Narbensparende Brustvergrößerung: Erfahrungen mit über 500 Implantaten

Zusammenfassung Einleitung Minimalinvasive und narbensparende Operationsmethoden gehen in der plastischen Brustchirurgie in Bezug auf die mit der Narbenbildung und Narbensichtbarkeit einhergehende Ästhetik meist mit deutlichen Vorteilen einher. Zudem werden auch Vorteile hinsichtlich Heilung und Erholungszeit beobachtet, weswegen narbensparende Techniken bei der Brustverkleinerung und Mastopexie bereits lange etabliert und gefragt sind. Moderne Weiterentwicklungen von Silikonimplantaten und neue, angepasste chirurgische Techniken können es nun ermöglichen, minimalinvasive und narbensparende Techniken auch bei der Brustvergrößerung mit ähnlichen Vorteilen anzuwenden. Methode In eine retrospektive Studie wurden 252 Patientinnen eingeschlossen, bei welchen in einen Zeitraum von zwei Jahren eine narbensparende Brustvergrößerung über einen inframammären Zugang durchgeführt wurde. Erfasst wurden die Implanttalage, die Größe, die Form und etwaige postoperative Komplikationen. Darüber hinaus wurden alle Patienten anhand des Breast-Q-Fragebogens (Augmentationsmodul) zu ihren Erfahrungen vor und ein Jahr nach der Operation befragt. Der Schwerpunkt lag hierbei auf dem Selbstwertgefühl (prä- und postoperativ) und der Zufriedenheit mit dem Ergebnis einer Brustvergrößerung unter besonderer Berücksichtigung der Narbe. Ergebnisse Die Bewertung des Operationsergebnisses und der Narbe war durchweg positiv. Es gab keine Komplikationen hinsichtlich des chirurgischen Zugangs, der Narbe oder des Implantats. Alle Patientinnen wiesen auf der Breast-Q-Skala von 0–100 eine signifikante Steigerung der Lebensqualität (Psychischen Wohlbefindens: 44 auf 77) auf und waren mit dem Ergebnis der Brustvergrößerung (Zufriedenheit mit den Brüsten: 28 auf 80; Zufriedenheit mit dem Ergebnis: 89 von 100) unter Berücksichtigung der Narbe zufrieden. Schlussfolgerung Die narbensparende (Minimal-Scar) Brustvergrößerung erfordert zwar einen größeren technischen Aufwand und operative Erfahrung, die Ergebnisse sind jedoch sowohl klinisch als auch psychologisch durchweg positiv und vielversprechend.

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFECT OF SAPTACCHADA (AL-STONIA SCHOLARIS) KSHARA PRATISARANA AND JATYADI GRITHA IN DUSHTAVRANA (NON-HEALING ULCERS)

Dushtavrana is a commonly and often encountered problem faced in surgical practice. The presence of Dushtavrana worsens the condition of the patient with different complications which may become fatal and life threatening. Local factors on wound like slough, infection and foreign body which affect the nor-mal process of healing. A healthy and fresh wound in a normal body heals earlier with minimal scar as compared with contaminated wound. Therefore, in the present study all efforts are made towards to keep the wound clean during various stages of healing. Good wound healing with Minimal Scar formation with minimal pain effectively is the prime motto of every surgeon. Acharya Sushrutha has explained 60 proce-dures for the management of Vrana at different stage. Kshara Karma is one among them which is men-tioned by Acharya Sushrutha and which is indicated in Dushtavrana due to its Chedana, Bhedana, Lek-hana & Tridosghna properties. Which does the Shodhna of Dushtavrana.

