bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning
Authors: Mirsadraee Saeed , Gorog Diana A. , Mahon Ciara F. , Rawal Bhavin , Semple Thomas R. , Nicol Edward D. , Arachchillage Deepa R. J. , Devaraj Anand , Price Susanna , Desai Sujal R. , Ridge Carole A. , Singh Suveer , Padley Simon P. G.
Published: January 2021

OBJECTIVES:

Severe coronavirus disease 2019 is associated with an extensive pneumonitis and frequent coagulopathy. We sought the true prevalence of thrombotic complications in critically ill patients with severe coronavirus disease 2019 on the ICU, with or without extracorporeal membrane oxygenation.

DESIGN:

We undertook a single-center, retrospective analysis of 72 critically ill patients with coronavirus disease 2019-associated acute respiratory distress syndrome admitted to ICU. CT angiography of the thorax, abdomen, and pelvis were performed at admission as per routine institution protocols, with further imaging as clinically indicated. The prevalence of thrombotic complications and the relationship with coagulation parameters, other biomarkers, and survival were evaluated.

SETTING:

Coronavirus disease 2019 ICUs at a specialist cardiorespiratory center.

PATIENTS:

Seventy-two consecutive patients with coronavirus disease 2019 admitted to ICU during the study period (March 19, 2020, to June 23, 2020).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

All but one patient received thromboprophylaxis or therapeutic anticoagulation. Among 72 patients (male:female = 74%; mean age: 52 ± 10; 35 on extracorporeal membrane oxygenation), there were 54 thrombotic complications in 42 patients (58%), comprising 34 pulmonary arterial (47%), 15 peripheral venous (21%), and five (7%) systemic arterial thromboses/end-organ embolic complications. In those with pulmonary arterial thromboses, 93% were identified incidentally on first screening CT with only 7% suspected clinically. Biomarkers of coagulation (e.g., d-dimer, fibrinogen level, and activated partial thromboplastin time) or inflammation (WBC count, C-reactive protein) did not discriminate between patients with or without thrombotic complications. Fifty-one patients (76%) survived to discharge; 17 (24%) patients died. Mortality was significantly greater in patients with detectable thrombus (33% vs 10%; p = 0.022).

CONCLUSIONS:

There is a high prevalence of thrombotic complications, mainly pulmonary, among coronavirus disease 2019 patients admitted to ICU, despite anticoagulation. Detection of thrombus was usually incidental, not predicted by coagulation or inflammatory biomarkers, and associated with increased risk of death. Systematic CT imaging at admission should be considered in all coronavirus disease 2019 patients requiring ICU.
Anterior thalamic nuclei deep brain stimulation inhibits mossy fiber sprouting via 3′,5′-cyclic adenosine monophosphate/protein kinase A signaling pathway in a chronic epileptic monkey model
Authors: Du Ting-Ting , Chen Ying-Chuan , Zhu Guan-Yu , Liu De-Feng , Liu Yu-Ye , Yuan Tian-Shuo , Zhang Xin , Zhang Jian-Guo
Published: January 2021

Background

Anterior thalamic nuclei (ATN) deep brain stimulation (DBS) is an effective method of controlling epilepsy, especially temporal lobe epilepsy. Mossy fiber sprouting (MFS) plays an indispensable role in the pathogenesis and progression of epilepsy, but the effect of ATN-DBS on MFS in the chronic stage of epilepsy and the potential underlying mechanisms are unknown. This study aimed to investigate the effect of ATN-DBS on MFS, as well as potential signaling pathways by a kainic acid (KA)-induced epileptic model.

Methods

Twenty-four rhesus monkeys were randomly assigned to control, epilepsy (EP), EP-sham-DBS, and EP-DBS groups. KA was injected to establish the chronic epileptic model. The left ATN was implanted with a DBS lead and stimulated for 8 weeks. Enzyme-linked immunosorbent assay, Western blotting, and immunofluorescence staining were used to evaluate MFS and levels of potential molecular mediators in the hippocampus. One-way analysis of variance, followed by the Tukey post hoc correction, was used to analyze the statistical significance of differences among multiple groups.

Results

ATN-DBS is found to significantly reduce seizure frequency in the chronic stage of epilepsy. The number of ectopic granule cells was reduced in monkeys that received ATN stimulation (P < 0.0001). Levels of 3′,5′-cyclic adenosine monophosphate (cAMP) and protein kinase A (PKA) in the hippocampus, together with Akt phosphorylation, were noticeably reduced in monkeys that received ATN stimulation (P = 0.0030 and P = 0.0001, respectively). ATN-DBS also significantly reduced MFS scores in the hippocampal dentate gyrus and CA3 sub-regions (all P < 0.0001).

Conclusion

ATN-DBS is shown to down-regulate the cAMP/PKA signaling pathway and Akt phosphorylation and to reduce the number of ectopic granule cells, which may be associated with the reduced MFS in chronic epilepsy. The study provides further insights into the mechanism by which ATN-DBS reduces epileptic seizures.
Risk Factors for Emergency Room and Hospital Care Among Patients With Solid Tumors on Immune Checkpoint Inhibitor Therapy
Authors: Parikh Anish B. , Zhong Xiaobo , Mellgard George , Qin Qian , Patel Vaibhav G. , Wang Bo , Alerasool Parissa , Garcia Philip , Leiter Amanda , Gallagher Emily J. , Clinton Steven , Mortazavi Amir , Monk Paul , Folefac Edmund , Yin Ming , Yang Yuanquan , Galsky Matthew , Oh William K. , Tsao Che-Kai
Published: January 2021

Objectives:

Immune checkpoint inhibitors (ICIs) are being increasingly used across cancer types. Emergency room (ER) and inpatient (IP) care, common in patients with cancer, remain poorly defined in this specific population, and risk factors for such care are unknown.

