Purpose: Supratip fullness, which leads to aesthetically unpleasing nasal tip, is a common problem in rhinoplasty. The convexity of cartilaginous framework on supratip area accounts for substantial part of the etiology. In this presentation, the author describes the technique for surgical correction of convexity of supratip area and controlling the degree of concavity of supratip.

Methods: A retrospective chart and intraoperative photo review was conducted for 91 consecutive patients (22 primary rhinoplasty and 69 secondary rhinoplasty). In all cases the author used columellar strut and shield graft or onlay graft for tip projection and derotation graft for controlling tip rotation. Supratip refinement suture was performed in 49 patients who presented undesirable supratip contour or supratip convexity.

Results: The supratip refinement suture allowed the desirable supratip contour achieved in all cases with no evidence of infection, bleeding, hematoma and deformity.

Conclusion: The author’s suture technique is a simple and reliable procedure for adjusting the degree of the supratip concavity, with the original cartilage preserved.

The complex approach to correction of the lower third of the face and the sub-chin zone is the key to the success in harmonizing not only this zone, but also rejuvenation in general. The most urgent is the question of combined minimally invasive methods of correction in the deformation type of facial aging. This type of aging is characterized by a significant amount of subcutaneous fat in the facial area and, as a rule, hypertrophied lumps of Bish (buccal fat), which is accompanied by a pronounced deformation of the lower third of the face with the formation of bryls and a second chin. We have developed and are actively using the algorithm for working with the lower third part of the face and the submental part of the deformation type of aging. The injection of botulinum neuroprotin is to remove of Bish lumps (buccal fat), laser liposuction of the lower third of the face and submental area. The advantages of this method are the speed of the operation, the local anesthesia, the absence of postoperative scars and pain, a short period of rehabilitation and a very good effect. The described method described allows providing minimally invasive correction of the lower third of the face and submental area with simultaneous retraction of soft tissues, which leads to a harmonious rejuvenation.a

Background:

Traumatic abdominal wall hernia (TAWH) is a rare type of hernia occurring secondary to blunt trauma, with a reported incidence of 0.2% on presentation CT scan1. There is currently no consensus regarding the optimum time for repair, though conservative management with serial imaging +/- expectant elective repair has been favoured.

Methods:

We present a case of a 20-year old female who was a seatbelt restrained rear-seat passenger in a road traffic collision and sustained two areas of Grade-5 TAWH along with bowel and colonic injuries. The patient was taken for an emergency laparotomy with initial conservative management of TAWH.

Results:

Four years post-index admission the patient’s abdominal wall was closed using Strattice Mesh. Delay was due to the inability of the patient to reach the 100-110kg goal operative weight and a pregnancy. During her pregnancy, the patient was managed by active surveillance involving the obstetric, plastics and trauma team.

Key messages:

This case illustrates successful delayed surgical repair of TAWH using biological mesh, without recurrence, demonstrating that elective repair provides a safe alternative to early repair in pregnancy.

We reiterate the importance of a multidisciplinary approach to TAWH, involving input from the trauma, plastic surgery, and obstetric – in the case of pregnancy – teams.

Objective: To evaluate early complications following mastectomy or conservative breast surgery with immediate reconstruction and identify the associated risk factors.

Methods: From January 2014 to December 2016, 131 female patients underwent immediate breast reconstruction in our department. All patients had a minimum follow-up of one year. Outcomes assessed included age, surgical technique, adjuvant and neoadjuvant therapy, comorbidities, smoking, complications and mortality.

Results: A total of 131 female patients who underwent immediate reconstruction were identified. The overall average age was 51 years (range from 33 to 80 years). Postoperative early complications occurred in 45 of 131 patients (about 34%). The most frequent complication was seroma (49%), followed by wound infection (16%), hematoma (11%), and wound dehiscence (9%) and in a lower percentage skin necrosis, implant exposure, steatonecrosis and lymphedema. Among these patients more than a half have comorbidities associated such as weight excess and obesity (BIM>25kg/m2) at about 36%, active smoking 18%, hypertension 18% and diabetes mellitus type 2 7%. In our study higher complication rates were related to mastectomy followed by tissue expander reconstruction. Other surgical techniques such as oncoplastic surgery with contralateral symmetrization had 40% of complications, latissimus dorsi flap associated with implant 2% and mastectomy with contralateral symmetrization 2%. About 98% underwent adjuvant therapy, mainly hormonotherapy and 22% have received neoadjuvant therapy. Only 1 case registered of metastatic disease and no cases of mortality.

Conclusions: Immediate breast reconstruction is becoming increasingly popular. Our study is consistent with previous studies that indicate breast reconstruction outcomes can be negatively affected by certain patient factors. Smoking, a high BMI, hypertension and diabetes mellitus are all associated with an increase in complications and inferior outcomes. Patient and surgical risk factors should be considered when deciding upon a reconstructive surgery to minimize complication rates and obtain better outcomes.

Introduction/Statement of the Problem: Migraine Headache (MH) is a very common disorder affecting 1.7–4% of the world’s adult population. The first line therapy for these patients is usually a combination of conservative treatments. Despite this large variety of options available, some patients remain refractory. For such group, migraine surgery might offer a definitive solution for their medical condition. In these patients, migraine is usually caused by extracranial nerve compression due vascular, fascial or muscular structures nearby. In patients suffering from frontal migraine nerve decompression can be achieved with selective myotomies of procerus, corrugator and depressor supercilii muscles.

