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Injection of aspirated fat for the correction of tissue defects is a common procedure in plastic surgery. The reported rates of fat cell survival vary greatly in the medical literature, and different techniques of harvesting, processing, and reinjecting the fat cells are claimed to be responsible for these differences. However, there is no agreement concerning the best way to process the harvested fat before reinjection. The present study was initiated to examine and evaluate the effect of a simple method of isolating the fat particles on the outcome of fat graft survival. In this study, the nude mouse model was used to examine the survival and take of the fat graft concentrated before injection by the cumbersome recommended closed centrifugation technique in comparison with the authors' recommended open method, using an operating room cotton towel as a platform for concentrating the fat cells and separating them from fluids, oil, and debris. One milliliter of concentrated human fat cells preprocessed by towel separation was injected into the nuchal subcutis of 11 nude mice in the study group, and the same amount of fat that was preprocessed by centrifugation was injected into 11 control mice. Injected fat survived in both groups. No significant differences were found regarding fat graft weight and volume, although a tendency for better survival was noticed in the experimental group. Histologic evaluation of the grafts revealed significantly less fibrosis within the study group, meaning that the quality of the fat grafts was better. The authors found this method to be simple, cheap, and friendly to the surgeon in comparison with traditional processing using the centrifuge.

Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and 1 case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.

Acute shortening, using the Ilizarov technique followed by progressive lengthening, is one of the methods used to deal with complex fractures combined with severe soft tissue injuries.We have summarized 12 patients who underwent acute shortening and stabilization using the Ilizarov frame. Nine of them underwent progressive lengthening to restore the length. For three patients, angulation of the bone segments was performed to save them from excessive bone debridement.Total wound closure and bone regeneration were achieved in all our patients. Five patients had pin-tract infection without involvement of the bone, and no major complications were noted.Using this technique, we found some advantages. First, there is less need for free and local flaps. Second, there is a decrease in the operating time and donor-site morbidity (important for patients with multiple organ trauma). Third, it provides a good option for restoring defects in severe cases with combined bone and soft tissue defects in the same session. Fourth, its implementation for short bone defects (3 cm) gives acceptable aesthetic and functional results. Fifth, angulation of the segments and subsequent graduated correction of misalignment reduces the length of shortening needed in patients with severe soft tissue loss by sparing the bone from unnecessary debridement. Sixth, it permits definitive treatment using an external fixator device, enabling the possibility of early functional loading. On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries.

A simple method for closure of a defect in the forehead area by four parallel flaps along the forehead wrinkle lines is illustrated. The main advantage of this method lies in its simple design, which enables the surgeon to close large defects with no elevation of the eyebrow, while preserving the hairline, and most of the suture lines are parallel to the forehead wrinkle lines.

In the last two decades, McKissock's technique for reduction mammaplasty was largely replaced by Robbins's inferior pedicle technique. However, a substantial number of plastic surgeons still perform McKissock's technique in the belief that it is superior to the inferior pedicle technique in terms of aesthetic results and complication rate. In this study, the authors compared the aesthetic results, complication rates, and patient satisfaction with the two techniques. Numerous studies in the past few years have shown an improvement in physical symptoms in addition to excellent patient satisfaction after breast reduction. However, almost all of these studies have used questionnaires that were mailed to the patients for evaluation. In the present study, aesthetic evaluations by the surgeon and an objective observer were performed in addition to evaluations by the patients themselves, thereby increasing the objectivity and the significance of the patients' evaluations. Two groups of 24 and 27 patients were compared. The groups were almost identical in terms of demographic data and the amount of breast tissue removed. The aesthetic results were good to excellent in both groups, and the groups had similar complication rates. When the patients' evaluations were compared with those of the surgeon and the objective observer, no significant difference was found between the observer and the patients. In one of the groups, the surgeon's evaluations were significantly higher than those of the patients, although they were not significantly higher than the observer's. In terms of aesthetic results, complication rates, and patient satisfaction, no differences existed between the groups. In addition, the patients' evaluations were determined to be a reliable index of aesthetic results and, in these cases, they were often identical to objective evaluations.