Methods:

We retrospectively reviewed charts for patients with solid tumors who received >1 ICI dose at 1 of 2 sites from January 1, 2011 to April 28, 2017. Demographics, medical history, cancer diagnosis/therapy/toxicity details, and outcomes were recorded. Descriptive data detailing ER/IP care at the 2 associated hospitals during ICI therapy (from first dose to 3 mo after last dose) were collected. The Fisher exact test and multivariate regression analysis was used to study differences between patients with versus without ER/IP care during ICI treatment.

Results:

Among 345 patients studied, 50% had at least 1 ER visit during ICI treatment and 43% had at least 1 IP admission. Six percent of ER/IP visits eventually required intensive care. A total of 12% of ER/IP visits were associated with suspected or confirmed immune-related adverse events. Predictors of ER care were African-American race (odds ratio [OR]: 3.83, P=0.001), Hispanic ethnicity (OR: 3.12, P=0.007), and coronary artery disease (OR: 2.43, P=0.006). Predictors of IP care were African-American race (OR: 2.38, P=0.024), Hispanic ethnicity (OR: 2.29, P=0.045), chronic kidney disease (OR: 3.89, P=0.006), angiotensin converting enzyme inhibitor/angiotensin receptor blocker medication use (OR: 0.44, P=0.009), and liver metastasis (OR: 2.32, P=0.003).

Conclusions:

Understanding demographic and clinical risk factors for ER/IP care among patients on ICIs can help highlight disparities, prospectively identify high-risk patients, and inform preventive programs aimed at reducing such care.
Multiple Site SBRT in Pediatric, Adolescent, and Young Adult Patients With Recurrent and/or Metastatic Sarcoma
Authors: Parsai Shireen , Sedor Geoffrey , Smile Timothy D. , Scott Jacob , Ochocki Allison , Vassil Nicole , Zahler Stacey , Angelov Lilyana , Chao Samuel T. , Qi Peng , Anderson Peter , Murphy Erin S.
Published: January 2021

Background:

Stereotactic body radiation therapy (SBRT) is increasingly used for patients with recurrent and or metastatic tumors. Sarcomas are generally considered not sensitive to radiotherapy and SBRT may allow for increased biological effectiveness. We report intermediate outcomes and toxicity for pediatric, adolescent, and young adult patients treated with SBRT to sites of recurrent and or metastatic sarcoma

Procedure:

We queried an Institutional Review Board-approved registry of patients treated with SBRT for metastases from pediatric sarcomas. Patients age 29 and below were assessed for local control, survival, and toxicity.

Results:

Thirty-one patients with a total of 88 lesions met eligibility criteria. Median patient age was 17.9 years at treatment. Sixteen patients were treated with SBRT to >1 site of disease. The median dose was 30 Gy in 5 fractions. The median follow-up time was 7.4 months (range: 0.2 to 31.4 mo). Patients were heavily pretreated with systemic therapy. In 57 lesions with >3 months of radiographic follow-up, the 6-month and 12-month local control rates were 88.3%±4.5% and 83.4%±5.5%, respectively. Radiographic local failures were rare (6/57 in-field, 4/57 marginal). Only 1/88 treated lesions was associated with a radiation-related high-grade toxicity; late grade 3 intestinal obstruction in a re-irradiated field while on concurrent therapy (gemcitabine and docetaxel). No acute grade ≥3 toxicity was observed.

Conclusions:

SBRT was well tolerated in the majority of patients with favorable local control outcomes. Additional studies will be required to determine the optimal SBRT dose and fractionation, treatment volume, and appropriate concurrent therapies.
Acute Generalized Exanthematous Pustulosis (AGEP) in 12 Patients Treated for SARS-CoV-2 Positive Pneumonia
Authors: Pezzarossa Enrico , Ungari Marco , Caresana Gioachino , Sagradi Fabio , Cimardi Leonardo , Pan Angelo , Testa Sophie , Aguggini Sergio , Varotti Elena , Tanzi Giulia , Manotti Laura , Ferrero Giuseppina , Gusolfino Marino Daniel , Trombatore Monica ,   for the CreSCO Study Group
Published: January 2021

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading throughout the world. The study describes 12 patients with SARS-CoV-2 pneumonia, who developed an acute erythematous rash with nonfollicular pinhead-sized pustules, without mucosal involvement. The clinical differential diagnosis was viral rash, acute generalized exanthematous pustulosis (AGEP), or multiform erythema. computed tomography with a diagnosis of interstitial pneumonia and a respiratory tract sample positive for SARS-CoV-2 in a reverse transcriptase polymerase chain reaction assay. Patients had signs of respiratory distress and were treated with hydroxychloroquine, darunavir, ritonavir, heparin, ceftriaxone, and azithromycin. Punch biopsies showed subcorneal pustules typical of AGEP. Dermal microvascular injury and thrombosis as described in skin damage by SARS-CoV-2 infection was not observed. The direct immunofluorescence for IgG, IgA, IgM, and C3 was negative in 8 patients investigated. A polymerase chain reaction for RNA SARS-CoV-2 performed on frozen skin was negative in 5 of 6 patients. Most of our patients were treated with systemic corticosteroids. After some days (4–10), the diffuse erythema and pustules had improved. AGEP is classified as a severe cutaneous adverse reaction, provoked by drugs and acute infections. Characteristically, removal of the offending agent leads to spontaneous resolution typically in less than 15 days. The recognition of AGEP is important, in order to avoid confusion with a systemic infection and consequently to avoid incorrect treatment. Cutaneous adverse reactions to drugs are common and are major health problems worldwide causing considerable costs for health care systems. We suggest that in the patients with AGEP during SARS-CoV-2 pneumonia, viral infection is a risk factor for developing drug reaction.
Tapentadol versus oxycodone analgesia and side effects after laparoscopic hysterectomy
Authors: Comelon Marlin , Raeder Johan , Drægni Tomas , Lieng Marit , Lenz Harald
Published: January 2021

