Redundant Tissues Research Articles

Clinical impact of valvular strands or Lambl's excrescences in the real-world practice

Abstract Background Due to recent advancements in high-resolution echo systems, valvular strands or Lambl’s excrescences are frequently observed in daily clinical practice. However, it can be challenging to differentiate these valvular structures as fibroelastomas or infective endocarditis. Although those redundant cardiac tissues are reported to cause embolic events, the incidence or outcomes of valvular strands and Lambl’s excrescences have not been well investigated. Purpose To investigate the clinical impact of valvular strands or Lambl’s excrescences (VS/LEs) on clinical outcomes. Methods We searched our hospital’s institutional echocardiography database for transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) reports with VS/LEs between 2018 and 2022. Patients diagnosed with infectious endocarditis or overt papillary fibroelastoma were excluded. Clinical outcomes of all-cause death, ischemic stroke, systemic embolism, or surgical resection were evaluated from the electronic medical chart. We analyzed the cumulative incidences of each clinical outcome for the entire cohort, and we compared cases assessed by TEE (With TEE) and cases confirmed by TTE only (TTE only). Results From the 53799 TTE and 3186 TEE tests, we found 340 reports from 174 cases with VS/LEs (With TEE, 67 cases, and TTE only, 107 cases). Only one stroke case was suspected of aortic valve strand origin for stroke at the index TEE or TTE. Surgical resection was performed in two cases (one each in With TEE and TTE only groups) within 30 days from the first detection of the VS/LEs. The median follow-up period was 355 days. We observed all-cause death in 8 cases (6.1%: With TEE, 1 case [1.6%] and TTE only, 7 cases [8.6%], P=0.09). Ischemic stroke occurred in 6 cases (5.0%: With TEE, 3 cases [6.5%], TTE only, 3 cases [4.1%], P=0.27). None of the deaths were associated with embolic events. We performed landmark analysis at 30 days for surgical resection, and five cases underwent surgical treatment at one year (With TEE, 5 cases, and TTE only, no case). All surgical resections for the VS/LEs were performed concurrently with other cardiac operations. Conclusions In this study, we observed that most VS/LEs were managed non-invasively and rarely associated with embolic events, especially TTE-only detected VS/LEs.

Machine learning method for the cellular phenotyping of nasal polyps from multicentre tissue scans

ABSTRACT Background This study aimed to establish a convenient and accurate chronic rhinosinusitis evaluation platform CRSAI 1.0 according to four phenotypes of nasal polyps. Research design and methods Tissue sections of a training (n = 54) and test cohort (n = 13) were sourced from the Tongren Hospital, and those for a validation cohort (n = 55) from external hospitals. Redundant tissues were automatically removed by the semantic segmentation algorithm of Unet++ with Efficientnet-B4 as backbone. After independent analysis by two pathologists, four types of inflammatory cells were detected and used to train the CRSAI 1.0. Dataset from Tongren Hospital were used for training and testing, and validation tests used the multicentre dataset. Results The mean average precision (mAP) in the training and test cohorts for tissue eosinophil%, neutrophil%, lymphocyte%, and plasma cell% was 0.924, 0.743, 0.854, 0.911 and 0.94, 0.74, 0.839, and 0.881, respectively. The mAP in the validation dataset was consistent with that of the test cohort. The four phenotypes of nasal polyps varied significantly according to the occurrence of asthma or recurrence. Conclusions CRSAI 1.0 can accurately identify various types of inflammatory cells in CRSwNP from multicentre data, which could enable rapid diagnosis and personalized treatment.

The reverse lip design: a design for safe and effective abdominoplasty

Conventional abdominoplasty includes the removal of an ellipse-shaped section of abdominal tissue between the umbilicus and mons pubis. However, this method can result in tension of the undermined flap, especially in the midline. To address this problem, we present reverse lip design as a modified method that also has aesthetic advantages. The reverse lip design entails a longer lower flap edge while preserving the triangular tissue in the vascularly stable pubis area. These markings create an image of a reverse lip shape with a cleft at the bottom of the lower markings. After typical lipoabdominoplasty is performed, redundant waist tissues can easily be pulled inward and downward. The reverse lip design abdominoplasty demonstrated no complications and required no further revisions after the procedure. Patients were generally satisfied with the aesthetic improvements in their body shape. They were also able to return to their routine activities approximately 1 week after the operation while wearing a supporting undergarment. This modified abdominoplasty using the reverse lip design reduces low midline tension of the undermined abdominal flap while enhancing body aesthetics with a slimmer waistline, leading to higher patient satisfaction.

