Extended Chest Wall Based Flap and Lipofilling for Immediate Breast Reconstruction for Obese Patients

Publication date: Available online 9 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Maria Cecilia Closs Ono, Ruth Maria Graf, Dayane Raquel de Paula, Fabiola Grigoletto Lupion, Renato da Silva Freitas

Percutaneous transluminal plasty: a novel approach for refractory anastomotic stricture after esophagectomy

Abstract

Anastomotic stricture is often observed after esophagectomy. Surgical treatment is considered for refractory stricture to conservative treatments. However, it is not established what type of surgery is safe and effective. In this report, we present a novel approach, percutaneous transluminal plasty, for refractory anastomotic stricture reconstructed via the subcutaneous route in esophagectomy. We believe that the effectiveness and safety of this technique is considerably good and can become a good alternative for refractory stricture after esophagectomy.

Sífilis maligna, una presentación de sífilis a tener en cuenta

Publication date: Available online 8 August 2018

Source: Actas Dermo-Sifiliográficas

Author(s): X. Fustà-Novell, D. Morgado-Carrasco, A. Barreiro-Capurro, C. Manzardo, M. Alsina-Gibert, Miembros del Grupo de Trabajo de Infecciones de Transmisión Sexual del Hospital Clínic de Barcelona, Irene Fuertes-de Vega, José-Luís Blanco, Anna González, Asunción Moreno, Miriam Álvarez, Jordi Bosch

Resumen

La sífilis maligna es una forma infrecuente de sífilis secundaria asociada a la infección por el VIH, caracterizada clínicamente por nódulos necróticos y lesiones ulceradas generalizadas. Presentamos 4 pacientes diagnosticados de sífilis maligna tras revisar los casos de sífilis diagnosticados en nuestro centro entre 2012 y 2016. Describimos los aspectos epidemiológicos, clínicos, histopatológicos y serológicos, así como su relación con el VIH y la respuesta al tratamiento. Aunque se trate de una forma de sífilis poco frecuente, en los últimos años ha aumentado el número de casos publicados, principalmente pacientes jóvenes infectados por el VIH. Es necesario incluir la sífilis maligna en el diagnóstico diferencial de pacientes infectados por el VIH con lesiones ulceradas y necróticas.

Abstract

Malignant syphilis is an uncommon form of secondary syphilis associated with HIV infection. Clinically, it is characterized by necrotic nodules and generalized ulcerated lesions. We present 4 cases of malignant syphilis diagnosed after evaluating syphilis cases diagnosed at our hospital between 2012 and 2016. We describe the epidemiologic, clinical, histiopathologic, and serologic characteristics of malignant syphilis and explore its response to treatment and association with HIV infection. Although malignant syphilis is uncommon, there has been an increase in the number of cases published in recent years, particularly in young HIV-positive patients. Malignant syphilis must be contemplated in the differential diagnosis of HIV patients with ulcerated, necrotic lesions.

Graphical abstract

Autologous Fat Grafting after Sarcoma surgery: evaluation of oncological safety

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Angela Pennati, Egidio Riggio, Giuseppe Marano, Elia Biganzoli

Abstract

Background

The regenerative effectiveness of lipoaspirate procedures relies on the presence of mesenchymal stem cells, but the stromal microenvironment and hormonal secretions of adipose tissue can be involved in cancer growth. Only few oncological outcome studies of fat grafting at the surgical site of malignant neoplasms of mesenchymal origin are available; none of these examined a series of sarcoma cases.

Objectives

We analyzed outcome in terms of local or distant spread and overall survival in order to investigate the oncological safety of fat grafting in sarcoma patients.

Patients and methods

Sixty consecutive patients who had undergone 143 fat grafting procedures after surgical resection of bone and soft tissue sarcomas of the head, trunk and limbs with clear resection margins were enrolled from 2004 to 2015 in our tertiary care center. A multidisciplinary sarcoma team administered adjuvant therapies. Patients were recurrence free at fat grafting.

Results

The overall median follow-up was 7.5 years. At follow-up after fat grafting (2.4 years), one patient had distant metastasis and two had local relapse. Kaplan-Meier analysis showed disease-free survival of 95.4% (CI:89.1-100.0) at 24 months. The risk of local recurrence within 24 months was 4.6% (CI:0.0-20.9). The probability of not having local recurrence after fat grafting was ≥89.1%.

