Plastic, Reconstructive & Aesthetic Surgery

Thu Jun 22, 2017 04:35
  Comment on JPRAS-D-17-00333"Ex-Vivo Flush Of The Vascularised Limb Allograft Reduces Inflammatory Burden Prior To Transplantation"
by Alexandros G. Sfakianakis via Aesthetic
Although vascularised composite allotransplantation (VCA) is increasingly being performed and for a widening range of indications – some now consider transplantation to be the standard of care for mid-forearm amputations1 – more widespread application is limited by the risks associated with lifelong immunosuppression.

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Thu Jun 22, 2017 03:30
  Traumatic Suprascapular Nerve Injury at the Notch—A Reason for the Posterior Approach in Brachial Plexus Reconstruction
by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603736

Background Optimal dynamic reconstruction of shoulder function requires a functional suprascapular nerve (SSN). Nerve transfer of the distal spinal accessory nerve (dSAN) to the SSN will in many cases restore very good supraspinatus and infraspinatus function. One potential cause of failure of this nerve transfer is an unrecognized more distal injury of the SSN. An anterior approach to this transfer does not allow for visualization of the nerve at the scapular notch which is a disadvantage when compared with a posterior approach to the SSN. Methods All patients of the senior author (S.F.) with traumatic brachial plexus injuries undergoing spinal accessory nerve to SSN transfer via the posterior approach were analyzed. Results Of the 58 patients, 11 (19.0%) demonstrated abnormal findings at the notch. In two of these 11 patients (18.2%), reconstruction was abandoned due to severe injury of the nerve. There was a higher rate of clavicular fractures in patients with SSN injuries at the notch, compared with no SSN injury at the notch (63.6 vs. 12.8%). Conclusion The dSAN to SSN transfer is a reliable reconstruction for restoration of shoulder external rotation and abduction. There is a high proportion of injuries to the nerve at the notch, which can be best appreciated from a posterior approach. The authors, therefore, advocate a posterior approach for this nerve transfer.
[...]


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Thu Jun 22, 2017 03:30
  Erratum to: Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review
by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603827




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Wed Jun 21, 2017 21:35
  Editorial
updated on Thu Jun 22, 2017 02:26 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 70, Issue 7
Author(s): Andrew Hart




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Wed Jun 21, 2017 21:35
  Comment on JPRAS-D-17-00333"Ex-Vivo Flush Of The Vascularised Limb Allograft Reduces Inflammatory Burden Prior To Transplantation"
updated on Thu Jun 22, 2017 02:26 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 21 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Daniel Wilks, Richard Baker, Simon Kay




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Wed Jun 21, 2017 10:11
  Role of Rhinoplasty in Transsexual Patients.
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:11
  Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Letter to PRS Editor: Re: "Comparing Round and Anatomically Shaped Implants in Augmentation Mammoplasty: The Experts' Ability to Differentiate the Type of Implant".
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  FDA authors publish articles on dermal filler materials, injection methods and skin preparation.
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Letter to PRS Editor: Re: "Comparing Round and Anatomically Shaped Implants in Augmentation Mammoplasty: The Experts' Ability to Differentiate the Type of Implant".
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Response to "Facial Contouring by Targeted Restoration of Facial Fat Compartment Volume: The Midface".
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Letter to PRS Editor: "Comparing Round and Anatomically Shaped Implants in Augmentation Mammoplasty: The Experts' Ability to Differentiate the Type of Implant".
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Letter to the PRS Editor: "Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant".
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 10:10
  Reply: Role of Rhinoplasty in Transsexual Patients.
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 07:40
  Palpation for pressure ulcers: examining the bony prominence and physical properties of the wound
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 21, 2017 07:40
  The financial and quality-of-life cost to patients living with a chronic wound in the community
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
ABSTRACT
Chronic wounds are associated with financial and personal costs. The system level expense associated with chronic wounds has been established, however, the out-of-pocket cost incurred by individuals who self-fund has not been the focus of extensive investigation. Recently, there has been renewed interest in evaluating quality of life, in line with the shift to patient enablement and self-care in chronic disease management.

The objectives of this research were to describe the out-of-pocket wound treatment costs and the quality of life of people who have chronic wounds. A questionnaire incorporating the Cardiff Wound Impact Schedule and purpose-designed instruments was completed by a non-probability, convenience sample of 113 people in Australia and Wales. Data was analysed using descriptive statistics.

The sample was on average 63·6 years of age and had wounds that were on an average 109 weeks duration. Participants had spent on average AU$2475 on wound dressing products since the wound started, and AU$121·82 in the most recent 28 days which represented 10% of their disposable income. Health-related quality of life was sub-optimal, 6/10 (ave) according to the Cardiff Wound Impact Schedule. Younger participants reported significantly poorer quality of life on all CWIS sub-scales when compared to older participants.

This study found that chronic wounds present a significant financial cost to individuals who must self-fund their wound dressings and other wound treatment related expenses. Participants who had access to wound product subsidisation also experienced personal financial costs. People who have chronic wounds experience sub-optimal quality of life therefore this condition is also costly to the individual's well-being. The quality of life of younger people has not received adequate attention and requires further consideration given the many years that younger people may have to live with this debilitating and often recurrent condition.

Continued action is required to reduce the financial and personal costs experienced by people who have chronic wounds. It is imperative that healthcare funding is directed to people who have chronic wounds, in particular to alleviate the out-of-pocket costs experienced by self-funders. Continued attention to the quality of life of people who have chronic wounds is required to minimise the negative effects of this condition and enhance well-being.



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Wed Jun 21, 2017 06:01
  Influence of surgical wrist denervation on proprioceptive changes: A systematic review
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
Abstract
The denervation of the wrist is a known method to treat the painful wrist. Pain relief and therefore functional improvement is the main goal to be achieved, but very little is known about other effects such the influence on proprioception. There are references that indicate an effect on reflex arcs after a certain stimulus on the wrist, and thus, changes in proprioception may come along with a surgical denervation. This systematic review was conducted to investigate if there is evidence that assesses the influence of surgical wrist denervation on proprioceptive changes and the methods that were used. Very few articles describe an effect of denervation on the proprioception of the wrist. Reliable tests to measure proprioception are rare. Such tests exist but still they comprise bias and lack of minimation of other influences such as optic input. Subject of further investigation should be proprioception itself and methods to test this quality objectively.

Level II, risk/prognostic study.



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Wed Jun 21, 2017 05:35
  Editorial
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
On the 23rd May the Royal College of Surgeons (England) hosted a NIHR Trauma Research Workshop that scoped the NHS priorities for research in the field of trauma care. As our military colleagues have demonstrated so effectively, particularly in the recent conflict in Afghanistan, Consultant Plastic Surgeons placed at the forefront of operative triage and first debridement have a powerful role in optimising patient outcomes and the efficiency of care pathways. Plastic Surgeons placed at the heart of definitive primary surgical care further enhance the functional restitution and cosmetic optimisation that can let patients regain the purpose and self-worth that are so necessary for holistic wellbeing and socioeconomic stability.

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Wed Jun 21, 2017 02:01
  Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction, a retrospective cohort study
updated on Wed Jun 21, 2017 15:01 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 20 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Christian Bonde, Hoda Khorasani, Jens Hoejvig, Henrik Kehlet
BackgroundA key component of modern analgesics is the use of multimodal opioid sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 inhibitor (COX-2). COX-2 inhibitors could be superior to NSAID due to the well-known side effects from NSAID (bleeding/gastrointestinal ulcers). However, COX-2 inhibitors have been suggested to increase flap failure rates. We report our experience with using COX-2 inhibitors as part of our postoperative MOSA after ABR using free flaps.Materials and Methods132 unilateral, secondary, ABR were performed (DIEP or MS-TRAM) in the NSAID period (2007-2011) and 128 in the COX-2 inhibitor period (2006, 2012-2014). The same surgical team operated all patients. Data were collected prospectively and reviewed to compare the two periods with special focus on re-operations due to bleeding/haematomas and flap thrombosis/failure. Comparisons between the COX-2 inhibitor and NSAID were performed.ResultsMedian age, ischaemia time, blood loss and operating time were similar in the two periods. Significantly more patients were re-operated due to postoperative haematoma in the NSAID group (n= 13/132, 9.8%) compared to the COX-2 inhibitor group, (n=4/128, 3.1 %), (p=0.02). We found no difference in flap loss between the NSAID (n=2/132; 1.5%) and the COX-2 inhibitor group (n=3/128, 2.3%), (p=0.63). No patients suffered thromboembolic complications or gastrointestinal bleeding.ConclusionsMultimodal analgesia using a COX-2 inhibitor is safe in ABR with free flaps and does not increase in flap failure. COX-2 inhibitors seems superior to NSAID with reduced risk of postoperative haematomas.



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Tue Jun 20, 2017 09:50
  SERI Surgical Scaffold in 2-Stage Breast Reconstruction: 2-Year Data from a Prospective, Multicenter Trial
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
imageBackground: Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. Methods: This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement. Investigator satisfaction (11-point scale: 0, very dissatisfied and 10, very satisfied) at 6 months was the primary endpoint. Ease of use, satisfaction, scaffold palpability/visibility, breast anatomy measurements via 3D images, SERI integration, histology, and safety were also assessed through 2 years after stage 1 surgery. Results: Analyses were performed on the per-protocol population (103 subjects; 161 breasts) with no protocol deviations that could affect outcomes. Ease of use and subject and investigator satisfaction with SERI were high throughout 2 years. Breast anatomy measurements with 3D images demonstrated long-term soft-tissue stability of the lower breast mound. Key complication rates per breast were tissue/skin necrosis and wrinkling/rippling (8.1% each) and seroma, wound dehiscence, and breast redness (5.0% each). Over 2 years, 4 breasts in 4 subjects underwent reoperation with explantation of any device; 2 breasts required SERI explantation. SERI was retained in 98.8% of breasts (159/161) at 2 years. Conclusions: SERI was associated with high and consistent levels of investigator and subject satisfaction and demonstrated soft-tissue stability in the lower breast through 2 years. SERI provides a safe, long-term benefit for soft-tissue support in 2-stage breast reconstruction.

