Mauricio Raigosa

Assessing the Long-Term Viability of Facial Fat Grafts: An Objective Measure Using Computed Tomography

BACKGROUND Autologous fat transplantation for soft tissue augmentation is a commonly used technique without a universally accepted approach. The literature includes a variety of reports describing varying degrees of success or failure. OBJECTIVE To evaluate the behavior of facial fat grafts in humans with the use of an objective measuring tool. METHODS A prospective randomized study, comparing patients pre- and postoperatively, was designed to evaluate the long-term viability of fat grafting. Participants were 18 men and 8 women between 34 and 59 years of age (mean, 45.07 yrs; standard deviation, 6.54 yrs). A total of 52 hemifaces in 26 patients diagnosed with HIV and demonstrating facial lipoatrophy were treated with fat transplantation using Colemans technique. HIV-positive patients were chosen as study participants because their nearly total lack of subcutaneous fat diminishes the bias in the evaluation of fat volume. Fat graft viability was evaluated by measuring the volume of adipose tissue evolution via computed tomography scan before fat grafting, at the second month after fat grafting, and 1 year after fat grafting. Descriptive statistical analysis was performed. RESULTS The mean volume on the right and left cheeks before fat grafting was 1.57 cc. The mean volume 2 months after the procedure was 2.93 cc with a statistically significant mean increase of 1.36 cc (P < .001) between baseline and the second month after the procedure. The mean volume after 12 months was 3.29 cc (P < .001), with a mean increase compared with the baseline of 1.72 cc, and of 0.36 cc between months 2 and 12. The statistically significant posttreatment improvement (P < .001) was maintained until month 12 of the follow-up period. CONCLUSIONS Using objective measurement, this study demonstrates that with one fat grafting procedure a durable result can be achieved, persisting for a minimum of 12 months without any trend towards reabsorption.

Male‐to‐Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

BACKGROUND Patients with male-to-female gender dysphoria (GD) require multidisciplinary assessment and management. Nowadays, more and more patients decide to undergo genital reassignment surgery (GRS) to have aesthetic and functional external female genitalia. Different techniques of this procedure have been described. Orchiectomy, penile disassembly, creation of a neovaginal cavity, repositioning of urethral meatus, and clitorolabioplasty may be identified as the five major steps in all of these techniques. METHODS We conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male-to-female GD at our department between November 2008 and August 2013 with a minimum follow-up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department. RESULTS Follow-up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases. CONCLUSIONS GRS can provide good functional and aesthetic outcomes in patients with male-to-female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina.

Assessment of a Suction-Assisted Cartilage Shaver Plus Liposuction for the Treatment of Gynecomastia

BACKGROUND The development of feminized breasts in men may cause significant emotional distress and embarrassment, particularly in young men and adolescents. Numerous techniques have been described for the correction of gynecomastia, many of which include the removal of fat and glandular tissue. OBJECTIVE The authors assess the utility of combining vibroliposuction with the use of a power-assisted arthroscopic-endoscopic cartilage shaver to correct gynecomastia and suggest a treatment algorithm for patients with gynecomastia. METHODS Forty consecutive patients with a median age of 32 years (range 19-57 years) and with varying degrees of gynecomastia underwent a combined approach that included vibroliposuction (power-assisted tumescent liposuction) for the removal of fatty tissue, followed by the removal of fibrous tissue with the use of a power-assisted cartilage shaver. Follow-up periods ranged in duration from six to 18 months. RESULTS All patients had satisfactory results. However, expansive hematomas requiring surgical drainage developed in three patients. Other complications included one case of insufficient resection requiring reoperation and three cases of hyperpigmentation and skin irregularities in patients with grade I gynecomastia. CONCLUSIONS Combination treatment using vibroliposuction and a power-assisted arthroscopic-endoscopic cartilage shaver is an effective treatment for gynecomastia, but the technique has a learning curve. This procedure is most appropriate for patients with grades II and III gynecomastia, or as a first-stage treatment for patients with grade IV gynecomastia.

Cortical tibial bone graft for nasal augmentation: donor site short scar.

The nose is the central part of the face and the most prominent facial feature. Augmentation rhinoplasty is one of the most exciting and arduous techniques for plastic surgeon and patient. Fourteen cases of augmentation rhinoplasty with cortical tibial bone graft are presented. An endonasal approach was used in 13 cases and an open approach in one case, with a donor site short scar (1.5 cm) in every case. The average follow up was 2 years and no significant bone resorption was observed. No remarkable complications or complications requiring surgery were noted during the follow up. The cosmetics results have been gratifying.

Waterproof Camera Case for Intraoperative Photographs

Accurate photographic documentation has become essential in reconstructive and cosmetic surgery for both clinical and scientific purposes. Intraoperative photographs are important not only for record purposes, but also for teaching, publications, and presentations. Communication using images proves to be the superior way to persuade audiences. This article presents a simple and easy method for taking intraoperative photographs that uses a presterilized waterproof camera case. This method allows the user to take very good quality pictures with the photographic angle matching the surgeon’s view, minimal interruption of the operative procedure, and minimal risk of contaminating the operative field.

Columella reconstruction using a free flap from the first web space of the foot.

Nasal columella defects can result in significant cosmetic and functional deformities. If a local flap transfer cannot be performed, columella reconstruction becomes a significant challenge for the surgeon. The columella of a healthy 30-year-old woman whose nose was scarred and contracted because of cocaine abuse, was successfully reconstructed by transferring a microvascular free flap from the first web space of the foot. The reconstructed columella had a satisfactory contour and a good texture, although there was slight, albeit unproblematic, color mismatching.

Multislice Computed Tomography Angiography of the Fourth Dorsal Interosseous Space in Cadavers

PURPOSE To study computed tomography angiography (CTA) findings and compare anatomic correlation of the 4th dorsal metacarpal spaces and to determine the role of this technique for anatomic studies and flap design. METHODS Hands from 17 cadavers were injected with a radiopaque mixture. The specimens were imaged using 16-detector-row computed tomography. Each image was analyzed by a radiologist, a plastic surgeon, and an anatomist. The following data were recorded: the presence of the 4th dorsal metacarpal artery, proximal and distal communicating branches and distal recurrent branch, and the number of cutaneous perforators. Afterwards, a meticulous dissection was carried out. A correlation between the radiologic findings and the gross anatomy was established. RESULTS In all specimens, the 4th dorsal metacarpal artery and distal recurrent branch were identified. In 15 cases, at least 1 perforator was identified within the 4th space. In 2 cases, no perforator was identified. In all cases, the radiologic findings correlated with the anatomic findings in the dissection. CONCLUSIONS Multislice CTA provides good-quality information about the vascular anatomy of the dorsal aspect of the hand, including perforator vessels less than 0.5 mm in diameter. Multislice CTA allows for observation of the axis, trajectory, and branching pattern of the blood vessels and, most importantly, demonstrates the anatomic relationships among blood vessels, bones, and soft tissue.

Self-made compressive dressing for vaginoplasty.

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