Experience of injected fat grafting

Eighteen months' experience with the injected fat grafting technique used in 208 patients to correct various problems such as buttocks (augmentation and reshaping), trochanteric depressions, breast augmentation, scar depressions, thighs and legs (calf and ankle augmentation), small wrinkles and depressions of the face (Romberg's disease), nasolabial fold, upper outer breast quadrant, liposuction sequela, fingers and hands is presented. This method shows major advantages with few complications. Some technical details and recommendations for successful fat grafting are also presented.     

Augmentation/Mastopexy: How to Select and Perform the Proper Technique

During a period of 8 years, 384 female patients underwent simultaneous surgery for placement of implants and mastopexy. The surgical techniques used were selected according to the characteristics of each particular case. The determining variables in the selection were ptosis of the nipple–areola complex (NAC) and distance from the NAC to the inframammary fold. Only three surgical techniques were used: NAC lifting (n = 30), periareolar pexy (n = 196), and inverted T pexy (n = 158). The degree of general satisfaction with each of the techniques was 89%, 82%, and 92%, respectively. Round and anatomic implants were used, respectively, for 258 (67%) and 126 (33%) of the patients, with their use depending on the medical indications and each patient’s choice. All complications were minor, and their overall incidence was 18%. Factors such as proper choice of the surgical technique, type of implant, approach to placement of the implant, type of suture, and removal of tissue for the pexy are fundamental to obtaining a good result. With these factors kept in mind, it is possible to perform the combined procedure of mastopexy and implantation, to minimize the complications, and to obtain satisfactory results over the mid and long terms.     

“Reverse” Dual-Plane Mammaplasty

Background The authors present a new type of dual-plane mammaplasty and preliminary results obtained with it. The technique is aimed at improving the final natural appearance of breasts without adding additional risks of dislocation. Methods The eligibility criteria specified patients with sufficient breast tissue to disguise the implant, patients with asymmetric hypoplasia, and patients with an intense workout activity. The exclusion criteria specified patients with very little breasts. The technique is based on combined subglandular positioning in the superior part of the breast and retrofascial–precostal positioning in the inferior part. Results Beginning in January 2000, 57 patients were recruited. No postoperative bleedings, hematomas, or seromas were observed. In 93% of cases, good final shapes were obtained. After 1 year of follow-up evaluation, no displacement, asymmetry, or rupture was recorded. Only three patients (5.3%) showed mild monolateral capsular contractures (Baker II type), which resolved using capsulotomy without prostheses removal. Conclusions “Reverse” dual-plane mammaplasty is a new technique that gives a good anatomic final appearance with no risk of displacement. The low risk of complications renders it feasible and safe for aesthetic breast augmentation. Further studies are necessary to compare this technique with retroglandular and retropectoral approaches.     

Breast cancer after breast augmentation with silicone implants

Background: Although epidemiological studies have failed to demonstrate an increased incidence of breast cancer in women who had undergone prior prosthetic augmentation mammoplasty (PAM), it has been reported that when breast cancer arises in this group it presents mostly in a palpable form and at a more advanced stage. This is thought to be secondary to suboptimal mammographic evaluation caused by the masking effect of the implant. This study was undertaken to determine, in our experience, whether breast cancer arising in women who had undergone PAM could be detected in a prepalpable form by mammography and whether it presented at a more advanced stage as compared with nonaugmented women with breast cancer. Methods: The charts of 22 patients, treated by at least one of the authors, in whom 23 breast cancers developed after PAM (group A) were retrospectively reviewed. The comparison groups consisted of 611 nonaugmented patients who underwent 636 procedure for the treatment of primary breast cancer at our institution (group B) and the surveillance, epidemiology, and end results (SEER) data (group C). Parameters studied were mode of detection, tumor size, axillary lymph node involvement, and histopathology. Results: No significant differences between the groups were found in mean tumor size (group A vs. group B), the incidence of preinvasive cancer (group A vs. group B), or axillary lymph node involvement (group A vs. group B and group A vs. group C). Breast-preserving surgery was performed significantly less in augmented patients (group A vs. group B). Conclusion: We conclude that prepalpable and preinvasive breast cancer can be detected in the PAM patient by mammography and that the stage of presentation in this group is not significantly different than in nonaugmented patients. Total mastectomy is preferred over breast-preserving procedures for the treatment of breast cancer in the PAM patient. Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

Festkörperaugmentation bei Kalkaneustrümmerfrakturen

Background

Comminuted calcaneal fractures are a consequence of high impact trauma to the foot. Stable fixation and anatomically correct repositioning of the joint surfaces are often a problem. To improve fracture treatment, surgical techniques in combination with new augmentation materials have been tested.

Methods

This study presents a new concept of osteosynthesis of complex calcaneal fractures in combination with an alternative augmentation technique. Solid body augmentation was developed and mechanically tested against standard techniques. The solid body was used for augmentation of a central fracture void in combination with conventional plating.

Results

The results show a statistically significant higher stability of the new hybrid osteosynthesis concept against conventional plating techniques under in-vitro conditions.