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Tue Jun 20, 2017 09:50
  Personality Traits as Predictors of Quality of Life and Body Image after Breast Reconstruction
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
imageBackground: It has been suggested that personality traits may influence patient-reported outcomes of breast reconstruction, but the research is limited. We investigated, in a prospective study, whether personality traits predict the achieved body image and quality of life (QoL) after breast reconstruction. Methods: Patients planning to undergo breast reconstruction at a University Hospital were consecutively recruited from January 2014 to January 2016. Participants completed validated measures of personality, body image, and QoL, before and 6 months after breast reconstruction. The influence of personality traits on achieved body image and QoL was explored with multivariate linear regression modelling, adjusting for baseline scores, demographics, and clinical variables. Results: Of 247 eligible patients, 208 (84%) participated. Twelve patients (6%) were excluded due to failed reconstruction. Of the remaining 196 patients, 180 (92%) completed the follow-up questionnaire. When adjusted for baseline QoL scores, higher trait Neuroticism, higher trait Openness, and higher body mass index measured at baseline showed to be independent and statistically significant predictors of deteriorating QoL scores from baseline to 6-month follow-up (P

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Tue Jun 20, 2017 08:28
  The absence of CD56 expression can differentiate papillary thyroid carcinoma from other thyroid lesions
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
http://orlhealth.blogspot.com/2017/06/the-absence-of-cd56-expression-can.html

The neural cell adhesion molecule CD56 is an antigen important for the differentiation of the follicular epithelium. Recent studies have reported low or absent expression of CD56 in papillary thyroid carcinoma (PTC) and its presence in normal thyroid tissue, benign thyroid lesions, and most follicular non-PTC tumors. Aim: We wish to estimate the value of CD56 in the differentiation of PTC (including follicular variant-PTC [FV-PTC]) from other nontumoral lesions and follicular thyroid neoplasias. Settings and Design: This was a retrospective, case–control study. Subjects and Methods: We analyzed the expression of CD56 in normal thyroid follicular tissue, 15 nonneoplastic thyroid lesions (nodular hyperplasia, Graves' disease, and chronic lymphocytic thyroiditis/Hashimoto), and 38 thyroid follicular cell neoplasms (25 cases of PTC). The immunohistochemical reactions were performed on sections stained with anti-CD56 antibody. Statistical Analysis Used: We used the Chi-square test, values of P< 0.05 being considered statistically significant. Risk analysis was applied on these studied groups, by calculating the odds ratio (OR) value. Results: Our results indicated that CD56 immunoexpression had differentiated PTC from benign nonneoplastic lesions (P = 0.002), as well as from follicular neoplasias (P = 0.046). There were no significant differences regarding CD56 expression between FV-PTC and classical PTC (P = 0.436). The immunoexpression of CD56 has differentiated PTC from other thyroid non-PTC lesions (P < 0.001), with 26.4 OR value. Conclusions: CD56 has been proved to be a useful marker in the diagnosis of PTC, including FV-PTC. Its absence can help differentiate FV-PTC from other thyroid nodules with follicular patterns.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Tue Jun 20, 2017 04:35
  Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction, a retrospective cohort study
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
A key component of modern analgesics is the use of multimodal opioid sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 inhibitor (COX-2). COX-2 inhibitors could be superior to NSAID due to the well-known side effects from NSAID (bleeding/gastrointestinal ulcers). However, COX-2 inhibitors have been suggested to increase flap failure rates. We report our experience with using COX-2 inhibitors as part of our postoperative MOSA after ABR using free flaps.

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Tue Jun 20, 2017 02:20
  Early Markers of Angiogenesis and Ischemia during Bowel Conduit Neovascularization
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603905

Background Bowel flaps are a good and reliable method to restore the continuity of the aerodigestive tract. Radiated fields, contaminated recipient sites, or depleted recipient vessels may increase the risk for ischemic injury after transfer. During ischemic events, we believe that bowel conduits with serosa have a delayed neovascularization process at its new recipient site.We conducted an ischemia/reperfusion murine model to understand the difference among bowel conduits with and without serosa. Materials and Methods Two groups of rats were compared: control group (jejunal conduit with serosa) and a target group (jejunal conduit without serosa). These conduits were harvested from the peritoneal cavity and transferred into a subcutaneous pocket. After 72 hours of transfer and pedicle ligation, histological changes related to ischemia/reperfusion were assessed. In addition, tissue markers of angiogenesis (CD34), ischemia (lactate dehydrogenase [LDH]), and inflammation (interleukin [IL]-1β and IL-6) were analyzed. Results Two groups (n = 20) of male rats were analyzed. Histology showed intact jejunal mucosa in the target group. The control group showed decreased number of mucin, globet cells, decreased height, and fragmentation of villi with the absence of intestinal glands. Markers of angiogenesis (CD34) were higher in the target group. In addition, markers of ischemia (LDH) (p = 0.0045) and inflammation (IL-1b, p = 0.0008, and IL-6, p = 0.0008) were significantly lower in the target group as compared with the control group. Conclusions In circumstances in which the recipient site does not offer an adequate and healthy bed or a vascular insult occurs, bowel flaps with less amount of serosa may be able to neovascularize faster thereby increasing its chances of survival.
[...]


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Tue Jun 20, 2017 02:20
  Accelerated Lymph Flow in Early-Stage Secondary Lymphedema Detected by Indocyanine Green Fluorescence Lymphography
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603740

Background The purpose of this study was to evaluate the lymph function of the lower extremities and to identify early symptoms of lymph dysfunction in secondary lymphedema by observing lymph flow with indocyanine green (ICG) fluorescence lymphography (LG). Methods We retrospectively evaluated the lymph flow of 108 limbs in 54 female patients with leg lymphedema secondary to pelvic lymphadenectomy for gynecological carcinoma and 14 limbs in 7 female controls without a history of pelvic lymphadenectomy or radiotherapy. ICG was injected into four points at the distal part of the lower extremity. Lymph flow was evaluated by measuring the proximal point where the ICG could be observed 5 minutes after rest and 15 minutes after a walking exercise. Results In the controls, lymph flow was stable at rest and was well enhanced by exercise. In patients with early-stage lymphedema, lymph flow was already enhanced at rest (p = 0.005) and was further enhanced by exercise. In advanced-stage lymphedema, lymph flow was not enhanced, even by exercise (p = 0.001). Conclusion ICG-LG could evaluate lymph flow and functions of lymph systems and detect accelerated lymph flow in early-stage secondary lymphedema. Detecting accelerated lymph flow may facilitate early detection and treatment of secondary lymphedema.
[...]


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Mon Jun 19, 2017 22:30
  Delaying Implant-Based Mammary Reconstruction After Radiotherapy Does Not Decrease Capsular Contracture: An In Vitro Study
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 17 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mostafa El-Diwany, Jean-Philippe Giot, Marie-Josée Hébert, Alain M. Danino
The most common complication of irradiated implant-based mammary reconstruction is fibrosis and capsular contracture. The indications for post mastectomy adjuvant radiotherapy have significantly broadened. Facing an increased number of patients who will require radiotherapy, most guidelines recommend delaying reconstruction after radiotherapy to prevent long-term fibrotic complications. Does radiotherapy permanently alter cellular properties which will adversely affect implant-based reconstruction? If so, is there a benefit in delaying reconstruction after radiotherapy?Our in-vitro model simulates two implant-based mammary reconstruction approaches: the irradiated implant and the delayed implant reconstruction beneath healthy un-irradiated tissue post radiotherapy. We performed cell culture of fibroblasts and endothelial cells, in an attempt to simulate these two surgical conditions. Irradiated fibroblasts simulate the capsular tissue seen around the breast-implant. The delayed reconstruction approach is simulated by non-irradiated fibroblasts conditioned with supernatant culture media obtained from irradiated endothelial cells.Irradiation induced fibrosis through fibroblast differentiation into myofibroblasts, as demonstrated by increased α-smooth-muscle actin levels in fibroblasts. This constitutes the basis for scar tissue contraction observed in irradiated implant-based breast reconstruction. Irradiation of endothelial cells induced irreversible cell cycle arrest known as senescence and secretion of the pro-fibrotic connective tissue growth factor. Non-irradiated fibroblasts conditioned with culture media obtained from irradiated endothelial cells exhibited myofibroblast differentiation and expression of fibrotic phenotype akin to capsular contracture.Our results demonstrate that radiotherapy causes irreversible cellular changes which permanently alter the microenvironment in favour of fibrosis. Given that these changes are permanent, delaying reconstruction does not present an advantage in preventing capsular contracture.



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Mon Jun 19, 2017 22:30
  Microneedling: Where do we stand now? A systematic review of the literature
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 17 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ramaut Lisa, Hoeksema Henk, Pirayesh Ali, Stillaert Filip, Monstrey Stan
BackgroundPatients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging.ObjectiveThis review aims to evaluate the current evidence in the literature on microneedling.MethodsA systematic literature review was performed by searching the electronic databases Pubmed and Google Scholar. The reviewed articles were analysed and compared on study design, treatment protocol, outcome parameters, efficacy measurement and results to evaluate the strength of the current evidence.ResultsMicroneedling was investigated in experimental settings for its effects on atrophic acne scars, skin rejuvenation, hypertrophic scars, keloids, striae distentiae, androgenetic alopecia, melasma and acne vulgaris. Several clinical trials used randomisation and single-blindation to strengthen the validity of the study outcome. Microneedling showed significant results when used on its own and when combined with topical products or radiofrequency. When compared to other treatments, it showed similar results but was prefered due to minimal side-effects and shorter downtime.ConclusionThis systematic review positions microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles. The current literature does show some methodological shortcomings and further research is required to truly establish microneedling as an evidence based therapeutic option for treating scars, wrinkles and other skin conditions.



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Mon Jun 19, 2017 22:30
  A prospective randomized study comparing centrifugation and sedimentation for fat grafting in breast reconstruction
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 17 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): I. Sarfati, R.F.D. van la Parra, C.A. Terem-Rapoport, D. Benyahi, C. Nos, K.B. Clough
BackgroundFat grafting is an efficient method to correct large volumetric defects after mastectomy.There is ongoing debate regarding the best method of processing the harvested fat before fat grafting. The aim of this study was to introduce a new MRI-model and to compare two fat processing techniques measuring the gain in soft tissue thickness after fat grafting to the chest wall.MethodsFifty-one mastectomy patients (one double sided), who required delayed implant reconstruction, and with poor skin conditions were proposed fat grafting prior to implant reconstruction. At the time of fat grafting patients were randomly assigned to centrifugation or sedimentation of the aspirated fat. The trial was undertaken in a single-center private practice setting. The gain in soft tissue thickness of the chest wall was measured using an MRI model, with twelve predefined points for measurement. Two MRI's were performed, one prior to fat grafting and one eight weeks thereafter. The radiologist was blinded for the fat graft processing method used.ResultsSeven cases were excluded because they did not complete their second MRI. The analyses was thus based on 44 patients (one double sided). Centrifugation was performed in 21 cases and sedimentation in 24 cases. The mean gain in soft tissue thickness was +7.0 mm in the centrifugation group and +8.8 mm in the sedimentation group (p = .268). The mean operative time was 88 minutes in the centrifugation group and 78 minutes in the sedimentation group (p=. 11). There were no adverse events for any of the patients.ConclusionsWe developed a simple and reproducible MRI model to objectively measure and evaluate different fat processing techniques prior to fat grafting. With a median time of eight weeks after one session of fat grafting, there was no benefit of centrifugation over sedimentation.



