Aim: A clinically useful treatment laser must generate stable and precise energy of low diffusivity. This study assessed the photothermal response of a Q-switched ruby laser (QSRL) in the treatment of oculodermal melanosis (Nevus of Ota).

Methods: A two-year retrospective review of 40 patients with oculodermal melanosis treated with a QSRL (λ = 694 nm, pulse duration = 25 ns, 3 mm spot size, energy density 6-10 J/cm²) was performed. Demographics included an age range of 18-54 years (mean 28) and a gender distribution of 25 females and 15 males. The values recorded from real-time infrared thermal imaging of the lasered skin were inserted into standard thermal wave equations. This permitted analysis of the resultant temperature distributions related to the energy change.

Results: Skin temperature was unchanged during the initial heating stage. This was followed by a very rapid temperature rise. A thermal burn injury manifested by dermal-epidermal disruption, resulted when the energy density of the QSRL exceeded 8 J/cm² (> 44 ℃).

Conclusion: The use of infrared thermal imaging with a standard thermal wave equation allows prediction of skin temperature distribution when QSRL is used for the treatment of oculodermal melanosis. With the use of appropriate settings, complications may be minimized.

This study was conducted to evaluate changes in the composition of a poly-L-lactic D-lactic acid and trimethylene carbonate (PLDLA-TMC) sheet after insertion into the human body. A 35-year-old woman had an orbital fracture that was reconstructed using a PLDLA-TMC sheet. During iliac bone grafting for enophthalmos 190 days after the insertion, the sheet was removed and analyzed using gel permeation chromatography and Fourier transform infrared spectroscopy. The weight average molecular weight decreased (from 151,000 Da to 10,000 Da), as did the number average molecular weight (from 15,600 Da to 255 Da). An amide functional group peaks at 1,655.43 cm^-1 (1,670-1,640 cm^-1) and its stretch band at 1,541.26 cm^-1 (1,640-1,550 cm^-1) newly appeared due to serum or tissue fluid incorporation. PLDLA-TMC is expected to exhibit favorable degradation properties.

Aim: The aim of the study was to provide early muscular reinnervation to avoid muscle atrophy and functional loss in an experimental model.

Methods: Fifty rats were divided into five groups. In group 0 (control group) only nerve dissection was performed. Total peroneal nerve section was performed in the remaining groups. Immediate end-to-end neurorrhaphy (EEN) was made in group 1. In group 2, an end-to-side neurorrhaphy (ESN) was performed from the tibial nerve to the peroneal nerve. In group 3, a direct EEN, plus an ESN, were used as a nerve graft as a bridge from the donor nerve (tibial); all nerve coaptations were performed through an epineural window. In group 4, only a neurotomy was made without any type of reconstruction.

Results: Neural diameters were similar in groups 0, 1, and 3 (38 ± 1 μm, 31 ± 6 μm, 32 ± 3 μm). Neural fibers in group 3 had an 18% increase in the number of axons (P < 0.001) when compared to group 0. Group 2 (28 ± 1 μm) and group 4 (19 ± 3 μm) had diminished diameters with a lower index of muscle regeneration. Animals in group 4 presented with “clawed” lower extremities and had difficulty with ambulation. Neural graft diameters was similar in groups 2 and 3 (33 ± 4 μm, 31 ± 3 μm), but axon density was significantly higher in group 3 (53 ± 6 μm, 39 ± 8 μm) (P < 0.001). Axon density was 36% higher when the combination of EEN and ESN with a neural graft through an epineural window was performed.

Conclusion: This study revealed that the combination of EEN and ESN repairs with the addition of a neural graft provides a lower index of muscle fiber destruction, and can be a reliable method for reconstruction in high neural injuries.

Aim: The primary aim of this investigation into the correlation between prosthetic breast reconstruction, antibiotic prophylaxis and surgical drains was to determine whether the short-term prophylaxis recommended in the current guidelines is in fact able to sterilize the peri-prosthetic pocket in patients undergoing prosthetic breast reconstruction via tissue expansion, permanent implant placement, or Becker implants, as well as augmentation to correct symmetry.

