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Three-dimensional (3D) surface imaging has found its place in aesthetic surgery globally. The first attempt to use 3D surface imaging technique in clinic was in 1944 by Thalmaan, who used stereo photogrammetry to examine an adult with facial asymmetry and a baby with Pierre Robin syndrome. Three-dimensional photography is becoming more common allowing for a more dynamic facial evaluation, although it is associated with increased cost., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Cosmetic rhinoplasty involves surgical manipulation of the nasal cartilages, nasal bones, lining mucosa and extracartilaginous soft. The nasal tip is a complex composite arrangement of tissues. These structures are responsible for creating individuality and asymmetries and for controlling nasal air entry and valving. Medical aesthetics involves filling relevant areas of the tip with hyaluronic acid to disguise grooves or soft defect contour defects. Standard tip surgery involves an open or closed approach. Manipulation of the flexible alar cartilage using intracartilaginous and interartilaginous sutures is preferable to resection, and alar base reduction is becoming more prevalent., Competing Interests: Disclosure The author has nothing to disclose., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Background: Recently there have been concerns raised about anaplastic large cell lymphoma (ALCL) associated with breast implants., Objectives: The main aim of this article was to review and analyze the published literature specifically for hematopoietic malignancies associated with breast implants and postulate a hypothesis for their etiology and pathogenesis., Methods: The PubMed database was searched using key words "lymphoma" and "breast implants" for published papers and abstracts on implant-associated hematopoietic malignancies., Results: The authors found 83 published cases reported of lymphomas associated with breast implants in the medical literature. The reported cases involved various subtypes of lymphomas and the majority were ALCL, of which 66 were confirmed as ALK negative; however there was no association with any particular type of implant. The more aggressive cases and reported low death rate appeared to be related to the presence of breast masses at the time of presentation rather than effusion. The remaining reports were occasional case reports of T-cell lymphoma, follicular lymphoma, marginal zone B-cell lymphoma, primary effusion lymphoma and lymphoplasmacytic lymphoma., Conclusions: Considering the many thousands of women that have breast implants every year; the compiled data show that there is a very small risk of developing lymphoma. Increased awareness of association between implants and ALCL is needed globally and prospective patients considering breast implants should be fully informed of the risk. As the behavior of ALCL in these cases was indolent as compared with other primary breast lymphomas, it could suggest an abnormal reactive process., Level of Evidence: 3, (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Since the first description of "The free abdominoplasty flap for breast reconstruction" by Hans Holmstrom in 1979, [see Ref. 1] the use of lower abdominal tissue has revolutionised reconstruction of the breast. DIEP (deep inferior epigastric perforator) free flap offers an abundance of reconstructive material, aesthetically-pleasing results and limited donor site morbidity. We report our first case of breast reconstruction with what presently is known as DIEP flap, performed in 1991 at St. Andrew's Centre for Plastic Surgery and Burns in Essex, The United Kingdom and the recent follow up results. We also discuss the historical events surrounding the evolution of this unpublished case and other documented cases., (Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Polyurethane-coated conical implants were introduced by Silimed (US distributor: Sientra, Santa Barbara, California) in 2008 and offer an alternative to round or anatomically shaped implants. By their design and volume distribution, they naturally create central volume and give a reasonable fullness to the upper pole while lifting some ptotic breasts, thus avoiding the need for classical mastopexy., Objectives: The authors discuss the advantages of conical implants as an alternative to conventional silicone implants for women with breast ptosis., Methods: In the 2-year period between December 2010 and December 2012, a consecutive series of 302 women underwent implant-based breast surgery procedures (236 primary augmentations, 59 revisions, and 7 mastopexy-augmentations) with conical polyurethane devices. Implant volumes ranged from 225 to 560 cc, with low- to medium-profile devices predominating. No extra-high-profile implants were used. Only 1 patient had a drain inserted on completion of a revision augmentation., Results: There were no infections (0%) and no wound dehiscence (0%). Four cases required reoperation (1.3%). Patient satisfaction scores were universally high (average, 9.94/10). There have been no capsular contractures to date, but follow-up is short., Conclusion: The modern conical, polyurethane implant has many advantages over the conventional round or anatomically shaped implants and offers patients an ideal compromise between volume, natural upper pole fullness, and a lift without mastopexy scars.