A defined, serum-free cell culture medium supplemented with nonsteroidal anabolic hormones, insulin, thyroxin, and growth hormone was found to accelerate wound healing by stimulating vascularized granulation tissue formation, epithelialization, and angiogenesis. The aim of this work was to study the effect of cell culture medium on the survival rate of cephalically based random dorsal skin flaps in an animal model. A total of 77 Sprague-Dawley rats were randomized into five treatment groups: pharmacologic delay with cell culture medium, flap enhancement with cell culture medium, surgical delay, biological delay with saline, and control. Statistically significant differences in distal flap necrosis were found among all groups (p

The single-pedicle transverse rectus abdominis myocutaneous (TRAM) flap is frequently associated with partial flap necrosis. Hyperbaric oxygen has previously been shown to increase the survival of skin flaps, although there has been no investigation of possible beneficial effects of hyperbaric oxygen on survival of the TRAM flap. The present study compares the effectiveness of hyperbaric oxygen therapy, normobaric 100% oxygen, a hyperbaric air-equivalent mixture, and no treatment at all (control group), in the prevention of TRAM flap necrosis in a rat model. Forty-eight animals were randomly assigned to one of the four above-mentioned groups. The surviving area of the flap was evaluated 7 days after surgery. The hyperbaric oxygen treatment protocol consisted of five 9-minute sessions breathing 100% oxygen at a pressure of 2.5 atmospheres absolute during the first 48 hours, starting within 1 hour of surgery. The areas of surviving skin paddles ranged from 38.5 percent in the control group to 52.5 percent in the group treated with hyperbaric oxygen. One-way analysis of variance indicated that flap area survival was significantly greater in the hyperbaric oxygen group (F = 2.69, p = 0.05). Tukey's pairwise comparison and the two-sample t test indicated that the group treated with hyperbaric oxygen differed significantly from the control group (Tukey's critical value = 3.8, rejection level = 0.05, t test p = 0.01). Our results suggest that the hyperbaric oxygen treatment protocol used improves survival in the rat TRAM flap. However, the optimal treatment protocol to achieve this objective even in the rat seems to be variable, and further studies are required before extrapolating these data to human applications.

This study was performed in an attempt to further elucidate the pathogenesis of delayed postburn blistering. Two cases were studied ultrastructurally and immunohistochemically, 1 with blisters on the recipient site of autologous split-thickness skin grafts and the other on the donor site. Ultrastructurally, the basement membrane was on the roof of the blisters in both cases, except for a single small blister in the first case where it was on the dermal floor. In the blister roofs, the basement membrane showed small or marked segments of discontinuity. In the adjacent non-blistered healed skin, the basement membrane was usually continuous, and anchoring fibrils were present. Immunoperoxidase staining on frozen sections, using antibodies to laminin, laminin 5, collagen IV, and collagen VII, showed a mostly continuous linear pattern in the adjacent non-blistered skin, which often became discontinuous near the blisters and markedly discontinuous in the blister roofs. In the blister floors, weakly stained linear or granular deposits of some of these components were sometimes also present. The results of this study support discontinuity of the basement membrane as the main anomaly in delayed postburn blistering. Disturbance in the reassembly or local breakdown of the basement membrane components might be the underlying defect.

Immediate breast reconstruction with the tissue expander is now established as an accepted procedure after mastectomy, and large series have been published concerning the technique and its complications. Unfortunately, only scarce information is available regarding the long-term aesthetic results and patient satisfaction achieved by immediate reconstruction using tissue expansion. In this study, we reviewed 52 patients who had undergone immediate breast reconstruction using the tissue expander with a follow-up of at least 1 year after completion of the reconstruction. We developed an objective assessment of patient satisfaction, aesthetic results, and the factors affecting them. The results show remarkable concordance of assessment by patient, surgeon, and independent observer: All gave good scores for aesthetic appearance (6.4 to 7.4 on a scale of 1 to 10). A total of 92.3 percent of patients rated their satisfaction as good to excellent. Symmetry was the main parameter influencing the patients' score, while the surgeon's score also was affected by the quality of the inframammary fold and capsular contracture. Breast size, chemotherapy, complications, time interval, and additional procedures had no relation to either scoring or patient satisfaction.