Conclusions

This work investigated a new concept of internal support of multifragmentary calcaneal fractures. Augmentation of defect voids in the calcaneus with a mechanically stable solid body implant in combination with stable screw anchorage in this implant leads to a higher stability compared to plate-fixation and augmentation with cancellous bone under in-vitro conditions.     

Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study

Background

Surrogates of aortic wave reflection and arterial stiffness, such as augmentation index (AIx), augmentation pressure, pulse wave velocity (PWV) and pulse pressure amplification (PPampl) are independent predictors of cardiovascular risk. A novel ambulatory, brachial cuff-based oscillometric device has been recently developed and validated, yielding 24-h assessment of the aforementioned parameters (Mobilo-O-Graph). Aim of this study was to investigate the feasibility and reproducibility of wave reflection and arterial stiffness estimation by pulse wave analysis using this device.

Methods

Thirty treated or untreated hypertensives (mean age: 53.6 ± 11.6 years, 17 men) had test–retest 24-h monitoring one week apart using the test device.

Results

Mean numbers of valid aortic readings per subject, between test and retest, were comparable. Approximately 12 aortic readings per subject (17%) were not feasible or valid. No differences were observed for any 24-h parameter between the two assessments. Bland–Altman plots showed no systemic difference, while the limits of agreement for each parameter indicated high reproducibility (AIx: − 7.2 to 8.2%, AP: − 3.7 to 4.1 mm Hg, PWV: − 0.39 to 0.41 m/s, PPampl: − 0.08 to 0.06). This was further verified by intraclass correlation coefficients which were > 0.8 for each parameter.

Conclusions

Non-invasive 24-h estimation of wave reflection and arterial stiffness indices, derived by the test device, appear to be highly reproducible. Future studies should investigate whether these measurements have additive prognostic value for cardiovascular risk stratification, beyond common brachial blood pressure measurements or single estimations of wave reflection and PWV at office settings.     

Advancing synthetic therapies for the treatment of restless legs syndrome

ABSTRACT

Introduction: Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) is a common sensory-motor neurological disorder that impairs nocturnal rest causing decreased alertness, depressed mood, reduced job performance and poor quality of life. In patients affected by moderate to severe RLS/WED, a pharmacological treatment is mandatory.

Areas covered: The present review is based on an extensive Internet and PubMed search from 1996 to 2019. It is focused on drugs currently used and under development (phase III and beyond) for the treatment of RLS/WED.

Expert opinion: The drugs currently available for the treatment of the disease do not always allow for obtaining the optimal control of symptoms, in particular in the long-term treatment. Although initially effective, long-term dopaminergic treatment tends to wane over time and augmentation can occur. Updated international guidelines now recommend α2δ calcium channel ligand medications as the initial drug of choice. Oxycodone-naloxone demonstrated a significant and sustained treatment effect for patients with severe RLS/WED insufficiently controlled with previous treatments. Head-to-head trials of different drugs, as well as more studies on nondopaminergic agents and combination therapy, are greatly needed. Monoamine oxidase B inhibitors could be good candidates for the initial treatment of RLS/WED, sparing stronger dopaminergic agents for later stages of the disease.     

Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial

Pertrochanteric fractures are a rising major health-care problem in the elderly and their operative stabilisation techniques are still under discussion. Furthermore, complications like cut-out are reported to be high and implant failure often is associated with poor bone quality. The PFNA^® with perforated blade offers a possibility for standardised cement augmentation using a polymethylmethacrylate (PMMA) cement which is injected through the perforated blade to enlarge the load-bearing surface and to diminish the stresses on the trabecular bone. The current prospective multicentre study was undertaken to evaluate the technical performance and the early clinical results of this new device.In nine European clinics, 59 patients (45 female, mean age 84.5 years) suffering from an osteoporotic pertrochanteric fracture (Arbeitsgemeinschaft für Osteosynthesefragen, AO-31) were treated with the augmented PFNA^®. Primary objectives were assessment of operative and postoperative complications, whereas activities of daily living, pain, mobility and radiologic parameters, such as cement distribution around the blade and the cortical thickness index, were secondary objectives.The mean follow-up time was 4 months where we observed callus healing in all cases. The surgical complication rate was 3.4% with no complication related to the cement augmentation. More than one-half of the patients reached their prefracture mobility level within the study period. A mean volume of 4.2 ml of cement was injected. We did not find any cut-out, cut through, unexpected blade migration, implant loosening or implant breakage within the study period.Our findings lead us to conclude that the standardised cement augmentation using the perforated blade for pertrochanteric fracture fixation enhances the implant anchorage within the head–neck fragment and leads to good functional results.     

McGhan解剖型假体在双平面隆乳术中的临床应用研究

目的探讨McGhan解剖型假体在双平面隆乳术中的临床应用研究,并对手术操作经验进行总结。方法全麻下取乳晕切口,McGhan解剖型假体置于腔隙中,其中下1／3部分位于胸大肌后间隙,上2／3部分位于乳腺后间隙。结果术后随访时间6～12个月,本组患者术后外形更为自然,手术效果满意,无包膜挛缩、血肿、瘢痕增生及感染等并发症出现。结论采用了McGhan解剖型假体的双平面隆乳艇合了乳腺后间隙及胸大肌后间隙假体隆乳术的优点,发挥了解剖型假体的优势,临床效果满意。