Unlabelled: Abdominoplasty is a surgical procedure designed to rejuvenate truncal aesthetics, in which restoring "normal" waistline definition is one of the most challenging elements. Advancement in surgical techniques is reducing surgical risk and improving aesthetic outcomes. In this study we adopted the "Brazilian" abdominoplasty technique, originally presented by Ramos at the International Society of Plastic Surgeons Meeting in Australia (2008). Waist definition is improved by medially advancing Scarpa's fascia and repairing any divarication of the rectus abdominis muscles before vertically reducing redundant skin. In our study we demonstrated the role of Scarpa's fascia as an important part of the superficial fascial system, which helps define waist contour. The technique we demonstrate shows improved contouring and waist definition with lower complication rates (by minimising dissection and dead spaces)., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Surgeons are commonly confronted with breast contour deformities and defects that result from previous surgical interventions. These soft tissue deformities can be corrected by conventional reconstructive flap surgery using autologous tissue, but there can be donor site morbidity. Smaller volume replacement is possible using temporary fillers such as hyaluronic acid or polylactic acid, or by using 'permanent' fillers such as autologous fat, but large defects are notoriously difficult to fill and often the fillers resorb or migrate. The patient described in this case report had an exchange of polyurethane implant (PU) in the left breast and correction of a contralateral breast contour filling deformity. A left breast partial capsulectomy was performed after implant removal and the capsule graft was inserted into a predissected pocket where soft tissue augmentation was required. A biopsy from the PU capsule was reported to show a foreign body type giant cell reaction to PU material in a fibrous capsule, lined by synovial metaplasia. The post-operative result showed satisfactory soft tissue revolumisation. PU breast implant structured capsule has thus been used as filler to correct breast soft tissue deformity and contour defects. Clearly it may have a use in other anatomical sites., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Yannas and Burke developed the concept of the dermal regeneration template in the 1970s. It is now a widely accepted tool in the treatment of burns as well as in reconstructive surgery., Methods: The authors present a previously published study of Integra used in 20 consecutive patients to reconstruct 30 anatomical sites and then analyze the histologic and clinical outcomes. Wound healing was evaluated by examination of weekly punch biopsy specimens with standard and immunohistochemical stains. Patient satisfaction was assessed using a visual analogue scale, and scar appearance was assessed using a modified Vancouver Scar Scale., Results: Four distinct phases of dermal regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. Patients reported increased range of movement and improvement in appearance compared with their preoperative states., Conclusions: The color of the matrix reflected the stage of neodermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal dermal collagen. The authors also present their current protocol and experience with using Integra for a range of reconstructive procedures.

Contour defects resulting in deformity caused by lack of tissue can be improved by conventional surgery using autologous tissue, but there is always a donor site morbidity. Integra has been available since the early 1980's for use in acute burns and more recently in reconstruction. It has been shown histologically to act as a tissue regeneration template. The regenerated dermis is buried under an autologous thin split-skin graft. In this study, the principle of burying Integra (without the silicone layer) has been applied to deep tissue defects in 12 reconstructive cases. Such regenerated tissues survive at least 3 years after burying. Modification to the technique to avoid visible edges are being developed.

