Lateral Buttock Research Articles

Eye-Tracking Insights into the Perception of Buttocks.

Aesthetic enhancements to the buttock region have grown in demand due to media influence and evolving beauty standards. Using eye-tracking technology, we sought to uncover subconscious visual preferences regarding the buttock aesthetic. The objective of this investigation was to assess visual gaze patterns in assessing female buttocks among Caucasian and Asians through eye-tracking technology. 67 participants viewed photographs of buttocks from various angles, and eye movements were analyzed using the Tobii Pro Nano eye-tracker. Males fixated on the intergluteal cleft for 0.96 ± 1.1s and the thigh gap for 0.07 ± 0.2s; while, females fixated for 0.81 ± 0.9s and 0.06 ± 0.2s on the same regions, respectively. Significant gender differences were observed in the intergluteal cleft (p = 0.002) and upper lateral buttock (p < 0.001). This study offers new insights into the observation of buttocks. The consistent attention toward the intergluteal cleft across demographics could be of potential significance in the aesthetic perception of buttocks. However, diverse gaze patterns also underscore the multifaceted nature of human attraction. These findings hold implications for plastic surgery, aesthetic medicine, and the sociocultural understanding of beauty. A deeper dive into aesthetic preferences is pivotal for a holistic understanding of human perceptions of attractive buttocks. 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 Table of Contents or the online instructions to Authors www.springer.com/00266 .

Unusual Presentation of Congenital Dermal Sinus on Lateral Buttock

Unusual Presentation of Congenital Dermal Sinus on Lateral Buttock

Update on Oblique Flankplasty: Easily Executed, Long-Lasting, Integral Component of Total Body Lift Surgery.

Twenty years ago, coordinated aesthetic surgery for laxity and lipodystrophy after massive weight loss (MWL), so-called total body lift surgery (TBL), encompassed circumferential hip hugging transverse lower body lift (LBL) with possible buttock auto-augmentation, and a transverse bra line upper body lift (UBL) with breast reshaping. Brachioplasty and vertical thighplasty were often included. Disappointing aesthetics of the posterior torso led to innovation with J-torsoplasty and oblique flankplasty. The goal of this study was to demonstrate in a large clinical series and in a range of case presentations from 2 plastic surgeons that oblique flankplasty with lipoabdominoplasty (OFLA) optimally narrows the waist, suspends lateral buttocks and thighs, and integrates with J-torsoplasty and vertical thighplasty to tighten skin and aesthetically contour the torso and thighs with an acceptable rate of complications. Retrospective chart review of 151 consecutive flankplasties between June 2010 and April 2023, including sex, age, BMI, associated operations, complications, and revisions was performed. Five case presentations were accompanied by limited photographs and a marking video. Across a broad clinical spectrum, malleable oblique flankplasty resected bulging flanks and, facilitated by neighboring liposuction and/or J-torsoplasty, consistently pulled in lax skin and anchored through cadaver-proven dense dermal adherences lax tissues to create a long-lasting skintight shapely torso and upper thighs, with only 3.3% problematic wounds. Five diverse cases showed broad applicability. OFLA, often with J-torsoplasty and neighboring liposuction, aesthetically recontours torso skin laxity in a variety of presentations with a low rate of complications in a high-risk population.

Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis?

Trochanteric bursitis is a common complication following total hip replacement (THR), and it is associated with high level of disability and poor quality of life. Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis. To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis. This retrospective cohort study was conducted in the secondary care setting at a large district general hospital. Between January 2010 and December 2020, 954 patients underwent elective primary THR by two contemporary arthroplasty surgeons, one excising the bursa and the other not (at the time of THR). All patients received the same post-operative rehabilitation and were followed up for 1 year. We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis. Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups. 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not. A total of 5 patients (incidence 0.5%) developed trochanteric bursitis following THR; 4 of whom had undergone bursectomy as part of their surgical approach, 1 who had not. There was no statistically significant difference between the two groups (Z value 1.00, 95%CI: -0.4% to 1.3%, P = 0.32). There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR; all of whom were treated with THR and synchronous trochanteric bursectomy, and 7 had resolution of their lateral buttock pains but 1 did not. Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis. However, it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.

Gluteal Fold: Cadaveric Dissection of the Superficial Fascial System in the Buttock and Anatomy-Based Gluteal Liposculpture.