Methods: A total of 96 women who had undergone prosthetic breast reconstruction surgery were considered. Patients were recruited from the Plastic Surgery Clinic, Gemona, and the Surgery Clinic, Udine, both affiliated with the Udine “Santa Maria della Misericordia” University Hospital between May 2013 and May 2014. All patients were administered the recommended short-term antibiotic prophylaxis, i.e. 2 g cephazolin (plus 1 g eventually given after 3.5 h of surgery) 30 min before surgery. Records pertaining to each patient were kept in a specific study chart.

Results: Samples of peri-prosthetic drainage fluid were taken from 92.5% of the recipients of breast reconstruction/implant surgery. Only 2.3% of the samples analyzed were found to be positive for microbial strains.

Conclusion: The results of this preliminary study are encouraging, demonstrating that the guidelines regarding short-term antibiotic prophylaxis are indeed effective.

The use of stem cells for regenerating damaged organs and tissues which are unable to heal on their own is a widely studied field in plastic and reconstructive surgery as well as medicine in general. Among various stem cell types, adipose-derived stem cells (ASCs) are especially considered to be an ideal stem cell population for several clinical situations. These cells could be harvested from fat with relatively less invasive methods with high yield rates. ASCs have proved to be worthy of more research to understand the mechanisms behind their regenerative abilities. However, it remains uncertain if ASCs show their main effects by their multipotency, or by secreting abundant amounts of cytokines and growth factors. The authors have performed a review of the current publications and literature on the ASCs’ immunophenotypical properties and isolation methods as well as basic and clinical science research about the mechanisms behind their regenerative effects. The purpose of this article is to synthesize information regarding ASCs’ paracrine effects and their ability to differentiate into other cell lines, comparing these aspects in order to lead future research for a more effective cell therapy utilizing these cells.

Aim: With little manipulation, compression bandages placed circumferentially around the digit can be rolled up the digit, creating a tourniquet effect. The aim of this study was to elucidate the pressures induced by self-adherent bandages applied circumferentially around the fingers.

Methods: After fabricating various clay finger models using the live finger as a model, the pressure of each self-adherent bandage was measured at the level of the proximal phalanx. Two different self-adherent bandages were applied with variables of different levels of tightness, number of wraps, and whether each was rolled up or not. Pressure was measured using a digital measuring device at a standardized location.

Results: The measured pressure of 3 wraps along the adult finger model was higher than 1 wrap or 2 wraps, and untightened bandages had lower pressures than those of tightened bandages. The pressures of the unrolled bandages were lower than those of rolled up bandages, and pressures along the live finger of the rolled up group were higher than those in the adult finger model. Additionally, measured pressures from the child finger model were higher than those from the adult model.

Conclusion: Precautions should be taken to prevent rolling up dressing materials, especially in children.

Rhinophyma is a less-common subtype of rosacea that presents as thickened skin with enlarged sebaceous glands that may progress to large bulbous growths with dilated pores on the nose. Rhinophyma can lead to morbidity aesthetically and sometimes functionally. The prevalence of rosacea ranges from 1% to 20%. The exact pathogenesis is not known, but potential factors include altered circulation, changes in microorganisms and/or alterations in immunity. Here the authors present a unique case where a patient presented with unilateral rhinophyma: a presentation warranting work up to rule out other more worrisome entities.

Aim: The post-bariatric patients who undergo torsoplasty often incur postoperative complications that dilate their recovery time. The authors propose the technique of extended abdominoplasty, described in 2012 for aesthetic torso remodeling, in post-bariatric patients in order to reduce complications and hospitalization time.

Methods: The authors performed 21 extended abdominoplasties and compared them with 21 torsoplasties in post-bariatric patients during a 1-year period. Data studied was age, gender, duration of the procedure, blood loss, complications and hospitalization duration.

Results: Peri and postoperative bleeding led to 3 cases of anemia necessitating blood transfusions in 14.3% of the second group; no blood transfusion was needed in the first group. No other major complications occurred during the postoperative period in both groups.

Conclusion: The authors believe that extended abdominoplasty is a viable alternative to the torsoplasty in selected patients presenting a severe adipocutaneous circumferential laxity, as occurs in post-bariatric patients with a significant weight loss.

