Jeremy Niddam

Indocyanine green applications in plastic surgery: A review of the literature

INTRODUCTION Use of indocyanine green (ICG) near-infrared fluorescence as a dye to assess tissue vascularization is now well standardized. The aim of this literature review was to review and resume the most recent recommendations for ICG use in its plastic surgery applications. METHODS A systematic literature review was performed using Medline, EMBASE, and PubMed databases to obtain the latest recommendations for ICG in plastic surgery. Inclusion criteria were all articles written in English language that evaluated pre-, intra-, or postoperative ICG applications in surgical procedures usually performed by plastic surgeons. Case reports, reviews, meta-analyses, and experimental studies on animals or cadavers were excluded after title and abstract screening. RESULTS Of the 1389 article titles retrieved, 41 full-text articles met the inclusion criteria. ICG applications in plastic surgery were ICG lymphangiography used in sentinel lymph node mapping for breast cancer and melanoma and in microsurgery for the staging and treatment of secondary chronic lymphedema. The latest updates of ICG angiography in assessing free flaps, pedicled flaps, or large skin paddles were also retrieved. CONCLUSIONS Large prospective studies suggest that ICG lymphography could be used as a single tracer to reliably perform sentinel lymph node biopsy. In the case of cutaneous melanoma, ICG lymphography increases node detection sensitivity and accuracy in conjunction with lymphoscintigraphy. In chronic lymphedema, it is useful for pre- and postoperative staging and intraoperative anatomical location of lymphatic pathways when lymphovenous bypass is indicated. ICG angiography is used intraoperatively to assess free flap anastomosis and design skin paddles and postoperatively to monitor buried flaps. In pedicled perforator flaps or for large skin paddles, intraoperative ICG angiography is strongly correlated with postoperative outcomes. LEVEL OF EVIDENCE 3.

Primary Fat Grafting to the Pectoralis Muscle during Latissimus Dorsi Breast Reconstruction

Background: Latissimus dorsi flap is one of the best options for immediate and delayed breast reconstruction. However, this technique is limited by the tissue volume provided by the flap. To improve breast volume while reducing complications, fat grafting is now very often used in addition to latissimus dorsi flap. To the best of our knowledge, fat grafting was always performed as a second-line surgery, at least a few months after the flap procedure. We aimed to report our experience with an associated breast reconstruction technique combining musculocutaneous latissimus dorsi flap with intrapectoral lipofilling for totally autologous breast reconstruction. Methods: Between September 2014 and January 2015, 20 patients underwent this technique for unilateral autologous breast reconstruction (14 delayed and 6 immediate breast reconstructions). A mean harvested fat volume of 278 ml (range: 190–350 ml) and a mean injected fat volume of 228 ml (range: 170–280 ml) were used. Results: None of the patients experienced complications, such as flap necrosis, breast skin necrosis, hematomas, or infection. One of the patients developed a seroma, which was treated with 3 drainage punctions. Only 2 patients underwent delayed fat grafting procedure. Conclusion: Totally autologous breast reconstruction combining latissimus dorsi flap and intrapectoral fat grafting in the same procedure is a new technique allowing increased breast volume in a single surgery.

DIEP flap for breast reconstruction: Retrospective evaluation of patient satisfaction on abdominal results

BACKGROUND Although some papers have analyzed patient satisfaction after traditional abdominoplasty, studies that have specifically assessed patient satisfaction on abdominal reconstruction after deep inferior epigastric perforator (DIEP) surgery are lacking. AIM The aim of this study was to assess satisfaction, specifically for abdominoplasty results, in patients who underwent breast reconstruction with a single DIEP flap. METHODS This retrospective study included 53 consecutive patients who underwent unilateral breast reconstruction with a DIEP flap. The patients were all clinically evaluated during a specific consultation and answered a satisfaction survey based on a four-point scale (unsatisfied, satisfied, happy, and very happy). RESULTS A total of 50 patients responded to the survey. The average age was 52.3 years. This study revealed that 52% of the patients were happy or very happy with the aesthetic result of their abdomen. A total of 34% of the patients confessed that they preferred their abdomen before surgery. A further analysis of the dissatisfied patients showed particular dissatisfaction with dog-ears (50%), residual abdominal overhang (18%), or the horizontal scar (12%). The average distance between the horizontal scar and vulvar anterior commissure was 10.6 cm. A total of 86% of the patients were happy or very happy with the preoperative counseling. CONCLUSIONS The authors note the necessity to give detailed preoperative information to explain the final abdominal aesthetic result, which can be quite different from the patients expectations.