The anatomy and formation mechanism of the gluteal fold (GF) remain unclear. Given that understanding the anatomy of the superficial fascial system (SFS) may facilitate the improvement of liposuction techniques, this study aimed to clarify and define the anatomical components of the GF. A total of 20 fresh female buttocks and thighs were dissected sagittally to observe the changes of the SFS along the GF and were dissected horizontally to observe the SFS on the upper, middle, and lower levels of the buttock. Through these dissections, 2 patterns of the SFS in the GF region were identified. The retinaculum cutis (RC)-dominant SFS, named the fascial condensation zone, features an extremely dense and tough RC, originating from the bony structures (eg, the ischium) and radially anchored by the dermis. The fat-dominant SFS features a classic double-layered SFS structure. The RC-dominant SFS is mainly distributed at the medial GF, thus forming the depressed fold. It gradually disappears along the GF and the SFS becomes fat-dominant, making the fold increasingly less visible. At the lateral buttock, the SFS of the buttock and thigh reach an identical status in terms of morphologic features, showing a smooth curve between the buttock and the thigh instead of a fold. Thus, based on these findings, different liposuction methods were formulated to manage GF contouring. The SFS of the GF region shows a regional variation pattern. Topographic anatomy of the SFS in the GF region helps us understand GF contour deformities and provide an anatomical basis for surgical correction.

Gross anatomical study of the subcutaneous structures that create the three-dimensional shape of the buttocks.

The purpose of this study was to clarify the subcutaneous structures involved in the morphology of the gluteal region for clinical application. Thirty-seven formalin-fixed cadavers and one soft-fixed cadaver were used in this study. Gluteal tissue was removed from five formalin-fixed cadavers. A horizontal section and sections parallel to the long axis of the body were made from the excised tissue, and the subcutaneous fat was removed to observe the fibrous structure within the subcutaneous fat. Two formalin-fixed cadavers and one soft-fixed cadaver were used to perform conventional gross anatomical dissection and histological examination. On 30 formalin-fixed cadavers, the thickness of the subcutaneous fat was measured in various areas of the buttocks. The thickness of subcutaneous fat was thicker in the center of the buttocks and thinner on the lateral buttocks. Superficial fascia (SF) was found only in the upper buttock, being indistinct in the lower buttock. In the sacral and coccygeal areas, the dermis was tightly adhered to the bone as a single mass. Fibers arose from around the iliac crest to the SF. On the medial side of the gluteal fold, a strong fiber arose from the sciatic tubercle and inserted into the gluteus maximus and dermis. By identifying the characteristic subcutaneous structures of the gluteal region, we were able to identify the anatomical structures that shape the three-dimensional morphology of the buttocks. These findings may be useful in surgical treatments such as improving the buttock shape.

Congenital fistula between the lateral buttock and postanal dermal sinus tracts with a low-type anorectal malformation

A congenital fistula between the lateral buttock and postanal dermal sinus tracts with a low-type anorectal malformation has not been previously reported. The aim of this study was to clarify the clinical characteristics and optimal surgical management of this condition. Three female patients were noted to have a pit in the left upper lateral buttock and a postanal orifice. Fistulography and magnetic resonance imaging showed no connection between the pit and orifice in the first case and a connection in the second and third cases. In the first case, surgical exploration showed firm tracts from both the lateral buttock and postanus running deep to the tip of the coccyx, with a thin cord between them. The tracts were excised, but the cord was left. In the second and third cases, the fistula was excised. The center of the sphincter muscle was placed at the postanal orifice in all three cases; thus, anal transplantation was performed. Histopathological examination showed stratified squamous epithelium of the skin in the wall of the fistula. The first case developed a pelvic abscess 22 months after surgery. Therefore, complete excision is crucial to minimize the risk of postoperative pelvic abscess.

Congenital dermal sinus in the lateral buttock

We report a case of a one-year-old boy with a congenital dermal sinus situated at the lateral buttock. The exact pathway of the sinus was shown by magnetic resonance imaging, contrast medium examination and computed tomographic examination. The sinus was not connected to the spinal canal and the sinus ended near the anterior surface of the sacral bone in a blind manner. Complete surgical resection of the sinus was achieved after these imaging examinations.

