A novel punch biopsy technique without scissors or forceps

Rituximab Treatment Of Pemphigus Foliaceus- A Retrospective Study Of 12 Patients

Feasibility of using computer simulation to predict the postoperative outcome of the minimally invasive Nuss procedure: Simulation prediction vs. postoperative clinical observation

The Nuss procedure is the most minimally invasive and commonly used surgical correction for pectus excavatum (PE) by using a pre-bent pectus bar to elevate the deformed chest wall. However, there exist some complications such as postoperative pain as well as surgical uncertainties due to human judgement. It is therefore important to understand the biomechanical effect of the pectus bar on PE thoraces undergoing an operation to alleviate the postoperative pain as well as to improve surgical outcome.

Should Planned/Desired Pregnancy be Considered an Absolute Contraindication to Breast Reconstruction with Free Abdominal Flaps? A Retrospective Case Series and Systematic Review

Autologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to becoming pregnant postoperatively due to concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Hence, the authors examined the clinical outcome in patients who became pregnant following autologous breast reconstruction.

Long-Distance Care of Face Transplant Recipients in the United States

Promising aesthetic and functional outcomes in facial transplantation have fueled the interest of patients and providers alike. However, there are currently only 11 active face transplant centers in the United States, and only five have accumulated operative experience to date, resulting in an extremely unbalanced geographical distribution of providers. Since face transplant recipients must receive life-long follow-up, this presents unique challenges for face transplant candidates and provider teams, as long-distance travel may add considerable difficulty to pre- and post-transplant care.

“Immediate breast reconstruction with a Wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap”

Preservation of the nipple-areola complex (NAC) in immediate reconstruction of ptotic and large breasts is surgically challenging. This article presents a modification of the inferior dermal flap ("dermal sling") to a vertical bipedicle flap with NAC preservation. The flap is well described in breast reductions, but has never been described in a mastectomy setting. The study reviews data for a case series of 17 breasts in 11 women who were reconstructed with the new technique. The complication rate was 12 percent and the vertical bipedicle NAC-sparing flap has to be considered a feasible option in women with ptotic and/or large breasts.

Risk factors for developing capsular contracture in women after breast implant surgery A systematic review of the literature

Capsular contracture is the most frequent complication in breast augmentation or reconstruction with breast implants. The exact mechanism for this complication is not completely understood. Yet, it is most likely to be a multifactorial condition. Several patient-, as well as surgery-, and implant-specific risk factors have been related to cause capsular contracture. This review aims to provide a clear overview of all risk factors for capsular contracture.

DONOR SKIN ALLOGRAFT SURVIVAL AFTER BONE MARROW TRANSPLANTATION: CASE REPORT AND SYSTEMATIC REVIEW OF THE LITERATURE

we present a case of skin allograft survival in a patient who previously received a bone marrow transplant from the same HLA-matched donor. DNA fingerprinting of skin biopsies showed mixed cellularity originating from the donor and recipient (68% and 32% donor DNA in the allograft skin and the native recipient's skin, respectively). Histologic sections demonstrated both grade 3/4 rejection and graft-versus-host- disease. We have conducted a systematic review in search for other cases of donor skin allograft survival after a bone marrow or hematopoietic stem cell transplantation.

Are facial injuries really different?

The article by Rahtz and colleagues concludes that appearance concern after facial injury may not lead either to stigma or to psychosocial burden.1 This is the conclusion that I reached this conclusion in an uncontrolled follow-up study of facial casualties of the First World War treated at the Cambridge Military Hospital, Aldershot and the Queen's Hospital, Sidcup (now Queen Mary's Hospital).

Integrative Methylome and Transcriptome Analysis to Dissect Key Biological Pathways for Psoriasis in Chinese Han Population

Psoriasis (Ps) is a chronic recurring hyperproliferative and inflammatory skin disease with a diverse prevalence rate ranging from 0.17%-4% of the people worldwide [1]. The pathogenesis of Ps involves a complex interplay of genetic and environmental factors. Genetic linkage analysis, candidate gene association study, genome-wide meta-analysis and genome-wide association studies (GWAS) have found numerous susceptibility genes or loci associated with Ps in different populations [2–7]. However, analyses based on sequence variation like gene mutation, single nucleotide polymorphism (SNP) and copy number variation (CNV) demonstrated that only about 13% of the total proportion of heritability for diseases could be explained [8,9], suggesting that non-DNA sequence changes such as epigenetic, gene-gene interactions, epigenetic and genetic synergies may have important effects on disease developing [10–12].

