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Background: The use of wetting solutions (WSs) during high-volume liposuction is standard; however, the optimal amount of WS and its components and their effect on postoperative complications are unclear. We evaluated the effect of a WS and its components, calculated according to ideal body weight (IBW), on postoperative complications. Methods: High-volume liposuction with a WS containing 0.5 g of lidocaine and 0.5 mg of epinephrine in each liter was performed in 192 patients. Patients who received ≤90 mL/kg of WS were designated as group I and those who received >90 mL/kg of WS as group II. Postoperative complications and adverse events that occurred until discharge were recorded. Results: The mean total amount of epinephrine in the WS was significantly higher for group II (3.5 mg; range, 3.0–4.0 mg) than for group I (2.0 mg; range, 1.8–2.5 mg; p < 0.001), as was the mean total amount of lidocaine (3.5 g [range, 3.5–4.3 g] vs. 2.0 g [range, 1.8–2.5 g], respectively; p < 0.001). No major cardiac or pulmonary complications occurred in either group. Administration of >90 mL/kg of WS increased the median risk of postoperative nausea 5.3-fold (range, 1.8- to 15.6-fold), that of hypertension 4.9-fold (range, 1.1- to 17.7-fold), and that of hypothermia 4.2-fold (range, 1.1- to 18.5-fold). The two groups had similar postoperative pain scores and blood transfusion rates. Conclusions: The risks of postoperative nausea, vomiting, hypothermia, and hypertension may increase in patients who receive >90 mL/kg of WS calculated according to IBW during high-volume liposuction. [ABSTRACT FROM AUTHOR]

The article compares reconstruction with free muscle flap and anterolateral thigh perforator flaps (ALT) among 29 patients, sixteen of which had ALT flaps and thirteen had muscle flaps. Results were compared using flap scores and complications, operative time, hospitalization, gait and shoewear problems. The study concludes that ALT flap diminishes donor site morbidity and is ideal for soft tissue reconstruction of the dorsal foot, heel and plantar foot, while muscle flaps offer less complicated tissue transfers and are preferred at the ankle region.

The article describes free anterolateral thigh flap (ALT) as a means to reconstruct car tire foot injuries in children. Four patients underwent the procedure with one flap re-explored for hematoma evacuation and salvaged, and all four survived with no donor site complications. The study concludes that ALT flap provides an ideal soft tissue reconstruction for car tire injuries in children, contracts less compared to muscle flaps, and contains a vascularized fascia that can be used for extensor tendon reconstruction.

Prefabrication and prelamination are experimental and clinical applications of reconstructive surgery and inspired the vascularization challenge of engineered tissues. The purpose of this study is to test the efficiency of "minimally invasive transfer of angiosomes" to enhance the vascularization of the final construct during prefabrication and prelamination. Fifteen rabbits were used for this study. Three of the animals were used in a pilot study to develop the protocol. During the study, thoracodorsal and lateral thoracic vascular pedicles on each side constituted 4 study groups. The pedicles were prepared to simulate prelamination with and without transfer of angiosomes, and prefabrication with and without transfer of angiosomes. In all of the groups, a 10 x 15 mm auricular cartilage graft was used as the construct to be vascularized. After 2 weeks, vascularization of the grafts was evaluated by means of microangiography and histology. Results indicate that both prelamination and prefabrication with transfer of angiosomes displayed better vascularization, both qualitatively and quantitatively. However, prelamination with transfer of angiosomes group displayed distinct statistical superiority. The results suggest that minimally invasive transfer of angiosomes coupled with the procedure significantly increases the induction of angiogenesis during prelamination and prefabrication.

Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap to reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds more practical and creative to use a free-style manner during pedicled perforator flap surgery, instead of being obliged to predefined templates for this type of procedure.

