bluuebunny/crossref_metadata_2025 huggingface dataset:
Botulinum Toxin A in Tissue Expander Breast Reconstruction: A Double-blinded Randomized Controlled Trial
Authors: Lemaine Valerie , Lohse Christine M. , Mandrekar Jay N. , Ramaker Sheri A. , Convery Phyllis A. , Nguyen Minh Doan , Tran Nho V.
Published: January 2021

Background:

Subpectoral tissue expander breast reconstruction is often associated with muscle spasms, pain, and discomfort during tissue expansion. In this study, we hypothesized that an intraoperative injection of botulinum toxin A (BTX-A) in the pectoralis major muscle reduces the pain associated with tissue expansion and improves women’s physical well-being.

Methods:

Between May 2012 and May 2017, women undergoing immediate subpectoral tissue expander breast reconstruction were randomized to administer 100 units of BTX-A or a placebo injection. A numeric pain intensity scale and the physical well-being scale of the BREAST-Q: Reconstruction Module were used to test our hypothesis. Data on postoperative oral narcotic consumption were not collected.

Results:

Of the 131 women included in the analysis, 48% were randomized to placebo and 52% to BTX-A. The preoperative median pain intensity score was 0 [interquartile range (IQR), 0–1], and the median preoperative BREAST-Q score was 91 (IQR, 81–100). The median slopes for the change in pain intensity scores from baseline throughout tissue expansion for those randomized to placebo and BTX-A were −0.01 (IQR, −0.02 to 0.00) and −0.01 (IQR, −0.02 to 0.00), respectively (P = 0.55). The median slopes for the change in BREAST-Q scores from baseline throughout tissue expansion for those randomized to placebo and BTX-A were 0.04 (IQR, −0.17 to 0.14) and 0.02 (IQR, −0.06 to 0.13), respectively (P = 0.89).

Conclusion:

In this study, we found that an intraoperative intramuscular injection of 100 units of BTX-A in the pectoralis major muscle did not reduce postoperative pain and patient-reported physical well-being when compared with placebo.
Two-stage Neoscrotum Reconstruction Using Porcine Bladder Extracellular Matrix after Fournier’s Gangrene
Authors: Thayer Jacob , Mailey Brian A.
Published: January 2021

Background:

Fournier’s gangrene is a life-threatening infection. Survivors can be left with significant deformity of their external genitalia. We present our technique for restoring a more normal appearance to the scrotum.

Methods:

A 2-stage orchiopexy and scrotoplasty are performed. At the first stage, the testicles are delivered to their anatomic place and sutured together. Xenograft powder and wound matrix are used to stimulate a granulation response. After 2–3 weeks, split-thickness skin grafting is performed to create a neoscrotum. This is protected for 1 week with negative pressure wound therapy. Postoperatively, the scrotum is protected with nonstick dressings to prevent synechiae to the perineum.

Results:

Two to three weeks after product application, a robust granulation tissue bed can be seen, which is very receptive to a meshed skin graft scrotal pouch. Circumferential negative pressure wound therapy is safe and prevents synechiae of the scrotum to perineum. The scrotum healed without issue and demonstrated an acceptable aesthetic result.

Conclusions:

This technique produces a near-normal appearing scrotum in the normal anatomic position for the testicles. The porcine xenograft material incites an intense granulation reaction, producing a wound bed amenable to accept a skin graft at 2–3 weeks. This 2-stage procedure to create a neoscrotum can be considered for the reconstruction of disfigured genitalia from Fournier’s gangrene wounds.
V-Y Flap for Nasal Reconstruction
Authors: Viciana Enrique J. , Lessard Anne-Sophie
Published: January 2021

The nasal tip is a complex zone for reconstruction. Numerous flap reconstructions have been proposed. In addition to the technique presented here, only the Gillies-Millard bishop’s miter flap and the paramedian forehead flap should be considered. The bilobed flap should be discontinued. The double-opposing V-Y flap for nasal tip reconstruction described here is an excellent method for reconstruction of limited defects of the nasal tip. These are mirror-image cutaneous flaps which require careful, skillful technique to preserve the delicate nerves and vessels. This challenging technique should only be attempted by qualified surgeons. Triangular cutaneous flaps are marked on either side of the defect, oriented transversely. The flaps are elevated and advanced with careful, gentle dissection. Ligamentous structures are cut while preserving the neurovascular supply. No cautery is used. The procedure is performed in an operating room with local anesthesia and with the patient under IV sedation. A patient who underwent this reconstruction is shown preoperatively, early postoperatively, and late postoperatively. The results demonstrate no tip distortion with imperceptible scars. The steps to undertake this procedure are outlined in detail. Rules for nasal tip reconstruction are proposed.
Gouty Stenosing Tenosynovitis: Trigger Finger as a First Presentation of Tophaceous Gout
Authors: Doucet Véronique , McLeod Graham J. , Petropolis Christian J.
Published: January 2021

