Current treatment options for acanthosis nigricans

The microbiota of traumatic, open fracture wounds is associated with mechanism of injury

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Use of Antibiotic Impregnated Resorbable Beads Reduces Pressure Ulcer Recurrence: A Retrospective Analysis

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Risk factors for hypertrophic burn scar pain, pruritus, and paresthesia development

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Tetrathiomolybdate, a copper chelator inhibited imiquimod-induced skin inflammation in mice

Humans have witnessed huge exploration and extensive utilization of heavy metal in the past few centuries. As a result, tremendous amount of heavy metal has entered the environment, in soil, water, and air, and inevitably into human bodies. In terms of millions of years of human evolution, elevation of the levels of heavy metal in the body is a quite recent event [1]. Increased body levels of heavy metal can cause many harmful effects [2]. Despite some heavy metals are essential for human body, toxic levels can cause inflammation and oxidative stress [3–6].

Algoritmo de tratamiento con omalizumab en urticaria crónica espontánea

Publication date: Available online 11 August 2018

Source: Actas Dermo-Sifiliográficas

Author(s): J. Spertino, E. Rozas Muñoz, L. Curto Barredo, I. Figueras Nart, A. Gimenez Arnau, E. Serra Baldrich, M. Bonfill-Ortí, V. Expósito-Serrano, A. Guilabert, G. Melé Ninot, M. Villar Buil, J. Garcias Ladaria, X. García Navarro, M. Vilavella, I. Bielsa Marsol, G. Aparicio Ortiz, C. Baliu Piqué, A. Álvarez Abella, N. Lamas Domenech, J.M. Mascaró

Resumen

Antecedentes y objetivo

Los ensayos pivotales de omalizumab en urticaria crónica espontánea (UCE) tienen un periodo de tratamiento de entre 12 y 24 semanas. Sin embargo, muchos pacientes en práctica clínica requieren periodos de tratamiento más prolongados. Por ello el objetivo es presentar un algoritmo de manejo del fármaco.

Materiales y métodos

El documento de consenso que detallamos nace de la puesta en común, aceptación, revisión y confrontación de la literatura reciente del grupo de trabajo de UCE «Xarxa d'Urticària Catalana i Balear» (XUrCB).

Resultados

Se inicia el tratamiento a dosis autorizada y se ajusta la dosis en intervalos trimestrales en función del Urticaria Activity Score de los últimos 7 días (UAS7) y/o el Urticarial Control Test (UCT).

Conclusiones

El algoritmo propuesto pretende servir de guía respecto a cómo ajustar dosis, cómo y cuándo parar el fármaco y el modo de reintroducirlo en casos de recaída.

Abstract

Background and objective

Pivotal trials with omalizumab for treatment of chronic spontaneous urticaria (CSU) are generally run over 12 to 24 weeks. However, in clinical practice, many patients need longer treatment. In this article, we present an algorithm for treatment with omalizumab.

Material and methods

The consensus document we present is the result of a series of meetings by the CSU working group of "Xarxa d'Urticària Catalana i Balear" (XUrCB) at which data from the recent literature were presented, discussed, compared, and agreed upon.

Results

Treatment with omalizumab should be initiated at the authorized dose, and is adjusted at 3-monthly intervals according to the Urticaria Activity Score Over 7 days, the Urticaria Control Test, or both.

Conclusions

The algorithm proposed is designed to provide guidance on how to adjust omalizumab doses, how and when to discontinue the drug, and how to reintroduce it in cases of relapse.

Uptake and accumulation of polycyclic aromatic hydrocarbons in the mangroves Avicennia marina and Rhizophora mucronata

Abstract

This study investigated the uptake and accumulation of polycyclic aromatic hydrocarbons (PAHs) in two mangrove species, Avicennia marina and Rhizophora mucronata. We tested the hypothesis that A. marina would absorb and accumulate more PAHs than R. mucronata. One-year old seedlings of both species were subjected to Bunker Fuel Oil 180 for 3 weeks, and the concentration of PAHs was analyzed by gas chromatography-mass spectrometry (GC/MS). The concentration of PAHs was significantly higher in A. marina than in R. mucronata. The major portion of the PAH pool was in roots (96% in A. marina, 98% in R. mucronata) compared to leaves. The dominant PAHs in roots of both species possessed two to three rings and included phenanthrene, anthracene, fluorene, and acenaphthene. In shoots, PAHs in A. marina included phenanthrene, chrysene, anthracene, acenaphthene, benzo[k+b]fluoranthene, pyrene, benzo[a] anthracene, and benzo[a] pyrene, while those in R. mucronata included phenanthrene, naphthalene, fluoranthene, fluorene, and acenaphthene. Phenanthrene was the dominant PAH in roots and shoots of both species. The greater susceptibility of A. marina appears to be due to its greater root length and specific root length, which permit more exposure to oil than R. mucronata. Other contributory factors include root anatomical characteristics such as larger air spaces, lower suberization of root epidermal cells, lower concentrations of polyphenols, tannins, lignin, and a less efficient antioxidative system. This study provides novel information on differences in the uptake and accumulation of PAHs in two contrasting mangrove species.