Aim: To demonstrate an algorithmic approach to hypospadias repair with the aid of the surgical microscope as a teaching aid, as well as an ergonomic tool.

Methods: One hundred and two patients were operated on between 2009 and 2013, all by the senior surgeon (M Dalal). This is a retrospective review of results in the case series. The procedures used were one stage repair with no incision of the urethral plate, or the two stage Bracka repair.

Results: Fifty-six patients underwent the one stage procedure and 46 patients underwent the two stage Bracka repair. Early complication rate was 4.9% (n = 5) and late complication rate was 10.7% (n = 11). The fistula rate specific to one stage and two stage procedures was 5.3% (n = 3) and 13% (n = 6) respectively.

Conclusion: A structured approach to hypospadias surgery will aid the surgeon in choosing the appropriate procedure for the appropriate patient. The authors have chosen to use 2 types of repair for all hypospadias subsets based on the algorithm. They find the microscope an invaluable teaching aid, whilst at the same time providing an ergonomic benefit, and providing a wide range of surgical site magnification.

Syndactyly consists of a variable fusion of soft tissue or of bone in adjacent fingers. This has important aesthetic and functional impacts on the development of the child due to the abnormal appearance of the hand. When the 1st web space is affected, it compromises grasp and development of the clamp function. Affliction of the 2nd, 3rd or 4th webspaces hinder the independent movement of the fingers adjacent to it. Current syndactyly release techniques have inherent disadvantages such as the use of skin from both the interdigital halves of the syndactylized fingers, the need to skin graft the donor site, postoperative flexion contracture, and need of 2 or more surgical procedures to obtain the desired result. The authors present 7 cases with incomplete simple 2nd, 3rd or 4th webspace syndactylies of multiple etiologies. All cases were treated at the unit of the corresponding author. The flap used in the treatment for all 7 cases did not require skin grafting of the flap donor site and used only skin from one of the fingers, while achieving a webspace dimension similar to normality, with a short recovery period. Furthermore, there were no postoperative finger contractures, diminishing the risk of future relapse.

Aim: The aim was to study the effectiveness of the reverse latissimus dorsi muscle flap in reconstruction of complex defects of the back.

Methods: This is a retrospective study of patients who underwent reverse latissimus dorsi flap for reconstruction of the back, in a tertiary care hospital. The patient demographics, etiology, surgery indications and complications were studied.

Results: The study had five patients between 2012 and 2016 who underwent reverse latissimus dorsi flap for reconstruction. The flaps survived in all the patients. Two patients had complications, unrelated to the latissimus dorsi muscle flap.

Conclusion: The vascularity of the flap is reliable can be used to obliterate the dead space, can be used to control the infection, in complex cases of the back.

The authors present the double-paddled pectoralis major myocutaneous flap as a successful alternative for the reconstruction of complex orocervical defects following failure of prior microvascularized free flaps or free flap harvest is not feasible. This method was used for the reconstruction of post-ablative defect in a 36-year-old male with a T4 squamous cell carcinoma of the base of tongue with laryngeal involvement. The distal paddle was adapted to reconstruct a defect of the floor of the mouth and further sutured in two layers (muscle-basal mandible and skin paddle-oral mucosa) while the proximal skin paddle was used to close the cervical skin and the peri-tracheostomy defect.

Aim: This study aimed to investigate the efficacy of the myocutaneous flap of the rectus abdominis in the surgical treatment of a large defect on the female chest following keloid excision.

Methods: According to the location and size of the keloid on the chest, a myocutaneous flap based on the left or right rectus abdominis muscle was designed and transferred for repair of a chest defect following keloid resection. Radiotherapy was performed in the surgical area on the first and seventh postoperative days.

Results: From January 2015 to March 2016, rectus abdominis myocutaneous flap coverage and early radiotherapy were used to treat 7 cases of keloids on the female chest. A postoperative follow-up of 10-14 months (average 12 months) was conducted. All the flaps survived well without evidence of keloid recurrence, and all patients achieved an improved chest shape.

