bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral Lower Limb Salvage after Fourth-degree Burns: Subscapular Axis Free and Chimeric Flaps Effectiveness in Complex Reconstruction
Authors: Brito Íris M. , Vaz Miguel , Brandão Carla , Sanches Fernanda , Diogo Carla 
Published: March 2021

Summary:
Microsurgery is usually required for reconstruction of complex lower limb defects, preserving otherwise unsalvageable injuries. Fourth-degree burns are severe traumatic injuries. A case of bilateral lower limb salvage through a resourceful use of subscapular axis free and chimeric flaps for acute burn reconstruction of extensive lower leg injuries is reported. A 48-year-old man sustained a 40% surface area flame burn, circumferential and full-thickness at the lower limbs. Debridement of fourth-degree burns of the anterior lower legs resulted in bone exposure of the left and right tibias, right medial malleolus, and Achilles tendon. A latissimus dorsi (LD) flap plus a chimeric subscapular axis free flap with 3 components (LD, serratus anterior (SA), and parascapular) were designed for reconstruction. LD insetting for left tibia coverage with anastomoses to anterior tibial vessels was performed. Right side flap insetting provided tibia coverage with LD; medial malleolus with SA; and Achilles tendon with parascapular flap. An anatomical variation required anastomoses to proximal (chimeric LD + SA) and distal (parascapular) ends of posterior tibial vessels because of an independent origin of the pedicles. At 10-months follow-up after intensive rehabilitation, the patient showed proper functional outcomes at daily-life and work activities with autonomous walking using a single crutch. This case highlights the importance of microsurgery and chimeric flaps for limb salvage in extreme situations. The authors review and discuss the surgical options, emphasizing specific considerations of microsurgical reconstruction in burn patients.
Treatment of Post-mastectomy Lymphedema with Herbal Medicine: An Innovative Pilot Study
Authors: Chiu Tor-Wo , Kong Shun-Ling , Cheng King-Fai , Leung Ping-Chung 
Published: March 2021

Background:
Lymphedema of the arms or legs is a difficult clinical problem yet devoid of effective treatment. Lymphedema is the result of obstructed lymphatic flow secondary to chronic infection, parasitic infestation, or postsurgical obstruction (eg, after axillary dissections). We arranged this clinical trial to investigate whether patients with limb lymphedema can benefit from a standard dose of Astragalus plus Paeoniae rubra to improve the symptomatology, functional capacity, and quality of life (QOL).

Method:
The pilot study was designed as a self-control clinical trial. Patients with post-mastectomy lymphedema were recruited. A double-herb formulation (Astragalus, Paeoniae rubra) with standard dosage was administered orally in a powdered form, 6 times per week for 6 months. Outcome measurements included standard limb volume changes measured by water displacement method; handgrip strength; and QOL for limb lymphedema questionnaire (LYMQOL).

Results:
There were no reported adverse effects or complications; there were no episodes of infection during the period of study. There was a tendency of limb volume reduction by 6 months, which, however, did not reach statistical significance. There was a significant improvement in appearance and symptom scores as was assessed with the LYMQOL questionnaire.

Conclusions:
The oral herbal formula improved the symptomatology and QOL among the pilot group of patients with post-mastectomy lymphedema. Side effects were absent, and there was a trend of lymphedema reduction.
Severe Skin Ulcer on the Hand Caused by Hemodialysis Shunt-related Venous Hypertension That Required a Skin Graft
Authors: Kuwahara Masamitsu , Yoneda Tatsuo 
Published: March 2021

Summary:
In dialysis patients, peripheral venous hypertension–induced hand ulcers are rare. We report a case in which a severe hand ulcer was treated with skin grafting after shunt ligation. The patient was a 60-year-old woman who been undergoing dialysis for 13 years. Twelve years ago, a shunt was created in her right wrist via a side-to-side anastomosis. Swelling and congestion occurred in the right hand, and skin ulcers developed on the dorsal proximal portions of the index, middle, ring, and little fingers. No central vein obstruction was apparent. The right wrist shunt was explored, and the distal vein was ligated. A new shunt was created at the right elbow, but the proximal end of the vein that was used for the wrist shunt had to be used, resulting in complete cephalic vein occlusion from the wrist to the elbow. The swelling extended to the entire forearm. Four weeks after the wrist and elbow shunts were ligated, conservative treatment had resulted in granulation tissue formation in the ulcers. Debridement and full-thickness skin grafting from the abdomen were performed. Overall, skin graft survival was 75%. In conclusion, in this patient, side-to-end anastomosis of the proximal vein might be appropriate for shunt creation. When venous hypertension is suspected, ensuring an appropriate alternative shunt, promptly detecting the cause of the problem, and appropriate treatment are important. Venous hypertension must be completely resolved before surgery for ulcers.
Digital Image Analyses of Preoperative Simulation and Postoperative Outcome following Blepharoptosis Surgery
Authors: Zheng Xiaodong , Yamada Hiroko , Kamao Tomoyuki , Goto Tomoko , Shiraishi Atsushi 
Published: March 2021

