T. G. S. Fiala

Update: lifting the malar fat pad for correction of prominent nasolabial folds.

The malar fat pad suspension technique is a safe and effective method for rejuvenation of the aging midface. When combined with the SMAS-platysma rotation flap face-lift as a multi-vector technique, most of the changes that occur with aging are addressed and corrected in an anatomic fashion, resulting in an aesthetically pleasing result. Careful attention to the tension and position of the suspension suture enhances the improvement of the infraorbital flattening as well as correcting the excessive prominence of the nasolabial fold.

The effects of rigid fixation on craniofacial growth of rhesus monkeys.

A male infant rhesus monkey model was used to examine the growth effect on the craniofacial skeleton caused by osteotomy and three types of fixation: inter-fragmentary wiring, microplate and screw fixation, and “extensive” microplate and screw fixation. The animals (n = 12) were allowed to mature until cranial growth was at least 95 percent complete. Direct craniometric measurements were obtained and analyzed for differences in the three treated groups. A group of unoperated male animal skulls also was analyzed as controls (n = 5). A subtle visible and measurable restriction of growth in the operated area occurred in all treatment groups. Significant differences (p > 0.05) were found in only 4 of the 39 craniometric chords measured. Interfragmentary wiring showed fewer growth-restrictive effects than standard use of microfixation plates. Extensive use of rigid fixation devices caused the greatest degree of growth disturbance. Osteotomy and fixation in the infant rhesus monkey affect craniofacial growth, with the degree of growth restriction increasing with the amount of fixation hardware. (Plast. Reconstr. Surg. 93: 1, 1994.)

Augmentation Mammoplasty: Results of a Patient Survey

A detailed survey on aesthetic augmentation mammoplasty was sent to patients who had undergone this procedure at the Massachusetts General Hospital between July 1973 and July 1991 to determine the incidence of postoperative complications after augmentation mammoplasty, and to qualify the factors related to patient satisfaction (n = 304). Surgical records of respondents were examined. After a mean follow-up of 8.2 years, there were no patients with known breast cancer or autoimmune disease after augmentation. Five implants (2.5%) were replaced due to leakage. Other complications were rare. Overall satisfaction was high and correlated inversely with capsular contracture ratings and elapsed time. Contracture ratings increased with time for silicone implants. Gel implants in the submuscular position were softer than subglandular ones after 5 years elapsed time. Most women are satisfied after augmentation mammoplasty, despite a significant incidence of capsular contracture. The incidence of other adverse effects after augmentation is low. Augmentation mammoplasty does not appear to be an inducer of autoimmune disease or of breast cancer.Fiala TGS, Lee WPA, May JW Jr Augmentation mammoplasty: results of a patient survey.

The antithrombotic effects of ticlopidine and aspirin in a microvascular thrombogenic model.

In the effort to reduce a persistently significant failure rate in free tissue transfers and digital replantations, the efficacy of two oral platelet inhibitors, aspirin and ticlopidine, was examined using the arterial inversion graft, a known microvascular thrombogenic model. Forty male New Zealand White rabbits were used to create eighty 5-mm inversion grafts. Four groups were blindly given perioperative oral drug therapy: ticlopidine, aspirin, both, or neither (control). Vessel patency was evaluated at 1 hour and 1 week after surgery. The patency rate for the control group was 20 percent at 1 hour and 5 percent at 1 week. The drug-treated patency rates at 1 hour and 1 week, respectively, were 45 percent (p = 0.046) and 15 percent for ticlopidine, 35 percent and 10 percent for aspirin, and 45 percent (p = 0.046) and 20 percent for the combination therapy. This study shows that ticlopidine alone or in combination with aspirin significantly increases the 1-hour patency rates in a reliable thrombosis model, but it fails to show a significant increase in the final patency rates by either drug administered alone or in combination. The benefit in clinical microvascular surgery of either aspirin or ticlopidine is not determined by this study.

Microfixation of acute orbital fractures.

Microfixation techniques were used as an adjunct to the use of miniplates and screws in the acute treatment of fractures involving the orbit in 42 patients over a 2-year period. Miniplates were used in all fractures at the Le Fort I level and at the zygomatic-frontal suture in high-energy injuries. Microfixation was used to stabilize all other fractures of the zygomatic, nasoethmoid, and frontal areas. Problems with plate visibility and objectionable palpability through thin periorbital skin were eliminated. The use of microplates allowed more precise positioning of small fragments than possible with miniplates or interfragmentary wires. Fracture reduction remained clinically stable in the frontal and nasoethmoid areas. Microplates were inadequate to resist soft tissue deforming forces along the infraorbital rim and the zygomatic arch in high-energy injuries.Yaremchuk MJ, Del Vecchio DA, Flala TGS, Lee WPA. Microfixation of acute orbital fractures. Ann Plast Surg 1993;30:385–397

Bacterial Clearance Capability of Living Skin Equivalent, Living Dermal Equivalent, Saline Dressing, and Xenograft Dressing in the Rabbit

Two new skin substitutes, Living Skin Equivalent (LSE) and Living Dermal Equivalent (DE), have recently been developed. In this experiment, the ability of the LSE and DE preparations to function as biological dressings in an acute wound model was tested. Forty full-thickness wounds were made in New Zealand White rabbits. Each wound was inoculated with 5 ± 105 Staphylococcus aureus organisms. Twenty-four hours later, one of the following four dressings was applied: saline gauze, porcine-derived xenograft, LSE, or DE. Daily dressing changes and wound biopsies for bacterial counts were performed. At 96 hours after inoculation, split-thickness autograft was applied to all wounds. Skin graft take was assessed 5 days later. In all treatment groups, bacterial counts decreased over time (p = 0.02). At 72 and 96 hours after inoculation, wounds dressed with LSE or DE had significantly lower mean bacterial counts than wounds treated with xenograft dressing (p < 0.01). No significant differences were found among the LSE-, DE-, or saline-treated groups. Skin grafts took well in LSE-and DE-treated wounds. In conclusion, the LSE and DE were more effective than xenograft in reducing bacterial wound contamination in this model, thereby demonstrating their potential application as biological dressing materials.Fiala TGS, Lee WPA, Hong H-Z, May JW Jr. Bacterial clearance capability of Living Skin Equivalent, Living Dermal Equivalent, saline dressing, and xenograft dressing in the rabbit.