Periorbital Rejuvenation

The periorbital region, consisting of the eyebrows, upper and lower eyelids, glabella, and pericanthal region, is particularly susceptible to early signs of aging. Overall, this process is influenced by both genetic and environmental factors. Periorbital rejuvenation continues to be an area of advancement with evolution in both noninvasive and invasive techniques. In this article, we will review minimally invasive and surgical procedures in the treatment of periorbital aging.

INTRODUCTION

The orbital structures function to protect our visual system, arguably the most important sense in today's visual and digital world. Any interruption or imbalance of the binocular visual system will have profound impact upon every aspect of a patient's life. Add to this the obvious cosmetic impact facial appearance and symmetry plays, and one soon realizes that any surgical intervention within and around the orbit requires intimate knowledge of the anatomy and physiology of the tissues contained therein.

Interleukin-1beta in synergism gabapentin with tramadol in murine model of diabetic neuropathy

Abstract

Neuropathic pain is a complication of cancer and diabetes mellitus and the most commonly used drugs in the treatment of the diabetic neuropathic pain have only limited efficacy. The aim of this study was to evaluate the role of the biomarker interleukin-1beta (IL-1ß) in the pharmacological interaction of gabapentin with tramadol in a model of diabetic neuropathic pain. CF-1 male mice, pretreated with 200 mg/kg i.p. of streptozocin (STZ), were used and at day 3 and 7 were evaluated by the hot plate test and the spinal cord level of IL-1ß was determined. Antinociceptive interaction of the coadministration i.p. of gabapentin with tramadol, in basic of the fixed the ratio 1:1 of their ED50 values alone, was ascertained by isobolographic analysis. Tramadol was 1.13 times more potent than gabapentin in saline control mice, 1.40 times in STZ mice at 3 days and 1.28 times in STZ at 7 days. The interaction between gabapentin and tramadol was synergic, with an interaction index of 0.30 and 0.22 for mice pretreated with STZ at 3 and 7 days. The combination of gabapentin with tramadol reversed the increased concentration of IL-1β induced by STZ in diabetic neuropathic mice. These findings could help clarify the mechanism of diabetic neuropathy.

Usefulness of dermoscopy/dermatoscopy to improve the clinical and histopathologic diagnosis of skin cancers

Publication date: Available online 13 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oriol Yélamos, Ralph P. Braun, Konstantinos Liopyris, Zachary J. Wolner, Katrin Kerl, Pedram Gerami, Ashfaq A. Marghoob

Abstract

Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared to naked-eye examination. Dermoscopy can also lead to the detection of thinner and smaller cancers. Furthermore, dermoscopy leads to more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, since most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers. Visualizing dermoscopic structures in the ex vivo specimens can also be beneficial. It can improve the histologic diagnostic accuracy by targeted step-sectioning in areas of concern, which can be marked by the clinician before sending the specimen to the pathologist, or by the pathologist on the excised specimen in the laboratory. In addition, ex vivo dermoscopy can also be used to select tumor areas with genetic importance since some dermoscopic structures have been related to mutations with theragnostic relevance. In the second article of this continuing medical education series we review the impact of dermoscopy on the diagnostic accuracy of skin cancer, how can dermoscopy affect the histopathologic examination, and which dermoscopic features may be more relevant in terms of histological and genetic prediction.

Dermoscopy/dermatoscopy and dermatopathology correlates of cutaneous neoplasms

Publication date: Available online 13 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oriol Yélamos, Ralph P. Braun, Konstantinos Liopyris, Zachary J. Wolner, Katrin Kerl, Pedram Gerami, Ashfaq A. Marghoob

Abstract

Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc.) to inform clinical management decisions. Dermoscopic findings and/or images provided to pathologists offer an important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form will provide little value to pathologists. Since most dermoscopic structures have direct histopathological correlates, dermoscopy can act as an excellent communication bridge between the clinician and the pathologist. In the first article of this continuing medical education series we review dermoscopic features and their histopathologic correlates.

Health shocks in sub-Saharan Africa: are the poor and uninsured households more vulnerable?

In developing countries, health shock is one of the most common idiosyncratic income shock and the main reason why households fall into poverty. Empirical research has shown that in these countries, households...

Encuesta sobre las características y honorarios de la práctica dermatológica privada española en 2018

Publication date: Available online 12 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): A. Martin-Gorgojo, I. García-Doval, E. del Río de la Torre

Resumen

Antecedentes y objetivo

Las tarifas por acto médico y los hábitos de asistencia privada de los dermatólogos apenas han sido objeto de estudio, al menos en nuestro entorno inmediato. Con el presente trabajo pretendemos describir hábitos de prestación de servicios, medios de cobro, promoción y fijación de tarifas de los dermatólogos que realizan asistencia privada en España. Secundariamente, buscamos analizar las diferencias por sección territorial, edad y sexo.

Materiales y métodos

Estudio descriptivo transversal a partir de un cuestionario on-line con un total de 31 preguntas dirigido exclusivamente a dermatólogos con asistencia privada en España, abierto a respuestas del 17 de mayo al 5 de junio de 2018. Los datos fueron analizados comparando por sección territorial, sexo y edad.

