IUCN conservation status does not predict glucocorticoid concentrations in reptiles and birds

Abstract

Circulating glucocorticoids (GCs) are the most commonly used biomarker of stress in wildlife. However, their utility as a tool for identifying and/or managing at-risk species has varied. Here, we took a very broad approach to conservation physiology, asking whether IUCN (International Union for the Conservation of Nature) listing status (concern versus no obvious concern) and/or location within a geographic range (edge versus non-edge) predicted baseline and post-restraint concentrations of corticosterone among many species of birds and reptiles. Even though such an approach can be viewed as coarse, we asked in this analysis whether corticosterone concentrations might be useful to implicate species at risk. Indeed, our effort, relying on HormoneBase, a repository of data on wildlife steroids, complements several other large-scale efforts in this issue to describe and understand GC variation. Using a phylogenetically informed Bayesian approach, we found little evidence that either IUCN status or edge/non-edge location in a geographic distribution were related to GC levels. However, we did confirm patterns described in previous studies, namely that breeding condition and evolutionary relatedness among species predicted some GC variation. Given the broad scope of our work, we are reluctant to conclude that IUCN status and location within a range are unrelated to GC regulation. Indeed, we encourage future more targeted efforts on GCs in at-risk populations to reveal how factors leading to IUCN listing or the environmental conditions at range edges impact individual performance and fitness, particularly in the mammals, amphibians and fish species we could not study here because data are currently unavailable.

A new non-invasive graphical method for quantification of cerebral blood flow with[ $$^{123}\hbox {I}$$ 123 I ] IMP

Abstract

Objective

[ \(^{123}\hbox {I}\) ] N-isopropyl-p-iodoamphetamine ( \(^{123}\hbox {I}\) -IMP) is an ideal perfusion tracer for single photon emission computed tomography, which shows good linearity between cerebral blood flow (CBF) and accumulation. However, quantification of CBF using \(^{123}\hbox {I}\) -IMP without arterial blood sampling has been challenging, with previous methods requiring empirically obtained regression formulae to estimate CBF. Furthermore, the CBF value obtained via some of the previous methods would be affected by the clearance rate of \(^{123}\hbox {I}\) -IMP from the lungs. This paper introduces a new non-invasive quantification method for CBF using \(^{123}\hbox {I}\) -IMP and dynamic planar images.

Methods

We have developed a theory based on Microsphere model. This method does not involve regression formulae for estimation and allows for direct measurement of CBF, considering the clearance rate of \(^{123}\hbox {I}\) -IMP from the lungs. The study method is executed as easily as conventional Graph-Plot method. We compared the CBF values obtained by our study method and the established autoradiograph (ARG) method.

Results

CBF values obtained using the new method demonstrated significant correlation with values determined using ARG method.

Conclusions

The novel method described presents a reliable and more simple way of determining CBF when compared to current methods.

Der Wert Alpiner Forschungseinzugsgebiete im Bereich der Fernerkundung, der Schneedeckenmodellierung und der lokalen Klimamodellierung

Zusammenfassung

Der Hochgebirgsraum ist traditionell ein Raum mit wenigen bis keinen Messstationen. Vorortmessungen sind nur in ausgesuchten Gebieten oder nur punktuell verfügbar. Aus diesem Grund werden Landoberflächenmodelle, regionale Klimamodelle und Fernerkundungsdaten eingesetzt, um die benötigte Information zur erzeugen. Wie diese Daten im Gebirgsraum tatsächlich sind, bleibt dabei oftmals offen, da Evaluationsdatensätze fehlen, oder nur lückenhaft vorhanden sind. Besonders wertvoll sind in diesem Zusammenhang alpine Einzugsgebiete, die – meist aufgrund der Bemühungen von regionalen Gruppen oder Organisationen – einen höheren Grad an Instrumentierung aufweisen. Das vom bayerischen Umweltministerium geförderte Einzugsgebiet um die Umweltforschungsstation Schneefernerhaus an der Zugspitze (D) ist ein solches Gebiet. Die drei diskutierten Fallbeispiele zeigen, mit welchen Unsicherheiten zu rechnen ist, wenn Modelle gänzlich ohne oder mit wenig Basisdaten aus dem Zielgebiet betrieben werden. Weiterhin soll der Nutzen alpiner Forschungseinzugsgebiete im Kontext optimierter Modellsetups, verbesserter Modellergebnisse und abgeleiteter Fernerkundungsprodukte aufgezeigt werden.

The biodiversity hypothesis and immunotolerance in allergy

Abstract

Background

The human immune system is capable of detecting a multitude of substances and organisms in the environment and responding to these in a variety of ways. This includes immune responses to pathogens, on the one hand, and immunotolerance in the form of immunoregulatory responses, resulting in either the termination of immune responses or in tolerance to harmless and endogenous substances, on the other. The development of immunotolerance is an active process that is essentially characterized by interaction with microbiota and environmental components and is primarily mediated by regulatory T cells.

Methods

This article provides an overview of selected scientific articles and is addressed also to non-specialists. It is based on a literature search in PubMed, specialist databases, and guidelines.

Results

According to the diversity hypothesis, exposure in early childhood to broad biodiversity is now considered to reduce the risk of developing allergic diseases.

Conclusion

Therefore, tolerance induction emerges in allergology not only as a potential concept for prevention, but also as a treatment approach in atopic diseases.

Non-celiac gluten/wheat sensitivity (NCGS)—a currently undefined disorder without validated diagnostic criteria and of unknown prevalence

Abstract

Within the last decade, non-celiac gluten/wheat sensitivity (NCGS) has been increasingly discussed not only in the media but also among medical specialties. The existence and the possible triggers of NCGS are controversial. Three international expert meetings which proposed recommendations for NCGS were not independently organized and only partially transparent regarding potential conflicts of interest of the participants. The present position statement reflects the following aspects about NCGS from an allergist's and nutritionist's point of view: (A) Validated diagnostic criteria and/or reliable biomarkers are still required. Currently, this condition is frequently self-diagnosed, of unknown prevalence and non-validated etiology. (B) Gluten has not been reliably identified as an elicitor of NCGS because of high nocebo and placebo effects. Double-blind, placebo-controlled provocation tests are of limited value for the diagnosis of NCGS and should be performed in a modified manner (changed relation of placebo and active substance). (C) Several confounders hamper the assessment of subjective symptoms during gluten-reduced or gluten-free diets. Depending on the selection of food items, e.g., an increased vegetable intake with soluble fibers, diets may induce physiological digestive effects and can modify gastrointestinal transit times independent from the avoidance of gluten. (D) A gluten-free diet is mandatory in celiac disease based on scientific evidence. However, a medically unjustified avoidance of gluten may bear potential disadvantages and risks. (E) Due to a lack of diagnostic criteria, a thorough differential diagnostic work-up is recommended when NCGS is suspected. This includes a careful patient history together with a food-intake and symptom diary, if necessary an allergy diagnostic workup and a reliable exclusion of celiac disease. We recommend such a structured procedure since a medically proven diagnosis is required before considering the avoidance of gluten.

SCIT with a high-dose house dust mite allergoid is well tolerated: safety data from pooled clinical trials and more than 10 years of daily practice analyzed in different subgroups

Abstract

Background

Efficacy of house dust mite (HDM) allergen immunotherapy (AIT) in allergic rhinitis and controlled allergic asthma has been documented in controlled trials with adults and children. However, tolerability comparing clinical development and post marketing data, particularly in different subgroups, is missing.

Methods

We performed an analysis of pooled safety data for subcutaneous AIT (SCIT) with a high-dose house dust mite allergoid from 6 randomized, controlled trials (RCT) in HDM allergic respiratory disease (ARD) and of post marketing safety data from more than 10 years including different subgroups (age, gender, asthma status).

Results

In all, 500 patients with ARD were treated in RCTs: 279 received the marketed dose of 1800 protein nitrogen units (PNU) high-dose HDM allergoid AIT (214 double-blind placebo controlled [HDM-DBPC], 65 children/adolescents usual care controlled [HDM-RCT(UC)]), and 221 placebo (PL). 38.8% adverse events (AEs) were observed with 1800 PNU in HDM-DBPC (31.2% PL, 35.5% HDM-ALL [1800 PNU]); the difference was primarily because of local reactions; there was no difference in systemic reactions (10.9% PL, 11.2% HDM-DBPC, 11.2% HDM-ALL); one out of 279 high-dose HDM allergoid-treated patients had a serious adverse event (SAE).