A new esophageal elongation technique for long-gap esophageal atresia: in vitro comparison of myotomy techniques

Abstract

Background

Complications such as stricture, leakage, recurrent tracheoesophageal fistula and mucosal pouch are commonly seen in myotomy techniques used for long-gap esophageal atresia (LGEA) treatments. Therefore, we think that there is a clear need for other techniques which would enable us to create more robust and longer esophagus in such cases. In this study, we reviewed multiple V-myotomy (VM) technique and the differences of the said technique with Livaditis circular myotomy (LM) and Kimura spiral myotomy (KM) techniques using literature as an aid.

Methods

21 esophagus samples from 21 male lambs aged 12 months were used in vitro for the study. All esophageal samples were matched to have a length of 120 mm. Samples were divided into 3 groups of 7 and VM, LM and KM techniques were used in each group, respectively. Post-op esophagus lengths, elongation amount with each incision and perforation pressures were measured.

Results

Post-op esophageal lengths were measured as 227, 210 and 200 mm for VM, LM and KM, respectively. Elongation amount per incision was measured as 5.1, 4 and 3.34 mm, again in previous order of VM, LM, and KM. Finally, perforation pressure following VM, LM, and KM was measured as 460, 400, and 410 mmHg.

Conclusion

VM was found to significantly increase total esophagus length and elongation per incision over LM and KM. In addition, VM was also shown to have a higher perforation pressure. Although in vivo live animal studies are required, we can say that VM can be used to create longer and robust esophagus.

A multicenter, randomized, single‐blind trial comparing the efficacy of viable cryopreserved placental membrane to human fibroblast‐derived dermal substitute for the treatment of chronic diabetic foot ulcers

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Do you know when a wound has healed? Insights from a large‐scale multinational consumer survey

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Prurigo pigmentosa au cours de la grossesse

Publication date: Available online 11 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): I. Devred, A. Sfecci, N. Cardot-Leccia, J.-P. Lacour, T. Passeron

Résumé

Introduction

Le prurigo pigmentosa est une dermatose inflammatoire rare marquée par son caractère prurigineux et son aspect réticulé typique du tronc, laissant un réseau pigmenté cicatriciel. Elle est très rarement rapportée en dehors de l'Asie et est encore méconnue en France.

Observation

Une femme de 21 ans, originaire du Maghreb, présentait une éruption très prurigineuse, faite de macules et de papules coalescentes formant un réseau réticulé inflammatoire sur le tronc. Cette éruption survenait lors du premier trimestre d'une grossesse marquée par des vomissements gravidiques majeurs ayant conduit à la perte de 13 kg, avec présence d'une cétonémie et d'une cétonurie. Devant l'aspect clinique caractéristique, l'absence de diagnostic différentiel et un aspect histologique compatible, le diagnostic de prurigo pigmentosa était retenu. L'évolution était marquée par des phases de diminution de l'inflammation et du prurit en alternance avec des poussées inflammatoires rythmées par des ré-ascensions de la cétonémie. Les symptômes étaient seulement résolus au deuxième trimestre de la grossesse, après disparition des vomissements, laissant un réseau hyperpigmenté brun séquellaire.

Discussion

Bien que rare, le prurigo pigmentosa a un aspect clinique très évocateur qui doit facilement en faire évoquer le diagnostic. D'étiologie encore indéterminée, il a été rapporté dans des cas de jeûne intense, d'anorexie, de diabète de type 1 mais aussi dans deux autres cas de grossesse avec vomissements intenses. Notre observation souligne l'importance de rechercher et de prendre en charge efficacement une cétonémie sous-jacente pour obtenir une rémission des poussées inflammatoires de prurigo pigmentosa.

Summary

Introduction

Prurigo pigmentosa is a rare inflammatory dermatosis characterized by pruritic and reticulate papules on the trunk leaving hyperpigmentation. This dermatosis has been rarely described outside Asia. The pathophysiology remains obscure.

Case report

We report the case of a 21-year-old North-African woman presenting with a highly pruritic eruption with numerous erythematous macules and papules coalescing in a reticular pattern on the trunk. The eruption occurred during the first trimester of pregnancy, which was marked by severe vomiting resulting in weight loss of 13 kg with ketonemia and ketonuria. Taking into account the characteristic pattern of the eruption, the absence of differential diagnosis, and the histological examination, we concluded on a diagnosis of prurigo pigmentosa. Progression of the disease exhibited phases of decreased inflammation and of pruritus alternating with episodes of inflammatory flares triggered by relapses of ketonemia. The symptoms finally resolved during the 2nd trimester of pregnancy after vomiting ceased. Secondary reticulated hyperpigmentation was observed.