Background:
Before blepharoptosis surgery, simulation of eyelid features, including lid height and crease position, is often performed. However, discrepancies of the simulation and outcome can occur. The purpose of this study was to analyze the pre- and postoperative images and to evaluate factors contributing to the discrepancies.

Methods:
Forty-one involutional blepharoptosis patients (68.2 ± 7.1 years) underwent levator aponeurosis advancement. A semicircular bent wire was used to push the preoperative ptotic eyelid up to simulate the postoperative appearance of the eyelid. Digital images of the simulation were compared with the appearance at 3 months after the surgery. The ImageJ software was used to analyze the pre- and postoperative margin reflex distance-1 (MRD-1), pretarsal show (PTS), fissure height (FH), and ocular surface area (OSA). Factors with a potential of affecting the predictability of simulation were determined.

Results:
During simulation, the MRD-1 was 3.6 ± 0.4 mm, the PTS was 3.48 ± 1.2 mm, the FH was 8.5 ± 0.9 mm, and the OSA was 120.7 ± 22.3 mm2. After the surgery, the corresponding values were 3.3 ± 1.2 mm, 3.3 ± 1.5 mm, 8.6 ± 1.4 mm, and 119.1 ± 25.1 mm2, respectively. The postoperative MRD-1 was significantly smaller than that of the simulation (P = 0.005, paired t test). The MRD-1 simulation error was positively correlated with the length and width of the skin resection (all P < 0.05), and the PTS error was positively correlated with the length of the skin resection (r = 0.332, P = 0.031) and negatively correlated with the preoperative OSA (r = −0.588, P = 0.007).

Conclusions:
The postoperative appearance of the eyelid can be simulated fairly accurately by pushing up the upper eyelid with a curved wire. However, the MRD-1 tended to be overestimated, especially for cases requiring a large skin resection.
A Simple and Scarless Method for Inframammary Fold Correction Using a Barbed Suture
Authors: Tomita Koichi , Taminato Mifue , Nomori Michiko , Maeda Daisuke , Seike Shien , Tashima Hiroki , Yano Kenji , Kubo Tateki 
Published: March 2021

Background:
In the typical procedure for secondary correction of the inframammary fold (IMF) following breast reconstruction, a large incision is often required, and this increases surgical invasiveness. The “drawstring method” is a simple procedure for recreating a smooth IMF. We modified the drawstring method and developed an essentially scarless method for IMF correction from small stab incisions.

Methods:
Patients at our hospital who presented with IMF ptosis or loss of definition after breast reconstruction and required IMF correction, as well as those who requested IMF recreation for the contralateral breast, during the period spanning May 2016 to June 2019 were considered for this study. We collected and analyzed demographic data, as well as complications and postoperative outcomes.

Results:
The new method was performed on 20 patients, with the following breakdown: IMF recreation after breast reconstruction with a deep inferior epigastric artery perforator flap (11 patients), IMF recreation after breast reconstruction with a breast implant (2 patients), IMF recreation after breast reconstruction with fat graft (5 patients), and IMF recreation for the contralateral breast (2 patients). Overcorrection of the IMF stabilized by 2–3 months postoperatively, resulting in a smooth and well-defined IMF. For non–breast implant cases, the implant volume increased at the lower pole. Slack in the suture was observed in only 2 patients of the deep inferior epigastric artery perforator group and in 1 patient of the breast implant group after 6 months postoperatively.