Children (n = 39)/adolescents (n = 26) had fewer related AEs and local reactions compared to adults; systemic reactions: children 12.8%, adults 11.2% adolescents 7.7%. Females had slightly more AEs. Treatment was well tolerated in asthmatic patients (n = 267; GINA I n = 32, II n = 104, III n = 17, 114 no classification).

In more than 10 years more than 100,000 patients were treated with high-dose HDM allergoid (1800 PNU) under daily practice conditions. Adverse drug reactions (ADRs) were reported in 0.5% of patients. 94.6% of these ADRs were expected.

Conclusion

SCIT with the marketed dose of high-dose HDM allergoid was well tolerated in clinical development and in daily practice. There was no increased risk for the investigated patient subgroups. Tolerability was comparable to HDM sublingual immunotherapy (SLIT) tablets.

Fragrances as allergens

Abstract

Contact allergies due to fragrances are common. If one adds up the reaction incidences of the indicators of fragrance allergy (fragrance mix [FM] I + II, balsam of Peru and turpentine), these reach 17% in a hospital collective (Information Network of Departments of Dermatology [IVDK] data 2016) and are thus higher than those for nickel allergy (approximately 16%). In the case of positive reactions to FM I, >50% do not react to one of the components. This type of reaction should be interpreted as allergic with caution, unless other data (e. g., positive history, application test) support this interpretation. FM-I-positive individuals often react to oak moss (27.2%) and isoeugenol (18.2%). These are followed by hydroxycitronellal (10.9%), cinnamal (10.6%), cinnamyl alcohol (8.4%), eugenol (7.3%), geraniol (5.5%), and amyl cinnamal (1.5%). The frequency of sensitization (SF) to the individual fragrances depends on their allergenic potency (measured using the local lymph node assay, LLNA) and the frequency of use (extent of exposure). The relationship between SF and exposure is described by the sensitization exposure quotient (SEQ). The SEQ is a measure of the risk of sensitization. In general, it correlates with the SF on the one hand and with the allergenic potency (hazard) on the other. Exceptions to this rule indicate a newly recognized problem: (1) Although methyl 2-octynoate plays no role in SH statistics, it came third after tree moss and oak moss with its SEQ (=risk); (2) despite its low potency, hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral®) had a relatively high risk. In this particular case, potency (the inherent hazard) was not the determinant of risk, but rather the overly high doses used. Allergy monitoring by clinical epidemiology needs to be more heavily supplemented by data on exposure.

Comparative physiological behaviors of Ulva lactuca and Gracilariopsis lemaneiformis in responses to elevated atmospheric CO 2 and temperature

Abstract

Physiological metabolisms of seaweeds usually suffered climate changes in the field. Gracilariopsis lemaneiformis and Ulva lactuca, collected from Nan'ao Island, Shantou, China, were cultured under ambient and elevated CO₂ supply (390 and 800 μl L⁻¹), with low and high temperatures (15 °C and 25 °C) for 2 weeks, aiming to compare the difference of the main physiological metabolism between two seaweed species in response to the elevated CO₂ and high temperature. At 15 °C, the pH reduction in the culture medium caused by elevated CO₂ was larger in G. lemaneiformis than in U. lactuca. At 25 °C, elevated CO₂ significantly increased photosynthetic rates (P_n or P_g) and maintained constant respiratory rates (R_d) in G. lemaneiformis. However, for 25 °C-grown U. lactuca, the increment of CO₂ did not enhance the P_n (P_g) rates but rapidly decreased the R_d rates itself. With the higher R_d/P_g ratios in G. lemaneiformis than U. lactuca, the warming thereby promoted more allocation of photosynthetic products to respiratory consumption in G. lemaneiformis. Both P_g and R_d rates exhibited lower temperature acclimation in two seaweeds. In addition, elevated CO₂ markedly increased the relative growth rate (RGR) and phycobiliprotein (PB) contents at 25 °C, but exhibited no enhancement of chlorophyll a (Chl a), carotenoids (Car), soluble carbohydrate (SC), and soluble protein (SP) contents in G. lemaneiformis, with the reduction of SC when temperature increased only. We suggested that climate changes were probably a more benefit to U. lactuca than to G. lemaneiformis, inherently justifying the metabolism during G. lemaneiformis maricultivation.

Pollution assessment of heavy metal accumulation in the farmland soils of Beijing’s suburbs

Abstract

In this study, we used GIS to assess heavy metal concentrations and their spatial variations in Beijing's suburban farmlands. The Beijing soil heavy metal background values (background values), the primary standard of the Chinese Environmental Quality Standard of Soil (primary standard), and the Environmental Quality Standard of Green Food Production Site (green standard) were used as the standards for assessing soil heavy metals. Results showed that the average Hg value was higher than that of the primary standard. The Ni and Pb values were lower than the corresponding background values. From the percentage area, the concentration is 100% area with As, more than 93% area with Cr, Cu, Pb and Zn, and 67% area with Cd and Hg, meeting the primary standard; over 97% area met the green standard. The calculated Nemerow index showed that less than 3% of the samples were slightly polluted, indicating good environmental quality. But the accumulated pollution of Cd and Hg was relatively high in some areas which was mainly affected by the high density of the industry. The farmland soils in Beijing suburbs were found to be suitable for farming, but a small percentage of the soils exceeded the green standard; Cd and Hg levels require special attention.

Usurpation of the role of the plastic surgeon as a public health problem in Mexico: Reflections on a case.

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Usurpation of the role of the plastic surgeon as a public health problem in Mexico: Reflections on a case.

Arch Plast Surg. 2018 Jul;45(4):390-392

Authors: Garcia-Espinoza JA, García-Manzano RA, Aguilar-Aragón VB

PMID: 30037204 [PubMed]

Giant extraskeletal chondroma of the hand: A rare case.

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Giant extraskeletal chondroma of the hand: A rare case.

Arch Plast Surg. 2018 Jul;45(4):388-389

Authors: Wenny R, Pollhammer MS, Duscher D, Aitzetmueller MM, Haslhofer DJ, Huemer GM, Schmidt M

PMID: 30037203 [PubMed]

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature.

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Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature.

Arch Plast Surg. 2018 Jul;45(4):384-387

Authors: Kappen IFPM, Nguyen DT, Vos A, van Tits HWHJ

Abstract
Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.

PMID: 30037202 [PubMed]

Traumatic cerebrospinal fluid leakage following septorhinoplasty.

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Traumatic cerebrospinal fluid leakage following septorhinoplasty.

Arch Plast Surg. 2018 Jul;45(4):379-383

Authors: Youssef A, Ahmed S, Ibrahim AA, Daniel M, Abdelfattah HM, Morsi H

Abstract
Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

PMID: 30037201 [PubMed]

Successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug.

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Successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug.

Arch Plast Surg. 2018 Jul;45(4):375-378

Authors: Sashida Y, Kayo M, Hachiman H, Hori K, Kanda Y, Nagoya A

Abstract
In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

PMID: 30037200 [PubMed]

Breast augmentation surgery using an inframammary fold incision in Southeast Asian women: Patient-reported outcomes.

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Breast augmentation surgery using an inframammary fold incision in Southeast Asian women: Patient-reported outcomes.

Arch Plast Surg. 2018 Jul;45(4):367-374

Authors: Randquist C, Por YC, Yeow V, Maglambayan J, Simonyi S

Abstract
Background: This analysis presents patient-reported outcomes of breast augmentation procedures performed in Singapore using an inframammary fold incision and the "5 Ps" best practice principles for breast augmentation. These data are the first of their kind in Southeast Asian patients.
Methods: Through a retrospective chart review, patients who underwent primary breast augmentation with anatomical form-stable silicone gel breast implants using an inframammary fold incision were followed for ≥6 months postoperatively. The BREAST-Q Augmentation Module (scores standardized to 0 [worst] - 100 [best]) and Patient and Observer Scar Assessment Scale (POSAS; 1 [normal skin] to 10 [worst scar imaginable]) were administered. Responses were summarized using descriptive statistics. Patient-reported events were collected.
Results: Twenty-two Southeast Asian patients (mean age, 35.1 years) completed ≥1 postoperative BREAST-Q and POSAS assessment and were assessed 11 months to 5.5 years postoperatively. The mean postoperative BREAST-Q satisfaction with breasts and psychosocial well-being scores were 69.2 and 84.0, respectively. The mean POSAS score for their overall opinion of the scar was 4.2; the mean scores for all scar characteristics ranged from 1.2 to 4.2. Over 90% of patients (20/22) said that they would recommend the procedure. Patient complaints following surgery included anisomastia (possibly pre-existing; n=2), sensory loss at the nipple (n=2) or around the nipple (n=3), scarring (n=4), and slight capsular contracture (n=1). No patients required reoperation.
Conclusions: Southeast Asian patients reported high long-term satisfaction scores on the BREAST-Q scale and with their scar characteristics following breast augmentation using an inframammary fold incision, and nearly all said they would recommend this procedure. No reoperations were necessary in patients assessed for up to 5.5 years postoperatively.