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Mon Jun 19, 2017 19:14
  Exercise prior to, but not concomitant with, stress reverses stress-induced delayed skin wound healing
updated on Tue Jun 20, 2017 14:41 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Stress-induced prolonged inflammation impairs cutaneous wound healing. Exercise may inhibit this effect via an anti-inflammatory mechanism. Our aim was to investigate the effect of moderate exercise on skin wound healing in chronically stressed mice. Mice were trained five times per week on a treadmill or received no training. Mice underwent daily rotational stress from the 6th week until euthanasia. During the 8th week, two wounds were created in the dorsum and collected 10 days later. A control group only received wounds. Exercise was performed prior to and simultaneous with stress for two weeks or only prior to stress. Stress increased normetanephrine levels 10 days after wounding, resulting in an increased amount of inflammatory cells and reduced expression of inflammatory cytokines as well as angiogenesis, myofibroblast differentiation and matrix deposition. Concomitant exercise and stress potentiated these effects, intensifying the delayed wound contraction. When exercise was performed only prior to stress, however, the mice showed reduced inflammatory cells in granulation tissue 10 days after wounding and improved wound healing compared to animals with exercise and concomitant stress. Moderate exercise in association with stress potentiates the stress effect; however, when exercise was performed prior to stress, wound healing was improved. This article is protected by copyright. All rights reserved.



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Mon Jun 19, 2017 09:50
  Microsurgical reconstruction of pharyngoesophageal defects—case series and critical review of the literature
updated on Mon Jun 19, 2017 14:40 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
The reconstructive goals after laryngopharyngoesophagectomy are the reestablishment of the digestive conduit, achievement of adequate swallowing, and voice restoration. The pharyngoesophageal segment is typically reconstructed with a jejunal or a fasciocutaneous free flap. The gastro-omental free flap offers unique advantages in high-risk surgical fields. The best reconstructive option is still a matter of controversy. A retrospective study was conducted to assess the morbidity and functional results of microsurgical pharyngoesophageal reconstructions performed at our institution in the last 16 years and compare them with the literature.

Methods
A retrospective review was conducted on patients who underwent pharyngoesophageal microsurgical reconstruction between 1999 and 2016 at a single institution. The perioperative morbidity, mortality, and functional outcomes were evaluated and compared with similar published case series.

Results
A total of 14 free flap reconstructions were performed, after pharyngolaryngoesophagectomy or pharyngoesophageal radionecrosis. Patients received jejunal, radial forearm, gastro-omental, or anterolateral thigh flaps. There was one flap failure and one perioperative death. The rates of stricture and fistula were 8.3 and 16.7%, respectively. Oral diet was achieved in all patients and 71% have been considered to have an intelligible speech. At 1-year post-op, 71.4% of the patients were alive and the 3-year survival rate was 35.7%.

Conclusions
The reconstruction of the pharyngoesophageal segment requires safe, reliable, and functional single-stage solutions. Fasciocutaneous flaps seem to provide better functional results and allow a shorter hospital stay, while enteric flaps appear to be more reliable in adverse surgical fields.

Level of Evidence: Level IV, therapeutic study.



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Sun Jun 18, 2017 10:14
  Forked Columellar Strut: An Adjunctive Technique for Correction of Caudal Septal Deviation
updated on Sun Jun 18, 2017 15:04 by Alexandros G. Sfakianakis via Aesthetic
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Sat Jun 17, 2017 23:19
  Measuring the carbon footprint of Plastic Surgery: a preliminary experience in a Chilean teaching hospital
updated on Sun Jun 18, 2017 03:43 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 16 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Juan Enrique Berner, Maria del Pilar Gras, Luigi Troisi, Thomas Chapman, Pedro Vidal




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Sat Jun 17, 2017 23:19
  Reply to: ‘Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up’
updated on Sun Jun 18, 2017 03:43 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 16 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nihull Jakharia-Shah, Priyanka Chadha, Jenny Geh




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Sat Jun 17, 2017 23:19
  Pedicled Omental Flaps in the treatment of complex spinal wounds after en-bloc resection of spine tumors
updated on Sun Jun 18, 2017 03:43 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 16 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Andrea Sambri, Alessandro Gasbarrini, Sergio Cialdella, Pierandrea De Iaco, Stefano Boriani
Study DesignA retrospective study of 5 patients who underwent pedicled omental flap following spine tumor removal.Summary of Background DataPostoperative wound dehiscence represents a major complication in spinal surgery, in particular after en-bloc tumor resections, due to the extended sacrifice of soft tissues and adjuvant radiation and chemotherapies.MethodsFive patients (mean age of 52 years (range, 24-71 years) who underwent omental flaps for the treatment of post-operative complication in spine tumor resections were retrospectively evaluated.ResultsFour out of 5 patients underwent omental transposition after a mean of 15 months (range, 4-27) from the previous surgery because of a dehiscence of the wound (all of them had cerebrospinal fluid leak, 1 transpleural, in 3 cases associated to deep infection) whereas 1 patient underwent the omental flap procedure at the time of elective spinal surgery because of several contemporary risk factors for wound healing.At the time of discharge after a mean of 36 days (range, 23-53), all patients had well-healed surgical wounds with an acceptable structural and aesthetic result.One of the patients had ileus, requiring a surgical lysis of abdominal adhesions 3 months after omentum flap procedure. No other complications were observed.ConclusionOur data suggest that a pedicled omental flap is a viable option for the treatment of complicated spinal wounds, helping in the resolution of the infection and CSF leak.



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Sat Jun 17, 2017 10:24
  Bilateral HPV Positive Squamous Cell Carcinoma In Situ of Conjunctiva.
updated on Sat Jun 17, 2017 14:47 by Alexandros G. Sfakianakis via Aesthetic
A 45 year-old woman presented with blurred vision and irritation of the left eye. Clinical examination revealed a superior palpebral conjunctival lesion consistent with a diagnosis of papilloma. She was lost to follow up despite repeated attempts to schedule a biopsy, and presented again after an extended period with bilateral disease. Subsequent biopsy confirmed bilateral squamous cell carcinoma in situ which was human papilloma virus-16 positive by molecular testing. She declined further treatment; during the subsequent year, the lesions extended across the bulbar conjunctiva bilaterally. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Sat Jun 17, 2017 10:24
  Ultrasonographic Images of Nasal Bone Fractures with Water Used as the Coupling Medium
updated on Sat Jun 17, 2017 14:47 by Alexandros G. Sfakianakis via Aesthetic
imageBackground: Ultrasonography can show local and superficial fractures of the nasal bone. However, it is difficult to see the whole nasal bone. We used water as the coupling medium for ultrasonography. Methods: This method was used in 76 nasal bone fracture cases from July 2011 to March 2013, and we could obtain clear images of the entire nasal bone and surrounding bones. However, in some images, there were artifacts and blurred areas. The patterns of blurring were classified and their causes were analyzed. Results: The 6 patterns of artifacts and blurred images were (1) Blurred side wall of the nasal bone in 68 cases, (2) air bubbles in the water in 68 cases, (3) unclear deep portions by attenuation in 23 cases, (4) distorted images caused by shaking of the probe in 44 cases, (5) parallel shadows due to multiple reflections in 18 cases, and (6) mysterious shadows caused by side lobes of the ultrasound beams in 55 cases. Almost all of them could be avoided by adding some small changes of techniques. Conclusions: Our methods can provide whole clear images of the nasal bone and surrounding bones in 1 field. Almost all the artifacts and blurred images which occurred during the performance of our methods could be avoided by adding some small changes, for example, tilting the probe, pouring the water slowly, and moving the probe closer to the nose.

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Sat Jun 17, 2017 05:10
  Reply to: ‘Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up’
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
We read with great interest the paper entitled 'Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up,' by Rose et al.1 The article raised some excellent points regarding the necessity and sustainability of regular specialist follow-up of low-risk squamous cell carcinoma (SCC). We too have recently conducted an analysis of SCC recurrence and follow-up schedules via a retrospective analysis of SCCs excised by the senior author over a 2-year period from January 2014 to January 2016.

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Sat Jun 17, 2017 05:09
  Delaying Implant-Based Mammary Reconstruction After Radiotherapy Does Not Decrease Capsular Contracture: An In Vitro Study
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
The most common complication of irradiated implant-based mammary reconstruction is fibrosis and capsular contracture. The indications for post mastectomy adjuvant radiotherapy have significantly broadened. Facing an increased number of patients who will require radiotherapy, most guidelines recommend delaying reconstruction after radiotherapy to prevent long-term fibrotic complications. Does radiotherapy permanently alter cellular properties which will adversely affect implant-based reconstruction? If so, is there a benefit in delaying reconstruction after radiotherapy?Our in-vitro model simulates two implant-based mammary reconstruction approaches: the irradiated implant and the delayed implant reconstruction beneath healthy un-irradiated tissue post radiotherapy.

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Sat Jun 17, 2017 05:09
  Microneedling: Where do we stand now? A systematic review of the literature
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging.

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Sat Jun 17, 2017 05:09
  Pedicled Omental Flaps in the treatment of complex spinal wounds after en-bloc resection of spine tumors
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
A retrospective study of 5 patients who underwent pedicled omental flap following spine tumor removal.

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Sat Jun 17, 2017 05:09
  Measuring the carbon footprint of Plastic Surgery: a preliminary experience in a Chilean teaching hospital
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
Global warming is an ongoing phenomenon defined by a steady increase in the Earth temperature. Even though still controversial, evidence suggests that human activity could have an impact on this process by the emission of the so-called greenhouse gases.

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Sat Jun 17, 2017 05:09
  A prospective randomized study comparing centrifugation and sedimentation for fat grafting in breast reconstruction
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
Fat grafting is an efficient method to correct large volumetric defects after mastectomy.There is ongoing debate regarding the best method of processing the harvested fat before fat grafting. The aim of this study was to introduce a new MRI-model and to compare two fat processing techniques measuring the gain in soft tissue thickness after fat grafting to the chest wall.

