bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of Intrapelvic Defects Using the Free Anterolateral Thigh Flap
Authors: Wong Alvin , Sbitany Hani 
Published: November 2019

BackgroundReconstruction of intrapelvic soft tissue defects traditionally relies on regional pedicled myocutaneous flaps. However, there remain situations in which local options are unavailable. We review our experience treating intrapelvic defects with the anterolateral thigh (ALT) microvascular free flap.MethodsA retrospective, institutional review was conducted from 2014 to 2018 of patients undergoing microvascular ALT flap reconstruction of intrapelvic defects. Four patients were identified in this cohort out of 92 total pelvic reconstruction cases.ResultsAll patients underwent abdominoperineal resection (APR) for rectal cancer treatment. In the two male patients, pelvic abscesses and bladder leak necessitated soft tissue reconstruction after radiation and APR. In both, regional tissue options were unavailable, and a buried ALT free flap was used for soft tissue reconstruction. Both female patients developed rectovaginal fistulas secondary to their tumor burden, necessitating posterior vaginal wall resections. Prior surgical scars and ostomies made abdominal wall tissue unavailable; thus, free ALTs were used to eliminate intrapelvic dead space and reconstruct the posterior vaginal wall. In all cases, recipient vessels were the deep inferior epigastric artery and vein. Flap survival was 100%.ConclusionsPelvic reconstruction has traditionally been addressed with local/regional pedicled flaps. In cases where these are unavailable, the free ALT flap is a versatile option when buried for intrapelvic reconstruction or posterior vaginal wall lining. We also propose updating Cordeiro et al.'s classic vaginal defect reconstruction algorithm to include the free ALT flap for type IB cases in which the rectus abdominis is unavailable.
Noncontrast Magnetic Resonance Lymphangiography in a Rare Case of Everolimus-Related Lymphedema
Authors: Cellina Michaela , Oliva Giancarlo , Soresina Massimo , Menozzi Andrea , Boccanera Dario , Gibelli Daniele 
Published: November 2019

Abstract
Everolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in solid-organ transplant recipients. Although mTOR inhibitors are usually well tolerated, their adverse effects have been reported: sirolimus treatment in transplant patients has been rarely reported to be associated with lymphedema of the skin and subcutaneous tissues, whereas the use of everolimus seemed to be less burdened by this type of adverse effect. We report the case of a 58-year-old man with a history of end-stage renal disease of unknown etiology who had undergone right renal transplantation 11 years before. After the transplant, the patient soon developed bilateral progressive swelling involving feet and legs. The symptoms of the left limb improved markedly after discontinuing everolimus. This condition has been classified as everolimus-induced lymphedema. The patient was referred to our department for the execution of a noncontrast magnetic resonance lymphangiography, that is, a noninvasive magnetic resonance imaging technique that has recently proposed for the study of lymphedema. Noncontrast magnetic resonance lymphangiography showed asymmetry between the lower extremities with signs of advanced lymphedema located in the right lower limb and dilated peripheral lymphatic vessels.
Drug withdrawal is currently the only effective solution for treating this type of secondary lymphedema; however, with the prolonged use of the drug, lymphedema tends to persist even after mTOR inhibitor suspension, with only partial clinical improvement, as in this case.
This case report describes the imaging characteristics of such condition at noncontrast magnetic resonance lymphangiography and discusses the rare adverse effects of everolimus. Immediate suspension of the drug is the only effective strategy to avoid the persistence of this disorder.
Prepectoral Versus Subpectoral Direct to Implant Immediate Breast Reconstruction
Authors: Mirhaidari Shayda J. , Azouz Vitali , Wagner Douglas S. 
Published: November 2019

Background
Implant-based reconstruction is currently the most common postmastectomy breast reconstruction modality with over 86,000 procedures performed in 2017. Although various methods for reconstruction techniques have been described, partial subpectoral implant placement with or without acellular dermal matrix coverage remains the most popular approach. Recently, prepectoral implant placement has gained increased recognition as a method that avoids some of the potential morbidities of submuscular implant placement. Currently, few studies have examined the outcomes of performing this approach. The purpose of this study was to evaluate and compare the outcomes of prepectoral and subpectoral direct to implant (DTI) immediate breast reconstruction.