PMID: 30037199 [PubMed]

Camptodactyly: An unsolved area of plastic surgery.

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Camptodactyly: An unsolved area of plastic surgery.

Arch Plast Surg. 2018 Jul;45(4):363-366

Authors: Singh V, Haq A, Priyadarshini P, Kumar P

Abstract
Background: Camptodactyly refers to permanent flexion contracture at the proximal interphalangeal joint. Most cases are limited to fifth-finger involvement. Although common, the treatment of camptodactyly is controversial. Many published studies have emphasized conservative treatment, while others have described surgical procedures. The problem with this deformity is that it presents in several forms, which means that there is no single model for effective treatment. The aim of this paper is to present the difficulties encountered with this condition and the management thereof on an individual basis.
Methods: This is a case series of 14 patients (nine males, five females) who underwent surgical treatment. The results were classified using the method from Mayo Clinic as excellent, good, fair, and poor.
Results: Fourteen patients with 15 fingers underwent surgery, and the results achieved were as follows: excellent, 0; good, 1; fair, 6; poor, 8. The treatment of camptodactyly still remains controversial, and hence proper planning individualized to each patient is needed to achieve the maximal improvement with realistic goals.
Conclusions: Although we performed individualised surgery, our careful follow-up was not able to identify any method as superior over another with respect to gain in extension and loss of flexion. We therefore propose that the extensor mechanism should not be disturbed during surgery to treat camptodactyly cases.

PMID: 30037198 [PubMed]

The effect of increasing the contact surface on tendon healing.

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The effect of increasing the contact surface on tendon healing.

Arch Plast Surg. 2018 Jul;45(4):357-362

Authors: Bilgen F, Duman Y, Bulut Ö, Bekerecioğlu M

Abstract
Background: The most common complication after tendon repair is the development of adhesion, with subsequent rupture.
Methods: In this study, we present a new method in which the tendon healing contact surface is increased to reduce these complications. The tendons of chickens in groups 1, 3, and 5 were transversely cut and repaired with in the traditional fashion with double-modified Kessler method and 5/0 polypropylene. In the other groups, 3 mm of the tendon was removed from the proximal half of the upper end and from the distal half of the lower end of the tendon, and they were repaired with the modified Kessler method. The tendons of the chickens in groups 1 and 2 were evaluated immediatelly after surgery. Groups 3 and 4 were evaluated at 4 weeks after surgery. Groups 5 and 6 were evaluated at 6 weeks.
Results: Increases in transient inflammation and connective tissue formation were observed more clearly in the group treated with the new method in histopathological investigations at weeks 4 and 6. The stretching test showed statistically significant differences between groups 3 and 4 (P<0.05) and groups 5 and 6 (P<0.05).
Conclusions: When repairing tendons with the new method, the healing surface increases and the direction of collagen fibers at the surface changes. Because of these effects, the strength of the tendon healing line increases; we therefore expect that this technique will enable patients to safely engage in early active exercise after the operation, with less risk of tendon rupture.

PMID: 30037197 [PubMed]

Extension block and direct pinning methods for mallet fracture: A comparative study.

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Extension block and direct pinning methods for mallet fracture: A comparative study.

Arch Plast Surg. 2018 Jul;45(4):351-356

Authors: Han HH, Cho HJ, Kim SY, Oh DY

Abstract
Background: Mallet fracture can easily occur during sports activities or in daily life; however, the principles and methods of treatment for such fractures remain debated. Among the surgical treatments, various methods of closed reduction have been proposed. We treated patients with the extension block method (EBM) and the direct pinning method (DPM), and then compared the results. We assessed differences in range of motion and measurements of finger movement after surgery.
Methods: A total of 41 patients who underwent surgery from August 2013 to September 2015 were evaluated retrospectively. Among them, 21 patients were treated with the EBM and 20 patients were treated with the DPM. We then compared extensor lag, range of motion, and outcomes according to Crawford's criteria between before surgery and at 6 to 8 months postoperatively.
Results: The postoperative extensor lag improvement was 4.28° and 10.73°, and the postoperative arc of motion was 55.76° and 61.17° in the EBM and DPM groups, respectively. The Crawford assessment showed no statistically significant difference between the groups, although the score in the DPM group was higher than that in the EBM group (3.5 vs. 3.1).
Conclusions: As closed reduction methods for the treatment of mallet fracture, both the EBM and DPM showed good results. However, the DPM proved to be superior to the EBM in that it produced greater improvements in extensor lag and range of motion.

PMID: 30037196 [PubMed]

Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap.

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Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap.

Arch Plast Surg. 2018 Jul;45(4):345-350

Authors: Shaikh SA, Bawa A, Shahzad N, Yousufzai Z, Ghani MS

Abstract
Background: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site.
Methods: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively.
Results: A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss.
Conclusions: For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.

PMID: 30037195 [PubMed]

The efficacy of elongated axillary incision on extended latissimus dorsi flap for immediate breast reconstruction.

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The efficacy of elongated axillary incision on extended latissimus dorsi flap for immediate breast reconstruction.

Arch Plast Surg. 2018 Jul;45(4):340-344

Authors: Park TS, Nam SB, Choi JY, Bae SH, Lee JW, Kim HY

Abstract
Background: In performing extended latissimus dorsi (ELD) flap procedures, a skin paddle design on the bra line helps reduce visible scarring. This improves the patient's satisfaction with the outcome. However, such a design leads to a longer operation time and increased fatigue of the surgeon due to the narrow operative field. In this study, the authors propose a method that elongates the axillary incision line posteriorly by 1.5 cm from the lateral border of the latissimus dorsi muscle. We examined whether this method could shorten the operation time and compared the incidence of complications between patients who underwent this novel procedure and patients who underwent the traditional procedure.
Methods: In this study of patients who underwent ELD flap procedures for immediate breast reconstruction, 89 underwent surgery with the elongated axillary incision and 45 underwent surgery without the elongated incision. The total operation time and complications were retrospectively examined based on the patients' medical records, and we examined whether there was any statistically significant difference in the total operation time.
Results: In the experimental group with the elongated axillary incision, the operation time ranged from 125 to 255 minutes (median, 175 minutes). In contrast, in the control group without the elongated axillary incision, the operation time ranged from 142 and 340 minutes (median, 205 minutes). The operation time was statistically significantly different between the two groups, and no significant complications were observed in the experimental group.
Conclusions: Elongation of the axillary incision alone may shorten the operation time of the ELD flap procedure without causing additional complications.

PMID: 30037194 [PubMed]

A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander.

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A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander.

Arch Plast Surg. 2018 Jul;45(4):333-339

Authors: Kono H, Ishii N, Takayama M, Takemaru M, Kishi K

Abstract
Background: Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume.
Methods: We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05×the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II.
Results: X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases.
Conclusions: The volume of a free TRAM flap can be straightforwardly estimated preoperatively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

PMID: 30037193 [PubMed]

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction.

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Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction.

Arch Plast Surg. 2018 Jul;45(4):325-332

Authors: Song SH, Kwon H, Oh SH, Kim SJ, Park J, Kim SI

Abstract
Background: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures.
Methods: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctival incision and an elevator through the intraoral incision.
Results: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted.
Conclusions: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

PMID: 30037192 [PubMed]

Secondary contouring of flaps.

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Secondary contouring of flaps.