Injury triggers fascia fibroblast collective cell migration to drive scar formation through N-cadherin

Scars are more severe when the subcutaneous fascia beneath the dermis is injured upon surgical or traumatic wounding. Here, we present a detailed analysis of fascia cell mobilisation by using deep tissue intravital live imaging of acute surgical wounds, fibroblast lineage-specific transgenic mice, and skin-fascia explants (scar-like tissue in a dish – SCAD). We observe that injury triggers a swarming-like collective cell migration of fascia fibroblasts that progressively contracts the skin and form scars. Swarming is exclusive to fascia fibroblasts, and requires the upregulation of N-cadherin. Both swarming and N-cadherin expression are absent from fibroblasts in the upper skin layers and the oral mucosa, tissues that repair wounds with minimal scar. Impeding N-cadherin binding inhibits swarming and skin contraction, and leads to reduced scarring in SCADs and in animals. Fibroblast swarming and N-cadherin thus provide therapeutic avenues to curtail fascia mobilisation and pathological fibrotic responses across a range of medical settings.

MANAGEMENT OF SHALYAJ NADIVRAN BY MODIFIED KSHARASUTRA W.S.R. TO PILONIDAL SINUS

Pilonidal sinus is a disease that most commonly arises in the hair follicles of the natal cleft of the sacrococcygeal. Incidence is more common in men as they are hairier than women. The factor which increases the risk of pilonidal sinus is continuous sitting, obesity, sedentary occupation, family history, local trauma. The surgical management commonly practiced are included incision and drainage, excision and primary closure, excision and healing by secondary intention, excision with reconstructive flap technique (Bascom’s method). However, the risk of recurrence or of developing an infection of the wound after the operation is high. In Ayurveda as clinical features, the pathology of Pilonidal sinus and Shalyaj nadivrana described in Sushruta Samhita are very much similar to each other we can correlate with Shalyaj type of Vrana with Pilonidal sinus. Sushruta has explained Shastrakarma with the intervention of ‘Ksharsutra’ procedure for the management of Nadi vran (PNS). This case study was presented on a male patient aged 39 years. He was suffering from pilonidal sinus for 9 months and treated successfully with partial sinus excision along with Ksharsutra therapy. Partial sinus excision followed by Ksharsutra ligation in the remaining intact tract was performed under local anaesthesia. The Ksharasutra was changed weekly for 3 sittings. Observation revealed that sinus track cut through and healed by 5 weeks. The patient was under observation for one year to check for recurrence. Ksharasutra treatment not only minimizes complications and recurrences, causing minimal scar but also facilitates the patient to resume early working with less discomfort as well as reduced time and cost.

A REVIEW ARTICLE ON DUSHTA VRANA AND ITS MANAGEMENT IN AYURVEDA

Dushta Vrana is a common encountered problem faced in surgical practice. The presence of Dushta Vrana can damage the condition of the patient with different complications and may become fatal. Factors affecting on wound are slough, infection and foreign body, which can delay the normal process of healing. A healthy wound in a heals earlier as compared to a contaminated wound. Therefore it is important to keep the wound clean during the various stages of its healing. Good wound healing with minimal scar formation with least pain effectively is the prime motto of every surgeon. Acharya Sushruta has ornately explaind six types of Dushta Vrana and management of Dushta Vrana is included by number of drugs, broadly classified into Vranashaodhana and Vrana ropana.

Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin

Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.

The management of auricular defect using retroauricular flap

Management of auricular defect is still a challenge for reconstructive plastic surgeons. The complexity of anatomy and shape will make the reconstruction complicated. It is also inevitable that choosing the right donor to close the defect that resembles the original contour is one of the success indicators of any ear reconstruction. There are wide selections of techniques for the management of auricular defect. Retroauricular flap is one of the best choices in auricular reconstruction due to its vascular richness, low of failure rate, similarity of tissue contour and the ease of closing the donor-site defect primarily. This article reported three cases of auricular defect with various causes: crushed injury, human bite, and tumor excision. Two stages of surgeries were performed on all three patients. After sufficient debridement, the ear defect is planted beneath retroauriculomastoid dermis. The second stage, three weeks from the first surgery, the donor flap is separated from it host. One week follow up after the second stage surgery, all of the post-operative wounds showed no signs of infection, minimal scar formation and has satisfied aesthetic outcomes. The retroauricular flap has the advantages of simple dissection, low failure rate and has a good shape, texture, color for a very good aesthetic results. This flap may be considered as a good solution in the management of auricular defect and a flap bank for ear reconstruction.