MICROSURGERY AN INTEGRAL PART OF PLASTIC SURGERY

ScienceDaily (Apr. 19, 2012) — Surgeons at the Buncke Clinic at California Pacific Medical Center, part of the Sutter Health network, have successfully reattached the forehead and scalp of a 22-year-old Stockton woman whose hair was caught in machinery at her workplace. This type of surgery is extremely rare, and has been successfully performed only a handful of times world-wide.

The woman was flown by helicopter to CPMC, where Buncke Clinic surgeons performed the seven hour surgery using special microsurgery techniques. Microsurgery is a surgical technique that allows the surgeon to repair small nerves and blood vessels with sutures thinner than human hair.
"By repairing six blood vessels with the microscope as an aid, we were able to successfully restore the blood supply and replant the completely amputated forehead and scalp," said Dr. Brian Parrett and Dr. Bauback Safa, lead surgeons on the procedure. "The patient's scalp hair began to grow back within days after the surgery and she was able to go home after just one week."
"I put my trust in their hands," said patient Sonya Dominguez. "Without them, I probably wouldn't be here."
The procedure performed is one of very few known surgeries of its kind. "Microsurgery offers hope to patients who, until recently, had few options," explains Gregory Buncke, MD, head of the Buncke Clinic and chief of plastic surgery at CPMC. "The difference it can make in a person's life is remarkable. If this type of surgery had not been available to this young woman, she would have had extensive and permanent disfigurement."



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ARMY VETERAN SAYS FACE TRANSPLANT GAVE HIM A NEW LIFE

The second person in the U.S. to receive a face transplant -- a 62-year-old Vietnam veteran and former heroin addict -- continues to recover and says the surgery has given him a new lease on life. "When you replace a missing part, it restores a person's humanity," said plastic surgeon Bohdan Pomahac, who led the surgery. "For someone with no human facial features, it gives them the appearance of looking human again." WBNS-TV (Columbus, Ohio)/The Associated Press (4/12)

50 YEARS LATER, SILICONE BREAST IMPLANTS POPULARITY GOING STRONG

Doctors in the 1950s tried making breast enhancements of polyurethane, cartilage, sponges, wood and glass, but breast augmentation began to take off in 1962, when Frank Gerow and Thomas Cronin developed the silicone implant. Advances over the next half-century have included rupture resistance and hundreds of size and shape options. Breast enhancement is now the most commonly performed plastic surgery in many countries. BBC (3/28)

MELANOMA RATES ON THE RISE AMONG YOUNG ADULTS

The incidence of melanoma has increased dramatically among people younger than 40, and young women in their 20s and 30s are the hardest hit, Mayo Clinic researchers report in the April issue of Mayo Clinic Proceedings. Dermatologist Jerry Brewer, MD, and colleagues culled data from the Rochester Epidemiology Project for first-time diagnoses of melanoma in patients who were aged 18 to 39 from 1970 to 2009. They found that melanoma rates increased eightfold among young women and fourfold among young men. Exactly why rates are on the rise is not 100% clear, but the researchers speculate that the use of indoor tanning beds is likely a key culprit. "A recent study reported that people who use indoor tanning beds frequently are 74% more likely to develop melanoma, and we know young women are more likely to use them than young men," Brewer says in a press release. "The results of this study emphasize the importance of active interventions to decrease risk factors for skin cancer and, in particular, to continue to alert young women that indoor tanning has carcinogenic effects that increase the risk of melanoma."
[Source: Mayo Clinic Proceedings]

POST RADIATION BREAST RECONSTRUCTION

Arlington Heights, Ill. - Breast cancer patients whose treatment includes radiation therapy are at higher risk of complications after implant-based breast reconstruction, reports a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
But even with major complications, reconstruction is eventually successful in 80 percent of radiation-treated patients, according to the new research by ASPS Member Surgeon Dr. Kant Y. Lin, MD, and colleagues at University of Virginia, Charlottesville. Smoking also increases the risk of complications after breast reconstruction, the study reports.
Radiation Therapy Increases Complications of Breast Reconstruction

The researchers looked at how radiation affected complication rates in 194 breast cancer patients undergoing two-stage, implant-based breast reconstruction after mastectomy. About 12 percent of reconstructions were done on women undergoing radiation therapy before mastectomy, and six percent in women who received radiation after mastectomy.
In two-stage reconstruction, a tissue expander is first placed to increase the amount of the patient's own skin available for reconstruction. In the second stage, performed some months later, the reconstruction is completed using the additional skin and breast implants.
The results confirmed an increased complication rate in women undergoing radiation therapy, whether before or after mastectomy. In both radiation groups, the complication rate during reconstruction was over 40 percent, compared to 14 percent for women who did not receive radiation.
Types of complications also differed between groups. Twenty-two percent of women undergoing radiation had problems related to wound healing -- a well-known consequence of radiation damage to tissues. In contrast, wound complications occurred in less than two percent of women not treated with radiation, and only in smokers. Smoking is also a known risk factor for wound-healing problems.
Problems related to the tissue expander were the second most common complication in the radiation groups, with a rate of 19 percent. The overall risk of major complications requiring additional surgery was about six times higher in women receiving radiation therapy, after adjustment for other factors. For smokers, the risk of major complications was more than three times higher.
Data Will Help to Guide Reconstruction Decisions

Based on their findings, the rate of complications leading to repeat surgery for women who have undergone radiation therapy appears "prohibitively high," Dr. Lin and coauthors write. And yet they note that 80 percent of women with radiation therapy -- even with major complications -- had successful breast reconstruction surgery.
Radiation causes tissue damage that increases the risk of complications of breast reconstruction, among other types of surgery. In general, breast reconstruction using the patient's own (autogenous) tissue is preferred for patients who have undergone radiation therapy. However, this type of reconstruction requires more extensive surgery and a longer recovery time.
Implant-based reconstruction is much quicker, but requires the use of radiation-damaged tissues. Because it is very effective in reducing the risk of recurrence, radiation therapy has become an increasingly common part of combination therapy approaches to breast cancer.
The study provides important new data to help balance the risks and benefits of implant-based breast reconstruction after radiation therapy, Dr. Lin and colleagues believe. They write, "This information will allow both physicians and patients to make better informed decisions regarding their breast reconstruction procedures."
Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.