Conclusions:
Our new method allows for the recreation of an essentially scarless, smooth, and well-defined IMF. IMF definition can be adjusted by altering the depth of the barbed suture. Since this method can be performed under local anesthesia, it offers the benefits of reducing medical costs and physical burden on patients.
Targeted Muscle Reinnervation for Partial Hand Amputation
Authors: Chepla Kyle J. , Wu-Fienberg Yuewei 
Published: March 2021

Background:
Targeted muscle reinnervation for the treatment of symptomatic neuromas after upper limb amputation has been described for shoulder disarticulation and for transhumeral and transradial amputations. Early clinical outcomes are promising and demonstrate a statistically significant reduction in phantom limb pain and a decrease in residual limb pain.

Methods:
We performed a cadaver dissection of the motor branches arising from the median and ulnar nerves to assess whether this technique could be applied to symptomatic neuromas after partial hand and finger amputations.

Results:
After identification of all branches under 4.5x loupe magnification, we performed simulated transfers of digital nerves to lumbrical motor branches, common digital nerves to lumbrical motor branches or the recurrent motor branch, and the common sensory portion of the ulnar nerve to a hypothenar motor branch.

Conclusions:
The proximity of all sensory nerves to motor branches and the numerous redundant motor nerve targets available support our hypothesis that targeted muscle reinnervation is possible after partial hand or finger amputation. Further studies will be required to refine clinical indications and evaluate outcomes.
Cannula Size Effect on Stromal Vascular Fraction Content of Fat Grafts
Authors: Becker Hilton , Vazquez Oscar Adrian , Rosen Tans 
Published: March 2021

Background:
Fat is an active and dynamic tissue composed of adipocytes supported by a structural framework known as the stromal vascular fraction (SVF). SVF is traditionally isolated by enzymatic processing, but new methods are being investigated to isolate it mechanically. Recent studies propose that fat harvested with larger cannulas has a higher survival rate, most likely due to a higher concentration of SVF.

Methods:
Lipoaspirates were obtained from 10 patients who underwent elective liposuction using a 5-mm and a 1-mm cannula attached to a syringe using standard pressure. The fat was aspirated from the same area at adjacent sites. An estimated 5-mm fat particles were also cut down to 1-mm using a micronizer (Marina Medical). A 5-cm3 volume of each sample was compressed through a 0.5-mm opening strainer and rinsed with normal saline to extrude the oil. The resultant SVF left on the strainer was then measured in a 1-cm3 syringe.

Results:
The volume extracted from a 5-mm cannula (mean, 0.23 cm3; SD, 0.10) versus a 1-mm cannula (mean, 0.11 cm3; SD, 0.06) was statistically significant (P = 0.009). An H&E-stained slide from the SVF was obtained for confirmation. Finally, 5-mm fat particles cut down to 1-mm particles using the micronizer resulted in an average volume of 0.20 cm3, which was higher than the average volume harvested with a 1-mm cannula.

Conclusions:
Harvesting with a 5-mm cannula resulted in significantly more SVF than harvesting with a 1-mm cannula. Resizing fat particles harvested with a larger cannula down to 1-mm resulted in higher SVF than SVF obtained with a 1-mm cannula directly.
Comparison of Various Kinds of Probes for Lymphedematous Limbs
Authors: Hara Hisako , Mihara Makoto 
Published: March 2021

Summary:Recently, there has been a growing interest in the use of lymphatic ultrasound in the preoperative investigation of lymphaticovenous anastomosis. The device used for the performance of lymphatic ultrasound varies among surgeons. In this case report, we compared several probes (18 MHz, 24 MHz, and 33 MHz linear probes) in 2 cases, to detect the lymphatic vessels in the lymphedematous limbs. In the upper limb lymphedema case, the lymphatic vessels were located at a depth of <5 mm. They could be better observed with the 33 MHz probe than with the 18 MHz probe. The probe with a high frequency (33 MHz) and high resolution seemed to be suitable for superficial layers <5 mm in depth. On the other hand, the probe of 33 MHz was not appropriate for the lymphedematous lower limb because the lymphatic vessels are usually located at around a depth of 1 cm. When comparing the 18 MHz and 24 MHz probes in observing the lymphatic vessels in the lower limb, the 24 MHz probe seemed more suitable because of its higher resolution. Among these options, the 33 MHz probe was suitable for lymphedematous upper limbs, and the 24 MHz probe was suitable for lymphedematous lower limbs.
Three-dimensional Printed Customized Adjustable Mallet Finger Splint: A Cheap, Effective, and Comfortable Alternative
Authors: Papavasiliou Theodora , Shah Rushabh K. , Chatzimichail Stelios , Uppal Lauren , Chan Jeffrey C.Y. 
Published: March 2021