BACKGROUND

Tapentadol is an opioid, which acts as a μ-opioid receptor agonist and inhibits noradrenaline reuptake in the central nervous system. This dual mechanism of action results in synergistic analgesic effects and potentially less side effects. This has been shown in treatment of chronic pain but postoperative studies are sparse.

OBJECTIVES

The main aim was to compare the analgesic effect of tapentadol with oxycodone after laparoscopic hysterectomy. Opioid side effects were recorded as secondary outcomes.

DESIGN

Randomised, blinded trial.

SETTING

Single-centre, Oslo University Hospital, Norway, December 2017 to February 2019.

PATIENTS

Eighty-six opioid-naïve American Society of Anesthesiologists physical status 1 to 3 women undergoing laparoscopic hysterectomy for nonmalignant conditions.

INTERVENTION

The patients received either oral tapentadol (group T) or oxycodone (group O) as part of multimodal pain treatment. Extended-release study medicine was administered 1 h preoperatively and after 12 h. Immediate-release study medicine was used as rescue analgesia.

MAIN OUTCOME MEASURES

Pain scores, opioid consumption and opioid-induced side effects were evaluated during the first 24 h after surgery.

RESULTS

The groups scored similarly for pain at rest using a numerical rating scale (NRS) 1 h postoperatively (group T 4.4, 95% CI, 3.8 to 5.0, group O 4.6, 95% CI, 3.8 to 5.3). No statistically significant differences were found between the groups for NRS at rest or while coughing during the 24-h follow-up period (P = 0.857 and P = 0.973). Mean dose of oral rescue medicine was similar for the groups (P = 0.914). Group T had significantly lower odds for nausea at 2 and 3 h postoperatively (P = 0.040, P = 0.020) and less need for antiemetics than group O. No differences were found for respiratory depression, vomiting, dizziness, pruritus, headache or sedation.

CONCLUSION

We found tapentadol to be similar in analgesic efficacy to oxycodone during the first 24 h after hysterectomy, but with significantly less nausea.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03314792.
Prevention of preterm birth in multiples
Authors: Dom Aaron M. , Mather Andrew , Seligman Neil S.
Published: January 2021

Purpose of review

Multifetal pregnancy carries increased risk of preterm delivery, and consensus on management options to prevent early birth in this population has not been reached. This review serves to summarize the most contemporary findings on this controversial topic.

Recent findings

Examination-indicated cerclage is effective in reducing preterm birth in twin pregnancies, whereas cerclages for other indications are less convincing. Cervical pessary may be beneficial for patients with a short cervix and in those who have had threatened preterm labor. Progesterone supplementation for multifetal gestation alone is not beneficial, but it can be considered in those with a history of prior singleton preterm birth.

Interventions for preterm birth prevention in multiple gestations remain under investigation, and further data is required in order to reach consensus for this high-risk population.
A Simple Bedside Technique for Quantifying Volumetric Defects Prior to Hydroxyapatite Cranioplasty
Authors: Cubitt Jonathan , Liang Derek , Chang Ling-Yun , Fowler Adam , Cooper Michael , Marucci Damian
Published: January 2021

Contour irregularities following pediatric craniofacial surgery are common. Hydroxyapatite cranioplasty is a successful technique for optimizing the aesthetic outcome in these patients. We describe a simple technique that can be carried out at the bedside to calculate the volume of hydroxyapatite needed and therefore optimize the preoperative planning for hydroxyapatite cranioplasty.
Breast Implant–associated Anaplastic Large Cell Lymphoma in Colombia: Report of a Multidisciplinary National Registry
Authors: Ossa Gomez Carlos Andres , Robledo Abad Jose Fernando , Duque Alejandro , Huertas Ramiro , Fidalgo Ana Maria , Rivas Taffur Giovanna , Caicedo Mallarino Jose Joaquin , Torres Fabio , Mantilla Duran William Armando , Abello Virginia , Miranda Roberto N. , Echeverri Carolina , Clemens Mark Warren
Published: January 2021

Background:

An estimated 43,390 breast augmentation surgeries (86,780 implants) and 1486 breast implant reconstructions are performed annually in Colombia, representing the second-most breast surgery destination in South America, the fourth in the western hemisphere, and the fifth country worldwide. No previous reports have evaluated the incidence of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) epidemiology or outcomes in a Hispanic population. Published data on the incidence of this disease in Colombia are unknown; therefore, a National Joint Multidisciplinary Committee was developed between the Colombian scientific societies of Mastology, Plastic Surgery, Hemato-Oncology, and the Invima (The National Food and Drug Surveillance Institute) to track national cases of BIA-ALCL.