Conclusion

We found no evidence of an increased cancer risk after fat grafting procedures in sarcoma patients, but a stimulatory role of fat cannot be excluded for bone sarcomas based on the cases reported here and further studies are therefore needed.

Half-transection Method Combined with Intravascular Stent for Supermicrosurgical Lymphaticovenular Anastomosis

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Wang Jing, Mitsunaga Narushima

The impact of surgical alar (lower lateral) cartilage manipulation on lateral crural stiffness

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Kathak Vachhani, Pierre Lapaine, Saeid Samiezadeh, Cari M. Whyne, Jeffrey A. Fialkov

Abstract

Background

Cephalic trimming of the alar (or lower lateral) cartilage may cause weakening leading to external nasal valve collapse. Numerous methods have been proposed to combat this weakening in order to maintain lateral crural stiffness. The purpose of this study was to quantify the effect of mucosal stripping, cephalic trimming, cephalic turn-in flap, and lateral crural strut grafting on lateral crural stiffness.

Methods

In situ cyclic compressive loading was performed on eight lateral crura in 4 fresh frozen cadaveric specimens. Testing was performed on the unaltered degloved cartilage (intact) and following each of the following interventions: mucosal stripping, cephalic turn-in flap, cephalic trimming, and lateral crural strut grafting. Linear regression of the generated force-displacement curves was used to calculate stiffness. Each intervention was compared to the intact cartilage.

Results

Alar cartilage of all of the specimens demonstrated a linear response to compressive loading. Intact cartilage had a mean stiffness of 3.53 N/mm. Mucosal stripping and cephalic turn-in flaps yielded similar stiffness values to intact cartilage. Cephalic trimming reduced stiffness in all cases by a mean of 1.09 N/mm (p = 0.003). Lateral crural strut grafting significantly increased stiffness by a mean of 3.67 N/mm (p = 0.0001).

Conclusions

Cephalic trimming leads to decreased lateral crural stiffness in cadaveric specimens. Cephalic turn-in flaps restore pre-trimmed stiffness, and lateral crural strut grafting increases overall stiffness of the cartilage. These findings should be considered in patients undergoing rhinoplasty, particularly if there are concerns regarding potential external valve collapse.

“Hand rejuvenation by Stromal Enriched Lipograft”

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Aris Sterodimas, Filippo Boriani, Beatriz Nicaretta, Luiz Haroldo Pereira

Skin Perforator Mapping Method for Anterolateral Thigh Flap using Indocyanine Green Angiography

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Ryohei Ishiura, Minami Fujita, Megumi Furuya, Chihena Banda, Mitsunaga Narushima

Potential of performing a microvascular free flap reconstruction using solely a 3D Exoscope instead of a conventional microscope

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Andrzej A. Piatkowski, Xavier H.A. Keuter, Rutger M. Schols, René R.W.J. van der Hulst

New technical method to correct secondary vermilion deformities with cleft lip

Publication date: Available online 8 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Takatoshi Yotsuyanagi, Ken Yamashita, Makoto Yamauchi, Asuka Sugai, Shinji Kato, Ayako Gonda, Arisa Kita, Ayaka Kitada

Summary

Various techniques for correcting whistling deformities that occurred after primary surgery for cleft lip have been reported. These techniques are mainly intended to correct the lack of volume of the red lip. However, irregularity of the dry-wet lip junction (mucocutaneous junction) in the red lip has rarely been mentioned. If the wet lip is located in an exposed area, not only is the aesthetic appearance poor but also uncomfortable complications such as a crusted or bleeding lip repeatedly occur under a dry condition.

A new technique for correcting the irregular line of the dry-wet lip junction is described in this report. The technique is simple. After removal of the exposed wet lip, flaps are designed on both dry lip sides of the defect as M-W-M plasty and are transposed toward the defect. The dog-ears are small, the scar is inconspicuous because it is incorporated with the wrinkle line, and scar contracture is prevented. In addition, more soft tissues may be included to correct a mild whistling deformity.

