bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy
Authors: Stern Karen L. 
Published: March 2023

Purpose of review
Percutaneous nephrolithotomy (PCNL) continues as the gold standard for the surgical management of large renal stones. This short review is intended to highlight recent publications on PCNL of all tract sizes, from mini to standard.

Recent findings
Literature on PCNL in the last 2 years has focused on several main themes – decreasing complications, improving postoperative pain control, and new technology to improve outcomes. Mini-PCNL continues to prove effective and safe, with a new vacuum sheath showing promise of improving stone-free rates and decreasing infections. In terms of infections, preoperative midstream urine culture continues to be a poor indicator of postoperative infection. One of the biggest changes to PCNL practice is the reintroduction of tranexamic acid, which has shown to significantly decrease bleeding and improve outcomes. In terms of postoperative pain control, local blocks are effective and low risk.

Summary
There are many options for surgeons when it comes to PCNL from sheath size to pain management to preoperative medication to decrease bleeding. Future research will continue to highlight, which advances are the most beneficial.
Mesothelioma In Situ Mimicking Well-differentiated Papillary Mesothelial Tumor
Authors: Galateau-Salle Francoise , Hamilton Trevor , MacNeill Andrea , Hofman Véronique , Sequeiros Ruth , Sagan Christine , Le Stang Nolwenn , Churg Andrew 
Published: March 2023

We have previously hypothesized that well-differentiated papillary mesothelial tumor (WDPMT) consists of 2 morphologically identical lesions, one of which is true WDPMT, while the other is a form of mesothelioma in situ. Here, we report 8 examples of the latter phenomenon, 3 with pleural disease (2 men/1 woman, ages 66 to 78 y); and 5 with peritoneal disease (all women, ages 31 to 81 y). At presentation the pleural cases all had effusions but no evidence of pleural tumor on imaging. Four of the 5 peritoneal cases had ascites as the initial finding and all 4 had nodular lesions that by imaging and/or direct inspection were thought to represent a diffuse peritoneal malignancy. The fifth peritoneal case presented with an umbilical mass. Microscopically, the pleural and peritoneal lesions looked like diffuse WDPMT, but all had lost BAP1. Occasional microscopic foci of superficial invasion were present in 3/3 pleural cases, while single nodules of invasive mesothelioma and/or occasional foci of superficial microscopic invasion were found in all of the peritoneal cases. The pleural tumor patients developed what clinically appeared to be invasive mesothelioma at 45, 69, and 94 months. Four/five peritoneal tumor patients underwent cytoreductive surgery and heated intraperitoneal chemotherapy. Three with follow-up data are alive without recurrence at 6, 24, and 36 months; 1 patient refused treatment but is alive at 24 months. We conclude that mesothelioma in situ morphologically mimicking WDPMT is strongly associated with the synchronous or metachronous development of invasive mesothelioma, but that these lesions appear to progress very slowly.
Nipple projection change in immediate breast reconstruction after nipple-sparing mastectomy and use of an acellular dermal matrix strut for maintaining nipple projection
Authors: Kim Jong-Ho , Kang Jiwon , Najmiddinov Bakhtiyor , Kim Eun-Kyu , Myung Yujin , Heo Chan Yeong 
Published: March 2023

Introduction:
Nipple-sparing mastectomy (NSM) has gained popularity as more studies have supported its oncological safety. Although there have been some studies reporting complications including mastectomy flap and nipple necrosis, there have been few reports discussing the change in nipple projection following NSM. This study aimed to analyze the change in nipple projection after NSM and identify risk factors for nipple depression. In addition, we present a new method for maintaining nipple projection.

Methods:
Patients who underwent NSM between March 2017 and December 2020 at our institute were included in this study. We measured the pre- and postoperative nipple projection height and used a nipple projection ratio (NPR) to compare the change in height. Univariate and multivariate analyses were performed to examine the correlation of variables with the NPR.

Results:
A total of 307 patients and 330 breasts were included in this study. There were 13 cases of nipple necrosis. The postoperative nipple height was decreased by 32.8%, which was statistically significant. In multiple linear regression analysis, the use of an ADM strut was positively correlated with the NPR and implant-based reconstruction and post-mastectomy radiation therapy were negatively correlated with the NPR.

Conclusions:
The results of this study demonstrated that the reduction in nipple height after NSM was statistically significant. Surgeons need to be aware of these changes following NSM and explain this possibility to patients who have risk factors. The application of an ADM strut should be considered for the prevention of nipple reduction.
The Ninth and Tenth Costal Cartilages are Available and Safe Options for Rhinoplasty: A Cadaveric Anatomical Study
Authors: Yeo Hyeonjung , Lee Dongkyu , Paik Daehyang , Son Daegu 
Published: March 2023

Summary:
Some authors prefer the ninth costal cartilage for autogenous rhinoplasty, but few anatomical studies focus on tapering shape and harvesting safety regarding pneumothorax risk. Therefore, we studied the size and related anatomy of the ninth and tenth costal cartilages.
Twelve fresh cadavers (24 ribs) were studied. We measured the length, width, and thickness of the ninth and tenth costal cartilages at the osteochondral junction (OCJ), midpoint and tip. To evaluate safety during harvesting, we measured the thickness of the transversus abdominis muscle beneath the costal cartilage.
The mean lengths of the ninth and tenth cartilages were 99.1±25.0 and 60.6±22.5 mm, respectively. The ninth cartilage was 11.8±2.6, 9.0±2.4, and 2.5±0.5 mm wide, and the tenth cartilage was 9.9±2.0, 7.1±2.0, and 2.7±0.5 mm wide at the OCJ, midpoint and tip, respectively. The ninth cartilage was 8.4±2.0, 6.4±1.5, and 2.4±0.6 mm thick, and the tenth cartilage was 7.0±2.2, 5.1±1.7, and 2.3±0.5 mm thick at each point. For the transversus abdominis muscle, the thickness was 2.1±0.9, 3.7±1.0, and 4.5±1.3 mm at the ninth cartilage and 1.9±0.5, 2.9±1.1, and 3.7±1.4 mm at the tenth cartilage at each point.
The size of the cartilage was sufficient for autogenous rhinoplasty. The transversus abdominis muscle provides thickness for safe harvesting. Furthermore, if this muscle is breached during cartilage harvest, the abdominal cavity is exposed but not the pleural cavity. Consequently, there is a very low risk of pneumothorax at this level.
A Novel, Minimally Invasive Festoon Surgery: Mini Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12 Year Analysis
Authors: Gupta Lopa Y. , Gupta Sarina S. , Bamberger Jacob N. , Gupta Kasmira R. 
Published: March 2023

Background:
Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The author presents outcomes with subjective and objective evaluation of an office-based novel, minimally invasive (1 cm incision) festoon repair: MIDFACE (Mini-Incision Direct Festoon Access, Cauterization and Excision).

Methods:
Charts of 75 consecutive patients from 2007 to 2019 were evaluated. Photographs of 39 who met inclusionary criteria were evaluated by 3 expert physician graders for festoon and incision visibility (339 randomly scrambled preoperative and postoperative photographs taken with and without flash and from 4 different views–close-up, profile, full-frontal, and worm’s eye) using paired student t-tests and Kruskal-Wallis tests for statistical evaluation. Surveys returned by 37 of 75 patients were evaluated for patient satisfaction and possible contributing factors to festoon formation or exacerbation.

Results:
There were no major complications in the 75 patients who underwent MIDFACE. Physician grading of 39 patients (78 eyes, 35 women; 4 men; mean 58±7.7 years) demonstrated statistically significant sustained improvement in festoon score postoperatively up to 12 years regardless of view or flash. Incision scores were the same pre- and post-op, indicating incisions could not be detected by photography. Average patient satisfaction was 9.5 on a Likert scale of 0-10. Possible factors for festoon formation or exacerbation included genetic (51%), pets (51%), prior hyaluronic acid fillers (54%), neurotoxin (62%), facial surgery (40%), alcohol (49%), allergies (46%), and sun exposure (59%).

Conclusions:
MIDFACE repair results in sustained improvement of festoons with an office-based, minimally invasive procedure with high patient satisfaction, rapid recovery, and low recurrence.
Active Heating Following Cryolipolysis Reduces Efficacy as well as Side Effects – A Prospective Randomized Split-Body Trial
Authors: Dahmann Sonja , Sanders Agnes , Saarbeck Christina , Batsilas Ioannis , Meyer-Marcotty Max 
Published: March 2023

Background:
Cryolipolysis – a popular noninvasive technique for body contouring – has less side effects compared to liposuction, however, its effectiveness in terms of reducing local adipose tissue is also lower. This study is, to our knowledge, the first prospective controlled, investigator-blinded split body trial to evaluate whether post cryolipolytic heating can increase the efficacy.

Methods:
25 subjects were treated with one session of cryolipolysis on the lower abdomen and a subsequent heating with a mud pack of a randomized side of the treated region (left or right). Epidemiological data, temperature, edema, erythema, hypesthesia and pain level were obtained. Photographs, fat layer thickness (on ultrasound, caliper and abdominal girth), satisfaction and side effects were documented over a follow-up period of 12 weeks.

Results:
The side effects - edema, erythema and hypesthesia – faded almost completely with heating, whereas they remained on the non-heated site. However, the mean sonographic reduction of local adipose tissue after 12 weeks was significantly lower on the heated than on the control sites (9.6% vs. 14.1%; p=0.0003). The overall satisfaction was high (9.2 out of 10 points), even though only 44% of participants had a subjective recognition of fat loss without difference between the sites.

Conclusions:
Active heating following cryolipolysis increases bodily wellbeing by reducing common side effects. However, it reduces the effectiveness of cryolipolysis significantly and should therefore be avoided. Further improvements are necessary to enhance the efficacy of cryolipolysis.
“Extended Frontalis Muscle Advancement Technique for Severe Congenital Blepharoptosis”
Authors: Cang Zheng-Qiang , Liu Chao-Hua , Cui Jiang-Bo , Fan Xiao , Chen Yong-Jun , Song Bao-Qiang , Hao Dong-Yue , Peng Pai , Cao Jiao 
Published: March 2023

Background:
The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and under-correction. This article describes the authors’ extended frontalis muscle advancement technique that takes extensive subcutaneous separation through the eyelid crease incision for the treatment of severe congenital blepharoptosis.

Methods:
A retrospective review was performed that included patients with severe congenital ptosis who underwent extended frontalis muscle advancement technique from April of 2019 to April of 2021. Preoperative evaluation included age, sex, and margin reflex distance 1 (MRD1), levator function, and lagophthalmos. Postoperative evaluation including correction result, closure function of eyelid, cosmetic result was performed at the last follow-up.

Results:
From April of 2019 to April of 2021, a total of 102 patients (137 eyes) who underwent extended frontalis muscle advancement technique were included in the study. The mean postoperative MRD1 in unilateral and bilateral ptosis patients was 3.84 ± 0.60 mm and 3.86 ± 0.56, respectively, and 126 eyes (92.0 percent) showed successful correction. Postoperatively, the mean residual lagophthalmos was 0.88 ± 1.40 mm, and 127 eyes (92.7 percent) showed excellent or good eyelid closure function. The average score of cosmetic results was 8.29 ± 1.34, and 94 patients (92.2 percent) had an excellent or good cosmetic result.

Conclusions:
Extensive subcutaneous separation relieves the mutual restriction between the forehead skin and frontalis muscle. The extended frontalis muscle advancement technique is effective in correcting severe congenital ptosis, while minimizing under-correction, residual lagophthalmos, eyelid contour abnormality and eyebrow ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Defining the Cervical Line in Face Lift Surgery: A Three-Dimensional Study of the Cervical and Marginal Mandibular Branches of the Facial Nerve
Authors: Lindsey John T. , Lee James J. , Phan Ho Tan Phat , Lindsey John T. 
Published: March 2023

Background:
Continuous subSMAS dissection in the cheek with subplatysmal dissection in the neck is an important feature of many face lift techniques, yet the neural anatomy in this area remains unclear, and recommendations regarding continuous dissection of these adjacent areas vary widely. The purpose of this study is to define the vulnerability of the facial nerve branches in this transitional area from the face lift surgeon’s perspective and to specifically identify the location of the cervical branch penetration through the deep cervical fascia.

Methods:
Ten fresh and 5 preserved cadaveric facial halves were dissected under 4X loupe magnification. The skin was reflected followed by elevation of a SMAS-platysma flap with identification of the location of cervical branch penetration through the deep cervical fascia. The cervical and marginal mandibular branches were then dissected retrograde through the deep cervical fascia to the cervicofacial trunk to confirm identifications.

Results:
The anatomy of the cervical and marginal mandibular branches were found to be similar to the other facial nerve branches, all of which initially course deep to the deep fascia in their post-parotid course. The location of emergence of the terminal branch or branches of the cervical branch through the deep cervical fascia was consistently at or distal to a line from a point 5 cm below the mandibular angle on the anterior border of the sternocleidomastoid muscle to the point where the facial vessels course over the mandibular border (Cervical Line).

Conclusion:
Continuous dissection of the SMAS in the cheek with subplatysmal dissection in the neck crossing over the mandibular border is possible without jeopardizing the marginal mandibular or the cervical branches if done proximal to the Cervical Line. This study serves as the anatomic justification of continuous SMAS-platysma dissection and has implications for all types of SMAS flap manipulations.
“Defining the Ideal Male Buttocks”
Authors: Kollu Tejas , Giutashvili Tinatini , Bhat Deepa , Fournier Craig , Patel Ashit 
Published: March 2023

Background:
There is no well-defined male buttock aesthetic. The authors performed a crowdsourced analysis in order to define the ideal male buttocks.

Methods:
A survey was deployed using the Amazon MTurk platform. Respondents rated a panel of digitally altered male buttocks from most to least attractive using three views. Respondents were asked questions pertaining to their own interest in gluteal augmentation, self-reported body type, and other demographics.

Results:
A total of 2,095 responses were recorded; 61% were male, 52% were between the ages of 25-34, and 49% were Caucasian. The preferred lateral ratio in the AP dimension was 1.18, the oblique angle between the sacrum, lateral gluteal depression, and point of maximal projection of the gluteal sulcus was 60 degrees, and posterior ratio between the waist and maximal width of the hips was .66. This corresponds to moderate gluteal projection in the lateral and oblique views, with a narrower gluteal width and defined trochanteric depression in the posterior view. Loss of the trochanteric depression was associated with lower scores. Subgroup analysis revealed differences when stratified by region, race, sexual orientation, employment industry, and athletic interest. No appreciable difference was found based on respondent gender.

Conclusions:
Our results demonstrate that there is a preferred male gluteal aesthetic. This study suggests that males and females favor a more projected male buttock with a more pronounced contour, but preferred a narrow width with defined lateral depression. These findings have the potential to guide future aesthetic gluteal contouring techniques in males.
A Four-Year Institutional Experience of Immediate Lymphatic Reconstruction
Authors: Granoff Melisa D. , Fleishman Aaron , Shillue Kathy , Johnson Anna Rose , Ross JoEllen , Lee Bernard T. , Teller Paige , James Ted A. , Singhal Dhruv 
Published: March 2023

Introduction:
Up to 1 in 3 patients may go on to develop breast cancer-related lymphedema (BCRL) after treatment. Immediate Lymphatic Reconstruction (ILR) is a surgical procedure that has been shown in early studies to reduce the risk of BCRL. However, long-term outcomes are limited due to its recent introduction and different institutions’ eligibility requirements. This study evaluates the incidence of BCRL in a cohort that underwent ILR over the long-term.

Methods:
A retrospective review of all patients referred for ILR at our institution from September 2016 through September 2020 was performed. Patients with preoperative measurements, a minimum 6-months follow-up data and at least one completed lymphovenous bypass were identified. Medical records were reviewed for demographics, cancer treatment data, intra-operative management and lymphedema incidence.
Results: A total of 186 patients with unilateral node-positive breast cancer underwent axillary nodal surgery and attempt at ILR over the study period. Ninety patients underwent successful ILR and met all eligibility criteria, with a mean patient age of 54 (sd: 12.1) years and median BMI of 26.6 (q1-q3: 24.0-30.7) kg/m2. Median number of lymph nodes removed was 14 (q1-q3: 8-19). Median follow-up was 17 months (range: 6-49). 87% of patients underwent adjuvant radiotherapy of which 97% received regional lymph node radiation. At the end of the study period, we found an overall 9% rate of LE.

Conclusion:
Utilizing strict follow-up guidelines over the long-term, our findings support ILR at time of axillary lymph node dissection is an effective procedure that reduces the risk of BCRL in a high-risk patient population.
Long-term Maintenance of Projection of Nipples Reconstructed Using 3D-printed Poly-4-Hydroxybutyrate (P4HB) Bioabsorbable Scaffolds
Authors: Dong Xue , Shih Sabrina , Premaratne Ishani D. , Sariibrahimoglu Kemal , Ginter Paula , Scott Jeffrey , Limem Skander , Spector Jason A. 
Published: March 2023

Background:
For patients who are unable to undergo nipple-sparing mastectomy, reconstruction of the nipple-areolar complex (NAC) has been shown to promote greater satisfaction in cosmetic outcome, body image and sexual relationships. Although there have been a variety of techniques developed to optimize the shape, size, and mechanical properties of the reconstructed NAC, maintenance of sustained nipple projection over time remains a challenge for plastic surgeons.

Methods:
3D-printed Poly-4-Hydroxybutyrate (P4HB) scaffolds were designed and fabricated then 1) filled with either mechanically minced or zested patient-derived costal cartilage (CC) 2) designed with an internal P4HB lattice (rebar) to provide interior structure to foster tissue ingrowth or 3) left unfilled. All scaffolds were wrapped within a CV flap on the dorsa of a nude rat.

Results:
One year after implantation, neo-nipple projection and diameter was well preserved in all scaffolded groups compared to non-scaffolded neo-nipples (p<0.05). Histologic analysis showed significant vascularized connective tissue ingrowth at 12 months in both empty and rebar scaffolded neo-nipples and fibrovascular cartilaginous tissue formation in mechanically processed CC-filled neo-nipples. The internal lattice promoted to more rapid tissue infiltration and scaffold degradation, and best mimicked the elastic modulus of the native human nipple after one year in vivo. No scaffolds extruded or caused any other mechanical complications.

Conclusion:
3D printed biodegradable P4HB scaffolds maintain diameter and projection while approximating the histologic appearance and mechanical properties of native human nipples after one year with a minimal complication profile. These long term pre-clinical data suggest that P4HB scaffolds may be readily translated for clinical application.
Dermal Nipple-Areola Complex perfusion through full thickness circumareolar scars: a porcine model for safe delay in two-stage nipple sparing mastectomy.
Authors: TONDU Thierry , JACOBS Christel , VANDEVIVERE Yzabel , VERHOEVEN Veronique , TJALMA Wiebren , HUBENS Guy , BLONDEEL Phillip , DE GREEF Kathleen , Ysebaert Dirk 
Published: March 2023

Introduction:
Nipple sparing mastectomy (NSM) has evolved to a standard surgical option. NSM complication rate remains high in large breasts. To reduce the risk of necrosis several authors propose delayed procedures to enhance blood supply to nipple-areola complex (NAC). The purpose of this study in a porcine model is to show adequate redirection of NAC perfusion by neoangiogenesis through circumareolar scars.

Methods:
Delayed two-staged NSM is simulated in 52 nipples (6 pigs) with a 60-days interval. The nipples undergo a full thickness circumareolar incision onto the muscular fascia with preservation of underlying glandular perforators. After 60 days NSM is performed through a radial incision. A silicone sheet is introduced in the mastectomy plane to prevent NAC revascularization by wound bed imbibition. Digital colour imaging is used to assess necrosis. Near-infrared fluorescence with indocyanine green (ICG) is used to assess perfusion patterns as well as perfusion in real time.

Results:
No NAC necrosis is seen after 60 days delay in all nipples. In all nipples ICG-angiography shows complete alteration of NAC vascular perfusion pattern from subjacent gland to a capillary fill following devascularization exhibiting a predominant arteriolar capillary blush without distinct larger vessels.
Conclusion: NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full thickness scars provides sufficient dermal perfusion after 60 days delay. Identical staged delay in humans may be a surgically safe NSM option and could broaden therapeutic NSM indications in difficult breasts. Large clinical trials are necessary to provide identical results in human breasts.