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Sat Jun 17, 2017 04:29
  Le lifting ou bodylifting trochantéro sous-fessier (TSF) une technique adaptée aux gros excès trochantériens : à propos de 11 cas
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 16 June 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Ruffenach, C. Bruant-Rodier, E. Robert, F. Bodin, C. Dissaux
IntroductionLes séquelles d'amaigrissement font l'objet d'une demande croissante. Au-delà de l'abdominoplastie, le bodylifting ajoute au traitement antérieur une remise en tension cutanée postérieure dont le gain morphologique porte essentiellement sur la partie supérieure de la ceinture pelvienne, siège de la cicatrice. Certaines femmes ont une morphologie particulière avec un excès trochantérien majeur qui justifie d'un traitement spécifique.Matériel et méthodesSur la base de la technique publiée en 1964 par Pitanguy, les auteurs proposent un lifting de la face externe de la cuisse dont la cicatrice redessine la partie inférieure de la fesse, du sillon sous-fessier vers la région inguinale, en croisant la région trochantérienne. Onze cas d'excès trochantériens majeurs après amaigrissement sont présentés. Dans 4 cas, l'excès trochantérien est traité par lifting trochantéro sous-fessier (TSF) seul. Dans 7 cas, il est associé à une abdominoplastie pour réaliser un bodylifting TSF.RésultatsLes complications et les résultats sont présentés. L'excès trochantérien est réduit, la fesse harmonieuse et les patientes satisfaites.DiscussionLes modifications sont apportées à la technique tant décriée de Pitanguy ; la liposuccion dédermisation remplace la résection monobloc, la cicatrice se verticalise sur le trochanter pour rejoindre la cicatrice de l'abdominoplastie. Cette technique est une alternative à la résection verticale face externe des cuisses associée au bodylifting classique.ConclusionLe lifting TSF est une solution élégante pour traiter les gros excès trochantériens. Il est adaptable. Il peut devenir un bodylifting TSF dans les cas de grands amaigrissements.IntroductionThere is a growing demand for weight loss sequelae. Some women have a particular morphology with a major trochanteric excess that warrants specific treatment.Materials and methodsOn the basis of the technique published in 1964 by Pitanguy, the authors suggest a lift of the external face of the thigh with the scar redrawing the lower part of the buttock, from the gluteal fold to the inguinal region by crossing the trochanteric region. Eleven cases of major trochanteric excess after slimming are presented. In 4 cases, the trochanteric excess is solely treated by trochanteric under gluteus lift. In 7 cases, it is associated with abdominoplasty to perform a trochanteric under gluteus bodylifting.ResultsComplications and results are presented. The trochanterian excess is reduced, the buttock is harmonious and the patients satisfied.DiscussionModifications are made to the much criticized technique of Pitanguy. The lipectomy replaces the monobloc resection, the scar is verticalized on the trochanter to join the abdominoplasty scar. This technique is an alternative to the vertical trochanteric resection associated with classic bodylift.ConclusionThe trochanteric under gluteus lift is an elegant solution for treating large trochanteric excess. It is adaptable. It can become bodylifting TSF in the cases of great slimming.



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Sat Jun 17, 2017 04:29
  La reconstruction de lèvre inférieure selon Camille Bernard : mise au point sur une confusion éponymique
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 16 June 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): K.W. Marck, D. Martin
L'utilisation d'éponymes honore ceux qui ont contribué au développement de la médecine et facilite la communication entre collègues. Elle impose une bonne connaissance historique pour savoir qui est vraiment le premier à avoir proposé une technique donnée. Au 19e siècle, deux différentes opérations portant sur la lèvre inférieure ont reçu l'« appellation » Camille Bernard. En nous plongeant dans la littérature médicale des années 1853 à 1855, nous avons tenté d'élucider les rôles respectifs de quatre chirurgiens impliqués dans ces techniques : Bernard, Saemann, Desgranges et Burow. Il ressort de cette étude que Bernard, Burow et Desgranges méritent tous trois une appellation éponyme comme nous l'avons démontré.The use of eponyms honours those who have contributed to the development of medicine and facilitates communication between colleagues. Eponyms are based on historical knowledge to know who was the first to use a given technique. In the previous century, two different operative procedures have been attached to the 'so called' Bernard lower lip reconstruction. This historical literature on lip reconstruction with a focus on the years 1853–1855 elucidates the roles of Bernard, Saeman, Desgranges and Burow, and gives suggestions for eponyms that do justice to the innovating surgeons Bernard, Burow and Desgranges.



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Sat Jun 17, 2017 04:29
  Endoscopic robot-assisted C7 nerve root retrophalangeal transfer from the contralateral healthy side: A cadaver feasibility study
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 16 June 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): C. Bijon, L. Chih-Sheng, D. Chevallier, N. Tran, F. Xavier, P. Liverneaux
Controlateral C7 nerve root transfer in brachial plexus palsy requires a nerve graft and large incisions. This study investigated the feasibility of transferring the right C7 to the left C7 nerve root, without a graft, via a minimally invasive retropharyngeal approach. After installation of 6 trocars of 1cm diameter in the supraclavicular space, a Da Vinci SI® robot was placed. After locating the right brachial plexus, the C7 root was sectioned flush with the clavicle, transferred behind the pharynx and sutured to the left C7 root severed at the foramen level. The duration of the procedure was 2h40min. No technical difficulties were encountered. The hypothesis of this work was verified since it was possible to carry out a transfer of the right C7 root on the left C7 root by direct retropharyngeal suture without graft and by a minimally invasive technique.



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Sat Jun 17, 2017 04:29
  Chirurgie mammaire de réassignation vers le sexe masculin : étude rétrospective de la satisfaction des patients transsexuels après mastectomie
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 16 June 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): B. Bertrand, A.-S. Perchenet, T.R. Colson, D. Drai, D. Casanova
IntroductionLa mastectomie bilatérale de réassignation sexuelle vers l'homme est la première et souvent l'unique intervention chirurgicale permettant au patient transsexuel d'accéder physiquement au sexe masculin. C'est une chirurgie spécialisée nécessitant un accompagnement psychologique particulier. L'objectif de notre étude était d'évaluer la satisfaction des patients opérés de mastectomie bilatérale de réassignation vers le sexe masculin et l'impact sur leur vie sociale et personnelle.Matériel et méthodeL'ensemble des 22 patients opérés entre janvier 2012 et mars 2013 pour mastectomie bilatérale de réassignation ont été contacté par courrier pour être inclus dans l'étude. La satisfaction après intervention était mesurée par auto-questionnaire adapté du questionnaire de reconstruction mammaire du Q-Breast modifié pour la chirurgie de réassignation sexuelle. Un score global supérieur à 320/378 était considéré comme « tout à fait satisfaisant ».RésultatsSeize patients sur 22 (73 %) ont répondu au questionnaire. Le score moyen était de 332/378, correspondant à un résultat « tout à fait satisfaisant ». Le score d'évaluation du bien-être psychologique était de 54,5/60.ConclusionNotre étude a confirmé le bénéfice réel de la chirurgie de mastectomie bilatérale dans le processus de réassignation sexuelle vers l'homme, à la fois en termes de qualité de vie et de confiance en soi. Les patients ont rapporté une importante satisfaction quelle que soit la technique utilisée et une amélioration de l'intégration sociale après chirurgie. Cependant, cette chirurgie ne doit s'envisager que dans le cadre d'une prise en charge globale par une équipe multidisciplinaire expérimentée.BackgroundMammaplasty in gender reassignment surgery is often poorly understood, due to a lack of information about this condition and its therapy. The aim of this work was to evaluate patient satisfaction following bilateral mastectomy for female-to-male gender reassignment.MethodsWe contacted 22 patients who underwent mammaplasty for female-to-male gender reassignment between January 2012 and March 2013 in our university hospital. Patients were sent postal questionnaires. A modified Q-breast questionnaire adapted for gender reassignment surgery enabled us to objectively evaluate patient aesthetic and psychological satisfaction. An overall score superior to 320 was considered as very satisfied for the patient.ResultsA total of 73% of the patients answered the questionnaire. The mean score was 332/378. This score corresponded to "very satisfied" on our questionnaire. The psychological score was 54.5/60.ConclusionThis study showed that a real benefit was obtained in terms of patient quality of life and self-confidence. The high level of patient satisfaction confirmed that gender reassignment mastectomy is a useful and valid procedure, which enables these patients to reclaim their place in society. It can only be considered if it is within the framework of structures that ensure comprehensive and pluridisciplinary treatment for the patient.



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Sat Jun 17, 2017 04:29
  Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database
updated on Sat Jun 17, 2017 09:33 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603739

Background Patients diagnosed with end-stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction. Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction. Methods Two cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD). Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p < 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30-day mortality. However, there was no significant difference regarding flap failure among groups. Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patient's medical condition to succeed with this reconstructive effort.
[...]


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Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Fri Jun 16, 2017 18:34
  Noninvasive screening test for detecting early stage lymphedema using follow-up computed tomography imaging after cancer treatment and results of treatment with lymphaticovenular anastomosis
updated on Fri Jun 16, 2017 22:58 by Alexandros G. Sfakianakis via Aesthetic
Background
Although early detection is valuable for secondary lymphedema treatment, existing screening tests are not popular. This study aimed to propose a novel method of screening lymphedema patients based on the thickness of the subcutaneous fat measured with perioperative computed tomography (CT) and present the results from evaluation of patients who underwent those examinations was performed.

Method
The medical records of 96 gynecological cancer patients and 189 breast cancer patients, whose lymphatic function was assessed with indocyanine green lymphography, were reviewed. In gynecological cancer patients, the perioperative temporal subcutaneous fat thickness index (T-SFTI) was calculated from presurgical and follow-up CT data, and in breast cancer patients, the postoperative crosswise subcutaneous fat thickness index (C-SFTI) was calculated. In lower extremity lymphedema patients, the effect of lymphaticovenular anastomosis (LVA) was also evaluated using T-SFTI.

Results
Perioperative T-SFTI was assessed in 180 lower extremities, and it was significantly higher in 46 lymphatic dysfunction limbs (1.21 ± 0.08) than in 134 normal lymphatic function limbs (1.03 ± 0.08), (P < .01). Postoperative C-SFTI was assessed in 53 upper extremity, and it was significantly higher in 11 lymphatic dysfunction limbs (1.31 ± 0.21) than in 42 normal lymphatic function limbs (1.01 ± 0.06), (P < .01). In lower extremity lymphedema patients, T-SFTI improved significantly after planned conservative treatments and LVA (P = .04).