Conclusion

Although rare, the highly evocative clinical presentation of the eruption should help clinicians in diagnosing prurigo pigmentosa. While pathophysiology remains undetermined, prurigo pigmentosa was reported in cases of intense fasting, anorexia, type-1 diabetes, and in two other cases of pregnancy with severe vomiting. Our case underlines the need to screen for and treat underlying ketonemia to achieve control of the inflammatory flares of prurigo pigmentosa.

On snubbing proximal intentions

Abstract

In the simplest case, a proximal intention is an intention one has now to do something now. Recently, some philosophers have argued that proximal intentions do much less work than they are sometimes regarded as doing. This article rebuts these arguments, explains why the concept of proximal intentions is important for some scientific work on intentional action, and sketches an empirical approach to identifying proximal intentions. Ordinary usage of "intend" and the place of intention in folk psychology and scientific psychology are discussed.

L’hydrochlorothiazide augmenterait le risque de mélanome

Publication date: Available online 10 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J.-L. Schmutz

Exchange Rate and Risk of Noise-Induced Hearing Loss in Construction Workers

Akaike information criterionconstruction3-dB5-dBexchange ratehearing lossnoisenoise-inducedimpacttask-based

Synergetic effect of hydrochar on the transport of anatase titanium dioxide nanoparticles in the presence of phosphate in saturated quartz sand

Abstract

The rapid development of nanomaterials has led to the unavoidable leakage and release of nanoparticles (NPs) into soil and the underlying groundwater. It is possible for chars and phosphate introduced into soil to improve crop soil properties by improving contact with NPs. In this study, the influences of hydrochar and/or phosphate on the anatase nTiO₂ transport behaviors were investigated under different conditions. The breakthrough curves (BTCs) and retention profiles were obtained by the saturated sand column experiments. The additional analysis of zeta potentials, sedimentation kinetics, Raman mapping, and the two-site kinetic attachment model (TSKAM) was conducted to explore the possible underlying mechanisms. The simultaneous presence of phosphate and hydrochar acted in a synergetic fashion to enhance the transport of nTiO₂ in a sand medium compared to the facilitated effect of single phosphate or hydrochar. The higher levels of hydrochar induce the more nTiO₂ in the high IC solution passing through the saturated sand columns in the co-presence of phosphate. It was attributed to the competitive adsorption of hydrochar with nTiO₂ to the sand site and the phosphate adsorption on nTiO₂ occurred simultaneously through the sand columns. The fitting results of BTCs using TSKAM showed that the value of k₂ for nTiO₂ (the irreversible attachment coefficient at site 2) was smaller than that of k_1d/k₁ (the first-order reversible detachment and attachment coefficient at site 1, respectively), suggesting irreversible retention of anatase nTiO₂ at site 1. The value of k_1d/k₁ could be better used to explain the retention of nTiO₂ with combined phosphate and hydrochar. This study provides insight into the implications of phosphate and/or hydrochar for nTiO₂ transport in crop soil environments.

Graphical abstract

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The Gracilis Free Flap Is a Viable Option for Large Extremity Wounds

Background Traditionally, the gracilis free flap is used for coverage of small- to medium-sized wounds (100 cm2). Methods We retrospectively reviewed records of 34 patients who underwent extremity soft-tissue reconstruction using gracilis free flaps for wounds larger than 100 cm2 from 1998 to 2016. The primary outcome was overall flap success rate. Secondary outcomes were rates of major and minor complications. Mean defect size was 145 cm2 (range, 104–240 cm2). Seven flaps covered defects greater than 175 cm2. Indications were tumor extirpation (n = 18) and traumatic/posttraumatic wounds (n = 16). The most common time period for flap coverage was immediately (3 days or less) after the defect was created (n = 14). Most flaps were solely muscle (n = 28) and were used for lower extremity or foot coverage (n = 29). Results The overall success rate was 94%. Major and minor complications occurred in 5 and 13 cases, respectively. The most common major complication was unplanned reoperation (n = 5), and the most common minor complications were partial skin graft loss (n = 3), partial flap necrosis (n = 3), and planned recipient-site reoperation (n = 5). Conclusions Reconstruction of large extremity wounds using the gracilis free flap showed a 94% success rate with few major complications.