Mullerian remnant cutaneous cysts

Mullerian remnant cysts, also referred to as cutaneous ciliated cysts, are rare skin lesions most commonly found in young females on their lower extremities but can also be found in other locations. The pathogenesis of these lesions is important for understanding their significance and there is a paucity of literature on the clinical course and management of these rare and typically benign masses in young patients. We report a case of a 2 cm Mullerian remnant cyst on the lateral buttock in an 11-year-old female with a prior ovarian cystectomy. The current literature regarding the complex origin and clinical management of these unusual cutaneous lesions is reviewed.

Relief of Sitting Pain by Resecting Posterior Femoral Cutaneous Nerve, and Elucidation of Its Anatomical Branching Pattern.

Injury to the posterior femoral cutaneous nerve (PFCN) produces sitting pain in the buttock, posterior thigh, and/or the ischial tuberosity. The anatomy of the PFCN has not been well described, and just one small cohort of patients has been reported to have resection of the PFCN. Retrospective review of all patients undergoing resection of the PFCN for sitting pain by the senior author between 2012 and 2019 was performed. Evaluation was done by chart review, intraoperative description of the anatomy of the PFCN, and the outcome of resection of the PFCN with implantation of the proximal nerve into the gluteus muscle. Outcome was determined by direct patient examination, email reports, and telephonic interview. Fifty-two patients were included in this study, of which nine were bilateral operative procedures. Thirty-four patients had sufficient follow-up data at a mean of 23 months (3-85 months, range). MRI evidence of hamstring injury was present in 50% of the patients. The classic PFCN anatomy was present in 44% of limbs with the other 56% having a high division permitting branches to the lateral buttock and posterior thigh to be preserved. In patients with bilateral anatomy observations, symmetry was present in 67%. An excellent result (absence of sitting pain, normal activities of daily living [ADL]) was obtained in 53%, a good result (some residual sitting pain with some reduction in ADL), was obtained in 26% and no improvement was observed in 21% of patients. Sitting pain due to injury to the PFCN can be relieved by the resection of the PFCN with implantation of the proximal end into muscle. Presence of an anatomical variation, a high division of the PFCN, can permit preservation of sensation in the lateral buttock and posterior thigh in the patient whose symptoms involve just the perineum and ischial tuberosity.

Restoration of Inferior Gluteal Crease in Combined Lower Buttock and Posterior Thigh Lifting

Background: Gluteal contouring surgeries gained a growingpublic interest. No single procedure can correct differentdeformities. The patient’s existing anatomy determines thebest way to recontour the buttocks.Patients and Methods: The study included nine femalepatients with gluteal contour deformity in the form of: Longbuttocks, double inferior gluteal crease, excess tissue of thelower lateral buttock area and banana roll deformity of theupper posterior thigh. They underwent lower buttock andupper thigh lifting with restoration of the inferior glutealcrease. Two of them were post-bariatric patients and neededadditional transverse medial thigh lifting at the same operation.Liposuction of the related anatomical areas was done in allpatients. Lipofilling of deficient areas of the buttocks foraugmentation or adjusting contour asymmetry was done in 5patients including the 2 post-bariatric ones.Results: Medical photographs were collected preoperativelyand 3 months post-operatively. The averagepatients’ follow-up period was 3.1 months. All patients weresatisfied with the results. Only one patient had mild buttockcontour asymmetry. No other complications were recorded.Conclusion: The lower buttock and upper posterior thighlifting can be safely combined with preservation of the inferiorgluteal crease. It’s a useful procedure for correction of therecorded gluteal contour deformities with high patient’ssatisfaction rate

Abstract: The Neighboring Flap Theory: A New Idea for Defect Closure Achieving Both Reducing the Defect and Confirmed Primary Donor Closure