Summary
Mallet finger deformity is a common and debilitating injury of the fingertip, accounting for 10% of all tendon and ligament injuries. It involves a disruption of the terminal extensor mechanism of the distal phalanx. Patients can experience significant pain and swelling of the fingertip and have significant morbidity without treatment. Nonoperative treatment using joint immobilization with splints is the mainstay of management. Traditionally, prefabricated and thermoplastic splints have been utilized; however, issues with comfort and skin complications such as maceration can lead to patient noncompliance and eventually, poor outcomes. To address this, we demonstrate our experience with the design, manufacture, and application of individualized 3D printed mallet finger splints. The splints were found to provide advantages akin to traditional thermoplastic splints, with the addition of being low cost, easy to manufacture, and environmentally friendly.
Complications and Patient-reported Outcomes in Transfemale Vaginoplasty: An Updated Systematic Review and Meta-analysis
Authors: Bustos Samyd S. , Bustos Valeria P. , Mascaro Andres , Ciudad Pedro , Forte Antonio J. , Del Corral Gabriel , Manrique Oscar Javier 
Published: March 2021

Background:
Vaginoplasty aims to create a functional feminine vagina, sensate clitoris, and labia minora and majora with acceptable cosmesis. The upward trend in the number of transfemale vaginoplasties has impacted the number of published articles on this topic. Herein, we conducted an updated systematic review on complications and patient-reported outcomes.

Methods:
A update on our previous systematic review was conducted. Several databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were assessed. Random effects meta-analysis and subgroup analyses were performed.

Results:
After compiling the results of the update with the previous systematic review, a total of 57 studies pooling 4680 cases were included in the systematic review, and 52 studies were used in the meta-analysis. Overall pooled data including any surgical technique showed rates of 1% [95% confidence interval (CI) <0.1%–2%] of fistula, 11% (95% CI 8%–14%) of stenosis and/or strictures, 4% (95% CI 1%–9%) of tissue necrosis, and 3% (95% CI 1%–4%) of prolapse. Overall satisfaction was 91% (81%–98%). Regret rate was 2% (95% CI <1%–3%). Average neovaginal depth was 9.4 cm (7.9–10.9 cm) for the penile skin inversion and 15.3 cm (13.8–16.7 cm) for the intestinal vaginoplasty.

Conclusions:
Transfemale vaginoplasty is a key component of the comprehensive surgical treatment of transfemale patients with gender dysphoria. Over time, we will see an increased demand for these procedures, so adequate surgical training, clinical/surgical experience, and research outcomes are required, as we continue to strive to provide the best care possible for a population in need.
Effect of Le Fort I Maxillary Repositioning on Three-Dimensional Nasal Tip Rotation: A Comparative Study with Implication for the Asian Nose
Authors: Denadai Rafael , Chou Pang-Yun , Yao Chuan-Fong , Chen Ying-An , Lin Yi-Yu , Huang Chiung-Shing , Lo Lun-Jou , Chen Yu-Ray 
Published: March 2021

Background:
Le Fort I maxillary repositioning influences nasal morphology. In Asian cultures, upward nasal tip rotation with increased nostril exposure is considered aesthetically unpleasant and can have psychosocial consequences. This three-dimensional imaging–based study evaluated the effect of different Le Fort I maxillary movements on nasal tip rotation.

Methods:
Consecutive patients who underwent two-jaw orthognathic surgery (n = 107) were enrolled. To achieve a standard head orientation, preoperative and 1-week and 12-month postoperative cone-beam computed tomography–derived three-dimensional craniofacial models were superimposed. Tip rotation angle was calculated according to the Frankfort horizontal plane for all three-dimensional digital models. The final tip rotation angle change was defined as 12-month postoperative value minus preoperative value. Translational maxillary movement types (advancement versus setback and intrusion versus extrusion), postoperative maxillary segment locations (anterosuperior, anteroinferior, posterosuperior, or posteroinferior), and actual linear maxillary changes were noted.