Resultados

Se recibió un total de 234 respuestas, paritarias en cuanto a sexo y proporcionadas en cuanto a las secciones territoriales de la Academia Española de Dermatología y Venereología (AEDV). Pudieron constatarse algunas diferencias por sección territorial, edad y sexo. Destacaban las tarifas sistemáticamente menores de las dermatólogas, incluso tras ajustar por factores de confusión mediante modelos de regresión.

Conclusiones

Quedan descritas características de la asistencia privada en Dermatología en España. El hecho de que haya tarifas más baratas entre las dermatólogas requiere de un estudio más detallado, probablemente mediante técnicas de investigación cualitativa.

Abstract

Background and objective

Per-visit fees and the characteristics of private practice in dermatology have been studied very little, at least in Spain. This study aims to describe how dermatologists in private practice in Spain provide services, collect payment, promote their services, and establish fees. We also analyze differences by region, age, and sex.

Materials and methods

We performed a descriptive, cross-sectional study based on an online questionnaire with a total of 31 questions aimed exclusively at dermatologists in private practice in Spain. The questionnaire was open for responses from May 17 to June 5, 2018. The data were analyzed by comparing region, sex, and age.

Results

A total of 234 questionnaires were returned, with equal numbers of male and female respondents and proportional numbers in terms of the regional sections of the Spanish Academy of Dermatology and Venereology (AEDV). Some differences were found for region, age, and sex. The fees of female dermatologists were consistently lower, even after adjusting for confounding factors by means of regression models.

Conclusions

We have described the characteristics of private dermatology practice in Spain. Charging of lower fees by female dermatologists requires more detailed study, probably using qualitative research techniques.

Graphical abstract

Photoprotective potential of medicinal plants from Cerrado biome (Brazil) in relation to phenolic content and antioxidant activity

Publication date: Available online 13 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Alesandra Ricardo Nunes, Ana Livya Moreira Rodrigues, Dinalva Brito de Queiróz, Icaro Gusmão Pinto Vieira, João Francisco Câmara Neto, João Tavares Calixto Junior, Saulo Relison Tintino, Selene Maia de Morais, Henrique Douglas Melo Coutinho

Abstract

Photooxidative damage affects cellular lipids, proteins and DNA in addition to being involved in the pathobiochemistry of erythema formation, premature skin aging, photodermatoses development and skin cancer. Phenolic compounds, flavonoids and hydroxycinnamic acid esters protect plant tissues against harmful UV-radiation. This study aimed to evaluate the sun protection factor of several Brazilian plant extracts in relation to UVB radiation absorption, which causes skin cancer, and to correlate the findings with their antioxidant activity, as well as with total phenol and flavonoid content. The antioxidant activity of the extracts were evaluated using the DPPH radical scavenging test. The photoprotective effect was evaluated using the methodology developed by Mansur. The antioxidant activity from the extracts showed IC₅₀ values ranging from 4.91 to 132.24 μg/mL when compared to the standard quercetin with an IC₅₀ of 5.01 μg/mL; the phenolic content varied from 3.77 to 57.14 mg GAE/g extract while flavonoid content varied from 1.80 to 5.89 mg EQ/g extract. Almost all extracts showed a potential for UVB radiation absorption in accordance with the ANVISA (Agência Nacional de Vigilância Sanitária) technical regulation for cosmetic sunscreens. The extracts with greater sun protection factors were those originating from Lippia microphylla (SPF = 26.82) and Dimorphandra gardneriana (SPF = 20.12). A sun protection factor of 15 or higher contributes to protect the skin, where the presence of sakuranetin flavonoids and quercetin glycosides contribute to this action.

Synthesis, characterization and unravelling the binding interaction of new bioactive 4-hydroxycoumarin derivative with calf thymus DNA: Insights from spectroscopic and theoretical aspect

Publication date: Available online 13 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Abhijit Mukherjee, Suvranil Ghosh, Rudraditya Sarkar, Satyajit Samanta, Sudipto Ghosh, Mahadeb Pal, Adinath Majee, Sukanta Kumar Sen, Bula Singh

Abstract

In the progress of small molecule drug candidates, 4-hydroxycoumarin based compounds bearing a crucial place as potent antibiotic agents with appreciable safety in drug invention. Being synthetically and easily obtainable, 4-hydroxycoumarin related compounds with planar structure have been promoted predominantly as DNA targeting agent. Nevertheless, here we elucidate the synthesis, characterization and theoretical study of bio-active small molecule 4-hydroxy-3,4′-bichromenyl-2,2′-dione (4HBD). Then we have illuminated the binding interactions of 4HBD with calf thymus DNA (ctDNA), which is particularly designed for biological application. Extensive investigations of the binding of 4HBD with ctDNA are provided by utilizing multi-spectroscopic and molecular docking approaches, including UV–vis absorbance, steady-state, time-resolved fluorescence spectroscopy and circular dichroism study. The calculated binding and quenching constant value from quantitative data analysis of absorption and emission spectroscopy shows that 4HBD binds to the ctDNA groove. Further confirmation of the same is found by comparative displacement and iodide quenching studies. Negative enthalpy, negative free energy and positive entropy change imply a hydrophobic force monitors the association of 4HBD with the biomacromolecule. Interestingly the small molecule (4HBD) shows potential anti-bacterial activity against the model pathogenic gram-negative (Escherichia coli and Pseudomonas aeruginosa) and gram-positive (Bacillus subtilis and Staphylococcus aureus) bacteria. The noncytotoxic nature of the 4HBD is demonstrated in vitro with the help of MTT assay by normal kidney epithelial (NKE), breast cancer cells (MCF-7) and human prostate cancer cell (PC3) lines. Hemolytic assay exhibits insignificant hemolysis of human erythrocyte cells at the minimum inhibitory concentration (MIC) of these tested bacteria. In this regard the present invention of 4-hydroxycoumarin based antimicrobial and noncytotoxic 4HBD molecule holds future promise in the development of new antibiotics.