Dynamic 18F-FET PET is a powerful imaging biomarker in gadolinium-negative gliomas

Abstract

Background

We aimed to elucidate the place of dynamic ¹⁸F-FET-PET in prognostic models of gadolinium (Gd)-negative gliomas.

Methods

In 98 patients with Gd-negative gliomas undergoing ¹⁸F-FET-PET guided biopsy, time activity curves (TAC) of each tumor were qualitatively categorized as either increasing or decreasing. Additionally, post-hoc quantitative analyses were done using minimal time-to-peak (TTP_min) measurements. Prognostic factors were obtained from multivariate hazards models. The fit of the biospecimen- and imaging-derived models was compared.

Results

A homogeneous increasing, mixed, and homogeneous decreasing TAC pattern was seen in 51, 19, and 28 tumors, respectively. Mixed TAC tumors exhibited both increasing and decreasing TACs. Corresponding adjusted 5-years survival was 85%, 47%, and 19%, respectively (p<0.001). Qualitative and quantitative TAC measurements were highly inter-correlated (p<0.0001): TTP_min was longest (shortest) in the homogeneous increasing (decreasing) TAC group and in between in the mixed TAC group. TTP_min was longer in IDH-mutant tumors (p<0.001). Outcome was similarly precisely predicted by biospecimen- and imaging-derived models. In the biospecimen model, WHO grade (p<0.0001) and IDH status (p<0.001) were predictors for survival. Outcome of homogeneous increasing (homogeneous decreasing) TAC tumors was nearly identical with both TTP_min >25 min (TTP_min ≤12.5 min) tumors and IDH-mutant grade II (IDH-wildtype) gliomas. Outcome of mixed TAC tumors matched that of both intermediate TTP_min (>12.5 min and ≤25 min) and IDH-mutant, grade III gliomas. Each of the three prognostic clusters differed significantly from the other ones of the respective models (p<0.001).

Conclusion

TAC measurements constitute a powerful biomarker independent from tumor grade and IDH status.

A novel punch biopsy technique without scissors or forceps

Publication date: Available online 9 June 2018
Source:Journal of the American Academy of Dermatology
Author(s): Ali Moiin, Brett C. Neill

Prevalence of patients eligible for anti-IL-5 treatment in a cohort of adult-onset asthma

Publication date: Available online 9 June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Pinja Ilmarinen, Leena E. Tuomisto, Onni Niemelä, Hannu Kankaanranta
BackgroundAntibodies against IL-5 pathway have been developed for treatment of late-onset eosinophilic steroid-resistant asthma. However, the prevalence of severe asthma and the proportion of patients who could benefit from such treatment among general population of asthmatics remains unknown.ObjectiveTo evaluate the prevalence and characteristics of patients eligible to anti-IL-5 treatment and severe asthma in an unselected cohort of adult-onset asthma.MethodsSeinäjoki Adult Asthma Study (SAAS) is a 12-year follow-up study of patients with new-onset adult asthma (n=203). Prevalence was estimated based on information collected at 12-year follow-up visit. Healthcare use was collected from the whole 12-year follow-up period.ResultsPrevalence of anti-IL-5-treatable patients was 2%, when the following criteria were used: daily use of medium-to-high ICS dose and LABA, ≥2 exacerbations/previous year and blood eosinophil count ≥300 cells/μl or FeNO≥50ppb. Prevalence of severe asthma, as defined according to ERS/ATS, was 5.9% and only one patient met criteria for both groups. When compared to anti-IL-5-eligible patients, severe asthmatics were more often current smokers at diagnosis, obese, used higher ICS dose and had higher blood neutrophils 12 years after diagnosis. Both groups differed from non-severe asthma by higher number of all and unplanned respiratory-related visits to healthcare. Severe asthmatics showed the highest number of hospitalizations.ConclusionsIn a cohort of unselected consecutive patients with adult-onset asthma, 5.9% fulfilled criteria for severe asthma and 2% qualified for anti-IL-5 treatment. Both groups represent a high burden to healthcare and specifically targeted treatment could lead to lower use of healthcare at long-term.