Conclusion
Assessment of subcutaneous fat thickness using CT is useful for screening early stage lymphedema. If the efficacy of this method is validated, patients worldwide may be assessed using the same criterion.



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Fri Jun 16, 2017 11:24
  Erratum zu: Hybridoperationssaal vs. konventioneller Operationssaal
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 16, 2017 11:24
  Single-incision-Laparoskopie
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
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Zusammenfassung
Hintergrund
Seit Einführung der Single-incision-Laparoskopie (SIL) besteht Uneinigkeit innerhalb der Fachgesellschaften zur generellen Empfehlung einer Anwendung dieser minimalinvasiven Methode.

Fragestellung
Prüfung der wissenschaftlichen Evidenz in der Darstellung verbesserter Ergebnisse im Vergleich zur Multi-port-Laparoskopie (MPL).

Material und Methoden
Beschreibung der aktuellen technischen Entwicklung mit Auswertung der rezenten prospektiv randomisierten Studien und methodisch hochwertigen Metaanalysen bezogen auf verschiedene Organbereiche. Diskussion der eigenen Erfahrungen anhand von 4209 SIL-Eingriffen.

Ergebnisse
Die SIL findet in allen Bereichen der Allgemein- und Viszeralchirurgie Anwendung. Im Zuge der großen Euphorie der ersten Jahre wurden vielfach methodisch schwache Studien publiziert. Der generelle Beweis einer signifikanten Verbesserung der Morbidität ist wissenschaftlich nicht erbracht. Die Verbesserung des kosmetischen Ergebnisses ist entweder offenkundig (SIL-Leberresektionen) oder aber nicht klar belegbar (SIL-Cholezystektomien).

Diskussion
Nach überwundener Lernkurve erweist sich die SIL als sicher und machbar. Die wissenschaftliche Evidenz erlaubt keine Pro- oder Kontra-Stellungnahme ohne Berücksichtigung der individuellen chirurgischen Expertise.



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Fri Jun 16, 2017 10:29
  Becker nevus syndrome and ipsilateral breast hypoplasia: a systematic literature review
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Although the Becker nevus syndrome (BNS) is primarily defined as a Becker nevus (BN) in association with ipsilateral breast hypoplasia or musculoskeletal malformation, there are case reports about various associated malformations. The purpose of this study was to identify and analyze the common manifestations of the BNS. We conducted a systematic literature research about BNS and reviewed all available literature. In order to get an overview of the clinical manifestation, we analyzed all case reports by descriptive statistics. The most common manifestation of a BNS is breast hypoplasia, followed by musculoskeletal malformation and scoliosis. The regional correspondance between the skin manifestation and the malformation was strong for breast hypoplasia, musculoskeletal malformation, maxillofacial dysplasia, and lipodystrophy. Not all of the reported malformations are likely to be a manifestation of the BNS. By far, the most commonly described malformation is ipsilateral breast hypoplasia. Therefore, we would like to enhance the awareness of this syndrome among plastic surgeons.

Level of Evidence: Not ratable.



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Fri Jun 16, 2017 06:40
  3D Cone Beam Computed Tomography Volumetric Outcomes of rhBMP-2/demineralized bone matrix vs Iliac Crest Bone Graft for Alveolar Cleft Reconstruction*.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Background: Recent studies indicate that recombinant human bone morphogenetic protein (rhBMP-2) in a demineralized bone matrix scaffold (MS) is a comparable alternative to iliac bone autograft in the setting of secondary alveolar cleft repair. Post-reconstruction occlusal radiographs demonstrate improved bone stock when rhBMP-2/MS is used, but lack the capacity to evaluate bone growth in three dimensions. This study uses cone beam computed tomography (CBCT) to provide the first clinical evaluation of volumetric and density comparisons between these two treatment modalities. Methods: A prospective study was conducted with 31 patients and 35 repairs of the alveolar cleft over a two-year period. Twenty-one repairs utilized rhBMP-2/MS while 14 repairs utilized iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months to evaluate bone fill; CBCT images were obtained at 6-9 months to compare volumetric and density data. Results: At 3 months, postoperative occlusal radiographs demonstrate that 67% of patients receiving rhBMP-2/MS had complete bone fill of the alveolus, vs 56% of patients in the autologous group. In contrast, CBCT data shows 31.6% (95% CI: 24.2- 38.5%) fill in the rhBMP-2/MS group compared with 32.5% (95% CI: 22.1-42.9%) in the autologous population. Density analysis demonstrated identical average values between the rhBMP-2/MS and iliac bone crest group (1.38g/cc). Conclusions: These data demonstrate comparable bone regrowth and density values following secondary alveolar cleft repair using rhBMP-2/MS vs. autologous iliac bone graft. CBCT provides a more nuanced understanding of true bone regeneration within the alveolar cleft that may contribute to the information provided by occlusal radiographs alone. (C)2017American Society of Plastic Surgeons

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Fri Jun 16, 2017 06:40
  The Whitaker Classification of Craniosynostosis Outcomes: An Assessment of Inter-Rater Reliability.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Purpose: The Whitaker classification (WC) is a simple and widely used system for describing aesthetic outcomes after craniosynostosis surgery. The purpose of this study is to evaluate its inter-rater reliability for patients who have undergone frontal-orbital surgery. Methods: A retrospective review of patients with craniosynostosis who underwent surgical intervention at a tertiary referral center was conducted. Inclusion criteria were: single-suture craniosynostosis, surgical intervention before age two years, and photographs taken prior to revisions between 5 and 20 years of age. Thirteen craniofacial surgeons independently reviewed the subject's photographs and assigned WC. Inter-rater reliability was assessed with Cohen's kappa. Results: Twenty-nine subjects were included. Average ages at surgery and the time of post-operative photographs were 0.8 years, and 12.8 years, respectively. The [kappa] value for all 13 raters was 0.1567 (p

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Fri Jun 16, 2017 06:39
  Discussion: Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 16, 2017 06:39
  Academic Productivity, Knowledge, and Education in Plastic Surgery: The Benefit of the Clinical Research Fellow.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Summary: Academic research productivity is limited by strenuous resident and faculty schedules, yet is imperative to the growth and success of our discipline. We report institutional experience with our clinical research fellowship model, providing two positions per year. A critical analysis of research productivity was performed for all trainees, faculty, and research fellows from 2000-2015. All articles in-print were individually collected to identify academic appointment at time of publication for the authors. Academic productivity was determined by number of peer-reviewed publications, podium presentations, and h-index. Podium presentations at two national and one regional plastic surgery meetings were collected. Academic fate of previous research fellows was also noted. Overall, 18 faculty, 38 fellows, 41 residents, and 8 research fellows were included. During the 16-year time-frame, 484 articles were published in print. Notably, 92 articles were published from 2000-2007 and 392 articles were published from 2008-2015 (p=0.0066), demonstrating linear growth after instituting the research fellowship. Additionally, 33 articles were published from 2002-2004 pre-leadership change, 47 from 2005-2007 post- leadership change but pre-fellowship, and 58 from 2008-2010 in the first few years of the fellowship (p=0.0204). Overall, 39.9% of publications appeared in PRS, with a total of 77 different peer-reviewed journal inclusions. AAPS, ASPS, and NESPS podium presentations totaled 143 between 2005-2015. Of the 8 previous fellows who applied into integrated and independent programs, 100% have matched. Incorporation of a formalized research fellowship into a plastic surgery program can drastically increase clinical research contribution in a reproducible fashion. (C)2017American Society of Plastic Surgeons

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Fri Jun 16, 2017 06:39
  Soft Tissue Reconstruction of Large Spinal Defects: A 12-year Institutional Experience.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Background: Radical spinal resections can lead to considerable defects requiring soft tissue reconstruction. The purpose of this study was to review our institutional experience of over a decade with reconstruction of spinal defects and identify risk factors predictive of wound complications, particularly focusing on timing of reconstruction with ablative surgery. Methods: We retrospectively reviewed patients who underwent spinal resection and required soft tissue reconstruction from 2002-2014. Patient characteristics, operative details, and complication rates were collected. Logistic regression was performed to identify risk factors for wound complications. Results: Of 289 reconstructions performed in 259 patients, 64 cases (22.1%) had major wound complications requiring reoperation. Lumbosacral defects were the most common location (43.6%) and paraspinous muscle flaps were the preferred reconstructive method used for all defect regions. A total of 224 reconstructions (77.5%) were performed immediately at time of spinal surgery, and 65 (22.5%) were performed in delayed fashion as result of wound complications from previous spinal surgery. Patients with immediate reconstructions required significantly fewer instrumentation removal rates (0.9% v. 4.6%, p=0.043), unplanned reoperations (0.5 v. 1.3, p

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Fri Jun 16, 2017 06:39
  Facial Contouring by Targeted Restoration of Facial Fat Compartment Volume: The Midface.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 16, 2017 06:39
  Discussion: Gynecomastia classification for surgical management: A systematic review and novel classification system.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 16, 2017 06:39
  Symmetry restoration at rest after masseter-to-facial nerve transfer: Is it as efficient as smile reanimation?.
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Background: Masseter-to-facial nerve transfer is a highly efficient technique for reanimating paralyzed muscle and has been reported to restore facial symmetry at rest. However, no systematic studies have been performed, and the effects of preoperative droop oral commissure on postoperative symmetry at rest have rarely been reported. Methods: The authors retrospectively analyzed 35 patients with masseteric-facial nerve anastomosis and assessed the quality and quantity of the dynamic recovery and the oral commissure symmetry at rest. The dynamic and static effects were then compared. Results: All of the patients' Terzis scores were increased post-operatively, and over half of the patients presented restored symmetrical smiles (Terzis scores of 4 or 5). The postoperative symmetry scale of oral commissure at rest improved in 18 of 35 patients. Both the mean postoperative AD-OCE (altitude difference of oral commissure excursion) and the postoperative AD-OCP (altitude difference of bilateral oral commissure position) were decreased compared to preoperative values. The preoperative symmetry had a significant effect on the postoperative AD-OCP. The effects of the dynamic and static symmetry improvements were transformed to a comparable factor '[alpha]'. The dynamic [alpha] was significantly greater than static [alpha]. Conclusions: Masseter-to-facial nerve transfer is a reliable technique for smile reanimation. However, it has only a limited effect on the improvement of symmetry at rest. Assessing the preoperative symmetry of oral commissure at rest can be used to predict postoperative outcomes, and patients with severely droop oral commissure (symmetry scale III or IV) should receive static suspension. (C)2017American Society of Plastic Surgeons