Methodology & Theoretical Orientation: From 2011, in our Plastic Surgery Unit at the University of Parma, Italy, we performed 69 frontal myotomies in patients suffering from frontal migraine. 64 were bilateral procedures and 5 were monolateral (3 right, 2 left). We carried out these surgical procedures with a minimally invasive, single-access, endoscopic technique. All patients have been hospitalized and discharged the day after the procedure.

Findings: In patient treated with endoscopic frontal myotomies, positive results were observed in 94% of the patients (32% complete elimination, 62% partial improvement). 6% of the patients did not report any improvement of their condition. The most commonly observed adverse event was post-operative frontal edema.

Conclusion & Significance: Frontal migraine is a common and debilitating condition that can be treated successfully with minimally invasive surgical procedures. Our single-access endoscopic technique provided satisfactory results with minimal post-operative recovery time for the patients.

A fingertip amputation is the most common type of amputation seen in the upper extremity. The management is characterized by a great deal of confusion as there are a variety of repairs described. Treatment options range from conservative management, local flaps to replantation of the amputated part each with its own advantages and disadvantages. The choice of appropriate treatment modality depends on various factors like age, comorbidities, occupation, and goals of the patient. Multiple studies have shown variable results and choice of the appropriate option is difficult.

Aim: To statistically analyses fingertip injuries management in patients presented at a tertiary care centre, to describe the epidemiology of fingertip injuries, to describe selection criteria of appropriate treatment modality in patients and to propose a new treatment algorithm for treatment of fingertip injuries.

Methodology: Data was recorded from January 2016 to January 2018 of 636 patients with 813 fingertip injuries (Allen type I,II,II,IV) presenting to a tertiary care trauma centre. The epidemiological data was collected and analyzed. The cases were classified according to Allen’s classification. The treatment modalities used were: conservative, primary closure, Split-thickness, Full-thickness, and Composite grafts, local flaps (homo-digital and hetero-digital) loco-regional flaps, revision and shortening, replantation. Follow-up assessment was done at 24 weeks and second at 24 months. The following functional goals were assessed after formulating a scoring system (percentage points were calculated) to be able to analyses the data statistically. Primary goals: Length of digit(s), Objective Sensation assessment (Revised Nottingham Sensory Assessment), Subjective sensation assessment, Total Active Movement, Cosmesis (Nail deformity and Patient satisfaction score). Secondary Goals: Minimum Hospital Stay.(< or > 24 hours), Minimum work days loss.(< or > 7 days), Donor Site morbidity. Exclusion criteria: All cases requiring secondary procedure due to failed primary procedure.

Data Analysis and Results: Data from 813 cases over a period of two years from January 2016 to January 2018 was analyzed by T-Test and linear regression using SPSS software and Microsoft Excel. Majority of the injuries were due to Door crush injuries (64%) with right side more affected than left and middle finger (42%) was most commonly involved. The best results for the primary goals (60%) were achieved for local flaps and were found to be statistically significant. The worst results (65%) in terms of secondary goals were seen in cases of replantation as can be attributed to prolonged hospital stay in cases requiring admission and/or re-look surgeries and heterodigital local flaps (62%) in view of loss of work days.

A treatment algorithm is thus proposed as per the injury classification and functional outcome assessment.

Carlo Fante is a first year resident at the School of Plastic, Reconstructive and Aesthetic Surgery of the University of Parma directed by Professor Edoardo Raposio. He works in the unit “Chirurgia della cute ed annessi, mininvasiva, rigenerativa e plastica” specialized in the surgical treatment of the migraine headache that is here performed since the 2011.

Objective: To evaluate early complications following mastectomy or conservative breast surgery with immediate reconstruction and identify the associated risk factors.

Methods: From January 2014 to December 2016, 131 female patients underwent immediate breast reconstruction in our department. All patients had a minimum follow-up of one year. Outcomes assessed included age, surgical technique, adjuvant and neoadjuvant therapy, comorbidities, smoking, complications and mortality. 

Results: A total of 131 female patients who underwent immediate reconstruction were identified. The overall average age was 51 years (range from 33 to 80 years). Postoperative early complications occurred in 45 of 131 patients (about 34%). The most frequent complication was seroma (49%), followed by wound infection (16%), hematoma (11%), and wound dehiscence (9%) and in a lower percentage skin necrosis, implant exposure, steatonecrosis and lymphedema. Among these patients more than a half have comorbidities associated such as weight excess and obesity (BIM>25kg/m2) at about 36%, active smoking 18%, hypertension 18% and diabetes mellitus type 2 7%. In our study higher complication rates were related to mastectomy followed by tissue expander reconstruction. Other surgical techniques such as oncoplastic surgery with contralateral symmetrization had 40% of complications, latissimus dorsi flap associated with implant 2% and mastectomy with contralateral symmetrization 2%. About 98% underwent adjuvant therapy, mainly hormonotherapy and 22% have received neoadjuvant therapy. Only 1 case registered of metastatic disease and no cases of mortality.

Conclusions: Immediate breast reconstruction is becoming increasingly popular. Our study is consistent with previous studies that indicate breast reconstruction outcomes can be negatively affected by certain patient factors. Smoking, a high BMI, hypertension and diabetes mellitus are all associated with an increase in complications and inferior outcomes. Patient and surgical risk factors should be considered when deciding upon a reconstructive surgery to minimize complication rates and obtain better outcomes.