BackgroundAutologous fat graft has become a useful technique for correction of acquired contour deformity in reconstructed breasts. However, there remains controversial regarding the efficacy and safety of the practice for reconstructive breast surgery.MethodsA retrospective review was performed on 102 patients who had secondary fat grafting after breast reconstruction. Fat harvest, refinement and injection were done by Coleman's technique. All patients were followed up postoperatively within 1 month and after 6 months including physical examination and ultrasonography. In 38 patients, the reabsorption rate was calculated by serial changes of thickness between skin and pectoral fascia in the ultrasonic finding. Locoregional recurrence rate was compared with control group of 449 patients who had breast reconstruction without fat graft in the same time period.ResultsAverage 49.3 mL fat was injected into each breast. The most common location of fat graft was upper pole, followed by axilla, lower and medial breasts. During 28.7 months of average follow-up period, 2.9% of total patients had symptoms of palpable mass on fat graft side and ultrasonography identified fat necrosis and cyst formation in 17.6% of the patients. Calculated fat reabsorption rate was 32.9%. Locoregional recurrence was occurred in 1 patient (0.9%) and the rate was not different significantly with control group (2%).ConclusionsAlthough further studies are required to provide surgeons with definitive guidelines for the implementation of fat grafting, we propose autologous fat graft is an efficient and safe technique for secondary breast reconstruction.

BackgroundManagement of positional plagiocephaly by wearing a cranial molding helmet has become a matter of growing medical interest. Some research studies reported that starting helmet therapy early (age 5 to 6 months) is important and leads to a significantly better outcome in a shorter treatment time. The aim of the present study was to evaluate the effectiveness of cranial remodeling treatment with wearing helmet for older infants (≥18 months).MethodsWe conducted a retrospective study of 27 infants with positional plagiocephaly without synostosis, who were started from 2008 to 2012. Every child underwent a computerized tomography (CT) before starting helmet therapy to exclude synostosis of the cranial sutures and had CT performed once again after satisfactory completion of therapy. Anthropometric measurements were taken on using spreading calipers in every child. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy.ResultsThe discrepancy of CVA and CVAI of all the patients significantly decreased after cranial molding helmet treatment in older infants (≥18 months) 7.6 mm from 15.6 mm to 8 mm and 4.51% from 9.42% to 4.91%. Six patients had confirmed successful outcome, and all subjects were good compliance patients. The treatment lasted an average of 16.4 months, was well tolerated, and had no complication. Additionally, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the wearing time per was shorter.ConclusionThis study showed that treatment by cranial remodeling orthosis was effective if the patient could wear the helmet longer and treatment duration was somewhat longer than in younger patients, well tolerated in older infants and had no morbidity. This therapeutic option is available and indicated in these older infants before other cranial remodeling surgery.

BackgroundMany options are available to cover a palatal defect, including local or free flaps. The objective of this study was to evaluate the usefulness of palatal mucoperiosteal island flap in covering a palatal defect after tumor excision.MethodsBetween October 2006 and July 2013, we identified 19 patients who underwent palatal reconstruction using a palatal mucoperiosteal island flap after tumor excision. All cases were retrospectively analyzed by defect location, size, tumor pathology, type of reconstruction, and functional outcomes. Speech and swallowing functions were evaluated using a 7-point visual analog scale (VAS) score.ResultsAmong the 19 patients, there were 7 men and 12 women with an age range of 25 to 74 years (mean, 52.5±14.3 years). The size of flaps was 2-16 cm2 (mean, 9.4±4.2 cm2). Either unilateral or bilateral palatal island flaps were used depending on the size of defect. During the follow-up period (mean, 32.7±21.4 months), four patients developed a temporary oronasal fistula, which healed without subsequent operative. The donor sites were well re-epithelized. Speech and swallowing function scores were 6.63±0.5 and 6.58±0.69 on the 7-point VAS, indicating the ability to eat solid foods and communicate verbally without significant disability.ConclusionThe palatal mucoperiosteal island flap is a good reconstruction modality for palatal defects if used under appropriate indications. The complication rates and donor site morbidity are low, with good functional outcomes.

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