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Fri Jun 16, 2017 06:39
  Microsurgical Hepatic Artery Reconstruction Using Ikuta A-II Double Clamp
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
imageSummary: We performed hepatic artery (HA) reconstruction on 24 patients between January 2010 and October 2016. Six of 24 patients used an Ikuta type A-II vascular clamp (A-II group). The mean age was 38.0 years (range, 1–61 years). There was no blood leakage at the anastomosed site in any of the patients. No patients required an additional vascular clamp, and none developed HA thrombosis. Eighteen of 24 patients used a conventional vascular clamp. The mean age was 36.1 years (range, 1–65 years; conventional group). Sixteen of 18 patients required an additional vascular clamp due to blood leakage from the HA. There was no significant difference between the 2 groups in mean age or diameter of the recipient HA. However, there was a significant difference in the proportion of patients who required an additional vascular clamp (n

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Fri Jun 16, 2017 03:29
  Oncoplastic breast surgery: comprehensive review
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Breast cancer is the most common female cancer in Western populations, affecting 12.5% of women, with 1.38 million patients per year. Breast-conserving surgery followed by postoperative radiotherapy replaced the radical and modified-radical procedures of Halsted and Patey as the standard of care for early-stage breast cancer once the overall and disease-free survival rates of breast-conserving surgery were demonstrated to be equivalent to those of mastectomy. However, excision of >20% of breast tissue, low or centrally located cancer, and large-sized breasts with various grades of breast ptosis, result a in unacceptable cosmetic outcomes.

Oncoplastic breast surgery evolved from the breast-conserving surgery by broadening its general indication to achieve wider excision margins without compromising on the cosmetic outcomes. Thus, oncoplastic breast surgery can be defined as a tumor-specific immediate breast reconstruction method that applies aesthetically derived breast reduction techniques to the field of breast cancer surgery and allows for higher volume excision with no aesthetic compromise. However, contralateral breast symmetrization should be regarded as an intrinsic component of the oncoplastic surgery. The main procedures involved are volume-displacement or volume-replacement techniques, which depend on breast size and cancer size/location. Volume-displacement or reshaping procedures apply the plastic surgery principles to transpose a dermo-glandular flap of breast tissue into the defect site, while volume-replacement techniques use autologous tissues to replace the volume loss that follows tumor resection. Furthermore, these procedures are more complex and time-consuming than those involved in breast-conserving surgery.

Based on current literature, the authors analyze the different techniques and indications of the oncoplastic breast surgery, determining its complication rate, in order to help both surgeons and their patients in the decision-making stage of breast reconstruction.

L'articolo Oncoplastic breast surgery: comprehensive review sembra essere il primo su European Review.



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Fri Jun 16, 2017 02:09
  The Importance of Facts and the Role of Academic Publishers in Today's World—A Publisher's View
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg 2017; 33: ix-ix
DOI: 10.1055/s-0037-1600099




Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text



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Thu Jun 15, 2017 22:04
  Lymphatic invasion and the Shields index in melanoma metastases predicting
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 13 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Zorica Špirić, Mirela Erić, Živka Eri
IntroductionFindings of the prognostic significance of lymphatic invasion are contradictory. In order to find out as efficient cutaneous melanoma metastasis predictor as possible Shields et al. have created a new prognostic index. The aim of this study was to examine if the lymphatic invasion analysis and the Shields index calculation can be used in predicting lymph nodes status in patients with cutaneous melanoma.MethodsLymphatic invasion of the 100 melanoma specimens was detected through the use of dual immunohistochemistry staining for lymphatic endothelial marker D2-40 and for melanoma cells S-100. The Shields index was calculated as a logarithm by multiplying the melanoma thickness, square of peritumoural lymphatic vessel density and the number 2 for present lymphatic invasion.ResultsThere was no statistically significant difference between lymph node metastatic and nonmetastatic melanomas regarding the lymphatic invasion. Metastatic melanomas showed a significantly higher Shields index value compared to nonmetastatic melanomas (p=0.00). Area under the ROC curve (AUC) proved that the Shields index (AUC=0.86, 95% confidence interval (CI) 0.79-0.93, p=0.00) was the most accurate predictor of lymph node status, followed by the melanoma thickness (AUC=0.76, 95%CI 0.67-0.86, p=0.00) and American Joint Committee on Cancer staging (AUC=0.75, 95%CI 0.66-0.85, p=0.00), while lymphatic invasion was not successful (AUC=0.56, 95%CI 0.45-0.67, p=0.31). The Shields index achieved 81.3% sensitivity and 75% specificity (cut-off mean value).ConclusionsOur findings show that D2-40/S-100 immunohistochemical analysis of lymphatic invasion cannot be used for the lymph node status predicting, while the Shields index calculation predicts disease outcome more accurately than the melanoma thickness and AJCC staging.



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Thu Jun 15, 2017 21:33
  Duration of Facial Paralysis in Studies of Emotion and Well-Being
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
To the Editor We are grateful for the recent publication from Johns Hopkins University bringing attention to the association among facial paralysis (FP), depression, and quality of life. Nellis et al found that 42.1% of patients with facial paralysis screened positive for depression, having significantly higher Beck Depression Inventory scores than control patients. Those with a worse degree of paralysis (House-Brackmann grade ≥3) were significantly more likely to screen positive when controlling for female sex. Absent from logistic regression analysis was paralysis duration. Although the authors acknowledge this limitation, we wish to elaborate on the importance of measuring duration of FP. It is plausible that duration moderates the effect of FP on depression. We suggest this is related to the tendency to mispredict the impact of present and future emotion states on well-being.

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Thu Jun 15, 2017 20:32
  Duration of Facial Paralysis in Studies of Emotion and Well-Being—Reply
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
In Reply We appreciate Chaiet and Carpenter's thoughtful contribution regarding our recently published article "Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients."

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Thu Jun 15, 2017 20:32
  Recreational Activity and Facial Trauma Among Older Adults
updated on Fri Jun 16, 2017 15:48 by Alexandros G. Sfakianakis via Aesthetic
This database analysis uses the National Electronic Injury Surveillance System to collect data to evaluate the incidence of recreational activity–associated facial fractures among older adults and to further delineate injury characteristics including demographics, fracture location, and activities.

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Thu Jun 15, 2017 08:35
  Issue Information
updated on Thu Jun 15, 2017 09:03 by Alexandros G. Sfakianakis via Aesthetic
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Thu Jun 15, 2017 04:12
  Non-surgical wound closure—a simple inexpensive technique
updated on Thu Jun 15, 2017 08:35 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
Primary suture closure of wounds is often the optimal solution for soft tissue defect closure because of its simplicity and satisfactory outcome, yet it may be impeded by high -tension closure. The customary application of skin grafts, flaps, free tissue transfer, or tissue expansion is often associated with relatively more complex surgical reconstructive procedures, significant morbidity and extended hospitalization and prolonged recovery period.

Methods
We retrospectively investigated all patients who underwent wound closure using a mechanical wound closure device between 2014 and 2016 in a tertiary hospital center. The device consisted of stainless steel hooks, sutured over the opposite wound edges, and rubber bands for generating tension which is gradually increased. Approximated wound margins were sutured or allowed to heal by secondary intention.

Results
The mechanical device was applied in 50 patients. There were 38 males and 12 females. Wound size ranged from 3 to 25 cm. In most of the patients there was a satisfactory wound margin approximation. However, in 6 patients skin hook cut through from wound margins occurred due to excessive rubber band tension. In 5 patients, it was decided to also apply negative-pressure wound therapy along with the device. After application of the wound closure device, a residual raw area remained in other 4 patients in whom a split thickness graft was applied. During follow-up, hypertrophic scar and wound dehiscence were found in 5 patients.

Conclusions
The mechanical wound closure device herein presented is a simple and inexpensive technique that allows a significant reduction in surgical costs and surgery-related morbidity.

Level of Evidence: Level IV, therapeutic study.



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Wed Jun 14, 2017 15:18
  Präoperative Gendiagnostik und Bildgebung bei kindlichen Phäochromozytomen und Paragangliomen
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 14, 2017 15:18
  Der Schatten der Transparenz
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 14, 2017 12:12
  A retrospective study: Can we differentiate between repeat self-inflicted burn patients and those who commit a self-inflicted burn as an individual occurrence?
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
Self-inflicted burns (SIB) are a significant cause of burns morbidity worldwide. A sub-group of SIB patients demonstrate recurrent SIB behaviour causing repeated morbidity and an increasing strain on hospital resources. The ability to predict which patients are likely to demonstrate repeat behaviour will allow for more targeted intervention in this group. The aim of this study was to identify the factors that differentiate patients who repeat SIB from those who commit SIB as an individual occurrence.

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Wed Jun 14, 2017 11:02
  „Liquid biopsy“
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 14, 2017 10:08
  Lymphatic invasion and the Shields index in melanoma metastases predicting
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
Findings of the prognostic significance of lymphatic invasion are contradictory. In order to find out as efficient cutaneous melanoma metastasis predictor as possible Shields et al. have created a new prognostic index. The aim of this study was to examine if the lymphatic invasion analysis and the Shields index calculation can be used in predicting lymph nodes status in patients with cutaneous melanoma.

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Wed Jun 14, 2017 09:29
  Assessing and comparing the quality of wound centres: a literature review and benchmarking pilot
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
ABSTRACT
Multidisciplinary wound centres are currently facing an increase in both the incidence of wounds and the complexity of care. This has resulted in rising costs and increased interest in the effectiveness of treatments. Little evidence is available regarding optimal wound centre organisation and effectiveness; therefore, measuring the quality of wound centres has become more important. This study aims to assess the evidence concerning quality by describing the state of the art of wound centres and organisational effectiveness by developing indicators of quality and by assessing their suitability in a pilot study. A multi-method approach was used: a literature review performed resulted in the development of an indicator list that was consequently subjected to expert review, and a benchmark study was completed comparing eight wound centres in the Netherlands. We thus provide a description of the relevant state-of-the-art aspects of wound centre organisation, which were multidisciplinary collaborations and standardisation of the organisation of care. In literature, significant patient-related effects were observed in improved healing rates and decreased costs. A total of 48 indicators were selected. The indicator list was tested by a benchmark study pilot. In practice, the outcome indicators were especially difficult to generate. Six indicators regarding structure, three regarding process and five regarding outcome proved feasible to measure and improve quality of wound centres.