Ptosis Sensitivity Threshold for the Lay Observer

Purpose This study aims to understand the degree to which ptosis is recognizable to a layperson. Methods Fifteen color drawings of a gender-neutral human face were created. Six faces exhibited right-sided ptosis (decreased margin reflex distance 1 and lengthened tarsal platform show) of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, and 3 mm, respectively. Six more faces exhibited left-sided ptosis of the same amounts. The 12 ptotic faces and 3 symmetrical faces were randomly placed on three 11-inch by 14-inch sheets of paper with 5 faces on each page. Lay observers were provided 6 seconds per face to indicate whether it appeared to be asymmetrical. Statistical tests examined the observers' ability to detect asymmetry better than chance. Sex differences in correctly recognizing asymmetry in ptosis at each 0.5 mm increment were analyzed. Results One hundred thirty-one lay observers were enrolled in the study. Fifty-seven were women and 74 were men. Lay people were able to correctly recognize ptosis better than chance when the asymmetry was 1.5 mm or greater. Moreover, females were more accurate in recognizing ptosis at 1.5 mm, 2.0 mm, and 2.5 mm of asymmetry. Conclusions Lay observers tend to recognize between 1.0 mm and 1.5 mm of ptosis on one side as being abnormal. This may have implications in the selection of candidates for ptosis surgery and the analysis of subsequent surgical outcomes.

The ReSurge Global Training Program: A Model for Surgical Training and Capacity Building in Global Reconstructive Surgery

Background A paradigm shift is underway in the world of humanitarian global surgery to address the large unmet need for reconstructive surgical services in low- and middle-income countries (LMICs). Here, we discuss the ReSurge Global Training Program (RGTP), a model for surgical training and capacity building in reconstructive surgery in the developing world. The program includes an online reconstructive surgery curriculum, visiting educator trips, expert reconstructive surgeon involvement, trainee competency tracking system, and identification of local outreach partners to provide safe reconstructive surgery to the neediest of patients in the developing world. Methods A retrospective review of the components of the RGTP from July 2014 through June 2017 was performed. Trainee milestones scores were analyzed to observe trends toward competency in specific plastic surgery skill sets. Results There were a total of 38 visiting educator trips during the study period. The trips took place in 10 LMICs. A total of 149 trainees were evaluated in the context of the visiting educator trips with 377 distinct submodule evaluations. Four trainees had more than 10 submodule evaluations over 2 or more visiting educator trips. There was notable improvement in milestones ratings over time among the trainees in this program. Conclusions The RGTP is a model of reconstructive surgical training and capacity building in LMICs. Trainees develop important skill sets in reconstructive surgery as a result of their involvement in the program. This comprehensive training approach addresses the disparity in access to care in the developing world by providing short- and long-term solutions to unmet reconstructive needs.

Salvage of Threatened Cardiovascular Implantable Electronic Devices: Case Series and Review of Literature

Background The treatment of infected or exposed cardiac pacing and defibrillator devices is controversial. The conservative and widely accepted management calls for removal of the device and leads with immediate or delayed replacement of new components in a new site. Lead extraction carries a 2% major complication risk. In this article, we describe our experience with device salvage techniques and review the current literature. Methods This is a retrospective case series of consecutive patients with infected, exposed, or at-risk implanted cardiac devices that were treated with aggressive surgical debridement, local pocket irrigation, and revision. A comprehensive review of the literature regarding device infection management was performed. Results Ten patients with threatened devices were identified. Surgical revision with the aim to salvage the device was successful in 8 (80%) of 10 cases. Seventeen retrospective publications were reviewed. All indicate success with attempted salvage surgery, but heterogeneity of data limits formal meta-analysis and prevents management recommendations. Conclusions Cardiac pacing and defibrillator devices with low-grade infection or threatened exposure may be salvaged without explantation. Despite the lack of clear management guidelines or data, plastic surgeons may be asked to assist in the management of threatened cardiac devices. Further prospective trials are required to evaluate the safety, efficacy, and cost-effectiveness of attempted implant salvage.

The Tuck-in Mastopexy

Background Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. The aim of this article is to describe a mastopexy technique used for grades 1 to 2 ptosis, "tuck-in" mastopexy technique. Methods Keyhole pattern was used for skin markings. All the planned skin excision areas were de-epithelialized. Breast mound was elevated as a 1-piece flap with extensive subglandular dissection. Elevated breast flap was reshaped and repositioned. Skin incisions were sutured in 2 layers. Results Seventeen patients were operated on with this technique; average follow-up time was 10.1 months. No major complications were seen. The results were pleasing for both the patients and the surgeon. Conclusions The "tuck-in" mastopexy technique uses breast mound as 1-piece flap, which has great vascularity from medial, superior, and lateral pedicles. Large areas of de-epithelialization facilitate reshaping and repositioning. It permits simultaneous or secondary breast augmentation with silicone gel implants. This easy-to-do technique has low complication rates and a short learning period.