Arch Plast Surg. 2018 Jul;45(4):319-324

Authors: Kim TG, Choi MK

Abstract
Perforator flaps are becoming increasingly common, and as primary thinning techniques are being developed, the need for secondary contouring of flaps is decreasing. However, many reconstructive flap procedures still incorporate secondary debulking to improve the functional and aesthetic outcomes. Direct excision, liposuction, tissue shaving with an arthroscopic cartilage shaver, and skin grafting are the four major methods used for secondary debulking. Direct excision is primarily applied in flaps where the skin is redundant, even though the volume is not excessive. However, due to the limited range of excision, performing a staged excision is recommended. Liposuction can reduce the amount of subcutaneous tissue of the flap and protect the vascular pedicles. However, the main drawback of this method is its limited ability to remove fibrotic tissues, for which the use of a shaver may be more convenient. The main drawback of using a shaver is that it is difficult to simultaneously remove excess skin. Skin grafting enables the removal of sufficient excess tissue to recover the contour of the normal limb and to improve the color match, facilitating excellent aesthetic results.

PMID: 30037191 [PubMed]

Flap thinning: Defatting after conventional elevation.

Related Articles

Flap thinning: Defatting after conventional elevation.

Arch Plast Surg. 2018 Jul;45(4):314-318

Authors: Park BY

Abstract
Perforator flaps become a reliable option for coverage of various defects and the interest is change from survival of perforator flaps to make thin flaps for better aesthetic and functional outcomes. Multiple flap thinning methods have been demonstrated but it has not been widely attempted because of concerns about compromising circulation of flap thinning. This article will demonstrate the feasibility and benefits of flap thinning technique: defatting after conventional flap elevation.

PMID: 30037190 [PubMed]

Thin elevation: A technique for achieving thin perforator flaps.

Related Articles

Thin elevation: A technique for achieving thin perforator flaps.

Arch Plast Surg. 2018 Jul;45(4):304-313

Authors: Jeong HH, Hong JP, Suh HS

Abstract
Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.

PMID: 30037189 [PubMed]

Anatomic basis for flap thinning.

Related Articles

Anatomic basis for flap thinning.

Arch Plast Surg. 2018 Jul;45(4):298-303

Authors: Park SO, Chang H, Imanishi N

Abstract
Flap thinning is a procedure for making a thick flap thinner. This procedure does more than simply fill in the defected area, and it is better for reconstructing the area both functionally and aesthetically. However, because flap thinning is a rather blind procedure, it may have harmful effects on flap vascularity. Therefore, the vasculature of a flap must be understood before performing flap thinning. This paper analyzes the basic anatomy underlying flap thinning based on the previous anatomic study that categorized flaps into 6 types by their vascular structures. This paper also reviews specific studies of frequently practiced flap procedures (deep inferior epigastric artery perforator flap, thoracodorsal artery perforator flap, and anterolateral thigh flap) and presents important precautions for flap thinning procedures. Finally, this paper briefly examines the axiality of the subdermal plexus, which needs to be taken into account when performing flap thinning.

PMID: 30037188 [PubMed]

PRS Korea 2017 & 2018: How to organize an International Plastic Surgery Congress and how to make it more attractive.

Related Articles

PRS Korea 2017 & 2018: How to organize an International Plastic Surgery Congress and how to make it more attractive.

Arch Plast Surg. 2018 Jul;45(4):295-297

Authors: Choi JW

PMID: 30037187 [PubMed]

Usurpation of the role of the plastic surgeon as a public health problem in Mexico: Reflections on a case.

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Usurpation of the role of the plastic surgeon as a public health problem in Mexico: Reflections on a case.

Arch Plast Surg. 2018 Jul;45(4):390-392

Authors: Garcia-Espinoza JA, García-Manzano RA, Aguilar-Aragón VB

PMID: 30037204 [PubMed]

Giant extraskeletal chondroma of the hand: A rare case.

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Giant extraskeletal chondroma of the hand: A rare case.

Arch Plast Surg. 2018 Jul;45(4):388-389

Authors: Wenny R, Pollhammer MS, Duscher D, Aitzetmueller MM, Haslhofer DJ, Huemer GM, Schmidt M

PMID: 30037203 [PubMed]

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature.

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Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature.

Arch Plast Surg. 2018 Jul;45(4):384-387

Authors: Kappen IFPM, Nguyen DT, Vos A, van Tits HWHJ

Abstract
Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.

PMID: 30037202 [PubMed]

Traumatic cerebrospinal fluid leakage following septorhinoplasty.

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Traumatic cerebrospinal fluid leakage following septorhinoplasty.

Arch Plast Surg. 2018 Jul;45(4):379-383

Authors: Youssef A, Ahmed S, Ibrahim AA, Daniel M, Abdelfattah HM, Morsi H

Abstract
Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

PMID: 30037201 [PubMed]

Successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug.

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Successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug.

Arch Plast Surg. 2018 Jul;45(4):375-378

Authors: Sashida Y, Kayo M, Hachiman H, Hori K, Kanda Y, Nagoya A

Abstract
In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

PMID: 30037200 [PubMed]

Breast augmentation surgery using an inframammary fold incision in Southeast Asian women: Patient-reported outcomes.

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Breast augmentation surgery using an inframammary fold incision in Southeast Asian women: Patient-reported outcomes.

Arch Plast Surg. 2018 Jul;45(4):367-374

Authors: Randquist C, Por YC, Yeow V, Maglambayan J, Simonyi S

Abstract
Background: This analysis presents patient-reported outcomes of breast augmentation procedures performed in Singapore using an inframammary fold incision and the "5 Ps" best practice principles for breast augmentation. These data are the first of their kind in Southeast Asian patients.
Methods: Through a retrospective chart review, patients who underwent primary breast augmentation with anatomical form-stable silicone gel breast implants using an inframammary fold incision were followed for ≥6 months postoperatively. The BREAST-Q Augmentation Module (scores standardized to 0 [worst] - 100 [best]) and Patient and Observer Scar Assessment Scale (POSAS; 1 [normal skin] to 10 [worst scar imaginable]) were administered. Responses were summarized using descriptive statistics. Patient-reported events were collected.
Results: Twenty-two Southeast Asian patients (mean age, 35.1 years) completed ≥1 postoperative BREAST-Q and POSAS assessment and were assessed 11 months to 5.5 years postoperatively. The mean postoperative BREAST-Q satisfaction with breasts and psychosocial well-being scores were 69.2 and 84.0, respectively. The mean POSAS score for their overall opinion of the scar was 4.2; the mean scores for all scar characteristics ranged from 1.2 to 4.2. Over 90% of patients (20/22) said that they would recommend the procedure. Patient complaints following surgery included anisomastia (possibly pre-existing; n=2), sensory loss at the nipple (n=2) or around the nipple (n=3), scarring (n=4), and slight capsular contracture (n=1). No patients required reoperation.
Conclusions: Southeast Asian patients reported high long-term satisfaction scores on the BREAST-Q scale and with their scar characteristics following breast augmentation using an inframammary fold incision, and nearly all said they would recommend this procedure. No reoperations were necessary in patients assessed for up to 5.5 years postoperatively.

PMID: 30037199 [PubMed]

Camptodactyly: An unsolved area of plastic surgery.

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Camptodactyly: An unsolved area of plastic surgery.

Arch Plast Surg. 2018 Jul;45(4):363-366

Authors: Singh V, Haq A, Priyadarshini P, Kumar P

Abstract
Background: Camptodactyly refers to permanent flexion contracture at the proximal interphalangeal joint. Most cases are limited to fifth-finger involvement. Although common, the treatment of camptodactyly is controversial. Many published studies have emphasized conservative treatment, while others have described surgical procedures. The problem with this deformity is that it presents in several forms, which means that there is no single model for effective treatment. The aim of this paper is to present the difficulties encountered with this condition and the management thereof on an individual basis.
Methods: This is a case series of 14 patients (nine males, five females) who underwent surgical treatment. The results were classified using the method from Mayo Clinic as excellent, good, fair, and poor.
Results: Fourteen patients with 15 fingers underwent surgery, and the results achieved were as follows: excellent, 0; good, 1; fair, 6; poor, 8. The treatment of camptodactyly still remains controversial, and hence proper planning individualized to each patient is needed to achieve the maximal improvement with realistic goals.
Conclusions: Although we performed individualised surgery, our careful follow-up was not able to identify any method as superior over another with respect to gain in extension and loss of flexion. We therefore propose that the extensor mechanism should not be disturbed during surgery to treat camptodactyly cases.

