Summary The authors of this review present a comprehensive assessment of the techniques and indications in the treatment of the long upper lip. Setting aside the maxillofacial malformations, the review is focused on senescence as the most frequent etiology. A graphical reminder of the anatomical entities and of the upper lip proportions allows optimal preoperative planning. All current treatment options, from fillers to surgical excision and dermabrasion, are reviewed and summarized in order to provide an overview of each technique's expected results and contraindications.
Background Phalloplasty with the radial forearm free flap is associated with a large donor site defect. Aim To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm. Methods Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure. All 37 patients were evaluated by questionnaire and by careful clinical examination. Pressure perception was assessed with the Semmes-Weinstein monofilament test. Sensory recovery, skin quality, and cosmetic result also were compared. The contralateral arm was used as the control. Outcomes Pressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect. Results Our findings support the hypothesis that MatriDerm can be used to preserve sensory function and decrease morbidity of the donor site. Clinical Implications The use of a dermal substitute decreases the morbidity of the forearm free flap donor site. Strengths and Limitations The strength of this study is its retrospective nature conducted of a prospectively maintained database of 37 consecutive radial forearm free flaps with superimposable dimensions and location performed by the same surgeon, thus limiting biases. A limitation is its small sample (particularly for the control group). Conclusion Our experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients.
Background: Among breast reduction mammoplasty, the inferior pedicle-based (IFP) technique is considered the most performed by plastic surgeons. A growing interest for the supero-medial based pedicle (SMP) mammoplasty technique has been documented in literature and clinical practice. However, no real evidence exists on the superiority of one technique over another.Methods: This study represents a retrospective multimodal analysis, using a prospectively maintained database, comparing wise pattern breast reduction techniques (IFP vs. SMP) over a 24-month follow-up.From January 2015 to July 2017, all patients undergoing wise pattern bilateral reduction mammoplasty, using either an IFP or a SMP technique, were included in the study and divided in two groups. Preoperative breast measurements included sternal notch-to-nipple distance (SN-N), infra-mammary fold to inferior border of Nipple Areolar Complex (NAC) distance length and ptosis. The same measurements were recorded at 2 weeks, 6 months and 24 months post-op. Complications were recorded and aesthetic outcomes were evaluated.Results: A total of 58 patients were included in the study, among which 36 (62%) were treated with a SMP technique and 22 (38%) with an IFP technique. At the 24-month follow-up timepoint, the SN-N distance was significantly shorter (*P<0.05) in the SMP group, with a significantly smaller elongation of the lower pole arc (29.5% increase in length in the SMP group and 40.9% in the IFP group). Aesthetic result gave significantly higher mean VAS score for SMP patients compared to IFP patients. Conclusions:The SMP technique provides stable and satisfactory results in term of breast shape, overcoming some of the major concerns related to the use of an IFP technique (lower pole elongation and ptosis recurrence), maintaining a superimposable complication rate.
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