Materials and Methods:

We performed a retrospective review (survey-based study) of historical cases since 2011–2019, and a prospective collection of all patients with a confirmed World Health Organization diagnosis of BIA-ALCL identified in a newly established National Registry of BIA-ALCL. The trial was approved by Institutional Review Board (IRB).

Results:

Eighteen cases of BIA-ALCL were identified in Colombia between 2011 and 2019. Hundred percent developed as sequelae of textured implants. Six patients (33.3%) presented either a peri-implant capsule mass or axillary lymph node involvement. Seven (38.9%) required adjuvant chemotherapy most commonly with CHOP regimen. Different brands of implants were associated with our cases. One death (5.6%) was attributed to BIA-ALCL, and one (5.6%) case displayed with relapsed with bone marrow involvement requiring a bone marrow transplantation. Six cases (33.3%) were identified with advanced stage (IIB-IV). Disease-free survival of 92.3% was achieved at 30.8-month follow-up.

Conclusions:

Colombia has one of the highest volumes of breast surgery and use of textured surface breast implants in the world. This study is the initial report of an implant registry in South America. A high proportion of advanced disease may be a consequence of delayed presentation, lack of disease awareness, and timely access to tertiary cancer centers for diagnosis and treatment. Brands other than Allergan and Mentor were found to be associated with BIA-ALCL in our study.
Dissecting Cellulitis of the Scalp: A Review and Case Studies of Surgical Reconstruction
Authors: Cuellar Trajan A. , Roh Daniel S. , Sampson Christian E.
Published: January 2021

Background:

Dissecting cellulitis of the scalp (DCS) is a part of the follicular occlusion tetrad (hidradenitis, acne conglobata, and pilonidal disease). It is a spectrum disorder that can be severe and refractory to medical management. The authors describe 3 such cases successfully treated with surgical resection and reconstruction and present a scoring system for timely referral of such patients to a reconstructive surgical team.

Methods:

A literature review of all available cases of DCS was undertaken, and the treatments and outcomes were reviewed. Our institution has had 3 recent cases that demonstrated delayed presentation common in the severe spectrum of this condition. All underwent radical surgical resection and reconstruction with skin grafting that was very positively received by all the patients.

Results:

Three cases of DCS were treated with radical scalpectomy, and split-thickness skin grafting was done with a good cosmetic outcome and a high degree of subjective patient satisfaction. All would have received timely referral if the presented scoring system had been applied earlier.

Conclusions:

DCS is a rare but debilitating condition that may progress to a medically refractory condition requiring surgical intervention. Surgical resection and skin grafting offer a durable cure, but delayed presentations are common. Use of a scoring system may reduce the time to surgical referral for refractory cases.
Panniculectomy: Practical Pearls and Pitfalls
Authors: Janis Jeffrey E. , Jefferson Ryan C. , Kraft Casey T.
Published: January 2021

Panniculectomy is an increasingly common operation, given the current obesity epidemic and the increasing prevalence of bariatric surgery. At first glance, it could be considered a technically simple operation; however, this procedure can be fraught with complications, given the patient population and high demands placed on compromised abdominal tissue. Sufficient attention must be given to the nuances of patient optimization and surgical planning to maximize safe and ideal outcomes. We highlight our practical tips when performing standard or massive panniculectomy for preoperative optimization, intraoperative techniques, and postoperative management to reduce complication and maximize outcomes of this procedure from a surgeon’s and a patient’s perspective.
A New Triangular Rotation and Advancement Pulp Flap for Lateral Oblique Fingertip Defect
Authors: Zhou Jian-Long , Zhao Qian , Zhang You-Lai , Sun Yu-Wen , Zhao De-Hua , Li Yue-Hong , Xu Lei
Published: January 2021

Background:

The fingertip is one of the most common sites of traumatic injuries faced by hand surgeons. In cases of lateral oblique amputation, only limited alternatives are available for reconstruction. This study introduced a new method involving rotation and use of an advancement pulp flap for covering lateral oblique defect and evaluated its outcome.

Method:

A series of 12 patients with 14 lateral oblique fingertip defects were recruited in this study. All fingertips were unreplantable and were injured distal to the proximal one-third of nail bed, with phalanx exposed. All cases received surgical reconstruction using a triangular rotation and advancement pulp flap. Static 2-point discrimination, cold intolerance, pain, hypersensitivity, range of motion, and aesthetic satisfaction were evaluated 6 months to 12 months postoperation.

Result:

Bone defect was noted in 7 cases. The area of defect was 10×7–20×12 mm2, and the angle of defect was 30–60 degrees. Mean follow-up was 14.3 months. No hook nail deformity, cold intolerance, and hypersensitivity were observed. One patient complained about pain postoperation, demanding a second operation. Static 2-point discrimination was between 5 and 8 mm in all cases. Range of motion of distal interphalangeal joint recovered to 20–45 degrees at the last follow-up. No stiffness was observed in the interphalangeal or metacarpophalangeal joints. All patients were satisfied with the appearance of the flap.