Conclusion: The rectus abdominis myocutaneous flap is a viablemethod for wound closure following resection of large keloids on the female chest.

Aim: Keloids often occur on the chest wall, with high recurrence rates despite surgery and radiotherapy. Garment pressure therapy is commonly used to treat hypertrophic scars and keloids. Irregularity of the chest wall surface can inhibit the effects of the garment pressure therapy. This clinical study is to determine the effect of inflatable pressure garment in preventing keloid recurrence after keloid operation and radiotherapy.

Methods: Chest wall keloid was removed and radiotherapy was administered at the surgical sites on the 1st and 7th postoperative days in 61 patients. An inflatable pressure garment device was designed and its pressure effect was confirmed by comparing it with the general pressure garment at the sites of the right and left infraclavicular area, manubrium and sternal area between breasts. The keloid patients were treated with inflatable pressure garment device 1 month after the operation. The clinical results were observed.

Results: The detected pressures were 0.26 ± 0.21, 0.49 ± 0.16, 0.53 ± 0.10 and 0.91 ± 0.17 kPa at the sites of the right infraclavicular area, the manubrium area, the left infraclavicular area and sternal area between breasts with the general pressure garment. These were obvious lower (P < 0.05) than that generated with the inflatable pressure garment device of which the average pressures were 7.26 ± 0.41, 7.6 ± 0.32, 9.02 ± 0.54 and 10.31 ± 0.14 kPa at the corresponding sites. Sixty-one patients were treated with this device after keloid surgical excision and radiotherapy. Satisfactory results were observed.

Conclusion: Appropriate and effective pressure can be generated with inflatable pressure garment on the chest wall. This device may be useful in preventing chest wall keloid recurrence after keloid operation and radiotherapy.

Aim: Over the past two decades, there has been a dramatic increase in the research of the use of autologous fat grafting in clinical practice. Despite the many advantages this method possesses, the unpredictable fat resorption rates limit its use. The primary aim of this study was to develop an accurate, quick, non-invasive assessment tool, using the nuclear magnetic resonance (NMR) technique, which allows the injection of fat in small droplets rather than in large aliquots (the main drawback of our formerly described method) which allows assessment of fat retention in a more clinically relevant way.

Methods: A total of 7 nude mice were transplanted with human fat using the Coleman technique. Pre- and post-transplantation and then once weekly, mice were analyzed using an NMR scanner. At the end of the 7-week experimental period the mice were sacrificed.

Results: Seven weeks following transplantation 7 mice demonstrated a decrease of 40% of their average fat content compared to immediately post transplantation (standard deviation of 18%). All mice followed the same trend, and the low standard deviation throughout emphasizes the accuracy of NMR as a reliable assessment tool.

Conclusion: This preliminary study demonstrates that NMR is a reliable and accurate tool to assess fat content, and has allowed development of a clinically relevant animal model for human fat transplantation.

Aim: To assess volume management in patients presenting with breast asymmetry and ptosis.

Methods: Retrospectively collected data was analysed. The patients were divided into 3 groups. Group A included patients who had volumetric difference alone and had different size implants alone. Group B included patients who had volumetric difference with breast ptosis requiring mastopexy with different size implants. Group C included patients who presented with breast asymmetry with ptosis and had same size implants on both sides with different volume breast reduction.

Results: Subgroup A1 included 145 patients who had larger implants placed on right side. Subgroup A2 included 95 patients who had larger implants on the left side. Subgroup B1 included 7 patients who had larger implants on the right. Subgroup B2 included 13 patients who had larger implant on the left side. Subgroup C1 included 7 patients who had larger reduction on right side. Subgroup C2 included 11 patients who had larger reduction on left.

Conclusion: When different volume implants are used, the vast majority of the patients do not require a volume difference of more than 60 mL. When the breast is larger on the right then larger mean volumes are used on left side to offset the larger right breast.

