The abdominal wall is perfused anteriorly by the superior and deep epigastric vessels with a smaller contribution from the superficial system. The lateral abdominal wall is perfused predominantly from perforators arising from the intercostal vessels. Reconstruction of soft tissue defects involving the abdomen presents a difficult challenge for reconstructive surgeons. Pedicle perforator propeller flaps can be used to reconstruct defects of the abdomen, and here we present a thorough review of the literature as well as a case illustrating the perforasome propeller flap concept. A patient underwent resection for dermatofibrosarcoma protuberans resulting in a large defect of the epigastric soft tissue. A propeller flap was designed based on a perforator arising from the superior deep epigastric vessels and was rotated 90° into the defect allowing primary closure of the donor site. The patient healed uneventfully and was without recurrent disease 37 months following reconstruction. Perforator propeller flaps can be used successfully in reconstruction of abdominal defects and should be incorporated into the armamentarium of reconstructive microsurgeons already facile with perforator dissections.

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Ultrasound-assisted lipoplasty for reduction of fatty breasts and fixation has been found to be a safe technique with promising aesthetic results when it is applied in selected patients and performed by a surgeon with expertise with ultrasound-assisted body contouring. From 1995 to 2000, 120 patients were treated with ultrasound energy to decrease the fatty component of the breast tissue and at the same time to lift the breast mound. Each patient was evaluated preoperatively with mammograms for correct assessment of the nature and consistency of the breast tissue. Only patients with fibrofatty and fatty breast parenchyma were selected for breast reduction and fixation with ultrasound-assisted lipoplasty. Patients with suspect mammograms (calcification) and a strong family history of breast cancer were not considered. All the prescreening and the postoperative long-term mammographic evaluations were conducted by a radiologist with high competence in breast tissue resonance. Patients' age ranged from 17 to 53 years. Total aspirate ranged from 300 to 1200 ml for size, of which 65 percent was supranatant (fat) and 35 percent was infranatant (tumescence solution and blood). Patients were operated on while they were under general anesthesia; more recently, pure tumescent anesthesia was tried with success in minor cases. Breast dimensions were assessed with breast sizers (before and after the operation), and breast measurements were assessed using a classic breast drawing. Minimum follow-up of patients was 4 years. Particular care was given to evaluating long-term breast tissue appearance through mammographic studies and to looking for suspected calcifications. No evidence of a suspect mass or calcifications was found during the 4-year follow-up. The main advantages of the technique are a significant reduction in breast volume (up to three cup sizes), significant breast lift (up to 5 cm), and nearly invisible scars (1.5 cm in length at the inframammary sulcus and at the axilla).

The physical and technical principles of ultrasonically assisted liposculpturing (UAL) are described, and clinical experience through 4 years (1992–1996) of use of this procedure is presented. The technique relies on the surgical use of ultrasonic energy, which allows the selective destruction or emulsification of adipose tissue, producing a “cream,” which is then aspirated. The procedure produces less edema and bruising than does traditional liposuction and allows a great degree of skin retraction due to “stimulation” of the dermis of the treated areas. Clinical application of ultrasonically assisted liposculpturing is for lipodystrophy, secondary cases, and difficult areas such as the inner thigh, circumferential thigh, calf, and abdomen. There is little blood loss, and a greater volume of fat tissue can be removed in one session. UAL can be used to treat obesity. This method has been applied to surgery of the breast for volume reduction of the adipose components in the fatty breast (mostly in juvenile breast) and for skin retraction after dermis stimulation for correction of minor-degree ptosis. This technique chiefly relies on the selective destruction of mainly the fluid fraction of the adipose tissue, which represents nearly 90% of all the adipose tissue's volume. Contrary to traditional liposuction, which mechanically attacks and destroys all the structures of the dermis that may have undesired side effects, UAL selectively destroys only the target adipocytes and spares the supporting structures of the skin and dermis, such as vessels, nerves, collagenic matrix, and elastic fibers, thus conserving the elasticity of the treated areas.

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