Background: Tumescent local anesthesia (TLA) is widely used in esthetic surgery due to its ability to reduce complications, eliminate the need for general anesthesia, provide effective pain control, and shorten hospitalization times. Methods: This study evaluates the use of TLA in 80 patients who underwent augmentation mastopexy between 2010 and 2022. A tumescent solution containing 500 mg lidocaine, 672 mg sodium bicarbonate, and 1 mg epinephrine in 1000 mL of saline was infiltrated, with an average of 300 mL per breast. The surgical technique involved creating a subpectoral pocket for textured round implants (250–400 cc), followed by careful hemostasis. Results: No patients required conversion to general anesthesia, and there were no signs of toxicity or major complications. Minor complications included wound dehiscence (6.2%), hematoma (2.5%), and capsular contracture (2.5%). Pain management satisfaction at 3 months post-surgery was rated as “outstanding” by 12.5% of patients, “excellent” by 67.5%, and “good” by 20%. The longest follow-up was 6 years, with no implant ruptures except one (1.2%). Conclusions: While the study did not include a control group or statistical analysis, the findings suggest that TLA is a safe and effective alternative to general anesthesia for augmentation mastopexy, providing excellent pain control and a low rate of complications.

Background: Involutional lower eyelid ectropion is a common disorder of the elderly population. Several surgical approaches have been described in the literature to address the multifactorial nature of this condition, each targeting different factors contributing to its development. Nevertheless, no single procedure has proven to be superior to the others. This study aims to assess the safety and effectiveness of a new 3-step combined technique in treating involutional ectropion. Methods: The surgical technique consists of a combination of lateral lid-shortening with removal of a base-up triangle (modified Bick procedure), lower eyelid skin release, and transposition of a laterally based myocutaneous flap from the upper eyelid. A retrospective chart review was conducted for all patients treated with this procedure at our institution between 2012 and 2023 was performed. Self-reported patient satisfaction with functional and esthetic outcomes was evaluated three months after surgery. Results: A total of thirty-six patients (forty-five eyelids) were included in the study, with a mean follow-up period of 22 months (range 3–144). Minor surgical revision was performed in one case for early wound dehiscence following premature stitches removal. The overall success rate was 93.2%, with one case of undercorrection and two cases of recurrence recorded at three years postoperatively. No additional complications or recurrences were observed during the follow-up period. Conclusions: The 3-step combined procedure demonstrated high efficacy and safety, offering excellent functional and esthetic outcomes. This approach provides a reliable solution for treating involutional ectropion, making it a valuable addition to the surgical options for this condition.

AIM: High-energy ankle traumas often lead to extensive soft tissue loss and ligament damage, making reconstruction both challenging and crucial for restoring stability and function. This study evaluated the effectiveness of using a free anterolateral thigh (ALT) flap with a fascia lata extension for addressing complex soft tissue defects and repairing the deltoid ligament in complex post-traumatic ankle injuries. CASE PRESENTATION: A 38-year-old man was examined at the Plastic Surgery Unit three months after a motorcycle crash for reconstruction of a soft tissue defect and deltoid ligament repair. Clinical examination revealed a 3 × 5 cm soft tissue defect with bone exposure and ankle instability. Reconstruction was planned and performed using a free ALT flap with an extension of the fascia lata and a fascia lata graft for deltoid ligament repair. No complications of the flap and no clinical signs of local infection were observed. During the follow-up period of 12 months, the ankle stability and the gait were improved with a reduction in pain. RESULTS: No complications related to the flap or clinical signs of infection were observed postoperatively. During the 12-month follow-up period, the patient exhibited improved ankle stability, reduced pain, and enhanced gait. At the one-year follow-up, the patient achieved a satisfactory functional outcome with an American Orthopedic Foot and Ankle Society (AOFAS) score of 79 points. The reconstructed tissue demonstrated adequate coverage, and the deltoid ligament repair provided joint stability. While flap bulkiness necessitated minor debulking surgery, the aesthetic and functional outcomes were satisfactory, with the patient expressing high satisfaction at 15 months post-surgery. CONCLUSIONS: The ALT flap combined with fascia lata graft is a viable option for soft tissue loss and deltoid ligament injury in clinical cases. While the ALT flap offers numerous advantages, including ease of harvest, pedicle length, and versatility, its bulkiness may necessitate revision surgery. However, despite this drawback, the combination of ALT flap and fascia lata demonstrated positive outcomes in our patient, highlighting its effectiveness in providing adequate tissue coverage and repairing the deltoid ligament.

