No abstract

Solitary lipomas and familial multiple lipomatosis are the most common benign tumors and are very well encapsulated. They are very slow growing and have the potential for recurrence if incompletely excised and a very remote chance for malignant changes. These can be freed from surrounding tissue without difficulty, but because of the fibrous nature of the capsule, its violation is more likely with suction technique and may result in an inadequate resection, possibly leading to recurrence. Furthermore, liposuction alone will not allow histopathological study of the swellings. Therefore, we report here the treatment of moderate (>4-10 cm) and large (>10 cm) lipomas with liposuction-assisted surgical extraction of the capsule via the same wound (1 cm in length). This capsule extraction is aimed at avoiding recurrence and evaluating the histopathological nature of these swellings. 16 patients (nine men and seven women) presented with solitary lipomas (in 11 patients) and multiple lipomas (in five patients) have been successfully treated. Methods involved 1-cm incision for both liposuction and surgical removal of the capsule. Another 1-cm counter-incision may be needed in case of large size lipomas. High patient satisfaction was achieved because of the good cosmetic results due to the small postoperative residual scar and the smooth postoperative course. There has been no recorded recurrence in six years postoperative followup.

Reconstruction of soft-tissue defects of the hand with exposed tendons, joints, and bone represents a challenge to the plastic surgeon, and such defects necessitate flap coverage to preserve hand function and to protect its vital structures. Reported here is the study of an island adipofascial flap based solely on the distal five to eight septocutaneous perforators of the radial artery and their venae comitantes. Designing the flap in the form of an island with skeletonization of the distal perforators of the radial artery ensures its vascular pattern from these perforators alone with no connection to the ulnar artery perforators or posterior interosseous artery perforators, as is the case with fascial pedicled flaps. Furthermore, designing the flap as an island facilitates the arc of rotation and avoids the pedicle kink when the flap is turned 180 degrees. Preservation of the radial artery, as well as the mild thickness of the flap are further advantages. The drawbacks of such a flap include temporary impaired sensation at the donor site, the obvious scar in the forearm, and loss of hair. Eleven fresh and fixed cadaver upper extremities were dissected to delineate the vascular pattern and to define the arc of rotation of the flap. Also, a clinical approach was conducted on two patients who sustained extension scar contracture with tendon adhesions of the dorsum of the hands, on two patients who sustained first web space contracture, and on two patients who had full-thickness soft-tissue loss over the palm; and finally on two patients who sustained traumatic soft-tissue loss over the dorsum of their hands with exposed tendons and metacarpal bones.

Although abdominal dermolipectomy is a frequently performed procedure, few publications have reported on the safety of the procedure in the scarred abdomen. The aim of this study was to stress the possibility of performing a natural-looking abdominoplasty with no complication such as skin necrosis or liponecrosis in the presence of abdominal scars and to clarify that the scarred abdomen is not a great limitation for full abdominoplasty as reported in the literature. Seventy-six abdominoplasties were performed on scarred patients from July of 1997 to June of 2003. Twenty-five patients had oblique subcostal scars, six patients had median supraumbilical scars, three patients had median infraumbilical scars, 10 patients had appendectomy scars, nine patients had paramedian supraumbilical scars, eight patients had paramedian infraumbilical scars, seven patients had long transverse scars of repaired ventral hernias, and eight patients had multiple small scars after laparoscopy. In addition, there were concomitant transverse cesarean delivery scars in 40 patients. All patients underwent full abdominoplasties, plication of the musculoaponeurotic system, and liposuction assistance if required (45 patients). Of 76 subjects, three patients had very limited liponecrosis at the watershed area. Eleven patients (14.5 percent) were morbidly obese and heavy smokers. In comparisons of postabdominoplasty complications, such as liponecrosis, wound infection, and dehiscence with and without liposuction in scarred abdomen, no significant differences were found. Secondary revision was more common among abdominoplasties without liposuction [seven of 45 (15.6 percent) versus 12 of 31 (38.7 percent); p = 0.02]. In conclusion, there is no limitation or contraindication for abdominal dermolipectomy with or without liposuction assistance on the previously scarred abdomen as long as the vascular zones of the abdomen are respected. The abdominal wall dissection is limited to allow only the plication of the musculoaponeurotic system, and aggressive liposuction is avoided.

Necrotizing fasciitis is an aggressive, deep-seated infection of the fascia and subcutaneous fat with necrosis of the overlying skin, and it is a toxin-mediated disease. The aim of this study was to review 13 cases of necrotizing fasciitis of the perineum and the external genitalia region with regard to the diagnosis, treatment, and methods of reconstruction of secondary defects. The study was performed from June 1997 to May 2001 and involved 11 men and 2 women who ranged in age from 35 to 67 years (mean age, 53 years). All patients presented to the plastic surgery unit with huge secondary defects of the urogenital region, upper thigh, and lower abdomen after being excised initially by general surgeons. Eight patients were treated with bilateral flaps, and the unilateral flap was used in 2 patients. The V-Y island fasciocutaneous flap, used to resurface the urogenital region after necrotizing fasciitis, is considered a new indication. The V-Y axial-pattern design of the flap is also considered a new modification, which enabled the flap to be advanced and tailored nicely in the midline. The idea of using the V-Y-plasty design is raised because the perineum has a pair of symmetrical anatomic structures. In addition, this procedure conserves tissue and the flap donor site is closed primarily without tension. Both aesthetic and functional results were satisfactory.