RESUMEN
BACKGROUND: Most surgeons choose to de-epithelialize when performing a mastopexy to minimize the risk of nipple-areola-complex (NAC) necrosis. Preservation of the dermis and thus the subdermal plexus is thought to be crucial for the survival of the NAC. However, this has never been scientifically proven. Deskinning involves resection of the epidermis and the dermis and is a timesaving alternative to de-epithelialization. In this study, we present data from mastopexy patients with or without implant surgery with total deskinning of the Wise pattern. METHODS: From September 2012 to March 2020, a single surgeon performed all inverted-T mastopexies using the deskinning technique. The patients were included retrospectively, and data were collected by reviewing the patients' medical records with emphasis on NAC necrosis. RESULTS: The cohort consisted of 274 consecutive patients who underwent bilateral mastopexy. Of these, 134 patients underwent mastopexy as the only procedure and 140 patients underwent mastopexy in combination with implant surgery. The median follow-up was 29 months (IQR 13-40 months). No complete NAC-necrosis occurred. Unilateral, partial NAC necrosis occurred in three patients who underwent mastopexy in combination with implant surgery. CONCLUSION: The NAC necrosis rate following inverted-T mastopexy using the deskinning technique is comparable to the rate of NAC-necrosis reported in the literature following mastopexy using the de-epithelialization technique. Our findings support that the use of deskinning is a safe and time-efficient method for patients undergoing inverted-T mastopexy. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the table of Contents or the online Instructions to Authors www.springer.com/00266.
Asunto(s)
Mamoplastia , Colgajos Quirúrgicos , Estudios de Cohortes , Estética , Humanos , Pezones/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Lip carcinomas are among the most common malignant tumours of the head and neck region but reports on the course and outcome of this disease are mainly based on Mediterranean, South American, and Oceanian populations. The aim of the study was to describe the treatment and outcome of patients with lip carcinoma at a Danish department of plastic surgery. METHOD: We conducted a single institution retrospective cohort study including patients with primary cancer of the lips including squamous cell (SCC), basal cell (BCC), and basosquamous carcinomas (BSC) in a 5-year period. RESULTS: We included 108 consecutive patients. Median age was 72 years (range 28 -98) and 58% were male. Seventy patients (65%) were diagnosed with SCC, 36 (33%) BCC, and 2 (2%) BSC. The majority of lesions were stage T1 (84%) and T2 (11%). An unexpected total of 35 (32%) patients experienced wound healing problems; whereof 19 (54%) classified as mild (not demanding treatment), 10 (29%) as moderate (non-functional surgical corrections or medical treatment of infection needed) and 6 (17%) experienced severe dehiscence (requiring surgical intervention for functional improvement). Total defect size ≥20 mm and full thickness excision was directly correlated to the risk of early postoperative complications (p-value: 0.03 and 0.04). Three patients (2/36 with BCC; 6% and 1/70 with SCC; 1%) developed local recurrence and five patients with SCC (5/70; 7%) developed regional lymph node metastases. One patient (1%) died from metastatic SCC. CONCLUSION: This study confirms that lip carcinoma is associated with a risk of recurrence and mortality. However, the risk of wound complications is notable compared to other series.
Asunto(s)
Causas de Muerte , Neoplasias de los Labios/patología , Neoplasias de los Labios/cirugía , Labio/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/mortalidad , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Estudios de Cohortes , Dinamarca , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias de los Labios/mortalidad , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Análisis de SupervivenciaRESUMEN
The survival of a microsurgically replanted segment of nose in a 41-year-old woman was facilitated by the assistance of the medicinal leech Hirudo medicinalis. An arterial microanastomosis was made to a severed partial segment of nose with no possibility of recreating a venous anastomosis. The resulting venous congestion was treated with nine days of treatment with a medical leech until venous neovascularisation had been achieved. At follow-up six months after discharge there was a well-heeled nasal segment and a satisfying functional - as well as cosmetic - result.