Background/Objectives: High-energy trauma to the lower limb often results in extensive soft tissue loss with exposure of critical structures, posing a serious threat to limb viability. Early and effective coverage is crucial to prevent infection, promote bone healing, and preserve function. This report presents the use of a latissimus dorsi free flap for circumferential soft tissue reconstruction following a severe crush injury. Methods: We describe the case of a young female patient who sustained a high-energy crush trauma with a comminuted, displaced fracture of the middle and distal third of the tibia and complete circumferential soft tissue loss. Due to the extent and location of the defect, a latissimus dorsi free flap was selected for reconstruction. The surgical technique, microsurgical anastomosis, postoperative care, and rehabilitation protocol are detailed. Results: The latissimus dorsi flap provided reliable coverage of the entire defect, protected the underlying bone and hardware, and promoted wound healing. No major complications were observed. Functional recovery was satisfactory, with progressive weight-bearing and joint mobility achieved during follow-up. Conclusions: In complex lower limb injuries with extensive soft tissue damage, free flap transfer remains a key strategy for limb salvage. The latissimus dorsi flap, due to its size, reliability, and versatility, represents a valuable option for circumferential coverage and restoration of limb function following high-energy trauma.

This investigation explores the potential impact of Negative Pressure Wound Therapy (NPWT) dressing on mommy makeover surgical wounds. The focus is on optimizing the healing process and post-surgical care to mitigate complications like wound dehiscence, seroma, and hematoma. A prospective study spanned from October 2015 to April 2022, involving 40 patients undergoing mommy makeover surgery for aesthetic purposes. The randomized division resulted in two groups. Group one (n = 20) had donor sites covered with NPWT dressing, while group two (n = 20) received standard dressings lacking known healing-promoting agents. The assessment of complications served as an index of NPWT efficacy, and scars were evaluated using the Vancouver Scale. Immediate post-surgical use of NPWT dressings significantly expedited wound healing compared to fine-mesh gauze dressings. Furthermore, it almost eradicated discomfort and pain in all patients, indicating excellent compliance. Patients tolerated NPWT well, with no instances of dressing failure or non-compliance. This study underscores the utility of NPWT dressing in managing mommy makeover surgery wounds. The dressing’s bio-occlusive properties create an optimal environment for wound healing, simultaneously minimizing pain, discomfort, and preventing key complications such as seroma and unfavorable scar appearance.

Reconstruction of the calcaneal region presents unique challenges due to its complex anatomy and critical weight-bearing function. This retrospective study aims to report our experience in cases of calcaneal defects repaired with various free flap types, and to evaluate the long-term outcomes of the reconstructions. We retrospectively reviewed 25 patients who underwent microsurgical free flap reconstruction for calcaneal defects between January 1997 and March 2022. Demographics, defect characteristics, surgical techniques, and outcomes were analyzed. Out of the 25 cases, 18 patients (72%) were male, with a median age of 55 years. Successful reconstructions were achieved in 24 patients (96%) using various free flap types: ALT flap (8cases), Parascapular flap (4 cases), Gracilis flap (5 cases), TAP flap (5 cases), Radial forearm flap (2 cases), and in one case, deep circumflex iliac artery (DCIA) osteocutaneous flap. These reconstructions demonstrated good functional recovery and minimal complications. Only one case (4%) experienced flap failure due to venous thrombosis, necessitating revision surgery without success. The most frequent complication was the sliding (6 cases) due to the excessive bulk which was addressed with revision surgery. The average follow-up period was 8 months, with patients regaining satisfactory ambulation and improved quality of life. Based on our results, microsurgical free flap reconstruction has proven to be a valuable technique for addressing calcaneal defects and, according to many Authors, it offers a high success rate and favorable long-term outcomes. In selected cases, revision surgery may be necessary to address bulk-related issues.