INTRODUCTION: Covering a large defect with minimal donor site morbidity is a challenging task in reconstructive surgery. Recent advances in perforator flaps provides further alternatives. The research for angiosome or perforasome distinguishes the maximum size of each flap.1 The maximum size with direct donor site closure is determined by its position and has individual variation. The size of flap is, of course, measured from the size of the defect. The flap size tends to be slightly larger than the defect to avoid tension on the flap after suture. MATERIALS AND METHODS: Our new idea, flap elevation from adjacent area, enables making the defect smaller and simple in calculating the largest size of flaps. Preoperatively the perforators for flap around the defect should be detected. The pedicle of the flap should be inside the defect. The ligation test is done on the edge of the defect in the direction of the pedicle, and the maximum distance of these ligation points is the flap breadth. The length is decided as needed. RESULTS: From April 2012 to February 2016, 8 malignant tumor excision cases were treated with this method. Among them, 3 cases were anterolateral thigh flaps (ALT) or tensor fasciae latae musculocutaneous flap for inguinal to lateral buttocks. 3 cases were anterior chest wall reconstructions by vertical rectus abdominis musculocutaneous (VRAM) flaps or thoracoacromial perforator flap. 2 cases were latissimus dorsi musculocutaneous flaps (LD) for back. In one of VRAM cases, the 35x15cm size skin paddle was divided into 2 pieces to cover 25x21cm defect. None of the flaps failed. All the donor sites were closed directly. CONCLUSION: There are many studies about reduction in the donor site morbidity.2,3 Especially for large flaps, reducing the width by dividing the skin paddle or combined flap enables direct closure of the donor sites.4,5 To reduce the defect, partial direct closure is useful, but results in big dog ear. Our method enables two advantages by taking the flap from the neighboring area intentionally, because the dog ear is used as flap. If the breadth is less than the defect size, dividing the flap into some pieces is useful especially for LD, VRAM, and ALT. REFERENCES: 1. Taylor GI, Pan WR. Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg. 1998;102(3):599–616. 2. Arnez ZM, Khan U, Pogorelec D, Planinsek F. Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity. Br J Plast Surg. 1999;52(5):351–4. 3. Hekner DD, Abbink JH, Van es RJ, Rosenberg A, Koole R, Van cann EM. Donor-site morbidity of the radial forearm free flap versus the ulnar forearm free flap. Plast Reconstr Surg. 2013;132(2):387–93. 4. Sawaizumi M, Maruyama Y, Kawaguchi N. Vertical double flap design for repair of wide defects of the lower limb, using combined ascending scapular and latissimus dorsi flaps. J Reconstr Microsurg. 1995;11(6):407–14. 5. Sawaizumi M, Maruyama Y. Sliding shape-designed latissimus dorsi flap. Ann Plast Surg. 1997;38(1):41–5.

Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers

Few options, apart from the buttock area, are available for autologous breast reconstruction in thin teenagers. The aim of the present study was to objectively evaluate and compare donor-site morbidity of the inferior gluteal artery perforator (IGAP) flap with that of the previously described inferior gluteal musculocutaneous flap. A retrospective review of all IGAP flaps for breast reconstruction performed in teenagers between June 2006 and April 2011 at the Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, was performed. Patients were invited to undergo a specific physical evaluation and complete a questionnaire on aesthetic and functional outcomes. Thirteen records and 11 photographic charts were reviewed. Lateral buttock flattening was noticeable in nine of 11 cases. Three patients experienced some degree of inferior displacement of the gluteal crease. All six patients available for the appointment presented with a zone of dysesthesia or hypoesthesia in the territory of the operated buttock and/or posterior thigh. No motor impairment was found. The questionnaire, completed by eight patients, revealed that six were satisfied or very satisfied with the surgery. Appearance of the operated buttock was rated 3.4 on a scale from 1 to 5 (5 = normal) compared with the normal side. The IGAP flap remains a suitable option for breast reconstruction in slim teenagers. Similar to the myocutaneous flap, the major donor-site morbidity of the IGAP flap remains sensory impairment involving the posterior femoral cutaneous nerve. There is, however, less visible lateral depression when it is harvested as a perforator flap.

Ultrasound Guided Piriformis Injection with Confirmation of Needle Placement Through Electromyography

Dear Editor: Piriformis syndrome is a controversial topic that consists of a constellation of symptoms that may mimic spondylosis, radiculopathy, sacroiliac joint pain, and facet arthropathy [1]. One of the modalities of piriformis syndrome treatment is direct injection of medication into the piriformis muscle belly [2]. Previous authors have reported various methods in performing piriformis injections: fluoroscopically, motor stimulation, and most recently, ultrasound (US) guidance [3–5]. We describe a case presentation and, to our knowledge, the first report of combined use of US with electromyography (EMG) confirmation of muscle placement for piriformis muscle injection. A 60-year-old male presented to our clinic with lower back, left hip, and left buttock pain for 6 years. The pain was sharp in quality and radiated toward the left lateral buttock and hip. The pain was rated 6/10 at initial presentation and was aggravated by prolonged sitting, squatting, and bending over. Pain was improved with rest. On examination, the patient demonstrated mild tenderness along the left lumbar spine and paraspinal muscles, as well as tenderness to palpation in the left lateral buttock area. Straight leg raise test was positive in the left lower extremity. Motor examination revealed full …

