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Although the cause of ptosis in most PDP is mechanical process or dysfunction, this case of PDP had bilateral true eyelid ptosis due to poor levator palpabrae superioris muscle excursion with coexisting signs and symptoms of complete form PDP. This finding highlights the need to investigate for bilateral true eyelid ptosis caused by abnormal levator palpabrae superioris muscle function in patients diagnosed with PDP. © 2019 The Authors.Malignant cylindroma is a rare and poorly understood cutaneous malignancy. There is a paucity of literature on these lesions, with only a select number of case reports and limited guidelines on management. We present a case of a 60-year old patient with a malignant cylindroma of the scalp treated surgically with staged perimeter excision and summarize our review of the literature with a focus on management of this potentially aggressive disease. © 2019 The Authors.Filler rhinoplasty is susceptible to spreading because of the way the nose protrudes away from the face. Often, the well-defined appearance immediately after the procedure is poorly maintained, and the nasion area develops a bulbous appearance. Therefore, I developed a "dual plane technique" to prevent spreading and to maintain the desired shape of the filler rhinoplasty. Dual plane injections were administered in 96 patients. Based on the anatomy of the nose, a highly elastic filler was injected in the deep fat layer and a moderately elastic filler was injected in the superficial fat compartments. The retrograde linear threading technique was used to inject the fillers to prevent mixing with each other. Afterwards, the highly elastic hyaluronic acid filler was injected from the anterior nasal spine into the supracartilaginous layer by a retrograde linear threading technique. All patients were followed up for at least 3 months, during which time there were no major complications and aesthetic satisfaction was high. The dual plane technique is an injection technique based on the anatomical base. Different types of filler can be used according to the plane and filler rheology to obtain an aesthetically pleasing result. © 2019 The Author(s).Implant rupture is a common complication of breast implant surgery. Removal of silicone gel after breast implant rupture can be difficult and time-consuming. In the medical literature, a few other methods attempt to solve this challenge. We propose a simple and efficient technique to maximize its removal by suction. This method bypasses the problem, given the disadvantages of silicone's high viscosity. Moreover, the necessary equipment is inexpensive and readily available in any operating room. © 2019 The Authors.True aneurysms of the arteries of the hand are vanishingly rare. We report a case detailing the surgical management of a 44-year old gentleman with a true common digital artery aneurysm. This report adds to the current sparse literature on digital artery aneurysms and their presentation, investigation and management. © 2019 The Authors.Background Blepharoptosis operations are performed under local anaesthesia, and it is necessary to determine the location where the levator aponeurosis is fixed to the tarsus by checking opening and closing of the eyelids during surgery. Changes in posture during the operation affect the facial condition in various ways. This study was performed to clarify the differences in palpebral fissure height according to intraoperative head position. Methods Sixty subjects (48 women and 12 men aged 20-76 years) were enrolled in the study. The palpebral fissure height of the dominant eye was measured in the head-neutral position and 30° head-down position. Results The total fissure height in the 30° head-down position was lower than that in the head-neutral position. Conclusions The head-down position affects the patient's fissure height and may mislead the operator. Blepharoptosis operation under local anaesthesia should be performed with the patient in the head-neutral position. © 2019 The Author(s).Background Lymphedema is a chronic pathology characterized by progressive swelling due to lymphatic dysfunction (1). Literature contains few studies that focus on male genital lymphedema. A variety of surgical techniques as part of the male genital lymphedema therapeutic strategy has been described. Supramicrosurgical lymphatico-venular anastomosis s-LVA, based on connecting lymphatic collectors to venules, has evidenced efficient outcomes thus far. However, the peculiarity of the genital area may lead to an innovative and even more accurate surgical technique as a treatment of male genital lymphedema lymphatic pre-collectors located superficially over the fascial layer can be used to perform the ultramicrosurgical anastomosis. Purpose of the study In this paper, the authors report their experience of this new surgical concept based on anastomosing lymphatic precollectors to venules. Methods We performed a retrospective study from 2014 to 2016. Six male patients with primary genital lymphedema underwent ultramicrosurgical lymphatico-venular anastomosis in Siena University Hospital, Italy. Results Ultramicrosurgical lymphatico-venular anastomosis has evidenced positive outcomes in terms of prognosis, infectious complications, volume reduction, and quality of life. The average cellulitis rate dropped from 2.5 episodes a year to 0.5 episodes after surgical intervention. selleck chemicals The mean satisfaction index passed from 1.33 before the intervention to 2.83. Conclusion Ultramicrosurgical lymphatico-venular anastomosis represents a challenging physiological approach for male genital lymphedema with promising outcomes. © 2019 The Authors.Aims Extra-articular fifth metacarpal fractures are treated operatively and non-operatively without consensus. We aim to establish whether there are differences in patient-reported outcome, objective clinical outcome and adverse events for skeletally mature patients with closed extra-articular fractures of the 5th metacarpal that are treated operatively versus non-operatively. Patients Skeletally mature patients with closed, extra-articular 5th metacarpal fractures. Methods A systematic review and meta-analysis of randomised controlled trials using methodology adapted from the Cochrane Handbook for Systematic Review of Interventions and compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO CRD42018091633). Results Two trials of 5th metacarpal neck fractures met the inclusion criteria and were included in the final pooled analysis (n = 125). There were no significant differences in patient-reported, objective clinical or radiographic outcomes between the operative and non-operative groups at 12 months.
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