A new approach to deal with post burn knee contracture Yehuda Ullmann a,∗, Alexander Lerner b, Yitzchak Ramon a, Isaac J. Peled a, Michael Sudri b a Burn Unit, Plastic Surgery Department, Faculty of Medicine, Rambam Medical Center, “Technion” Institute of Technology, Haifa, Israel b Orthopedic Department A, Faculty of Medicine, Rambam Medical Center, “Technion” Institute of Technology, Haifa, Israel

Chordee or ventral curvature of the penis is commonly associated with and occasionally without hypospadias. The usual recommended treatment is excision of the fibrous tissue that is responsible for the bowing. This results in a proximal retraction of the meatus. With a different concept and explanation of the ventral curvature, we treat this abnormal condition as a shortage of tissue. More than a hundred consecutive cases of chordee with and without hypospadias were treated by skin release and dorsal to ventral transposition of preputial skin as well as hypospadias repair. The whole procedure is simple, planned as a single-stage operation with less morbidity or fewer complications. The meatus is not pushed back proximally, no dissection distal to the meatus is performed, and there is no need for tissue excision. The results were very successful, with no recurrence of the ventral curvature.

Background. The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated procedures. Objective. To examine the role of frozen storage as a means of preserving the fat obtained by suction-assisted lipectomy for repeated procedures. Methods. Human adipose tissue obtained by suction-assisted lipectomy was stored in a domestic refrigerator at –18°C for 2 weeks. After thawing, the fat was injected into nude mice. In the control group, the fat was injected immediately after the harvesting procedure. Grafts were dissected out and compared 15 weeks postinjection. Results. Injected fat survived in both study and control groups. No significant differences were found between fat graft weight and volume, or in any of the histologic parameters examined. Conclusion. Fat obtained by suction-assisted lipectomy may be preserved for future use by freezing.

A simple and reliable method for securing the cannulated polyethylene tube to the blood vessel wall prior to intravascular dye injection is described. The three-tie technique has been used in many vascular anatomic studies without any leakage of the injection fluid taking place around the tube.

Background: The treatment of distal tibial osteomyelitis represents a challenge for orthopedic and plastic surgeons. The affected tissues should be debrided and good vascularized tissue should cover the defect, but the option of a muscle flap covering the area is limited. Free flaps are used but require longer operating time and experience with microsurgery, may result in donor-site morbidity, and sometimes add bulky tissue to the area. The authors present their experience with a sural musculoneurocutaneous flap for the treatment of chronic osteomyelitis of the distal tibia. Methods: Over a 2-year period, nine distally based sural musculoneurocutaneous flaps were used in the treatment of chronic osteomyelitis of the distal tibia. Four patients had comorbid conditions (smoking, diabetes mellitus, venous insufficiency, or obesity). The clinical aspect was represented by drainage sinuses located in the distal part of the tibia. Five patients had postsurgical scars on the lateral malleolar region and one had medial and lateral malleolar scarring. Three patients had an Ilizarov device at the time of wound coverage. Results: All wounds were closed successfully. Dehiscence surrounding the flap was encountered in a single case that was attributable to inadequate bone debridement; this flap was raised to allow extending the debridement, and a local medial fasciocutaneous flap completed wound coverage. Distal tip necrosis of the flap was encountered in two cases. Conclusions: The sural musculoneurocutaneous sural flap was successfully used for treatment of distal tibia osteomyelitis. Although it is believed that lateral malleolar scars might compromise the flap, the flaps in the authors' series survived. This flap can also be applied to patients with external fixators without removing the apparatus.

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins1 mm were more satisfied after IPL, while those with leg veins1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.

We are reporting herein the result of a 22 cm tibial lengthening after using an acute shortening technique with acute temporary angulation for salvage of a posttraumatic lower limb injury. The patient was referred to our center 2 weeks after a Gustilo IIIB open complex injury to the lower limb that included bone and soft-tissue loss. After surgical debridement, the tibial gap was 22 cm and the soft-tissue defect on the anterior aspect of the calf measured 12 x 20 cm. An acute shortening using a 50 degrees angulation (apex posteriorly) of the tibia in an Ilizarov frame was done after a full assessment of all reconstructive surgical options. After complete wound healing, a progressive correction of the angulation was done. Bilevel tibial distraction at a rate of 1.75 mm/day restored the original lower limb length. The 22 cm tibial elongation included 17 cm proximal lengthening and 5 cm distal lengthening. The fractures consolidated after 371 days, all wounds had closed, and no signs of osteomyelitis were present. Good aesthetic and functional results were obtained. The patient had no leg discrepancy compared to his normal limb and he returned to his previous occupation as a garage mechanic and to his favorite sport, boxing. To our knowledge, this is the first report in the English literature of tibial lengthening of this magnitude following acute trauma.