Methods
Data from a prospective cohort of consecutive patients undergoing prepectoral DTI immediate breast reconstructions at our institution from February 2016 to November 2017 were collected. The incidence of complications such as mastectomy skin flap necrosis, seroma, hematoma, infection, implant loss, and unexpected reoperation were recorded and compared with a cohort of consecutive patients who underwent subpectoral DTI immediate breast reconstruction from May 2014 to July 2015.

Results
One hundred twelve prepectoral DTI immediate breast reconstructions were performed on 62 patients. Four breasts (4.4%) were diagnosed with infection. There were 8 breasts (7.1%) that suffered from mastectomy skin flap necrosis (5 partial thickness necrosis, 3 full thickness necrosis). There was 1 implant loss related to full thickness necrosis that required salvage with autologous tissue reconstruction. Prepectoral breast reconstruction had less esthetic revisions and comparable complications when compared with the historical subpectoral cohort.

Conclusions
When compared with the subpectoral DTI approach, prepectoral DTI breast reconstruction grants favorable complication rates and improved esthetic outcomes. Prepectoral DTI breast reconstruction is a safe modality that should be considered in any patient who is a candidate for immediate breast reconstruction.
Outcomes Following Breast Reconstruction in Patients With Prior Mantle Radiation for Treatment of Hodgkin's Lymphoma
Authors: Freniere Brian , Irwin Timothy , Guldbrandsen Gretchen , Lafleur Emily H. , Dominici Laura , Sturgeon Daniel , Chun Yoon S. 
Published: November 2019

Purpose
External beam radiation in the mantle field has been a mainstay of therapy for Hodgkin's lymphoma for decades. The incidence of breast cancer in patients treated with mantle radiation is known to be elevated. Few studies have examined outcomes of breast reconstruction in this high-risk group. The current study presents the largest series of immediate breast reconstruction in this population and aims to evaluate reconstructive outcomes and examine differences between implant-based and autologous reconstructions.

Methods
A retrospective review of records from a 10-year period at 2 institutions was undertaken. Patients treated with mantle radiation for Hodgkin's lymphoma who subsequently underwent mastectomy with immediate reconstruction were identified. Patient demographics, clinical characteristics, and outcomes including complications and operative revisions were gathered. Univariate and multivariate analyses were conducted to assess differences between implant-based and autologous reconstructions.

Results
A total of 97 breast reconstructions were performed in 52 patients. Seventy-nine reconstructions were implant-based, and 18 were autologous. Patients with implant-based reconstructions were older than autologous reconstructions (47 ± 8.8 years vs 42 ± 6.5 years, P < 0.05). Both groups had long-term follow-up; however, the mean follow-up duration was shorter in the implant-based compared with the autologous group (5 years vs 8.3 years; P < 0.05). Otherwise, the groups were similar with respect to BMI, medical comorbidities, oncologic diagnosis, and therapy. The interval between mantle radiation and reconstruction was comparable for implant-based and autologous groups (23.4 ± 9 years vs 21.3 ± 6.1 years, P = 0.6). The overall complication rate of breast reconstruction was not statistically different between the implant-based and autologous groups (35% vs 16%, P = 0.16). Three implant-based reconstructions (3.7%) required explantation. There were no complete flap losses in the autologous group. An associated 6-fold higher rate of unplanned revisions was observed with the autologous reconstruction group compared with the implant-based reconstruction group (odds ratio, 6.09; 95% confidence interval, 1.14–32.48; P = 0.035).