A comparative study of the clinical andhistopathological features of normal labial mucosa and redundant tissue in double lip

Introduction: double lip is one of lip abnormalities that may be congenital or acquired. It consists of a fold of excess tissue on the mucosal side of the lip. It causes functional and aesthetic problems to affected patientsAim of the work : The present study was performed to compare clinically and histopathologically between redundant tissue in double lip and normal labial mucosa.Subjects and methods: Seventeen patients with congenital non syndromic double lip were selected. Redundant tissues were removed surgically together with part of adjacent normal mucosa as part of the surgical manipulation. Hematoxylin and eosin staining was done to compare both tissues microscopically. Expression of ki-67 and p53 was evaluated in both tissue by immunohistochemistryResults: Clinically, redundant tissue appeared as thick extra fold with normal mucosal color and soft consistency analogous to normal labial mucosa. This redundant tissue was removed surgically without any complications. Histopathologically, normal labial mucosa revealed non keratinized stratified squamous epithelium and delicate underlying connective tissue. Excess tissue exhibited parakeratosis, acanthosis, elongation of rete pegs. The underlying connective tissue was fibrotic with inflammatory cell infiltration. In normal labial mucosa, ki-67 was detected only in parabasal layer of epithelium whereas it was localized in parabasal and superficial layers of epithelium in redundant tissue. No expression of p53 was detected in both normal and excess tissue. For both ki-67 and p53, the difference in expression between normal and redundant tissue was significant.Conclusion : Redundant tissue is a benign hyperplastic tissue that require surgical removal. So surgical excision here is the treatment of choice when excess tissue causes functional and aesthetic problems. Moreover, the high proliferation of redundant tissue may necessitate the surgical excision of this tissue.

Effectiveness of remold eyelid structure method of blepharoplasty for thickening eyelid

Objective To explore the method and efficacy of using Y flap formed to remold double eyelid structure of blepharoplasty for thickening eyelid. Methods A total of 97 cases of single eyelids and thickening eyelid were treated with surgery, to release the space before tarsus fascia and levator palpebrae aponeurosis to form a continuous interspace of the orbicularis oculi muscle. Then joint fascia was reconstructed to format Y flap, on which both sides of the levator aponeurosis and orbital septum fascia were tightened and the redundant fat and fascial organization removed. The lateral fat pad under the orbicular muscle were wedge-shaped sheared along the orbital margin after double eyelid was formed. Few patients presented acrimal glands prolapse, which suspended to return the lower margin of the orbital bone. Finally according to the upper eyelid anatomy suture each layer of incision was closed. Results The 97 cases underwent surgical treatment and the incisions were healed by first intention, in which 3 cases had slight skin ptosis at the lateral double crease due to the conservative tissue removal and 2 cases had the double eyelid width asymmetry due to the tissue was removed unevenly. They were adjusted satisfiedly 3 months later. All cases were followed up for more than 3 months and acquired satisfactory improvement and beautification. Incision was healed hiddenly. Conclusions This method can be used to tease and adjust the upper eyelid levels clearly and completely, which makes redundant tissues removed in place and double eyelid located accurately. By this method single eyelid combined thickening eyelid could be solved aestheticly at the same time and get a natural, popular and natural shape. Key words: Blepharoplasty; Slitting up method; Remodled eyelid structure; Thickening eyelid; Blepharoplasty

Technical update of barbed pharyngoplasty for retropalatal obstruction in obstructive sleep apnoea

Barbed pharyngoplasty aims to reduce lateral retropalatal obstruction by pulling up the soft palate anterolaterally. However, barbed pharyngoplasty can be less efficient in some cases of obstructive sleep apnoea, especially in the presence of an elongated uvula with redundant tissues over it. This paper describes an attempt to overcome this drawback by modifying barbed pharyngoplasty, using a single continuous suture technique. Thirty-four patients were assigned to two groups based on the surgical procedure performed. Those with an elongated uvula were treated with modified barbed pharyngoplasty (n = 17); the others were treated with barbed pharyngoplasty (n = 17). Pre- and post-operative quality of life questionnaires, and questionnaires concerning diet, pain and return to activity, were completed. Pre- and post-operative polysomnography was performed as an objective measurement. There was no significant difference between barbed pharyngoplasty and modified barbed pharyngoplasty in terms of outcomes. However, reductions in the apnoea/hypopnea index, Epworth Sleepiness Scale and snoring visual analogue scale scores were greater in the modified barbed pharyngoplasty group. Modified barbed pharyngoplasty is a safe and feasible method, and eliminates the need for surgical resection of the redundant soft tissues around the uvula while lifting up the uvula base.

Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans

BackgroundSeveral methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.MethodsThree-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient’s Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack–Lehane grade.ResultsThe area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697–0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.ConclusionsOne factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.Trial registrationClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.

Isolation and Culture of Periimplantation and Early Postimplantation Mouse Embryos.

Key developmental processes of cell fate decisions and morphogenetic transformations take place during the periimplantation and early postimplantation stages of mouse embryogenesis. Howeveranalysing these fundamental events relies on direct observations of cultured embryos, which are challenging to obtain. To address this challenge,here we provide a detailed protocol describing a workflow for isolating early implanted embryos, removing of redundant extraembryonic tissues anddescribing the culture conditions that support further embryo development in vitro.

Double Lip: A Review of Literature and a Case Report

Ascher’s syndrome is a rare congenital anomaly causes recurrent edema of the upper eyelid resulting in blepharochalasis in one hand and similar edema of the lip resulting in a double lip on the other hand. Double lip is characterized by two soft, flabby masses of tissue on either side of the midline of the lip. This anomaly primarily causes an aesthetic problem, and it becomes more apparent during speak and smile. Thus, unaesthetic appearance remains the main patients’ complain for surgical correction. A 33-years-old male patient complained gradual enlargement of his upper lip resulting in unpleasant appearance causing him embarrassment during smile and speech. The patient was systemically healthy no history of systemic diseases, no family history for the reported condition. Clinical examination revealed bilateral blepharochalasis clinically presented as atrophy of redundant upper eyelid skin with an obvious double upper lip at rest with the inflated appearance on smiling. Based on patient’s demand for enhancing appearance and smile, surgical treatment of the double lip by transverse elliptical incisions from both commissures to the midline was performed in order to reduce the excessive bulk of redundant tissues. Ten days later, sutures removed, healing was more than satisfactory, and treatment resulted in improved esthetic with high patient satisfaction.

Three-Dimensional Analysis of Midfacial Soft Tissue Changes After Maxillary Posterior Impaction and Intraoral Vertical Ramus Osteotomy for Mandibular Setback in Class III Patients.

This study investigated the correlation between the 3-dimensional changes in midfacial soft tissues, including the parasagittal area and maxilla-mandible complex, after Le Fort I maxillary posterior impaction and bilateral intraoral vertical ramus osteotomy (B-IVRO), using cone-beam computed tomography (CBCT). This retrospective study included 22 skeletal Class III patients (6 men and 16 women; mean age 21.6 years) who underwent orthognathic surgery. Three-dimensional CBCT images taken before and 1 year after surgery were superimposed based on the cranial base. Midfacial soft tissues, including those in the parasagittal area (paranasal area, anterior cheek area, lateral cheek area) and midsagittal areas of the face, were evaluated using reconstructed CBCT images. Correlations and the ratios between soft tissue and hard tissue movement were calculated. After surgery, both paranasal areas showed significant forward movement (about 2.0 mm) and the largest upward movement (about 0.15 mm) among the 3 areas. The paranasal areas moved forward with a ratio of 0.5, according to vertical movement of B. Orthognathic surgery using Le Fort I maxillary posterior impaction with B-IVRO mandibular setback results in forward movement of midfacial soft tissues, even though sagittal movement of the maxilla is limited because facial muscles and retaining ligaments pull the redundant soft tissues, which are caused by vertical movement of the maxilla-mandible. This midfacial soft tissue change with maxillary posterior impaction could be advantageous to patients who have paranasal depression and protrusion of the upper lip owing to proclined upper incisors, which are prevalent among Asian Class III patients.

