Acne Scars

Plast Reconstr Surg. 2009 May; 123(5): 1544-52Uygur F, Sever C, Tuncer S, Alagöz SBACKGROUND: Full-thickness burns involving the antecubital area result in severe contractures. Functional impairment is inevitable if the affected areas are not managed properly. Proper treatment requires complete release and radical excision of the scar tissue, followed by reconstruction using durable tissue that will not contract during long-term follow-up. METHODS: Nine patients with flexion contractures were reconstructed with pedicled thoracodorsal artery perforator flaps between 2004 and 2008. All of the patients were male, and their ages ranged from 20 to 23 years (mean, 21.4 years). The size and orientation of the skin islands were planned according to the defect size and orientation. The size of the flaps varied from 6.5 to 9.0 cm in width (mean, 8.0 cm) and 16.0 to 21.0 cm in length (mean, 20.0 cm). All of the patients were followed up for 6 to 12 months (mean, 9.3 months). RESULTS: All of the flaps used on the postburn antecubital contractures survived completely. Minimal transient venous congestion occurred in two flaps during the early postoperative period. A complete range of motion at the elbow joint was achieved in all patients by the end of the reconstruction period. CONCLUSIONS: This study revealed that the pedicled thoracodorsal artery perforator flap is a suitable alternative for postburn elbow contractures. A very long pedicle can be obtained to transfer the flap to the antecubital area without tension. With its thin, pliable texture and large size, it adapts well to forearm skin and the donor-site scar is considered cosmetically acceptable.

Plast Reconstr Surg. 2009 May; 123(5): 1471-80Vinh VQ, Van Anh T, Ogawa R, Hyakusoku HBACKGROUND: The supraclavicular flap is an excellent flap that has been used widely, but its vascular reliability remains unclear. In this article, the authors report the results of their anatomical studies on 40 flaps from 20 preserved cadavers and their clinical studies of 103 supraclavicular flaps in 101 patients. METHODS: In their anatomical study, the authors analyzed the important anatomical features that are useful for harvesting flaps. In their clinical study, the authors analyzed the cases in terms of flap reliability. RESULTS: The supraclavicular artery branched from the transverse cervical artery in all 40 specimens (100 percent). Although it arose from the middle third of the clavicle in 90 percent of the specimens, it arose from the lateral third of the clavicle in four specimens (10 percent). Moreover, the transverse cervical artery originated from the subclavian artery in two of 40 specimens (5 percent) rather than from the thyrocervical trunk. The origins of the supraclavicular and transverse cervical arteries were on average 4.12 cm apart (range, 3 to 5.5 cm). In our clinical study, 101 of the 103 flaps (98.1 percent) were (vascular-pedicled) island flaps and five (4.9 percent) were transferred under a skin tunnel. We also performed a supercharged flap transfer using posterior circumflex humeral vessels. Of the 103 flaps, 97 survived completely (94.2 percent), but four and two exhibited superficial distal necrosis (3.9 percent) and total necrosis (1.9 percent), respectively. CONCLUSIONS: Supraclavicular flaps are reliable, but vascular anomalies exist. In the authors' experience, the posterior circumflex humeral artery could be used for supercharging the supraclavicular flap.

Graefes Arch Clin Exp Ophthalmol. 2009 Apr 29; Costagliola C, Semeraro F, Cipollone U, Rinaldi M, Della Corte M, Romano MRBACKGROUND: To report 12-month follow-up results of 156 eyes treated with anti-VEGF for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration, and to verify the efficacy of this treatment in terms of functional results and changes of morphology of choroidal membrane for the different types of choroidal neovascularization analyzed. METHODS: This prospective case series study included subjects with different forms of subfoveal CNV. After the first intravitreal injection of 1.25 mg bevacizumab at baseline, re-injections of bevacizumab were scheduled at least 4 weeks after initial treatment following standardized criteria. RESULTS: One hundred and fifty six patients were divided into two study groups: 60 eyes with classic CNV (group C) and 96 eyes with occult CNV (group O). The improvement in BCVA was greater in group C than group O, although the difference was not statistically significant (P = 0.26). The area of CNV and subretinal fibrous tissue/disciform scar remained stable over time in both groups. The macular thickness significantly decreased through the follow-up period in both groups. The hyper-reflective area of the neovascular complex remained stable in both groups during the first 6 months of follow-up, whereas a slight increase of hyper-reflective lesion size occurred throughout the second 6 months of follow-up. CONCLUSION: The CNV lesion treated with IVB didn't disappear in neither group, but showed less exudation, demonstrated by a decrease in the area of leakage from CNV, subretinal fluid area, and centre point retinal thickness on OCT.

Plast Reconstr Surg. 2009 May; 123(5): 1597-603Brink RR, Beck JB, Anderson CM, Lewis ACBACKGROUND: Suction-assisted lipectomy is an integral component of abdominoplasty for many surgeons. Its potential to affect the vascularity of the abdominal flap is usually offset by limiting the extent of undermining and not suctioning the central flap. The authors address whether these guidelines apply to direct excision of subscarpal fat and whether direct excision provides aesthetically superior abdominoplasty results with fewer complications. METHODS: A 10-year review of consecutive abdominoplasty patients (n = 181) was conducted. Undermining was done to the xyphoid and just beyond the lower rib margins superiorly and at least as far as the anterior axillary line laterally. Fat deep to Scarpa's fascia was removed by tangential excision in all zones of the abdominal flap, including those considered at high risk for vascular compromise if subjected to liposuction after similar undermining. Concurrent liposuction of the abdominal flap was not done. Thirty patients had concurrent flank liposuction. RESULTS: No patients experienced major full-thickness tissue loss. The incidence of limited necrosis at the incision line requiring subsequent scar revision was 0.7 percent in the 151 patients having abdominoplasty and 6.7 percent in the 30 patients having abdominoplasty combined with flank liposuction. Erythema and/or epidermolysis was seen in 4.8 percent of the abdominoplasty patients and 10 percent of the abdominoplasty/ flank liposuction group. The rate of seroma formation in both groups was approximately 16.5 percent. CONCLUSIONS: Direct excision of subscarpal fat does not subject any zone of the abdominoplasty flap to increased risks of vascular compromise. It is a safe technique that provides excellent abdominoplasty results.