Daniela Delogu

Infections of Breast Implants in Aesthetic Breast Augmentations: A Single-Center Review of 3,002 Patients

BackgroundA large retrospective analysis examined primary aesthetic breast augmentations to find specific factors that could favor or counteract the occurrence of infections.MethodsData were collected from the personal databases of two different surgeons at the Crown House Hospital, Oldbury, Birmingham, United Kingdom, from January 1999 to December 2004. All the patients who received primary aesthetic breast augmentation with or without associated mastopexy were recorded.ResultsA total of 3,002 women were reviewed. Infections were experienced by 33 patients (1.1%). The analysis showed that Mentor prostheses and local antibiotics both were protective against the occurrence of infections (p < 0.05). On the contrary, the use of drains significantly increased the risk fivefold (p < 0.05).ConclusionsThe incidence of infections in aesthetic breast augmentations is 1.1%, and Mentor prostheses, antibiotics in the pocket, and the use of drains seem associated with their occurrence.

A Retrospective Analysis of 3,000 Primary Aesthetic Breast Augmentations: Postoperative Complications and Associated Factors

BackgroundA large retrospective analysis was performed on a homogeneous group of patients undergoing primary aesthetic breast augmentations to define complication rates and find associated factors.MethodsData were collected from the personal databases of two different surgeons working at the Crown House Hospital, Oldbury, Birmingham, United Kingdom. The period considered was January 1996 to December 2001. All patients who received primary breast augmentation with or without associated mastopexy for cosmetic purposes were recorded.ResultsA total of 3,002 women were included in the study. Hematomas were present in 46 patients (1.5%), infections in 33 patients (1.1%), breast asymmetries in 23 patients (0.8%), rippling in 21 patients (0.7%), and capsular contractures in 14 patients (0.5%). The multivariate analysis found that implant placement and the technique used for pocket creation were variables associated with complications (p < 0.05). Capsular contractures carried a progressive cumulative risk and, in our series, appeared 5 years after surgery. No association was found between contractures and hematomas or infections.ConclusionsThe overall incidence of complications in our series was relatively high (4.6%). Surgical placement of prostheses and the technique used for pocket creation were associated with complications. However, few patients required reoperation (1.6%), and the overall satisfaction rate was acceptable (visual analog score, 7).

The Use of Hyalomatrix PA in the Treatment of Deep Partial-Thickness Burns

Since 2001, Hyalomatrix PA (Fidia Advanced Biopolymers, Abano Terme, Italy) has been used in our center on pediatric burned patients as a temporary dermal substitute to cover deep partial-thickness burns after dermabrasion. This “bridge” treatment was adopted to remove necrotic debris (dermabrasion) and to stimulate regeneration in a humid and protected environment (Hyalomatrix PA). We present results obtained with this approach. On the third to fifth day after admission, dermabrasion was practiced on deep burned areas, which were covered with Hyalomatrix PA. Change of dressings was performed every 7 days. On day 21, those areas still without signs of recovery were removed with classic escharectomy and covered with thin skin grafts. We treated 300 patients. Sixty-one percent needed only one dermabrasion treatment, 22.3% (67 patients) more than one, and 16.7% (50 patients) the classic escharectomy. A total of 83% of patients healed within 21 days. Our study suggests that the combination of dermabrasion with a temporary dermal substitute could be a good and feasible approach for treatment of deep partial-thickness burns. Prospective randomized studies are now necessary to compare our protocol with the gold standard treatment of topical dressings.

Versajet hydrosurgery versus classic escharectomy for burn débridment: a prospective randomized trial.

Our purpose was to conduct a prospective randomized trial to compare the Versajet system (Smith & Nephew, London, UK) vs hand-held dermatome escharectomy for burn débridment. All patients admitted over the course of 1 year at our burn center were recruited and randomly assigned to Versajet or hand-held dermatome escharectomy. We evaluated the 1) time for complete débridment and 2) the efficacy of Versajet in reaching the correct dermal plane. Secondary end points were the assessment of postoperative pain (evaluated with the visual analog scale), adverse effects, complete healing times, and contractures rates (after 6 months). A total of 87 patients were analyzed in two homogeneous groups of 42 (Versajet) and 45 (escharectomy) patients. All of them received adequate débridment, but the Versajet procedure was faster (P < .05) and more precise in obtaining the correct plane. One Versajet patient required ligation of a large subcutaneous vessel, which inadvertently was cut during the procedure. Versajet is a feasible, simple, and safe technique that hastens surgical débridment of burns and adds more precision to the procedure.