manejo de la psoriasis moderada-grave en condiciones de práctica habitual en el ámbito hospitalario español

Publication date: Available online 8 June 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J.L. López-Estebaranz, P. de la Cueva-Dobao, C. de la Torre Fraga, M. Galán Gutiérrez, E. González Guerra, J. Mollet Sánchez, I. Belinchón Romero
IntroducciónEn España existe actualmente escasa información sobre el manejo de los pacientes con psoriasis en la práctica clínica diaria de los dermatólogos.ObjetivoEl objetivo de esta encuesta de opinión fue recoger información de los dermatólogos españoles expertos en el manejo de los pacientes con psoriasis sobre los protocolos que realizan en su práctica clínica habitual.Material y métodosEncuesta de opinión realizada mediante cuestionario on line remitido a 75 dermatólogos expertos en el manejo de la psoriasis. El cuestionario, diseñado específicamente para la encuesta de opinión, incluía 12preguntas sobre diferentes aspectos de la práctica clínica en el tratamiento de la psoriasis moderada-grave.ResultadosLa tasa de respuesta fue del 96% (n=72). Los biológicos fueron la opción más usada como monoterapia. El 64,3% de los encuestados señaló que sus pacientes permanecen 1-2años con terapias sistémicas clásicas antes de la transición a biológicos, y el principal determinante para decidir la transición fue el control inestable de la actividad de la enfermedad. El 85,7% dio importancia «alta» o «muy alta» a considerar una puntuación PASI <3 como objetivo terapéutico. Los fármacos de elección más consensuados fueron etanercept en población pediátrica (78,6%), adalimumab y etanercept en artritis psoriásica (64,3%) y ustekinumab en pacientes con frecuentes ausencias domiciliarias (78,6%), baja adherencia (71,4%) e historia de esclerosis múltiple o enfermedades desmielinizantes (64,3%).ConclusiónEsta encuesta de opinión proporciona una perspectiva única sobre las opiniones de una muestra representativa de los dermatólogos expertos en cuanto al tratamiento actual de la psoriasis con fármacos biológicos en España.BackgroundThere is currently little information available on the management of patients with psoriasis in the daily clinical practice of dermatologists in Spain.ObjectiveThe aim of this study was to survey a group of Spanish dermatologists with particular expertise in the management of psoriasis to determine their opinions on the protocols used in routine clinical practice.Material and methodsA cross-sectional study based on an online survey about the management of psoriasis sent to 75 dermatologists. The survey, which was specifically designed for the study, included 12questions on different aspects of clinical practice in the treatment of moderate to severe psoriasis.ResultsThe response rate was 96% (n=72). Biologics were the most widely used monotherapy option. In total, 64.3% of respondents reported that their patients used conventional systemic therapies for 1 to 2years before switching to a biologic drug and that the main reason for the switch was unstable control of disease activity. Overall, 85.7% assigned a "high" or "very high" importance to the use of a Psoriasis Area Severity Index score of <3 as a treatment goal. The drugs of choice among the respondents were etanercept for pediatric patients (78.6%), adalimumab and etanercept for patients with psoriatic arthritis (64.3%), and ustekinumab in patients frequently away from home (78.6%) and patients with a history of multiple sclerosis, demyelinating diseases (64.3%), or poor adherence to treatment (71.4%).ConclusionThis study provides a unique overview of the opinions of a representative sample of expert dermatologists on the current use of biologics for the treatment of psoriasis in Spain.

Why not be a desertist?

Abstract

Many philosophers believe that luck egalitarianism captures "desert-like" intuitions about justice. Some even think that luck egalitariansm distributes goods in accordance with desert. In this paper, we argue that this is wrong. Desertism conflicts with luck egalitarianism in three important contexts, and, in these contexts, desertism renders the proper moral judgment. First, compared to desertism, luck egalitarianism is sometimes too stingy: it fails to justly compensate people for their socially valuable contributions—when those contributions arose from "option luck". Second, luck egalitarianism is sometimes too restrictive: it fails to justly compensate people who make a social contribution when that contribution arose from "brute luck". Third, luck egalitarianism is too limited in scope: it cannot diagnose economic injustice arising independently of comparative levels of justice. The lesson of this paper is that luck egalitarians should consider supplementing their theory with desert considerations. Or, even better, consider desertism as a superior alternative to their theory.

