A Study of Aesthetic and Functional Outcome Following Structural Fat Grafting for Facial Scars and Contour Deformity

Study Design: This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity who underwent structural fat grafting. Objectives: The aim of the present article is to highlight how fat grafting helps to improve aesthetic and functional outcome in facial scars and contour deformities. It also highlights the factors that need to be considered while planning autologous fat grafting to get better aesthetic results. Methods: This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity. The study was conducted from May 2014 to April 2019 in a tertiary care hospital. All the patients were followed up for a minimum period of 1 year from the date of surgery. Assessment of post-operative aesthetic outcome, in terms of satisfaction, was done using the Visual Analogue Scale (VAS), which ranges from 1 to 10 by the patient and operative surgeon. Results: The mean age was 30.8 9.8 years. Out of 60 patients, 20 patients underwent additional procedure like dermabrasion and collagen dressing to improve aesthetic outcome. Among 60 patients, 24 patients had transient edema and 10 patients had bruising at the recipient site. There were no major donor site complications except pain which was managed conservatively. Mean patient satisfaction score is 7 and mean surgeon satisfaction score is 7.25. Conclusion: Despite the ongoing concerns about survival and longevity of fat grafts and also unpredictability of long-term outcomes, fat grafting has become a very useful surgical tool to improve the quality of facial scars and correct contour deformity. Our series shows excellent outcome both clinically as well as from the patient satisfaction. Future research is warranted in the fields of the adipocyte derived stem cells and to expand the clinical application of fat grafting.

Pancreatic Pseudocyst with Mediastinal Extension Presenting as Pseudo-Kirklin Sign—Multimodality Imaging

A mass lesion of the gastric cardia or fundus causing an alteration in the normal regular, translucent gastric fundal air shadow on a frontal erect chest radiograph is referred to as “the Kirklin sign.” Here we present “Pseudo-Kirklin sign” observed on the frontal radiograph of a 46-year-old male patient due to a soft tissue shadow/contour deformity of the fundal gas shadow caused by pseudocyst of the pancreas. We evaluated the patient using plain radiography, contrast enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasound (EUS) with the cyst drained under EUS guidance. So far only two cases of mediastinal pseudocysts have been drained successfully by EUS-guided aspiration.

Basic Techniques of Fat Grafting

In this chapter, the authors describe a standardized approach to fat grafting based on available scientific studies to obtain the best results for patients. Assessment of the defect and choosing the appropriate fat graft method is essential to achieving the desired result for different patients’ needs. Thus, fat grafting can be classified into small, large, and mega-volume fat grafting for an individualized approach. Once the indication for fat grafting is identified, the fat grafting technique can then be chosen based on the defect or contour deformity. Operative technique is detailed in terms of proper selection of donor site, proper harvest and processing of fat based on the fat grafting method chosen, along with proper placement of fat grafts and postoperative care.

Fluid Cartilage as New Autologous Biomaterial in the Treatment of Minor Nose Defects: Clinical and Microscopic Difference Amongst Diced, Crushed, and Fluid Cartilage

Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with fluid cartilage filler gently injected as autologous fluid graft in deep planes of defect of the nose that were close to the bone or the cartilage. A computerized tomographic scan control was performed after 12 months. Pearson’s Chi-square test was used to investigate differences in cartilage density between native and newly formed cartilages. The endpoints were the possibility of using fluid cartilage as filler with aesthetic and functional improvement and versatility. Patients were followed up for two years. The constructs of fluid cartilage graft that were injected in the deep plane resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. This report demonstrated that fluid cartilage grafts are useful for cartilage regeneration in patients with outcomes of rhinoplasty, internal nasal valve collapse, and minor congenital nose aesthetics deformity.

Treatment of Morell Lavallee Lesion (MLL) with Arthroscopy

Background: Previous approval for treatment of persistant Morell lavallee soft tissue degloving lesion has included open debridement or simple compression or serial aspiration under USG guidance or insertion of surgical vacuum or sclerodesis with tetracycline/doxycycline. None of them had proven the minimally invasive surgical technological effect of arthroscopy. Purpose of study: This study evaluates the minimally invasive surgical effectiveness and use of radio frequency ablation under arthroscopy for treatment of persistant Morell lavallee soft tissue degloving lesion. This technique provides satisfactory cosmetic and functional effect as overall outcome. Methods: We treated 7 cases of persistant Morell lavallee lesion between Nov 2010 to March 2013. These lesions developed in 5 male and 2 female patients (Mean age 36.57yr, Range 23-48 yrs) due to various mode of trauma. The lesion involved the thigh region in 3 patients with gluteal, distal leg, knee and forearm being other region involved. An area of palpable fluctuance was the most coherent examination finding. MRI and Ultrasonography confirmed the diagnosis with clinical evidences. Treatment was achieved by placement of arthroscope, aspiration of fluid and radio frequency ablation of inner layer of capsule and proceed with compressive elastic bandaging. Healing was defined as the loss of fluctuation with complete absence of fluid on ultrasonography (USG). Result: The average duration of the persistence of the lesion was 3 month. All lesions were evacuated arthroscopically and found to be negative on culture. The mean follow up period was 11 month (Range 6-24 month). All patients showed complete resolution of fluid collection and no contour deformity at final follow up. All the lesions healed exclusive of any infections or other complication. No recurrences were detected during the follow up period. A persistent feeling of tightness was the most common problems faced on long term follow up. Conclusion: The persistant closed degloving lesion can be managed easily, conveniently and effectively with radio frequency ablation under arthroscopy. Patients were satisfied with cosmetic problems like contour deformity, tightness of skin, rough scar mark, diminished sensation and skin mobility at site of lesion.