Gout can lead to the deposition of tophi and chronic arthritis, for which surgical management is indicated when tophi interfere with the function of the finger. This case report discusses the management of a 37-year-old man with a past medical history of gout who presented with triggering of his small finger from gouty infiltration of his flexor digitorum profundus (FDP) tendon. An exploratory procedure that included tenolysis and release of the A1 pulley was performed. Gouty infiltration of the FDP tendon was noted intraoperatively and biopsied, which was later confirmed by histopathological analysis as being gouty tophus. The patient regained full function of the affected finger postoperatively and has since had no recurrence. Gouty tenosynovitis is a rare cause of trigger finger and should be considered as part of the differential diagnosis. Treatment for gouty tenosynovitis consists of A1 pulley release and careful excision of gouty tophus to restore tendon glide and hand function.
The Impact of COVID-19-based Suspension of Surgeries on Plastic Surgery Practices: A Survey of ACAPS Members
Authors: Sarac Benjamin A. , Schoenbrunner Anna R. , Wilson Stelios C. , Chiu Ernest S. , Janis Jeffrey E.
Published: January 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic led to a drastic decline in the number of elective surgeries performed in the United States. Many national societies and local governments provided recommendations for surgeons to initially suspend and progressively resume elective surgery. The authors used a survey to the American Council of Academic Plastic Surgeons (ACAPS) to assess the effect on plastic surgeons.

Methods:

An electronic survey questionnaire was distributed to 532 members of ACAPS. Data on individual and plastic surgery practice demographics, COVID-19 prevention measures, and procedures or services that were being performed or delayed were collected and analyzed.

Results:

An estimated 161 members (30.2%) completed the survey. Changes in hospital policy were cited as the most common reason (89%) for determining which procedures were currently offered. Results vary by specialty. Notably, <10% of respondents who normally offered aesthetic procedures currently offered any procedures during the survey. Subspecialty-specific results and prevention measures when seeing clinic patients are further summarized and discussed.

Conclusions:

Plastic surgeons have seen a drastic decrease in the variety of procedures and services they are allowed to offer during the COVID-19 pandemic. To help plan a return to normalcy, surgeons should create and implement plans to protect patients and staff from coronavirus transmission, assure financial solvency, and consider the effects of delayed surgeries on both the physical and mental health of their patients. In doing so, surgeons and their patients will be better prepared in the event of a resurgence of the virus.
Large Diaphragm Defect Reconstruction Using Reverse Latissimus Dorsi Muscle Flap
Authors: Fukuyama Sotatsu , Okochi Masayuki , Komuro Yuzo , Sakao Yukinori , Sano Keiji
Published: January 2021

Surgical treatment of bronchobiliary fistula (BBF) is difficult. A 47-year-old woman presented with a cough with yellow yielding sputum due to BBF. The patient had the adhesion of the liver, diaphragm, and lung. We performed liver, diaphragm, and lung resections. Patient had a large defect of diaphragm. Diaphragm reconstruction was performed using a pedicled reverse latissimus dorsi muscle flap. No flap necrosis was observed. Seven months after surgery, the patient did not present yellow yielding sputum and the BBF was not observed in the computed tomography. This surgical procedure was useful for treating the diaphragm defect both safely and easily. We believe that the reverse pedicled latissimus dorsi muscle flap is a reliable alternative for large diaphragm reconstruction after severe BBF.
Patient Satisfaction with Medical Tourism: A Review of 460 International Plastic Surgery Patients in Colombia
Authors: Campbell Alex , Restrepo Carolina , Navas Genesis
Published: January 2021

Background:

Cosmetic surgery is at the forefront of an exploding medical tourism industry. Patients are able to research options globally through the internet, and increasing numbers are seeking improved service, quality, and value through surgery overseas. Little work has been done to measure the patient experience when traveling for surgery and, to our knowledge, this is the largest study of its kind to examine patient satisfaction with medical tourism.

Methods:

We retrospectively reviewed patient satisfaction surveys completed by 460 consecutive international patients receiving cosmetic surgery at a private plastic surgery practice in Cartagena, Colombia, between February 2016 and April 2018.

Results:

Overall patient satisfaction was excellent, with 98.2% responding that they would refer us to friends and family. Patient satisfaction ratings across all other items was also very high (range: 97.1%–100%) for information provided, the surgeon, the staff, facilities, and payment.

Conclusions:

Excellent patient satisfaction is possible with medical tourism if the patient perceives and receives value through effective results, a pleasant experience, and favorable costs. These successes in plastic surgery medical tourism highlight the potential for significant continued growth in this sector as a whole.
Velopharyngeal Space Assessment in Patients Undergoing Le Fort 1 Maxillary Advancement
Authors: Saleh Eli , Saleh Joseph , Beauchemin Gabriel , El-Jalbout Ramy , Borsuk Daniel E.
Published: January 2021

Background:

The effects of maxillary advancement on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study was to compare the pre- and post-operative velopharyngeal anatomic configuration modifications as measured on CT scans.