Biomonitoring birds: the use of a micronuclei test as a tool to assess environmental pollutants on coffee farms in southeast Brazil

Abstract

Birds have often played an important role as environmental bioindicators, and different species can be useful due to their bioaccumulating capacity. The micronuclei test is a cytologic technique used for accessing DNA and is a biomarker for damage to DNA. This study analysed the Cerrado avian community, especially the efficiency of the blue-black grassquit (Volatinia jacarina) in responding to pesticide contamination in situ on different-sized coffee farms in southeast Brazil. The micronuclei test was used in erythrocytes of birds. Eighty-two individuals of 21 bird species belonging to 11 families that were found in all study areas were used to evaluate micronuclei (MN) frequency. Two hundred fifty-two MN were counted in every area of study. The MN average count was 3/10,000 erythrocytes, and 17.1% of all bird species exhibited no MN. The average MN was 1.29 ± 0.69 in small farms, 2.59 ± 1.65 in medium farms, and 5.41 ± 1.34 in large farms. Small farms accounted for 14.3% of MN frequency, medium farms 27.8%, and large farms 57.9%. V. jacarina was the most abundant species found and displayed a sensitive response to environmental contamination. Pesticides appear to induce MN formation in a dose-dependent way when farms are analysed according to their area. Therefore, biomonitoring birds remain an efficient means to detect environmental pollutants, especially pesticides. V. jacarina responds as a sensitive biomonitor, showing a dose-dependent response to pesticides used in coffee farms.

Skin-Reduction Breast Reconstructions with Prepectoral Implant covered by a combined dermal flap and Titanium-coated polypropylene mesh

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marco Marcasciano, Juste Kaciulyte, Marika Gentilucci, Leonardo Barellini, Diego Ribuffo, Donato Casella
A rise in breast reconstruction after mastectomy was registered in the last few decades. Conservative mastectomies as Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) developed as well and it was introduced a new goal to achieve: to ensure adequate coverage to the implant minimizing eventual complications as well as maximize cosmetic outcomes.We report our experience performing immediate pre-pectoral implant based breast reconstruction following skin reducing mastectomy, by using a combined inferior dermal flap and Titanium-coated polypropylene mesh, TiLoop Bra pocket. In selected patients with adequate soft tissue residual coverage, excellent aesthetic results and low complication rate combined with cost saving was achieved.

Long-Distance Care of Face Transplant Recipients in the United States

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): William J. Rifkin, Amit Manjunath, Laura L. Kimberly, Natalie M. Plana, Rami S. Kantar, G. Leslie Bernstein, J. Rodrigo Diaz-Siso, Eduardo D. Rodriguez
Promising aesthetic and functional outcomes in facial transplantation have fueled the interest of patients and providers alike. However, there are currently only 11 active face transplant centers in the United States, and only five have accumulated operative experience to date, resulting in an extremely unbalanced geographical distribution of providers. Since face transplant recipients must receive life-long follow-up, this presents unique challenges for face transplant candidates and provider teams, as long-distance travel may add considerable difficulty to pre- and post-transplant care. Furthermore, by compromising follow-up, this burden of travel may impact the ability of experienced face transplant centers to collect data, share knowledge as these patients are followed, and continue to advance the field. This article highlights the unique logistical and ethical implications of the highly probable long-distance nature of face transplant care in the United States, a challenging aspect of management that has not been previously discussed in the literature. Furthermore, we review current strategies in the long-distance management of solid organ transplantation (SOT) recipients, and propose several possibilities to help address these challenges in facial transplantation based on SOT experience.

