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Background: The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction.Methods: A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing of the native skin and flap skin.Results: A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated DIEP flaps in 45 patients were tested at different follow-up time points. Nerve coaptation was significantly associated with lower monofilament values in all areas of the reconstructed breast (adjusted difference, -1.2; p Conclusions: This study demonstrated that nerve coaptation in DIEP flap breast reconstruction is associated with a significantly better sensory recovery in all areas of the reconstructed breast compared with noninnervated flaps. The length of follow-up was significantly associated with the sensory recovery.

Background: The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors' group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced.Methods: A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site.Results: A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent.Conclusions: The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors' second choice after the deep inferior epigastric artery perforator flap.

Background: Three-dimensional (3D) camera systems are increasingly used for computerized volume calculations. In this study we investigate whether the Vectra XT 3D imaging system is a reliable tool for determination of breast volume in clinical practice. It is compared with the current gold standard in literature, magnetic resonance imaging (MRI), and current clinical practice (plastic surgeon's clinical estimation).Methods: Breast volumes of 29 patients (53 breasts) were evaluated. 3D images were acquired by Vectra XT 3D imaging system. Pre-existing breast MRI images were collected. Both imaging techniques were used for volume analyses, calculated by two independent investigators. Breast volume estimations were done by plastic surgeons during outpatient consultations. All volume measurements were compared using paired samples t-test, intra-class correlation coefficient, Pearson's correlation, and Bland-Altman analysis.Results: Two 3D breast volume measurements showed an excellent reliability (intra-class correlation coefficient: 0.991), which was comparable to the reliability of MRI measurements (intra-class correlation coefficient: 0.990). Mean (SD) breast volume measured with 3D breast volume was 454 cm(3) (157) and with MRI was 687 cm(3) (312). These volumes were significantly different, but a linear association could be found: y(MRI) = 1.58 x (3D) - 40. Three-dimensional breast volume was not significantly different from volume estimation made by plastic surgeons (472 cm(3) (69), P = 0.323).Conclusions: The 3D imaging system measures lower volumes for breasts than MRI. However, 3D measurements show a linear association with MRI and have excellent reliability, making them an objective and reproducible measuring method suitable for clinical practice.

INTRODUCTION: During the last 2 decades, the incidence of positional plagiocephaly and brachycephaly has increased. Treatment options are conservative and can include physiotherapy and molding helmet therapy. The decision to start helmet therapy is based on patient history and subjective assessment of cranial shape by the physician and the parents. Recently, a noninvasive, objective, reliable, and valid measurement instrument became available: the plagiocephalometry (PCM). Because there are no data available comparing the result of PCM with subjective assessment of cranial shape, we performed the current study. METHODS: All consecutive children with positional plagiocephaly and brachycephaly admitted to the craniofacial outpatient clinic between October 2008 and July 2009 were included. Physician and parents assessed the cranial shape of the child, using a numeric scale from 1 to 10. In consultation with the parents, the physician decided whether helmet therapy was indicated. Plagiocephalometry was performed after visit to the physician. RESULTS: We included 75 patients in our study. There was a significant correlation between the numeric score from the physician and both the oblique diameter difference index (P < 0.001) and the cranial proportional index (P = 0.023). There was no significant correlation between the numeric score from the parents and both the oblique diameter difference index (P = 0.427) and the cranial proportional index (P = 0.155). CONCLUSIONS: There is a significant correlation between the subjective assessment of cranial shape by the physician and PCM results. Plagiocephalometry can be a useful additive tool to assess cranial shape.

