Lassiterneville6228

The cell survival theory and the cell replacement theory contribute to the current thinking regarding free adipose graft persistence after transplantation and influence the principles applied to autologous fat transfer procedures. Both theories necessitate the reestablishment of circulation for graft survival. To minimize ischemic death, according to Khouri, fat grafts should be injected with at most 1.6-mm-wide ribbons to optimize the graft-to-recipient interface for oxygen diffusion and neovascularization. The graft is eventually incorporated into the surrounding tissue. We present a curious intraoperative finding, in a 51-year-old woman 2.5 months post-grafting for failed implant reconstruction after radiation. Several large, well-circumscribed, clearly viable adipose tissue nodules, up to 2 cm in diameter, were present inside the capsule. These were so loosely attached to the capsule of the breast pocket that a mere gentle hand sweep and irrigation after opening the cavity caused them to dislodge and float to the surface of the irrigation fluid. This finding begs additional questions about the current understanding of the mechanisms of tissue viability after grafting. It raises the clinical possibility that larger aliquots of transferred fat can be viable than previously perceived.Ravitch repair is a common surgical procedure to correct chest wall deformities. In this procedure, a subperichondreal cartilage resection of the deformed parasternal cartilage, and if necessary a repositioning of the sternum, is performed. Insufficient regeneration of the resected cartilage may result in sternocostal instability or even floating sternum. This rare complication presents with symptoms of pain and exercise intolerance. Methods We describe sternocostal instability in 3 adolescent patients after the Ravitch procedure for pectus carinatum and reviewed the literature on this topic. Results Our patients suffered different degrees of instability. In all cases, we eventually achieved a satisfactory outcome. There is little literature on sternocostal instability. It is a rare complication, mainly occurring after reoperation by damaging the perichondrium. Conclusions Malunion of costal cartilage is a rare complication of open pectus repair. To achieve the best regeneration and stability of the sternum, less extended resection of cartilage should be performed and the number of cartilages resected should be limited. The perichondrium must be kept intact. Autologous grafts, growth-enhancing materials, and metal or bioabsorbable struts may contribute to stabilization and regeneration of the cartilage.Female-to-male mastectomy often renders the chest skin and nipple-areolar complex (NAC) insensate. We propose a new technique of preserving the intercostal nerves and using them to reinnervate the NAC after mastectomy. Methods We performed a prospective analysis of transmasculine patients who underwent female-to-male mastectomy. The technique involves dissecting out the lateral intercostal nerves to length and performing a neurorrhaphy to nerve stumps at the base of the NAC. Sensory outcomes, as assessed with Semmes-Weinstein monofilaments, were compared to a cohort of patients who underwent mastectomy without neurotization. Results Ten patients with a mean age of 17.5 years (range 16-19 years) underwent mastectomy. The final follow-up was a mean of 15.4 ± 4.3 months for the treated group and 40.7 ± 12.9 months for the control group. Compared to control patients, treated patients had significant improvement in sensation at the nipple (P ≤ 0.0002), areola (P = 0.0001), and peripheral breast skin (P = 0.0001). For treated patients, there was no statistically significant difference in sensation between preoperative and postoperative sensation in all tested areas at final follow-up. Conclusion This proof of concept study suggests that immediate reinnervation of the NAC after mastectomy enhances recovery of NAC sensation in patients undergoing female-to-male mastectomy and may be further generalized to women undergoing postmastectomy breast reconstruction.One of the primary goals of penile reconstruction for female-to-male transsexuals is to enable voiding while standing. Metoidioplasty represents a viable option, but it is associated with a high rate of postoperative fistula formation and recurrence, which affects the aesthetic and functional outcomes. Subsequent surgical repair using scarred and inadequate local tissue may contribute to fistula recurrence. The folded superficial circumflex iliac artery perforator (SCIP) island flap offers sufficient well-vascularized tissue and skin envelope for the reconstruction of the urethra and outer skin after failed metoidioplasty. The SCIP flap can be elevated as a hairless thin flap, making it useful in urethral reconstruction even when it is folded. We describe a case of a 44-year-old female-to-male transsexual patient who developed a refractory urethrocutaneous fistula after metoidioplasty. Surgical repairs were attempted using local tissue 4 times without success. The patient presented to our hospital, and we performed urethral reconstruction using a folded, pedicled SCIP flap for both urethra and skin augmentation. The postoperative course was uneventful, with satisfactory functional results and low donor-site morbidity. No fistula recurrence was observed during the 2 years of follow-up. This novel procedure offers a viable alternative technique for refractory urethrocutaneous fistula repair.Complications with liposuction are not uncommon; some of these are very serious and can be life-threatening. In this case report, we represent a case of bowel perforation with liposuction.Fournier's gangrene is a life-threatening soft tissue infection requiring aggressive debridement of the perineum. Surgical debridement results in large defects of the scrotum requiring reconstruction for functional coverage of the testes. Several studies have described scrotal reconstruction utilizing split thickness skin grafts or local flaps. These procedures create additional morbidity in an unhealthy patient population. WRW4 This report describes a patient who presents for delayed scrotal reconstruction utilizing tissue expansion. Tissue expander-based reconstruction provides reconstruction of native scrotal soft tissue without additional donor site morbidity. A 40-year-old man presented to an outside hospital with Fournier's gangrene and underwent significant soft tissue debridement. He had an almost complete loss of his native scrotum with his testes surgically banked in his bilateral thighs. He presented to our clinic for a delayed scrotoplasty. The patient was taken to the operating room and a single tissue expander was inserted into the perineum.