Keloid management has always been frustrating and challenging. The combination therapy of surgical excision and radiation therapy was deemed as the last resort for decades. The authors performed a thorough and comprehensive review over the mechanisms on how radiation therapy damages the keloid cells. The keloid cells’ cellular response towards damage induced by irradiation was also studied based on original and current literatures. Mechanisms of damage generated by radiation therapy on keloid cells remained partially understood. However, direct damage was identified playing dominant role, in contrast to damage involved cancer cell apoptosis. Moreover, the p53 pathway and some inflammatory factors like interleukin-6 were believed to function in cellular response to irradiation. However, the transforming growth factor beta, which was the major dysregulated pathway involved in pathogenesis of keloid formation showed no apparent correlation with cellular response to irradiation damage. These pathways could partially explain radiation resistance in some refractory keloid lesions. The scientific basis and experimental proof in this field was still inadequate, which drove us to find more evidence to identify the key regulator response to damage engendered by radiation therapy. Further pathway identification may benefit the drug development to prevent keloid recurrence.

Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although the most common complication associated with this surgery is diffuse venous congestion, its origin remains unclear. The aim of this study was to assess the anatomical characteristics of the anterior abdominal wall vessels that could predict venous congestion, using CTA with 3D virtual reconstruction.

Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases were identified. For each case, 3 controls that had not exhibited any vascular complications were randomly selected.

Results: The global venous congestion rate was 4.14%. No statistically significant differences were found between the groups’ superficial inferior epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371), number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652), direct communications between SIEV-perforators (P = 0.418), and communications of both SIEVs across the abdominal midline (P = 0.371).

Conclusion: The present study provided new information concerning the identification of the controversial anatomical features associated with venous congestion in DIEP flaps. CTA and 3D virtual reconstruction were useful tools for evaluating the abdominal wall anatomy and for planning DIEP breast surgery, but neither for predicting nor preventing the diffuse congestive phenomenon.

Aim: Autogenous iliac crest bone graft is frequently used in immediate reconstruction of post ablation defect of benign mandibular pathologies. The aim of this study was to conduct a systematic literature review on the complication and failure rates with this technique and factors associated with failure.

Methods: The initial literature search in PubMed and Cochrane databases identified 915 articles.

Results: Of these, 7 were included in the final review. The majority of the studies were retrospective in nature. These articles encompassed 127 procedures with non-vascularized iliac crest bone graft; with complication rate of 13.3% and failure rate of 3.1%, most complications did not result in failure. All failures were due to infection with no main factor associated with failure.

Conclusion: Use of non-vascularized iliac crest bone graft for immediate mandibular reconstruction appears to be associated with low complication and failure rates in carefully selected cases.

Aim: Maxillofacial surgery has always aimed to find alternative therapies to treat severe maxillary hypoplasia. Distraction osteogenesis of the midface has become the technique with the best functional and aesthetic results. Nevertheless, anchoring a distractor to the middle third of the face continues to involve complex planning. Plus, achieving the desired force vector can sometimes be cumbersome and uncomfortable. The aim of this study is to propose a novel skeletal anchorage technique for the rigid external distractor.

Methods: Non-controlled, prospective study of 9 patients with severe midface hypoplasia who were treated with distraction osteogenesis using a rigid external distractor anchored to the infraorbital rims and the bilateral pyriform apertures. The activation phase started the first postoperative day at a rate of 1 mm per day. The consolidation period lasted 6 to 8 weeks.

Results: Eight patients achieved the desired distraction objective (24.5 mm on average), with only 1 suffering a 5-mm relapse. None of the patients reported complications.

Conclusion: Distraction osteogenesis of the midface by skeletal anchorage is an alternative method when treating patients with severe maxillary hypoplasia. It has significant advantages compared to traditional anchoring because it simplifies the procedure, diminishes the costs and complications.

Aim: To explore the characteristics of normal hair distribution in Han Chinese.

Methods: A total of 146 healthy Han Chinese and 41 patients with androgenetic alopecia (AGA) were selected as research subjects. Digital photographs of the vertex, temporal, and occipital regions were taken after their hair was trimmed. An image analysis software was used to compute the number of follicular units (FUs) and hairs.

