Konstantinos Seretis

Tapia’s Syndrome: An Unexpected but Real Complication of Rhinoplasty: Case Report and Literature Review

Extracranial involvement of the recurrent laryngeal and hypoglossal nerves, also known as Tapia’s syndrome, is a rare complication of airway management under general anesthesia. We report such a case after an otherwise uncomplicated rhinoplasty. After reviewing the other nine reported cases of Tapia’s syndrome, we found that half of the patients had undergone rhinoplasty or septorhinoplasty. The risk factors, etiology, clinical course, recovery potential, and preventive measures are analyzed and discussed. Although Tapia’s syndrome after rhinoplasty/septorhinoplasty appears to be rare, it should be considered by both the anesthetist and the plastic surgeon, and most importantly, special attention should be paid to preventive strategies.

Free sensate medial plantar flap for contralateral plantar forefoot reconstruction with flap reinnervation using end-to-side neurorrhaphy: a case report and literature review.

Reconstruction of weight‐bearing plantar defects remains a challenge due to the unique characteristics of the plantar skin and thus the limited available options. The medial plantar flap, either pedicled or free, represents an ideal option, but its use as sensate flap for forefoot defects has been scarcely reported. We present a case of plantar forefoot reconstruction with a free sensate medial plantar flap, with end‐to‐side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve of the recipient. Last follow‐up, at 2 years post‐op, verified a very good functional and aesthetic outcome, indicating that the suggested approach may prove the treatment of choice in selected cases of plantar forefoot reconstruction.

Prevention of Seroma Formation Following Abdominoplasty: A Systematic Review and Meta-Analysis

Background With seroma formation being the most common complication of abdominoplasty, multiple surgical strategies have been proposed to lower the seroma rate, yet their effectiveness is unclear. Objectives The objective of this systematic review and meta-analysis was to comprehensively summarize and quantify the effects of preventive surgical measures for seroma in patients undergoing abdominoplasty. Methods A predetermined protocol was used. An electronic search in MEDLINE, Scopus, the Cochrane Library, and CENTRAL electronic databases was conducted from inception to June 2016. This search was supplemented by a review of reference lists of potentially eligible studies and a manual search of key journals in the field of plastic surgery. Eligible studies were prospective controlled studies, which investigated prevention of seroma formation and reported on seroma rate. Secondary outcomes were rate of hematoma, wound dehiscence, infection, reoperation and hospital readmission, time to drain removal, total drain output, and length of hospital stay. Results The meta-analysis included nine studies with 664 abdominoplasty patients. Seroma rate was 7.5% in the prevention group and 19.5% in the control group with the odds ratio (95% confidence interval) being 0.26 (0.10-0.67), P = .006, favoring the prevention group. Similar results were also revealed for infection rate, time to drain removal, and length of hospital stay. Subgroup analysis showed that preservation of Scarpas fascia, tissue adhesives and, possibly, progressive tension sutures reduce, independently, seroma formation. Conclusions This meta-analysis provides strong evidence that the use of certain preventive measures during abdominoplasty, compared to conventional procedure, reduces seroma formation. Level of Evidence 2

Metabolic Effects of Large-Volume Liposuction for Obese Healthy Women: A Meta-analysis of Fasting Insulin Levels

Level of Evidence V 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

Tissue expansion and latissimus dorsi transfer for arm-thorax synechia reconstruction.

Inadequate treatment of severe burn injury often results in scar contractures with subsequent functional impairment and cosmetic deformities depending on the body area involved. Arm-thorax synechia is a rare but devastating complication of burns. The authors report a case of a 17-year-old boy with subtotal arm-thorax synechia, secondary to burn contracture. Reconstruction was accomplished, in two stages, with the use of tissue expanders and a latissimus dorsi muscle flap. The postoperative course was uneventful in both stages, with complete survival of both the expanded skin and the muscle flap. Early initiation of intensive rehabilitation resulted in excellent functional outcome, while significant aesthetic improvement was also ensured. In conclusion, the combined use of tissue expansion and latissimus dorsi transfer may prove to be a very good option in the treatment of complex postburn axillary contractures. The main advantages of the suggested method are the best quality of skin provided by tissue expansion and the safe coverage of any vital structures exposed with the use of the muscle flap.

