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Objective: The combination of a single pedicle local flap with tattooing for complete nipple areola complex (NAC) reconstruction is currently the most supported method. Although many technical descriptions of NAC reconstruction exist in the medical literature, there are no data that define the ideal areola size (diameter of the areola) after bilateral mastectomy and breast reconstruction considering the previous areola size., Methods: This was a 3-year (2009-2012) observational, analytical, and longitudinal prospective study with 103 patients who had undergone NAC tattooing as the last process of bilateral breast reconstruction after surgery for breast cancer. Statistical differences in the areola size and the jugulum-nipple distance before mastectomy and after reconstruction were analyzed by paired Student t tests with a 95% confidence interval., Results: The jugulum-nipple distance before mastectomy was 4.23 cm larger than after bilateral reconstruction (mean jugulum-nipple distance: 23.89 cm vs 19.66 cm), and for that reason shorter (more cephalad). The areola size before mastectomy was 1.59 cm larger than the one chosen by the patient for reconstruction (mean diameter of the areola: 5.25 cm vs 3.65 cm)., Conclusions: We conclude that, after bilateral mastectomy and reconstruction, the jugulum-nipple distance is smaller and women prefer smaller areola sizes.

Objective: An accurate diagnosis of nasal fracture is dependent on a thorough history and physical examination. The purpose of this investigation was to create a simple method to establish the diagnosis of nasal fracture based only on clinical criteria., Methods: A retrospective chart review was carried out of 220 patients suspected of nasal fracture admitted to a hospital specializing in occupational injuries in 2003 and 2004. Sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each clinical criterion (8), all the possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). The following clinical criteria were considered for the analysis: epistaxis, periorbital and/or perinasal ecchymosis, nasal wound or laceration, airway obstruction, nasal inflammation, lateral deviation, irregular nasal dorsum, and acute septal injury. Logisitic regression was used to assess statistical significance., Results: For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture were very low (<35%). However, specificity and positive predictive values were relatively high (>90%) and increased, respectively, when at least 1 criterion was present (92% and 94%, respectively), when 2 clinical criteria were present (98% and 96%, respectively), and when at least 3 clinical criteria were present (100% for both)., Conclusions: The presentation of the clinical criteria can be a valuable method for the diagnoses of nasal fracture; nevertheless, when these clinical criteria are absent, the possibility of the nasal fracture cannot be ruled out though the possibility is remote.

Objective: The management of lower eyelid reconstruction has a variety of treatment strategies with varying success depending on the patient. We tried to apply the most suitable reconstruction techniques for this particular case., Methods: We report a case of a 99-year-old woman, with a vision loss of 70% in the left eye and 40% in the right eye, who underwent basal cell carcinoma resection of the lower right eyelid 3 months before. The margins of resection and the deepest layers were affected. After the histopathology report, we decided to plan a more aggressive treatment with a total resection of the lower right eyelid. We had a case with 3 added difficulties: the old age of the patient, the vision loss in the contralateral eye, and the size of the resection., Results: On the basis of our experience and the bibliography reviewed, we decided to use the chondromucosal nasal flap for the posterior lamella reconstruction and the transposition flap of von Langenbeck for the anterior lamella. We found it was a good election for this patient since we achieved good functional, anatomical, and aesthetical results with a one-step operation., Conclusions: The chondromucosal nasal flap with the transposition flap of von Langenbeck was a good election for a total lower eyelid defect reconstruction in an old patient with a high vision loss in the contralateral eye.