Results: The mean FU density of the 146 healthy Han Chinese was 74.36 ± 13.33 units/cm² and their mean hair density was 143.33 ± 28.08 hairs/cm². There was no significant difference between males and females (P > 0.05). The mean FU density in the occipital region of AGA patients was 77.78 ± 2.99 units/cm² and their mean hair count was 148.12 ± 6.98 hairs/cm². Both were lower than those of healthy Han Chinese, and the differences were statistically significant (P < 0.001). Two-hair FUs (52.62%) were the predominant type found in Han Chinese.

Conclusion: The FU and hair densities of healthy Han Chinese are lower than those of whites and Africans. the study provides hair transplantation surgeons with information on hair distribution in Han Chinese. It also provides a quantitative basis for the area of donor site and transplantation density necessary for hair transplantation surgeries. the research findings provide some theoretical data for the hair distribution characteristics of Han Chinese. These data can contribute to the preoperative assessment, surgery planning, and postoperative outcome evaluation by hair transplantation surgeons.

Aim: Breast reconstruction has several beneficial effects on psychosocial well-being and quality of life. The ultimate goal has always been to create the most natural breast mound. Thus in many centers, the unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains the most common technique for breast reconstruction. Our objective was to retrospectively compare the outcomes of ipsilateral and contralateral pedicle TRAM flaps.

Methods: The total of 110 patients underwent unilateral breast reconstruction with pedicle TRAM flap at Cancer Institute of Tehran University of Medical Science from January 1996 to June 2011. Premorbid risk factors, postoperative outcomes and demographic data were assessed. The analysis of the recordings was done by SPSS 20.

Results: Out of 110 patients who were included in the study, 87 had ipsilateral and 23 contralateral pedicle TRAM flaps. The incidence of flap complications that did not require surgical intervention was 19.7% in ipsilateral and 30.4% in contralateral pedicle TRAM flap. The incidence of flap loss requiring revision was significantly higher in contralateral group (P = 0.001). Major complications were noted in 11.5% of the ipsilateral pedicle TRAM patients and 26.1% of the contralateral group (P < 0.001). Minor complications were noted in 17.2% of the ipsilateral pedicle TRAM patients and in 34.8% of the contralateral group (P < 0.001). Total early hospital stay was longer in contralateral pedicle TRAM flaps (7.66 days vs. 10.68 days, P = 0.83). Higher complications were encountered in contralateral pedicle TRAM flaps compared to ipsilateral pedicle TRAM patients (39.1% vs. 19.5%, P = 0.001). The type of pedicled TRAM flap (ipsilateral vs. contralateral), had significant effect on complications (odds ratio = 0.007, P = 0.002) while other variables had no significant effect on the incidence of complications.

Conclusion: This study indicates that the overall outcome and mid-term morbidity-free survivals of ipsilateral pedicle TRAM flap breast reconstruction are statistically superior to contralateral pedicle TRAM flap breast reconstruction. Both of these procedures are reasonably feasible and safe. These findings lead us to discourage the use of contralateral pedicle TRAM flap when an ipsilateral option is feasible.

Aim: To evaluate possible results with the stimulation use of minoxidil and the strengthening of hair roots with nutritional cyclical supplements, resulting in increased hair regrowth, without the use of anti androgens and enzyme blockers.

Methods: This prospective controlled clinical trial compares the current acknowledged form of treatment for hair loss within two controlled groups for both men and women against the use of cyclical nutritional therapy and minoxidil 2%. One hundred patients in each of the 4 groups, a total of 400 patients, were followed for 1 year. The progress was evaluated every 2 months with computerised measurements of hair density, hair calibre, global photography and uniquely designed self-assessment scores.

Results: The use of nutritional supplements showed consistent improvements in both treatment groups of men and women against the controlled groups with a correction of hair fall and minimum 18% increased density within 2 months with further improvement to a maximum of 156% over 1 year.

Conclusion: Hair loss occurs when weak, sensitive, follicles are affected by multiple causes. Hair regrowth can be achieved consistently and safely by strengthening the hair roots and promoting hair growth without necessarily depending on the use of anti androgens.

Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent to contour the dorsal surface. However, there are no reference values in literature for the location and degree of angulation. The authors studied the dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of angulation of the dorsal cortex.

