Background: Superficial liposuction has found its application in maximizing and creating a lifting effect to achieve a better aesthetic result. Due to initial high complication rates, these procedures were generally accepted as risky. In a response to the increasing concerns over the safety and efficacy of superficial liposuction, the authors describe their 14-year experience of performing superficial liposuction and analysis of postoperative complications associated with these procedures. Methods: From March of 1995 to December of 2008, the authors performed superficial liposuction on 2398 patients. Three subgroups were incorporated according to liposuction methods as follows: power-assisted liposuction alone (subgroup 1), power-assisted liposuction combined with ultrasound energy (subgroup 2), and power-assisted liposuction combined with external ultrasound and postoperative Endermologie (subgroup 3). Statistical analyses for complications were performed among subgroups. Results: The mean age was 42.8 years, mean body mass index was 27.9 kg/m², and mean volume of total aspiration was 5045 cc. Overall complication rate was 8.6 percent (206 patients). Four cases of skin necroses and two cases of infections were included. The most common complication was postoperative contour irregularity. Power-assisted liposuction combined with external ultrasound with or without postoperative Endermologie was seen to decrease the overall complication rate, contour irregularity, and skin necrosis. There were no statistical differences regarding other complications. Conclusion: Superficial liposuction has potential risks for higher complications compared with conventional suction techniques, especially postoperative contour irregularity, which can be minimized with proper selection of candidates for the procedure, avoiding overzealous suctioning of superficial layer, and using a combination of ultrasound energy techniques.

Background: Extensive defects of the lower extremities are usually reconstructed with microvascular free flaps because of inadequate local tissues and wound complexity. Many attempts have been made to reconstruct such defects using the chimeric flap concept, enabling flaps with larger surface areas to be used while maintaining economical tissue use. The latissimus dorsi chimeric flap is one of the most useful tools for resurfacing extensive limb defects. Methods: Twelve patients with extensive lower leg defects underwent reconstruction with latissimus dorsi chimeric flaps between January of 2008 and March of 2012. A skin flap based on the cutaneous perforators, a latissimus dorsi muscle flap based on the muscular branches, and a serratus anterior muscle flap based on the branch from the thoracodorsal artery were harvested accordingly; the flap design depended on the dimensions and characteristics of the defect. Results: A total of 12 chimeric flaps were harvested and used, with the average surface area, including skin and muscle components, being 614 cm². The mean surface area of the skin flaps used was 355.6 cm². The mean area of the latissimus dorsi muscle flap was approximately 228 cm², and the surface areas of the three serratus anterior flaps used were 56 cm², 70 cm², and 180 cm². Flaps survived in all cases. Primary closure was used for all of the donor sites except one, and there was minimal donor-site morbidity. Conclusion: The authors’ results show that the latissimus dorsi chimeric free flap is a useful and versatile reconstructive option for extensive defects of the lower extremities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

In severe, infected scalp defects, locally available tissues are not sufficient for reconstruction and are often unhealthy. In this situation, healthy free tissue transfer offers abundant vascularity of uncompromised tissue that can control infections and a single-stage reconstruction. Between March 2002 and May 2010, 18 patients (20 cases) underwent traumatic scalp defect reconstruction with coincident infections as follows: 16 cases of postcranioplasty infections with previous traumatic open skull fractures and 4 cases of traumatic defects with infections without cranioplasties. Eighteen patients underwent 20 latissimus dorsi free flaps: 8 cases were latissimus dorsi perforator flaps without muscle and 12 cases were latissimus dorsi myocutaneous flaps. The mean flap size was 214 cm². All patients healed well during the follow-up period. A latissimus dorsi flap in the supine position is an alternative for reconstruction of scalp defects with postcranioplasty or traumatic infections.

Pseudoaneurysm of the superficial temporal artery is an unusual complication. Diagnosis is based on clinical findings and radiologic study. The standard treatment is surgical ligation and resection, and other treatment options include radiologic intervention, thrombin injection, and conservative treatment. In this article, the authors report several cases of pseudoaneurysm and suggest a treatment protocol to manage pseudoaneurysm of the superficial temporal artery. We conducted a retrospective review of 11 patients who underwent treatment of superficial temporal artery pseudoaneurysm between April 2002 and July 2011. According to the duration of the aneurysm, we divided the superficial temporal artery pseudoaneurysms into 3 stages: “Acute” stage is less than 3 weeks, “Subacute” stage is from 3 weeks to 3 months, and “Chronic” stage is more than 3 months. Among the 11 patients who were diagnosed with superficial temporal artery pseudoaneurysms, 7 cases were treated by surgical resection, 2 cases by conservative treatment, 2 cases by thrombin injection, and 1 case by radiologic intervention. There was no recurrence during the follow-up periods. The most successful standard treatment is surgical resection. More recently, many nonsurgical treatments have been used, such as conservative treatment, thrombin injection, endovascular embolization, or coiling. Every method has its advantages and disadvantages and should be chosen according to the chronicity and size of the pseudoaneurysm, patient’s clinical status, including hemodynamic stability, patient’s aesthetic preferences, and compliance. The authors suggest a systematic treatment protocol depending on the stage of the pseudoaneurysm, patients’ status, and preferences.