Commentary on Intraoperative Analgesic Consumption and Hospital Discharge Criteria in Select Reduction Mammaplasty Patients: A Closer Look

No abstract available

A Technique for the Prevention of Recurrent Eyebrow Ptosis After Brow Lift Surgery

Background Preventing the recurrence of eyebrow ptosis after brow lift surgery is challenging. We developed a novel technique to maintain elevation of the eyebrow after brow lift surgery. Methods A consecutive sample of patients who underwent brow lift surgery between June 2014 and June 2016 was divided into 2 groups. Group A underwent resection of excess skin during brow lift surgery; group B underwent the new eyebrow lift technique, which involved resecting skin and the lateral part of the orbital orbicularis oculi muscle, elevating the lower margin of the orbital orbicularis oculi muscle, and suturing it to the orbital periosteum. Eyebrow height and patient satisfaction were measured preoperatively and after surgery. Results This study included 273 patients. Mean follow-up time was 24.8 months (range, 6–52 months). Brow height was similar in groups A and B immediately postoperatively (group A: 28.37 ± 3.02 mm vs group B: 29.21 ± 2.97 mm) and at 6 months after operation (group A: 26.65 ± 2.53 mm vs group B: 27.45 ± 2.77 mm). At 12 months (group A: 22.73 ± 2.31 mm vs group B: 25.61 ± 2.62 mm) and 24 months (group A: 20.76 ± 2.22 mm vs group B: 24.74 ± 3.10 mm) after operation, the amount of brow elevation was significantly greater in group B. Two patients in group B experienced supraorbital neuralgia after surgery, which resolved by the 6-month follow-up. At 12 and 24 months after operation, patients in group B were significantly more satisfied with their surgery than patients in group A. Conclusion Our novel technique is simple and effective for preventing recurrent eyebrow ptosis after brow lift surgery.

Surgical Refinement Following Free Gracilis Transfer for Smile Reanimation

Importance Gracilis free muscle transfer is widely regarded as the gold standard functional smile reanimation in long-standing facial palsy. Although most patients achieve meaningful oral commissure movement, a subset has suboptimal aesthetic outcomes due to midfacial bulk or oral commissure malposition. Safe refinements that do not compromise excursion would be a welcome addition to the surgical armamentarium for this population. Objectives The goal of this study was to describe surgical approaches to the 3 most common postoperative sequelae that detract from the final result after gracilis facial reanimation and to examine how these surgical refinements affect aesthetic outcome, smile excursion, and quality of life. Design This was a retrospective case series. Setting Tertiary care center (Massachusetts Eye and Ear Infirmary Facial Nerve Center). Participants Of 260 gracilis transfers performed since 2003, meaningful excursion (>3 mm) but poor aesthetic outcome requiring additional surgery was noted in 21 patients and was related either to excess muscle bulk (9), resting inferior malposition of the oral commissure (9), or resting superior/lateral malposition of the oral commissure (3). Intervention Specific surgical interventions to address each of these negative sequelae were developed and refined, to preserve muscle functionality but eliminate the unsightly feature. Main Outcome Aesthetic status, determined by midfacial symmetry; quantitative smile excursion; and quality of life (using the FaCE instrument) were measured before and after revision. Results Patients who underwent gracilis refinement directed at either muscle debulking, or gracilis tightening or loosening experienced significantly improved aesthetics/midfacial symmetry and improved quality of life with no significant decrease in smile excursion. Conclusions Improved aesthetics and quality of life can be achieved through targeted revision of the gracilis free tissue transfer, without significant loss of smile excursion.

Financial Implications of Atypical Mycobacterial Infections After Cosmetic Tourism: Is It Worth the Risk?

Background Cosmetic tourism has become increasingly popular despite many associated risks. The economic impact of atypical mycobacterial infections in cosmetic tourism is poorly defined in the literature. We sought to investigate the costs and clinical course of patients with these infections. Methods A retrospective review of all patients managed by the Plastic Surgery Division at Columbia University Medical Center from 2013 to 2014 with atypical mycobacterial surgical site infections after cosmetic surgery outside the United States was performed. Data including patient demographics, procedure costs, clinical course, impact on daily life, and costs associated with complications were collected using hospital billing information, patient questionnaires, telephone interviews, and clinical charts. Cost analysis was done to identify the personal and societal costs of these complications. Results Data from 10 patients were collected and analyzed. Management of mycobacterial infections cost an average of $98,835.09 in medical charges. The indirect cost of these infections was $24,401 with a mean return to work time of 6.7 months. Total patient savings from cosmetic tourism was $3419. The total cost of a mycobacterial infection was greater than $123,236.47. Although the incidence of mycobacterial infection abroad is unknown, the potential cost of an infection alone outweighs the financial benefits of cosmetic tourism if the risk exceeds 2.77%. Conclusions Atypical mycobacterial infections as a result of cosmetic tourism come at considerable cost to patients and the health care system. When our results are taken into consideration with other risks of cosmetic tourism, the financial risks likely far outweigh the benefits.