Abstract 77: A Phase I Open-Label Study Evaluating the Safety of Acellular Adipose Tissue (AAT), a Novel Soft Tissue Reconstruction Solution, in Healthy Volunteers

PURPOSE: Adipose tissue is used by surgeons for a variety of applications, including soft tissue reconstruction and wound healing. However, harvesting adipose tissue from patients presents challenges such as donor-site morbidity, outcome variability, and difficulty in obtaining adequate volumes to correct large defects. To address this clinical challenge, we aimed to create an “off-the-shelf” adipose material using mechanical and chemical processing techniques which remove lipids and living cells while processing the tissue into an injectable form preferred by patients and physicians. Preclinical testing of this Acellular Adipose Tissue (AAT) conducted in mouse, rat, and swine models demonstrated the biocompatibility of the AAT implants and their ability to provide soft tissue volume replacement while promoting the migration of adipose stem cells (ASCs) into the tissue matrix. The aim of our present study is to assess the safety of AAT in healthy human volunteers. METHODS: A 12-week, prospective, Phase I study in healthy volunteers assessing the safety and tolerability of AAT intended for the repair of soft tissue defects in humans was initiated. The trial evaluated subcutaneous injections of AAT administered in redundant tissues previously scheduled for surgical removal in an elective surgical procedure (i.e., panniculectomy). Participants enrolled in excision time points ranging from 1 to 12 weeks post-injection. Excised implants were assessed using histopathological analyses including hematoxylin and eosin staining (H&E) and by flow cytometry (FACS). The primary outcome of safety was determined by the incidence and rate of adverse and unanticipated events. The secondary outcome of tolerability was determined by patient- and physician-reported satisfaction with the intervention. Histological analysis evaluated cell migration into the matrix and tissue development, two key components of long-term efficacy. RESULTS: Eight healthy volunteers participated in this Phase I study assessing the safety of AAT. No patients experienced an adverse or unanticipated event related to their participation in this study. AAT implants were well-tolerated and demonstrated satisfactory participant comfort and physician ease-of-use ratings. Additionally, we evaluated immune profiles of AAT using flow cytometry to quantify the presence of T cells, B cells, dendritic cells, macrophages, M1-polarized (inflammatory) macrophages, and M2-polarized (wound-healing) macrophages. Our preliminary results indicate that AAT is associated with pro-regenerative immune responses, including M2 macrophage polarization and increased IL-4 expression. CONCLUSION: AAT is a new soft tissue reconstruction material showing promising results in this Phase I study for safe use in humans. Further studies, including a Phase II trial, are necessary to determine efficacy in humans.

The Impact of Abdominal Contouring with Monsplasty on Sexual Function and Urogenital Distress in Women Following Massive Weight Loss.

Monsplasty treats massive weight loss (MWL) patients with redundant tissues in the mons region. Monsplasty, however, is not a routine component of abdominal contouring. The goal of this study was to evaluate the changes in urinary and sexual functioning in patients who undergo abdominal contouring with monsplasty vs non-operated controls. A prospective study was performed of patients who underwent abdominal contouring + monsplasty or no surgery. The Urogenital Distress Inventory Short Form (UDI-6) and the Female Sexual Function Index (FSFI) questionnaires were administered to both groups at baseline and then three months later. The surgical (n = 20) and nonsurgical groups (n = 20) were similar related to patient demographics, body mass index after MWL, parity, relationship status, hormonal status, and baseline UDI-6/FSFI scores (all P values >0.05). After three months, there was a statistically significant decrease in the UDI-6 score for the surgical groups vs the nonsurgical group: median UDI-6 score = -0.01 (interquartile range [IQR], -7.65-5.55) vs 0 (IQR, 0-11.11) (P = .03). There was no change for the Female Sexual Function Index in the surgical vs nonsurgical groups: median FSFI = 0.20 (IQR, -1.20-1.58) vs 0.95 (IQR, 0.08-2.58) (P = .11). Urinary dysfunction improved even at the early time point of three months following abdominal contouring procedures including monsplasty. At the early postoperative period of three months, however, there was no significant change in female sexual function. Monsplasty in conjunction with abdominal contouring is recommended in the MWL female patient. 2 Therapeutic.