A 6-Year Experience in Flat Helix Correction With a Simple Procedure

OBJECTIVE To present our 6-year experience in flat helix correction with a simple procedure. Among the many different congenital ear deformities lies the flat helix. The correction of this anomaly must be considered owing to its significance to the overall shape and appearance of the auricle. METHODS Our surgical method is based on a geometrical approach, with radiating beveled incisions of the helical cartilage and subsequent overlapping and suturing of small triangular cartilaginous flaps. The method was applied in 15 patients over 6 years and was combined with correction of prominent ears in 9 cases. RESULTS Curling of the helix was achieved in all cases. A step deformity detected in 2 initial cases led to minor technique modification. No recurrences were recorded during the follow-up period (mean follow-up, 32 months). All patients were satisfied with the aesthetic outcome. CONCLUSIONS The method applied is a relatively simple and reliable procedure that allows the restoration of the curvilinear shape of the helix. It can be performed under local anesthesia (along with any other procedure that a prominent ear may require), causes no visible scars, and delivers consistently effective results.

Single stage functional reconstruction of both peroneal tendons and overlying skin with an anterolateral thigh flap and vascularized fascia lata: A case report

Reconstruction of complex soft tissue defects in the distal lower leg remains challenging, since anatomical constraints limit the local options available in this area. In this report, we present a case of single stage functional reconstruction of both peroneal tendons and overlying skin with an anterolateral thigh flap and vascularized fascia lata. A 55‐year‐old patient underwent wide excision of a synovial sarcoma in the distal lower leg, which resulted in a complex defect including the peroneus longus and brevis tendons (10 cm), and the overlying skin (14 × 8 cm). Functional reconstruction was achieved in a single stage with a composite anterolateral thigh flap with vascularized fascia lata of similar dimensions to those of the defect. The fascia lata component of the flap was longitudinally split in two segments. Each of them was rolled up, and that way, two separate vascularized neotendons were created. The neotendons bridged the gap of peroneal tendons, whereas the skin paddle of the flap provided stable soft tissue coverage to the reconstructed tendons. Flap pedicle was anastomosed to the anterior tibial vessels. Early and late postoperative periods were uneventful. Follow up at 1 year postoperatively showed excellent neotendon incorporation, as well as a very good functional and aesthetic outcome. The use of the method described may be a useful alternative in single stage functional reconstruction of composite defects comprising two or even more tendons and the overlying skin.

The effects of abdominal lipectomy in metabolic syndrome components and insulin sensitivity in females: A systematic review and meta-analysis.

BACKGROUND Adipose tissue is an endocrine organ, which is implicated in the pathogenesis of obesity, metabolic syndrome and diabetes. Lipectomy offers a unique opportunity to permanently reduce the absolute number of fat cells, though its functional role remains unclear. This systematic and meta-analysis review aims to assess the effect of abdominal lipectomy on metabolic syndrome components and insulin sensitivity in women. METHODS A predetermined protocol, established according to the Cochrane Handbooks recommendations, was used. An electronic search in MEDLINE, Scopus, the Cochrane Library and CENTRAL electronic databases was conducted from inception to May 14, 2015. This search was supplemented by a review of reference lists of potentially eligible studies and a manual search of key journals in the field of plastic surgery. Eligible studies were prospective studies with ≥1month of follow-up that included females only who underwent abdominal lipectomy and reported on parameters of metabolic syndrome and insulin sensitivity. RESULTS The systematic review included 11 studies with a total of 271 individuals. Conflicting results were revealed, though most studies showed no significant metabolic effects after lipectomy. The meta-analysis included 4 studies with 140 subjects. No significant changes were revealed between lipectomy and control groups. CONCLUSIONS This meta-analysis provides evidence that abdominal lipectomy in females does not affect significantly the components of metabolic syndrome and insulin sensitivity. Further high quality studies are needed to elucidate the potential metabolic effects of abdominal lipectomy. Systematic review registration PROSPERO CRD42015017564 (www.crd.york.ac.uk/PROSPERO).