PMID: 30037198 [PubMed]

The effect of increasing the contact surface on tendon healing.

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The effect of increasing the contact surface on tendon healing.

Arch Plast Surg. 2018 Jul;45(4):357-362

Authors: Bilgen F, Duman Y, Bulut Ö, Bekerecioğlu M

Abstract
Background: The most common complication after tendon repair is the development of adhesion, with subsequent rupture.
Methods: In this study, we present a new method in which the tendon healing contact surface is increased to reduce these complications. The tendons of chickens in groups 1, 3, and 5 were transversely cut and repaired with in the traditional fashion with double-modified Kessler method and 5/0 polypropylene. In the other groups, 3 mm of the tendon was removed from the proximal half of the upper end and from the distal half of the lower end of the tendon, and they were repaired with the modified Kessler method. The tendons of the chickens in groups 1 and 2 were evaluated immediatelly after surgery. Groups 3 and 4 were evaluated at 4 weeks after surgery. Groups 5 and 6 were evaluated at 6 weeks.
Results: Increases in transient inflammation and connective tissue formation were observed more clearly in the group treated with the new method in histopathological investigations at weeks 4 and 6. The stretching test showed statistically significant differences between groups 3 and 4 (P<0.05) and groups 5 and 6 (P<0.05).
Conclusions: When repairing tendons with the new method, the healing surface increases and the direction of collagen fibers at the surface changes. Because of these effects, the strength of the tendon healing line increases; we therefore expect that this technique will enable patients to safely engage in early active exercise after the operation, with less risk of tendon rupture.

PMID: 30037197 [PubMed]

Extension block and direct pinning methods for mallet fracture: A comparative study.

Related Articles

Extension block and direct pinning methods for mallet fracture: A comparative study.

Arch Plast Surg. 2018 Jul;45(4):351-356

Authors: Han HH, Cho HJ, Kim SY, Oh DY

Abstract
Background: Mallet fracture can easily occur during sports activities or in daily life; however, the principles and methods of treatment for such fractures remain debated. Among the surgical treatments, various methods of closed reduction have been proposed. We treated patients with the extension block method (EBM) and the direct pinning method (DPM), and then compared the results. We assessed differences in range of motion and measurements of finger movement after surgery.
Methods: A total of 41 patients who underwent surgery from August 2013 to September 2015 were evaluated retrospectively. Among them, 21 patients were treated with the EBM and 20 patients were treated with the DPM. We then compared extensor lag, range of motion, and outcomes according to Crawford's criteria between before surgery and at 6 to 8 months postoperatively.
Results: The postoperative extensor lag improvement was 4.28° and 10.73°, and the postoperative arc of motion was 55.76° and 61.17° in the EBM and DPM groups, respectively. The Crawford assessment showed no statistically significant difference between the groups, although the score in the DPM group was higher than that in the EBM group (3.5 vs. 3.1).
Conclusions: As closed reduction methods for the treatment of mallet fracture, both the EBM and DPM showed good results. However, the DPM proved to be superior to the EBM in that it produced greater improvements in extensor lag and range of motion.

PMID: 30037196 [PubMed]

Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap.

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Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap.

Arch Plast Surg. 2018 Jul;45(4):345-350

Authors: Shaikh SA, Bawa A, Shahzad N, Yousufzai Z, Ghani MS

Abstract
Background: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site.
Methods: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively.
Results: A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss.
Conclusions: For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.

PMID: 30037195 [PubMed]

The efficacy of elongated axillary incision on extended latissimus dorsi flap for immediate breast reconstruction.

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The efficacy of elongated axillary incision on extended latissimus dorsi flap for immediate breast reconstruction.

Arch Plast Surg. 2018 Jul;45(4):340-344

Authors: Park TS, Nam SB, Choi JY, Bae SH, Lee JW, Kim HY

Abstract
Background: In performing extended latissimus dorsi (ELD) flap procedures, a skin paddle design on the bra line helps reduce visible scarring. This improves the patient's satisfaction with the outcome. However, such a design leads to a longer operation time and increased fatigue of the surgeon due to the narrow operative field. In this study, the authors propose a method that elongates the axillary incision line posteriorly by 1.5 cm from the lateral border of the latissimus dorsi muscle. We examined whether this method could shorten the operation time and compared the incidence of complications between patients who underwent this novel procedure and patients who underwent the traditional procedure.
Methods: In this study of patients who underwent ELD flap procedures for immediate breast reconstruction, 89 underwent surgery with the elongated axillary incision and 45 underwent surgery without the elongated incision. The total operation time and complications were retrospectively examined based on the patients' medical records, and we examined whether there was any statistically significant difference in the total operation time.
Results: In the experimental group with the elongated axillary incision, the operation time ranged from 125 to 255 minutes (median, 175 minutes). In contrast, in the control group without the elongated axillary incision, the operation time ranged from 142 and 340 minutes (median, 205 minutes). The operation time was statistically significantly different between the two groups, and no significant complications were observed in the experimental group.
Conclusions: Elongation of the axillary incision alone may shorten the operation time of the ELD flap procedure without causing additional complications.

PMID: 30037194 [PubMed]

A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander.

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A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander.

Arch Plast Surg. 2018 Jul;45(4):333-339

Authors: Kono H, Ishii N, Takayama M, Takemaru M, Kishi K

Abstract
Background: Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume.
Methods: We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05×the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II.
Results: X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases.
Conclusions: The volume of a free TRAM flap can be straightforwardly estimated preoperatively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

PMID: 30037193 [PubMed]

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction.

Related Articles

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction.

Arch Plast Surg. 2018 Jul;45(4):325-332

Authors: Song SH, Kwon H, Oh SH, Kim SJ, Park J, Kim SI

Abstract
Background: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures.
Methods: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctival incision and an elevator through the intraoral incision.
Results: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted.
Conclusions: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

PMID: 30037192 [PubMed]

Secondary contouring of flaps.

Related Articles

Secondary contouring of flaps.

Arch Plast Surg. 2018 Jul;45(4):319-324

Authors: Kim TG, Choi MK

Abstract
Perforator flaps are becoming increasingly common, and as primary thinning techniques are being developed, the need for secondary contouring of flaps is decreasing. However, many reconstructive flap procedures still incorporate secondary debulking to improve the functional and aesthetic outcomes. Direct excision, liposuction, tissue shaving with an arthroscopic cartilage shaver, and skin grafting are the four major methods used for secondary debulking. Direct excision is primarily applied in flaps where the skin is redundant, even though the volume is not excessive. However, due to the limited range of excision, performing a staged excision is recommended. Liposuction can reduce the amount of subcutaneous tissue of the flap and protect the vascular pedicles. However, the main drawback of this method is its limited ability to remove fibrotic tissues, for which the use of a shaver may be more convenient. The main drawback of using a shaver is that it is difficult to simultaneously remove excess skin. Skin grafting enables the removal of sufficient excess tissue to recover the contour of the normal limb and to improve the color match, facilitating excellent aesthetic results.

PMID: 30037191 [PubMed]

Flap thinning: Defatting after conventional elevation.

Related Articles

Flap thinning: Defatting after conventional elevation.

Arch Plast Surg. 2018 Jul;45(4):314-318

Authors: Park BY

Abstract
Perforator flaps become a reliable option for coverage of various defects and the interest is change from survival of perforator flaps to make thin flaps for better aesthetic and functional outcomes. Multiple flap thinning methods have been demonstrated but it has not been widely attempted because of concerns about compromising circulation of flap thinning. This article will demonstrate the feasibility and benefits of flap thinning technique: defatting after conventional flap elevation.

PMID: 30037190 [PubMed]

Thin elevation: A technique for achieving thin perforator flaps.

Related Articles

Thin elevation: A technique for achieving thin perforator flaps.

Arch Plast Surg. 2018 Jul;45(4):304-313

Authors: Jeong HH, Hong JP, Suh HS

Abstract
Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.

PMID: 30037189 [PubMed]

Anatomic basis for flap thinning.

Related Articles

Anatomic basis for flap thinning.

