RESUMEN

Combination antiretroviral therapy (CART) reduces the mortality and morbidity in HIV-infected patients. However, facial lipoatrophy (FLA) is one of the well-known side-effects of this treatment and subsequently imposes major problems for HIV-infected patients. In the last decade, ample experience has been obtained with both local therapeutic options as well as possible systemic treatment options. Soft tissue fillers are a relatively simple and efficient treatment option for FLA. Especially, the biodegradable semi-permanent fillers combine a good effect with durability and an acceptable safety profile. The best way to prevent or restrict the development of FLA remains the exclusion of thymidine analogue nucleoside reverse-transcriptase inhibitors from the CART schedule.

Asunto(s)

RESUMEN

A 42-year-old man was referred to the plastic surgery outpatient clinic with the request for body contouring surgery after previous bariatric surgery elsewhere. With help of the bariatric interventions he had lost 109 kg and now weighed 227 kg. At this stable weight he had a large surplus of abdominal wall skin with functional hindrance and inflammation due to chafing. After treating his comorbidity we eventually performed an extended abdominal dermolipectomy and excised 32.8 kg of skin surplus. There was some temporary wound dehiscence which was treated conservatively. The patient was very satisfied with the improvement in his body contour.

Asunto(s)

RESUMEN

Injectable filler materials can be valuable to aesthetic surgeons. To date, hardly any short-term and no long-term complications of polyalkylimide injections (Bio-Alcamid) have been reported. We present and discuss the history of 18 patients who had such complications. The patients were between 31 and 55 years of age. The time between injection and the onset of complications of polyalkylimide ranged from 1 month to 3 years. Additional invasive therapy at, or near, the site of injections triggered the onset of infection in 10 patients. By use of T2-weighted MRI with fat suppressing spectro-presaturation inversion recovery (SPIR) the filler material can be visualised. Once infection or migration of the permanent filler occurs, the therapeutic options are limited to surgical removal by a direct approach. Polyalkylimide should be handled under strict antiseptic circumstances. This does not only apply at the time of initial injections, but even more during any subsequent invasive treatment such as evacuation of surplus deposits or additional surgical procedures at, or near, the site of injection.

Asunto(s)

RESUMEN

A retrospective survey of the medical charts of all 36,518 patients attending the Accident and Emergency Department of the VU University Medical Centre, in Amsterdam, from January 1 to December 31, 1996 was performed. Of these, 4303 sustained one or more fractures, and hand fractures accounted for 19% of all fractures. Patients with hand fractures were typically men aged between 15 and 35 years. The right hand was involved as often as the left. Most of the hand fractures involved the metacarpals but, as a group of bones, the combined phalanges were most commonly fractured. The little finger ray was most commonly injured of the hand. We found no seasonal variability in the incidence of hand fractures.

Asunto(s)

RESUMEN

In male-to-female trans-sexuals in whom the hormonal treatment has not resulted in sufficient growth of the breasts, augmentation mammaplasty may be considered. Mammaplasty is performed in two-thirds of our patients who have had vaginoplasties. We present our experience of 201 patients operated on at the Academisch Ziekenhuis Vrije Universiteit in Amsterdam up to 1997. The patients' mean age was 34 years (range 17-76) and the mean follow-up was four years (range 2 weeks to 16 years). In keeping with our protocol, most patients had had oestrogen therapy and a successful real-life experience for a minimum of 1.5 years. The mean size of implants has nearly doubled over the years. Male-to-female trans-sexuals often request large breasts and repeated augmentation mammaplasties were required, mainly in cases where the result of initial augmentation was not outspoken.

Asunto(s)

RESUMEN

Testosterone and its metabolite dihydrotestosterone are the libido hormones for the male, vital to sex drive and sexual function. Fear of loss of libido and orgasm is the main reason to retain at least one testis in male-to-female transsexuals during vaginoplasty. We report on four South American transsexual patients in whom we resected a remaining testis to illustrate the superfluity of retaining it. Because there are multiple reasons for castration, we advise that bilateral orchidectomy be performed in the course of sex reassignment surgery for male-to-female transsexuals.