Wound infections in aesthetic abdominoplasties: the role of smoking.

Background: In this prospective study, the authors followed patients who underwent aesthetic abdominoplasty to determine the influence of smoking on the occurrence of postoperative wound infections. Methods: Patients who underwent aesthetic abdominoplasty were considered eligible for the study. The authors excluded postbariatric patients, those with ongoing clinical infections, those receiving a recent antibiotic course, and those with systemic diseases such as arteriosclerosis and diabetes mellitus. Smokers were advised to quit smoking at least 4 weeks before surgery. Results: Starting in February of 2004, the authors enrolled 84 patients. Postoperative infections were present in 13 patients (15.5 percent) and were superficial in 10 (77 percent). All but one occurred in smokers. These had a certain number of cigarettes smoked per day, years of smoking, and higher estimated overall number of smoked cigarettes when postoperative infections were present. The relative risk of smoking on infections was 12. A cutoff value of approximately 33,000 overall cigarettes smoked determined 3.3 percent false-positive and 0 percent false-negative rates. Conclusions: Smoking is an important issue in aesthetic surgery that needs to be accurately addressed during the preoperative interview. In the future, the analysis of smoke-related, easy-to-gather variables such as the estimated overall number of cigarettes smoked until surgery could help stratify patients according to their risk of manifesting infections.

Breast asymmetries : A brief review and our experience

The authors describe their personal experience with the management of mammary asymmetries. A review of their database from January 1998 to January 2005 identified 177 patients with idiopathic breast asymmetries. All these cases had been classified previously into six groups. Bilateral asymmetric hypertrophy and unilateral hypertrophy were treated with reduction mammaplasty. Unilateral hypertrophy with amastia or hypoplasia of the contralateral side was managed with reduction and augmentation mammaplasty. Unilateral amastia or hypoplasia (Poland’s syndrome) was treated with a single monopedicle transverse rectus abdominis muscle (TRAM) flap, and asymmetric bilateral hypoplasia was managed with augmentation mammaplasty. Unilateral mammary ptosis was treated with mastopexy and augmentation mammaplasty. The proposed classification, derived from the authors’ experience in this field, gives an idea of how they usually treat these patients. It is useful for a first evaluation, but after that, every treatment must always be individualized on a patient-by-patient basis.

Autologous cartilage graft rhinoplasties

Background:The authors report their experience with autologous graft rhinoplasties.Methods:Data were collected retrospectively, with selection of only autologous grafts from 2,000 rhinoplasties performed at the Plastic and Reconstructive Department of the University of Rome Tor Vergata.Results:A total of 62 patients from January 1995 to January 2005 were selected. Most of the patients were treated with the “open tip” technique, whereas 9.7% had a classic endonasal approach. Follow-up evaluation was performed with outpatient visits at 2 and 6 weeks, then at 3, 6, and 12 months. Good aesthetic results were obtained for 93.5% of the patients, and 83.7% had complete satisfaction.Conclusion:Autologuos cartilage graft rhinoplasty is an affordable technique easy to learn that widens possibilities of interventions for nasal pyramid reconstruction.

Systemic apoptotic response after thermal burns.

The systemic pathophysiologic changes following thermal injuries affect multiple organs and body systems leading to clinical manifestations including shock, intestinal alterations, respiratory and renal failure, immunosuppression and others. Recent advances in the comprehension of mechanisms underlying systemic complications of thermal injuries have contributed to uncover part of the cellular and molecular basis that underlie such changes. Recently, programmed cell death (apoptosis) has been considered playing an important role in the development of such pathological events. Therefore, investigators utilizing animal models and clinical studies involving human primates have produced a large body of information suggesting that apoptosis is associated with most of the tissue damages triggered by severe thermal injuries. In order to draw the attention on the important role of apoptosis on systemic complications of thermal injuries, in this review we describe most of these studies, discuss possible cellular and molecular mechanisms and indicate ways to utilize them for the development of therapeutic strategies by which apoptosis may be prevented or counteracted.

Body contouring after weight loss: the plastic-bariatric surgery symbiosis.