Methods: Cadaveric dissections of 118 metacarpals from 30 hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy. These pictures were analyzed using Image J software. The dorsal cortex angle was measured in each image, and the center of rotation of angulation (CORA) was identified. The distance from the CORA to the base of metacarpal was measured and calculated as a percentage of the metacarpal length.

Results: The average dorsal angle of the metacarpals was 11.5°. The average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°; SD, 4.73), 3rd = 10° (range, 1-25°; SD, 5.28), 4th = 11° (range, 1-20°; SD, 4.45), 5th = 12° (range, 2-24°; SD, 5.11). The average location of the CORA from the base of the metacarpal as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger, 52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger.

Conclusion: These measurements are able to serve as reference values for plate bending while operating on a metacarpal fracture or metacarpal corrective osteotomy.

The media has a large influence on what constitutes modern day beauty, as it suggests to susceptible young girls and boys what makes someone beautiful. The term “beautiful” is portrayed as curvy, thin, tall, with voluptuous hair, big eyes, large breasts, round buttocks, and full lips. Very few people in society naturally appear like this, and thus many people undergo cosmetic surgery for this desired look. This article will examine the difference of opinions regarding the exact age to consider aesthetic plastic surgery. Adolescence is frequently bullied about any defect. The authors discuss some of these opinions and present three very unusual cases where early surgery has been beneficial.

The management of recurrent pressure ulcers is a frequent problem in patients with spinal cord injuries. Many local muscle and fasciocutaneous flaps can be used to cover ulcers of all sizes. However, when a recurrent pressure ulcer has been repeatedly addressed, the number of available flaps becomes quite limited. Contralateral muscles, such as the gracilis, can be used to cover recurrent ischioperineal ulcers and should be employed before last resort surgeries, such as hip disarticulation and the total thigh flap.

Aim: Autologous tissue transfer to salvage breast reconstruction following a previously failed or unsatisfactory reconstruction has been described by previous studies to be an effective strategy to optimize outcomes. The purpose of this systematic review is to assimilate the relevant literature to evaluate surgical and aesthetic outcomes following autologous breast reconstruction in the setting of a prior unsuccessful reconstruction.

Methods: A systematic review of the English literature was performed on Pubmed/MEDLINE to identify all manuscripts reporting surgical outcomes, aesthetic outcomes, or patient satisfaction of autologous breast reconstruction in the setting of a previously failed or unsatisfactory breast reconstruction.

Results: Nineteen studies met the criteria for inclusion. Of these, 15 studies reported outcomes following autologous conversion of unsuccessful prosthetic reconstruction (778 breasts). Pooled-analysis of these studies demonstrated total flap loss in 1.6%, microsurgical revision in 3.2%, total complications in 21.7%, and revision surgery in 26.5%. Review of these studies demonstrated high rates of positive aesthetic outcomes and patient satisfaction. Five studies (54 patients) evaluated outcomes following autologous salvage of prior unsuccessful autologous breast reconstruction. Pooled-analysis of these studies demonstrated no instances of microsurgical revision, total complications in 42.2%, and revision surgery in 70.0%. Total flap failure following tertiary reconstruction utilizing microsurgical free flaps occurred in 9.5%. Data describing aesthetic outcomes or patient satisfaction was lacking in these studies.

Conclusion: Autologous conversion in the setting of unsuccessful prosthetic breast reconstruction appears to be valuable option to improve outcomes. There is little evidence to suggest that prior prosthetic reconstruction negatively impacts outcomes of autologous breast reconstruction. Data describing autologous breast reconstruction following prior flap loss is limited but suggests it is viable method to salvage breast reconstruction in appropriate patients.

Aim: Propeller flaps provide excellent reconstructive options for defects of many etiologies. Trunk wounds are a commonly encountered issue for the plastic surgeon and multiple techniques to address them should be prepared for implementation. Propeller flaps are a subject rarely brought up as an option to address these wounds. The authors sought to elucidate this topic in the current plastic surgery literature available.

Methods: A PubMed search was conducted based upon the defined inclusion and exclusion criteria and publications reviewed in detail. Search terms included "trunk wound propeller flap", "trunk propeller flap", and "freestyle trunk wound flap". Duplicate studies were excluded. Data was extracted from each study pertaining to trunk wounds and reconstructions with propeller flaps.