Face-lifting is now a common aesthetic procedure, performed mainly by plastic surgeons but increasingly also by ENT surgeons, oral surgeons, general surgeons and dermatologists. The level of expertise is dependent on training and exposure to patients, in addition to basic surgical skills. With cosmetic surgery clients, a holistic approach to patients is becoming increasingly important and, with increasing demands from the Care Standards Committee, there should be less demand for part-time aesthetic surgeons. This paper describes the working practice and thought processes of a single surgeon, based on 14 years of a busy aesthetic surgery practice. There are numerous types of face-lift described in the literature but, in practical terms, the simplest technique often gives the best result, with little risk of morbidity. Undoubtedly, some clients need an aggressive approach but, in most cases, the vertical pull mini-face-lift gives consistently good results in cases that are carefully assessed preoperatively and managed by skilled aesthetic/plastic nurses in the postoperative period. This paper is unique in its holistic approach to assessment, technique and aftercare. It is designed for the sensible surgeon, looking for a low-risk technique that reaps professional satisfaction and a happy client base. The more complex face-lift should be referred to recognized specialists in the field.

Integra dermal regeneration template (Integra Life Sciences, Plainsboro, N.J.) is an effective treatment for full-thickness burns. It can also be useful in contracture release procedures; however, the clinical utility of a dermal regeneration template in contracture release procedures has not been adequately characterized. In this multicenter investigation, the outcomes of release procedures incorporating a dermal regeneration template for 89 consecutive patients, who underwent a total of 127 contracture releases, were retrospectively evaluated. The procedures involved the application of Integra, which includes a temporary silicone epidermal substitute and an artificial dermal layer. After formation of a neodermis, the silicone layer is removed and replaced with an epidermal autograft. Data on patient and contracture site history, treatment methods, physician assessments of range of motion or function, patient satisfaction, recurrence, and adverse events were collected with a standardized questionnaire. Release procedures for the study patients involved the neck, axilla, trunk, elbow, knee, hand, and other anatomical sites. The mean postoperative follow-up period was 11.4 months. At 76 percent of the release sites, range of motion or function was rated as good (significant improvement in range of motion or function) or excellent (maximal range of motion or function possible) by physicians. Responding patients expressed satisfaction with the overall results of treatment at 82 percent of the sites. No recurrence of contracture at 75 percent of the sites was observed during follow-up monitoring. Patient age and prior surgical treatment at the site did not significantly affect the results of treatment. However, outcomes were superior at mature sites, i.e., those for which more than 12 months had elapsed since the original injury. Postoperative complications rarely necessitated regrafting. These results indicate that a dermal regeneration template provides a useful alternative technique for contracture release procedures. The study data indicate that this approach leads to favorable functional outcomes and a high rate of patient satisfaction. This modality also seems to be versatile, because a range of anatomical sites are amenable to treatment with a dermal regeneration template, regardless of prior surgical treatment, and both pediatric and adult patients respond well to this form of therapy. Furthermore, Integra confers functional and cosmetic benefits similar to those of full-thickness grafts but without comparable potential for donor-site morbidity.

We report a head and neck full-thickness burn injury that was reconstructed with a tissue-engineered dermal template and then early implantation of microdissected hair follicles through the silicone epidermis 12 days after the burn injury. The treatment resulted in complete reepithelialization and a hair-bearing scalp without the need for a split-thickness skin graft. Restoration of the stem cell population, hair growth, and earlier reepithelialization were achieved using this novel micrografting technique, and histologic examination confirmed maturation of a normal skin type over the subsequent 2 years.

Despite the recent improvements in cell culture and dermal regeneration methods, tissue engineering of skin has yet to receive widespread acceptance in the management of burn injuries. The reasons for this are complex and include not only the inherent costs of (particularly) setting up and running such a system but also the continuing difficulties in achieving successful engraftment of the neoepidermis. The latter has previously been addressed in a number of ways, including improving the recipient bed and using pre-confluent delivery systems to allow earlier application of cells to that wound bed. One area that has received little attention is that of the optimal wound dressing to use with this technology; the cells are very poorly attached at early time points, and, in this context, the traditional dressing of paraffin gauze has never been formally assessed in comparison with newer materials. Using a porcine acute wound chamber model, we performed a prospective randomised trial to assess four different wound dressings with reference to the amount of epidermal cover gained and the histological quality of the regenerated skin after 3 weeks. Out of the four materials tested, polyurethane foam (Allevyn) was superior histologically (although equal in take rate with paraffin gauze), whilst polythene sheet (Opsite) and silicone sheet were substantially inferior. We conclude that the traditional dressing used with this technology should be compared with polyurethane foam in a clinical trial. In the future, novel dressings should be formally tested against traditional methods before being adopted., (Copyright 2001 The British Association of Plastic Surgeons.)

