Letters to Editor
Figure 2: (a) Sterile ice packs being used during surgery, (b) ice packs cooling the prepared amputated part for replantation
b a
Conflicts of interest
There are no conflicts of interest.
R. Jayakumar, Rahul Bamal1, Amrita Mandal1
Department of Plastic, Microvascular and Cosmetic Surgery, Specialist’s Hospital, Kochi, Kerala, 1Department of Burns,
Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
Address for correspondence:
Dr. Rahul Bamal, Bamal Hospital, Rohtak - 124 001, Haryana, India. E-mail: rahulturbo@yahoo.co.uk REFERENCES
1. O’Brien BM. Replantation surgery. Clin Plast Surg 1974;1:405-26. 2. Tamai S. Twenty years’ experience of limb replantation – Review
of 293 upper extremity replants. J Hand Surg Am 1982;7:549-56.
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Website: www.ijps.org DOI:
10.4103/0970-0358.197222
Silicone breast implants
and echocardiographic
interactions: A brand new
study
Sir,
We present a retrospective observation of 120 patients who underwent implantation of prosthetic devices in the mammary region over a period from April 2010 to April 2014 to assess the impact of the prosthetic implant
on the execution echocardiographic examination.[1]
The cohort of patients was divided into four groups of thirty patients:
• Group A: Patients submitted to the left breast reconstruction with tissue expander and implant after modified radical mastectomy
• Group B: Patients submitted to the left breast reconstruction with expander and implant after skin/nipple sparing mastectomy
• Group C: Patients submitted to subglandular breast augmentation
• Group D: Patients submitted to submuscular breast augmentation.
No limitations on implant volumes were present.
All patients were subjected to echocardiographic investigation to study cardiac chambers and valves with the possibility of assessing abnormalities of all type. In four cases were observed interferences on the acquisition and interpretation of echocardiographic images.[2]
The patients who experienced echocardiographic limitations both belonged to Group A (patients who underwent breast reconstruction with expander and implant after modified radical mastectomy) and among the patients of this group, were those with implants of greater volume and size.
From a clinical point of view, on the basis of the study, we can state that the implantation of prosthetic devices in the breast region, both in cosmetic that in oncoplastic surgery of the breast, does not cause considerable difficulties in
How to cite this article: Jayakumar R, Bamal R, Mandal A. A novel
technique for continuous cooling till re-establishment of blood flow during major limb replants. Indian J Plast Surg 2016;49:429-30.
© 2016 Indian Journal of Plastic Surgery | Published by Wolters Kluwer - Medknow
Letters to Editor
the acquisition and interpretation of echocardiographic images.[1,3] Nevertheless, in the case of implants with large
volume and size, we detected limitations confined to a single acoustic windows. However, they did not affect the ability to execute the echocardiographic examination that could be easily performed through traditional or modified projections.
Still further studies are required to establish better the connection between silicone implants and echocardiographic images, to appraise surgeons and patients about eventual diagnostic difficulties.
From a medical‑legal point of view, especially in patients submitted to breast reconstruction with expander and implant, it is important, in our opinion, to include in the informed consent information about the possibility that the breast implant can limit, in some projections, the execution of echocardiography, which remains, by the way, executable. Breast implants are not considered ‘long‑life‑devices’ from the Food and Drug Administration, but they remain for years in the patients’ body, so they must be informed on the issues highlighted by this letter, to reduces medical‑legal repercussions.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Roberto Cuomo, Giuseppe Nisi, Luca Grimaldi, Cesare Brandi, Carlo D’Aniello Department of Plastic and Reconstructive Surgery, University
of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy
Address for correspondence:
Dr. Roberto Cuomo, Unit of Plastic and Reconstructive Surgery, University of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy. E-mail: robertocuomo@outlook.com REFERENCES
1. Movahed MR. Impairment of echocardiographic acoustic window caused by breast implants. Eur J Echocardiogr 2008;9:296-7. 2. Lopez H, Harris KM. Ultrasound interactions with free silicone in
a tissue-mimicking phantom. J Ultrasound Med 1998;17:163-70. 3. Takayanagi S. Augmentation mammaplasty using implants: A
review. Arch Plast Surg 2012;39:448-51.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Access this article online
Quick Response Code:
Website: www.ijps.org DOI:
10.4103/0970-0358.197233
Severe iatrogenic nostril
stenosis
Sir,
We have read with great interest, the article[1] of Ebrahimi
and Shams concerning a case with severe post‑operative nostril stenosis in a female patient who underwent multiple – primary and secondary – rhinoplasty operations.
The risk of nostril stenosis development after primary rhinoplasty is not high but the cost following it can be, especially important. The appearance of a severe complication following a purely aesthetic surgical intervention can turn a healthy person to a patient with unexpected consequences. We believe that, in such cases where nostril constriction is possible to happen due to nasal valve intra‑operative injury, prevention might be the best solution following the basic “better safe than sorry” principle.
Many different internal nasal splints[2‑4] have been
proposed over time. In similar cases where the nasal valve was affected, we have used a simple, “handmade” internal nasal splint made of X‑ray film pieces [Figures 1 and 2]. We have recently used them not only on post‑nasal valve injury patients with high risk of nostril stenosis development but also as a standard post‑rhinoplasty splint. Their
How to cite this article: Cuomo R, Nisi G, Grimaldi L,
Brandi C, D’Aniello C. Silicone breast implants and echocardiographic interactions: A brand new study. Indian J Plast Surg 2016;49:430-1.
© 2016 Indian Journal of Plastic Surgery | Published by Wolters Kluwer - Medknow
Indian Journal of Plastic Surgery September-December 2016 Vol 49 Issue 3 431