Asunto(s)

RESUMEN

Illicit subcutaneous injections of massive quantities of highly viscous fluids are still performed, often by unqualified persons. Fifteen male-to-female transsexuals consulted the authors regarding their devastating long-term outcomes after the injection of up to 8 liters of alleged silicone or mineral oil to feminize their bodies. After a latency period of up to 17 years, these injections led to complications ranging from scarring and deformity to infections. These patients were treated conservatively for inflammation and infection or surgically by resection of the oil-infested areas. In view of the potential dangers, feminization by the injection of high-viscosity fluids should be soundly condemned.

Asunto(s)

RESUMEN

Basal cell carcinoma of the anus is extremely rare, accounting for only 0.1% of anorectal malignancies. We report the reconstruction of the anus with a biaxial pedicled scrotal island myofasciocutaneous flap following excision of an anal basal cell carcinoma, and conclude that this technique may be valuable in the reconstruction of the anal region.

Asunto(s)

RESUMEN

Fractures of the base of the metacarpals are usually treated conservatively. The intra-articular fracture of the base of the first metacarpal ('Bennett fracture') is an exception to this rule because inadequate repositioning and fixation of the dislocated radial fragment lead to permanent deformity of the joint and subsequent degenerative joint disease. The dislocated intra-articular fracture of the base of the fifth metacarpal is similar to a Bennett fracture in many aspects. Repositioning of this 'mirrored' Bennett fracture cannot be guaranteed by a plaster cast. Inadequate repositioning will lead to pain, reduced strength and early degenerative joint disease. We present six patients with dislocated intra-articular fractures of the base of the fifth metacarpal to illustrate the necessity of surgical reduction and fixation.

Asunto(s)

RESUMEN

Sir Harold D. Gillies was the father of modern plastic surgery. Apart from being an extraordinary surgeon, he was an innovator of surgical instruments and an outstanding golfer. He adopted Kocher's suture scissors and converted them for needleholding. The authors believe that the surgeon Gillies adapted this needleholder to fit his golfer's hand.

Asunto(s)

Asunto(s)

RESUMEN

From December of 1980 to May of 1998, 390 male-to-female transsexuals underwent vaginoplasty by inversion of the penile skin and a triangular perineoscrotal flap. Although minor modifications were made throughout the years, the basic surgical technique remained the same over this 17.5-year period. In 86 of the 390 patients (22 percent), secondary corrections of the vulva were deemed necessary. A total of 130 corrections were performed in these 86 patients. In the same 17.5-year period, the authors performed 26 secondary corrective procedures in 19 patients in whom the initial vaginoplasty had been done elsewhere. Bilateral Z-plasties were performed 69 times to center the labia in instances when the ventral part of the labia majora remained too far apart. This is not advisable, primarily because it will reduce the vascular supply of the penile skin flap. Introital widening by five-flap advancement was performed in 40 cases in which a dorsal skin fold obstructed the introitis. The use of the triangular perineoscrotal flap favors the vaginal and introital width, but its base should be close to the anal ring to prevent such a skin fold. Secondary construction of the labia minora was performed 27 times, and a skin reduction of the labia majora was performed 20 times. So far, the authors have been unable to develop a satisfactory method for primary construction of the labia minora. Because the appearance of the vulva may charge gradually during the first postoperative year, secondary vulvar corrections should not be performed in that period.

Asunto(s)

RESUMEN

BACKGROUND: Penile amputation, vaginoplasty, and clitoroplasty help male-to-female transsexuals accept their bodies and increase psychosocial function. Subsequent colpectomy is unusual. CASES: We report three patients in whom complicated, long-term problems subsequent to vaginoplasty led to total colpectomy in one case of neovaginal overgrowth of condylomata acuminata, and in two cases of colitis in rectosigmoid transplants used for neovaginoplasties. CONCLUSION: Before inversion of penile skin, in cases in which the genital skin has condylomata, the risk of condylomata overgrowth might be anticipated. Rectosigmoid vaginoplasty might result in therapy-resistent colitis, which also could lead to colpectomy.