Methods:

This is a retrospective cohort study of 44 patients with and without cleft palate who were treated with maxillary advancement. The pre- and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional CT scan reconstructions.

Results:

For the linear distances measured, a statistically significant difference was found when comparing the pre- and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space (P = 0.001 and 0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas, and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre- and post-operative scans (P < 0.05). Mean changes in the measures did not differ over time (pre- and post-operative) depending on whether there was a prior history of cleft palate repair.

Conclusions:

Although structural modifications of the pharyngeal space are inherent to maxillary advancement, its surface area and volume do not significantly change. The use of 3-dimensional reconstruction using CT scans should be the first choice for evaluation of the upper airway.
Intraoral Approach for a Congenital Teratoma in the Orbit Extending into the Pterygopalatine Fossa
Authors: Tsukamoto Ayumi , Kobayashi Shinji , Yabuki Yuichiro , Yamada Takayuki , Itou Susumu , Tanaka Yukichi , Maegawa Jiro , Satake Toshihiko
Published: January 2021

This article reports an intraoral approach for a congenital mature teratoma in the orbit, extending into the pterygopalatine fossa and the zygoma remodeling due to biological and functional matrix theory during the neonatal period. The operation took place on the 56th postnatal day due to gradual proptosis of the left eye from the socket. The entire orbital tumor could be surgically removed via the inferior orbital fissure, which had been expanded by the pressure of the tumor. This case suggests that orbital tumors expanding into pterygopalatine fossa can be removed by the intraoral approach because the bone of infants is so soft. The eyeball of the patient was temporarily depressed after the operation, but that was improved by tissue remodeling with time. Therefore, it is recommended that reconstructive surgery for an infant should be performed at the age of 12 months or older.
Management of Residual Spitz Nevus in Surgical Specimens following Biopsy and Excision
Authors: Beijnen Usha E. A. , Walsh Landis R. , Nuzzi Laura C. , Schmidt Birgitta A. R. , Labow Brian I. , Taghinia Amir H.
Published: January 2021

Background:

Proper management of Spitz nevi continues to be debated, with treatment ranging from observation to surgery. To better characterize the outcome of surgical procedures performed for incomplete initial excision or biopsy, we sought to ascertain the histopathological presence of residual Spitz nevi in a set of surgical specimens.

Methods:

We retrospectively reviewed 123 records with histologically-confirmed Spitz nevus. Data concerning treatment, clinical features, histopathological margin involvement, and presence of residual lesion on subsequent procedural specimens were collected.

Results:

Fifty-three percent of lesions (n = 65) were initially sampled by shave or punch biopsy, and the remainder (n = 58) were formally excised without initial biopsy. The rates of re-excision for involved margins were: shave biopsy (92.2%), punch biopsy (78.6%), and formal excision (13.8%). In total, 61.0% of patients who underwent an initial procedure of any kind had involved margins, but only half of those re-excised for involved margins (57.6%) had histologically residual lesion on repeated excision. A significantly higher proportion of initial punch biopsies (90.9%) resulted in residual lesion (in secondary excision specimens) when compared with shave biopsy (48.9%) and formal excision (62.5%; P < 0.05).

Conclusions:

Findings suggest that clinicians may consider shave biopsy over punch biopsy for diagnosing suspected lesions, when indicated and appropriate. Given the rarity of malignant transformation and the frequency of residual nevus, observation may be reasonable for managing pediatric patients with histologically-confirmed Spitz nevi, who are post initial biopsy or excision despite known histopathological margin involvement.
A Plastic-neuro Effort: Vascularized Soft-tissue Coverage for Hostile Wound Bed with Multiple Ventricular Shunt Failures
Authors: Meshkin Dean H. , Economides James M. , Dowlati Ehsan , Fan Kenneth L. , McGrail Kevin , Evans Karen K.
Published: January 2021

Cerebral ventricular shunt placements are the most common neurosurgical procedure performed today, which play a life-long role in the care of patients with hydrocephalus. Complication rates requiring shunt replacement are as high as 25%, and the potential need for multiple revisions throughout a patient’s life may result in the formation of scar tissue and compromised wound healing. Without addition of vascularized tissue, patients with scalp scarring and impaired wound healing then enter a cycle of impaired skin closure followed by shunt infection, failure, and revision with little promise of long-term operative or therapeutic success. This plastics-neuro collaboration is the first known report of a free vastus lateralis muscle flap for coverage of a cerebral ventricular shunt, in a patient with congenital hydrocephalus and 17 previous ventricular shunts revisions due to infections and soft tissue exposure from scarring and a hostile wound bed. In the setting of extensive scarring, the free vascularized muscle flap provides soft tissue and vascular supply capable of promoting wound healing, maintaining scalp integrity, and reducing the incidence of shunt infection and the subsequent need for future revision, as supported by the complication-free status of the same patient now 16 months since the date of operation.
Peripheral Neurectomy for Management of Trigeminal Neuralgia Refractory to Multiple Surgical Procedures
Authors: Ferri Francisco , Forleiter Craig M. , Montorfano Lisandro , Konstantinidis Michael , Borghei-Razavi Hamid , Mascaro-Pankova Andres
Published: January 2021