Adipose tissue injection as a free graft for the correction of soft-tissue defects is a widespread procedure in plastic surgery. The main problem in achieving long-term soft-tissue augmentation is partial absorption of the injected fat and hence the need for overcorrection and re-injection. The purpose of this study was to improve the viability of the injected fat by the use of interleukin-8. The rationale for the use of interleukin-8 was its abilities to accelerate angiogenesis and attract inflammatory cells and fibroblasts, providing the injected adipocytes more feeding vessels and a well-established graft bed to enhance their viability. Human adipose tissue, obtained by suction-assisted lipectomy, was re-injected into the subcutis in the scalp of nude mice. Interleukin-8 (0.25 ng) was injected subcutaneously to the scalp as a preparation of the recipient site 24 hours before the fat injection and was added to the fat graft itself (25 ng per 1 cc of injected fat). In the control group, pure fat without interleukin-8 was injected and no interleukin-8 was added for the preparation of the recipient site. One cubic centimeter of fat was injected in each animal in both the study and control groups. There were 10 animals in each group. The animals were euthanized 15 weeks after the procedure. Graft weight and volume were measured and histologic evaluation was performed. In addition, triglyceride content and adipose cell sizes were measured as parameters for fat cells viability. Histologic analysis demonstrated significantly less cyst formation in the group treated with interleukin-8. No significant differences were found between the groups with regard to graft weight and volume or the other histologic parameters investigated. No significant differences were demonstrated in adipose cell sizes and their triglyceride content. In conclusion, less cyst formation, indicating improved quality of the injected fat, can be obtained by the addition of interleukin-8. Further studies of various dosages of interleukin-8 and their long-term effect are required before these encouraging results could be applied clinically.

A simplified and knifeless technique for otoplasty is presented. Correction of the prominent ear is easily achieved by subcutaneous and transcartilaginous nonabsorbable permanent sutures after cartilage resilience is weakened by needle scoring. This technique was very successful in 11 consecutive cases with up to 30 months of followup.

Exposure of silicone breast implants usually leads to infection and extrusion. According to the literature, implant extrusion rates are not higher than 2% 1 and removal of the implant is recommended. 2 During the past 3 years, the authors dealt with eight implant exposures (six women: two cases of bilateral exposure and four cases of unilateral exposure). All the pockets were infected. Patients were offered two alternatives: immediate removal of the implant and reimplantation after a few months or conservative treatment with an effort to close the exposed area after the discharge stopped. All the patients in this study chose the latter alternative. Four out of eight implants were saved. The authors had to remove the other four. The average follow-up of these women was 2 years and there were no signs of capsular contracture or any other problems. According to this series, 50% of eight exposed breast implants could be saved with conservative treatment.

Congenital auricular deformation is not an uncommon phenomenon, and it may cause substantial annoyance to the growing child. Many parents of affected children will seek surgical correction of the deformed auricles. The variety of techniques that have been described for the correction of this anomaly suggests that none has been considered satisfying. The consequent possible surgical complications should also be considered, when the surgical procedure can be replaced by an effective conservative treatment. The authors describe their experience using early splinting for congenital auricular deformities. Fifty-two newborn infants with lop, prominent, Stahl's, and constricted ears referred to us by the neonatal department staff were enrolled in this study. Putty Soft, a vinyl polysiloxane impression material, has been used for early molding of the auricles. Surgical tapes were used for the fixation of the mold and to fix the auricle to the scalp. The results were evaluated by one of the parents and by a layperson (medical student) 6 months after completion of the procedure. The above-described early splinting procedure was applied onto 92 auricles of 52 newborn infants aged 1 to 10 days, mostly around day 3. The mean treatment time was 6.8 weeks. All treated auricles were improved, 87 percent were rated as excellent improvement, and there were no complications related to the treatment. The authors conclude that early splinting of deformed auricles should be offered to parents of affected children, and the awareness of this procedure by neonatologists, pediatricians, and nursery staff should be increased.

Addressing war injuries requires tailoring treatment that provides the best functional and aesthetic results within a reasonable period of time. The authors report a young soldier who sustained a gunshot injury that caused an open fracture of the proximal tibia and patella (Gustilo type B-III). A local muscle flap could not be used, and thus the authors decided to use the already applied Ilizarov device for gradual expansion of the wound edge. The expanded skin covered the exposed fracture successfully, and later enabled solid union of the fracture. This reconstructive method seems to be an original solution for the management of open fractures, and additional proof that well-vascularized skin may be equivalent to a muscle flap, and may be considered for selected patients.