The treatment of extensive burn injuries has been enhanced by the development of artificial skin substitutes. Integra Artificial Skin, an acellular collagen-glycosaminoglycan (C-GAG) dermal equivalent requires a two-stage grafting procedure. However, preseeding the C-GAG dermal equivalent with cultured fibroblasts and keratinocytes, with the aim of performing a single-stage grafting procedure, may be beneficial in terms of replacing the requirement for traditional split-skin grafts. In this comparative in vitro study, the interactions of cultured human dermal fibroblasts and epidermal keratinocytes in Integra Artificial Skin in comparison to cadaver deepidermalized dermis (DED) was investigated. An increase in cell proliferation and migration in the C-GAG dermal equivalent was observed over time. Cocultures of fibroblasts and keratinocytes on both dermal equivalents showed positive expression of proliferation, differentiation, and extracellular matrix (ECM) protein markers. Organization of keratinocytes in the epidermal layers of DED composites were better compared to the C-GAG composites. Deposition of ECM proteins was enhanced in the presence of keratinocytes in both dermal equivalents. Results demonstrate that in vitro the C-GAG dermal equivalent is biocompatible for cell attachment, migration, proliferation, and differentiation. Preseeding Integra Artificial Skin with cultured autologous fibroblasts and keratinocytes for in vivo application, as a single-stage grafting procedure, warrants testing. A better clinical outcome may be achieved as shown by our in vitro results of the coculture composites.

Integra artificial skin was introduced in 1981 and its use in acute surgical management of burns is well established, but Integra has also been used in patients undergoing reconstructive surgery. Over a period of 25 months, the authors used Integra to cover 30 anatomic sites in 20 consecutive patients requiring reconstructive surgery and then analyzed the clinical and histologic outcomes. The most common reason for surgery was release of contracture followed by resurfacing of tight or painful scars. The authors assessed patients' satisfaction using a visual analog scale and scar appearance using a modified Vancouver Burn Index Scale. They evaluated the progress of wound healing by examining weekly punch-biopsy specimens with standard and immunohistochemical stains. Patients reported a 72 percent increase in range of movement, a 62 percent improvement in softness, and a 59 percent improvement in appearance compared with their preoperative states. Pruritus and dryness were the main complaints, and neither was improved much. Four distinct phases of dermal regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. The color of the wound reflected the state of neodermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal dermal collagen. The authors conclude that Integra is a useful tool in reconstructive surgery. The additional cost of its use can be justified by its distinct benefits compared with current methodology.

Eighteen cases of turret exostoses of the hand have been reported, all associated with dorsal injuries. We present a case of turret exostosis involving the volar aspect of the thumb., (Copyright 2000 The British Association of Plastic Surgeons.)

Interleukin-10 (IL-10) is an anti-inflammatory cytokine that has been shown to alter HLA expression in some hemopoietic cells. In skin, the presenting capacity of Langerhans' cells is reduced by IL-10, but little is known about the effect of IL-10 on keratinocytes. Using in vitro experiments, we have shown that IL-10 augments the HLA-DR expression of keratinocytes in the presence of interferon gamma. The increase in HLA-DR expression increased the stimulation and proliferation of allogeneic peripheral blood mononuclear cells, which in turn increased the in vitro rejection of allogeneic keratinocytes. Therefore exogenous application of IL-10 to cultured keratinocytes augments the rejection by allogeneic peripheral blood mononuclear cells in vitro conditions rather than having the suspected protective effect.