Trigeminal Neuralgia (TN) is defined as a recurrent, unilateral, brief, electric shock-like pain and is associated with a significant deterioration in quality of life due to the debilitating nature of the pain. The first line treatment is medical therapy, and surgical treatment is reserved for patients with inadequate pain control or undesirable side effects. Surgical options for treatment may include microvascular decompression (MVD), stereotactic radiosurgery, percutaneous radiofrequency rhizotomy, and percutaneous balloon compression of trigeminal ganglion. MVD is considered the procedure of choice due to its high efficacy and safety profile; however, it carries a recurrence rate of 1%–5% annually and 15%–35% long term. Although re-operative MVD has been reported for recurrent cases, it carries a high risk of complications due to arachnoid adhesions and distorted anatomy. Peripheral neurectomy is a simple, expeditious, low-risk procedure that is well tolerated by patients and can be done even under local anesthesia. We report a case of a 69-year-old man who presented with a debilitating TN in the V1 and V2 territory refractory to MVD, stereotactic radiosurgery, and percutaneous balloon compression of the trigeminal ganglion, who had been treated with neurectomy of the left supraorbital, supratrochlear, and infraorbital nerves, with an excellent outcome at 6 months follow-up. Peripheral neurectomy is an effective alternative for patients with refractory TN who failed multiple surgical interventions. Previous publications have reported an elevated long-term recurrence rate after this procedure, perhaps due to peripheral nerve regeneration or neuroma formation. It is not yet studied whether using nerve conduits may lead to a decrease in recurrence.
Implications of Pass/Fail Step 1 Scoring: Plastic Surgery Program Director and Applicant Perspective
Authors: Lin Lawrence O. , Makhoul Alan T. , Hackenberger Paige N. , Ganesh Kumar Nishant , Schoenbrunner Anna R. , Pontell Matthew E. , Drolet Brian C. , Janis Jeffrey E.
Published: January 2021

Background:

As early as 2022, United States Medical Licensing Examination Step 1 results will be reported as pass or fail, rather than as 3-digit numeric scores. This survey examines the perspectives of plastic surgery applicants and program directors (PD) regarding this score reporting change.

Methods:

A 24-item survey was distributed to integrated applicants from the 2018–19 and 2019–20 application cycles. An analogous 28-item survey was sent to integrated and independent plastic surgery training program directors. Data were analyzed using summary tables and marginal homogeneity tests.

Results:

164 applicants (33.2%) and 64 PDs (62.1%) completed the survey. Most applicants (60.3%) and PDs (81.0%) were not in favor of the score reporting change. As a result of binary scoring, a majority of respondents anticipate that residency programs will use Step 2 CK scores to screen applicants (applicants: 95.7%, PDs: 82.8%), prioritize students from more prestigious medical schools (applicants: 91.5%, PDs: 52.4%), and that dedicated research time will become more important (applicants: 87.9%, PDs: 45.3%). Most applicants (66.4%) and PDs (53.1%) believe that there will be an increase in plastic surgery applicants. Applicants and PDs anticipate that the top 3 metrics used by programs when deciding to offer an interview will change as a result of binary Step 1 scoring.

Conclusions:

Most plastic surgery applicants and PDs do not support the change in United States Medical Licensing Examination Step 1 scoring to pass or fail. The majority believe that other metrics (such as Step 2 CK scores, research experience, and medical school reputation) will become more important in the application process.
Approach to the Pan-brachial Plexus Injury: Variation in Surgical Strategies among Surgeons
Authors: Lanier Steven T. , Hill J. Ryan , James Aimee S. , Rolf Liz , Brogan David M. , Dy Christopher J.
Published: January 2021

Background:

Treatment of pan-brachial plexus injuries has evolved significantly over the past 2 decades, with refinement and introduction of new surgical techniques, particularly free functional muscle transfer. The extent to which contemporary brachial plexus surgeons utilize various techniques as part of their treatment algorithm for pan-plexus injuries and the rationale underlying these choices remain largely unknown.

Methods:

A case scenario was posed to 12 brachial plexus surgeons during semi-structured qualitative interviews. The case involved a young patient presenting 6 weeks after a pan-plexus injury from a motorcycle accident. Surgeons were asked to formulate a treatment plan. Inductive thematic analysis was used to identify commonalities and variation in approach to treatment.

Results:

For shoulder function, the majority of surgeons would graft from a viable C5 nerve root, if possible, though the chosen target varied. Two-thirds of the surgeons would address elbow flexion with nerve transfers, though half would combine this with a free functional muscle transfer to increase elbow flexion strength. Free functional muscle transfer was the technique of choice to restore finger flexion. Finger extension, intrinsic function, and sensation were not prioritized.

