Maximilian Zaussinger

Background: The rising incidence of massive weight loss (MWL) in women has led to an increased demand for breast surgery. Autoaugmentation and implant-based augmentation mastopexy represent well-established procedures in this patient population. However, there is a notable lack of direct comparison of these 2 surgical approaches in the current literature. Methods: This retrospective study included 100 consecutive patients with MWL over the past 7.6 years (64 autoaugmentation and 36 implant-based). Complication and surgical revision rates were collected retrospectively. During a follow-up examination, postoperative BREAST-Q scores, 36-item Short Form Health Survey scores, and aesthetic outcomes were evaluated. Results: The included patients had a mean age of 39 ± 10.6 years and a median follow-up time of 2.8 years (range, 0.3 to 7.6 years). In the autoaugmentation group, most aesthetic evaluation criteria and postoperative BREAST-Q scores for Satisfaction with Breasts ( P < 0.001) and Satisfaction with Outcome ( P < 0.001) were significantly higher. According to Clavien-Dindo classification, complications in the autoaugmentation group were mainly managed conservatively, whereas most complications in the implant group required surgical revision ( P = 0.009). Recurrent ptosis occurred more frequently in the implant group. The 36-item Short Form Health Survey results indicated no significant group differences. Conclusions: A tendency toward increased use of autoaugmentation techniques among 100 patients with MWL was observed, achieving significantly higher outcome scores and lower complication rates. If sufficient breast tissue is available, implant use should be avoided in this patient population. If an implant is required, patients should be thoroughly informed about the higher complication rates and potential need for revision surgery.

Background: Tranexamic acid (TXA) has been increasingly acknowledged as a beneficial pharmacological agent in plastic surgery. However, despite its proven efficacy and safety, there is limited research on its intravenous application in gender-affirming mastectomy, particularly regarding its effect on drain duration, drain output, and length of hospital stay. Methods: In this retrospective single-center study, patients who underwent double incision mastectomy with free nipple grafts were categorized into two cohorts: one group receiving TXA and a control group without TXA utilization (TXA vs no-TXA). Demographic characteristics, surgical data, and complication rates were analyzed and compared. Results: A total of 75 patients were included, with 34 procedures performed without the administration of TXA and 41 patients receiving TXA. The median age of the study population was 24 years (range 18–57). Postoperative bleeding requiring surgical revision was significantly less frequent in the TXA group ( p = 0.038). Total drain output ( p = 0.048), drain duration ( p < 0.001) and length of hospital stay ( p = 0.008) were significantly reduced in the TXA group. No thromboembolic events or seizures were observed. Conclusions: This study demonstrated that intravenously administered TXA significantly reduces the incidence of postoperative hematoma, length of hospital stay, drain duration, and output after gender-affirming mastectomy. Based on these findings, we would recommend the use of TXA in double incision mastectomy with free nipple grafts to minimize the occurrence of seroma formation and major bleeding-related complications. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19–62 years) and a mean follow-up time of 15 months (range 5–24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine.

Background/Objectives: Perineal reconstruction after abdominoperineal excision often requires complex closures and is fraught with wound healing complications. Flap-based approaches introduce non-irradiated vascularized tissue to the area of resection to fill a large soft-tissue defect and dead space, reduce the risk of infection, and facilitate wound healing. Employing perforator flaps with their beneficial donor site properties, the authors have developed a concept of bilateral superior gluteal artery perforator (SGAP) flaps to restore extensive perineal defects. Methods: This retrospective case series was conducted between September 2015 and December 2019. We included three patients who received bilateral SGAP flap reconstruction after oncological resection. One deepithelialized SGAP flap was used for obliteration of dead space, combined with the contralateral SGAP flap for superficial defect reconstruction and wound closure. Results: Within this patient population, two male and one female patient, with a median age of 62 years (range, 52–76 years), were included. Six pedicled SGAP flaps were performed with average flap dimensions of 9 × 20 cm (range 7–9 × 19 × 21). No flap loss or no local recurrence were documented. In one case, partial tip necrosis with prolonged serous drainage was observed, which was managed by surgical debridement. No further complications were detected. Conclusions: The combination of two SGAP flaps provides maximal soft tissue for defect reconstruction and obliteration of dead space, while maintaining a very inconspicuous donor site, even with bilateral harvesting. Given these advantages, the authors recommend this promising approach for successful reconstruction of perineal defects.

Background Complications after abdominoplasty remain an unsolved issue in body contouring surgery. The antifibrinolytic drug tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. The aim of this study was to investigate the influence of intravenously administered TXA on complications and patient safety after abdominoplasty. Methods Within this retrospective single-center study, patients who underwent abdominoplasty and received intravenous TXA were selected and compared to randomly selected patients who underwent abdominoplasty without administration of TXA. The patient population was divided into two study groups (TXA vs no TXA). Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed. Results Fifty-seven female and 3 male patients with a median age of 38 years and a mean BMI of 25.6 ± 3.3 kg/m² were included in the study. Except smoking history, demographic data showed no statistically significant differences between both groups. The most common complication was seroma formation (n = 16; 23.9%), and its occurrence was statistically significantly lower in the TXA group (p = 0.023). Furthermore, postoperative seroma aspiration was performed in statistically significant lower numbers in the TXA group (p < 0.05). No thromboembolic events or seizures were observed. Discussion The outcomes of this study showed that the intravenous administration of TXA leads to a significant reduction of seroma formation and postoperative seroma aspiration after abdominoplasty. Simultaneously, no adverse thromboembolic events were detected. Hence we would recommend administration of TXA in body contouring surgery to decrease the incidence of seroma formation. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5–12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20–80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries.