bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Surgical Drainage on Complications after Sentinel Lymph Node Biopsy for Melanoma
Authors: Torresetti Matteo , Scalise Alessandro , Pelliccioni Michele , Taddei Francesco Mauro Junior , Di Benedetto Giovanni 
Published: March 2023

Background:
The real benefit of using drains for reducing the risk of complications in sentinel lymph node biopsy (SLNB) has not been investigated yet. We aimed to evaluate the role of drain after SLNB and to determine if a correlation exists between drains and early complications.

Methods:
This is a retrospective study of patients who underwent SLNB for melanoma from 2016 to 2021. Patients were dichotomized into two groups according to the use of drain. The between-group comparison (drainage group versus no drainage group) was performed by using Mann-Whitney U test and chi-square test. A regression analysis was conducted to identify predictors of complications.

Results:
Of 218 individuals analyzed, 18 (8.4%) had postoperative complications. The most common complications were seroma (5.1%) and wound dehiscence (1.4%). The between-group analysis showed no significant differences in complication rate, whereas the operative time was significantly higher in the drainage group (P = 0.007), as well as the hospital stay (P ≤ 0.0001) and the duration of postoperative antibiotic therapy (P = 0.02). The regression analysis found body mass index and multiple basins of SLNB (axilla with groin) to be significant predictors of having a complication (P = 0.03 and P = 0.05, respectively). The operative time was found to be a predictor of seroma (P = 0.04).

Conclusions:
Drainage use in SLNB prolonged hospital stays and duration of postoperative antibiotic therapy, thus resulting in higher costs. The preemptive use of drainage is suggested in selected settings of patients.
Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm
Authors: Alowais Fahad Abdullah , Alfaqeeh Faisal A. , Alammar Alwaleed K. , Mortada Hatan , Skef Zafer , Alshammari Mishal , Idrees Yasser Elsayed 
Published: March 2023

Background:
Self-inflicted hand injuries have been described in the literature with varying nomenclature (factitious, malingering, and self-induced hand injuries). Identifying and treating these patients is complex and requires a multidisciplinary team approach at a high cost. There is a lack of literature that describes the different patterns and characteristics of hand injuries among military personnel, especially in Saudi Arabia. We conducted a chart review study involving military personnel who attended the emergency department with hand injuries in Saudi Arabia to fill this gap.

Methods:
This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018.

Results:
A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days.

Conclusions:
Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.
Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis
Authors: Ponich Brett , Lafreniere Ann-Sophie , Hartley Rebecca , Temple-Oberle Claire F. 
Published: March 2023

Background:
Temporal artery biopsy (TAB) in diagnosing giant cell arteritis has been criticized due to surgical risks, a high false negative rate, and redundant information when patients already met American College of Rheumatology criteria. The objective of this study was to investigate TAB's impact on steroid treatment duration.

Methods:
A retrospective chart review garnered patient demographics, symptoms, comorbidities, and steroid treatment duration in patients undergoing TAB at a single center. Steroid treatment was compared between TAB+ and TAB - patients.

Results:
One hundred seven patients undergoing TAB were included. Patients were predominantly women (70.1%) with a median age of 74 years (46 -91). Of 107 TAB results, 74 (69.2%) were negative, 23 (21.5%) were positive, and 10 (9.3%) were found to be indeterminate. In TAB+ patients, the mean erythrocyte sedimentation rate was not significantly different than TAB - patients (60.2 versus 43.7, P = 0.45), nor was the median C-reactive protein (38.8 versus 18.1, P = 0.17). Regarding steroid use, both TAB+ and TAB - patients had a similarly high rate of prebiopsy steroid initiation (82.6% versus 70.3%, P = 0.32). More TAB+ patients remained on steroids at 6 weeks (95.0% versus 57.4%, P = 0.004), 6 months (95% versus 37.7%, P < 0.001), 1 year (65.0% versus 31.1%, P = 0.024), and 18 months (50.0% versus 19.7%, P = 0.045). By 2 years, the difference no longer met significance (35.0% versus 14.8%, P = 0.12). P = 0.12).

Conclusion:
TAB positivity does seem to influence maintenance of steroids up to 18 months after biopsy.
Clostridium Histolyticum Collagenase Underdosed for Multicord Injection in Dupuytren’s Disease: A Retrospective Cohort Study
Authors: Boriani Filippo , Raggini Filippo , Evangelista Andrea , Gustar Adrian , Figus Andrea 
Published: March 2023

Background:
An underdosing of collagenase clostridium histolyticum (0.32 mg) is proposed as a potentially effective option in patients with additional cords in the same hand, after the first cord has been treated with the regular dose of 0.58 mg. The aim of this study was to analyze whether this additional dose is tolerated and effective.

Methods:
Patients with Dupuytren’s disease affecting MCP joints with at least two independent pathological cords, causing deformity of two digits, were considered, with their written informed consent, for a simultaneous injection of the two cords with a single vial of collagenase. Digits treated with the standard dose of 0.58 mg were compared with digits injected with the smaller dose of 0.32 mg. Passive extension deficit and range of motion were evaluated after injection. Complications were also compared.

Results:
A total of 26 patients (29 hands) were included in the study. Of these, nine patients had two independent cords within one hand, and 17 patients had a single cord (three of these with a cord in each hand). Thirty-five digits were injected, 23 with 0.58 mg and 12 with 0.32 mg. Apart from a smaller mean percentage variation in passive extension deficit within 24 hours in the 0.58-mg dose compared with 0.32 mg (29% versus 40%, P = 0.031), no other differences emerged if a dose of 0.32 mg is used instead of 0.58 mg, in terms of selected outcome measures and rate of complications (P > 0.05).

Conclusion:
Underdosing collagenase clostridium histolyticum is equally effective in the treatment of Dupuytren’s disease.
A Pilot Randomized Clinical Trial of Early Ambulation after Groin Reconstruction with Sartorius Muscle Flaps
Authors: Nguyen Audrey B. , Kohn Michael A. , Lentz Rachel , Hansen Scott L. 
Published: March 2023

Background:
The use of muscle flaps, such as the sartorius muscle, for groin coverage in high-risk vascular patients has been shown to reduce complication rates. However, it remains unknown whether earlier postoperative ambulation is associated with improved postoperative outcomes for groin muscle flaps following infrainguinal vascular surgery.

Methods:
We performed a pilot randomized trial to analyze the effect of early ambulation on postoperative outcomes in patients who had groin reconstruction with sartorius muscle flaps following infrainguinal vascular surgery at our academic institution.

Results:
Fourteen patients were randomized to standard ambulation (on postoperative day 6), and 14 patients were randomized to early ambulation (on postoperative day 2). The treatment arms were similar with respect to age, body mass index, risk category, smoking status, and comorbidities. Median length of stay was 6 days in the early group versus 7 days in the standard group. Immediate and long-term physical function and general health were better in the early group There were slightly more wound complications in the standard (57.1%) versus the early group (42.9%), and the early group had more lymphatic complications (35.7% versus 14.3%).

Conclusions:
The decision to ambulate a patient after this surgery continues to be a decision between the vascular and plastic surgeons. However, this pilot trial has shown the safety profile of early ambulation and that it should be considered for specific patients. Additionally, this trial has provided valuable information for performing a larger scale randomized controlled trial to determine the optimal postoperative protocol for patients with these reconstructions.
Pulsed Dye Laser for Treatment of Basal Cell Carcinoma
Authors: Baran Kelsey L. , Cheung Tiffany C. , Csank George A. , Michaels Basil M. 
Published: March 2023

Background:
Basal cell carcinoma (BCC) is the most common malignancy worldwide. The incidence of BCC is increasing up to 10% per year worldwide. Surgical excision and Mohs surgery are the gold standard treatment modalities. However, patients may not be candidates for surgery. Pulsed dye laser (PDL) is a novel technique for treating BCC.

Methods:
Patients with biopsy-proven BCC underwent two treatments with PDL at 6-week intervals at Berkshire Cosmetic and Reconstructive Surgery Center. Patients returned 6 weeks after the second treatment for evaluation for response to treatment. Follow-up examinations were conducted at 6, 12, and 18 months after treatment with PDL.

Results:
Twenty patients with 21 biopsy-proven BCCs were treated with PDL at Berkshire Cosmetic and Reconstructive Surgery Center between 2019 and 2021. Nineteen BCCs had a complete response after two treatments, for a clearance rate of 90%. Two of the 21 lesions did not respond for an incomplete response rate of 10%.

Conclusion:
PDL is an effective nonsurgical treatment option in the management of BCC.
Folded Radial Forearm Free Flap for the Reconstruction of Total Soft Palate Defects: Operative Technique
Authors: Nocini Riccardo , Favero Vittorio , Molteni Gabriele , Pinto Valentina , Chiarini Luigi , Nocini Pier Francesco 
Published: March 2023

Background:
The surgical plan to reconstruct the palate must be carefully prepared given the morphological peculiarity of the soft palate forming both the roof of the mouth and the floor of the nasal cavity. This article focuses on the use of folded radial forearm free flaps to manage isolated defects of the soft palate in the absence of tonsillar pillar involvement.

Methods:
Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap.

Results:
All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned.

Conclusions:
The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate.
Analgesia and Sedation at Terminal Extubation: A Secondary Analysis From Death One Hour After Terminal Extubation Study Data*
Authors: Tripathi Sandeep , Laksana Eugene , McCrory Michael C. , Hsu Stephanie , Zhou Alice X. , Burkiewicz Kimberly , Ledbetter David R. , Aczon Melissa D. , Shah Sareen , Siegel Linda , Fainberg Nina , Morrow Katie R. , Avesar Michael , Chandnani Harsha K. , Shah Jui , Pringle Charlene , Winter Meredith C. 
Published: March 2023

Objectives:
To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD).

Design:
Secondary analysis of data collected for the Death One Hour After Terminal Extubation study.

Setting:
Nine U.S. hospitals.

Patients:
Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010–2021).

Measurements and Main Results:
Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/Fio
2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4–11.0 yr). The median TTD was 15 minutes (IQR, 8–23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3–1.8 mg/kg/hr) (n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11–0.44 mg/kg/hr) (n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD.

Conclusions:
Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.
Reoperative Transaxillary Subfascial Breast Augmentation and Fat Grafting: Technical Highlights and a Step-by-Step Video Guide
Authors: Munhoz Alexandre Mendonça , Marques Neto Ary de Azevedo , Maximiliano João 
Published: March 2023

Summary:
Reoperative procedures following breast augmentation are frequently more complex than primary cases because of local complications and insufficient soft tissue coverage. While the transaxillary (TA) incision is more indicated in primary breast augmentation, limitations of this approach include secondary surgeries and correcting complications after using this approach by the same incision. Combining the TA technique with a subfascial pocket has been suggested to avoid breast scarring and the limitations of submuscular pockets represented by breast animation. With advances in autogenous fat grafting (AFG) techniques, implant coverage alternatives and more natural outcomes have been reported from more superficial implant pockets. The simultaneous AFG with silicone implants (defined as hybrid breast augmentation) has recently been evaluated as an attractive procedure. These two techniques combine to provide breast projection and natural cleavage while camouflaging the implant edges. AFG is also important to reduce the intermammary distance and achieve a smoother transition between the breasts. The TA approach can be useful in reoperative breast augmentation, as our results show, and also avoids additional scarring on the breast. This article and the accompanying videos provide a detailed, step-by-step guide to reoperative hybrid breast augmentation using a subfascial TA approach, with a predictable and optimized surgical outcome.
“Weight Control Following Body Contouring Surgery – Long-Term Assessment of Postbariatric and Non-bariatric Patients”
Authors: Henderson Joshua T. , Koenig Zachary A. , Woodberry Kerri M. 
Published: March 2023

Background:
Few reports of weight maintenance following body contouring (BC) surgery present weight measurements as percent weight change, and most of these studies do not isolate BC to specific body areas. This study analyzes weight control in the trunk-based BC population and further compares BC outcomes in postbariatric and non-bariatric patients.

Methods:
We performed a retrospective cohort study of consecutive postbariatric and non-bariatric patients who underwent trunk-based BC (abdominoplasty, panniculectomy, and circumferential lipectomy) from 1/1/2009 through 7/31/2020 at West Virginia University. A minimum twelve-month follow-up was required for inclusion. With BC surgery date as the reference point, percent total weight loss (%TWL) was assessed at six-month intervals for two years following BC and every year thereafter. Change over time was compared between postbariatric and non-bariatric patients.

Results:
Within the twelve-year timeframe, 121 patients meeting criteria underwent trunk-based BC. Average follow-up from date of BC was 42.9 months. Sixty patients (49.6 %) had previously undergone bariatric surgery. From pre-BC to endpoint follow-up, postbariatric and non-bariatric patients experienced a 4.39 ± 10.93% and 0.25 ± 9.43% increase in weight from baseline, respectively (p=0.0273). Once nadir weight loss was attained, weight regain occurred through endpoint follow-up in both groups (11.81% in the postbariatric patients and 7.56% in the non-bariatric BC cohort, p=0.0106).

Conclusion:
Long-term weight regain is common following trunk-based BC surgeries, specifically in postbariatric patients. Although this should not contend with the psychological benefit of removing this excess tissue, it is important to report results with ideal weight metrics to optimally assess outcomes in this population.
The Changes of Sonographic Thickness with Identification of 9-Layers, Roughness, and Hydration in Dorsal Hand after Injection of Hyaluronic Acid Filler
Authors: Kim Jong Seo 
Published: March 2023

Background:
Using high resolution sonography, soft tissue thickness with detailed soft tissue layers can be measured accurately to assess volumizing effects of fillers.