Evaluating the role of small particle hyaluronic acid fillers using micro-droplet technique in the face, neck and hands: a retrospective chart review

A machine learning pipeline for internal anatomical landmark embedding based on a patient surface model

Abstract

Purpose

With the recent introduction of fully assisting scanner technologies by Siemens Healthineers (Erlangen, Germany), a patient surface model was introduced to the diagnostic imaging device market. Such a patient representation can be used to automate and accelerate the clinical imaging workflow, manage patient dose, and provide navigation assistance for computed tomography diagnostic imaging. In addition to diagnostic imaging, a patient surface model has also tremendous potential to simplify interventional imaging. For example, if the anatomy of a patient was known, a robotic angiography system could be automatically positioned such that the organ of interest is positioned in the system's iso-center offering a good and flexible view on the underlying patient anatomy quickly and without any additional X-ray dose.

Method

To enable such functionality in a clinical context with sufficiently high accuracy, we present an extension of our previous patient surface model by adding internal anatomical landmarks associated with certain (main) bones of the human skeleton, in particular the spine. We also investigate different approaches to positioning of these landmarks employing CT datasets with annotated internal landmarks as training data. The general pipeline of our proposed method comprises the following steps: First, we train an active shape model using an existing avatar database and segmented CT surfaces. This stage also includes a gravity correction procedure, which accounts for shape changes due to the fact that the avatar models were obtained in standing position, while the CT data were acquired with patients in supine position. Second, we match the gravity-corrected avatar patient surface models to surfaces segmented from the CT datasets. In the last step, we derive the spatial relationships between the patient surface model and internal anatomical landmarks.

Result

We trained and evaluated our method using cross-validation using 20 datasets, each containing 50 internal landmarks. We further compared the performance of four different generalized linear models' setups to describe the positioning of the internal landmarks relative to the patient surface. The best mean estimation error over all the landmarks was achieved using lasso regression with a mean error of \(12.19 \pm 6.98\ \hbox {mm}\) .

Conclusion

Considering that interventional X-ray imaging systems can have detectors covering an area of about \(200\ \hbox {mm} \times 266\ \hbox {mm}\) ( \(20\ \hbox {cm} \times 27\ \hbox {cm}\) ) at iso-center, this accuracy is sufficient to facilitate automatic positioning of the X-ray system.

Allergic contact dermatitis caused by nickel in an eyebrow pencil

Contact Dermatitis, EarlyView.

Allergic contact dermatitis caused by mupirocin and pimecrolimus

Contact Dermatitis, EarlyView.

Allergic contact dermatitis caused by clindamycin

Contact Dermatitis, EarlyView.

Management of Incidental Hernia Discovered During Abdominal Contouring in Post–Bariatric Surgery Patients

Purpose An increase in bariatric surgery has led to a rise in postbariatric contouring procedures. Despite a comprehensive preoperative assessment, body habitus in these patients may significantly limit the abdominal exam. Abdominal contouring procedures typically elevate large portions of the skin and fat off the abdominal wall, and unexpected hernia may be discovered intraoperatively. No study to date has characterized such hernia discovery at the time of body contouring surgery. We reviewed our experience of management of incidental hernia found during abdominoplasty or panniculectomy after laparoscopic bariatric surgery. Methods Records of all post–bariatric surgery patients undergoing abdominal contouring procedures between 2007 and 2017 were reviewed to identify patients with incidental hernias discovered intraoperatively. These patients were further examined by reviewing operative details, patient-specific factors, and outcomes. Results Six hundred eighty-one post–bariatric surgery patients underwent abdominal body contouring procedures with incidental ventral hernia discovered in 36 patients (5.3% [45 hernias]). At the time of plastic surgery, average age was 49 years (range, 25–64 years), and body mass index was 30.7 kg/m2 (range 25–43 kg/m2). Of 36 patients with incidental hernia, 26 patients (72.2%) had a single hernia, and the remainder had multiple (27.8%). Mean hernia size was 4.1 cm2 (range, 0.25–24 cm2). Most hernias were located paraumbilical/umbilical (46.7%) or epigastric (37.8%). Ninety-eight percent of hernias were repaired primarily (n = 44) by the plastic surgeon, and in 1 case (2%), mesh repair was performed by a consulting general surgeon. Average follow-up was 1.9 ± 0.3 years. Only 1 patient (2.8%) developed hernia recurrence after 48 months. Other postoperative complications included superficial wound healing problems (19.4%), seroma (16.7%), suture abscess (5.6%), and cellulitis that resolved with antibiotics (5.6%). Conclusions This is the first study to characterize incidental hernia discovered at the time of body contouring in the post–bariatric surgery patient. The body contouring surgeon should be aware of this common finding. Hernias typically discovered during panniculectomy or abdominoplasty arise in umbilical or epigastric regions, likely from prior laparoscopic port sites, and can be safely repaired by the plastic surgeon with low overall complication rates.