Results: The electronic search yielded 49 results with 21 studies ultimately meeting inclusion criteria. A total of 365 flaps were described collectively amongst the included studies. Among them, 190 propeller flaps addressing trunk defects were performed across all studies reviewed to address a total of 165 defects of the trunk: 14 abdomen, 101 back, 50 chest defects and adjacent respective flaps were utilized for surgical reconstruction. Overall, cancer excision wounds were by far the most prevalent with 105 cases (59.0%). Defect sizes of those specified in the articles ranged from 2 cm × 5 cm to 30 cm × 24 cm. Of the 190 propeller flaps identified, 63 total complications were identified. The most common complication was 48 total cases of transient venous congestion (25.3%). The second most common complication was partial flap necrosis (6.3%). No total flap loss was noted. There were 2 cases of seroma (1.1%) and 1 case of wound breakdown (0.5%).

Conclusion: Propeller flaps are a viable reconstructive option for trunk wounds and should be in the armamentarium of plastic and reconstructive surgeons. Few studies are available in the literature regarding propeller flap reconstruction in trunk wounds. More aggregate data is needed in order to further review, evaluate, and refine propeller flap techniques and results.

Periarticular reconstruction of appendicular bones in skeletally immature patients after tumor resection is a surgical challenge that requires a multidisciplinary approach. The authors present a case of Ewing sarcoma of the proximal femur in an 8-year old girl treated with wide resection of the primary tumor and reconstruction using a vascularized fibula epiphyseal autograft within a cadaveric femoral allograft. The native femoral head was preserved to restore articular anatomy. Postoperative course was without complications. This report demonstrates the use of a vascularized fibula autograft within a cadaveric femoral allograft to optimize growth potential and joint durability in a pediatric patient.

Aim: Our goal was to ascertain if there was a role for larger breast implants in breast reconstruction.

Methods: Patients that underwent mastectomy and implant-based breast reconstruction were identified and reviewed.

Results: Of the total specimens, 92 (14.7%) weighed more than 800 g with a mean weight of 1140 g (range 803 to 2177 g). Of the patients with these larger specimens, 45 (48.9%) selected the largest available implants (800 mL implants) for their reconstruction.

Conclusion: There are patients undergoing mastectomy and implant-based breast reconstruction who are unable to have reconstruction to their native breast volume because of the current implant-volume restrictions.

The design and application of hyaluronic acid (HA)-based scaffolds to control cell response and construct ideal tissue engineering products have been of great interest in the past few decades. This review provides an overview of the biological properties of HA to better understand how to engineer a cell-scaffold composite that is qualified in tissue engineering; important tissue engineering applications of HA including cartilage tissue engineering; and lastly, the problems of the current research on HA. All the data described above were collected and analyzed from PubMed, EMBASE and Medline.

Aim: Aging affects the appearance of the eyelids and the surrounding malar region. Blepharoplasty improves the aesthetic appearance of this region, and multiple variants of the procedure have been reported. We here report our technique for modified lower lid blepharoplasty and cheek lift for patients with hypoplastic malar regions, which was introduced after observing prominent lower orbital rims in patients with flat malar prominences after blepharoplasty.

Methods: This technique combines standard canthopexy and cheek-lift for rejuvenation of the mid-face with redraping of orbital fat and concurrent sub orbicularis oculi fat pad (SOOF) lift to “double-breast” the lower orbital margin. Data on 33 patients who had undergone this modified lower lid blepharoplasty was collected retrospectively.

Results: Thirty-three patients underwent the modified lower lid blepharoplasty resulting in smooth and youthful appearance of the malar region that was consistent and sustained. No recurrence of V-deformity was observed on a median follow-up of 14 months. Twenty-two (66.6%) and 11 (33.3%) patients were pleased and satisfied with postoperative outcomes respectively. Three (9.1%) patients experienced minor postoperative complications and no major complication was observed.

Conclusion: The proposed modified lower lid blepharoplasty is a safe and effective alternative to the existing technique with improved aesthetic outcomes and therefore is recommended in patients with flat malar prominences.