Conclusions:

Our study sheds light on current trends in the approach to pan-plexus injuries in the U.S. and identifies areas of variability that would benefit from future study. The optimal shoulder target and the role for grafting to the MCN for elbow flexion merit further investigation. The role of FFMT plays an increasingly prominent role in treatment algorithms.
Key Areas for Development in Oncoplastic Breast Reconstruction
Authors: Molina Bianca J. , Shelby Rita D. , Janis Jeffrey E.
Published: January 2021

Background:

Oncoplastic breast reconstruction addresses lumpectomy or partial mastectomy defects after breast conserving surgery. A large subset of breast cancer patients may be candidates for oncoplastic partial breast reconstruction, but are likely underserved in the United States due to multiple factors. In this article, the authors provide an understanding of current trends in the literature and an overview of key areas for improvement in the delivery of breast cancer surgical care.

Methods:

A literature search of peer-reviewed articles relating to oncoplastic breast reconstruction was performed. In addition, current US laws relating to breast reconstruction, and communication and content from key surgical societies were reviewed. Key areas of improvement were identified after qualitative review of all sources.

Results:

Thirty-four relevant resources were included. There is a large potential population need for oncoplastic breast reconstruction, but no current accurate estimate of patients undergoing this type of reconstruction. There are a multitude of definitions and algorithms attempting to define and organize oncoplastic breast surgery. Legislative initiatives could be improved to prevent coverage gaps. Coding and billing for oncoplastic surgery is not standardized, which complicates both clinical implementation and research efforts. Collaboration between national societies is needed.

Conclusions:

Oncoplastic partial breast reconstruction is an important part of the total package of care that can be offered to the breast cancer patient. Improvements in legislation, coding, and billing, and unification of national society communications and initiatives can lead to better surgical outcomes for the breast cancer patient.
Managing Neuroma and Phantom Limb Pain in Ontario: The Status of Targeted Muscle Reinnervation
Authors: Létourneau Sasha G. , Hendry J. Michael
Published: January 2021

Background:

Painful neuromas (PN) and phantom limb pain (PLP) are common following amputation and are unreliably treated, which impacts quality of life. Targeted muscle reinnervation (TMR) is a microsurgical technique that repairs the severed proximal nerve end to a redundant motor nerve in the amputated stump. Evidence supports TMR as effective in treating PN and PLP; however, its adoption has been slow. This study aimed to characterize: (1) the populations experiencing post-amputation PN/PLP; (2) current trends in managing PN/PLP; and (3) attitudes toward routine use of TMR to manage PN/PLP.

Methods:

A cross-sectional survey was distributed to all orthopedic surgeons, plastic surgeons, and physiatrists practicing in Ontario, via publicly available emails and specialty associations. Data were collected on demographics, experience with amputation, managing post-amputation pain, and attitudes toward routine use of TMR.

Results:

Sixty-six of 698 eligible participants submitted complete surveys (9.5% response rate). Respondents had a greater experience with surgical management of PN (71% PN versus 10% PLP). However, surgery was considered a 3rd-line option for PN and not an option for PLP in 57% and 59% of respondents, respectively. Thirty participants (45%) were unaware of TMR as an option, and only 8 respondents have currently incorporated TMR into their practice. Many (76%) would be willing to incorporate TMR into their practice as either an immediate or delayed surgical technique.

Conclusions:

Despite its promise in managing post-amputation pain, awareness of TMR as a surgical option is generally poor. Several barriers to the widespread adoption of this technique are defined.
Endoscopic Retrograde Approach for Trigger Finger Release: A Cadaver Study
Authors: Brown Ashley M. , DellaMaggiora Ryan J. , Tsai Eugene Y. , Kulber David A.
Published: January 2021

Trigger finger is one of the most common causes of disability and pain in the hand. Current surgical techniques for trigger finger release fall short in that they are performed blindly with trauma to, or require incision of, the palmar fascia, which can be a source of significant and long-lasting morbidity. Retrograde endoscopic release of the A1 pulley was performed through a single incision at the proximal digital crease in cadaveric specimens. The fingers were then dissected to assess for completeness of release and inspected for injury to nearby structures. Complete release of the A1 pulley was noted in 16 of 16 fingers. No significant injuries to the A2 pulley and flexor tendon were found, and no injuries to the digital nerves or vasculature occurred. The described technique, as demonstrated in cadaveric specimens, is a feasible alternative approach in the treatment of trigger finger. The technique allows complete visualization of A1 pulley release through a single palmar fascia sparing incision.
LigaSure for the Creation of Bloodless Breast Pockets in Patients Undergoing Transaxillary Breast Augmentation
Authors: Kim Min Kuk , Lee Sangdal
Published: January 2021

Background:

The energy-based LigaSure device is widely utilized to facilitate dissection and hemostasis during various open and endoscopic procedures. Previous studies have demonstrated that this device can reduce intraoperative blood loss in various surgical settings. The present study aimed to report our experience with LigaSure and the advantages of using this device during transaxillary submuscular pocket dissection over those of a monopolar electrocautery dissector in patients undergoing breast augmentation.