Pyoderma gangrenosum is an unusual cause of skin necrosis following surgery, particularly in those without an associated systemic condition. There have been reports of the condition in this context but not in relation to breast reconstruction. We present a case of pyoderma gangrenosum following latissimus dorsi flap reconstruction of a breast., (Copyright 2000 The British Association of Plastic Surgeons.)

Koebner's phenomenon is an uncommon postburn complication. The following report describes a female child who sustained an 80% total body surface area scald which healed with conservative treatment. She developed a cutaneous Aspergillus infection involving only the previously scalded areas. The uninjured skin remained normal. She went on to develop systemic aspergillosis and died of multi-organ failure.

Toxic shock syndrome is associated with burn injuries in children and is a cause of significant morbidity in this group. Despite multiple cases of toxic shock syndrome in adults being reported since its original description it has not been reported in adult burn patients. We report a case of toxic shock syndrome in an adult following 25% flame burns.

Clinical assessment of burns is accurate for very deep and very shallow burns, but it has been suggested that there is a high degree of inaccuracy in the assessment of dermal burns. Histologic analysis has, by some, been considered too time-consuming for routine diagnosis. It also requires an expert skin histopathologist to categorize the depth. With the use of an in vitro model, we have found the use of cryosections and an immunofluorescent staining method to be quicker and more clear-cut than standard light microscopic techniques. We believe this method plays a role in helping to define burns that would benefit from early excision and grafting. However, further investigation is required to transform the method from an experimental model to standard practice in the clinical setting.

The seroprevalence and incidence of Helicobacter pylori infection were determined among 312 North American missionaries who were serving in developing countries between 1967 and 1984. The majority (81%) resided in sub-Saharan Africa. When initially evaluated, the missionaries had a mean age of 40 years, 65% were female, and all were of white race/ethnicity. An ELISA showed that the initial prevalence of IgG antibody to H. pylori was 17%. After a mean of 7.4 years of service (1917 person-years of exposure), 37 (14%) of 259 initially seronegative subjects seroconverted to anti-H. pylori, giving an annual incidence of 1.9%. These data indicate a relatively higher risk of H. pylori infection among missionaries compared with an annual incidence of seroconversion of 0.3-1.0% in industrialized nations. Long-term residents in developing countries should be evaluated for H. pylori infection when gastrointestinal symptoms develop.

Over the last decade, suction-assisted lipoplasty has been shown to be a safe and reliable procedure in the hands of trained individuals. A large number of plastic surgeons employ liposuction as an adjunct to surgery for gynecomastia with excellent results and low morbidity. An unusual problem, traumatic rupture of the pectoralis major muscle, has been observed by us in a patient who had undergone the procedure. The physical deficit arising from the injury may go unnoticed in all but the most physically active people, and surgeons should be wary of the possibility of this previously unreported complication.

Silicone breast implants have been used for augmentation mammoplasty for cosmetic purposes as well as for breast reconstruction following mastectomy for more than three decades. Though the use of the silicone gel filled variety has been banned in the USA except for special cases, they continue to be available elsewhere in the world including the UK. Despite the immense benefit they provide, their usage is associated with some complications. Most of these are related to the surgery and can be reduced by good surgical management. The major complications associated with their use is adverse capsular contracture, an outcome which can be very frustrating to manage. This article reviews the commonly reported complications and suggested management alternatives.

Scleroderma is a connective tissue disorder which includes fibrosis of the skin. Facial skin contraction leads to loss of forehead, periorbital, and nasolabial wrinkling and at the same time causes radial furrows around the contracted oral opening (microstomia). The lips become retracted. We describe a 41 year old lady whose upper lip was treated by free dermal graft and injection of fat to improve her perioral aesthetic appearance. The skin was taken from the right submammary fold and the fat was obtained from the abdomen by liposuction. Excess fat was stored in a sterile container at -70 degrees C for future use. The patient made a satisfactory recovery and has asked for her lower lip to be treated in the same way.