The Regenerative Capability of the Urodele Amphibians and Its Potential for Plastic Surgery

Newts and salamanders, both urodele amphibians, are the only vertebrates with tremendous regenerative potency throughout their lifetime. In contrast to the limited regenerative potential of most mammals, including humans, they can regenerate an entire limb after amputation and many other structures of their bodies, whereas humans mainly respond to injury by the formation of a scar. The intention of plastic surgery is to restore function of injured body parts, with the highest principle to replace "like with like." Despite tremendous improvements in surgical techniques over the last century, the remaining drawbacks include the availability of autologous tissue for transfer to restore extensive tissue loss. Here, some regenerative features of the urodeles are reviewed, in particular wound healing, nerve and limb regeneration, and their potential impact for reconstructive surgery are discussed. With a detailed molecular and cellular understanding of the urodele regeneration processes in combination with recent advances in tissue engineering, new perspectives for plastic surgery and especially improvements in regards to tissue regeneration are opened.

Diversity, Transgender, Vulnerable, Fetus, Entitlement, Evidence-Based, and Science-Based

No abstract available

Understanding the Anatomy of the Transverse Nasalis Aponeurotic Fibers and Its Importance in Asian Rhinoplasty

Background A complete release of the transverse nasalis aponeurotic fibers (TNAFs) during Asian rhinoplasty is critical for accurate positioning of the nasal implant and lengthening of the short nose. The objectives of this article are to clarify the anatomy of the TNAFs using cadaveric dissections and to present the clinical results after complete TNAF release in Asian rhinoplasty. Methods An anatomical dissection was performed in 8 cadavers to study the TNAFs, specifically the origin, insertion, and boundary of the TNAFs and the effect of the TNAF release on nasal length. Between January 2012 and December 2014, 2314 open implant augmentation rhinoplasties (1777 primary and 537 secondary) were performed by the senior author (J.J.). The records of these patients were retrospectively reviewed for results of TNAF release. A separately designed prospective clinical study was performed to document the nasal envelope extension after TNAF release in 52 consecutive patients. Results In the cadaver study, the anatomy and the boundaries of the TNAFs were clearly visualized and documented. With accurate release of the TNAFs, the ideal pocket for nasal implant can be defined, and the effect of the release of the TNAFs recorded. Release of the TNAFs also allows extension of the nasal envelope. However, measurements of the nasal envelope were not studied in the cadaver because the skin was degloved. From the clinical study with a follow-up ranging from 6 months to 1.5 years, the overall complication of open rhinoplasty using silicone implants incorporating TNAF release was 6%. In this group, 3.4% of patients required revision rhinoplasty. Releasing the TNAFs ensures an accurate implant pocket reducing the risk of implant deviation and implant visibility and increases the nasal length by 2.1 mm. Conclusions Complete release of the TNAFs is especially important in Asian rhinoplasty to facilitate accurate pocket dissection, allowing the extension of the nasal envelope in order to correct short nose or secondary contracted nose.

Acceptance of Vascularized Composite Allotransplantation (Face and Hand Transplant) in Singapore

Recent advancements and innovations in the burgeoning field of vascularized composite allotransplantation has enabled face and hand transplant to become a reality in the Western world. Plastic surgeons from the United States, France, and Spain have since performed vascularized composite allotransplantation as a novel therapeutic option in patients suffering from severe facial disfigurement and limb loss. Results have demonstrated remarkable functional and esthetic outcomes with improvements in the immense psychological, social, and emotional burdens that can arise in these patients. Despite the success of existing national solid organ transplant programs, face and hand transplant has yet to be established in this region. The specific aims of this study were to assess the attitudes and amount of risk Singaporeans are willing to accept towards receiving or donating face and hand transplants; and hence ultimately evaluate the feasibility of establishing such a program in Singapore.

Quality of Life of Patients After Immediate or Delayed Autologous Breast Reconstruction: A Multicenter Study

Introduction It is known that breast reconstruction improves quality of life (QoL) in women who underwent mastectomy. Previous studies showed that autologous immediate breast reconstruction is as safe as delayed breast reconstruction. However, there is not much known about the influence of the timing of the breast reconstruction on QoL. Therefore, this study aims to assess the effect of timing of the breast reconstruction on QoL, using the BREAST-Q questionnaire. Methods A total of 543 patients aged 18 years or older who underwent deep inferior epigastric perforator flap reconstruction after mastectomy (for prophylactic or oncological reasons) at least 12 months ago were selected in 3 hospitals in the Netherlands and invited to complete the BREAST-Q. Mean QoL outcomes were compared between patients who underwent immediate or delayed breast reconstruction. Furthermore, QoL outcomes were compared with recently published normative data of the BREAST-Q. Results Patients who underwent immediate reconstruction reported higher scores on satisfaction with psychosocial well-being, sexual well-being, physical well-being of the chest, and physical well-being of the abdomen. Patients who underwent delayed reconstruction reported higher scores on satisfaction with breasts, outcome, and nipples. However, after adjusting for potentially influencing factors, none of the differences were significant. Compared with the normative BREAST-Q data, both of our patient groups reported higher scores on satisfaction with breasts, psychological well-being, and sexual well-being, whereas they reported lower scores on satisfaction with physical well-being of the chest and the abdomen. Conclusions This study suggests that patients who underwent immediate or delayed deep inferior epigastric perforator flap breast reconstruction have comparable QoL more than 1 year after surgery, irrespective of the timing of the breast reconstruction.