Conclusions
In this study, long-term follow-up suggests immediate breast reconstruction in patients with prior mantle radiation can be achieved safely with an acceptable complication profile utilizing either implant-based or autologous techniques. Autologous breast reconstruction is linked with a higher rate of revisions compared with implant-based breast reconstruction in this study population.
Three-Dimensional Morphological Changes of the Upper Airway in Patients With Skeletal Class III Malocclusion After Orthognathic Surgery
Authors: He Lin , He Song , Wu Xi , Huang Yue 
Published: November 2019

Objective:
To evaluate the morphological changes of the upper airway of patients with skeletal Class III malocclusion after undergoing bilateral mandibular ramus dislocated mandibular retrogression (SSRO) or SSRO combined with Le Fort I maxillary osteotomy and 3-dimensional imaging.

Methods:
All previous studies related to the upper airway in patients with skeletal class III malocclusion and orthognathic surgery were collected from the PubMed, EMB, Cochrane Library, Web of science, ClinicalKey, EBSCO, Weipu, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature databases. The search date ends in August 2017. RevMan5.3 software was used to perform a meta-analysis related to upper airway morphology. Ten studies were included.

Results:
The meta-analysis showed that 6 months after SSRO, CV1, and CV2 did not change significantly (P >0.05), whereas CV3 and CV4 narrowed (P <0.05) and remained narrow after 1 year (P <0.05). (CV1,CV2,CV3,CV4: Plans parallel to the FH plane passing through the most anterior inferior point of the anterior arch of the atlas, the 2nd cervical vertebra, the 3rd cervical vertebra, the 4th cervical vertebra.) There was no significant change in nasopharyngeal volume or laryngeal pharyngeal volume (P >0.05), but oropharyngeal volume and total volume decreased (P ≤0.01). Six months after SSRO combined with Le Fort I maxillary osteotomy, the minimum cross-sectional area of the upper airway was smaller (P <0.05), there was no significant change in nasopharyngeal volume or oropharyngeal volume (P >0.05), and oropharynx volume and total volume decreased (P <0.05).

Conclusions:
Single and double jaw surgery has no significant effect on nasopharynx and oropharynx, but reduces laryngopharynx and total volume; however, whether this will result in postoperative obstructive sleep apnea-hypopnea syndrome or become ameliorated over time requires more in-depth study and a longer period of clinical observation.
G-CSF Inhibits Growths of Osteoblasts and Osteocytes by Upregulating Nitric Oxide Production in Neutrophils
Authors: Zhao Jian , Zhao Qiang , Ning Peng , Shang Kai , Liu Cong , Ni Mei , Li Chunpu , Zhang Kaigang , Gao Chunzheng 
Published: November 2019

Objective:
Granulocyte colony-stimulating factor (G-CSF) is the critical regulator of the proliferation, differentiation, and survival of granulocytes. Recently, it has been shown that G-CSF can adversely affect bone health in both animal models and patients. Here, the authors aimed to investigate whether G-CSF could inhibit the growth of osteoblasts and osteocytes by regulating nitric oxide.

Methods:
The C57BL/6 mice were divided into the control group, G-CSF treatment group and recovery group (G-CSF+L-NAME). The morphology of femurs was assessed by histology and immunohistochemistry. The expression of apoptosis-related molecules in femurs was detected by immunohistochemistry and quantitative RT-PCR, respectively. To examine if neutrophil-secreted factors can induce apoptosis in osteoblasts, Gr1-positive (Gr1+) neutrophils from the bone marrow of wild-type mice were sorted and co-cultured with MC3T3 pre-osteoblasts for 2 days.

Results:
The number of osteoblasts and newly embedding osteocytes significantly decreased and markers related to osteoblasts and osteocytes were downregulated in the G-CSF treatment compared to the control group. Moreover, G-CSF treatment did not change proliferation markers but induced apoptosis in osteoblast-lineage cells. The combined treatment of mice with G-CSF and a nitric oxide inhibitor partially restored the number of osteoblasts and osteocyte parameters.