A Single Surgeon's Experience With Transgender Female-to-Male Chest Surgery

Background Chest wall recontouring is a common surgical treatment of gender dysphoria in transmen and nonbinary individuals assigned female at birth. This study reviews more than 20 years of cases to identify risk factors for postoperative complications and likelihood of preservation of nipple sensation. Methods One hundred thirty-seven cases of female-to-male chest wall recontouring by a single surgeon from 1994 to 2016 were reviewed, 99 of which were included for final analysis. Double-incision free nipple graft and double incision with nipple transposition on a pedicle were the most common techniques used. Complication rates between these 2 techniques were compared, and multivariate analysis was used to identify possible predictors of major complications, and minor complications. Results No significant risk factors for major complications were identified. With regard to minor complications, advanced patient age (odds ratio [OR], 1.67; P = 0.03) and early surgical experience (OR, 5.08; P = 0.001) were found to be associated with increased risk. Preoperative hormonal treatment was found to trend toward a protective effect (OR, 0.13; P = 0.07). Conclusions Any of the reviewed techniques are safe in practice; however, there is a learning curve associated with their use, and longer follow-up will allow for the identification of late complications. The double incision with nipple transposition on a pedicle technique can be considered for patients for whom depigmentation of the nipple-areola complex is a significant concern, especially if they are willing to tolerate a potentially suboptimal chest contour.

Direct-to-Implant as a Frontline Option for Immediate Breast Reconstruction: A Comparative Study With 2-Stage Reconstruction

Background Immediate single-stage direct-to-implant breast reconstruction requires caution owing to the possibility of skin necrosis and implant failure. Nevertheless, this method has been performed widely for breast reconstruction. This study aimed to analyze the safety of single-stage implant reconstruction by comparing it with 2-stage reconstruction (TSR). Methods Immediate single-stage reconstructions (SSRs) and TSRs with a tissue expander, performed from January 2011 to December 2016, were retrospectively reviewed. Acellular dermal matrix was used in both groups to maintain similar pocket conditions. Risk factors were not considered in patient selection. Results We enrolled 290 patients including 8 who received bilateral breast reconstruction. A total of 298 breasts were operated, including 233 SSR cases (78%) and 65 TSR cases (22%). The surgical success (ie, the implant was maintained without explantation) rate was higher in SSR (97%) than in TSR (90.2%) (P = 0.03). Two-stage reconstruction had a significantly higher rate of hematoma (12.3% vs 3.4%, P = 0.005), seroma (41.5% vs 20.6%, P = 0.001), and implant failure (9.8% vs 3.0%, P = 0.03). However, the rate of skin necrosis was lower in TSR (7.7% vs 10.3%) with a trend toward significance (P = 0.053). The implant salvage rate was higher in SSR (61.1%) than in TSR (12.5%) even after revision operation (P = 0.013). Conclusions Single-stage reconstruction yielded a lower complication rate than TSR. Moreover, the high salvage rate of SSR causes less concern about implant failure despite the possibility of revision operation. Therefore, SSR may be considered a frontline method for breast reconstruction without any patient selection interference.

Resorbable Implants for Orbital Fractures: A Systematic Review

Background Orbital fractures are one of the most common sequelae of facial trauma. Objective The objective of this study was to summarize published data for resorbable implants in orbital reconstruction, including polymer composition, degradation characteristics, osteoconductivity, and complications such as enophthalmos, diplopia, and peri-implant inflammation. A literature search of the National Library of Medicine was performed via PubMed using the keyword resorbable orbital implant. A total of 27 studies were reviewed. Strength of data was assessed according to the Oxford Centre criteria. Results Most commercially available implants provide adequate tensile strength for up to 6 months (with the exception of polydioxanone, which loses strength within 1 month, and poly(D,L-lactide) within 3 months). This is sufficient for the isolated orbital floor or medial wall (tensile strength, ~300 MPa) but insufficient for reconstruction of load-bearing areas (eg, the inferior orbital rim with tensile strength of ~1.2 GPa). Thicker products (>1 mm) have increased risk for delayed inflammation than thinner products. Postoperative complications including delayed inflammation (0%–9%), eyelid malposition (0%–5%), enophthalmos (5%–16%), diplopia (0%–16%), infection (0%–2%), and infraorbital nerve hypesthesia (2%–18%) are variably distributed across implants with several notable exceptions: poly(L-lactide) has an increased risk of delayed inflammation, and polydioxanone has a risk of delayed enophthalmos and hematoma. Conclusions Resorbable implants are suitable for isolated medial wall or floor fractures with intact bony buttresses and function as a barrier rather than a load-bearing support.