Arch Plast Surg. 2018 Jul;45(4):298-303

Authors: Park SO, Chang H, Imanishi N

Abstract
Flap thinning is a procedure for making a thick flap thinner. This procedure does more than simply fill in the defected area, and it is better for reconstructing the area both functionally and aesthetically. However, because flap thinning is a rather blind procedure, it may have harmful effects on flap vascularity. Therefore, the vasculature of a flap must be understood before performing flap thinning. This paper analyzes the basic anatomy underlying flap thinning based on the previous anatomic study that categorized flaps into 6 types by their vascular structures. This paper also reviews specific studies of frequently practiced flap procedures (deep inferior epigastric artery perforator flap, thoracodorsal artery perforator flap, and anterolateral thigh flap) and presents important precautions for flap thinning procedures. Finally, this paper briefly examines the axiality of the subdermal plexus, which needs to be taken into account when performing flap thinning.

PMID: 30037188 [PubMed]

PRS Korea 2017 & 2018: How to organize an International Plastic Surgery Congress and how to make it more attractive.

Related Articles

PRS Korea 2017 & 2018: How to organize an International Plastic Surgery Congress and how to make it more attractive.

Arch Plast Surg. 2018 Jul;45(4):295-297

Authors: Choi JW

PMID: 30037187 [PubMed]

A novel dermo-cosmetic product containing thermal spring water, sucralfate, copper sulfate, and zinc sulfate in the management of hand eczema.

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A novel dermo-cosmetic product containing thermal spring water, sucralfate, copper sulfate, and zinc sulfate in the management of hand eczema.

Clin Cosmet Investig Dermatol. 2018;11:373-381

Authors: Ribet V, Mielewczyk E, Sirvent A, Georgescu V, Rossi AB

Abstract
Background: The regular use of cosmetic products plays a role in the management of hand eczema (HE) and aids in improving barrier function reducing dryness, roughness, pruritus and improving quality of life (QoL). The aim of this open-label study was to assess the efficacy and the reparative effect of a dermo-cosmetic product on subjects suffering from HE after 7 and 21 days of daily application.
Methods: The product was a water-in-oil (W/O) emulsion containing the active ingredients Avène thermal spring water, sucralfate, and copper and zinc sulfates. In total, 32 subjects suffering from either contact dermatitis or climatic dermatitis participated in the trial. The modified total lesion symptom score and physician global assessment scores were used to describe the severity of HE. The safety of the product was assessed through clinical scoring. The subjective tolerance, and acceptance, were documented using a self-assessment questionnaire completed by the subjects. The impact of the dermatosis on QoL was evaluated using the Dermatology Life Quality Index.
Results: After 7 days of application, both the physician and subjects noticed a significant improvement in HE. The formula was very well tolerated and accepted. These benefits were correlated with a significant improvement in QoL.
Conclusion: The W/O emulsion used in this study demonstrated real benefits for the subjects suffering from contact dermatitis and climatic dermatitis.

PMID: 30038513 [PubMed]

Chemical peels in the treatment of acne: patient selection and perspectives.

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Chemical peels in the treatment of acne: patient selection and perspectives.

Clin Cosmet Investig Dermatol. 2018;11:365-372

Authors: Castillo DE, Keri JE

Abstract
Acne vulgaris is the most common skin disorder in adolescents and young adults. It carries a significant psychological and economic burden to patients and society. A wide range of therapeutic options are available, including topicals and systemic therapies. Chemical peeling is a skin resurfacing procedure intended to regenerate normal skin from the application of exfoliative agents. It has been used for the treatment of acne vulgaris and other skin disorders for decades. There are several chemical agents with variable mechanisms of action, usually classified as superficial, medium, and deep peels. When selecting the patient and the appropriate peel, the dermatologist individualizes therapy, and performs an extensive interview, including past medical history and physical exam. Several host factors can affect the outcome of this procedure, including current psychological state, medications, history of surgery, and immune system, among others. The physician must also be confident that the peel is safe and effective for the target patient. The Fitzpatrick skin type scale is a useful tool to classify patients based on skin color and ability to tan, but also can be used to evaluate preoperative risk of postpeel response and complications. Dark-skinned patients (Fitzpatrick skin type IV-VI), including blacks, Asian, and Hispanic/Latino, are at higher risk of postinflammatory/postpeel hyperpigmentation. When treating these populations, deep chemical peels should be avoided, and preoperative preparation emphasized. There are many studies available in the literature supporting the use of superficial to medium depth peels as adjuvant therapy for acne vulgaris. This review article aims to present the most important factors when selecting a patient for a chemical peel, the evidence behind its safety and efficacy, and special considerations when choosing a specific agent.

PMID: 30038512 [PubMed]

Core–shell poly-methyl methacrylate nanoparticles covalently functionalized with a non-symmetric porphyrin for anticancer photodynamic therapy

Publication date: Available online 25 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Marco Ballestri, Enrico Caruso, Andrea Guerrini, Claudia Ferroni, Stefano Banfi, Marzia Gariboldi, Elena Monti, Giovanna Sotgiu, Greta Varchi

Abstract

Photodynamic therapy (PDT) is an anticancer modality that exploits singlet oxygen and other reactive oxygen species, that are formed by selective irradiation of photosensitive molecules, to kill cancer cells. Most photosensitizers (PS) are hydrophobic and poorly soluble in water and several nanoplatforms have been established to achieve a more efficient delivery. Moreover, the covalent binding of the PS to nanoparticles could in principle reduce unwanted bleaching of the PS, while preserving its photodynamic activity. In this study we report the synthesis of a novel non-symmetrical diaryl-porphyrin suitably modified with a polymerizable pendant, that was used for the preparation of core-shell poly-methyl methacrylate nanoparticles covalently loaded with the diaryl-porphyrin (PMMA@PorVa). Particles, which were prepared with two different porphyrin loadings, are spherical in shape and with a narrow hydrodynamic diameter around 70 nm and a positive zeta potential. Their photo-toxicity was tested against the human colon carcinoma cell line HCT116 and the human ovarian adenocarcinoma cell line SKOV3. PMMA@PorVa were able to inhibit tumor cells proliferation similarly to the free porphyrin, thus confirming that the covalent attachment of the PS to PMMA nanoparticles allows to preserve PS photodynamic activity and in vitro efficacy. Flow cytometric analysis of apoptotic cells demonstrates that, especially in SKOV3 cells, the free diaryl-porphyrin is more effective in inducing apoptosis.

Graphical abstract

Systemic IgE-Mediated Hypersensitivity Reaction to Topical Polymyxin B

Publication date: Available online 25 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Suzanne Y. Ngo, Joyce C. Rabbat

Recurrent Wheeze Phenotypes in Poor Urban Preschool-age Children

Publication date: Available online 25 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Monica B. Reddy, Andrew H. Liu, JoAnn L. Robinson, Mary D. Klinnert

Chronic Rhinitis Is A High-Risk Comorbidity For 30-Day Re-Admission Of Patients With Asthma And Chronic Obstructive Pulmonary Disease

Publication date: Available online 25 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Umesh Singh, Victoria Wangia-Anderson, Jonathan A. Bernstein

ABSTRACT

BACKGROUND

Early hospital readmissions for asthma and chronic obstructive pulmonary disease (COPD), measured as hospital readmission within 30 days from the last discharge, is a major economic burden to our healthcare system. Association of this measure with comorbid chronic rhinitis (CR) has not been investigated before despite significant clinical association between CR and asthma or COPD.

OBJECTIVE

To investigate the association of CR with the risk of asthma or COPD-related early hospital readmission rates.

METHODS

This retrospective cohort study was performed using the asthma- and COPD-related hospital encounter and patient comorbidity data between June 15, 2012 - July 19, 2017 from a large hospital care system in Cincinnati, Ohio. Patients (any gender, race or socioeconomic status, and of all ages) with a primary discharge diagnosis of asthma (n=4754 patients, 10,111 encounters) and COPD (n=2176 patients, 4,748 encounters) based on ICD-10-CM codes were included. Relevant comorbidities, including comorbid allergic rhinitis (AR) or non-allergic rhinitis (NAR), in such patients were identified using ICD-10-CM codes. The association between 30-day asthma or COPD-related hospital readmission (1,670 such encounters for asthma and 736 for COPD) and comorbid CR in the affected patients were determined using Cox proportional hazards models. Multivariate-adjusted hazard ratios (HR), adjusted for relevant patient comorbidities, compared 30-day asthma- and COPD-related readmissions of patients with CR with those patients without a CR diagnosis.