Rectus Abdominis Myofascial Flap for Vaginal Reconstruction After Pelvic Exenteration

Background Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap. Methods Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non–flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated. Results Eleven (68.8%) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3%) are still alive. Early complications were reported in 7 patients (43.8%), with 2 (12.5%) flap-related and 5 (31.3%) non–flap-related complications. Similarly, late complications were reported in 5 patients (31.3%), with 2 (12.5%) flap-related and 3 (18.8%) non–flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042). Conclusions This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.

Full-Thickness Chemical Burn From Trifluoroacetic Acid: A Case Report and Review of the Literature

Trifluoroacetic acid (TFA) burns are an ill-defined entity due to a lack of reported sizable burns from this chemical. In this case report of the largest reported burn from TFA, we demonstrate that TFA causes extensive, progressive full-thickness tissue injury that may initially appear superficial. Trifluoroacetic acid does not seem to involve the systemic toxicities that result from hydrofluoric acid burns, and there is no role for calcium gluconate in acute management based on this case. Operative intervention should be staged because wound beds may initially seem healthy yet demonstrate continued necrosis.

Topical Deferoxamine Alleviates Skin Injury and Normalizes Atomic Force Microscopy Patterns Following Radiation in a Murine Breast Reconstruction Model

Background Breast cancer is most commonly managed with a combination of tumor ablation, radiation, and/or chemotherapy. Despite the oncologic benefit of these treatments, the detrimental effect of radiation on surrounding tissue challenges the attainment of ideal breast reconstruction outcomes. The purpose of this study was to determine the ability of topical deferoxamine (DFO) to reduce cutaneous ulceration and collagen disorganization following radiotherapy in a murine model of expander-based breast reconstruction. Methods Female Sprague-Dawley rats (n = 15) were divided into 3 groups: control (expander), XRT (expander + radiation), and DFO (expander + radiation + deferoxamine [DFO]). Expanders were placed in a submusculocutaneous plane in the right upper back and ultimately filled to 15 mL. Radiation was administered via a fractionated dose of 28 Gy. Deferoxamine was delivered topically for 10 days following radiation. After a 20-day recovery period, skin ulceration and dermal type I collagen organization were analyzed. Results Compared with control, the XRT group demonstrated a significant increase in skin ulceration (3.7% vs 43.3%, P = 0.00) and collagen fibril disorganization (26.3% vs 81.8%, P = 0.00). Compared with the XRT group, treatment with topical DFO resulted in a significant reduction in ulceration (43.3% vs 7.0%, P = 0.00) and fibril disorganization (81.8% vs 15.3%, P = 0.00). There were no statistical differences between the control and DFO groups in skin ulceration or collagen disorganization. Conclusions This study suggests topical DFO is capable of reducing skin ulceration and type I collagen fibril disorganization following radiotherapy. This novel application of DFO has potential to enhance expander-based breast reconstruction outcomes and improve quality of life for women suffering the devastating effects of breast cancer.

Bilateral Locking of the Metacarpophalangeal Joint: A Case Report and Systematic Literature Review

Background The purposes of this article were to present an exemplary case of bilateral locked metacarpophalangeal (MCP) joint of the second metacarpal and to review the literature for a more comprehensive understanding of this condition. Methods For the literature review, PubMed and Google Scholar research were performed using the term "metacarpophalangeal joint (MCP joint) locking or locked metacarpophalangeal joint (MCP Joint)" with a set of inclusion and exclusion criteria. Results We recently treated a patient with bilateral locked MCP, which presented to our office on 2 separate occasions in the space of 3 years. The left hand was affected in 2015 and the right hand in 2018. After clinical and imaging investigations, the patient was operated on. The patient had a locking of the accessory collateral ligament behind a radial sided prominence of the second metacarpal head. After surgery, the patient regained full function of her index finger. On the basis of our literature review, we found 47 cases described in the literature, plus our case, the index finger (22), and the long finger (11) were most commonly involved. Conclusion Left untreated, the locked MCP joint may lead to a flexion contracture and disabilities in performing daily life activities. The diagnosis is mainly clinical. The radiographs can show degenerative changes or a particular shape of the metacarpal head/neck as a first clue to the possible cause. Gentle closed reduction can be attempted, but surgery is most often required. The surgical approach depends on the presumed localization of the pathology.