Risk factors for developing capsular contracture in women after breast implant surgery A systematic review of the literature

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yara Bachour, Claudia A. Bargon, Christel J.M. de Blok, Johannes. C.F Ket, Marco J.P.F Ritt, Frank B. Niessen
BackgroundCapsular contracture is the most frequent complication in breast augmentation or reconstruction with breast implants. The exact mechanism for this complication is not completely understood. Yet, it is most likely to be a multifactorial condition. Several patient-, as well as surgery-, and implant-specific risk factors have been related to cause capsular contracture. This review aims to provide a clear overview of all risk factors for capsular contracture.MethodsA systematic literature review was performed focusing on patient-, surgery- and/or implant-related factors related to capsular contracture in breast implants. PubMed, Embase.com, and Wiley/Cochrane Library databases were searched for relevant articles published from inception up to October 20, 2016. The included studies were assessed for the following main variables: study characteristics, patient characteristics, indication for surgery, type of surgery, implant characteristics, and other characteristics.ResultsData for the risk factors for the development of capsular contracture was retrieved from 40 studies. A presumptive increased risk in the development of capsular contracture for the following variables is shown: longer duration of follow-up, breast reconstructive surgery in patients with a history of breast cancer, subglandular implant placement, post-operative hematoma, and a textured implant surface. There is little, weak or no evidence for the other factors in relation to capsular contracture. This review also shows a large heterogeneity between studies and within the definition of capsular contracture.ConclusionThis review provides an overview of the relationship between patient-, surgery-, and implant-specific risk factors in the development of capsular contracture.

Music Made for the Original Maestro of Plastic Surgery

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A J Diver

Should Planned/Desired Pregnancy be Considered an Absolute Contraindication to Breast Reconstruction with Free Abdominal Flaps? A Retrospective Case Series and Systematic Review

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Shawn Moshrefi, Suhail Kanchwala, Arash Momeni
BackgroundAutologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to becoming pregnant postoperatively due to concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Hence, the authors examined the clinical outcome in patients who became pregnant following autologous breast reconstruction.MethodsPatients who underwent autologous breast reconstruction with free abdominal flaps that required an incision in the anterior rectus sheath were identified. Of those, patients who became pregnant post-reconstruction were included for subsequent analysis. Of particular interest were any peri- and post-partal complications that could be attributed to the preceding abdominal flap harvest. Additionally, a systematic review of the literature was performed.ResultsWe identified five patients who met inclusion criteria. All five patients underwent bilateral breast reconstruction with free muscle-sparing transverse rectus abdominis musculocutaneous (MS-TRAM) flaps. None of the patients had any pre-existing abdominal wall morbidity. All five patients proceeded to full-term and successfully delivered newborns, four of which were delivered via normal vaginal delivery and one via Cesarean section. No abdominal wall complications were noted during pregnancy, delivery, or post-partum.ConclusionContemporary data does not support the notion that breast reconstruction with free abdominal flaps is contraindicated in the setting of desired or planned pregnancy.

Lympahtico venous anastomosis and resection for genital acquired lymphangiectasia (GAL)

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): H Hara, M Mihara
The purpose of this paper is to report on the relationship between lymphoscintigraphic findings and the operative results of lymphatico-venous anastomosis (LVA) and resection of genital acquired lymphangiectasia (GAL). Seventeen GAL patients who underwent lymphoscintigraphy between April 2012 and June 2016 were included in this retrospective study. LVA and GAL resections were performed for 14 patients. The GALs were resected in a spindle shape to the full thickness of the genital skin and the wounds were closed primarily. Following the procedure, we investigated the recurrence rate and compared the results with the lymphoscintigraphic findings. The average follow-up period was 19.2 months. Six patients were without recurrence and eight patients experienced a small recurrence of GAL. The average period from the operation to recurrence was 16.8 months (range: 1-41 months). In the six patients who had genital accumulation in lymphoscintigraphy, two experienced recurrence (33.3 %), while six of the eight patients without genital accumulation experienced recurrence (75.0 %). The frequency of cellulitis was observed to be reduced postoperatively in all patients, and recurrence was observed in one patient at 11 months postoperatively. In conclusion, lower limb LVA combined with genital skin tumor resection was effective for preventing recurrence of GAL in patients who demonstrated communication between the lymphatic vessels in the lower limb and the genitals. This procedure also had the benefit of reducing the frequency of cellulitis for an average of 19.2 months of follow-up.