Conclusions:
The G-CSF can inhibit osteoblasts and osteocytes by upregulating nitric oxide.
Aesthetic Cranial Vault Expansion in a Child With Slit Ventricle Syndrome and Eumorphic Face
Authors: Canzi Gabriele , Auricchio Anna Maria , Iacopino Giorgia , Cenzato Marco , Talamonti Giuseppe 
Published: November 2019

Abstract
Ventricular shunting procedures represent the classical surgical treatment for hydrocephalus. Slit ventricle syndrome (SVS) with craniocerebral disproportion (CCD) and secondary craniosynostosis (SCS) is a well-known but uncommon complication following cerebrospinal fluid (CSF) shunting in children. Its general management includes shunt upgrade or revision, placement of anti-siphon devices, lumbo-peritoneal shunting, and endoscopic third ventriculostomy. Cranial expansion is generally considered a major procedure and is indicated when less invasive treatments fail. In these cases, SVS and associated SCS have been usually managed through anterior cranial vault expansion. This procedure aims to decrease the risk of further shunt revisions and to improve neurologic symptoms, but it takes the disadvantage of considerable iatrogenic alterations of the facial proportions. The authors report a case of a 6-year old boy with SVS and SCS, who maintained eumorphic face and was treated by an innovative post-coronal vault expansion ensuring a wide volume increase while avoiding any change of facial conformation.
Posterior Ischemic Optic Neuropathy Following Radiofrequency Thermocoagulation for the Treatment of Trigeminal Neuralgia
Authors: Cai Yi , Cai Xian-Liang 
Published: November 2019

Abstract
Radiofrequency thermocoagulation is one of the effective methods to treat trigeminal neuralgia. However, the complication of posterior ischemic optic neuropathy after treatment has not been reported, at present. In the present study, preoperative examination and intraoperative operation were successful, but visual acuity decreased after the operation. The cause was considered to be vasospasm induced by atherosclerosis, blood viscosity, and mental stress, which caused local ischemia, and subsequently, ischemic optic neuropathy.
The Impact of Complications and Pain on Patient Satisfaction
Authors: Berkowitz Rachel , Vu Joceline , Brummett Chad , Waljee Jennifer , Englesbe Michael , Howard Ryan 
Published: November 2019

Objective:
To measure the association between patient-reported satisfaction and regret and clinical outcomes.

Summary of Background Data:
Patient-reported outcomes are becoming an increasingly important marker of the quality of patient care. It is unclear however, how well patient-reported outcomes adequately reflect care quality and clinical outcomes in surgical patients.

Methods:
Retrospective, population-based analysis of adults ages 18 and older undergoing surgery across 38 hospitals in Michigan between January 1, 2017 and May 31, 2018.

Results:
In this study, 9953 patients (mean age 56 years; 5634 women (57%)) underwent 1 of 16 procedures. 9550 (96%) patients experienced no complication, whereas 240 (2%) and 163 (2%) patients experienced Grade 1 and Grade 2–3 complications, respectively. Postoperative pain scores were: none (908 (9%) patients), mild (3863 (40%) patients), moderate (3893 (40%) patients), and severe (1075 (11%) patients). Overall, 7881 (79%) patients were highly satisfied and 8911 (91%) had absolutely no regret after surgery. Patients were less likely to be highly satisfied if they experienced a Grade 1 complication [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.37–0.66], Grade 2–3 complication (OR 0.44, 95% CI 0.31–0.62), minimal pain (OR 0.80, 95% CI 0.64–0.99, moderate pain (OR 0.39, 95% CI 0.32–0.49), or severe pain (OR 0.23, 95% CI 0.18–0.29). Patients were less likely to have no regret if they experienced a Grade 1 complication (OR 0.48, 95% CI 0.33–0.70), Grade 2–3 complication (OR 0.39, 95% CI 0.25–0.60), moderate pain (OR 0.55, 95% CI 0.40–0.76), or severe pain (OR 0.22, 95% CI 0.16–0.31). The predicted probability of being highly satisfied was 79% for patients who had no complications and 88% for patients who had no pain.