Ultrasound guided piriformis injection with confirmation of needle placement through electromyography: a case report and description of a new technique

A 60 year old male presented to our clinic with lower back, left hip and left buttocks pain for 6 years. The pain was sharp in quality, and radiated toward the left lateral buttock and hip. The pain was rated 6/10, and aggravated by prolonged sitting, squatting, and bending over. On examination, the patient demonstrated tenderness along left lumbar paraspinals and lateral buttocks area. Straight leg raise and FAIR test was positive in LLE. Prior electromyography exam demonstrated a left L5 motor radiculopathy. L-spine MRI revealed multilevel degenerative disc disease. Having previously failed conservative treatment, including PT and gabapentin, a caudal epidural was performed. The patient reported no improvement in his symptoms after the injection. Upon further assessment, diagnosis of piriformis syndrome was considered. A diagnostic injection of lidocaine was performed under ultrasound and EMG guidance into the piriformis muscle. After the injection, the patient had relief of pain. One of the main treatments of piriformis syndrome is injection of local anesthetic or steroids into the piriformis muscle belly. Due to difficulty with needle placement, previous authors have reported various methods in performing piriformis injections: fluoroscopically, motor stimulation, and most recently, ultrasound guidance. With ultrasound alone, even with visualization of needle placement, it is difficult to ensure needle insertion into the piriformis muscle, as opposed to surrounding muscles, specifically the gluteus medius and gluteus maximus. To our knowledge, this is the first report of combined use of ultrasound with EMG confirmation of needle placement for a piriformis injection. Our technique offers the advantage of decreased radiation exposure when compared to fluoroscopy and verification of needle placement into the piriformis when compared to injections without EMG. In addition, our case presentation emphasizes the ability for piriformis syndrome to mimic other diagnosis. A 60 year old male presented to our clinic with lower back, left hip and left buttocks pain for 6 years. The pain was sharp in quality, and radiated toward the left lateral buttock and hip. The pain was rated 6/10, and aggravated by prolonged sitting, squatting, and bending over. On examination, the patient demonstrated tenderness along left lumbar paraspinals and lateral buttocks area. Straight leg raise and FAIR test was positive in LLE. Prior electromyography exam demonstrated a left L5 motor radiculopathy. L-spine MRI revealed multilevel degenerative disc disease. Having previously failed conservative treatment, including PT and gabapentin, a caudal epidural was performed. The patient reported no improvement in his symptoms after the injection. Upon further assessment, diagnosis of piriformis syndrome was considered. A diagnostic injection of lidocaine was performed under ultrasound and EMG guidance into the piriformis muscle. After the injection, the patient had relief of pain. One of the main treatments of piriformis syndrome is injection of local anesthetic or steroids into the piriformis muscle belly. Due to difficulty with needle placement, previous authors have reported various methods in performing piriformis injections: fluoroscopically, motor stimulation, and most recently, ultrasound guidance. With ultrasound alone, even with visualization of needle placement, it is difficult to ensure needle insertion into the piriformis muscle, as opposed to surrounding muscles, specifically the gluteus medius and gluteus maximus. To our knowledge, this is the first report of combined use of ultrasound with EMG confirmation of needle placement for a piriformis injection. Our technique offers the advantage of decreased radiation exposure when compared to fluoroscopy and verification of needle placement into the piriformis when compared to injections without EMG. In addition, our case presentation emphasizes the ability for piriformis syndrome to mimic other diagnosis.

Selective intraarterial injection of ICG for fluorescence angiography as a guide to extirpate perimedullary arteriovenous fistulas