Axillary Lymphadenectomy and Wound Complications in Implant-Based Breast Reconstruction

Background The most common method of breast reconstruction in the United States today is implant-based reconstruction. However, reported complication rates are high, from 30% to 50%. Thus, it is important for reconstructive surgeons to identify factors associated with or contributing to wound complications after breast reconstruction. This study sought to identify associations between axillary lymph node dissection and postoperative wound complications in implant-based breast reconstruction. Methods A retrospective chart review was performed of subjects undergoing breast oncologic and reconstructive surgery by a single breast surgeon and reconstructive surgeon, respectively, from 2013 to 2016. Medical records were reviewed of 273 subjects with 338 reconstructed breasts. Data were recorded on the extent of axillary node dissection and subsequent wound complications including seroma requiring percutaneous drainage, seroma requiring open drainage, wound dehiscence requiring local wound care, wound dehiscence requiring operative revision, implant exposure, and implant loss. Results Analysis of the data demonstrated an increase in complication rates with extent of axillary lymph node dissection; however, these rates did not reach statistical significance. Statistically significant associations, however, were identified between wound complication rates and other known risk factors including increasing age and body mass index, as well as smoking status. Conclusions Although an association between increasing complication rates and the extent of lymph node dissection has previously been reported, this study failed to demonstrate a statistically significant association with logistic regression analysis.

Should Constricted Ear Be Treated as Auricular Malformation or Deformity?

No abstract available

Chest Wall–Based Flap for Repairing Partial Mastectomy Defects: A Multipurpose Flap

Objective The objective of this study is to introduce a single and reproducible tissue-rearrangement oncoplastic technique that is applicable for all quadrants partial-mastectomy defects in small- to medium-sized breasts, using grounds drawn from cosmetic surgery. Methods Eleven small- to medium-sized breast cancer patients with tumor involvement of more than a quarter of the breast were operated on using the chest wall–based flap technique. The procedure is described in detail, and the results are analyzed in terms of both cosmetic and oncological results. Results The flap successfully reached all breast quadrants as necessary, as well as the areola-nipple complex. The resection borders were found to be free of tumor in all cases, and there were no perioperative complications. Patients rated nearly all the cosmetic parameters as "somewhat satisfied" or "very satisfied," and there was no evidence of fat necrosis in the postoperative mammography examinations. Conclusions Applying principles taken from the cosmetic plastic surgery lies at the base of any high standard reconstructive surgery in general and oncoplastic breast surgery in particular. The chest wall–based flap is suitable for the reconstruction of a wide range of breast lumpectomy defects and is feasible for small- to medium-sized breasts, which are usually not easily amenable to tissue rearrangement techniques. The learning curve is short, with replicable results.

Ceftriaxone-Resistant Aeromonas hydrophila Infection Following Leech Therapy: A New Resistant Strain

We report a case of ceftriaxone-resistant Aeromonas hydrophila infection in a 32-year-old man after medicinal leech therapy. The patient underwent a free gracilis muscle flap for dorsal foot soft tissue reconstruction. Because of persistent congestion after venous revision, medicinal leech therapy was initiated to aid in flap salvage. Intravenous ceftriaxone was administered prior to application of leeches for prophylaxis against A. hydrophila. Leech therapy was discontinued after 1 week, and ceftriaxone was discontinued 24 hours thereafter. An infection developed despite being on appropriate antibiotics. Culture sensitivities indicated that A. hydrophila was resistant to ceftriaxone.

Modified Treatment Algorithm for Pseudogynecomastia After Massive Weight Loss

Background Pseudogynecomastia is the increased aggregation of fatty tissue in the area of the male breast with resultant female appearance. Two forms can appear: pseudogynecomastia after massive weight loss (pseudogynecomastia obese [PO]) and pseudogynecomastia, which is caused only by adipose tissue (pseudogynecomastia fat). For PO, only the Gusenoff classification with corresponding operative treatment options exists. However, this classification is limited by the fact that it underestimates the extensive variability of residual fat tissue and skin excess, both crucial factors for operative planning. For this reason, we propose a modification of the treatment algorithm for the Gusenoff classification based on our results to achieve more masculine results. Materials and Methods A total of 43 male patients with PO were included in this retrospective study (grade 1a, n = 1; grade 1b, n = 1; grade 2, n = 17; grade 3, n = 24). Forty-two mastectomies with a free nipple-areola complex (NAC) transposition (grades 2 and 3) and 1 with a subcutaneous mastectomy (grade 1a) with periareolar lifting were performed. A retrospective chart review was performed to obtain data regarding age, body mass index, body mass index loss, weight loss, reason for weight loss, comorbidities, nicotine, and additional procedures, postoperative sensitive on the NAC transplants and complications. Results None of the free-nipple grafts were lost. Forty (95%) of 42 patients with mastectomy had a resensitivity on the NAC. Conclusions For pseudogynecomastia, the treatment algorithm of the Gusenoff classification should be modified and adapted according to our recommendations to achieve more optimal masculine results.

