Brachioplasty technique with the use of molds

Over previous years many surgical techniques have been developed to correct lipodystrophy and brachial skin laxity while providing a natural, discreet contour and symmetrical scars, a goal that has not always been achieved. In this study, the authors classify the alterations of the arm into three degrees and propose a different surgical treatment, to be used alone or associated with another procedure, for each classification. They developed a new technique that uses a mold to mark the incision in an italic double S-shape. From 1996 to 1998, 20 patients who underwent this surgery showed symmetrical and smaller scars with better results and minimal complications.     

Open rhinoplasty without skin-columella incision

For the last 4 years, the author has been using the open lower cartilaginous vault rhinoplasty, making an external cutaneous incision on the columella. After observing the improved results in patients with nasal tip, lateral crura, and medial crura difficulties, the author widely recommends the use of this procedure in selected patients. In addition to multiple advantages which have been reported useful in open-tip rhinoplasty in the past, the author has contributed two additional advantages: that it avoids scarring columella skin and that it can be extended to cope with defects of the entire lower cartilaginous vault. Disadvantages are some residual edema in some patients over a 6-months period and prolongation of operating time.     

Right Kocher's incision: a feasible and effective incision for right hemicolectomy. A retrospective study

ABSTRACT: BACKGROUND: The choice of incision in any surgery is determined by access to the surgical field, particularly when oncologic resection is required. Special consideration is also given to postoperative pain and its sequelae, fewer complications in the early post-operative period and a lower occurrence of incisional hernias. The aim of this study was to compare two types of incision, a right-sided Kocher's incision (KI) and a midline incision (MI), for patients undergoing right hemicolectomy, by focusing on on both short-term and long-term results. METHODS: The hospital records for 213 patients who had undergone right hemicolectomy for a rightsided adenocarcinoma between 1995 and 2009 were retrospectively studied. In total, 113 patients had been operated via KI and 100 patients via MI. Demographic details, operative data (explorative access to the peritoneal cavity, time of operation), recovery parameters (time with intravenous analgesic medication, time to first oral fluid intake, first solid meal, time to discharge), and oncologic parameters (lymph-node harvest, tumor, node, metastasis (TNM) stage, and resection margins) were analyzed. Post-operative complications were also recorded. The two groups were retrospectively well matched with respect to demographic parameters and the oncologic status of the tumor. RESULTS: The median length of the MI was slightly longer (120 versus 100 mm, P < 0.05). The median duration of the surgery for the KI group was significantly shorter (70 versus 85 minutes, P < 0.001). In three patients we performed wedge resection of liver metastasis, and in one patient we performed a typical right hepatectomy, which lasted 190 minutes. No major operative complications were noted. There was no immediate or 30-day post-operative mortality. The KI group had a significantly shorter median hospital stay (5 days) than the MI group (8 days). All patients underwent wide tumor excision, and clear resection margins were obtained in all cases. No significant differences in analgesia requirement or early postoperative complications were noted. Late post-operative complications includedt hree cases of obstructive ileus (a single episode of each that resolved conservatively) and two cases of incisional hernias. CONCLUSIONS: The KIn approach for right-sided colon cancer is technically feasible, safe, andl very well tolerated overal. It can achieve the same standards of tumor resection and surgical field accessibility as the MI, with a reduction in post-operative recovery time.     

"Zigzag" wavy-line periareolar incision

There is almost no mention of improvement in the aesthetics of areolar incisions in the plastic and reconstructive surgery literature. The most visible area of the breast is the central mound; therefore, it behooves surgeons to make an areolar incision as inconspicuous as possible. Minimal incision breast operations and short-scar operations, such as mastopexy and vertical reduction mammaplasty, use a circumareolar incision. This circumareolar technique, which specifically avoids a purse-string support suture, is useful in all periareolar incisions. This method creates a scar that mimics the elusive, natural irregularity between the areola and periareolar skin. The goal is to have an irregular, random, wavy line that appears more natural. Between August of 1998 and August of 1999, 104 "zigzag" wavy-line procedures were performed. The complications seen in this series included delayed healing in four patients and hypertrophic scar in two patients. No scars were surgically revised. The results demonstrated a definite difference compared to a circular scar. The zigzag wavy-line technique complements the innovative methods that shorten scars while they create a more natural, lasting breast mound. For areolar incisions, good results are deceptively subtle, but unnatural results can be painfully obvious. The zigzag wavy-line incision subtly eludes the eye in diminishing the signs the patient has undergone an operation.