Conclusions:
Patients who experienced postoperative complications and pain were less likely to be highly satisfied or have no regret. Notably, postoperative pain had a more significant effect on satisfaction and regret after surgery, suggesting focused postsurgical pain management is an opportunity to substantially improve patient experiences. More research and patient education are needed for managing expectations of postoperative pain, and use of adjuncts and regional anesthesia.
Successful Implementation of Unmanned Aircraft Use for Delivery of a Human Organ for Transplantation
Authors: Scalea Joseph R. , Pucciarella Tony , Talaie Tara , Restaino Stephen , Drachenberg Cinthia Beskow , Alexander Charlie , Qaoud Talal Al , Barth Rolf N. , Wereley Norman M. , Scassero Matthew 
Published: November 2019

Objective:
To understand and overcome the challenges associated with moving life-urgent payloads using unmanned aircraft.

Background Data:
Organ transportation has not been substantially innovated in the last 60 years. Unmanned aircraft systems (UAS; ie, drones) have the potential to reduce system inefficiencies and improve access to transplantation. We sought to determine if UASs could successfully be integrated into the current system of organ delivery.

Methods:
A multi-disciplinary team was convened to design and build an unmanned aircraft to autonomously carry a human organ. A kidney transplant recipient was enrolled to receive a drone-shipped kidney.

Results:
A uniquely designed organ drone was built. The aircraft was flown 44 times (total of 7.38 hours). Three experimental missions were then flown in Baltimore City over 2.8 miles. For mission #1, no payload was carried. In mission #2, a payload of ice, saline, and blood tubes (3.8 kg, 8.4 lbs) was flown. In mission #3, a human kidney for transplant (4.4 kg, 9.7 lbs) was successfully flown by a UAS. The organ was transplanted into a 44-year-old female with a history of hypertensive nephrosclerosis and anuria on dialysis for 8 years. Between postoperative days (POD) 1 and 4, urine increased from 1.0 L to 3.6 L. Creatinine decreased starting on POD 3, to an inpatient nadir of 6.9 mg/dL. The patient was discharged on POD 4.

Conclusions:
Here, we completed the first successful delivery of a human organ using unmanned aircraft. This study brought together multidisciplinary resources to develop, build, and test the first organ drone system, through which we performed the first transplant of a drone transported kidney. These innovations could inform not just transplantation, but other areas of medicine requiring life-saving payload delivery as well.
Timing of Preoperative Antibiotic Prophylaxis and Surgical Site Infection
Authors: de Jonge Stijn W. , Boldingh Quirine J. J. , Koch Anna H. , Daniels Lidewine , de Vries Eefje N. , Spijkerman Ingrid J. B. , Ankum Wim M. , Kerkhoffs Gino M. M. J. , Dijkgraaf Marcel G. , Hollmann Markus W. , Boermeester Marja A. 
Published: November 2019

Objective:
To test the hypothesis that surgical site infection (SSI) risk differs, after administration of surgical antibiotic prophylaxis (SAP) within 60–30 or 30–0 minutes before incision.

Background:
The importance of appropriate timing of SAP before surgery has long been recognized. However, available evidence is contradictive on the best timing within a 60–0 minutes time interval before incision. Here, we aim to evaluate previous contradictions with a carefully designed observational cohort.

Methods:
An observational cohort study was conducted in a Dutch tertiary referral center. For 2 years, consecutive patients with SAP indication undergoing general, orthopedic, or gynecologic surgery were followed for the occurrence of superficial and deep SSI as defined by the Center of Disease Control and Prevention. The association between timing of SAP and SSI was assessed using multivariable logistic regression.

Results:
After 3001 surgical procedures, 161 SSIs were detected. In 87% of the procedures, SAP was administered within 60 minutes before incision. Only antibiotics with short infusion time were used. Multivariable logistic regression indicated there was no conclusive evidence of a difference in SSI risk after SAP administration 60–30 minutes or 30–0 minutes before incision [odds ratio: 0.82; 95% confidence interval (0.57–1.19)].

Conclusions:
For SAP with short infusion time no clear superior timing interval within the 60-minute interval before incision could be identified in this cohort. We were unable to reproduce differences in SSI risk found in earlier studies.