Erni Plastic Surgery

BackgroundPostmastectomy breast edema is a common complication in patients undergoing immediate implant-based reconstruction, leading to physical and psychological consequences. Despite its clinical relevance, standardized prophylactic strategies remain lacking.ObjectivesThe authors of this study aim to evaluate the efficacy of an anti-edema formulation containing diosmin, coumarin, and arbutin (Linfadren, Omega Pharma Srl, Italy) in reducing postmastectomy breast edema and improving postoperative outcomes.MethodsA prospective, randomized clinical trial was conducted at a single tertiary care center. Women aged ≥18 years undergoing mastectomy with immediate implant-based reconstruction were randomized (1:1) into 2 groups: control (standard postoperative prophylaxis) and experimental (standard prophylaxis plus Linfadren, Omega Pharma Srl). Mastectomy flap thickness was measured using Vernier calipers, and breast edema symptoms were assessed with the Breast Edema Questionnaire (BrEQ). Follow-up visits were scheduled weekly during the first month, with additional evaluations at 6 weeks and 2 months.ResultsThe experimental group demonstrated a significant reduction in mastectomy flap thickness (45.95% decrease at 2 months vs stable or increased thickness in the control group, P < .05). BrEQ scores improved more rapidly in the experimental group, reflecting reduced symptoms of breast edema. Pitting edema prevalence was consistently lower in the experimental group compared with the control group throughout the study (P < .05).ConclusionsIn this study, the authors highlight the potential of Linfadren (Omega Pharma Srl) as an effective prophylactic treatment for postmastectomy breast edema. By mitigating edema, this approach may improve postoperative recovery, reduce complications, and enhance patients’ quality of life. Further large-scale studies are warranted to validate these findings.Level of Evidence: 2 (Therapeutic)

PurposeThis retrospective study aimed to evaluate the incidence of dehiscence following bone augmentation with patient-specific titanium meshes and to identify factors associated with its occurrence.Material and methodsPatients who underwent bone grafting with patient-specific titanium mesh between December 2014 and October 2021 were included. The primary outcome was the occurrence of dehiscence. The occurrence of dehiscences was recorded during the following time phases, enabling the determination of whether dehiscences occur early (< 2 weeks), in the mid-term (2–9 weeks), or later in the healing phase (> 9 weeks).ResultsA total of 78 patients undergoing 85 titanium mesh augmentations were included, with a mean follow-up period of 1.2 years. Dehiscence occurred in 33 meshes (38.8%), with 51.5% of these events arising during the early healing phase. In no case was premature removal of the titanium mesh required due to dehiscence. A statistically significant association was observed between dehiscence and both smoking behavior (p < 0.001) and the anatomical location of the maxillary defect (p = 0.029). No significant associations were found between dehiscence and gender (p = 0.160), periodontitis (p = 0.512), gingival phenotype (p = 0.495), defect type (p = 0.490), augmented bone volume (p = 0.373), or incision type (p = 0.354). Logistic regression analysis further identified smoking (odds ratio: 7.07; 95% CI: 2.19–22.80) and maxillary defect alveolar (odds ratio: 11.86; 95% CI: 0.34–4.60) as significant predictors of dehiscence.ConclusionDehiscence following customized titanium mesh augmentation was significantly associated with smoking and the location of the maxillary defect, underscoring the importance of early detection and timely intervention.Graphical

Introduction: Liposuction is a surgical procedure whereby excess subcutaneous fat is sucked out from the human body. This procedure has been introduced at the Tribhuvan University Teaching Hospital (TUTH) for the first time. Case Report: Reporting here two cases of diffuse gynaecomastia who underwent liposuction and reduction of breast tissue with minimal scarring and less hospital stay. Conclusion: Liposuction is an excellent option for diffuse gynaecomastia. It can be done as a day care procedure with very minimal scar and discomfort to the patient. Journal of Institute of Medicine Vol.28(1) 2006

Recent studies have identified a subpopulation of craniosynostotic individuals who exhibit progressive or delayed-onset synostosis and mild craniofacial growth abnormalities. These individuals may be good candidates for nonextirpation, distraction osteogenesis therapy. The present study was designed to test this hypothesis by using internal calvarial bone distraction in a rabbit model with familial delayed-onset craniosynostosis. Data were collected from 159 rabbits: 71 normal controls, 72 with delayed-onset coronal suture synostosis, 8 with delayed-onset coronal suture synostosis and coronal suturectomy, and 8 with delayed-onset coronal suture synostosis and distraction. At 10 days of age, all rabbits had amalgam markers placed on both sides of the frontonasal, coronal, and anterior lambdoidal sutures. At 25 days of age, correction was accomplished through either a 5-mm-wide suturectomy or distraction osteogenesis. An internal distraction appliance was fixed to the frontal and parietal bones and percutaneously and intermittently activated at an average of 0.10 mm/day for 42 days (4.11 mm total). Serial radiographs were taken at 10, 25, 42, and 84 days of age. Results revealed that rabbits with delayed-onset synostosis had significantly (p < 0.01) reduced coronal suture growth rates (0.04 mm/day) compared with the other three groups (0.07 mm/day). Rabbits with suturectomy and rabbits with distraction showed similar coronal suture responses. However, from 42 to 84 days of age, rabbits with distraction showed reduced growth at the vault sutures and abnormal growth patterns in cranial vault width, cranial vault shape, and cranial base angulation compared with the other three groups. Results demonstrated that, although the normal coronal suture growth rate was maintained in rabbits with delayed-onset synostosis using intermittent distraction osteogenesis, normal adult craniofacial structure was not achieved. Such anomalous growth was probably a result of altered growth vectors and compressive forces at adjacent sutures during distraction. These findings suggest that distraction osteogenesis without corticotomy may be a treatment alternative in individuals with progressive, delayed-onset synostosis, but that internal appliances that generate low-level, continuous distractive forces should be investigated and developed.