Letter to the Editor Following “A Combination Flap for Nasal Defect Reconstruction” by Rajshree Jayarajan, Annals of Plastic Surgery, 2018

No abstract available

Does Bowstringing Affect Hand Function in Patients Treated With A1 Pulley Release for Trigger Fingers?: Comparison Between Percutaneous Versus Open Technique

We aimed to inspect bowstringing after percutaneous and open release of the A1 pulley for trigger digits and its influence on hand function. Sixty-two patients with a resistant trigger digit were randomized to undergo either open release or percutaneous release of the A1 pulley. We quantified bowstringing of the digit using ultrasonography preoperatively and at 12 and 24 weeks after surgery. Pain on a visual analog scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; pinch power; and grip strength were assessed. Bowstringing was significantly increased at 12 weeks after surgery in both groups, and the mean value of the open release group was significantly greater than that of the percutaneous group (2.30 ± 0.58 mm vs 1.46 ± 0.51 mm, respectively; P = 0.035). However, the bowstringing was decreased at 24 weeks without showing significant difference between the 2 groups. The clinical outcomes of each cohort improved significantly, with no difference between the groups at final follow-up. No association was found between bowstringing and any clinical outcome measure. Bowstringing occurred by A1 pulley release with either the percutaneous or open technique does not affect clinical hand function in patients with trigger fingers.

Cadaver Study of Combined Neurovascular Sensate Flaps to Create Vaginal Erogenous Sensation During Male-to-Female Genital Confirmation Surgery: The Pedicle “O” Flap

Purpose The lack of erogenous sensitivity in the neovagina is one of the major shortcomings for patients undergoing male-to-female genital confirmation surgery. Remnant fibers of the dorsal nerve of the penis (DNP) after clitroplasty can potentially be used for a second neurovascular pedicle flap for intravaginal erogenous sensation. Methods An anatomic dissection of the DNP was performed in 10 male frozen pelvises to identify major trunks and their branches. Lateral branches of DNP were preserved for a sensate "O" pedicle flap for the vagina. The number of main branches in the lateral dorsal aspect of the penis was calculated to ensure sufficient erogenous innervation to the vagina. Cross sections of the penis were used for histological analysis. Optimal width and length of the new sensate flap were described. Results There were 1, 2, and 3 main branches in the lateral compartment in 2 (20%), 6 (30.7%), and 2 (42.8%) cadavers, respectively. A sensate pedicle flap from the lateral aspect of the glans penis with a mean width of 1.14 cm (range, 0.9–1.28 cm) ensured at least one main branch of the DNP for erogenous sensitivity of the vagina. This sensate vaginal flap and its neurovascular pedicle had a mean length of 9.8 cm (range, 8.7–10.3 cm) allowing its inset into the anterior vaginal canal. Conclusion Lateral branches of the DNP can be preserved for a pedicle sensate flap to the vagina, which can provide patients with an erogenous vaginal "spot" during male-to-female confirmation surgery.

Enamel Hypomineralization in Children With Clefts and the Relationship to Treatment: A Cross-sectional Retrospective Study

Objective The aim of this study was to determine whether molar incisor hypomineralization (MIH) is greater in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared with CLP waiting for secondary alveolar grafting (SAG) and with controls. Design A retrospective analysis of intraoral photographs of 13 CLP patients who underwent a PAG, 28 CLP prior to SAG, and 60 controls without CLP was performed. Mantel-Haenszel χ2 tests were used to compare the 3 groups for differences in MIH scores, and Wilcoxon rank sum tests were used to compare the groups for differences in average MIH scores. A 5% significance level was used for all tests. Results Molar incisor hypomineralization scores were significantly higher for the PAG and SAG groups compared with the control group (P

Optimal Reconstruction Method for Large Radionecrosis Following Breast Cancer Treatment: Utility of Free Transverse Rectus Abdominis Myocutaneous Flap Using Contralateral Internal Mammary Artery as Recipient

Introduction In extensive radionecrosis following radiotherapy for breast cancer (BC) treatment, the defect after excision can be reconstructed with a transverse rectus abdominis myocutaneous (TRAM) flap. In this study, we report outcome of free TRAM flap using contralateral internal mammary artery (IMA) as a recipient in comparison with pedicled TRAM. Methods We reviewed cases of chest wall radionecrosis following BC treatment during the past 8 years. Radionecrosis involving full-thickness soft tissue with defect sizes greater than 10 × 10 cm were included. We compared the outcomes of patients who underwent reconstruction with either pedicled TRAM flaps or free TRAM flaps. We used IMA as a recipient for free TRAM flap, whereas we used contralateral superior epigastric artery–based flap for pedicled TRAM. Results A total of 14 BC patients underwent chest wall reconstruction due to radionecrosis: 7 received pedicled TRAM flaps, 5 received free TRAM flaps, and 2 were excluded because of the small defect size. The pedicled and free TRAM groups were similar in patient demographics and defect size. However, distal flap loss rate was significantly higher in the pedicled TRAM group compared with the free TRAM group (P = 0.028). There was no difference in abdominal hernia incidence between the 2 groups (P = 0.100). Conclusions Wide chest wall defects caused by radionecrosis following BC treatment can be successfully reconstructed with a free TRAM flap that uses a contralateral IMA as a recipient. The free TRAM flap demonstrates a lower rate of distal flap loss than the pedicled TRAM flap, hence reduces the risk of severe morbidity.

