No abstract

Vaginal labiaplasty has become a more frequently performed procedure as a result of the publicity and education possible with the Internet. Some of our patients have suffered in silence for years with large, protruding labia minora and the tissue above the clitoris that is disfiguring and uncomfortable and makes intercourse very difficult and painful. We propose four classes of labia protrusion based on size and location: Class 1 is normal, where the labia majora and minora are about equal. Class 2 is the protrusion of the minora beyond the majora. Class 3 includes a clitoral hood. Class 4 is where the large labia minora extends to the perineum. There are two principal means of reconstructing this area. Simple amputation may be possible for Class 2 and Class 4. Class 2 and Class 3 may be treated with a wedge resection and flap advancement that preserves the delicate free edge of the labia minora (Alter, Ann Plast Surg 40:287, 1988). Class 4 may require a combination of both amputation of the clitoral hood and/or perineal extensions and rotation flap advancement over the labia minora.

Gastric ulceration developed in eight patients during intrahpeatic arterial infusion of 5-FU. Bleeding occurred in four instances and perforation in one. In all cases the catheter tip had been dislodged and was proximal to its correct position, allowing the stomach to be directly infused with 5-FU. No duodenal ulcers were noted. All patients were symptomatic for several days before the diagnosis was made. Of 20 patients with catheter dislodgement, five had documented ulcers, three had upper gastrointestinal bleeding of undetermined etiology, eight had epigastric pain or vomiting and only four were asymptomatic. Prompt determination of catheter position is necessary in patients receiving intrahepatic arterial infusion of 5-FU if symptoms consistent with gastric ulceration occur. Gastric ulcers should be vigorously treated because of the high rate of complications in patients receiving chemotherapy.

Although the authors initially experienced a significant migration rate, a modification in technique reduced this rate over the long term. Permafacial implants are an effective method of increasing fullness in the lip area, and they are associated with few complications and high patient satisfaction.

This report presents a preliminary study investigating the effects of large-volume liposuction on the parameters that determine type 2 diabetes. The study enrolled 31 patients with a body mass index (BMI) exceeding 30 kg/m(2) over a 1-year period. All the liposuction procedures were performed with the patient under local anesthesia using ketamine/valium sedation. Pre- and postoperative blood pressure, fasting glucose, glycosylated hemoglobin (HbA1C), weight, and BMI were evaluated for 16 of the 30 patients who returned for a follow-up visit 3 to 12 months postoperatively. The average aspirate was 8,455 ml without dermolipectomy and 5,795 ml with dermolipectomy. The data reveal a trend of improvement in blood sugar levels associated with weight loss that helps the patients. The average blood sugar level dropped 18% in our return patients, and the average weight loss was 9.2%. The average drop in BMI was 6.2%, and HbA1C showed a decrease of 2.3%. The patients with the best weight loss had the best reduction in blood sugar level and blood pressure. No transfers to the hospital and no thromboebolism occurred for any of the 31 patients. One dehiscence, two wound infections, and three seromas were reported. The authors hypothesize that large-volume liposuction in their series may have motivated some to diet, which could be explored in a larger series with control groups. Liposuction alone did not improve obesity but helped to motivate some of the patients to lose weight. These patients had the best results.