Results:
Advancement (1.79 ± 5.20 degrees) and intrusion (2.23 ± 4.96 degrees) movements demonstrated significantly larger final tip rotation angle changes than setback (−0.88 ± 5.15 degrees) and extrusion (0.09 ± 5.44 degrees) movements (all p < 0.05). Postoperative anterosuperior location (2.95 ± 4.52 degrees) of the maxillary segment demonstrated a significantly larger final tip rotation angle change than anteroinferior (0.48 ± 5.65 degrees), posterosuperior (−1.08 ± 4.77 degrees), and posteroinferior (−0.64 ± 5.80 degrees) locations (all p < 0.05). Translational maxillary movement and actual linear maxillary change were not correlated with final tip rotation angle change.

Conclusion:
Effects of Le Fort I maxillary repositioning on nasal tip rotation depend on movement types and maxillary segment location.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Pretransplant Hepatitis C Virus Treatment Decreases Access to High-quality Livers
Authors: Strauss Alexandra T. , Ishaque Tanveen , Weeks Sharon , Hamilton James P. , Simsek Cem , Durand Christine M. , Massie Allan B. , Segev Dorry L. , Gurakar Ahmet , Garonzik-Wang Jacqueline M. 
Published: March 2021

Background.
Despite the revolutionary role of direct-acting antivirals for hepatitis C virus (HCV), the treatment timing for liver transplant candidates remains controversial. We hypothesize that deferring treatment until after liver transplantation improves access to a larger and higher-quality donor pool without a detrimental impact on post-liver transplantation outcomes.

Methods.
This single-center study includes recipients that underwent deceased-donor liver transplant with HCV as the primary indication January 1, 2014, to December 31, 2018. For recipients that were untreated (n = 87) versus treated (n = 42) pre-LT, we compared post-LT mortality using Cox regression with inverse probability of treatment-weighted data.

Results.
Among pre-LT untreated recipients, 95% were willing to accept an HCV+ donor, and 44.8% received a positive HCV antibody and nucleic acid amplification test (NAT) liver. Among pre-LT treated recipients, 5% were willing to accept an HCV+ donor, and 100% received a negative HCV antibody and NAT liver. The median calculated model for end-stage liver disease at transplant was similar between pre-LT untreated (13, IQR = 9–22) and treated recipients (11, IQR = 8–14) (P = 0.1). Pre-LT treated recipients received livers from older (47 y old versus 37, P < 0.01) and higher body mass index donors (30.2 versus 26.6; P = 0.04) and spent longer on the waiting list (319 d 180, P < 0.001). Unadjusted post-LT mortality at 1 year was higher in the pre-LT treated recipients (14.6% versus 3.5%, P = 0.02). After adjusting for recipient factors, pre-LT treated recipients trended toward a 3.9 times higher risk of mortality compared with the pre-LT untreated recipients (adjusted hazard ratio = 0.973.8615.4) (P = 0.06).

Conclusions.
Deferring HCV treatment improves access to higher-quality donors and may improve post-LT survival.
COVID-19 Vaccine Perceptions in New York State’s Intellectual and Developmental Disabilities Community
Authors: Iadarola Suzannah , Siegel Joanne F. , Gao Qi , McGrath Kathleen , Bonuck Karen A. 
Published: March 2021

AbstractBackgroundPeople with intellectual and developmental disabilities (IDD) are at disproportionate risk for severe COVID-19 outcomes, particularly those living in congregate care settings. Yet, there is limited data on vaccine perceptions in the disability community.ObjectiveTo explore COVID-19 vaccine perceptions in individuals with IDD, their family members, and those who work with them, to inform a statewide vaccine information and messaging project.MethodsA national survey, adapted for the IDD community, was distributed to a convenience sample of IDD organizations throughout New York State, in five languages. Constructs included vaccine intention, reasons for vaccine hesitancy, and trusted sources of vaccine information. Zip code data were used to map respondent location and vaccine preferences.ResultsOf n= 825 respondents, approximately 75% intended to or had received the vaccine, across roles (i.e., people with disabilities, family members, direct care workers) and racial/ethnic groups. Greater vaccine hesitancy was reported in younger individuals and those making decisions on behalf of a person with IDD. Concerns included side effects and the swiftness of vaccine development. Black and Hispanic participants had heightened concerns about being an “experiment” for the vaccine. Trusted sources of information included healthcare providers and family members. Respondents who intended/got the vaccine were distributed throughout the state.ConclusionsVaccine preferences in this New York State disability community sample align with national data. Identified concerns suggest the need for community education that addresses misperceptions. Age and race differences in perspectives highlight the need for tailored education, delivered by trusted messengers.