The widespread use of antibacterial agents for prophylaxis has altered surgical practice markedly in the past 20 years and now represents one of the most frequent uses of antibiotics in hospitals, accounting for as many as half of all antibiotics prescribed. The present study was undertaken to determine the patterns of and reasons for antibacterial agent usage by today's practicing plastic surgeons in Israel. A survey of 78 Israeli plastic surgeons certified by the Israeli Association of Plastic Surgery was conducted. Questionnaires were mailed to all the certified plastic surgeons; 66 (84.6%) were completed and returned. The results indicate that prophylactic antibiotics are administered in a high percentage of aesthetic and reconstructive surgeries except for those in eyelids and nose. Most of the surgeons prefer to prescribe cephalosporins as their antibiotics of choice and the timing of administration is before or at the beginning of surgery. Placement of drains did not change the decision to use prophylaxis. Diabetes mellitus, steroid treatment, and chronic lung disease have a direct influence on the decision to use antibiotics; however, conditions such as ischemic heart disease, hypertension, and cigarette smoking do not influence their use. Personal experience was the main reason for prescribing antimicrobial agents. We conclude that although the infection rate in aesthetic and reconstructive operations is extremely low, most Israeli plastic surgeons still prefer to administer prophylactic antibiotics though no scientific hard data is available.

Reconstruction of the lip following excision of malignant tumors is a frequent task of the plastic surgeon. Adequate oncological treatment must be followed by a satisfactory aesthetic and functional result. A simple and successful technique of lip reconstruction is revisited. It consists in using the remaining lip, which is released by way of a horizontal mucomyocutaneous flap(s) and stretched to fill the gap. Twenty-six consecutive cases of T2-T3 squamous cell carcinoma of the lip were treated using this technique, with excellent aesthetic and functional results.

Reconstruction of the vulva with V-Y advanced triangular myocutaneous gracilis flap(s) is reported. Seven patients were treated with this technique following radical vulvectomy with two minimal complications. The reliability of this known flap and the usefulness of the V-Y advancement are stressed and make it a simple and successful technique.

Injection of aspirated fat is now the most commonly used technique for the filling of depressed areas. Partial absorption of the injected fat is the main limitation of this procedure. Cariel T.M. is an enriched serum-free cell culture medium, its ability to enhance the survival of human aspirated fat grafts was investigated in the nude mouse model. A volume of 0.75-cc Cariel preprocessed fat was injected under the scalp skin of 16 nude mice in the experimental group, and the same volume of saline preprocessed fat was injected to 15 control group of mice. Significant maintenance of the weight, 46 percent in the experimental group compared with 29 percent in the control group (p < 0.008), and the volume, 44 percent in the experimental group compared with 31 percent in the control group (p < 0.026), was observed, after 15 weeks, in this newly used model. It seems that addition of the nutrients enriched with anabolic hormones enabled the survival and take of more adipose cells in the graft.

Intraoperative rapid expansion of soft tissue of the palate is reported. Tissue is recruited by repeated injections of an isotonic solution in a tumescent-like technique, thus producing increasing swelling of the palatal soft tissue. Straight direct closure of palatal clefts and fistulas is achieved with minimal scarring at the midline, no secondary healing of raw surfaces, and satisfactory and encouraging results.

A turnover contralateral cephalic alar cartilage flap is suggested for the correction of cleft nose alar deformity. The cartilage flap from the normal side wraps around the deficient medial crus and acting as a pulley reposition and augments the affected alar cartilage. The satisfactory and long-lasting results obtained in our small series seem to justify this approach for improving cleft nasal deformities, and we think it should be available in our surgical armamentarium.

The surgical anatomy of the upper eyelid fat in the medial compartment was investigated in 388 patients and in 12 cadavers. We found two individual fat pads comprising this compartment. The difference among the investigated cases was found to be the extent of their separation. In 16.7 percent of the cadavers' eyelids the fat pads were entirely separated, in 45.8 percent they were separated to about half their length, while in 37.5 percent only the tips were separated. Among the patients in whom only the protruded fat was inspected, 59.8 percent of the fat pads were separated, and in the rest, only the tips were isolated. On histologic examination we could always identify two well-circumscribed fat pads, each surrounded by a fibrocollagenous tissue. At the level of their interconnection, a loose fibroareolar tissue was found. In practice, during blepharoplasty, both fat pads should be addressed in order to achieve the expected results.

