Results: Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists.Īverage follow-up postsurgery was 18 years (11-27). Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16.
Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction. Conclusions: Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.During the normal course of aging, post pregnancy, or after massive weight loss, the tissues that make up the breast can become more lax.
John Kim says that women who are a candidate for a breast lift are those who are happy with their breast volume but are unhappy with their sagging appearance. Breast tissue is located within the deep fatty layer immediately behind scarpa’s fascia the upper part of the breast is held to the chest wall by Cooper’s ligaments and the lower part of the breast is attached to fascia within the submammary fold (Frame 2017).
Dr purnell traverso skin#
The skeleton is the frame that holds muscles and soft tissue, which then create the frame that the skin and breast tissue drape over.īreast laxity is dependent on: volume, consistency of tissues, skin compliance, genetics, and the skeletal frame (Frame 2017). The visual appearance of the breast is dependent on the shaped and distribution of the aforementioned tissues. al defined the breast based on 8 separate units, inspired by the 8 gluteal aesthetic units defined by Dr. Centeno in a 2015 paper published in the Aesthetic Surgery Journey. These 8 points are places of measurement and symmetry: 1 and 2, 4 and 5, 3 and 6, as well as 7 and 8. Noting asymmetry in points 1 and 2 may suggest irregular pectoralis major muscle insertion point. A sunken appearance in units 4 and 5 can present the breasts as being smaller than they are. The volume of 3 and 6 should be small to create a narrow cleavage. Units 7 and 8 want to be seen versus covered by ptotic, sagging, breasts. Women have a number of options to decide how they want to proceed with a breast lift or mastopexy. In an article published in the Aesthetic Plastic Surgery Journal de Bruijn describes the mastopexy as a procedure that “counteracts the adverse effects of gravity and decrease in skin elasticity and firmness of the female breast.” In order to create a method for surgeons to create reliable long lasting results scientists created a 3-D woven mesh which creates an internal bra which becomes incorporated into breast tissue (de Bruijn).įigure 1 Photo of a real Dr. John Kim patient who had a breast lift without implants. The ideal internal bra will: not interfere with mammography, allow for long term host tissue replacement, and maintain strength, easy for the surgeon to use, easily stored, available in varying sizes, affordable, natural feel (Baxter). There are different internal bra materials available including: polypropylene mesh, human derived ADM, porcine derived ADM, and SERI scaffold. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery.Polypropylene mesh is durable, affordable and available in varying sizes and shapes but it is a foreign body and as such may lead to infections or exposure, in addition they may interfere with mammograms (Baxter). Additional Resources: American Board of Surgery, 2007. ** Source: American Board of Medical Specialties, 2007. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. * Source: American Board of Medical Specialties, 2007.
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