Patients with severe burns are susceptible to infection with Gram-positive organisms including methicillin-resistant Staphylococcus aureus, and often require higher antibiotic dosages compared with other patients. This study examined the pharmacokinetics of a single iv dose of teicoplanin (12 mg/kg) in 15 adults and five children with severe burns. Adults were aged 21-82 years with a median total body surface area (TBSA) burn of 30% (range 15-60%). Children were aged 10 months-l0 years with median TBSA burn of 15% (10-30%). At 12 h, the median serum teicoplanin concentration was 12.8 mg/L (9.027.1 mg/L) in adults and 7.6 mg/L (6.6-l0.8 mg/L) in children, (P < 0.01); at 24 h, the corresponding values were 8.3 mg/L (4.6-l2.9 mg/L) and 5.2 mg/L (4.2-6.0 mg/L). Using a three-compartment model, the median terminal half life in adults was 114 h (47-278 h). Children fitted a two-compartment model with a terminal half-life of 38 h (2l-41 h). The median concentration of teicoplanin in fluid from the burn wound was 60% of the serum antibiotic concentration. A single iv dose of 12 mg/kg of teicoplanin was sufficient to produce therapeutic serum concentrations in burn patients for 24 h, but monitoring of antibiotic levels in serum may be advisable in those with high total clearance, especially children.

The seroprevalence and incidence of hepatitis A, B, C, and E virus infection were determined among North American missionaries (n = 328) serving in various geographic locations between 1967 and 1984. The mean age of subjects at entry into the study was 39.7 years (range 5-73 years); 65% were female; 89% had lived outside the United States before the study began. Seventy-eight percent of subjects served in sub-Saharan Africa during the study. At initial evaluation, 50.9% of the subjects had antibodies to hepatitis A virus (total anti-HAV), 8.5% to hepatitis B virus core antigen (total anti-HBc), 0.6% to hepatitis C virus (total anti-HCV by second-generation immunoblot assay), and 0% to hepatitis E virus (IgG anti-HEV). After an average period of service of 7.3 years (2,396 person-years total), 5.8% of the missionaries seroconverted to anti-HAV, 5.5% to anti-HBc, 0.6% to anti-HCV, and 0% to anti-HEV. This study indicates a relatively low risk of hepatitis C and E virus infection among missionaries while confirming the previously reported high risk of hepatitis A and B virus infection. Hepatitis A and B vaccination is recommended for long-term travelers to developing countries.

Chloroquine continues to have a limited role in the chemoprophylaxis against malaria. Although periodic ophthalmologic examinations are recommended with weekly suppressive dosing, the occurrence of retinopathy associated with this regimen is unproven. Surveillance of career missionaries was conducted to explore the association between total body burden of chloroquine and the development of retinopathy. Five hundred eighty-eight missionaries, reflecting 6,250 person-years of chloroquine exposure were surveyed; 53 persons reflecting 560 person-years exposure with a median cumulative chloroquine dose in excess of 300 g were examined. Only one case of chloroquine-induced retinopathy was detected. This occurred in a missionary who had inappropriately taken chloroquine daily for at least six years as an anti-inflammatory agent for a connective tissue disorder. We also observed that expatriates often overused chloroquine because of apprehension about malaria and used the drug for unrelated conditions. Our results failed to demonstrate an association between a weekly chloroquine dosing regimen and drug-induced retinopathy.

Hemangiomas and lymphangiomas remain the most common benign tumors seen by the plastic surgeon that involve a neonate's skin and deeper tissues. A significant number of tumors undergo spontaneous regression and require no treatment. The port wine stain (PWS) remains one of the most difficult variants of hemangiomas to treat and continues to be psychologically traumatic throughout a patient's lifetime. Recently, advanced use of laser technology has yielded beneficial results for a significant number of these patients. This report illustrates the incorporation of facelift surgery as an adjunct in the overall management of older patients resulting in decreased use of cosmetics and great improvement in general well being.