Efficacy of autologous platelet-rich plasma combined with hyaluronic acid on skin facial rejuvenation: A prospective study

June 30, 2009. Corresponding medical records of included cases were then reviewed, with cases of icSCC treated via curettage alone included in this study. Patient and tumor characteristics were recorded, including duration of follow-up through the end of the study period (May 17, 2015). Tumors were considered recurrent if there was documentation of clinician or patient suspicion for recurrence with histologic confirmation of icSCC at the same site. Overall, 89 individual lesions from 80 unique patients met inclusion criteria and were included in this study. Duration of follow-up extended from 0 to 2502 days (6.8 years), with a median of 6 years. Most patients were male, with a mean age of 76 years at the time of diagnosis (Table I). Forty-four percent of lesions were located in low-risk sites, with a mean pretreatment size of 0.9 cm (range, 0.3-2.5 cm). Most lesions (76%) had tumor present at histologic margins, and 91% were well-differentiated (Table II). Three recurrences were identified (overall cure rate, 97%), 2 of which were located on high-risk sites, and 2 of the 3 recurrent lesions initially had positive histologic margins (Table II). One recurrent lesion was located on a high-risk site and was present at histologic margins before treatment with curettage. All recurrent lesions were welldifferentiated histologically (Table II). Time to recurrence (days) was 60, 68, and 78; 2 recurrences were initially curetted by the same staff dermatologist. Limitations of this study include incomplete medical records and suboptimal site documentation, potentially leading to missed recurrent tumors. Additionally, variation in curettage technique may have been present between clinicians (eg, disposable versus reusable curettes, number of passes with the curette) and practitioners may have preselected tumors and patients with certain characteristics for curettage alone. In conclusion, this study demonstrated a 97% cure rate of icSCC by curettage alone. Providers with adequate training in this technique should consider this treatment in icSCC with comparable features because it can be an efficient and effective modality for treating this tumor. Our small sample size precludes strong recommendations for precise tumor or technique selection. A prospective study is needed to further explore risk factors for recurrence as well as cosmetic outcomes, healing time, and complications associated with this procedure.

A Distally Based Sartorius Muscle Flap for a Gustilo Grade-III Open Fracture of the Lateral Femoral Condyle and the Head of the Fibula with a Complex Soft-Tissue Defect: A Case Report and Review of the Literature.

Case: We present a case of lower-limb trauma associated with an extensive soft-tissue defect around the knee joint, which led to the exposure of bone and the metalwork that was used for the management of the associated fractures. Coverage was performed with a distally based sartorius muscle flap in a single-stage procedure, allowing good recovery with a nice aesthetic and functional outcome at the 1-year follow-up. Additionally, we discuss alternative options for the coverage of severe soft-tissue defects based on the clinical context. Conclusion: A distally based sartorius muscle flap may be a suitable alternative for coverage of complex soft-tissue defects around the knee joint.

Efficacy of Autologous Platelet-rich Plasma Glue in Weight Loss Sequelae Surgery and Breast Reduction: A Prospective Study

Background: Seroma and hematoma formations are the most common complications after plastic surgery. The aim of this study was to assess the efficacy of autologous platelet-rich plasma (A-PRP) glue to reduce postoperative wound complications and improve surgical outcomes. Methods: Fifty-four patients were included in this study. They underwent breast reduction surgery, abdominoplasty, or limb lifting with A-PRP glue application on the entire surface of the subcutaneous tissue at the time of suture. Retrospective data were used for the control group. The primary endpoint was the incidence of postoperative seroma or hematoma. The secondary endpoint was the Patient and Observer Scar Assessment Scale score. Results: Demographics and clinical characteristics were not statistically different between the A-PRP glue group and the control group regarding age, sex ratio, and body mass index. After abdominoplasty, 37.5% of patients (3/8) in the control group experienced seroma and hematoma complications versus 12.5% of patients (2/16) in the A-PRP glue group (P = 0.55 and P = 0.25, respectively). After limb lifting, 50% of patients experienced postoperative complications in the control group versus no patient in the A-PRP glue group (P = 0.03*; * indicates that the P value is significant). After breast reduction, no patient experienced complication in the A-PRP glue group versus 25% of patients in the control group who experienced hematoma (P = 0.04*). The scar quality assessed 12 months after surgery showed no statistical differences between the groups. Conclusions: A-PRP glue seems effective to prevent seroma formation after limb lifting and hematoma formation after breast reduction. Wound-healing quality did not seem to be improved.

Comparison between the efficacy and safety of platelet‐rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study

The article entitled “Comparison between the efficacy and safety of platelet‐rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study” (Zeinab Abd El‐Samad Ibrahim, et al.) is very interesting but the methodology is not robust. Our mains comments concerned the count of the cells, the activation of the PRP and the method of assessment.