Methods:
In this prospective study, 1cc of monophasic stabilized hyaluronic acid (mS-HA) filler was injected utilizing subdermal scrapping fanning injection technique (ssFIT) into the dorsal superficial lamina (DSL) and dorsal intermediate lamina(DIL) for 20 patients, and the results were measured utilizing sonographic evaluation of soft tissue thickness, topographic computer analysis (TCA) of skin roughness, stratum corneum hydration (SCH) at 1-week,1,2,3,6-months.

Results:
The hand appearance and skin roughness improved in all patients. Soft tissue thickness in sonography was increased by 4.52mm(immediately-post-treatment), 5.52mm(1week), 4.89mm(1month), 4.25mm(2m), 4.08mm(3m), and 3.86mm(6m) from the pre-treatment baseline of 3.20mm. Roughness evaluated by TCA in 50(10) magnification dermascope photos, was reduced by 15.39(16.17)% at 1-month post-treatment, 21.5(18.12)% at 2-months, 22.7(23.91)% at 3-months, 27.16(38.12)% at 6-months, indicating improvements in fine wrinkles after the procedure. SCH on hand dorsum also improved during the follow up.

Conclusions:
Detail subdivided 9-layers of hand dorsum were established in author’s sonography study for the first time. Soft tissue thickness was increased more than 207% during follow-up after 1-session of the treatment, and placed HA materials was confirmed in DSL and DIL. The hand appearance and skin roughness improved in all patients. Veins and tendons became less apparent after the single injection, showing volumizing effects lasting more than 6 months. All patients stated that their skin became more moisturized with increased SCH, youthful and smooth during the follow-up period after only 1-session of ssFIT.
Multiplanar (4-Dimension) Breast Augmentation—A Personal Surgical Concept for Dynamic Implant-Tissue Interaction Providing Sustainable Shape Stability
Authors: Vogt Peter M. , Mackowski Marian S. , Dastagir Khaled 
Published: March 2023

Background:
In esthetic breast augmentation long-term shape stability and natural appearance remain an ongoing challenge. The authors found that to reduce the incidence of secondary deformity and increase the natural feel and appearance, a standard multiplanar procedure combining a subfascial and dual plane approach with fasciotomies will provide long-term stability and esthetic quality.

Patients and Methods:
The technique involves a submuscular dissection, release of the infranipple portion of the pectoralis muscle combined with the wide subfascial release of the breast gland, and scoring of the deep plane of the superficial glandular fascia. For long-term stability, a firm fixation of the glandular fascia at the inframammary fold to the deep layer of the abdomino-pectoral fascia is critical. Long-term results were analyzed for up to 10 years.

Results:
Postoperative measurements proved the intrinsic balance of the breasts without significant changes over time. The overall complication rate was <5%. Shape stability was observed over 10 years in more than 95% of the patients. Unsightly muscular animation could be avoided in almost every patient.

Conclusions:
Our results indicate that a technique of multiplane breast augmentation provides long-term stability and esthetic quality. By combining the benefits of well-established techniques of a submuscular dual plane, additional shaping through a controlled deep fasciotomy and stable inframammary fold fixation some of the existing tradeoffs of the different methods can be avoided.
Maxillectomy and Flap Reconstruction of Maxillary Defects After Cancer Ablation Through the Lip-Split Parasymphyseal Mandibulotomy Approach in Patients With Advanced-Stage Maxillary Malignant Tumors
Authors: Chen Wei-liang , Zhou Bin , Huang Zi-xian , Chen Rui , Hong Lei , Dong Xiao-yu 
Published: March 2023

Background:
The conventional approach for maxillectomy has some common and serious complications.

Aims:
The present study evaluated the outcomes of maxillectomy and flap reconstruction after cancer ablation using the lip-split parasymphyseal mandibulotomy (LPM) approach.

Methods:
Twenty-eight patients with malignant tumors, including squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma, underwent maxillectomy through the LPM approach. Brown classes II and III were reconstructed with the facial-submental artery submental island flap, an extensive segmental pectoralis major myocutaneous flap, and a free anterolateral thigh flap with the use of a titanium mesh, respectively.

Results:
All proximal margin frozen section specimens showed negative surgical margins. Anterolateral thigh flap failure occurred in 1 patient, whereas ophthalmic and mandibulotomy complications developed in 4 and 7 patients, respectively. In all, 84.6% of the patients had satisfactory or excellent lip esthetic results. Of the patients, 57.1% were alive with no evidence of disease, whereas 28.6% were alive with disease and 14.3% died of local recurrence or distant metastasis. No significant survival difference was evident among the squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma groups.

Conclusions:
The LPM approach can provide good surgical access, facilitating maxillectomy in advanced-stage malignant tumors with minimal morbidity. Facial-submental artery submental island flap and anterolateral thigh flap or extensive segmental pectoralis major myocutaneous flap with a titanium mesh are ideal techniques for reconstructing Brown classes II and III defects, respectively.