Conclusion:

The triangular rotation and advancement pulp flap is simple, safe, and reliable for treating lateral oblique defect of fingertip, providing scope for anatomical reconstruction and fair sensation and aesthetic recovery.
Chemotherapy-induced Nasopharyngeal Stenosis Treated with Bilateral Facial Artery Musculomucosal Flaps
Authors: Nishimon Mari , Ochiai Hiroko , Watanabe Shiho , Hirata Eri , Oka Aiko , Yazawa Masaki , Kishi Kazuo
Published: January 2021

We report the first case of a 50-year-old woman who developed nasopharyngeal stenosis (NPS) after chemotherapy for malignant lymphoma. The chemotherapy was effective, but NPS developed following treatment. The tumors of the pharynx and soft palate became necrotic and turned into scar tissue, which caused NPS, especially in the caudal part of the soft palate. The patient developed nasal obstruction and obstructive sleep apnea due to the stenosis. The patient underwent 2 surgeries to resolve the NPS: the first was a simple incision of the stenosis, and the second was Z-plasty and mucous membrane transplantation from the posterior pharyngeal wall. However, the NPS recurred soon after these 2 surgeries. We used bilateral inferior-based facial artery musculomucosal (FAMM) flaps as a solution for recurrent NPS, and it was effective in preventing further stenosis. The blood supply to the flaps was stable, and the size of the flaps was enough to compensate for the area of tissue deficit. The use of bilateral FAMM flaps allowed both sides of the NPS to be corrected, and the flaps provided sufficient retracting strength to keep expanding the nasopharyngeal space by pulling from both sides. After the operation, nasal obstruction was decreased, and the sleep quality of the patient improved significantly. The velopharyngeal function was maintained, and there was no symptom of nasopharyngeal insufficiency. Our results suggest that the bilateral FAMM flap is a suitable method to rescue intractable cases of NPS.
New Validated Method for Measuring Fat Graft Retention in the Breast with MRI
Authors: Herly Mikkel , Ørholt Mathias , Müller Felix Christoph , Hemmingsen Mathilde N. , Hansen Joachim , Larsen Andreas , Rasmussen Bo S. , Elberg Jens J. , von Buchwald Christian , Drzewiecki Krzysztof T. , Vester-Glowinski Peter V.
Published: January 2021

In this study, we present a new method for measuring fat graft volume retention in the breast based on magnetic resonance imaging scans and a validation study to assess its accuracy and precision. The method was validated by 4 observers using the magnetic resonance imaging scans of 14 patients undergoing breast augmentation with fat grafting. The method was translated into software and was used to measure the change in breast volume from a preoperative scan to a postoperative scan recorded within 3 hours after the surgery, which was compared with the injected fat graft volume. The new method measured the injected fat graft volumes with an average systematic overestimation of 6.3% (SD, 10.5). The median interobserver variation was <7%. We propose that this new method can be a good alternative to previous techniques for clinical research purposes. The software can be made available upon request free of charge for use on the MeVisLab platform.
A Strategic Approach to Nipple-sparing Mastectomy Reconstruction with a Wide-based Inframammary Fold Flap
Authors: Parus Anamaria , Venturi Mark L.
Published: January 2021

The single biggest advancement in the aesthetic outcome of breast reconstruction following mastectomy has been the contribution of nipple-sparing mastectomy. By preserving the nipple–areolar complex, patients do not experience the same sense of loss that is observed in the setting of skin-sparing mastectomy. Despite this significant contribution, the challenge remains as to how surgeons can extend this option to larger-breasted patients or patients with significant breast ptosis. Several strategies have been described, including reduction mammoplasty before mastectomy, bipedicled simultaneous mastopexy with mastectomy, and free nipple grafting. The authors have developed a novel approach to nipple-sparing mastectomy that preserves the nipple–areolar complex on a wide-based inframammary fold (IMF) flap and uses indocyanine green perfusion imaging to successfully and reliably perform nipple-sparing mastectomy with immediate reconstruction in larger-breasted ptotic patients. Six patients underwent bilateral nipple-sparing mastectomies and immediate breast reconstruction with a wide-based IMF flap. All patients underwent immediate reconstruction with prepectoral placement of tissue expanders to treat either breast cancer or ductal carcinoma in situ (DCIS), and all patients successfully completed exchange of expander to implant. There were no complications with infection, seroma, mastectomy flap, or nipple necrosis. Aesthetic results were in line with other nipple-sparing techniques. The wide-based IMF flap with nipple preservation is a viable option for larger-breasted ptotic patients who might not otherwise be candidates for nipple-sparing mastectomy. The approach described is a combination of surgical technique and indocyanine green perfusion technology to deliver reproducible results, with an emphasis on surgical safety and avoidance of complications.
Crowdsourcing the Ideal Nipple-Areolar Complex Position for Chest Masculinization Surgery
Authors: Cohen Wess A. , Maisner Rose S. , Hazim Nemesis , Ayyala Haripriya S. , Keith Jonathan D.
Published: January 2021

Background:

Chest masculinization surgery is increasing in prevalence. However, the ideal location of the nipple-areolar complex (NAC) is unknown. Our purpose was to determine the most aesthetically favorable male NAC position for use in chest masculinization through crowdsourcing.

Methods:

Using Adobe Photoshop CC 2017, 8 locations for the NAC were created based on previous literature descriptions. Amazon Mechanical Turk was utilized as a crowdsourcing interface—respondents were asked to rank the top 3 most favorable and least favorable images. Analysis of variance with subsequent Tukey HSD was used for a statistical comparison of favorability scores for different NAC localizations. Values were considered significant with P < 0.05.

Results:

Eight hundred nineteen respondents participated in the survey. NAC positions of Images C (mean score = 1.9222) and A (mean score = 1.7365) received higher favorability scores than those of Images D, E, F, G, and H (all P < 0.05). There were no significant differences between Images C and A (C versus A: P = 0.6412). NAC localizations from Images G (mean score = −2.0353) and H (mean score = −1.6908) received lower favorability scores than Images A, B, C, D, E, and F (all P < 0.05). There were no significant differences between Images G and H (P = 0.2279).

Conclusions:

Most respondents preferred Images C and A, and few favored Images G and H, suggesting that lateral NAC placement is favored over more medial localizations. Additionally, both Images C and A utilize relatively inferior NAC placements. Therefore, we recommend a location inferior and lateral to the NAC. Ultimately, NAC localization during chest masculinization will be the result of shared decision-making between the patient and the surgeon to fulfill each patient’s aesthetic goals.
The Perception of the Ideal Body Contouring in Mexico
Authors: Pérez Chávez Francisco , Flores González Emmanuel Armando , Ramírez Guerrero Oliver René , Gracida Mancilla Noé Isaías , Pérez Estrada Ulises
Published: January 2021

Background:

Over the centuries, our appreciation of beauty has changed, as has the social environment that influences our perspective. Currently we are trying to use measurable instruments to achieve a better aesthetic result in each patient, using as a reference the “golden ratio,” which is found in harmonies of all kinds—in art, nature, architecture, and today, in medicine—to aspire to the ideal proportion.

Methods:

We conducted a survey in which we showed participants 4 digitally modified images of a model with different body proportions, 1 with the golden ratio and 3 with other variable proportions. In total, 900 people were surveyed, of which 131 had attended cosmetic surgery consultation, and 769 respondents were recruited on our social networks.

Results:

Of the 900 respondents, 607 were women and 293 were men. Fifty-nine percent of the surveyed women chose image C (shown in Fig. 3) and similarly, so did 59.4% of surveyed men, which was not statistically significant; however, when considering age, we found the groups of 21–30, 31–40, and 41–50 chose image C at 46%, 65%, and 67%, respectively, whereas 44% of those over 51 years preferred image B, which is statistically significant.

Conclusions:

The image whose waist–hip harmony meets the golden ratio (1.61) is most often chosen as “the most beautiful,” by both men and women. It is also the preferred image for all age groups under 50.
Alveolar Bone Graft Stabilization with Custom Maxillary Splints
Authors: Kim Erinn N. , Graham Emily M. , Tuncer Fatma B. , Yamashiro Duane K. , Siddiqi Faizi A. , Gociman Barbu R.
Published: January 2021

For secondary alveolar bone grafting in cleft patients, the success of bone graft take is dependent upon creating an ideal environment for both bony and soft tissue healing. This is particularly challenging in patients with existing fistulas, wide clefts, and bilateral alveolar clefts, where large soft tissue mobilization is required to get a tensionless repair, and micro-motion around the bone graft is significantly higher. Herein we describe our method for manufacture and placement of a custom postoperative maxillary splint following secondary alveolar bone grafting. Our splint encompasses the palate and alveolus to stabilize the maxillary arch and protect the incision lines during healing. We find our splint to be a useful adjunct to facilitate postoperative healing following secondary alveolar bone grafting.
Hyaluronic Acid-based Filler Injection: Late-onset Thrombosis of the Frontal Vein
Authors: Gabrielpillai Jennis , Salamat Arash , Schaefer Christian , Kania Alexander , Lunatschek Christian , Eichhorn Klaus Wolfgang , Bootz Friedrich , Send Thorsten
Published: January 2021

Thrombosis is a serious complication of a hyaluronic acid-based filler injection. Little is known about the late-onset complications of fillers; therefore, an optimal complication management is necessary. In this case report, we describe a rare complication of thrombosis after a filler injection. A 35-year old woman was admitted to the emergency department, with swelling on her forehead in association with recurrent pain and light flashes in her right eye. Sonographic examination showed a thrombosis of the right frontal vein. The patient reported that a hyaluronic acid filler injection had been administered on the forehead 3 months ago. After several weeks of anticoagulation with heparin and apixaban, the symptoms persisted. The vein with thrombosis was ultimately resected under local anesthesia. Histological findings showed a chronic inflammatory reaction of the tissue to hyaluronic acid. Vascular complications may appear as late-onset complications even several months after the filler injection. Subcutaneous application of low molecular weight heparins is the therapy of first choice. If this treatment is not effective, resection of the thrombosis may be performed.
Lateral Pectoralis Major Muscle Flap for Axillary Defect Obliteration
Authors: Wheeler Chad K. , Sousa Janelle D. , Moline Stephanie R. , Fletcher Derek R. , Williams Emily A. , Pannucci Christopher J.
Published: January 2021

This article describes the use of a lateral pectoralis major muscle flap for preemptive obliteration of axillary defects in breast cancer patients having reconstructive surgery. The muscle flap is based on a consistent lateral branch of the pectoral component of the thoracoacromial system. The flap is useful to improve axillary contour after sentinel lymph node biopsy or axillary lymph node dissection, and to cover lymphovenous anastomoses.
Latissimus Dorsi-lumbar Artery Perforator Chimeric Flap with Intra-flap Crossover Anastomosis for Breast Reconstruction
Authors: Otani Naoya , Tashima Hiroki , Tomita Koichi , Kurita Tomoyuki , Kubo Tateki
Published: January 2021

Latissimus dorsi (LD) flaps are widely used in breast reconstruction for their ease of use and minimal sacrifice of the donor site. Various strategies to increase flap volume have been suggested, but tissue volume is often insufficient for patients with little subcutaneous fat. While lumbar artery perforator (LAP) flaps are advantageous for thin patients because they allow for the addition of a large amount of fat, the vascular pedicle is short and vascular grafts are often required. To address these shortcomings, we propose here a LD-LAP chimeric flap. Specifically, the LD flap and LAP flap are elevated as one piece, and the 6th or 7th intercostal artery perforators and lumbar artery perforators, which are harvested together with the flap, are connected via intra-flap crossover anastomosis. Anastomosis for both intercostal artery perforators and lumbar artery perforators was performed about 1 cm away from the flap. Indocyanine green angiography performed after anastomosis showed improved blood flow to the LAP flap portion of the chimeric flap. The chimeric flap was used in 4 patients, with a mean flap volume of 460 ml (range, 300–690 ml) and mean duration of 439 minutes (393–484 minutes) for reconstruction surgery. During the mean follow-up period of 29.5 months (range, 16–40 months), sufficient tissue volume was obtained and none of the patients developed flap necrosis. Although our method requires vascular anastomosis and may extend operative time, it substantially increases LD flap volume and thus is likely to be an effective auxiliary component to breast reconstruction using LD flaps.
Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap
Authors: De Santis Giorgio , Mattioli Francesco , Pinelli Massimo , Martone Andrea , Starnoni Marta , Fermi Matteo , Presutti Livio
Published: January 2021

Tongue cancer is the most common malignant neoplasm of the oral cavity. Occurrence in the tip of the tongue (TOT) is rare. We describe a case report of a TOT tumor excision and reconstruction with a prelaminated fasciomucosal radial forearm free flap. A 41-year-old white man was referred to our department for a squamous cell carcinoma of the tip of the tongue. The patient worked as an air traffic control official; therefore, conservation of speech intelligibility, both in Italian and English language, was of paramount importance. A transoral excision of TOT, bilateral selective neck dissection, and reconstruction with prelaminated fasciomucosal radial forearm free flap were performed. Adjuvant radiotherapy was necessary. The patient was completely re-established as an air traffic control officer. Successful tongue reconstruction of smaller defects depends on thinness, pliability of flap, and conservation of tongue mobility. Surgical options for TOT reconstruction are facial artery muscolomucosa flap, Zhao flap, radial forearm free flap, or primary suture. In the authors’ opinion, a fasciomucosal prelaminated RFFF offers a series of advantages for TOT reconstruction. The absence of subcutaneous tissue makes the PFRFFF much thinner than fascio-cutaneous flaps. Compared with mucosal loco-regional flaps, prelaminated flaps allow the preservation of oral mucosa lining while providing adequate bulk and reduced scar formation for optimal func- tional recovery. In our case report, the fasciomucosal flap allowed an adequate reconstruction of TOT volume with good functional and aesthetic outcomes. The flap’s added bulk and its minimal scar retraction granted free tongue movement and optimal speech intelligibility.
The Use of Multispectral Imaging in DIEP Free Flap Perforator Selection: A Case Study
Authors: Rammos Charalambos K. , Jones Glyn E. , Taege Sara M. , Lemaster Chelsey M.
Published: January 2021

Perforator selection is of paramount importance when performing a Deep Inferior Epigastric Perforator flap. Technological advancements within imaging modalities have proved invaluable in preoperative planning and intraoperative assessment. Computed tomographic angiography remains the gold standard for preoperative perforator mapping, while color ultrasound Doppler is considered more reliable for determining vessel caliber. Intraoperatively, an imaging modality that provides sequential, real-time assessment of various perforators’ supply to the flap would provide helpful insight to determine which perforator will optimize flap viability, especially of the most distal, lateral margins. Multispectral imaging, a variant of near infrared imaging, has emerged as an alternative method to assess tissue viability in the operating room as well as postoperatively. Unlike Spy technology, which is invasive and cost ineffective, the SnapshotNIR (KD203) is a handheld multispectral imaging device utilizing NIR to measure the oxygenation of the hemoglobin in the area to calculate the tissue oxygen content (StO2) displayed in a color image. The following case of a 46-year-old woman undergoing tertiary breast reconstruction for treatment of progressive grade 2 capsular contracture illustrates the utility and ease of KD203 application to intra-operative perforator determination in deep inferior epigastric perforator flap assessment.
Complicated Replanted Finger, 34 Years after Revascularization
Authors: Vanmierlo Bert , Vanmierlo Tim , Goubau Jean
Published: January 2021

Merely a few reports of late failure (later than the 7th postoperative day) of a digital replantation can be found in the literature. Discussions of the factors that might cause a late failure are concise. To our knowledge, there are no reports of failure in literature as late as the case we are presenting. An 87-year-old white man was diagnosed with acute complications of a digital replantation, 34 years after initial surgery. Ultrasound examination and an arteriography demonstrated occlusion of the arterial anastomosis. The patient’s surgical file revealed scars of former replantation surgery of both the index and the middle finger. In the latter, 1 artery and 2 veins were anastomosed. Considering the age and comorbidities of the patient, revascularization of the finger was not performed. Local wound care and analgesic drugs were prescribed. After initial deterioration and ulceration, gradual improvement was noticed. Total wound healing occurred at 3 months after the initial consultation. Compared with free flap surgery in general, finger replantations are at a higher risk of late complications because digital neovascularization is directly correlated to the contact surface area. This contact surface is usually larger in other free flaps. Furthermore, diseases that deteriorate circulation most likely affect the short- and the long-term survival of a digital replantation. From this point of view, performing both volar digital arterial anastomoses, whenever possible, might reduce early as well as late failure in replantation surgery.
A Novel Customized 3D Printed Arm Stand Improving Skin Preparation Efficiency in Hand Surgery
Authors: Papavasiliou Theodora , Chatzimichail Stelios , Kolaityte Valdone , Manou Vasiliki , Filson Simon
Published: January 2021