DONOR SKIN ALLOGRAFT SURVIVAL AFTER BONE MARROW TRANSPLANTATION: CASE REPORT AND SYSTEMATIC REVIEW OF THE LITERATURE

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Teresa Nunez-Villaveiran, Patrick Feasel, Sean Keenan, Rachel Aliotta, David Bosler, Duncan Stearns, Wilma Bergfeld, Raffi Gurunluoglu
Backgroundwe present a case of skin allograft survival in a patient who previously received a bone marrow transplant from the same HLA-matched donor. DNA fingerprinting of skin biopsies showed mixed cellularity originating from the donor and recipient (68% and 32% donor DNA in the allograft skin and the native recipient's skin, respectively). Histologic sections demonstrated both grade 3/4 rejection and graft-versus-host- disease. We have conducted a systematic review in search for other cases of donor skin allograft survival after a bone marrow or hematopoietic stem cell transplantation.MethodsAll reported cases in English, Spanish, French and German were captured using the electronic databases. Bibliographies of relevant articles were manually searched.ResultsNineteen patients (12 females) who received skin allografts from their bone marrow or hematopoietic stem cell donors were identified. Average age was 27.2 years (range 5 months - 64 years). Skin allografts were used to treat graft-versus-host- disease, Hertlitz-junctional epidermolysis bullosa, and to test tolerance prior to a kidney transplantation from the same donor. Eight cases were not receiving immunosuppressive therapy. Allografts survived in all patients. In three patients skin punch biopsies were taken and demonstrated mixed donor and recipient cellularity. The pathology result is specified in two more cases, with no signs of rejection.Conclusionssame donor skin allografts may be a safe option to treat severe cutaneous conditions in recipients of a bone marrow/hematopoietic stem cell transplantation. However, future studies are needed to confirm these results.

Feasibility of using computer simulation to predict the postoperative outcome of the minimally invasive Nuss procedure: Simulation prediction vs. postoperative clinical observation

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kwong Ming Tse, Long Bin Tan, Shu Jin Lee, Mohamed Zulfikar Rasheed, Bien Keem Tan, Heow Pueh Lee
The Nuss procedure is the most minimally invasive and commonly used surgical correction for pectus excavatum (PE) by using a pre-bent pectus bar to elevate the deformed chest wall. However, there exist some complications such as postoperative pain as well as surgical uncertainties due to human judgement. It is therefore important to understand the biomechanical effect of the pectus bar on PE thoraces undergoing an operation to alleviate the postoperative pain as well as to improve surgical outcome. The current study incorporated the finite element method (FEM) to simulate the entire Nuss procedure including the flipping process of the pectus bar on a preoperative PE patient-specific thorax model, in conjunction with comparison against the postoperative CT scans. The mid-sagittal sternovertebral elevation was found to be within 5.32 mm while the transverse sternal deviations ranged from 1.59 mm to 3.02 mm. The average discrepancy between the predicted contour and postoperative CT contour was about 3%. On a different note, the stress and strain distributions largely concurred with reported findings. High bilateral stress was seen to occur at the back of ribs near the vertebral column, and particularly over the 2^nd to 5^th ribs, while the greatest strain was found to be confined to the regions of costal cartilages. It is evident that the FEM is a feasible and robust approach of predicting the mechanical surgical procedure. This contributes to the future development of a predictive tool incorporated in surgical planning to enhance surgical management of pectus excavatum.

“Immediate breast reconstruction with a Wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap”

Publication date: Available online 9 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Richard Lewin, Christian Jepsen, Håkan Hallberg, Emma Hansson
Preservation of the nipple-areola complex (NAC) in immediate reconstruction of ptotic and large breasts is surgically challenging. This article presents a modification of the inferior dermal flap ("dermal sling") to a vertical bipedicle flap with NAC preservation. The flap is well described in breast reductions, but has never been described in a mastectomy setting. The study reviews data for a case series of 17 breasts in 11 women who were reconstructed with the new technique. The complication rate was 12 percent and the vertical bipedicle NAC-sparing flap has to be considered a feasible option in women with ptotic and/or large breasts.

