Richard A. Mladick

Combined gluteoplasty: liposuction and lipoinjection.

From April of 1995 to August of 1998, 62 female and four male patients had gluteoplasties. To improve the gluteal region, two techniques that create excellent results in other parts of the body, liposuction and lipoinjection, were combined. The ages of the patients ranged from 18 to 52 years (mean, 31 years). Liposuction was done with a tumescent technique in the lumbosacral, trochanteric, and subgluteal region to improve gluteal shape. The amount of fat aspirated was only that necessary to obtain the desired contour. In all cases, liposuction was also performed in other areas. Lipoinjection was done with round-tip cannulas in different planes of the gluteal region, and the fat was applied in small strips. The quantity of fat infiltrated varied from 120 to 280 cc per gluteus, with a mean of 210 cc. The results were evaluated by the patients and the surgical team with preoperative and postoperative photographs. Follow-up ranged from 3 months to 3 years and 5 months, with a mean of 17 months. No patient was dissatisfied with the results, and more than 90 percent considered their results good or excellent. Liposuction complications consisted of four seromas, six visible irregularities, and two palpable irregularities. Lipoinjection complications occurred in 16 gluteus regions (12 percent); all had gluteal temporal hyperemia and erythema, which resolved with conservative treatment except in one case (4 cc of sterile material corresponding to fat necrosis was drained in that patient). No irregularities or depressions occurred in the gluteus. One case of probable fat embolism syndrome had a satisfactory evolution. This gluteoplasty technique is simple and low in cost, with minimal morbidity and very good results. It is important to note that a good result does not depend on a great amount of fat infiltration but rather on a harmonious way of combining both surgical procedures: fat elimination by liposuction and gluteus augmentation by lipoinjection.

The muscle-suspension lower blepharoplasty.

The muscle-suspension (or muscle sling) lower blepharoplasty is a technique that can be used to some extent for all lower lids in which tightening and smoothing is desired. It seems to provide an extra degree of support by counteracting the natural tendency of gravity to produce scleral show or ectropion when the lid skin is tightened. It consists of anchoring a sling of orbicularis muscle to the periosteum of the lateral orbital rim, with an upward and lateral pull--while the skin is pulled in a more medial or upward direction.

Advances in liposuction contouring of calves and ankles.

Achieving a predictable, aesthetic result in liposuction contouring of the lower leg is now possible. The evolution of the technique has brought about preoperative, intraoperative, and postoperative advances. This article describes in detail these advances and their rationale.

Lipoplasty of the calves and ankles.

The author details his experience over the past 6 years with 53 patients who had lipoplasty of the calves and ankles. The patient selection and diagnosis are critical. Determining whether the problem is localized or circumferential (generalized) influences the approach. The incisions are outlined as well as the best technique to provide excellent access to the entire leg. Although the results take a considerable period of time to appear because of long-lasting edema, after 3 months in the localized cases and 6 months in the generalized cases, an excellent configuration of the lower leg may be obtained. The author has had no significant complications in this series.

Lingual flaps: effect on speech articulation and physiology.

The large anterior palatal fistula is one of the more difficult problems of cleft palate care for both surgeon and speech pathologist. Difficult for the surgeon because, in most cases, previous operations have heavily scarred the adjacent palatal tissue making it insufficient in quality and quantity; difficult for the speech pathologist since persistent nasal escape cannot be improved by exercises and training as can certain gaps in the velopharyngeal region. Not infrequently, both surgeon and speech pathologist gladly accept a compromise, prosthetic closure. While prosthetic closure may be acceptable for some older patients with large anterior palatal defects, we do not feel it is desirable for young cleft patients. A prosthetic closure for the cleft palate patient frequently is associated with a multitude of problems and inconveniences without obtaining an ideal closure. We have recently used a relatively new procedure, the lingual flap, to obtain closure in these difficult cases.

Treatment of the firm augmented breast by capsular stripping and inflatable implant exchange.

A technique of capsular stripping, removing a gel implant, and inserting an inflatable implant in front of the old capsule, is described for the relief of the firm breasts which sometimes develop after an augmentation mammaplasty. This technique puts all of the old capsule behind the new implant, and it does not require excessive dissection.

Identification of breast cancer patients with high risk of early recurrence after radical mastectomy

A prospective study of factors that might be helpful in predicting recurrence of breast cancer during the 2 years after radical mastectomy has been completed in 381 women by the Cooperative Breast Cancer Group (National Cancer Institute). Identification of clinical factors which might be associated with such recurrence has been achieved. A multivariate analysis of the data was oriented toward the identification of clinical factors other than lymph node status that might be simultaneously used to predict recurrence because of the current trend of cancer therapy toward more limited surgery. Degree of differentiation of the tumor, blood vessel invasion, patient age and tumor size were identified as important predictors of recurrence for premenopausal patients and tumor size was identified as important for postmenopausal patients. The addition of axillary lymph node status to these factors, however, made a significant improvement in the prediction equation for both pre- and postmenopausal patients. Studies of this type are of particular value to understand further the biology of breast cancer which is necessary to develop rational primary and adjuvant treatment strategies.

Immediate reconstruction of the pharynx after combined therapy for advanced tonsillar carcinoma

Abstract A combined approach of radiation therapy and surgery has been used in ten patients with advanced tonsillar carcinoma. Moderate doses of preoperative irradiation were promptly followed by a composite resection and immediate cervical or forehead flap reconstruction. The technic is discussed. The results have demonstrated excellent healing and impressive oral function. A longer follow-up period will be necessary to determine the value of this approach as a curative procedure.

Embryonal rhabdomyosarcoma of the head and neck in children (correlation of stage, radiation dose, local control, and survival)

Nineteen consecutive children are analyzed according to clinical stay, radiation dose (NSD), local control, and survival. The majority received 1600 to 1750 rets and courses of actinomycin during their radiation treatments. The favorable sites were the orbit, facial soft tissue, and the larynx. The primary site control rate was 89%, and the metastatic neck control rate was 80%. The 2-year survival was 70%, and the 5-year survival was 67%. Five children are alive and well 12 to 15 years after irradiation. Late sequelae are hypoplasia of the orbit and maxillary sinus.

Prostheses, stents, and splints for the oral cancer patient†

There are definite indications for the use of prosthetic devices in the treat ment of oral cancer. However, the use of these devices is not as widespread and well established as might be de sired. Furthermore, supportive and re habilitative prosthetic care of the oral cancer patient has not received the learned attention required to produce a sophisticated discipline. Few persons have given concentrated effort toward overcoming the lack of agreed opinion, uniformity in technique, discovery or application of new materials, nor have we acquired an adequate knowledge of predictable tissue response to pros theses and other mechanical devices. Although detailed guidelines might not be universally accepted at this time, it has been the intent of this com mittee to be as specific as possible in offering suggestions for treating the oral cancer patient and in presenting suggestions that are based upon cur rent experience and knowledge. It seems fitting in this study to recommend ideal standards for the use of prostheses in the therapy of oral cavity malignancy, since anything less might detract from the opportunities for eradicating the disease, for achiev ing long-term survival among patients