At the Frontiers of Plastic and Aesthetic Surgery

Free flaps from the lower abdomen represent the workhorses of modern autologous, microvascular breast reconstruction. Rare signs of venous congestion often become evident during the primary index operation, but a secondary shift of the initially dominant drainage of the DIEV system to the SIEV system with consequent malperfusion is a feared, rare event requiring urgent decision, and complex skill using vein grafts and additional anastomosis to restore a sufficient venous outflow. For secondary anastomosis of the SIEV, especially in stacked flaps, a vein graft to the DIEV or retrograde IMV may be necessary, but this requires an additional donor site, thus prolonging procedure time during the emergency operation and resulting in additional scars of the graft’s donor site. We report on a versatile, easy technique of scheduled inframammary fold banking of the dissected, flushed, and clipped non-dominant superficial epigastric vein (SIEV) in unilateral autologous breast reconstruction during the index operation. The banked graft may service as an easy and convenient accessible vein graft in the rare event of secondary shifting of the initial dominant drainage of the DIEV to the SIEV system with the need for urgent re-operation. We retrospectively evaluated the management and outcome of all suitable patients receiving autologous breast reconstruction with a unilateral abdominal DIEP or MS-Tram flap accompanied by banking of the SIEV in the breast pocket between 2017 and 2020 in the present study. In two out of 42 patients (4.8%) receiving autologous breast reconstruction with an abdominal DIEP or MS-TRAM flap with banking of the SIEV in the breast pocket, secondary malperfusion of the flap with progressive venous congestion occurred during the first 48 h perioperatively, between 2 and 37 (mean: 19.5) hours after skin closure. In both cases malperfusion was due to secondary SIEV system dominance, and the banked vein was used as an interpositional graft to the retrograde IMV (case 1) or the DIEV (case 2). Revision surgery lasted between 95 and 121 (mean: 108) minutes without the need for further vein graft harvesting, and further healing was uneventful. Based on the limited cases, inframammary fold banking of the non-dominant SIEV is a versatile, beneficial, and feasible concept with scarce additional dissection time and can be done in all unilateral breast reconstructions to have a reliable graft for emergency re-exploration. It is a useful approach in the context of spare part surgery and tissue banking to safeguard against the rare instance of venous congestion and need for an interpositional graft. Full article

Introduction: Hyperbaric oxygen therapy (HBOT) has been used over the past six decades to treat multiple conditions. This systematic review aims to identify and evaluate the clinical outcomes of hyperbaric oxygen therapy in the field of plastic, reconstructive, and aesthetic surgery, found in the literature from the year 2000 to the present. Methods: A systematic review of the literature focused on the conceptual and methodological aspects of the PRISMA Declaration. The search for clinical trials focused on the results of hyperbaric therapy in plastic, reconstructive, and cosmetic surgery. The Newcastle–Ottawa scale suggested by the Cochrane manual was applied to each study. The study was carried out with a defined protocol and was registered in PROSPERO, with code CRD42022301261. Results: From the 170 articles identified, 6 were selected. Five of them showed that hyperbaric oxygen therapy favored the reduction of the size of skin ulcers and increased the formation of granulation tissue (two trials; p < 0.05), increased the partial pressure of transcutaneous oxygen in patients with free flaps (one trial; p < 0.001), reduced perfusion in keloid scarring disorder (one trial; p < 0.01), and accelerated both the fading of melanin pigmentation and the decrease in age spot size (one trial; p < 0.05). The methodological quality was moderate in all cases because there was no blinding method reported. One study failed to find differences in flap survival, time to resolution of venous congestion, resolution of edema, and postoperative recovery period (p > 0.05). Conclusions: Hyperbaric oxygen therapy has been increasingly used in the field of plastic and reconstructive surgery, and has shown potential benefits in promoting wound healing, reducing the risk of infection, and improving the survival of tissues used in reconstructive procedures. Further research with more rigorous clinical trials is needed to fully understand the efficacy and optimal use of this therapy in the field of plastic and reconstructive surgery. Full article

Ameloblastoma is a benign yet locally invasive odontogenic neoplasm, characterised by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, with recurrence commonly occurring. The safety margin of resection is hence essential to avoid recurrence. Understanding the three-dimensional anatomy for reconstruction of mandibular defects after tumour resection often poses problems for head and neck surgeons. Historically, various autografts and alloplastic materials have been used in the reconstruction of these types of defects. Over time, advances in technology with computed tomography scanners and three-dimensional images enhance the surgical planning and management of maxillofacial tumours. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is vital for the clinical outcome. The objective of this paper was to report a clinical case of employing these methodologies for reconstruction after an extensive mandibular resection. The clinical outcomes were observed. A case of follicular ameloblastoma of the mandible is depicted in the following paper, where a 3D biomodel was used throughout the surgery. A 3D printed patient-specific titanium implant was manufactured and placed intraoperatively for reconstruction. The treatment had satisfactory postoperative results without complications. Titanium implants being bioinert, customisable and easily workable, especially with the help of 3D virtual planning techniques, can be considered as ideal alloplastic materials for mandibular reconstruction. Full article