Stability of mercury on a novel mineral sulfide sorbent used for efficient mercury removal from coal combustion flue gas

Abstract

Nano-structured zinc sulfide (Nano-ZnS) has been demonstrated to be a promising alternative to activated carbon (AC) for controlling mercury emission from coal combustion flue gas. The ultimate fate of the mercury-laden Nano-ZnS after mercury capture is mostly disposed in landfill with fly ashes. Thus, the stability of mercury adsorbed on the Nano-ZnS is of considerable significance in the secured disposal of fly ash after mercury removal and in the commercial application of the Nano-ZnS sorbent for removal of mercury from coal combustion flue gas. In this work, a modified toxicity characteristic leaching procedure (TCLP) was conducted to evaluate the leachability of mercury on the Nano-ZnS. The effects of leachate pH value, leaching time, liquid-to-solid ratio, and acid rain types on mercury leaching from the mercury-laden Nano-ZnS were systematically investigated. The TCLP results show that the concentration of mercury in leachate was far below the safe limit (200 μg/L) as imposed by the US Environmental Protection Agency (EPA) for classifying a material as a hazardous waste. All the key parameters that generally affected metal leaching rate exhibited slight effect on mercury leaching from the mercury-laden Nano-ZnS. Leaching tests at various highly severe conditions resulted in less than 0.01% mercury leaching from the mercury-laden Nano-ZnS. Sequential selective extraction tests demonstrated that mercury sulfide (HgS) was the dominant adsorption product on the Nano-ZnS, which guaranteed the excellent stability of mercury adsorbed on the Nano-ZnS.

Graphic abstract

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Waste-cleaning waste: synthesis of ZnO porous nano-sheets from batteries for dye degradation

Abstract

This paper describes a clean approach of waste-cleaning waste. Two-dimensional (2D) ZnO porous nano-sheets were synthesized from end-of-life zinc-carbon batteries via a simple homogeneous precipitation-calcination route, and the as-synthesized product was applied as photocatalyst for the purpose of photodegradation of methylene blue/MB aqueous solution under UV-Vis irradiation. Precipitation at ambient temperature resulted in the formation of the crystalline phase of zinc hydroxide nitrate hydrate [Zn₅(OH)₈(NO₃)₂(H₂O)₂], which was then transformed to ZnO through calcination. FE-SEM studies revealed the resulting ZnO had the morphology of porous nano-sheets with thickness of up to 100 nm. The photocatalytic activity tests proved that the batteries-derived ZnO porous nano-sheets can be a promising candidate for photodegradation of organic pollutant in industrial waste water. The results presented here confirm a possibility of utilization waste batteries as a resource of photodegrading MB in wastewater treatment, hereby an opportunity to deliver environmental benefits.

Graphical abstract

The effect of levamisole in the treatment of recalcitrant recurrent erythema multiforme major: An observational study

Erythema multiforme major (EMM) is an immune-mediated mucocutaneous eruption characterized by distinctive cutaneous target lesions with variable mucosal involvement. EMM is usually triggered by herpes simplex virus (HSV), Mycoplasma pneumoniae (M. pneumoniae), or other infections. Reactivation or reinfection of HSV accounts for more than 70% of cases of recurrent EMM. Although the majority of patients have a benign clinical course, more than 30% of patients suffer from frequent recurrences of EMM over years, leading to substantial morbidity [1,2].

Amylose cutanée dychromique autosomique récessive et mutations de GPNMB

Publication date: Available online 8 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): O. Dereure

Efficacy and safety data for checkpoint inhibitors in advanced melanoma under real-life conditions: A monocentric study conducted in Nice from 2010 to 2016

Publication date: Available online 8 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Taquin, E. Fontas, O. Massol, P. Chevallier, R. Balloti, G. Beranger, J.-P. Lacour, T. Passeron, H. Montaudié

Summary

Background

Immunotherapies using anti-CTLA4 and anti-PD1 antibodies have revolutionised the management of patients with advanced melanoma. The aim of our study was to analyse the efficacy and safety of immunotherapies in patients with advanced melanoma under real-life conditions.

Methods

We conducted a monocentric, retrospective, observational study that included all patients treated with immunotherapies (ipilimumab, i.e. ipi; nivolumab, i.e. niv and pembrolizumab, i.e. pbr) for advanced melanoma with exclusion of primary mucosal or ocular melanoma. The primary endpoint was progression-free survival (PFS).

Results

A total of 110 patients were included. Median PFS was better in the anti-PD1 group than in the anti-CTLA4 group (3.9 months vs. 2.9 months, P = 0.025). The frequency of adverse events of any grade was 53.4% with ipi, 66.7% with niv and 75% with pbr.

