Aisha McKnight

A modified keyhole technique for correction of macroglossia

The enlarged tongue, or macroglossia, may compromise vital function to the point that surgical correction is necessary. Although earlier procedures simply aimed at reducing tongue bulk, contemporary techniques attempt to decrease lingual dimension yet preserve critical neurosensory function. Still, modern approaches advise a broad variety of differing incisions and propose excision of various anterior, lateral, central, or circumferential lingual tissues. The keyhole technique allows direct excision of midline musculomucosal tissue along the tongue’s length. With this central tongue-reduction procedure, significant lingual resection is possible and crucial tongue function and neurovascular structure are maintained. In this article, as a supplement to our video demonstration, we describe a modified keyhole technique for macroglossia correction.

Socioeconomic Impact of Ethnic Cosmetic Surgery: Trends and Potential Financial Impact the African American, Asian American, Latin American, and Middle Eastern Communities Have on Cosmetic Surgery

The popularity of cosmetic surgery has increased around the world, and whereas in the past, the patient base consisted of mainly Caucasian individuals, interest in this field has grown among persons of varying ethnic backgrounds. Growing interest enables ethnic populations to contribute to the economic growth of the cosmetic surgery industry and impact the direction of the field in the future. Minority populations accounted for 22% of the cosmetic procedures performed in 2007, with the most common being liposuction, Botox((R)) generic botulinum toxin type A (Allergan, Inc., Irvine, CA), and chemical peels. Ultimately, changes in the population characteristics of the plastic surgery patient will alter the techniques of plastic surgeons that treat ethnic patients to cater to their physical differences. Factors such as increased cultural acceptance of plastic surgery, growing ethnic populations, and media emphasis on personal appearance have contributed to the increase in minorities seeking out cosmetic surgery. Escalating economic power within these populations has created an additional potentially lucrative market for interested plastic surgeons.

One-step Salvage of Infected Prosthetic Breast Reconstructions Using Antibiotic-impregnated Polymethylmethacrylate Plates and Concurrent Tissue Expander Exchange

PurposePeriprosthetic infection represents a major complication in breast reconstruction, frequently leading to expander-implant loss. Recent studies report variable success in the salvage of infected breast prostheses through systemic antibiotic therapy and surgical intervention. There is currently no consensus regarding a management algorithm for attempted salvage. The purpose of this pilot study was to evaluate the early outcomes of a protocol using antibiotic-impregnated polymethylmethacrylate (PMMA) implant placement with expander device exchange. MethodsA retrospective database was queried to identify all patients with infected implant-based breast reconstruction who were treated by the study authors and who underwent attempted salvage under the study protocol. All patients received intravenous antibiotics followed by surgical debridement of the infected pocket, insertion of antibiotic-impregnated PMMA plates and/or beads, device exchange, and postoperative antibiotics. After clinical resolution of infection, tissue expansion was performed with the PMMA implants remaining in situ until exchanged to permanent implants. ResultsAll patients with infected prosthetic breast reconstructions achieved implant pocket sterilization using this method. At a mean follow-up of 8.2 months (range, 1–19 months), none of these patients have required reoperation for capsular contracture. One patient, while under treatment with prednisone for a rash, developed recurrent infection, which led to explantation of her implant. Two patients underwent radiation therapy while an antibiotic plate and tissue expander were in place, with no observed exposure or infection recurrence. ConclusionsSustained local antibiotic delivery using PMMA implants and expander device exchange can successfully salvage an infected breast implant. Perceived benefits include shorter time to completed reconstruction, preserved skin envelope integrity, and possibly improved long-term aesthetic outcomes.

Use of a Three-Dimensional Model to Optimize a MEDPOR Implant for Delayed Reconstruction of a Suprastructure Maxillectomy Defect.