Asunto(s)

RESUMEN

Since the beginning of this century, trichloroacetic acid solutions of various concentrations have been used for chemical exfoliation. These solutions have been prepared by using four different formulas. To prepare a 50% solution, for instance, water may be added to 50 g of trichloroacetic acid crystals until 100 ml of solution is obtained (weight-to-volume solution). Alternatively, 50 g of water may be added to 50 g of trichloroacetic acid crystals (weight-to-weight solution), or 50 g of trichloroacetic acid crystals may be solved in 100 ml of water (weight-plus-volume solution). Finally, a saturated trichloroacetic acid solution (or "100% solution") may be diluted by an equal volume of water (dilution). Depending on the method used, these so-called 50% solutions contain 40 to 71 weight-to-volume percentages of trichloroacetic acid. From a review of 120 publications on trichloroacetic acid peeling that have appeared since 1926, it was concluded that the authors of 87 of these publications (73 percent) did not report their formula for the trichloroacetic acid solution. Any one of the four methods was reported to have been used by the 33 authors who did report their formula. Eight of 10 internationally reputed pharmacopeias were found not to include the formula of a trichloroacetic acid solution. Proper evaluation of results and prevention of complications of trichloroacetic acid chemexfoliation is only feasible if both the concentration and the formula of trichloroacetic acid solution are reported by the author. Practitioners who use a trichloroacetic acid solution need to establish that the concentration of the solution they apply corresponds with that of the solution reported in the literature.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Ovarium cancer is the fifth most common cause of cancer-related death in women and is the most common fatal gynecologic malignancy. So far, ovarium carcinoma has not been reported to have occurred in female-to-male transsexuals. OBJECTIVE AND METHOD: We report on two such cases. Long-term exposure to increased levels of endogenous and exogenous androgens is hypothesized to constitute an additional risk factor in transsexuals as it has been associated with ovarian epithelian cancer. CONCLUSION: Simultaneous salpingo-oophorectomy should be performed in any female-to-male transsexual undergoing hysterectomy in the course of gender-confirming therapy.

Asunto(s)

RESUMEN

Driven by a persistent and unchangeable need to undo the discrepancy between reality of the body and gender of the mind, most male-to-female transsexuals seek physical feminization through hormonal and surgical treatment. The authors report some rare presenting conditions and exceptional results of augmentation mammaplasty in 11 male-to-female transsexuals treated between January 1979 and January 1998, as well as describe how to treat these conditions. In patients in whom gynecomastia was treated previously, the remaining subcutaneous fatty tissue may be insufficient to cover the implants safely, and subpectoral implantation should be considered. Augmentation after unilateral correction of gynecomastia requires different sizes of implants. Although exceptional in male-to-female transsexuals, mastopexy is the treatment of choice to correct any mammary ptosis, but the patient may request augmentation mammaplasty to fill out the breasts. Previous stacking mammaplasty may have been performed subglandularly, subpectorally, or both. Stacking may not have been noticed prior to corrective surgery. Extrusion of the implant may be associated with avascular necrosis or infection, but also with the use of high concentrations of steroid placed within the lumen of fluid-filled implants. The correction involves removal of the implant, with skin graft or flap reconstruction of the affected area. Replacement of the implant may have to be delayed. Symmastia results from overzealous medial dissection coupled with overaugmentation. Combined restoration of the presternal subcutaneous integrity, and medial closure of the pocket by subcutaneous approach only, leads to satisfactory reconstruction of the presternal median cleavage. Galactorrhea may be the result of hyperprolactemia but is more often caused by stimulation of the intercostal nerve by the implants.

Asunto(s)

Asunto(s)

RESUMEN

When inversion of combined penile and scrotal skin flaps for vaginoplasty in male-to-female transsexuals has become impossible or has not led to functional results, alternative vaginoplasty techniques should be considered. Colocolpopoiesis involves major surgery and often leads to disappointing long-term results. An Abbé-McIndoe vaginoplasty applying split-thickness skin grafts often does not provide favorable results in the scarred area encountered after complications of skin flap inversion surgery. Because thicker skin grafts show less tendency to shrink, the use of a full-thickness skin graft has been advocated for vaginoplasty in females. In this paper, we present our technique of successful secondary vaginoplasty applying full-thickness skin grafts in six male-to-female transsexuals. In patients with sufficient groin and abdominal skin to spare, a miniabdominoplasty allows for acceptable donor site scarring combined with correction of the abdominal skin surplus. In flat-tummied patients, the conventional abdominoplasty will allow for sufficient skin to be harvested to ensure successful secondary vaginoplasty. Abdominoplastic vaginoplasty has been proven to provide a good alternative whenever a laparotomy is not favored or is contraindicated in secondary cases.

Asunto(s)

Asunto(s)