmentation mammoplasty. This experience is based on over 15 years in practice and working with more than 400 cases using different types of prostheses (single-lumen gel-filled, single-lumen saline-filled, double-lumen, smooth or texturized surfaces), different routes (submammary, periareolar, transaxillary), and different locations of the implant (complete submuscular, subglandular, subpectoral). Our present preference is for a partial submuscular (subpectoral) augmentation mammoplasty through an inferior periareolar route. The results of 91 consecutive patients operated on with this technique from January, 1990 to December, 1994, during the blow-up of the controversy on silicone, are reported.     

Mammoplasty for symmetry in breast reconstruction and histologic assessment

Background

In breast reconstruction, complementary surgery on the contralateral breast is sometimes necessary to obtain a satisfactory aesthetic result. This complementary mammoplasty for symmetry gives the surgeon the opportunity to verify the state of the mammary glandular tissue to rule out a possible occult tumour in the contralateral breast. Our objective was to determine the prevalence of borderline lesions and of in situ and invasive carcinoma in specimens of the contralateral breast in a mammoplasty for symmetry in patients with breast cancer.

Methods

We conducted a retrospective study of 145 breast reconstructions with mammoplasty for symmetry conducted at the Tours Regional Teaching Hospital in France.

Results

The glandular histologic result after mammoplasty was normal in 45.5% of patients, with benign pathologies in 38.9% and borderline lesions in 15.6% of patients. No invasive or in situ carcinoma was detected.

Conclusion

Systematic histologic analysis of glandular mammary tissue sampled after reduction mammoplasty in the particular context of breast reconstruction after breast cancer makes it possible to discover lesions that were not seen in presurgical evaluation. The early management of these borderline occult lesions could reduce the incidence of breast cancer in these at-risk patients.