Total Lower Lip Reconstruction with Free Forearm Flap Suspended on Adams Wires

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Maciej Rysz, Romuald Krajewski

‘The Silicone Siphon’ - A safe and simple method of removing silicone implant and content from the breast

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): R. Chukwulobelu, S. Seetharam, A.J. Desai, R. Ragoowansi

Comparative study of phrenic and partial ulnar nerve transfers for elbow flexion after upper brachial plexus avulsion–a retrospective clinical analysis

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yuzhou Liu, Yongqing Zhuang, Hu Yu, Hongtao Xiong, Jie Lao
The widely used nerve transfer sources for elbow flexion in patients with upper brachial plexus avulsion (UBPA) include partial ulnar nerve, phrenic nerve and intercostal nerves. A retrospective review of 21 patients treated with phrenic and partial ulnar nerve transfers for elbow flexion after UBPA was carried out. In the phrenic nerve transfer group, the phrenic nerve was transferred to the anterolateral bundle of anterior division of upper trunk; In the partial ulnar nerve transfer group, one fascicle of the ulnar nerve was transferred to the biceps branch. The British Medical Research Council (MRC) grading system, angle of elbow flexion, electromyography (EMG) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scoring were used to evaluate the recovery of elbow flexion at least 3 years postoperatively. The efficiency of motor function in phrenic nerve transfer group was 82%, while it was 80% in partial ulnar nerve transfer group. The outstanding rates of angle of elbow flexion were 64% and 70% in phrenic and partial ulnar nerve transfer groups, respectively. The DASH scores after surgery were significantly lower than those before surgery in the two groups. There was no statistical difference between the two groups in the changes of DASH scores before and after surgery. Both of phrenic and partial ulnar nerve transfers had good prognosis for elbow flexion in patients with upper brachial plexus avulsion.

Visualization of Lymphatic Ducts with Preoperative ICG Lymphography prevents Donor-Site Lymphedema Following PAP Flap

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ryohei Ishiura, Minami Fujita, Megumi Furuya, Chihena Banda, Mitsunaga Narushima

Historical Review of Dakin's Solution Applications

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Cristiane M. Ueno, Cody L. Mullens, Jeff H. Luh, William A. Wooden
Dakin's solution and the Carrel-Dakin method were developed and integrated into clinical practice in the early 20^th century, which were found to aid in effective wound healing and infection. This historical review briefly outlines highlights with respect to the history of infection management, wartime amputation, and wound treatment dating back to Galen through the early 20^th century. This paper extensively reviews and discusses the historic use of Dakin's solution, which was developed almost a century ago, in both wartime settings and in the civilian sector as well. This review further elaborates on the use of Dakin's solution in the current treatment of wounds in the United States. Additionally, we discusses the history of wound care with the emphasis on the Carrel-Dakin method. Lastly, this review discusses and presents contemporary application and utilization of Dakin's solution in two large tertiary care centers.

A technique to measure the tension across a wound in real time during wound closure

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Leonie Heskin, Ken Bourke, Jason Kelly

Review of Donor Site Complications Among Different Intra-Abdominal Vascularized Lymph Node Free Flaps: Future Tendency of Application Based on Anatomical Considerations

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ying-Sheng Lin, Hung-Chi Chen

Ultra-High Frequency Ultrasound in planning capillary perforator flaps: preliminary experience.

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Giuseppe Visconti, Akitatsu Hayashi, Hidehiko Yoshimatsu, Alessandro Bianchi, Marzia Salgarello

Internal Mammary Usability as Recipient Vessels in DIEP Breast Reconstruction in the Setting of Previous Radiation

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): William Leppard, Thomas Pomposelli, Eric I Chang, Ahmed Suliman, Fernando Herrera

