Use of Technologies to Improve the Liposuction Outcome Including Skin Texture and Form

Liposuction as the word suggests involves sucking out fat from the subcutaneous layers. In many parts of the world it is used interchangeably with weight loss and non-surgical fat reduction procedures. The gold standard for liposuction for many decades has been the “Suction assisted Liposuction’ also called SAL. Newer technologies have been introduced with varied claims about skin retraction, painless and complete evacuation of fat as well as a faster recovery. This chapter elaborates the personal experience of the Authors with regards to the discussed newer technologies bringing into perspective their indications, mechanism of action as well as clinical outcomes. At the outset the Authors would like to state emphatically that technologies are as good as the surgeon holding them and that somewhat same result can be achieved through a traditional liposuction in most of the cases. A surgeon looking to incorporate these technologies in practice should first achieve a mastery of traditional SAL for the best outcomes.

Prospective, Randomized, Comparative Study of the Cutaneous Effects of a Topical Body Treatment Compared to a Bland Moisturizer

Background Over time human skin thins and loses elasticity, and topical treatments attempt to reverse this process. Objectives Assess the efficacy of TransFORM Body Treatment (TFB) in skin rejuvenation compared to a bland moisturizer on the extensor and volar forearms. Methods Blinded participants were given two products to apply on the designated forearms with follow-up at 4, 8 and 12 weeks. Measurements included skin thickness, photography, dermatopathology, cutaneous elasticity by two separate devices, and patient reported outcomes. All were compared to baseline. Results Change in roughness: extensor -0.09 mm for bland moisturizer and -0.26 mm for TFB (P = 0.174); volar 0.01mm for bland moisturizer and -0.23 mm for TFB (P = 0.004). Change in recoil velocity: volar -56 degree/s for bland moisturizer and -24 degree/s for TFB (p = 0.61); extensor -95 degree/s for bland moisturizer and -63 degree/s for TFB (p = 0.57). Change in retraction speed: volar -3.25 ms for bland moisturizer and -20.08 ms for TFB (p = 0.33); extensor -2.17 ms for bland moisturizer and -10.83 ms for TFB (p = 0.66). Histology: TFB showed an increase in mucopolysaccharide content, new collagen and increase in elastin fibers in the papillary dermis. Change in Rao-Goldman score: volar -0.17 for bland moisturizer and -0.33 for TFB (p = 0.25); extensor -0.08 for bland moisturizer and -0.17 for TFB (p = 0.36). Conclusions Histology showed production of new collagen and elastin. Quantification of changes using skin thickness, skin retraction speed and skin recoil velocity showed trends that agree with the visual data.

Oncoplastic Approach to Giant Benign Breast Tumors Presenting as Unilateral Macromastia

Benign breast tumors attaining large size constitute an important cause of unilateral macromastia. Their usual treatment involves enucleation or excision with a margin based on pathology and waiting for spontaneous retraction of skin envelope. In very large tumors, this will leave the residual breast deflated and unaesthetic, with spontaneous skin retraction giving unpredictable results. Application of the principles of oncoplastic surgery are helpful in this situation. Here, we present two cases of benign giant tumors—a giant fibroadenoma and a giant lipoma—managed by reduction mammaplasty approach to restore the breast symmetry and aesthetics.

Prevention of Umbilical Sagging After Medium Definition Liposuction

Background The loss of the umbilical vertical axis, causing a horizontal shape deformity after liposuction, is a current aesthetic issue. The use of energy devices, such as LASER and VASER, has been advocated as an option for improving skin retraction, but no data are available on the prevention of umbilical sagging. Objectives The authors sought to describe a technique for preventing umbilical deformities after medium definition liposuction employing suction-assisted liposuction. Methods Over a period of 31 months, 62 patients underwent medium definition liposuction with direct needle fixation of the umbilical stalk to prevent horizontal umbilical deformities. All patients underwent surgery performed by a single surgeon (G.B.). All patients underwent objective measurements of the umbilical shape before and after the procedure utilizing digital image measurements by Mirror Image software, version 6.0 (Fairfield, NJ). Statistical analysis was performed with IBM SPSS Statistics V26. The mean age of the patients was 28.8 years. The follow-up evaluation was performed 2 weeks and 9 months postoperatively. Results Over a period of 31 months, 60 patients (96.7%) who underwent abdominal etching liposuction showed maintenance of (n = 9, 14.5%) or improvements in the umbilical shape 9 months postoperatively (n = 51, 82.2%, P < 0.05). Two patients (3.2%) experienced worsening of the umbilical shape after surgery despite suture fixation. Conclusions Horizontal shape deformities of the umbilicus after liposuction can be improved by utilizing direct needle fixation of the umbilical stalk. The approach has been shown to be effective, safe, and reproducible for the prevention of umbilical sagging in selected patients. Level of Evidence: 4