Patient preparation for hand surgery often necessitates skin preparation via the use of an assistant to hold the arm to be operated on in mid-air while disinfectant is applied. This study introduces a three-dimensional printed arm stand that decreases dead time during skin preparation, while also enabling the more efficient use of an assistant. The arm stand devices were customized on the anatomy of the patients and then successfully used on patients having general or regional anesthesia. A practical, reusable, and effective three-dimensional printed arm stand has been developed and applied on both adult and pediatric patients. We have found the bespoke device to be beneficial in terms of reducing theater dead time and overall costs, while increasing the efficiency of an upper limb operating theater list. The rapid prototyping cycle afforded by 3D printing renders this technology a valuable tool for developing medical devices with patient-precise dimensions.
Simultaneous Opposition Tendon Transfer with Median Nerve Decompression for Severe Bilateral Carpal Tunnel Syndrome in Adolescents with Hunter Syndrome: A Case Report
Authors: Uemura Takuya , Okada Mitsuhiro , Terai Hidetomi , Yokoi Takuya , Onode Ema , Shintani Kosuke , Konishi Sadahiko , Nakamura Hiroaki
Published: January 2021

Although carpal tunnel syndrome (CTS) is exceedingly rare in children, its prevalence in those with Hunter syndrome, mucopolysaccharidosis type II, is high. With the advent of hematopoietic stem cell transplantation and enzyme replacement therapy, the survival of patients with Hunter syndrome has dramatically improved. With improved longevity in these patients, CTS continues to progress with age. However, most patients with Hunter syndrome with CTS have generally been treated with an open carpal tunnel release (OCTR) only, without considering the severity. Here, we present a mid-term follow-up of a 16-year-old patient with Hunter syndrome associated with severe bilateral CTS successfully treated by the simultaneous opposition tendon transfer with an OCTR to improve the thumb function. Intraoperatively, the median nerve was constricted and flattened with congestion by the transverse carpal ligament. External and internal neurolysis of the scarred median nerve were performed and found epineural fibrosis and tethered epineurium. An intraneural lipoma of the left median nerve was especially resected with epineurotomy. During neurolysis and tendon transfer, the soft tissue was very viscous, a characteristic of mucopolysaccharidoses. Transferring the tension of the palmaris longus tendon to the abductor pollicis brevis for the thumb palmar abduction should be stronger than routine adult patients because the soft tissue such as the tendon excursion is stickier and more contracted in patients with Hunter syndrome. Postoperatively, a thumb spica splint was applied for 3 weeks, and then active motion exercises were cautiously started to prevent joint contracture. Early recognition and surgical intervention for CTS are essential in patients with Hunter syndrome.
Pathology Examination of Breast Reduction Specimens: Dispelling the Myth
Authors: Fisher Mark , Burshtein Aaron L. , Burshtein Joshua G. , Manolas Panagiotis , Glasberg Scot B.
Published: January 2021

Background:

More than 100,000 reduction mammaplasties are performed in the United States each year. There is large variance in reported incidence of cancerous/high-risk lesions, ranging from 0.06% to 4.6%. There has been debate whether histological review of breast reduction specimen is necessary. This study aimed to determine the incidence of cancerous/high-risk lesions and to evaluate risk factors for their occurrence.

Methods:

A retrospective review was conducted for all patients who underwent reduction mammaplasty in 2018 by the senior author. Variables collected included demographics, comorbidities, history of breast surgery, family/personal history of breast cancer, weight of specimen, and pathologic findings. All specimens underwent pathologic evaluation and categorized as benign, proliferative, or malignant.

Results

A total of 155 patients underwent 310 reduction mammaplasties. Pathologic evaluations found that 11 patients (7.1%) had positive findings, 9 (5.8%) had proliferative lesions, and 2 (1.29%) had cancerous lesions. Patients with pathology were older (P = 0.038), had a family history of breast cancer (P = 0.026), and had a greater weight of resected tissue (P = 0.005). Multivariable analysis showed family history of breast cancer (P = 0.001), prior breast surgery (P = 0.026), and greater weight of resected breast tissue (P = 0.008) had a higher likelihood of positive pathology.

Conclusions:

These findings demonstrate an incidence of positive pathology higher than that reported and illustrate the importance of histologic review of breast reduction specimens. Family history of breast cancer, prior breast surgery, and a greater weight of resected tissue increase risk for proliferative/cancerous lesions.
Practical Management of Pilonidal Disease
Authors: Kraft Casey T. , Khansa Ibrahim , Janis Jeffrey E.
Published: January 2021

Pilonidal disease is a common problem across the globe, with a wide variety of options for management, ranging from healing by secondary intention to flap closure. As new techniques have been introduced, the ideal method to reduce complications and limit recurrence has become unclear. In this review, we highlight the most common methods used to treat pilonidal disease, as well as the senior author’s preferred technique for management. Ideally, surgeons are able to choose the optimal procedure for each patient and maximize outcomes with minimal patient care burden and morbidity.