Propeller TAP Flap Breast Reconstruction – a Simplified Surgical Technique

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Gudjon Leifur Gunnarsson, Jens Holm, Nicolaj Duus, Mikkel Børsen-Rindom, Tina Tos, Camilla Bille, Lisbeth Hölmich, Jens Ahm Sørensen, Jørn Bo Thomsen
BackgroundThe propeller thoracodorsal artery perforator (TAP) flap in combination with a mesh and an implant has replaced the Latissimus Dorsi flap as the first-choice alternative for the DIEP flap for delayed breast reconstruction in our practice. The aim of this paper is to share our experience using the propeller TAP flap for delayed breast reconstruction with a focus on surgical technique.Material and methodsWe performed 123 propeller TAP flaps in 94 women aged 51 (26-71) years. Color Doppler ultrasonography guided propeller TAP flaps with minimal rotation and perforator dissection was used for delayed breast reconstruction using an implant and a mesh.ResultsThe intended delayed breast reconstruction was achieved in 120/123 (98%) cases, 65 unilateral and 29 bilateral. The flaps were raised on one perforator in 51 cases, two in 54 and three in 18 cases. Silicone implants were used for 86 reconstructions, expander 28 cases, Becker implant 6, and no implant three cases. The median implant volume was 300 cc. The median time for surgery was 3,5 hours for unilateral cases and 4 hours for bilalateral. Direct to implant breast reconstructions was used in 92/123 (75%) and two-stage in 28/123 (23%) reconstructions. The follow-up was 1 year and 8 months (two months to 4 years).ConclusionThe propeller TAP flap in combination with a mesh and an implant can safely be used for delayed breast reconstruction. The refined and simple procedure is fast and easy to perform in patients with well calibrated perforators identified by color Doppler ultrasound.

A Review of the Safety of Common Aesthetic Procedures during Pregnancy

Publication date: Available online 8 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nihull Jakharia-Shah, Priyanka Chadha, Lara Watson

A comparative analysis for the development and recovery processes of different types of clogging in lab-scale vertical flow constructed wetlands

Abstract

Clogging is a major operational and maintenance issue associated with the use of constructed wetlands. In this study, four lab-scale vertical flow constructed wetlands (VFCW) were used to fully understand the development mechanisms of various types of clogging and their recovery characteristics. The VFCWs were fed with glucose solution, starch suspension with and without bacteriostat, glucose, and starch mixed solution, respectively, to simulate Bio-clogging, organic particle clogging (Op-clogging), inert particle clogging (Ip-clogging), and the combination of Bio-clogging and Op-clogging (C-clogging). Resting operations with water decline were applied to relieve the clogging in the VFCWs. The results indicate that Op-clogging occurred first, followed by C-clogging and Bio-clogging. Ip-clogging took the longest time to develop and did not occur by the end of this study. The microscope analysis found that the extracellular polymeric substances (EPS) bonded the starch particles together to form a dense membrane-like structure and promoted the clogging process. In addition, surface clogging was observed in all four experimental beds. Op-clogging occurred much closer to the surface than those caused by soluble organic matter and inert particles. Furthermore, the growth of biofilm caused significant decline in hydraulic conductivity, whereas its influence on porosity was relatively slight. Moreover, applying resting operation with water decline was effective for recovery from Bio-clogging, Op-clogging, and C-clogging in VFCWs except for Ip-clogging. The results also implied the recovery rates through applying resting operation with water decline were much higher than that with constant water level.

Occurrence, removal and environmental risk of markers of five drugs of abuse in urban wastewater systems in South Australia

Abstract

The occurrence and fate of five drugs of abuse in raw influent and treated effluent wastewater were investigated over a period of 1 year in the Adelaide region of South Australia. Four wastewater treatment plants were chosen for this study and monitored for five drugs which included cocaine in the form of its metabolite benzoylecgonine (BE), methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and two opioids (codeine and morphine) during the period April 2016 to February 2017. Alongside concentrations in raw sewage, the levels of drugs in the treated effluent were assessed and removal efficiencies were calculated. Drug concentrations were measured by mixed-mode solid phase extraction and liquid chromatography coupled to a quadrupole mass spectrometer. Drug concentrations detected in the raw wastewater ranged from 7 to 6510 ng/L and < LOD to 4264 ng/L in treated effluent samples. Drug removal rates varied seasonally and spatially. The mass loads of drugs discharged into the environment were in descending order: codeine > methamphetamine > morphine > MDMA > BE. Results showed that all the targeted drugs were on average incompletely removed by wastewater treatment, with removal performance highest for morphine (94%) and lowest for MDMA (58%). A screening-level environmental risk assessment was subsequently performed for the drugs based on effluent wastewater concentrations. Based on calculated risk quotients, overall environmental risk for these compounds appears low, with codeine and methamphetamine likely to pose the greatest potential risk to receiving environments. Given the recognised limitations of current ecotoxicological models and risk assessment methods for these and other pharmaceutical drugs, the potential for environmental impacts associated with the continuous discharge of these compounds in wastewater effluents should not be overlooked.