Methods:

A total of 156 patients who underwent transaxillary breast augmentation between November 2019 and May 2020 were retrospectively reviewed. Submuscular pocket dissection using LigaSure was performed in 92 patients and a conventional technique using a monopolar electrocautery dissector was performed in the remaining 64 patients. A bloodless breast pocket was defined as a clear operating field with little or no blood staining at any stage of the procedure. All endoscopic procedures were recorded to determine whether bloodless pockets had been established. The amount of postoperative drainage at 1 day after surgery was also assessed to compare between the LigaSure and conventional groups.

Results:

Bloodless breast pockets were successfully established in 83 patients (90.2%) in the LigaSure group and in 38 patients (59.4%) in the conventional group (P < 0.001). Postoperative drainage amount at 1 day following surgery was significantly lower in the LigaSure group than in the conventional group (P < 0.001).

Conclusion:

Our findings indicate that the LigaSure system is a safe and effective alternative in breast augmentation requiring transaxillary submuscular dissection.
Thyroid Gland Flap for Minimally Invasive Reconstructive Head and Neck Surgery
Authors: Ogawa Tetsuya , Inukai Daisuke , Okamoto Hiroki , Sano Rui , Yamanaka Syunpei , Tsuzuki Toyonori , Naito Munekazu
Published: January 2021

Background:

Head and neck surgery sometimes causes small defects, and salvage surgery after chemoradiotherapy poses some risk because of damage to the surgical site from the previous treatment. We have developed a novel thyroid gland flap for head and neck surgical reconstruction and here we describe elevating the flap, including arc rotation, size, and suture technique, and our outcomes to date.

Methods:

Thyroid gland flap reconstruction was performed in 13 cases (11 patients) between July 2009 and May 2020. The clinical importance and adverse effects of the procedure were examined. Thyroid function and blood flow of the flap were assessed, and the status of the flap and irradiated recipient tissue was examined histopathologically.

Results:

Median age at surgery was 64.6 years (range 49–77 years). Two of the patients underwent reconstruction with a thyroid gland flap twice. There were 4 cases of primary head and neck cancer resection with neck dissection in which the flap was harvested from the thyroid gland as reinforcement. In 1 case, surgery was performed for cervical esophageal diverticulum. In all cases, the arc was limited to 6 cm and suturing was basic. There were no complications of the surgical procedure, and the postoperative course was uneventful. Contrast-enhanced computed tomography revealed adequate enhancement of the flap. Postoperative thyroid function was normal. The thyroid gland flap was firmly adapted and fused with the irradiated recipient tissue.

Conclusion:

The thyroid gland flap could be an effective tissue flap fed by the superior thyroid arteriovenous pedicle for head and neck reconstruction.
Facial Surgery in the Era of SARS-CoV-2 and Beyond: Challenges, Considerations, and Initiatives
Authors: DiCaro Michael V. , Mintz Joel , Shir Shirzad , Muse Andrew , Richards Joseph , Shah Amita , Farber Scott
Published: January 2021

The SARS-CoV-2 pandemic resulted in the implementation of healthcare practice regulations and restrictions across the United States. To facilitate safe patient management practices for facial plastic and reconstructive surgeons, appropriate guidelines and recommendations should be followed. Guidelines and recommendations should include a synthesis of the best evidence available from public health authorities and respected members in the surgery community. This review contains evidence-based suggestions that prioritize the safety of healthcare professionals and patients to help guide facial and reconstructive surgeons toward safe patient management.
Acute Superficial Vein Thrombosis of the Upper Extremity: A Case Report
Authors: Kwiecien Grzegorz J. , Coombs Demetrius M. , Sinclair Nicholas , Gastman Brian R. , Bassiri Gharb Bahar , Rampazzo Antonio
Published: January 2021

Superficial vein thrombosis has traditionally been considered a disease of the lower extremity. Less frequently it can affect the breast, chest wall, penis, or upper extremity. Cases involving upper extremities are usually associated with intravascular access, and the vast majority remain self-limiting. This case report presents a 63-year-old patient who had acute extensive thrombosis of cephalic and basilic venous systems following resection of a desmoid tumor from the flank. This was likely related to intraoperative positioning and resulted in severe symptoms mimicking deep vein thrombosis and carpal tunnel syndrome. Additionally, diagnostic tools available to the hand surgeon that allow prompt diagnosis, management, and prevention are discussed.
Short-term blood pressure variability, arterial stiffness, and cardiovascular events: results from the Bordeaux cohort
Authors: Cremer Antoine , Doublet Julien , Boulestreau Romain , Gaudissard Julie , Tzourio Christophe , Gosse Philippe
Published: January 2021

Objective:

Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness.

Methods:

Population: Bordeaux cohort of hypertensive patients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15’ day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included.

Results:

In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association.