RESULTS

Analysis was performed on 4,754 asthma and 2,176 COPD patients. The median follow-up period (+interquartile range) for asthma was 980 (+760) days and for COPD was 553 (+827) days. The HR for 30-day asthma- or COPD-related readmission rates were significantly higher in patients with AR [HR=4.4 (3.9, 5.0) and 2.4 (1.7, 3.2), respectively] or NAR [HR=3.7 (2.9, 4.9) and 2.6 (1.8, 3.7), respectively) compared to non-rhinitis patients. For asthma, both AR and NAR had higher HRs compared to all other co-morbidities analyzed. For COPD, both AR and NAR had HRs to the magnitude as obesity and hypertension.

CONCLUSION

AND RELEVANCE: Comorbid CR is significantly associated with 30-day asthma- and COPD-related readmissions. These findings are useful for guiding healthcare professionals to focus on outpatient management of both the upper and lower respiratory tracts in order to reduce early readmission of asthma and COPD patients.

Allergic Contact Dermatitis To Personal Care Products And Topical Medications In Adults With Atopic Dermatitis

Publication date: Available online 25 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Supriya Rastogi, Kevin R. Patel, Vivek Singam, Jonathan I. Silverberg

ABSTRACT

Background

Atopic dermatitis (AD) is associated with skin-barrier disruption, immune dysregulation, and application of emollients and topical medications, which may predispose towards developing allergic contact dermatitis (ACD).

Objective(s)

To determine the predictors of ACD and relevant allergens in AD.

Methods

A retrospective chart review was performed of 502 adults (age ≥18 years) who were patch-tested to an expanded allergen series from 2014-2017.

Results

Overall, 108 (21.5%) had current AD and 109 (21.7%) had past AD. Patients with vs. without current AD had similar proportions of any positive (+/++/+++: 80 [74.1%] vs. 254 [64.5%]; Chi-square, P=0.06), stronger (++/+++: 34 [31.5%] vs. 102 [25.9%], P=0.25) and irritant (56 [51.9%] vs. 188 [47.7%], P=0.45) patch test reactions. AD patients had significantly higher rates of positive reactions to ingredients in personal care products and topical medications, including fragrance mix II (P=0.04), lanolin (P=0.03), bacitracin (P=0.04), cinnamal (P=0.02), budesonide (P=0.01), tixocortol (P=0.02), and chlorhexidine (P=0.001); relevance was established in >90% of these reactions. Polysensitization occurred more commonly in patients with vs. without AD (35 [32.4%] vs. 75 [19.0%], P=0.01).

Limitations

Study performed at a single center.

Conclusion

AD patients had more positive patch test reactions to ingredients in personal care products, topical steroids and antibiotics.

Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships

Abstract

Introduction CenteringPregnancy® is well-regarded as an innovative group model of prenatal care. In 2009, Georgia's Southwest Public Health District partnered with local obstetricians and medical centers to expand prenatal care access and improve perinatal outcomes for low-income women by implementing Georgia's first public health administered CenteringPregnancy program. This paper describes the successful implementation of CenteringPregnancy in a public health setting with no prior prenatal services; assesses the program's first 5-year perinatal outcomes; and discusses several key lessons learned. Methods Prenatal and hospital medical records of patients were reviewed for the time period from October 2009 through October 2014. Descriptive analyses were conducted to examine demographic and clinical characteristics of women initiating prenatal care and to assess perinatal outcomes among patients with singleton live births who attended at least three CenteringPregnancy sessions or delivered prior to attending the third session. Results Six hundred and six low-income women initiated prenatal care; 55.4 and 36.4% self-identified as non-Hispanic black and Hispanic, respectively. The median age was 23 years (IQR 20, 28). Nearly 69% initiated prenatal care in the first trimester. Perinatal outcomes were examined among 338 singleton live births. The 2010–2014 preterm birth rate (% of births < 37 weeks gestation at delivery) and low birth weight rate (% of births < 2500 g) were 9.1 and 8.9%, respectively. Nearly 77% of women initiated breastfeeding. Discussion CenteringPregnancy administered via public–private partnership may improve access to prenatal care and perinatal outcomes for medically underserved women in low-resource settings.

Mukoide Pseudozysten – wann wie therapieren?

Zusammenfassung

Die Therapie der mukoiden Pseudozysten muss eine hohe Neigung zu Lokalrezidiven berücksichtigen. Aktuell stehen sowohl etablierte konservative als auch effektive operative Therapieverfahren zur Verfügung. Die Entscheidung über die geeignete Behandlungsmethode wird in Abhängigkeit von Lokalbefund und Beschwerden unter Berücksichtigung möglicher Nebenwirkungen getroffen. In dieser Übersicht werden Vor- und Nachteile der nichtinvasiven therapeutischen Optionen diskutiert. Zudem werden bewährte chirurgische Verfahren vorgestellt. Im Anschluss wird ein Therapiealgorithmus vorgeschlagen. Bei rezidivierenden und symptomatischen Läsionen mit Schmerzen oder Deformierung der Nagelplatte kann eine operative Therapie durch Exzision und Verschluss mittels kleiner Lappenplastik erwogen werden.

LY2109761 reduces TGF-β1-induced collagen production and contraction in hypertrophic scar fibroblasts

Abstract

Hypertrophic scars (HS) are fibro-hyperproliferative dermal lesions with effusive continuous accumulation of extracellular matrix components, particularly collagen. They usually occur after dermal injury in genetically susceptible individuals and cause both physical and psychological distress for the affected individuals. Transforming growth factor-β1 (TGF-β1) is known to mediate wound healing process by regulating cell differentiation, collagen production and extracellular matrix degradation. The sustained high expression of TGF-β1 is believed to result in the formation of hypertrophic scars. Inhibition of TGF-β1 signaling pathway may represent one of effective strategies for limiting excessive scarring. LY2109761, an orally active TβRI/II kinase dual inhibitor, has been previously reported that it had inhibitory effects on carcinomas and attenuates Radiation-induced pulmonary murine fibrosis. Our results revealed that LY2109761 reduced TGF-β1-induced collagen production and α-smooth muscle actin (α-SMA) expression, and attenuated TGF-β1-induced cell contraction in hypertrophic scar fibroblasts. The data from this study provide evidence supporting the potential use of LY2109761 as a novel treatment for hypertrophic scars.

The Potential Benefit of Pre-emptive Leukotriene Inhibitor Treatment to Breast Augmentation/Mastopexy Surgery

No abstract available

Facial Transplantation: Highlighting the Importance of Clinical Vigilance in Donor Selection

No abstract available

Postoperative use of multimodal analgesia: The need to control potential confounding variables

No abstract available

Texting Protected Health Information: a survey of Academic Plastic Surgeons

No abstract available

Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation

No abstract available

Mixed Reality in Plastic Surgery: A Primer

No abstract available

„Betrifft mich nicht“ betrifft zu viele

Der Dermatology Life Quality Index ist ein viel genutztes Instrument, um die Lebensqualität von Patienten mit Psoriasis zu messen. Er wird aber auch für Therapieentscheidungen herangezogen. Ob er dazu wirklich taugt, scheint angesichts neuer Studienergebnisse fraglich.

Qualitätsmanagement — zu oft noch Mauerblümchen im Praxisalltag

Die sektorenübergreifende Richtlinie zum Qualitätsmanagement des Gemeinsamen Bundesausschusses ist seit rund einem Jahr in Kraft. In vielen Praxen schlummert aber noch großes Optimierungspotenzial, sind sich Experten einig.

Mikronadelpflaster intensiviert lokale Psoriasistherapie

Die starke Verhornung der Haut erschwert bei Psoriasis das Eindringen von Topika und reduziert deren Wirkung. Könnte ein Mikronadelpflaster die Lösung sein?

Warum reagiert der Patient auf jeden Stich anders?

Apokrines Hydrozystom

Rosazea: Welche Rolle spielt Cathelicidin?

In einer aktuellen Studie wurde untersucht, inwiefern Vitamin D und Cathelicidin, ein Molekül der angeborenen Immunität, zur Rosazea beitragen.