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Wed Jun 14, 2017 09:28
  Using image J to document healing in ulcers of the foot in diabetes
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
Abstract
The aim of the study was to assess the reliability of measuring the cross-sectional area of diabetic foot ulcers using Image J software. The inter- and intra-rater reliability of ulcer area measures were assessed using digital images of acetate tracings of ulcers of the foot affecting 31 participants in an off-loading randomised trial. Observations were made independently by five specialist podiatrists, one of whom was experienced in the use of Image J software and educated the other four in a single session. The mean (±SD) of the mean cross-sectional areas of the 31 ulcers determined independently by the five observers was 1386·7 (±22·7) mm2. The correlation between all pairs of observers was >0·99 (P < 0·001). There was no significant difference overall between the five observers (ANOVA F1.538; P = 0·165) and no difference between any two (paired samples test t = −0·787–1·396; P ≥ 0·088). The correlation between the areas determined by two observers on two occasions separated by not less than 1 week was very high (0·997 and 0·999; P < 0·001 and <0·001, respectively). The inter- and intra-reliability of the Image J software is very high, with no evidence of a difference either between or within observers. This technique should be considered for both research and clinical use in order to document changes in ulcer area.



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Wed Jun 14, 2017 07:42
  Erratum to: an unusual pre-ligamentous thenar motor branch of the median nerve
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
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Wed Jun 14, 2017 07:42
  The cadaveric feasibility study of using filler augmentation at the lower nose for the reinforcement of the external nasal valve
updated on Wed Jun 14, 2017 19:45 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
Filler injections have been used in rhinoplasty to correct minor nose deformities and to augment the nasal dorsum. At the lower nose, the procedures are used to increase nasal tip projection and improve the bulbous nasal tip but they have never been used in the correction of the lateral crus weakness and collapsed external nasal valves.

Methods
The study was conducted with 14 human cadavers that underwent lower nose injection rhinoplasty using the columellar and alar injections as tripod augmentation. The nasal alae were tunneled and retrogradely injected by a needle. The compared parameters measured to evaluate the improvement before and after the treatment were basilar nasal width, interalar width, columella-nasal tip height, columellar-labial angle, and the length and width of the nostrils. Measurements were taken with a digital caliper. All measurements were matched and compared for statistical analysis.

Results
There were seven male and seven female Thai cadavers. Most of the values of the parameters were increased, but the basilar nasal width and interalar width were not changed. The columellar-labial angle, columella-nasal tip height, and nostril's length showed statistically significant differences (P < .05), leading to positive changes in the nostril cross-sectional area, the nasal tip projection and the external nasal valve.

Conclusions
Injection rhinoplasty of the lower nose as tripod augmentation of the external nasal valve increases the nasal tip projection and the nostril cross-sectional area thus improving the functional and esthetic appearance.Level of Evidence: Not ratable.



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Tue Jun 13, 2017 21:17
  "Novel Approach for Maximizing Follow-up in Cosmetic Surgery Clinical Trials: The Ideal Implant Core Trial Experience".
updated on Wed Jun 14, 2017 01:46 by Alexandros G. Sfakianakis via Aesthetic
BACKGROUND-: High follow-up rates are critical for robust research with minimal bias and particularly important for breast implant Core Studies seeking FDA approval. The Core Study for IDEAL IMPLANT, the most recently FDA-approved breast implant, utilized a novel incentive payment model to achieve higher follow-up rates than in previous breast implant trials. METHODS-: At enrollment, $3,500 was deposited into an independent, irrevocable trust for each of the 502 subjects and invested in a diversified portfolio. If a follow-up visit is missed, the subject is exited from the study and compensated for completed visits, but the remainder of her share of the funds stay in the trust. At the conclusion of the 10-year study, the trust will be divided among those subjects who completed all required follow-up visits. For primary and revision augmentation cohorts, FDA published follow-up rates from Core Studies were compared for all currently available breast implants. RESULTS-: Five-year follow-up rates for the IDEAL IMPLANT Core Study are higher for both primary augmentation and revision augmentation cohorts (94.9% and 96.7%, respectively) when compared to all other trials that have used FDA standardized follow-up reporting (MemoryShape,(R) Allergan 410,(R) and Sientra(R) Core Studies). CONCLUSIONS-: This trial demonstrates the utility of a novel incentive strategy to maximize follow-up in cosmetic surgery patients. This strategy may benefit future cosmetic surgery trials and perhaps any prospective research trial by providing more complete data. (C)2017American Society of Plastic Surgeons

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Tue Jun 13, 2017 21:17
  Antithrombotic therapies in digit replantation with papaverine administration: A prospective, observational study.
updated on Wed Jun 14, 2017 01:46 by Alexandros G. Sfakianakis via Aesthetic
Background: The primary objective of this study was to investigate whether the application of antithrombotic therapies affects the success rate of digit replantation. Methods: Total 477 digits of 319 patients who received dextran with low molecular weight heparin (dextran-LMWH), dextran with prostaglandin E1 (dextran-PGE1), or no antithrombotic therapy after replantation of complete amputated digits from 1 January 2012 to 1 January 2016 were included in this study. Papaverine were given by intramuscular injection to all patients with 90mg/day postoperatively. Results: There was no significant difference in all potential risk factors including age, smoking, Tamai's level of amputation, causes of injury and warm ischemia time among groups. The survival rate of digits from patients who received dextran-LMWH, dextran-PGE1, or no antithrombotic therapy had no significant difference. Conclusions: Antithrombotic therapies showed no significant benefit for digital replantation in patients receiving papaverine. (C)2017American Society of Plastic Surgeons

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Tue Jun 13, 2017 21:17
  Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy, Evaluation of Quality of Life and Outcomes.
updated on Wed Jun 14, 2017 01:46 by Alexandros G. Sfakianakis via Aesthetic
Background: The effects of postoperative radiotherapy on free flap based breast reconstruction are still controversial. Poor outcomes, breast distortion and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap. Methods: Between January 2013 and December 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors institution. Patients were divided in two groups depending on having received PMRT (Post mastectomy radiotherapy). Quality of life measured with BREAST Q questionnaire, self-reported aesthetic outcomes and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity was also analysed as the main surgical outcome. Results: Mean follow-up time after reconstruction was 23 months (6-48 months) No significant difference in quality of life or satisfaction scores were found between patients that underwent PMRT and patients who did not receive adjuvant RT. There were no significant differences in rates of fat necrosis among both groups. (11.1% vs 13.76% p=0.75) Conclusions: PMRT in patients undergoing immediate breast reconstruction with free flap does not seem to affect quality of life, satisfaction with the outcome and the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction. (C)2017American Society of Plastic Surgeons

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Tue Jun 13, 2017 20:32
  Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetrical Brachial Plexus Injury.
updated on Wed Jun 14, 2017 01:46 by Alexandros G. Sfakianakis via Aesthetic
Background: Upper trunk obstetrical brachial plexus injury (OBPI) can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and healthcare costs between nerve grafting and distal nerve transfers in children with upper trunk OBPI. Methods: In this prospective cohort study, children who received triple nerve transfers were followed with the Active Movement Scale (AMS) for 2 years. Their outcomes were compared to children who underwent nerve graft reconstruction. To assess healthcare utilization, a cost analysis was also performed. Results: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years post-surgery (p

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Tue Jun 13, 2017 20:32
  Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels.
updated on Wed Jun 14, 2017 01:46 by Alexandros G. Sfakianakis via Aesthetic
Background: Lymphaticovenular anastomosis (LVA) is a useful treatment option for compression-refractory lower extremity lymphedema (LEL), but its efficacy largely depends on severity of lymphosclerosis. To maximize LVA efficacy, it is important to elucidate factors associated with severe lymphosclerosis (SLS). Methods: Medical charts of 134 LEL patients who underwent preoperative indocyanine green (ICG) lymphography and LVA were reviewed to obtain data of clinical demographics, ICG lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis were classified into s0, s1, s2, and s3. Lymphatic vessels with s3 sclerosis was defined as SLS. Logistic regression analysis was used to identify independent factors associated with SLS. Results: In total, 962 lymphatic vessels were analyzed, among which SLS was observed in 97 (10.1%). Multivariate analysis revealed that independent factors associated with SLS were higher body mass index (odds ration [OR], 1.803; 95% confidence interval [CI], 1.041-3.123; P = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95% CI 1.201-4.617/2.135-9.362; P = 0.013/

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Tue Jun 13, 2017 11:02
  Contralateral Augmentation with a Transmidline Scarless Technique During Unilateral Breast Reconstruction Using Implants
updated on Tue Jun 13, 2017 15:31 by Alexandros G. Sfakianakis via Aesthetic
imageBackground: Unilateral breast reconstruction can be a challenge when attempting to achieve an aesthetically pleasing and symmetrical breast mound on the contralateral side. This study investigates the outcomes of using a contralateral augmentation transmidline scarless (CATS) technique to simultaneously augment the contralateral breast using implants. Methods: Between January 2004 and July 2016, patients undergoing unilateral implant-based breast reconstruction and simultaneous contralateral implant augmentation using a transmidline access were studied. Characteristics and complications using this technique were assessed. Results: Sixty-five (91.5%) of 71 patients used the CATS technique for unilateral breast reconstruction using implants with contralateral breast implant augmentation. The remaining 6 cases used a preexisting chest scar. In the assessment of complication rates between the reconstructed and augmented sides, the reconstructed side had a statistically significant higher rate of implant exposure (P = 0.04) and total complications (P = 0.02). In comparing the revision rates between these 2 groups, the need for implant change (P = 0.04) and the total revision rates (P = 0.01) were higher in the reconstructive side. Use of saline implants had a higher rate of chest wall and breast skin necrosis (P = 0.03) in comparison with silicone implants. There was not a statistically significant difference in complications when comparing timing of reconstructions (immediate versus delayed). Conclusions: The CATS technique can be performed safely, with a desirable aesthetic outcome, and also symmetry with minimal risk of symmastia during unilateral breast reconstruction using implant-based reconstruction.