Scar Contractures

Scar retractions occurring on mobile areas on the body surface, like the neck, the joints, the hand, and the face may induce functional limitations in skin availability during movements. Extensive burns, trauma, and infected wounds may be found as risk factors. The activation of populations of myofibroblasts may explain the occurrence of skin contracture, as they mechanically act on the matrix and induce skin retraction (Kwan and Tredget, Hand Clin 33(2):277–292, 2017). Pathological consequences of the contractures may vary from a moderate limitation of movement over a digital joint to a permanent neck contracture impairing eye vision in the horizontal plane. The shortage of skin capacity may vary from 2 to 10 cm. Most of the contractures respond to an active early treatment when there is an early diagnosis at 1 month after wound healing, but if diagnosed later specific surgical procedures are needed, like skin grafting, local or regional flaps, but also complex microsurgical flaps. Specific indications depend on the necessity to restore the function.

Retraction of cutaneous specimens: tumours and margins after surgical excision

AimsIn previous studies, skin retraction of dermato-pathological specimens after the surgical excision of tumours was calculated at 30% for the surface, with approximately 20% for the length and 15% for the width. The aim of this study was to analyse the retraction of the specimens and the retraction of the lesion and the margins.MethodsPatients who underwent excision of a skin tumour between January 2013 and July 2014 were randomly included.ResultsA total of 104 patients was included. There were 52% male with a mean age of 68.3 years. Seventy-eight per cent of the lesions were malignant (51% were basal cell carcinoma, 10% squamous cell carcinoma). The retraction of the area of the specimen (29%) was significantly greater than the retraction of the tumour (21%). On multivariate analysis, the localisation and the duration of fixation were independent predictors of the specimen area retraction. The retraction of the specimen was 17% in length and 15% in width. The retraction of the margins was calculated at 19% in length and 12% in width. The surgeon correctly evaluated the localisation of the smallest margin in 55% of cases.ConclusionsOur study provided additional data regarding the retraction of the tumours and margins. The guidelines for surgical excision of skin cancers recommend a clinical margin before excision, but the evaluation of the sufficiency of the margins is based on histological measurement. Our data are useful for the interpretation of the sufficiency of the margins.

Dystrophic Calcifications

Dystrophic calcifications are typically large (usually >1 mm), coarse, irregular or plaque-like and associated with lucent centers. They also may be thin, smooth, and round or oval, with lucent centers, called “rim” (previously also known as “eggshell”) calcifications. They form in response to trauma, including surgery or irradiation. They can be seen in association with other findings of breast trauma, including surgical clips, architectural distortion, skin retraction, skin thickening, oil cysts, or trabecular thickening. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for dystrophic calcifications. Topics discussed include findings after breast trauma or surgery/radiation treatment and the evolution of fat necrosis.

IgG4-Related Sclerosing Disease of the Breast in a Male Patient

IgG4-related sclerosing disease of the breast is a rare entity with 10 reports in the literature. We report the first case in a male patient. A 48-year-old male presented with 4-week history of palpable right upper outer quadrant breast mass associated with skin puckering. He reported a family history of breast cancer in his aunt. Ultrasound and mammography showed a spiculated 2.5-cm mass associated with skin retraction with extension to the pectoralis muscle. Ultrasound-guided core biopsy was performed. The findings were interpreted as acute and chronic inflammatory process. The patient subsequently denied improvement of the mass, and an excisional biopsy was performed. Histologic examination showed fibrosis and dense lymphoplasmacytic inflammation in the breast mass and muscle biopsy. Focal obliterative phlebitis was noted. IgG4-positive plasma cells were increased with counts of over 50 per high-power field. The diagnosis was confirmed as sclerosing IgG4-related disease of breast.

Medial Hip Arthroscopy Portals: A Novel Approach for Hip Pathologies. is it Feasible?

Purpose To report 3 patients operated on using medial hip arthroscopic portals, describe the surgical technique and clinical outcomes. Methods Three medial portals were made, the first one at the posterior edge of the adductor longus muscle (posterior medial portal), the second one at the anterior (anterior medial portal) and the third at the posterior border of the adductor longus, 5 cm distal to the inguinal crease (distal posterior medial portal). The first case was an 8-year-old boy with a lytic lesion at the posteromedial region of the femoral neck suggestive of sub-acute osteomyelitis. The second patient was a 21-year-old male with a posteromedial femoral neck nidus. The third patient was a 42-year-old male with a posteromedial femoral neck cystic lesion. Conclusions The described portals allowed successful access to posteromedial femoral neck. There were no neurovascular lesions, infection, femoral head osteonecrosis, skin retraction or functional limitation related to the portals.