Neues zu adjuvanter Therapie, „liquid biopsy“ und Wirkstoffkombinationen

Wenngleich auf dem ASCO 2018 keine Revolution ausgerufen wurde, gab es doch neue Fortschritte in der Melanomtherapie zu vermelden. In München diskutierten hochrangige Experten die neuesten Studiendaten — unter anderem zu Wirkstoffkombinationen bei Hirnmetastasen, dem richtigen Einsatz adjuvanter Therapien und der diagnostischen Methode der „liquid biopsy".

Europaweite Umfrage: Wie wird eine Lentigo maligna behandelt?

Ein standardisiertes Vorgehen in der Diagnostik der Lentigo maligna existiert bislang nicht, auch Vergleichsstudien zur Therapie fehlen. Eine Umfrage sollte nun einen Überblick über die diagnostischen und therapeutischen Vorgehensweisen der Ärzte bei LM-Patienten verschaffen.

Verborgenes Malignom tritt an der Haut zutage

Schwarzer Knoten im Augenwinkel

Beurteilen Ärzte und Patienten Narben gleich?

Narben werden nach einem chirurgischen Eingriff meist nur aus Sicht des behandelnden Mediziners bewertet. Dabei ist die Meinung der Patienten enorm wichtig, da sie Narben meist aus einer anderen Perspektive sehen. Eine Studie zeigt, dass die bestehenden Rating-Skalen deswegen nicht optimal sind.

Tumorfreie Ränder in der Biopsie von Basalzellkarzinomen wenig aussagekräftig

Wenn der Verdacht auf ein Basalzellkarzinom histologisch bestätigt wird, werden oft Angaben zum Randstatus des entnommenen Gewebes gemacht. Eine Studie stellt die Aussagekraft dieser Biopsate in Frage.

Inhaltsverzeichnis

Haarverlust nach endokriner Brustkrebstherapie

Patientinnen mit Brustkrebs, die Aromatasehemmer einnehmen müssen, haben ein gewisses Risiko, Haarausfall vom männlichen Typ zu entwickeln. Eine Forschergruppe aus New York hat das Phänomen des androgenetischen Haarausfalls von Frauen unter endokriner Brustkrebstherapie im Zuge einer retrospektiven Kohortenstudie systematisch untersucht.

Adjuvante Therapie schon für Stadium-II-Melanome?

Die drei Arten der Einzelfallprüfung

Neben Durchschnittsprüfungen können Ärzte jederzeit auch die meist von den Krankenkassen veranlasste Einzelfallprüfungen ereilen. Manche Prüfungen sind einfach nur lästig oder ärgerlich, bei anderen lohnt sich der Widerspruch.

Body Suspension

Die Modern-Primitives-Bewegung zelebriert die Neuinterpretation eines indianischen Rituals in umstrittenen Suspension-Performances.

Ist die „liquid biopsy“ schon praxistauglich?

Epidermale plus follikuläre Zellsuspension effektiv bei Vitiligo

Die Therapie einer Vitiligo zielt darauf ab, eine schnelle Repigmentierung zu erreichen. Gut geeignet ist die Transplantation epidermaler wie auch follikulärer Zellsuspensionen. Wie eine neue Studie demonstriert, erzielt die Kombination beider Zelltypen bessere Ergebnisse als die Einzeltherapie mit nur einer Zellsuspension. Sogar schwer zu behandelnde Stellen können damit effektiv therapiert werden.

Hände wie ein Mechaniker, Füße wie ein Wanderer

Dynamic Quadripolar Radiofrequency: Pilot Study of a New High-Tech Strategy for Prevention and Treatment of Vulvar Atrophy

Abstract

Background

The well-being of the vulva and a woman's quality of life are distinctly correlated. Recent years have seen an increasing flow of papers about nonsurgical vulvar rejuvenation techniques. Dynamic Quadripolar RadioFrequency (DQRFTM), one of the newest light- and energy-based vulvar rejuvenation technologies, has showed to be an effective option in aesthetic gynecology.

Objective

This article utilized qualitative and semi-quantitative evaluations of the short-term vulvar aesthetics to illustrate the efficacy of an accelerated DQRFTM vulvar rejuvenation program in women with mild to moderate vulvar hypotrophy.

Methods

Twenty women with mild to moderate vulvar hypotrophy were prospectively screened and evaluated from June 2016 to September 2017. Serial photographs documented the DQRFTM aesthetic impact on the vulvar area over the 2-month study period. The overall aesthetic improvement was rated with a Global Aesthetic Improvement Scale (GAIS) modified from a 5-point to a 10-point semi-quantitative rating tool. Complications and side effects were recorded.

Results

All women successfully underwent three planned DQRFTM procedures spaced 7 to 10 days apart. Signs and symptoms of vulvar hypotrophy and aesthetics of the vulvar area were already improving in most women after the first DQRFTM session, and improvements in vulvar aesthetics were persistently highly significant 1 month after the end of the DQRFTM rejuvenation program. No complications or side effects occurred.

Conclusions

Improvement of signs and symptoms of vulvar hypotrophy by DQRFTM rejuvenation of the labia majora was confirmed as a technically simple outpatient procedure with virtually no complications or side effects. In women with mild to moderate hypotrophy, this was possible with a rapid rejuvenation program of shortly spaced sessions.

Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique

Abstract

Background

Platysma bands are characteristic of an aging neck. Resection and plication of the platysma muscle is the basis of treatment. Yet, unfavorable surgical outcomes and improved understanding of platysma band etiology has shifted treatment towards nonsurgical rejuvenation.

Objective

Assesses efficacy, injection techniques, and complications associated with botulinum toxin injection for the treatment of platysma bands.

Methods

A systematic literature search was performed to identify articles reporting botulinum toxin injections for platysma bands in neck rejuvenation. The search included published articles in three electronic databases—Ovid MEDLINE, EMBASE, and the Cochrane Library—between January 1985 and December 2017.

Results

Three studies met the inclusion criteria, with a total of 78 patients undergoing botulinum toxin injection for platysma bands. Incobotulinumtoxin A (Xeomin®) was used in 62.3% (n=45/78) of patients, with 38.4% (n=30/78) having abobotulinumtoxin A (Dysport®). Efficacy was assessed using Merz platysma score scale (mean score and response rate-% patients responding to injections by at least one score). A mean score improvement of 2.0 points, with a response rate of 93.7% was observed after 14±2 days. At three months, mean score improvement was 1.2 points with response rate 86%. Patient-reported metrics demonstrated an improvement in 71/78 (91%) of subjects. There was a standard injection technique between studies, with a maximum 20IU of incobotulinumtoxin A and 5 U abobotulinumtoxin A used per band. Complications were reported in 12/78 (15.4%) patients, with none requiring further invention.

Conclusions

Botulinum toxin is highly effective treatment for isolated platysma bands. A safe injection technique is described and recommended for clinical practice.

Current Trends in Breast Augmentation: Analysis of 2011-2015 Maintenance of Certification (MOC) Tracer Data

Abstract

Background

Breast augmentation is the most common aesthetic surgery performed in the United States. Despite its popularity, there is no clear consensus on many aspects of the procedure.

Objectives

We assessed current trends and changes in breast augmentation from January 1, 2011 to December 31, 2015.

Methods

A retrospective cross-sectional study of 11,756 women undergoing breast augmentation based on the American Board of Plastic Surgery Maintenance of Certification (ABPS MOC) Tracer Database was performed.

Results

There were clearly dominant trends in how ABPS certified plastic surgeons performed breast augmentations. The majority of surgeries were performed in freestanding outpatient (47.3%) or office operating room (33.7%). The inframammary fold incision was most popular (75.1%), followed by periareolar (17.8%) and transaxillary approaches (4.1%). Implants were more commonly placed in a submuscular pocket (30.6%), compared to dual plane (26.7%) or subglandular (6.7%). Silicone implants (66.8%) were favored over saline (25.1%), with a statistically significant increase in silicone prostheses from 2011 to 2015. Data was "not applicable" or "other" in the remainder of cases. There was a dramatic increase in administration of both preoperative antibiotics (3.8% in 2011, 98.7% in 2015, p<0.05) and deep venous thromboembolism (DVT) prophylaxis (3.8% in 2011, 90.6% in 2015, p<0.05) during the study period. Both overall adverse events (7.4%) and reoperation rates (2.2%) were low.

Conclusions

Changes in standard-of-care for breast augmentation are reflected by the evolving practice patterns of plastic surgeons. This is best evidenced by the dramatic increase in use of antibiotic and DVT prophylaxis from 2011 to 2015.