Background: Reconstruction of defects around the ankle region has always been challenging for plastic surgeons. Distally based lateral and medial leg adipofascial flaps are among the flaps of choice for coverage of this difficult region. Presented here is the authors' clinical experience with these flaps, particularly emphasizing the complicated attempts in diabetic patients., Methods: Seven skin defects around the ankle were reconstructed with lateral and medial leg adipofascial flaps. The lowermost perforators of the peroneal or posterior tibial artery were identified preoperatively, and a straight incision through skin only was made proximal to this perforator. With the skin flaps reflected, the adipofascial flap was than raised in the subfascial plane. The perforators to be retained in the base were located and the flap was then turned over to cover the defect, followed by application of a split-thickness skin graft over the flap. The donor site was closed primarily., Results: The ages of the patients ranged from 25 to 80 years, and the size of the flaps ranged from 3 x 5 cm to 7 x 10 cm. Four defects were reconstructed with lateral leg adipofascial flaps, and medial leg adipofascial flaps were used in three. Two flaps healed uneventfully. Partial or total graft loss and partial flap necrosis were observed in five patients, four of whom were diabetic., Conclusions: Leg adipofascial flaps offer a valuable option for repair of defects around the ankle in many cases. However, adipofascial flaps should be used with caution in old, diabetic patients and, when performed, the probability of a second or third procedure should be considered.

Diabetic ulcers located in the plantar surface of the great toe resist conservative treatment modalities including skin grafts and usually require flap coverage for a stable reconstruction. Free tissue transfer is not feasible in these patients, because these defects are closely associated with peripheral vascular disease and local flap alternatives are extremely limited in this region. Reported here is the use of homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients with encouraging results.

Breasts are known to show cyclic changes in accordance with the menstrual cycle, and speculations have been made regarding the ideal timing of breast surgery in this extent, but the clinical evidence to support global acceptance and application is lacking. This study was designed to establish the relationship of intraoperative bleeding and postoperative drainage with the menstrual period of 35 reduction mammaplasty patients. The results indicate that both perioperative blood loss and postoperative drainage were significantly reduced when breast reduction is performed during the periovulatory phase compared with the perimenstrual phase. The authors strongly recommend the interval between days 8 and 20 of the menstrual cycle as a more convenient period to perform breast reduction. Drains may be avoided during this period, but they are preferred if the surgery is done during the perimenstrual phase.

Surgery is accepted as one of the most demanding professions that create both physical and mental strain on the performers. Therefore, the authors aimed to elucidate the mental burden of surgeons, which is dedicated to operative stress. They also tested the hypotheses that participating in surgery creates mental stress on surgeons that leads to cardiovascular changes, and that this stress is more pronounced for actual operators than for first assistants. The method chosen for this purpose was an analysis of heart rate variability. Twelve surgeons (five plastic surgery staff and seven plastic surgery residents) were monitored by a digital ambulatory Holter recorder on at least two occasions. Half of the recordings were carried out on operating days and the other half on office days. Heart rate variability indices (low frequency, high frequency, high frequency/low frequency ratio, and heart rate) were analyzed from those recordings using computerized research tool software. The heart rate variability indices of the operators showed statistically significant differences between operating days and office hours in favor of an increased sympathetic and decreased parasympathetic activity for the former. For first assistants, three of the parameters, with the exception of heart rate, changed in favor of a sympathetic predominance over parasympathetic activity; these changes were also statistically significant. These results showed a sympathetic hyperactivity for both operators and first assistants during the operations. When the sympathovagal balance of the actual operators was compared with that of assistants, the former group showed a more pronounced sympathetic arousal. This difference is accepted as a proof for the mental stress of the surgery being the main factor responsible for the sympathetic hyperactivity that we detected during the operations. Surgeons continuously face a unique mental strain that other professions rarely bring forth, and these psychological stressors are associated with alterations in cardiac autonomic control that may contribute to the development of cardiac disease. Prolonged sympathetic hyperactivity could anticipate cardiac discomfort in more experienced surgeons with marginal cardiac reserve. Such cardiac diseases would be reconsidered as occupation-related illnesses, which might be reimbursed to the physician. In addition, the legal responsibility of surgeons concerning their unfavorable results might be assessed with more understanding with a realization of their undue working conditions.