Conclusion:

Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensive patients, independently of average 24-h BP and arterial stiffness.
Specific Anti-hostility Effects of Atypical Antipsychotics in Persons with Schizophrenia: From Clozapine to Cariprazine
Authors: Citrome Leslie , Volavka Jan
Published: January 2021

Learning objective

After participating in this activity, learners should be better able to:

• Evaluate the anti-hostility effects of available atypical antipsychotic agents

In addition to hallucinations and delusions, persons with schizophrenia may exhibit hostility. In clinical trials of antipsychotics, hostility is routinely measured as part of rating scales such as the Brief Psychiatric Rating Scale or Positive and Negative Syndrome Scale. The availability of the atypical antipsychotic clozapine in 1989 led to the observation that it is possible to have a treatment effect on hostility that is independent of the treatment effect on hallucinations or delusions, and independent of general sedative effects. The data supporting this notion of a specific anti-hostility effect are the most robust for clozapine as the data include specifically designed randomized, controlled clinical trials. A specific anti-hostility effect is also observable to various degrees with most of the other atypical antipsychotics, as evidenced in post hoc analyses of clinical trials originally conducted for regulatory purposes, supplemented by post hoc analyses of large effectiveness trials. The generalizability of these studies, however, may be limited. Participants in these trials were not selected for aggressive and hostile behavior. Some of the studies also excluded patients with substance use disorders. The latter is particularly important because alcohol and substance use are well known to increase risk for hostility and aggression. Nevertheless, the repeated demonstrations of the specificity of an anti-hostility effect (in terms of statistical independence of effects on other positive symptoms and of sedation) are of potential clinical importance.
Mental Illness, Mass Shootings, and the Future of Psychiatric Research into American Gun Violence
Authors: Metzl Jonathan M. , Piemonte Jennifer , McKay Tara
Published: January 2021

This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in isolated “lone wolf” individuals. The destructive motivations must be situated, instead, within larger social structures and cultural scripts. Second, mental health professionals and scholars must carefully scrutinize any apparent correlation of violence with mental illness for evidence of racial bias in the official systems that define, measure, and record psychiatric diagnoses, as well as those that enforce laws and impose criminal justice sanctions. Third, to better understand the role of firearm access in the occurrence and lethality of mass shootings, research should be guided by an overarching framework that incorporates social, cultural, legal, and political, but also psychological, aspects of private gun ownership in the United States. Fourth, effective policies and interventions to reduce the incidence of mass shootings over time—and to prevent serious acts of violence more generally—will require an expanded body of well-funded interdisciplinary research that is informed and implemented through the sustained engagement of researchers with affected communities and other stakeholders in gun violence prevention. Emerging evidence that the coronavirus pandemic has produced a sharp increase both in civilian gun sales and in the social and psychological determinants of injurious behavior adds special urgency to this agenda.
GANGLION CELL–INNER PLEXIFORM LAYER THICKNESS IN EYES WITH NONEXUDATIVE AGE-RELATED MACULAR DEGENERATION OF DIFFERENT DRUSEN SUBTYPES
Authors: Nam Ki Tae , Chung Hyun Woo , Jang Sungmin , Hwang Soon-Young , Kim Seong-Woo , Oh Jaeryung , Yun Cheolmin
Published: January 2021

Purpose:

We sought to investigate the ganglion cell–inner plexiform layer (GCIPL) thickness in eyes with nonexudative age-related macular degeneration.

Methods:

We classified eyes into four categories—pachydrusen, soft drusen, subretinal drusenoid deposit (SDD), and soft drusen with SDD—and compared the baseline mean macular GCIPL thickness according to the Early Treatment Diabetic Retinopathy Study grid and its change between groups.

Results:

We classified 53, 29, 36, and 34 eyes into the four categories, respectively. The mean GCIPL thickness values in the 3-mm area were 82.61 ± 9.54 µm for the pachydrusen group, 79.11 ± 10.26 µm for the soft drusen group, 77.72 ± 6.04 µm for the SDD group, and 71.63 ± 8.69 µm for the soft drusen with SDD group (P < 0.001). The soft drusen with the SDD group showed a greater change in GCIPL thickness (−2.50 ± 0.29 µm/year) in the 3-mm area as compared with the pachydrusen group (−0.18 ± 0.35 µm/year), soft drusen group (−0.55 ± 0.36 µm/year), and SDD group (−0.55 ± 0.37) (all P < 0.001).

Conclusion:

The GCIPL thickness varied according to the type of nonexudative age-related macular degeneration. The thinner baseline GCIPL and its greater change in eyes with soft drusen with SDD may suggest that these eyes are experiencing more prominent neuroretinal degeneration in the central 3-mm area than those in the other groups.
SINGLE INJECTION RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS IN PATIENTS WITH WET AGE-RELATED MACULAR DEGENERATION
Authors: Bilgic Alper , Kodjikian Laurent , Mathis Thibaud , Sudhalkar Aditya A. , Vasavada Shail A. , Bhojwani Deepak M.
Published: January 2021

Purpose:

To determine the incidence of complete resolution of choroidal neovascular membrane-associated exudation with a single antivascular endothelial growth factor injection in treatment-naive wet age-related macular degeneration patients and its associated characteristics.

