AUTOLOGOUS FAT TRANSFER, BREAST LIPOMODELLING AND FAT TRANSFER TO THE FACE: CURRENT GOLD STANDARDS AND EMERGING NEW DATA

Autologous fat transfer techniques have experienced tremendous boom in the recent years. Plastic surgeons use these techniques to enhance both the features of the face and of the body. Over the years, controversies concerning fat harvesting, fat processing and fat injection came up. The authors of this review article describe their own experience with fat harvesting, processing and injection and show some of their own results. In addition, they discuss contemporary data from literature regarding the use and complications of fat grafting to the most common areas treated with fat grafting: breast and face.

[Reconstruction of complex abdominal wall defects using the component separation technique]

INTRODUCTION

Reconstruction of complex abdominal wall defects is among the most demanding procedures in reconstructive surgery. Introduction of the method of component separation represents the most significant advance in the care of these patients. We present our experience with the component separation technique on a series of 44 patients.

MATERIALS AND METHODS

We retrospectively reviewed patients operated on between 2009 and 2012. The inclusion criterion was the use of the component separation technique in the treatment of abdominal wall defect. The scoring criteria were recurrent hernia, wound hematoma, wound infection, skin necrosis and secondary healing.

RESULTS

We operated on 44 patients in the above period. The etiology of the defects was most frequently hernia in the scar after midline laparotomy (n = 29; 66%) and after incision across the epigastrium for total gastrectomy (n = 3; 7%). The other defects (n = 12; 27%) were caused by a wide diastasis of the abdominal rectus muscles (width 8-10 cm). The most common complication was a hematoma in the lateral part of the wound which occurred in 7 patients (16%). We did not detect any hernia recurrence in the original abdominal wall defects.

CONCLUSION

The method of components separation allows us to stitch the edges of the full-thickness abdominal wall to each other, even in cases of large hernias. The introduction of this technique into practice has reduced the risk of recurrence of large hernias without a significant increase in postoperative complications.

Penis augmentation by application of silicone material: complications and surgical treatment

BACKGROUND

Complications resulting from enlargement of the penis by applications of unknown types of silicone and mineral oils are well described. Surgical removal of the tissue altered by inflammation leads to the development of defects of various sizes, often circular from the glans penis to the scrotum. The options of subsequent surgical treatment described in literature are not very extensive. Most defects are managed with skin grafting, rarely V-Y advancement or bilateral scrotal flaps.

METHODS

We present a 36-year-old patient after application of unknown silicone material into the penis for cosmetic enlargement. After the application developed severe inflammation with ulceration and necrosis around the penis. Conservative treatment was not effective, therefore, the infiltrated skin with subcutaneous tissue of the entire penis was surgically removed. The resulting defect was covered by implantation of the penis under the skin of the scrotum.

RESULT

There were no complications in the postoperative course, pain that was present before the surgery immediately subsided. Skin suture healed completely within 14 days. Three months after the surgery the patient returned to normal sexual life.

CONCLUSIONS

Implantation of the penis under the skin of the scrotum is a fast, safe and effective method that can treat most of the circular skin defects of the penis. Scrotal skin is thin, soft, elastic and creates abundant and good cover around the entire penis.

[Breast reconstruction by autologous fat transfer]

INTRODUCTION

Autologous fat tissue transfer has recently become extremely popular in the field of plastic and reconstructive surgery. Fat represents a filling material with ideal properties - it naturally incorporates into tissues and it is autologous, and therefore 100% biocompatible. An increasing number of publications describe the regenerative properties of autologous fat tissue, especially when used in soft tissue with post-radiation damage. The aim of this article is to describe our experience with fat grafting in breasts.

MATERIALS AND METHODS

An autologous fat grafting operation consists in 3 phases - harvesting of fat tissue, its processing, and application of the graft. Fat harvesting is similar to classic liposuction. Common methods of fat tissue processing are centrifugation and the use of the PureGraft filter bags. The most important precondition for a favourable result of the operation is the correct graft application.

RESULTS

In the period between March 2011 and January 2012, we used this fagrafting to perform surgical breast reconstruction in 15 patients; 8 patients with a breast deformity after partial mastectomy and radiation, 2 patients after complete mastectomy, 2 patients after complete mastectomy reconstructed with the additional use of external expansion, 2 patients after implant reconstruction presenting with subsequent deformity and 1 patient with pectus excavatum. The patients were followed up for 3-12 months. Long-term retention of the graft was considered good.

CONCLUSION

By use of fatgrafting, we can achieve excellent results with minimal risk of complications in reconstructive breast surgery. Autologous fat has plenty of advantages when compared to other biomaterials. It is absolutely biocompatible and able to regenerate the surrounding tissue.

Our eight-year experience with breast reconstruction using abdominal advancement flap (207 reconstructions)

There are many possibilities for breast reconstruction after mastectomy. The use of abdominal advancement flap in combination with silicone implant is among the less commonly used methods, although it is simple, fast and leads to excellent results. We started to use this technique at our department eight years ago. Since then we have performed 207 breast reconstructions using abdominal advancement flap in combination with silicone implants. We performed follow-up checks on the patients for between one and six years.

Synmastia--an unusual complication of augmentation mammaplasty

Synmastia is a complication of breast augmentation which is not well known. It is a condition where the implants touch each other above the breast bone. In the article the authors describe not only the mechanism of its origination but also the opportunities for correction and the prospects of prevention. They illustrate formation of synmastia in a young woman with emphasis on probable causes and methods of its effective correction in their own case study.