Discussion

Our study shows slightly inferior efficacy data vs. clinical trials of ipi and niv because patients were presenting more severe illness at inclusion. Nevertheless, the study argues in favour of the superiority of anti-PD1 antibodies vs. anti-CTLA4 antibodies in terms of PFS and best overall response. Moreover, our study exhibits safety data comparable to those from clinical trials except for a lower frequency with ipi.

Conclusion

Our efficacy and safety data obtained under real-life conditions are reassuring since they are consistent with data already published.

Résumé

Introduction

Les immunothérapies par anti-CTLA4 et anti-PD1 ont révolutionné la prise en charge du mélanome avancé. Le but de ce travail était d'étudier l'efficacité et la tolérance des immunothérapies utilisées en conditions de vie réelle chez des patients traités pour un mélanome avancé.

Méthodes

Étude observationnelle, rétrospective, monocentrique, incluant les patients en immunothérapie par ipilimumab (ipi), nivolumab (ni) ou pembrolizumab (pbr) pour un mélanome avancé hors mélanome muqueux ou choroïdien. Le critère principal de jugement était la survie sans progression (SSP).

Résultats

Au total, 110 patients ont été inclus. La médiane de SSP des patients sous anti-PD1 était supérieure à celle des patients traités par anti-CTLA4 (3,9 mois vs. 2,9 mois ; p = 0,025). La fréquence de survenue d'évènements indésirables quel que soit leur grade était de 53,4 % pour l'ipi, 66,7 % pour le niv et 75 % pour le pbr.

Discussion

Notre étude montre des données d'efficacité légèrement inférieures à celles des essais cliniques pour l'ipi et le niv, en lien avec des patients plus sévères à l'inclusion. Néanmoins, notre travail est en faveur de la supériorité des anti-PD1 par rapport à l'anti-CTLA4 en termes de SSP et de meilleure réponse globale. Il objective enfin des données de tolérance comparables à celles des essais cliniques, mis à part une fréquence moindre d'évènements indésirables dans the ipi group.

Conclusion

Nos données d'efficacité et de tolérance des immunothérapies dans le mélanome avancé en vie réelle sont rassurantes car cohérentes avec les données de la littérature.

Skin Perforator Mapping Method for Anterolateral Thigh Flap using Indocyanine Green Angiography

Anterolateral thigh flap is one of the most popular flaps among microsurgeons. This flap was born in 19841), however it is still being refined to date 2, 3). In developing the flap, skin perforator mapping plays an important role in improving the reliability of operations. Nowadays, several methods of detecting perforators are reported. Among these, CT angiography, Sound Doppler and Color Doppler are the standard used to locate perforators.

Autologous Fat Grafting after Sarcoma surgery: evaluation of oncological safety

The regenerative effectiveness of lipoaspirate procedures relies on the presence of mesenchymal stem cells, but the stromal microenvironment and hormonal secretions of adipose tissue can be involved in cancer growth. Only few oncological outcome studies of fat grafting at the surgical site of malignant neoplasms of mesenchymal origin are available; none of these examined a series of sarcoma cases.

Potential of performing a microvascular free flap reconstruction using solely a 3D Exoscope instead of a conventional microscope

Since the introduction of the operating microscope in the mid of the 20th century reconstructive microsurgery has emerged and pushed its boundaries continuously 1, 2.

“Hand rejuvenation by Stromal Enriched Lipograft”

The rejuvenation of the hand has received increased attention recently. Autologous transplantation of fat tissue enables subcutaneous regeneration by refilling the subcutaneous space 1,2 and hence reducing some of the age-related degenerative processes of the hand dorsum such as epidermal changes, dermal and subdermal atrophy, with deep intermetacarpal spaces, prominent bones and tendons, and bulging reticular veins.

Extended Chest Wall Based Flap and Lipofilling for Immediate Breast Reconstruction for Obese Patients

Increasing rates of obesity in the general population have coincided with increased rates of obese patients with breast cancer1. Breast reconstruction in the overweight population represents a challenge for the plastic surgeon. Multiple studies have shown very high complication rates for both prosthetic and autologous reconstruction in these patients. Obesity confers independent risk of perioperative medical and surgical morbidity in breast reconstruction population2.