Methods:

Retrospective, observational study of naive wet age-related macular degeneration patients who received antivascular endothelial growth factor therapy with ranibizumab/aflibercept and demonstrated complete resolution of retinal exudation with a single injection. Complete resolution was defined as the total disappearance of the intraretinal fluid, cysts, and subretinal fluid and a return of retinal thickness to <250 μm on spectral-domain optical coherence tomography. All relevant data were collected. Follow-up was scheduled on Days 1, 7, and 30 postoperatively and then monthly, with at least 9 visits mandatory per year if the macula remained fluid free. Appropriate statistical analyses were performed.

Results:

Sixty-three patients (29 men; mean age 67.25 ± 4.40 years) were identified. The mean baseline and final-corrected distance visual acuity was 20/160 and 20/45, respectively. Patients completed a mean of 10.9 follow-up visits per year. Smaller choroidal neovascular membranes (<200 μm), early presentation, better presenting corrected distance visual acuity, subfoveal choroidal neovascular membranes, absence of blood/fibrosis, and use of aflibercept (2 mg) favored resolution with one injection.

Conclusion:

A subset (13.76%; 63/458, 95% confidence intervals: 10.73–17.25) of patients with treatment-naive wet age-related macular degeneration demonstrates resolution of choroidal neovascular membrane-associated exudation with a single antivascular endothelial growth factor injection, sustained over 2 years or more. This can lower therapy costs, treatments, office visits, and the potential risk of geographic atrophy.
SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGING OF THE CHORIOCAPILLARIS
Authors: Ledesma-Gil Gerardo , Fernández-Avellaneda Pedro , Spaide Richard F.
Published: January 2021

Purpose:

To analyze swept-source optical coherence angiography images acquired at different depths above and below the default location of the Zeiss PLEX Elite 9000.

Methods:

Normal eyes of subjects in their 20s and 30s were evaluated. Angiographic slab images were taken at the default location of 29 µm to 49 µm below the retinal pigment epithelium and 21 µm to 41 µm through 52 µm to 72 µm below in steps. The images were processed using the projection removal function from the device's software. Raw images were evaluated, as were images that underwent a published compensation technique that adjusts for light penetration to the sampled layer.

Results:

Eleven eyes of 11 subjects were evaluated for the uncompensated and the compensated sets with the projection removal function turned off and on. The default location, 29 µm to 49 µm below the retinal pigment epithelium, showed a granular choriocapillaris appearance. This appearance remained in all slabs from each group, differing slightly throughout depth. The projection removal function modified the grayscale values and diminished projection from overlaying retinal vessels. The compensation technique altered the appearance of flow deficits, and the changes induced by it were more evident on the images were the projection removal function was turned on.

Conclusion:

Flow images in swept-source optical coherence angiography of the choriocapillaris from varying levels are similar in appearance, suggesting projection from the choriocapillaris is important in image formation, although layers of vessels in the inner choroid may contribute by various amounts. A model explaining the prominent projection artifacts observed in the choroid with swept-source optical coherence angiography imaging is presented.
THE LONG-TERM EFFECT OF CYSTOTOMY WITH FIBRINOGEN CLOT REMOVAL FOR A CYSTOID MACULAR EDEMA SECONDARY TO IDIOPATHIC MACULAR TELANGIECTASIA TYPE 1: A CASE REPORT
Authors: Maki Hitomi , Imai Hisanori , Yamada Hiroko , Tetsumoto Akira , Hayashida Mayuka , Otsuka Keiko , Miki Akiko , Nakamura Makoto
Published: January 2021

Purpose:

To report the case of a patient with cystoid macular edema secondary to idiopathic macular telangiectasia (MacTel) Type 1, which was successfully treated by cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion.

Methods:

An 80-year-old man was referred to our department because of a visual defect in his right eye. His best-corrected decimal visual acuity was 0.7 (Snellen equivalent, 20/30). A fundus examination revealed clustered temporal juxafoveal microaneurysms and foveal cystoid macular edema. The patient refused to undergo conventional treatments, including direct retinal photocoagulation for microaneurysms, intravitreal anti–vascular endothelial growth factor injection, and intravitreal triamcinolone injection. However, he provided consent to undergo cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion.

Results:

His best-corrected decimal visual acuity was 0.2 (Snellen equivalent, 20/100) just before the surgery. A 27-gauge vitrectomy with internal limiting membrane peeling was performed. Cystotomy was performed during the surgery, and the fibrinogen clot visible in the cystoid cavity was also removed. Cystoid macular edema rapidly disappeared after the surgery. Three years postoperatively, the patient had best-corrected decimal visual acuity of 0.5 (Snellen equivalent, 20/40) at the last medical examination, and the cystoid macular edema had not recurred.

Conclusion:

Cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion could be valid treatment options for cystoid macular edema secondary to MacTel Type 1.