Curcumin and Biodegradable Membrane Promote Nerve Regeneration and Functional Recovery After Sciatic Nerve Transection in Adult Rats

Background Curcumin has immunomodulatory anti-inflammatory, antioxidant, and neuroprotective properties. The goal of this study was to determine the effects of curcumin and biodegradable membrane on nerve healing in rat sciatic nerve transected injuries. Methods Rats were divided into groups: (1) control group (Ctrl), (2) curcumin group (Cur), (3) membrane group (Mem), and (4) membrane and curcumin group (Mem + Cur). Functional recovery was evaluated at 2, 4, 6, and 8 weeks after surgery. At the end of the eighth week after surgery, histological assessments were done. Results At the end of 8th week after surgery, functional assessments (sciatic nerve index, withdrawal reflex latency, and electromyography) in the Mem + Cur group improved compared with other groups (P

Outcome of the Modified Meek Technique in the Management of Major Pediatric Burns

Introduction The modified Meek micrografting technique has been used in the treatment of severely burned patients and a number of articles have examined the use of the modified Meek technique in adults and in mixed-age groups. However, there is a paucity of research pertaining to the outcome in the pediatric age group. The aim of this study is to present our favorable outcome in pediatric major burns using the modified Meek technique. Methods A retrospective review of burn cases in Hospital Universiti Sains Malaysia from 2010 to 2015 was conducted. Cases of major burns among pediatric patients grafted using the Meek technique were examined. Results Twelve patients were grafted using the Meek technique. Ten (91.7%) patients were male, whereas 2 (8.3%) were female. The average age of patients was 6 years (range, 2–11 years). The average total body surface area was 35.4% (range, 15%–75%). Most burn mechanisms were due to flame injury (66.7%) as compared with scalds injury (16.7%) and chemical injury (16.7%). There was no mortality. All patients were completely grafted with a good donor site scar. The average graft take rate was 82.3%, although 8 cases had positive tissue cultures from the Meek-grafted areas. The average follow-up duration was 3.6 years (range, 1.1–6.7 years). Only 1 case developed contracture over minor joint. Conclusions The Meek technique is useful when there is a paucity of donor site in the pediatric group. The graft take is good, contracture formation is low, and this technique is cost-effective.

Primary Closure of Wide Fasciotomy and Surgical Wounds Using Rubber Band–Assisted External Tissue Expansion: A Simple, Safe, and Cost-effective Technique

Background Although decompressive fasciotomy is a limb-saving procedure in the setting of acute compartment syndrome, it leaves a large wound defect with tissue edema and skin retraction that can preclude primary closure. Numerous techniques have been described to address the challenge of closing fasciotomy wounds. This study reports our experience with fasciotomy closure using rubber bands (RBs) for external tissue expansion. Methods Patients were informed about RB closure and split-thickness skin graft options. Only patients who opted for RB closure and had wounds that could not be approximated using the pinch test underwent the procedure. Starting from the apex and progressively advancing, the RBs were applied to the skin edges at 3 to 4 mm intervals using staples. The RBs were advanced by twisting back-and-forth to create a criss-cross pattern. One week after application, fasciotomy wounds were closed primarily or underwent further RB application, based on clinical assessment of adequacy of skin advancement, compartment tension, and perfusion. Review of a prospectively maintained database was performed, including demographics, comorbidities, etiology, wound and operative details, hospital stay, and complications. Results Seventeen consecutive patients with 25 wounds (22 fasciotomy and 3 other surgical wounds) were treated using the RB technique. Average wound length and width measured 15.7 cm (range, 5–32 cm) and 5.2 cm (range, 1–12 cm), respectively. Locations of wounds included forearm (n = 12, 48.0%), leg (n = 7, 28.0%), hand (n = 4, 16.0%), elbow (n = 1, 4.0%), and hip (n = 1, 4.0%). Eighteen of 25 wounds (72.0%) were closed primarily after 1 RB application. Additional RB application was required for 5 wounds to achieve primary closure. Between stages, patients were discharged home if they did not have other conditions requiring in-hospital stay. No complications were observed, and no revision surgeries were required. Patient satisfaction was 100%, and all indicated that they would choose the RB technique over skin grafting. Conclusions The modified RB technique is a simple, safe, and cost-effective alternative for treating fasciotomy and other surgical defects resulting in high patient satisfaction and good cosmetic outcome, without the need for split-thickness skin graft or flap coverage.