Using a Bilobed Trapezius Myocutaneous Flap and a Scapula Osteomyocutaneous Flap to Reconstruct Through-and-Through Defects of the Hemimandible After Debridement of Advanced Mandibular Osteoradionecrosis

Objective The purpose of this study was to evaluate the outcomes of reconstructing through-and-through defects of the hemimandible after debridement of advanced mandibular osteoradionecrosis (ORN) with bilobed trapezius myocutaneous flaps and scapula osteomyocutaneous flaps. Methods Six patients with grade III mandibular ORN were treated with debridement of lesions. Type IIb soft tissue and type H hemimandible defects after surgery were reconstructed using bilobed trapezius myocutaneous flaps and scapula osteomyocutaneous flaps including the acromion, spine, and part of the medial scapular border based on the transverse cervical vessels. Results No flap failure occurred. Two patients experienced minor complications; one showed wound dehiscence at the donor site, and one showed minor plate exposure. No patient required nasogastric tube feeding or a permanent tracheotomy. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion in the upper limb. The patients were followed for 8 to 22 months; at the end of follow-up, all patients were living with no recurrence evidence of mandibular ORN or nasopharyngeal carcinoma. Conclusions The bilobed trapezius myocutaneous flap and scapula osteomyocutaneous flap based on transverse cervical vessels may be an effective approach to reconstruct through-and-through defects of the hemimandible and to provide satisfactory or acceptable functional and esthetic outcomes after debridement of advanced mandibular ORN.

Quantification of Chronic Lymphedema in a Revised Mouse Model

Background Lymphedema is a common and debilitating complication following cancer treatment with surgical lymph node excision and radiotherapy. Currently there are no curative treatments for lymphedema. Animal models that intended to replicate the disease have been inadequate, making a troublesome transition from experimental therapeutic studies into the clinic. It is therefore imperative to establish an experimental animal model that can reliably replicate clinical lymphedema. Methods To discover the optimal method of lymphedema induction, surgical lymph ablation and irradiation or silicone splint emplacement were combined in 8 experimental groups (n = 4). In total, 32 mice served in this study and were followed for 8 weeks after surgery. Outcomes included micro–computed tomography hind limb volumetry, lymphatic clearance measured with technetium Tc 99m (99mTc) human serum albumin lymphoscintigraphy and lymph vessel ectasia quantified with LYVE-1 immunohistochemistry. Results All trialed models but one resulted in only transient lymphedema or lasting lymphedema with adverse morbidity. Combined surgical lymph obstruction with 2 fractions of 10-Gy irradiation successfully induced lasting lymphedema without adverse events. Over the 8 weeks' follow-up, limb volumes were significantly increased at all time points (P

Double Supercharged Jejunal Interposition for Late Salvage of Long-gap Esophageal Atresia

Background A variety of surgical techniques exist to manage long-gap esophageal atresia (LGEA), including gastric pull-up (GPU), colonic interposition (CI), jejunal interposition (JI), and distraction lengthening. Salvage reconstruction for late failure of any conduit type is a complex surgical problem fraught with technical difficulty and significant risk. Jejunal interposition can be used as a salvage procedure in the management of LGEA. However, the opposing requirements of conduit length and adequate perfusion make the procedure technically challenging. Chronic comorbidities and abdominal and thoracic adhesions may further complicate these cases. Methods We report a technique for the management of 3 late treatment failures of LGEA using pedicled JI in conjunction with 2 additional arterial and venous anastomoses, or double supercharging. For 2 patients who presented with failed CI, pedicled JI was performed and supercharged to internal mammary vessels as well as vasculature preserved from the prior colonic flap mesentery. The third patient presented with failed GPU and underwent pedicled JI that was supercharged caudally to the gastroepiploic vessels and cranially to the left common carotid artery. Results No flaps were lost in any patients. Median operation time was 16.5 hours. Patients were monitored postoperatively in the intensive care unit for a median of 23 days, extubated after 14 days, and discharged at 41 days. Postoperatively, all patients tolerated an oral diet by discharge and continue to enjoy oral intake of all food consistencies without dysphagia or aspiration. Follow-up time spanned 2 to 4 years (average, 3.3 years). One patient required dilatations and temporary stent for stricture, and another required removal of prominent sternal wires; otherwise, no additional procedures were performed. Conclusions Although technically difficult, double supercharged JI should be considered as a salvage operation to restore esophageal continuity after CI or GPU failure for LGEA, when there are otherwise limited reconstructive options.

Histopathological Study of Meshed Versus Solid Sheet Acellular Dermal Matrices in a Porcine Model

Background Acellular dermal matrices (ADMs) are commonly used to support implant-based breast reconstruction. However, there is little comparative data on the incorporation process of different ADMs, and the value of meshing or fenestration versus solid sheet has not been established, although early clinical data suggest seroma rates may be reduced. This was a preclinical assessment of the incorporation process at optimal conditions in a pig model. Methods SurgiMend and AlloDerm matrices were implanted in subcutaneous pockets on the backs of 15-week-old female pigs. Half of the samples were meshed 1:2.5; the remainder was grafted as a fenestrated (SurgiMend) or solid sheet (AlloDerm). Tissues were harvested at 3 months. Histological slides were prepared for hematoxylin and eosin staining, and Masson trichrome and immunostaining with anticollagen type I fluorescein isothiocyanate stain. Histological parameters (inflammation, giant cell reaction, neovascularization, fibroplasias, and scar tissue formation) were graded blindly on a scale of 0 (no reaction) to 3 (severe reaction). Results All explanted ADMs (SurgiMend, n = 23; AlloDerm, n = 20) were firmly incorporated within the host tissue. SurgiMend showed more fibroplasia (P = 0.029) compared with AlloDerm in meshed or solid sheet form. Meshed ADMs showed a trend toward increased inflammation (P = 0.074) and giant cell reaction (P = 0.053) compared with solid sheet/fenestrated ADM. Conclusions Meshing ADM may allow cells to populate matrices more rapidly, promoting integration compared with solid sheet ADMs. This study sets the histological basis for further clinical investigations, with the aim of demonstrating lower complication rates (and particularly reduced seroma formation) with meshed ADMs.

Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Women With Previous Abdominal Incisions: A Comparison of Complication Rates

Background The deep inferior epigastric artery perforator (DIEP) flap is currently the most widely used method for autologous microsurgical breast reconstruction. There are mixed data in the literature regarding the impact of previous abdominal surgery on DIEP flap success in breast reconstruction. With this study, we take a closer look at the effect of prior abdominal surgery on DIEP flap and donor-site complications, with a particular focus on the different types of incisions and their influence on surgical outcomes. Methods A retrospective cohort study was conducted over a 6-year period. Five hundred forty-four consecutive DIEP flaps were divided into a control group (321 flaps) without previous abdominal surgery and an incision group (223 flaps) with previous abdominal surgery. A comparison between both groups was made in terms of flap and donor-site complications followed by a subgroup analysis based on single types of abdominal incisions. Results There were no significant differences between both groups in terms of age, body mass index, flap weight, smoking history, prior radiotherapy, diabetes, and coagulopathy (P > 0.05). The most common incision was low transverse incision (n = 116) followed by laparoscopy port (n = 103) and midline (n = 46) incisions. We found no significant differences between the control group and incision group in terms of flap complications. Subgroup analysis revealed that none of the 3 types of incision increase the flap or donor-site complications. Smoking and flap weight were the only 2 independent predictors for donor-site complications. Conclusions The results from this large series of consecutive DIEP flaps from our institution confirm that autologous breast reconstruction with DIEP flap can be safely performed in patients who have had previous abdominal surgeries; however, counseling patients about smoking is critical to avoid potential donor-site complications.

The 100 top‐cited publications in psoriatic arthritis: a bibliometric analysis

International Journal of Dermatology, EarlyView.

Balanitis xerotica obliterans: a review of diagnosis and management

International Journal of Dermatology, EarlyView.

Two case reports of telangiectasia macularis multiplex acquisita

International Journal of Dermatology, EarlyView.

Two cases of erosive pustular dermatosis of the scalp occurring after topical 3,75% imiquimod for actinic keratoses

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

Psoriasis and Suicidality: A Review of the Literature

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

Máxime “Max” Kuczyński: Father of Peruvian Public Health and of the 66th President of Peru

Dermatologic Therapy, EarlyView.

Comparison the effects of topical application of olive and calendula ointments on Children's diaper dermatitis: A triple‐blind randomized clinical trial

Dermatologic Therapy, EarlyView.

Agminated Blue Nevus with a GNAQ mutation: A Case Report and Review of the Literature

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

The expression of terminal deoxynucleotidyl transferase and paired box gene 5 in Merkel cell carcinomas and its relation to the presence of Merkel cell polyomavirus DNA

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Is CD1a useful for Leishmaniasis diagnosis in the new world?

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Acquired Perforating Calcific Collagenosis in a Drug Addict with Rhabdomyolysis and Transient Hypercalcemia

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Is C‐11 Methionine PET an alternative to 18‐F FDG PET for identifying recurrent laryngeal cancer after radiotherapy?

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Comparison of perfusion values after percutaneous transluminal angioplasty according to the severity of ischaemia in the diabetic foot

International Wound Journal, EarlyView.

Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

International Wound Journal, EarlyView.

An oral and maxillofacial navigation system for implant placement with automatic identification of fiducial points

Abstract

Purpose

Surgical navigation system (SNS) has been an important tool in surgery. However, the complicated and tedious manual selection of fiducial points on preoperative images for registration affects operational efficiency to large extent. In this study, an oral and maxillofacial navigation system named BeiDou-SNS with automatic identification of fiducial points was developed and demonstrated.

Methods

To solve the fiducial selection problem, a novel method of automatic localization for titanium screw markers in preoperative images is proposed on the basis of a sequence of two local mean-shift segmentation including removal of metal artifacts. The operation of the BeiDou-SNS consists of the following key steps: The selection of fiducial points, the calibration of surgical instruments, and the registration of patient space and image space. Eight cases of patients with titanium screws as fiducial markers were carried out to analyze the accuracy of the automatic fiducial point localization algorithm. Finally, a complete phantom experiment of zygomatic implant placement surgery was performed to evaluate the whole performance of BeiDou-SNS.

Results and conclusion

The coverage of Euclidean distances between fiducial marker positions selected automatically and those selected manually by an experienced dentist for all eight cases ranged from 0.373 to 0.847 mm. Four implants were inserted into the 3D-printed model under the guide of BeiDou-SNS. And the maximal deviations between the actual and planned implant were 1.328 mm and 2.326 mm, respectively, for the entry and end point while the angular deviation ranged from 1.094° to 2.395°. The results demonstrate that the oral surgical navigation system with automatic identification of fiducial points can meet the requirements of the clinical surgeries.