Background. Craniosynostosis is the premature fusion of one or more cranial sutures that produce abnormal head shape. Plagiocephaly is a general term that describes unilateral flattening of the anterior or posterior quarter of the cranium. Anterior plagiocephaly is almost always due to unilateral coronal synostosis. Early surgical treatment is the best option for these patients. The aim of this study was to investigate the surgical correction results of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies. Methods. All unicoronal craniosynostosis cases treated surgically from 2013 to 2016 at our hospital, with frontal bone symmetrization and staggered osteotomies and fronto-orbital advancement, were reviewed. The following variables were analyzed: sex, age, weight, hospital stay time, ICU stay time, per os (PO) starting time, anesthetic time, estimated blood loss volume (ml), estimated blood loss as percentage of total volume, surgical complication, follow-up time, and Whitaker grade. All data were analyzed with SPSS. Results. The study consisted of 33 patients (19 females, 14 males). Average age was 10.24 months, average weight was 8.97 Kg, average hospital stay time was 7.84 days, average ICU stay time was 1.69 days, average PO starting time was 1.24 days after surgery, average anesthetic time was 397.72 minutes, average estimated blood loss was 213.78 ml, and estimated blood loss as percentage of total volume was 31.69&#x25;. One case (3.03&#x25;) needed reoperation and two cases had postoperative seizure. No mortality was seen. Conclusion. It is supposed that surgical correction of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies results in lower blood loss, lower complication rate and reoperation, and more durable results.

Seyed Esmail Hassanpour

Masoumeh Abbasnezhad

Hamidreza Alizadeh Otaghvar

Adnan Tizmaghz

Surgical Correction of Unicoronal Craniosynostosis with Frontal Bone Symmetrization and Staggered Osteotomies

Felix J. Paprottka

Nicco Krezdorn

Heiko Sorg

S&#xf6;ren K&#xf6;nneker

Stiliano Bontikous

Ian Robertson

Christopher L. Schlett

Nils-Kristian Dohse

Detlev Hebebrand

Response to: Comment on &#x201c;Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years&#x201d;

Corrigendum to &#x201c;Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years&#x201d;

Background. The frequency of surgery involving elderly patients has been increasing. The use of free tissue transfers in the elderly has been examined previously (Howard et al., 2005, Hwang et al., 2016, Grammatica et al., 2015, Serletti et al., 2000, and Sierakowski et al., 2017), whereas there have not been any such studies of plastic surgery procedures. We evaluated the risk factors for complications after plastic surgery procedures performed under general anesthesia in patients aged &#x2265;75 years. Methods. The cases of patients aged &#x2265;75 years who underwent plastic surgery procedures under general anesthesia at the Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, between 2009 and 2016 were reviewed retrospectively. Multiple logistic regression analysis was used to identify the risk factors for postoperative complications. Results. Two hundred and sixty-three cases were reviewed. Complications were seen in 137 patients. Age was not predictive of complications. The risk factors included a serum albumin level of &#x3c;2.8&#x2009;g/dl (odds ratio (OR): 2.96), an operative time of &#x2265;120&#x2009;min (OR: 6.22), and an American Society of Anesthesiologists performance status of &#x2265;3 (OR: 2.39). Conclusions. Age is not contraindication for surgery in the elderly. It is important to assess comorbidities and perform surgical procedures as soon as possible to shorten the surgical period.

Kiyoko Fukui

Masaki Fujioka

Kazumi Yamasaki

Sho Yamakawa

Haruka Matsuo

Miho Noguchi

Risk Factors for Postoperative Complications among the Elderly after Plastic Surgery Procedures Performed under General Anesthesia

S. H. Heisterkamp

Comment on &#x201c;Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years&#x201d;

Purpose. Given the proposed increased risk of nipple-areolar complex (NAC) necrosis, nipple-sparing mastectomy (NSM) is generally not recommended for patients with large or significantly ptotic breasts. NAC preserving strategies in this subgroup include staged or simultaneous NSM and reduction mastopexy. We present a novel approach towards simultaneous NSM and reduction mastopexy in patients with large, ptotic breasts. Methods. Literature pertaining to NSM for women with large, ptotic breasts was reviewed and a surgical approach was designed to allow for simultaneous NSM and reduction mastopexy in such patients. Results. Eight patients underwent bilateral NSM with simultaneous reduction mammaplasty and immediate reconstruction. The majority of breasts demonstrated advanced ptosis (69&#x25; grade III, 31&#x25; grade II) and the average breast volume excised was 760 grams. In those patients without a history of smoking, NAC necrosis rates were 0&#x25;. In those patients with a history of smoking, 83&#x25; of breasts experienced NAC necrosis (60&#x25; total, 40&#x25; partial). One hundred percent of patients who smoked experienced some degree of NAC necrosis. Among breasts with grade II versus grade III ptosis, NAC necrosis rates were roughly equal. Conclusions. Historically, patients with large, ptotic breasts were excluded from NSM due to the proposed increased risk of NAC necrosis. This study demonstrates a safe approach towards NSM and reduction mastopexy using an inferior, wide-based, epithelialized pedicle. While all patients eventually achieved satisfactory results, there was an association between smoking and NAC necrosis. Smoking cessation is paramount to the operation&#x2019;s success.

M. E. Pontell

N. Saad

A. Brown

M. Rose

R. Ashinoff

A. Saad

Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

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Plastic Surgery International