The role of autonomic efferents and uncoupling protein 1 in the glucose-lowering effect of leptin therapy

ObjectiveLeptin reverses hyperglycemia in rodent models of type 1 diabetes (T1D). Direct application of leptin to the brain can lower blood glucose in diabetic rodents, and can activate autonomic efferents and non-shivering thermogenesis in brown adipose tissue (BAT). We investigated whether leptin reverses hyperglycemia through a mechanism that requires autonomic innervation, or uncoupling protein 1 (UCP1)-mediated thermogenesis. MethodsTo examine the role of parasympathetic and sympathetic efferents in the glucose-lowering action of leptin, mice with a subdiaphragmatic vagotomy or 6-hydroxydopamine induced chemical sympathectomy were injected with streptozotocin (STZ) to induce hyperglycemia, and subsequently leptin treated. To test whether the glucose-lowering action of leptin requires activation of UCP1-mediated thermogenesis in BAT, we administered leptin in STZ-diabetic Ucp1 knockout (Ucp1−/−) mice and wildtype controls. ResultsLeptin ameliorated STZ-induced hyperglycemia in both intact and vagotomised mice. Similarly, mice with a partial chemical sympathectomy did not have an attenuated response to leptin-mediated glucose lowering relative to sham controls, and showed intact leptin-induced Ucp1 expression in BAT. Although leptin activated BAT thermogenesis in STZ-diabetic mice, the anti-diabetic effect of leptin was not blunted in Ucp1−/− mice. ConclusionsThese results suggest that leptin lowers blood glucose in insulin-deficient diabetes through a manner that does not require parasympathetic or sympathetic innervation, and thus imply that leptin lowers blood glucose through an alternative CNS-mediated mechanism or redundant target tissues. Furthermore, we conclude that the glucose lowering action of leptin is independent of UCP1-dependent thermogenesis.

Outcomes of Breast Reconstruction After Mastectomy Using Deep Inferior Epigastric Perforator Flap After Massive Weight Loss.

Because of the correlation between breast cancer and obesity, plastic surgeons may encounter patients requiring reconstructive breast surgery after massive weight loss (MWL). Use of redundant abdominal skin for deep inferior epigastric artery perforator (DIEP) flap in these patients is a novel concept whose value has not been adequately studied. Assess the outcomes of the DIEP technique for breast reconstruction in the massive weight loss population. From 103 breast reconstruction patients having 150 DIEP flap procedures, 9 DIEP flaps were performed in MWL patients. Propensity score matching was used in a 1:2 ratio. Eighteen nonweight loss (NWL) patients were selected for comparison with 9 DIEP flaps performed in 6 MWL patients. Patients in 2 groups were matched for age and body mass index (BMI). Massive weight loss patients were compared with NWL patients on the basis of immediate versus delayed reconstruction and history of radiation; DIEP flap characteristics, including coupler size, additional venous anastomosis, need for re-exploration, and flap loss; length of hospital stay; abdominal wound healing complication; and hernia or bulging. There was no difference in the incidence of flap failures, bulging, or hernias requiring surgery in the MWL group. Additionally, there was no statistical difference in flap survival, abdominal complications, hospitalization days, operative time, or operative characteristics between the 2 groups. There was a significant positive correlation between immediate wound healing complications and comorbidities (P = 0.041). However, there was no correlation between wound healing complications and weight loss history. Only 6 MWL patients of a single surgeon were studied. For breast reconstruction after mastectomy, DIEP flaps can be used in MWL and NWL populations with equal flap success and abdominal donor site results. Therefore, cosmetic surgeons performing contouring procedures should consider sparing redundant abdominal tissues in patients requiring breast reconstruction.

Ian's modification of the classic V excision for reconstruction of the lower lip

T t i c l t t t triangular piece of skin and subcutaneous tissue are excised, and the underlying musculature spared (Fig. 2). efects of the lips and techniques for their reconstruction ave been extensively described. The causes differ, the most ommon being malignancy, trauma, vascular malformations, nd burns, followed by other conditions. Traumatic defects n particular have irregular margins and thickness, and so ngenuity is needed to restore all the functional and aesthetic lements. We have modified the classical V excision in such cases. ometimes it is necessary to sacrifice the skin of the proabium or mentum to allow vertical alignment of all lip argins without leaving any redundant tissues. 1 We describe modification in the classical V excision (described by ouis in 1768, quoted by 2) followed by primary closure, hich helps to maintain the bulk of the orbicularis oris uscle in the lip, and also balance the vermilion-cutaneous unction. Two patients with full thickness defects of one-third of the ower lip involving the vermilion, mucosa, muscle, and skin resented to our department after an assault. The wounds had rregular margins and loss of muscle, and extended into the kin inferiorly (Fig. 1).