Sozer et al. [4] recently outlined an important issue in aesthetic surgery. In recent years, bariatric surgery has become an important and growing field. Morbidly obese patients, who in the past were treated by internal medicine doctors and nutritionists, now can cure their disease with few postoperative complications. The widespread diffusion of these procedures and the application of minimally invasive techniques, with reduced postoperative discomfort and faster return to normal activity, have made these procedures available to most patients even in a day surgery setting [1]. The next step in the treatment of the morbidly obese patient is to determine how an acceptable aesthetic appearance can be restored once the patient has a stabilized body mass. Skin redundancy on the trunk, buttocks, breasts, upper arms, and thighs often is a significant problem after bariatric surgery, leading to poor quality of life and social acceptance. Additionally, this dermatochalasis also may be the cause of medical sequelae (i.e., intertrigo), functional limitations (i.e., in walking, urinating, and sexual activity), and psychosocial issues (depression) [2]. For all these reasons, the treatment of this generalized skin redundancy soon became a challenge. Recently, plastic surgery has begun to answer these problems. The experienced surgeon, often dealing with aesthetic requests, has many options available to correct the body deformities of these patients. Most of the altered body contours involving the abdomen, thighs, and buttocks can be effectively corrected with belt lipectomy and lower body lift [4]. Facial and neck skin redundancy can be corrected with rhytidectomy techniques [3]. Mastopexy operations with or without augmentation have been used to lift and fill redundancy defects of the breast. In our centers, we have organized the approach to obese patients in two phases. The first phase involves an initial collaboration between nutritionists, internal medicine doctors, and general surgeons to define indications for bariatric surgery and to cure postbariatric postoperative medical complications, mostly diarrhea and electrolyte imbalances. The second phase is set between general and plastic surgeons to define the optimal timing for aesthetic operations. Since April 2002, we have treated 43 obese patients with this approach. All of them were affected by primary obesity not related to other medical etiologies. They all underwent bariatric surgery procedures: gastric bending in 38 cases and intestinal bypass in the remaining cases. The mean age of the patients was 43.5 years (range, 26 65 years), and the mean weight loss was 68.3 kg (range, 34 134 kg.). The patients began their plastic surgery operations 13.4 months (range, 8 24 months) later. Because postobesity skin redundancy is a complex condition, it always required a multistep process involving an average of 5.3 operations (range, 4 8 operations) for each single patient to reach acceptable aesthetic results (Figs. 1 7). On a visual analog scale (VAS), the patients indicated a global satisfaction rate of 6.2 (range, 4 8) after bariatric surgery and 8.5 (range, 6 10) after plastic surgery. In our experience, the complexity of morbid obesity confirms that a multidisciplinary approach is required. With the use of this approach, aesthetic results are emerging as important outcomes for paCorrespondence to G. Gravante M.D. via U. Maddalena 40/a, 00043 Ciampino, Rome, Italy; email: ggravante@hotmail.com Aesth. Plast. Surg. 30:374 376, 2006 DOI: 10.1007/s00266-005-0217-7

Apoptotic cells are present in ischemic zones of deep partial-thickness burns.

Deep partial-thickness burns exhibit ambiguous behavior, either spontaneously healing or evolving into full-thickness burns. The aim of this study was to investigate these lesions for the presence of apoptotic cells and to compare their rate with that of superficial and full-thickness burns. We used colocalization of DNA fragments (ie, terminal deoxynucleotidyl transferase Biotin-dUTP nick end labeling) and Fas ligand CD95 antibodies to calculate the apoptotic rate of superficial, deep partial-thickness and full-thickness burns in 45 patients after the thermal injury. Biopsies were collected mainly during the acute postburn phase (first week of hospitalization). Deep partial-thickness burns presented apoptotic cells, both in the dermis and in cutaneous adnexa, and showed a higher apoptotic rate than superficial and full-thickness burns (44.5% in deep partial thickness, interquartile range 6.3–90.5%; 5.6% in superficial partial thickness, interquartile range: 0–13%; 0% for full-thickness burn; P = .000243). A significant greater apoptotic rate was present in cells of deep partial-thickness burns when compared with superficial and full thickness. These data would suggest that deep burns sustain an ischemic damage that forces cells to undergo apoptosis and could represent the biologic basis for their clinical evolution into full-thickness burns. Further correlation studies are now required to confirm this hypothesis.