Fluorescence angiography with indocyanine green (ICG) provides real-time information regarding the patency of vessels. To enhance the capability to delineate flow direction, flow velocity and sequence of dye filling in different components of complex spinal vascular lesions such as perimedullary arteriovenous fistulas (AVFs), we tried selective intraarterial injection of ICG with catheterization in the proximity of the AVFs. Prior to taking the position for surgery, a metallic introducer sheath was placed into the femoral artery, and placed over the patient's lateral buttock. After the exposure of the AVFs, a standard angiographic catheter was advanced into the proximal portion of the feeding artery and a small volume of diluted ICG (0.06mg in 5ml saline for one examination) injected repeatedly. To avoid the thromboembolism, heparinized saline was perfused continuously thorough the catheter and sheath. The small injection volume and the close proximity of the injection site to the lesions resulted in quick rise and fall of the fluorescence without any background. Time and spatial resolution of analysis were enhanced; flow dynamics such as direction, velocity and alteration after temporary occlusion were well visualized. The feeders and drainers were clearly distinguished, and the shunts could be precisely identified. Selective intraarterial injection ICG fluorescence angiography was very useful for perimedullary AVFs. Albeit that it requires intraoperative selective catheterization, this repeatable technique has an advantage to improve temporary resolution and provides accurate information of the flow dynamics through the complex anatomy of vascular lesions.

Lateral Buttock Congenital Dermal Sinus Tract -Case Report-

A 6-month-old female presented with purulent discharge from a dimple in the right lateral buttock. A subcutaneous abscess was palpated on the right paravertebral region at the L5-S1 level. She had low-grade fever with laboratory findings of leukocytosis and elevation of C-reactive protein levels. Klebsiella and Enterococcus species were cultured from the pus. Computed tomography (CT) clearly showed a tract traversing the subcutaneous tissue and connecting to the abscess. Magnetic resonance (MR) imaging showed no abnormality in the spinal canal. The diagnosis was infected congenital dermal sinus (CDS) in the right buttock. After normalization of body temperature and laboratory findings in response to antibiotic treatment, the dermal sinus tract was surgically removed. Intraoperative findings showed that the tract gradually tapered and ended at the subcutaneous abscess space over the lumbosacral fascia. Histological examination confirmed the lesion was dermal sinus. Although laterally placed CDS in the buttocks is extremely rare with only 5 previous cases reported, lateral CDS should be included in the differential diagnosis of a dimple in the buttocks. CT as well as MR imaging should be performed to evaluate suspected lateral CDS.

Lateral buttock and postanal congenital dermal sinus tract

We present 2 rare cases of lateral buttock and postanal congenital dermal sinus tract. These 2 children were noted to have a pit in the left upper lateral buttock and a postanal orifice after birth. Magnetic resonance imaging, computed tomography, and ultrasonography showed an inflammatory mass lesion in the buttock and a funicular structure adjacent to the rectum. Fistulography showed no connection between the pit and orifice. Surgical exploration revealed firm tracts from both the lateral buttock and postanus running deep to the tip of the coccyx. Histopathologic findings showed squamous cells in the walls of the sinus tracts. Our report broadens the clinical literature regarding congenital dermal sinus tract. We postulate that this disease may not always have a connection with the central nervous system, and our cases may provide examples of anal fistulas of congenital etiology in infants.

Correction for the Iatrogenic Form of Banana Fold and Sensuous Triangle Deformity

The "banana fold," or the infragluteal fold, is a fat deposit on the posterior thigh near the gluteal crease and parallel to it. The "sensuous triangle" is found at the junction of the lateral buttocks, the lateral thigh, and the posterior thigh. The iatrogenic forms of banana fold and sensuous triangle deformity are produced by excessive liposuction. The authors' experience using autologous fat transplantation to treat tissue defects led them to use this technique for correcting iatrogenic forms of banana fold and sensuous triangle deformity. The simplicity of the procedure, the low incidence of complications, and the high satisfaction rate makes autologous fat transplantation an attractive option for correcting iatrogenic complications of liposuction.

Congenital dermal sinus tract in the lateral buttock: unusual presentation of a typically midline lesion

Congenital dermal sinus tracts most commonly involve the midline and may communicate with the central nervous system. We present a 3-year-old girl with a pit in the upper lateral buttock noted since birth. Surgical exploration revealed a firm tract that dissipated in the gluteal fascia, and ultrasound confirmed the absence of any deeper extension. Microscopic examination revealed a sinus tract lined by dermal appendages and surrounded by an exuberant inflammatory reaction to hair. This location is distinctly unusual, and our report expands the clinical spectrum of congenital dermal sinus tracts and raises awareness that lesions prone to having a connection with the central nervous system may present quite laterally. Furthermore, this case provides insight into the pathogenesis of a disease that is often explained as a “defect of midline closure” and also illustrates an unusual setting for so-called “pilonidal disease.”