Supplemental Digital Content is available in the text., Background: Combining liposuction with abdominoplasties was considered risky during the 1980s and 1990s due to reports of increased complications rates and the belief that liposuction posed a danger to flap circulation. However, the corresponding author’s intraoperative observations at that time, that liposuction preserved all but the smallest blood vessels, negated the prevailing opinions that liposuction increased the risk to flap circulation, and in October 1996, liposuction assisted abdominoplasty (LAA) was first performed. Thereafter, LAA was honed to become a lipoabdominoplasty technique—not merely a combination of liposuction and abdominoplasty, a technique that utilizes liposuction as a dissection tool—hydro- and lipo-dissection, to dissect free and separate the abdominal flap from the deep fascia. Enhanced flap excursion could be demonstrated intraoperatively by selectively transecting the skin retaining ligaments and limiting liposuction to the flap’s undersurface, created a vascular lining layer rich in anastomosing blood vessels that provided a rich blood supply to the flap, enabling increased flap excursion. Methods: Five ninety-three consecutive ambulatory LAAs with circumferential torso liposuction and other area liposuction are presented and the surgical technique is illustrated and discussed. Results: There were no serious adverse events, anesthesia complications, hospital transfers, no venous thromboembolism or postoperative respiratory complications in the 593 cases. Patient satisfaction was high, and the results compared favorably with abdominoplasty results published in the scientific literature. Conclusions: LAA is a safe and effective abdominoplasty technique. Extensive clinical experience with LAA suggests longer flap excursion and improved perfusion. It routinely incorporates circumferential torso and other areas liposuction and has commonly included buttock fat grafting.

Background: Several options are described to treat keloid scars, none of them being 100% successful. Radiotherapy is suggested to have the most significant effect on recurrence rate. Objectives: The aim of the study is to confirm the effectiveness of iridium brachytherapy combined with surgery and to evaluate patient satisfaction. Patients and Methods: We retrospectively enrolled 24 patients with 30 keloids, treated by surgical excision and iridium 192 high-dose-rate (HDR) brachytherapy. Results: We observed a significant difference in scar thickness before and after the treatment (P

To evaluate quality of life (QOL) and parental satisfaction in children diagnosed and treated with molding helmet therapy (MHT) for positional plagiocephaly, a retrospective chart research was performed on 166 children who had visited the craniofacial outpatient clinic in the University Hospital of Maastricht between 2002 and 2003. Two questionnaires were sent to parents of these children. The first was used to measure QOL (TAPQOL questionnaire) and was related to a healthy control group. The second evaluated parents' satisfaction concerning the shape of their children's head before and after treatment. One hundred forty-two children were diagnosed with positional plagiocephaly. The group consisted of 111 boys (78.2%) and 31 girls (21.8%). Ninety-eight patients were treated by MHT and 44 had no treatment. Indications for treatment were an ARGENTA classification of type 3 or worse and subjective rating of head shape by the parents. Parents of all children treated with MHT were sent both questionnaires. Forty-six parents (response rate 47%) returned the questionnaires. This group consisted of 39 boys and eight girls. The healthy control group consisted of 251 children between the ages of 1 and 5 years and was used to validate the questionnaire in a previous study. There were no significant differences in QOL scores between the healthy control group and children treated with molding helmet therapy (P > 0.05). Parents gave an average rating of 3.6 before therapy and 7.5 after therapy, a difference of 3.9. Of 46 parents whose children had MHT, only two would not repeat or recommend this therapy. Reasons were unsatisfying result and, in one case, serious pressure spots with hair loss. The population in this study was similar to other studies. Results showed no difference in QOL between treated children and a healthy control group. This study showed that MHT in children with severe positional plagiocephaly does not have long-term adverse effects on QOL. Differences in subjective rating show that MHT has a good result on head shape. A 96% satisfaction rate shows that it is a pleasant therapy and gives a satisfying result.

Forty-one (impending) fractures were reviewed in 39 patients with metastatic bone disease. Thirty-one lesions were located in the femur, and the remaining ten lesions were located in the humerus. In 22 cases there were multiple lesions in the affected bone. All patients were treated with intramedullary nailing, 21 times because of a pathologic fracture and 20 times because of an impending pathologic fracture. There was no mortality related to the surgical procedures. In nine patients the postoperative course was complicated (four technical and five systemic complications). Pain relief was achieved in 29 patients. Ambulatory status was improved in 27 patients. A pathologic refracture in the same bone occurred in five cases, all located in the femoral neck. Intramedullary nailing is useful in the treatment of metastatic bone disease. This technique facilitates stabilization of the whole bone, which in our view, with respect to the presented data, is mandatory.