Aylin Bilgin Karabulut

Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction?

BackgroundThe optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial.MethodsEighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group.ResultsA significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II.ConclusionsExpander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.

A nomogram for predicting the degree of breast augmentation according to implant size.

Choosing the right implant size for a specific patient is a challenging aspect of breast augmentation. Bust circumference is obtained by measuring the chest circumference at the level of the nipple-areola complex. Pre- and postoperative bust circumference measurements obtained from 147 patients who underwent primary bilateral breast augmentation using round, textured, gel-filled implants were evaluated, and a practical reference list for future operations was developed. According to the results, each additional 100 ml in implant size yielded an approximate 2-cm increase in bust circumference. The authors believe these results gathered from systematic measurements may serve as a useful guide for choosing the right size implant for a satisfactory augmentation procedure.

Pressure sore of the forehead as a complication of middle ear surgery

To the Editor: Pressure sores are lesions caused by unrelieved pressure to any part of the body, especially portions over bony or cartilaginous areas. The formation of a pressure sore is a result of decreased tissue tolerance in the face of applied pressure of a defined duration and intensity [1]. The most frequent sites for pressure ulcers are the occiput, sacrum, ischial tuberosities, trochanters, lateral malleoli, and posterior heels of nonambulatory patients. However, the surgeon must be cognizant that other locations of the body can undergo stress necrosis due to prolonged external pressure. Examples include arms leaning over bed rails, nasal alae due to upward taping of nasogastric and feeding tubes, malar prominences due to inaccurate positioning during surgery, cervical region secondary to prolonged collar usage, and medial thighs due to indwelling urethral catheters [2-4]. Here, we report yet another atypically located pressure sore on forehead region secondary to prolonged and unintervened elastic bandage application following middle ear surgery. A 25-year-old woman was admitted to our plastic surgery clinic with a horizontal scar of 3×12 cm on her forehead (Fig. 1). She had undergone mastoidectomy a year ago for chronic otitis media. An elastic bandage had been applied continuously for 2 days (Fig. 2). A pressure ulcer was observed after its removal. Healing by secondary intention resulted in the aforementioned scar. After evaluation, excision of the scar was offered, but the patient refused it. Therefore, conservative measures were taken with limited success. Pressure sores are most commonly seen in dependent locations of the body in patients confined to bed. However, unusual sites may as well be candidates for iatrogenically induced pressure sore formation, and health care workers Eur J Plast Surg (2008) 31:151–152 DOI 10.1007/s00238-008-0228-0