M. Signorini

posttraumatic Lipomas: Where Do They Really Come From?

&NA; A series of nine patients is reported in which a subcutaneous lipoma appeared within a few months after a blunt trauma. Computerized tomography and/or nuclear magnetic resonance and/or echography were employed for the diagnosis in addition to physical examination. Surgical removal of the masses was then performed without any recurrence at the 3‐year minimum follow‐up. In four cases, suction‐assisted lipectomy was employed to minimize the scarring. However, in these cases a biopsy was first performed to rule out malignancy. The pathogenetic mechanisms of posttraumatic lipomas are reviewed in the literature and are found to be incompatible with some of the cases presented. Instead, the hypothesis of a true adipose tissue neoformation following trauma is suggested.

Clinical Evaluation of a New Self-Drying Silicone Gel in the Treatment of Scars: A Preliminary Report

Topical silicone gel sheeting and intralesional steroids are the only evidence-based recommendable forms of treatment to control the quality of a scar. The advantages and disadvantages of both are well known. This study was undertaken to verify the efficacy of a new topical silicone treatment: a self-drying spreadable gel that needs no means of fixation and cannot be seen because of complete transparency. Fresh surgical scars treated with the tested product showed significantly better outcomes than those untreated in a prospective trial involving a group of 160 patients. Patient compliance was particularly good, especially for scars on exposed areas such as the face, where the traditional gel sheeting is frequently discontinued at an early stage by patients who object to its visibility. The results of the self-drying silicone gel have indeed been satisfactory. Considering the effective results obtained and the good patient compliance, the authors currently rate this concept of treatment as the first choice for preventing hypertrophy of recent scars.

Fascio-fascial suspension technique in medial thigh lifts

Redundant thigh tissue can be corrected by the thigh lift. However, this is a seldomly used procedure because of postoperative problems such as inferiorly displaced and wide scars, vulvar distortion, and early recurrence of ptosis. In order to limit these complications, we developed a deep anchoring technique based on the overlap of the adductor longus and gracilis fasciae. A group of 18 patients underwent a medial thigh lift using this technique and were followed for at least 12 months after surgery. The fascio-fascial suspension gives strong vertical support with minimal tension on the skin, thereby reducing the complications traditionally associated with this procedure.

Updated evaluation of the activity of antibiotics in a burn centre

The results of microbiological tests performed in a burns unit between January 1989 and December 1990 have been analysed. Burn wound swabs and biopsies, blood cultures, central venous and urinary catheters, bronchial aspirates, pharyngeal swabs and faecal cultures for a total of 7950 examinations were considered. Staph. aureus was the most frequently isolated bacterium, followed by Staph. epidermidis, Pseud. aeruginosa and E. coli. The antibiograms have shown a low efficacy rate of cephalosporins, even of the latest generation, while with Gram-positive isolates the highest rates of activity were recorded by vancomycin and teicoplanin (100 per cent sensitivity). The situation seems better with Gram-negative organisms since they appear to be sensitive to a larger number of antimicrobial agents.

Congenital infiltrating lipomatosis of the face related to cytomegalovirus infection

A case of congenital infiltrating lipomatosis of the face is presented, associated with a congenital cytomegalovirus infection.

Self-expanding prostheses complicating augmentation mammoplasties

A new and serious complication was experienced by patients of three independent surgeons following routine augmentation procedures. In each case reported, double-lumen prostheses had been used. All cases were reoperated with a diagnosis of capsular contracture. However, at surgery it was found that the outer lumen of the prostheses had overfilled with 60–160 cc of interstitial fluid, probably because of an osmotic gradient. The possible causes of this unfortunate complication are considered.

Preliminary clinical experiences with the use of immunomodulators in burns

The remarkable progress achieved in control of infections in burned patients has significantly increased survival rates. Nevertheless, septic complications are still the leading cause of death in these patients. The immunologic disturbances present after severe burns certainly play a key role in susceptibility to infection, and in particular the impairments of the phagocytic system warrant major investigative efforts in order to increase host defenses. Determination of phagocytic and microbicidal capacity of neutrophils from burned patients evidenced a marked functional impairment of these cells. The alterations recorded were partly due to intrinsic (cellular) defects, and partly to extrinsic (serum) defects. Indeed, opsonic factors are known to be reduced in these patients, but also phagocytosis-inhibiting factors such as immunocomplexes have been detected in the patients we have studied. Administration of the immunomodulating agents methysoprinol and timostimoline were found to be effective in partially restoring neutrophil function. Rational immunotherapy in burned patients will consist of replacement of humoral mediators, clearance of inhibitory factors and stimulation of the cellular effectors of immunity.

Global Aesthetics Consensus: Hyaluronic Acid Fillers and Botulinum Toxin Type A-Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations.

Background: Combination of fillers and botulinum toxin for aesthetic applications is increasingly popular. Patient demographics continue to diversify, and include an expanding population receiving maintenance treatments over decades. Methods: A multinational panel of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated guidelines with a worldwide perspective for hyaluronic acid fillers and botulinum toxin. This publication considers strategies for combined treatments, and how patient diversity influences treatment planning and outcomes. Results: Global Aesthetics Consensus Group recommendations reflect increased use of combined treatments in the lower and upper face, and some midface regions. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Combination of toxin with fillers is appropriate for several indications addressed previously with toxin alone. New scientific data regarding hyaluronic acid fillers foster an evidence-based approach to selection of products and injection techniques. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin and fillers. It also informs longitudinal treatment planning, and analysis of toxin nonresponders. Conclusions: The emerging objective of injectable treatment is facial harmonization rather than rejuvenation. Combined treatment is now a standard of care. Its use will increase further as we refine the concept that aspects of aging are intimately related, and that successful treatment entails identifying and addressing the primary causes of each. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Superior Orbital Fissure Syndrome Complicating Zygomatic Fractures: Pathogenesis and Report of a Case Case Report

Superior orbital fissure syndrome complicates zygomatic fractures either when the nerves that cross the fissure are damaged by bone fragments, or when the increased pressure in the orbit at the time of the injury compresses the nerves against the rim of the fissure. Oedema and bleeding may also have the same effect. We present a patient who was treated conservatively, and the ophthalmological problem subsided, although not completely, within a year.

Facial Assessment and Injection Guide for Botulinum Toxin and Injectable Hyaluronic Acid Fillers: Focus on the Midface

This third article of a three-part series addresses techniques and recommendations for aesthetic treatment of the lower face. The lower face is considered an advanced area for facial aesthetic treatment. In this region, soft-tissue fillers play a more important role than neuromodulators and should be used first to provide structure and support before neuromodulators are considered for treatment of dynamic lines. Treatment of the lip, perioral region, and chin, in addition to maintaining balance of the lower face with the face overall, is challenging. Procedures on the lip should avoid overcorrection while respecting the projection of the lips on the profile view and the ratio of lip size to chin. The chin is often neglected, but reshaping the jawline can provide dramatic improvement in facial aesthetics. Both profile and anterior views are critical in assessment and treatment of the lower face. Finally, rejuvenation of the neck region requires fillers for structural support of the chin and jawline and neuromodulators for treatment of the masseter and platysma.