The use of a three-dimensional (3-D) model has been well described for craniomaxillofacial reconstruction, especially with the preoperative planning of free fibula flaps. This article reports the application of an innovative 3-D model approach for the calculation of the exact contours, angles, length, and general morphology of a prefabricated MEDPOR 2/3 orbital implant for reconstruction of a suprastructure maxillectomy defect. The 3-D model allowed intraoperative modification of the MEDPOR implant which decreased the risk of iatrogenic harm, contamination while also improving aesthetic results and function. With the aid of preoperative 3-D models, porous polypropylene facial implants can be contoured efficiently intraoperatively to precisely reconstruct complex craniomaxillofacial defects.

External distraction osteogenesis in the pediatric mandible.

SUMMARY Mandibular distraction osteogenesis is an effective tool with which to correct facial asymmetry, restore proper occlusion and, more importantly, create an appropriate airway in the micrognathic infant. As a component of many syndromes, micrognathia can impair feeding and speech development and can obstruct the neonatal airway. However, bony lengthening secondary to external mandibular distraction osteogenesis can provide added space, preventing oropharyngeal soft tissues from occluding the airway. Although external distraction of the mandible has been applied for more than a decade, this procedure often proves technically challenging. Here, as a supplement to their video presentation, the authors present a practical discussion of their current technique for mandibular distraction osteogenesis using an external device in a child with Treacher Collins syndrome.

Variations of Structural Components: Specific Intercultural Differences in Facial Morphology, Skin Type, and Structures

Analysis of the differences in facial morphology and skin structure and tone among ethnic groups within the realm of plastic surgery is relevant due to the increasing number of ethnic individuals seeking cosmetic surgery. Previous classifications of ideal facial morphologic characteristics have been revised and challenged over the years to accurately reflect the differences in facial structure that are aesthetically pleasing to individuals of differing ethnic groups. The traditional neoclassic canons reflected the European Caucasian facial morphology and cannot be used to classify facial characteristics in ethnic groups due to drastic differences in measurement and proportion. In addition, differences in biophysiologic properties of ethnic skin types influence the progression of aging and the ability of skin to withstand environmental insults. Thickness of the stratum corneum, water content, and melanin composition are important factors that were analyzed in varying ethnic groups. Although it appears that Caucasian Americans are subject to earlier onset of skin wrinkling and sagging than are African Americans due to thinner stratum corneum layers and decreased water content, more research needs to be conducted to be inclusive of other ethnic groups. These data will enable plastic surgeons to treat these groups more effectively while preserving their unique characteristics.

Congenital synmastia with concurrent fibroadenomas in a pediatric patient

Congenital synmastia, or absence of the intermammary sulcus, is a rare breast anomaly in the pediatric population. While acquired synmastia after breast augmentation is a well-documented entity, congenital synmastia is a rare condition with only four previous cases reported in the surgical literature. We describe the first patient with concurrent presentation of congenital synmastia and multiple fibroadenomas. A combined technique was used to both address the patients breast lesions and correct the defect.

Pediatric compartment syndrome following an insect bite: a case report

Allergic responses to insect bites are both a common and unwelcome occurrence for many individuals. In certain situations, however, they can have serious sequelae. In this case report, we describe the first case of compartment syndrome in a child who developed a large local reaction to a mosquito bite.

The first silicone breast implant patient: a 47-year follow-up.

The first augmentation mammaplasty is credited to Czerny from Heidelberg, who, in 1895, described transplanting a lipoma from the trunk to the breast in a partial mastectomy patient.1 From that time until the 1960s, a variety of nonsilicone materials were injected or implanted to augment or reconstruct the breast, with limited success.2 The modern era of breast augmentation was ushered in by Gerow and Cronin in 1962, with the introduction of the silicone implant, which was composed of an outer silicone elastomer shell filled with silicone gel.3 The evolution of silicone gel–filled breast implants over the past 40 years, controversies about its safety, the moratorium imposed by the U.S. Food and Drug Administration in 1992,4 and its recent approval for general use have spurred many debates regarding the use of these implants in women.5 This report is the 47-year follow-up and clinical assessment of the first silicone gel breast implant patient, almost five decades after her augmentation.