Phenol chemical peeling is a well known ancillary procedure for facial rejuvenation. It may be used as an adjuvant to rhytidoplasty or may be an alternative in selected patients or in patients who refuse to undergo both procedures and prefer a single stage and scarless procedure. The results are very gratifying and long lasting.

An unusual cause of calcinosis cutis is reported in a 73-year-old woman following subcutaneous fluid replacement, 36 years before consultation. Late secondary infection of the calcium deposits, 35 years after the causative event, was followed by local and systemic symptomatology. Healing was only achieved after wide surgical excision of the involved tissue and skin grafting.

A turnover contralateral cephalic alar cartilage flap is suggested for the correction of cleft nose alar deformity. The cartilage flap from the normal side wraps around the deficient medial crus and acting as a pulley reposition and augments the affected alar cartilage. The satisfactory and long-lasting results obtained in our small series seem to justify this approach for improving cleft nasal deformities, and we think it should be available in our surgical armamentarium.

An unusual case of traumatic self-inflicted bite of the lower lip in a 7-year-old girl is presented. As a result of the bite, due to a fall, four fragments of the right upper incisor tooth were embedded in the lower lip. The large tooth fragment appeared 18 days later, protruding through the skin of the lower lip. Radiographs confirmed the presence of these tooth pieces, which were removed under local anesthesia. Early diagnosis and surgical removal of the tooth fragments could prevent undesirable foreign-body reactions and scarring. Language: en

CO2 laser has been used for the treatment of 22 patients with xanthelasma palpebrarum. This office procedure done under local anesthesia is fast and easy. The lipomatous yellow plaques are accurately photovaporized in a bloodless field, layer by layer, until the lesion is totally eradicated. The treated area heals by reepithelization, ostensibly with virtually no scar contraction. All our patients were satisfied with their results, rating them from good to excellent. In 5 patients some pigmentation changes were noted. During follow-up periods varying from 15 to 54 months, only 2 (9%) patients had recurrences, which were retreated successfully. We postulate that treatment of xanthelasma palpebrarum by CO2 laser should be seriously considered in most patients.

Autologous free-fat injection for the correction of soft-tissue defects has become a common procedure in plastic surgery. The main shortcoming of this method for achieving permanent soft-tissue augmentation is the partial absorption of the injected fat, an occurrence that leads to the need for both overcorrection and repeated fat reinjection. Improving the oxygenation of the injected fat has been suggested as a means of helping to overcome the initial critical phase that occurs postinjection (when the fat cells are nourished by osmosis), increasing phagocyte activity, accelerating fibroblast activity and collagen formation, and enhancing angiogenesis. In addition, the hyperbaric oxygen-mediated decrement in endothelial leukocyte adhesion will decrease cytokine release, thereby reducing edema and inflammatory responses. The purpose of the present study was to examine the effect of hyperbaric oxygenation on improving the viability of injected fat. Adipose tissue obtained from human breasts by suction-assisted lipectomy was injected into the subcuticular nuchal region in nude mice. The mice were then exposed to daily hyperbaric oxygen treatments, breathing 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes. The duration of the administered hyperbaric oxygen therapy was 5, 10, or 15 days, according to the study group. Mice exposed to normobaric air alone served as the control group, and each group included 10 animals. The rats were killed 15 weeks after fat injection. The grafts were dissected out, weight and volume were measured, and histologic evaluation was performed. In all of the study groups, at least part of the injected fat survived, giving the desired clinical outcome. No significant differences could be found between the groups regarding fat weight and volume. Histopathologic examination of the dissected grafts demonstrated a significantly better integrity of the fat tissue in the group that received hyperbaric oxygen for 5 days (p = 0.047). This finding was manifested by the presence of well-organized, intact fat cells, along with a normal appearance of the fibrous septa and blood vessels. The worst results were found in animals treated by hyperbaric oxygenation for 15 consecutive days. An inverse correlation was found between an increased dose of the high-pressure oxygen and fat tissue integrity (r = -0.87, p = 0.076). The toxic effects of highly reactive oxygen species on fat cells might explain the failure of an excessively high dose of hyperbaric oxygen to provide any beneficial outcome. The clinical relevance of these results should be further investigated.