Namik K. Baran

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple.

Abstract. A method of repair is described for correction of abnormally enlarged nipple–areola complex following both periareolar mastopexy and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control the enlargement of nipple–areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast, especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy or reduction mammoplasty cases resulting in enlarged nipple–areola complexes, the size of the areola can also be corrected by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision, the shape of the breast is more acceptable and the size of the areola does not enlarge with time.

Delayed effect of denervation on wound contraction in rat skin.

&NA; Neuronal supply in soft tissues may be an important part of cutaneous wound healing. In order to observe the effect of denervation on wound contraction, rectangular full‐thickness skin defects were created on the dorsum of two groups of Wistar rats. In the experimental group (n = 20), spinal nerves corresponding to the area of the open wound (T11 to L2) were isolated and divided bilaterally. In the control group (n = 20), the same pairs of spinal nerves were dissected but left intact. Limits of denervation were verified by the pinprick test. Wound healing, which is primarily in the form of wound contraction in this model, was evaluated by tracing wound margins onto millimetric paper weekly. Wound contraction was delayed significantly in the experimental group (p < 0.05) at all follow‐up periods when compared with the controls. Loss of neuropeptide secretion from the nerve endings in denervated tissues may be responsible for the retarded wound contraction, since neuropeptides are thought to exert trophic effects on skin wound healing.

A different strategy in the surgical treatment of capsular contracture: leave capsule intact.

Abstract. The authors present their experience with the surgical treatment of capsular contracture to achieve better results in a safe, predictable, and practical way, and discuss the possible treatment modalities. They simply advise leaving the capsule intact, even if it is calcified, and create another pocket, rarely in the front or, more typically, at the back of the capsule. If the breast tissue is also ptotic, a mastopexy procedure may be added to the procedure, in addition to augmentation, with a rather small prosthesis placed in the new pocket or, occasionally, in the old one. External, forceable massage is not advisable to treat the capsule. Open capsulotomy and/or partial capsulectomy can be applied to release the capsule. However, it is not advisable since recurrence is usually inevitable. The purpose of this paper is to present a series of surgical procedures to avoid the problems created by the capsule and present different cases with good results.

Facial resurfacing in Xeroderma pigmentosum with monoblock full-thickness skin graft

A case of xeroderma pigmentosum with multiple skin tumors on the face that was treated with total excision and replacement of face skin except the eyelids with a monoblock full-thickness abdominal skin graft is reported. The quality and tumor-free features of the monoblock full-thickness skin graft in xeroderma pigmentosum are indicated. Despite the increased morbidity of the donor region, the radical surgical approach advocated here has improved the prognosis in the case reported.

The use of alloplastic materials in secondary rhinoplasties: 32 years of clinical experience.

Background: A retrospective evaluation of the authors’ 32 years of experience in revision rhinoplasty is presented. The authors suggest that iatrogenic nasal deformities are studied under four groups on the basis of their location and the affected structures: lower third, middle third, upper third, and combined deformities. The authors also present the vertical columellar incision for insertion of alloplastic implants and cartilage grafts, a genuine approach avoiding contamination with the nasal flora. Methods: A total of 182 cases were studied, as follows: lower third (n = 81), middle third (n = 65), upper third (n = 17), and combined (n = 19) deformities. The mean age of the patients was 40 years. Results: Our follow-up was a minimum of 2 years, and some of the cases with Proplast implants have been followed for as long as 21 years. During this rather long follow-up, only two of the Proplast implants had to be removed (one because of an acute infection and the other because of a chronic infection causing extrusion after 5 years). Conclusions: The authors have always preferred to use autogenous cartilage grafts for tip deformities and Proplast implants for middle and upper third saddle nose deformities whenever necessary. Their long-term results with Proplast for more than 20 years show that alloplastic materials may be as reliable as autogenous implants if the surgical principles are met and the cases are carefully selected.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Vascularized double-sided preputial island flap with W flap glanuloplasty for hypospadias repair.

&NA; Hypospadias surgery is one of the most challenging surgical interventions that still need further refinements for increased success rates. During the last 5 years, we operated on 26 mid‐penile or proximal hypospadias cases by using vascularized double‐sided preputial island flap and W flap glanuloplasty to achieve superior functional and aesthetic results. Follow‐up period of the patients revealed a 92.3 percent success rate with a single operation. Two cases developed fistula, which was located at the proximal anastomosis site. However, they were repaired in a second sitting without any additional problem. The basic aim in hypospadias surgery is the correction of chordee, reconstruction of urethra, and sufficient ventral penile skin coverage in one stage with minimal complication. The use of vascularized tissue for urethral reconstruction and ventral coverage is believed to have a superior healing capacity with better functional and cosmetic outcome. On the other hand, adding W flap glanuloplasty to this technique avoids the risk of meatal stenosis. We conclude that by combining the two above‐mentioned techniques, it is possible to cope better with this devastating congenital deformity.

A twelve year experience with reduction mammoplasty and abdominoplasty

In the last 12 years we performed mammoplasty on 191 patients, using the Wise pattern and the Strömbeck technique. In the same 12-year period, we also performed abdominoplasty in 108 patients, using the Pitanguy and the Grazer procedures. In the last four years we performed suction lipectomy in 43 patients, using the Illouz technique. In this article we present our moderate modifications on these techniques and the complications.

Complications of circumcision

Abstract Circumcision remains the most common operation performed on males. Although, not technically difficult, it is accompanied by a rate of morbidity and can result in complications ranging from trivial to tragic. The reported incidence of complications varies from 0.1% to 35% the most common being infection, bleeding and failure to remove the appropriate amount of foreskin. Forty patients suffering from different degrees of circumcision complications and their treatment are presented. In all patients satisfactory functional and cosmetic results were achieved. Whether it is done for ritualistic, religious or medical reasons circumcision should be performed by a fully trained surgeon using a proper technique as follows 1) adequate use of antiseptic agents; 2) complete separation of inner preputial epithelium from the glans; 3) marking the skin to be removed at the beginning of operation; 4) careful attention to the baby’s voiding within the first 6 to 8 h after circumcision; 5) removal or replacement of the dressings on the day following circumcision.

Vulva reconstruction with a tissue expander.

A patient with exstrophy of the bladder in whom we performed vulva reconstruction using a tissue-expansion technique and local flaps was presented. The ultimate result was in concert with the anatomic characteristics of normal external genitalia with regard to type of skin, pigmentation, hair pattern, quality of circulation, and sensory supply.