Evaluation of the chondrogenic maturation of in vitro chondrogenically induced BMSCs and ADSCs after implantation in nude mice

Evaluation of the chondrogenic maturation of in vitro chondrogenically induced BMSCs and ADSCs after implantation in nude mice

Hypnic jerks: neurophysiological characterization of a new motor pattern

FES is an often forgotten and underdiagnosed entity characterized by flaccid and easily everted upper lids, occurring spontaneously or with minimal manipulation. It is usually seen in overweight, middleaged males who complain of a foreign body sensation, burning, tearing and redness. Some studies have found an interesting association with OSAS [1,2]. This relationship may have both diagnostic and therapeutic implications. Nevertheless, the majority of OSAS patients, obese or non-obese, do not have FES. Furthermore, FES may also be a presenting symptom in patients with undiagnosed OSAS [2]. Although the cause remains unknown, in all probability OSAS has no real causative relationship, other than a sequence of extreme apnea, right heart failure, and increased venous pressure that worsens a propensity for this phenomenon. Additionally, treatment of obesity and OSAS may have a favourable effect on the course of FES [3]. The clinician should be aware of this association so that both underlying OSAS or FES can be detected. The condition should be suspected in any obese patient with chronic watery and red eyes. Besides weight loss and continuous positive airway pressure therapy if OSAS is suspected, treatment consists of supportive measures such as ocular lubrication, eyelid taping, or an eyeshield at bedtime to keep the eyelids closed while sleeping, and surgery to address horizontal laxity and redundant eyelid tissues.

Assessment of Eyebrow Position Before and After Upper Eyelid Blepharoplasty

Objective: Assess the occurrence of secondary brow ptosis after upper lid blepharoplasty.Methods: Forty-five individuals (n = 90 brows) submitted to upper lid blepharoplasty, were assessed by means of a comparative analysis using pre- and post-operatively digital photographs, in the primary position of the eye. The images were processed using ImageJ “software”, transferred to a computer, to an electronic Microsoft Excel 2002® worksheet. Angular measurements were used, taking the lateral canthal angle of the brow, the most medial point of the brow, the medial canthal angle and the lateral canthal angle of the lid as anatomical reference points. When the outer angles were reduced or the inner angles increased after surgery this was considered a brow ptosis. Individuals who had undergone lid surgery associated with the eyebrow, previous eyebrow surgery and those with eyelid ptosis were excluded. The difference between the pre-operative and post-operative measurements were analyzed statistically using the Student’s t-test for paired samples and the angular variation was compared with their corresponding contralateral sample using Wilcoxon’s non-parametric test.Results: The measurements obtained after the blepharoplasty show significant variations from those before the surgery, indicating that the correction of redundant tissues in the brow accentuates the tendency of the eyebrow to move down. The alterations are more important in the lateral portion of the eyebrow and they occur bilaterally.Conclusion: The assessment of angular measurements obtained pre- and post-operatively showed that there are secondary changes in the position of the eyebrow as a result of upper eyelid blepharoplasty.

The Superior Thyroid Artery Perforator Flap

The redundant tissues of the anterior neck are well suited as a donor site for fasciocutaneous flaps in head and neck reconstruction, with similar skin quality and numerous underlying perforators. However, historic cadaveric research has limited the use of this as a donor site for the design of long and/or large flaps for fear of vascular compromise. The authors undertook an anatomical study to identify the vascular basis for such flaps and have modified previous designs to offer the versatile and reliable superior thyroid artery perforator (STAP) flap. Forty-five consecutive computed tomographic angiograms of the neck were reviewed, assessing the vascular supply of the anterior skin of the neck. Based on these findings, eight consecutive patients underwent head and neck reconstruction using a flap based on the dominant perforator of the region. In all cases, a perforator larger than 0.5 mm was identified within a 2-cm radius of the midpoint of the sternocleidomastoid muscle at its anterior border. This perforator was seen to emerge through the investing layer of deep cervical fascia as a fasciocutaneous perforator and to perforate the platysma on its ipsilateral side of the neck, proximal to the midline. This was seen to be a superior thyroid artery perforator in 89 of 90 sides and an inferior thyroid artery perforator in one case. Eight consecutive patients underwent preoperative imaging and successful flap planning and execution based on this dominant perforator. The superior thyroid artery perforator (STAP) flap demonstrates reliable vascular anatomy and is well suited to reconstruction of a broad range of head and neck defects. Therapeutic, IV.

Body contouring following massive weight loss

Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them.