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Tue Jun 13, 2017 05:32
  Psychosocial and Aesthetic Advantages of Reconstruction after Prophylactic Mastectomy: A Quality of Life and Aesthetic Analysis
updated on Tue Jun 13, 2017 10:00 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1602785

Background Proper patient counseling regarding reconstruction after prophylactic mastectomy (PM) requires greater understanding of quality of life (QoL) and aesthetic outcomes. Our study evaluates these end points using the validated BREAST-Q and Garbay system. Methods We performed a retrospective chart review of 1,254 mastectomy patients (July 2008 through July 2012). Of those with completed preoperative BREAST-Q and reconstruction with a minimum of 6-month follow-up, 18 underwent bilateral PM (BPM), 36 underwent contralateral PM (CPM), and 30 matched controls were selected who underwent unilateral therapeutic mastectomy (TM) with contralateral symmetry procedure. Preoperative and 6-month postreconstruction BREAST-Q scores were compared within and between groups. Subsequently, aesthetic evaluation of 21 of a group of randomly selected reconstructions (7 TM, 7 CPM, and 7 BPM) was performed by 14 plastic surgery researchers. Potential correlations between aesthetic evaluations and QoL outcomes were examined. Results Demographic characteristics, preoperative satisfaction scores, and postoperative morbidity rates were similar among all three groups. Although reconstruction after BPM was associated with improved aesthetic outcomes (p < 0.001), a significant postoperative increase in satisfaction with breasts was noted only in the TM group (p = 0.006). CPM was associated with improved psychosocial well-being (p = 0.039) in our study. No further significant differences were noted. Conclusion Although BPM with reconstruction is associated with higher aesthetic outcomes compared with CPM or TM, QoL is not significantly increased. Reconstruction after CPM, but not BPM, is associated with increased psychosocial well-being. These valuable findings should be taken into account during preoperative counseling regarding elective PMs.
[...]


Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Mon Jun 12, 2017 22:07
  A retrospective study: Can we differentiate between repeat self-inflicted burn patients and those who commit a self-inflicted burn as an individual occurrence?
updated on Tue Jun 13, 2017 02:36 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 12 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Meelad Sayma, Simon Booth, Debbie Weller, Baljit Dheansa
Self-inflicted burns (SIB) are a significant cause of burns morbidity worldwide. A sub-group of SIB patients demonstrate recurrent SIB behaviour causing repeated morbidity and an increasing strain on hospital resources. The ability to predict which patients are likely to demonstrate repeat behaviour will allow for more targeted intervention in this group. The aim of this study was to identify the factors that differentiate patients who repeat SIB from those who commit SIB as an individual occurrence. A 3-step approach was adopted: (1) Initial data collection through the locally held records of the International Burns Injury Database (iBID), (2) Follow-up data of SIB patient information was extracted from patient notes, (3) Statistical data analysis. 75 records remained for analysis. 17 patients were identified as going on to commit SIB more than once and so classified as 'repeat SIB' patients (22.7%). Repeat SIB patients appeared to be more commonly female and Caucasian with a mean total body surface area of less than half the individual occurrence group. The repeat SIB group were also more likely to commit burns to their limbs and demonstrate previous non-burn deliberate self harm behaviour. 'Cold' burns were also committed more commonly in the repeat SIB group. This paper describes the largest sample of repeat SIB patients in the literature. It appears that repeat SIB patients have a set of differentiating factors that, when combined, allow for some element of prediction of these behaviours.



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Mon Jun 12, 2017 12:36
  Retraction Note to: New worldwide guidelines for treatment of inguinal hernia. The most important recommendations from HerniaSurge
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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Mon Jun 12, 2017 12:36
  Making Sense of Implant “Profile” in Breast Augmentation
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
imageSummary: The increasing variety of breast implants has led to their classification into "profile" types to guide implant cataloguing and selection. Implant "profile" describes the overall silhouette of the implant. It represents a permutation of all 3 dimensions of the implant: base diameter, projection, and volume. Implant "profile" is not the same as implant projection. Implant projection is a quantifiable linear measurement of the anterior–posterior dimension of the implant, whereas implant "profile" is a vendor-driven assessment that currently lacks universal standardization. Until "profile" assessments are standardized across vendors, it behooves us to be cognizant of their limitations as primary variables used to guide implant selection.

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Mon Jun 12, 2017 08:54
  Modified Frailty Index Score and Perioperative Risk in Laryngectomy : The 11 Variables Included in Modified Frailty Index Assessment : History of diabetes Functional status (not independent at baseline) History of pneumonia or chronic obstructive pulmonary disease History of congestive cardiac failure History of myocardial infarction History of percutaneous coronary intervention, stent placement, or angina History of hypertension (requiring medical treatment) History of peripheral vascular disease or ischemic rest pain History of impaired sensorium History of transient ischemic attack or cerebrovascular accident History of cerebrovascular accident with neurologic deficit
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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http://orlhealth.blogspot.com/2017/06/modified-frailty-index-score-and.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon Jun 12, 2017 08:41
  Barking Cough
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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https://youtu.be/IgZuVo81298?t=33

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon Jun 12, 2017 08:39
  Bovine cough
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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http://orlhealth.blogspot.com/2017/06/hoarse-voice-and-bovine-cough.html

<iframe width="640" height="360" src="https://www.youtube.com/embed/pLzezVufJ1o" frameborder="0" allowfullscreen></iframe>
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon Jun 12, 2017 08:19
  Hyperspectral X-ray transmission imaging................................3D chemical imaging
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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http://orlhealth.blogspot.com/2017/06/hyperspectral-x-ray-transmission.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon Jun 12, 2017 08:13
  Persistent lesion hyperintensity on brain diffusion-weighted MRI
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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http://orlhealth.blogspot.com/2017/06/persistent-lesion-hyperintensity-on.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon Jun 12, 2017 08:12
  Nausea, vomiting, loss of appetite and oliguria : haemoglobin =12.7 g/dL, indirect bilirubin =2.0 mg/dL, haptoglobin ≤6 mg/dL, platelet count =121 000/μL and schistocytes on peripheral smear.
updated on Mon Jun 12, 2017 17:03 by Alexandros G. Sfakianakis via Aesthetic
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http://orlhealth.blogspot.com/2017/06/nausea-vomiting-loss-of-appetite-and.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Sat Jun 10, 2017 22:55
  “A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial jump graft in facial palsy treatment.”
updated on Sun Jun 11, 2017 03:03 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 10 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Martinus M. van Veen, Pieter U. Dijkstra, Paul M.N. Werker
Nerve reconstructions are the preferred technique for short standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve gives a strong motor signal. The signal of a cross-face nerve graft is weaker, but spontaneous. Spontaneity in facial expression is believed to be of importance for psychological wellbeing. Therefore combination of the two procedures combines the best of both: a strong motor signal and a spontaneous smile. Aim of this study was to objectify this expected benefit. Of the 19 patients who received a hypoglossal-facial nerve anastomosis in the period from 1995 to 2015 in our institutions, 12 patients were included in this study, five with and seven without a cross-face nerve graft. The outcomes were compared using photographs, the disease-specific quality of life (Facial Clinimetric Evaluation scale (FaCE)), a self-reported synkinesis scale (Synkinesis Assessment Questionnaire), and presence of a spontaneous smile. Significant differences were found in preoperative excursion of the affected side of the mouth and the change in excursion. Median Total FaCE scores were considerably larger (18.3 points) for patients who underwent the combined procedure. A spontaneous smile was observed both with a cross-face nerve graft (n=2) and without (n=1). The addition of a cross-face nerve graft to a hypoglossal-facial nerve anastomosis resulted in a positive trend in disease-specific quality of life. This benefit could also be present with the combination of a cross-face nerve graft with another nerve transfer such as a masseteric-facial nerve anastomosis.



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Sat Jun 10, 2017 04:16
  “3D Bioprinting for Reconstructive Surgery: Principles, Applications and Challenges”
updated on Sat Jun 10, 2017 08:22 by Alexandros G. Sfakianakis via Aesthetic
Despite the increasing laboratory research in the growing field of 3D bioprinting there are few reports of successful translation into surgical practice. This review outlines the principles of 3D bioprinting including software and hardware processes, biocompatible technological platforms and suitable bioinks. The advantages of 3D bioprinting over traditional tissue engineering techniques in assembling cells, biomaterials and biomolecules in a spatially controlled manner to reproduce native tissue macro-, micro- and nano-architecture is discussed, together with an overview of current progress in bioprinting tissue types relevant for plastic and reconstructive surgery.

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Sat Jun 10, 2017 04:16
  Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials
updated on Sat Jun 10, 2017 08:22 by Alexandros G. Sfakianakis via Aesthetic
Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effect of gabapentin and pregabalin on post-surgical pain among patients undergoing breast cancer surgery.

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Sat Jun 10, 2017 04:16
  “A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial jump graft in facial palsy treatment.”
updated on Sat Jun 10, 2017 08:22 by Alexandros G. Sfakianakis via Aesthetic
Nerve reconstructions are the preferred technique for short standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve gives a strong motor signal. The signal of a cross-face nerve graft is weaker, but spontaneous. Spontaneity in facial expression is believed to be of importance for psychological wellbeing. Therefore combination of the two procedures combines the best of both: a strong motor signal and a spontaneous smile.

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Sat Jun 10, 2017 04:16
  Breast reconstruction by exclusive fat grafting: what about the breast projection?
updated on Sat Jun 10, 2017 08:22 by Alexandros G. Sfakianakis via Aesthetic
Autologous fat grafting in exclusive breast reconstruction has been booming in recent years (1,2). This technique has many advantages (autologous reconstruction, reduced scar, absence of muscle sample) as well as a secondary benefit on the improvement of patient silhouette. Its main disadvantage is still the need for performing several successive procedures under general anesthesia, most often to achieve a satisfactory breast volume.

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Sat Jun 10, 2017 04:16
  Body Contouring Procedures in Three or More Anatomical Areas are Associated with Long Term Body Mass Index Decrease in Massive Weight Loss Patients - a retrospective cohort study
updated on Sat Jun 10, 2017 08:22 by Alexandros G. Sfakianakis via Aesthetic
– Massive weight loss (MWL) patients who undergo body contouring plastic surgery (BCPS) display superior long-term weight maintenance. The effect of the number of anatomical areas contoured on weight dynamics is undetermined.

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Fri Jun 09, 2017 22:41
  Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ajit S. Rai, James S. Khan, Jasneet Dhaliwal, Jason W. Busse, Stephen Choi, P.J. Devereaux, Hance Clarke
Background and ObjectiveBreast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effect of gabapentin and pregabalin on post-surgical pain among patients undergoing breast cancer surgery.Databases and Data TreatmentWe searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from inception to November 2015. Studies enrolling adult patients undergoing breast cancer surgery randomly assigned to preoperative gabapentin or pregabalin versus placebo or active control, and assessed acute (≤24 hours) or chronic (≥2 months) pain, were included. We conducted meta-analyses when possible, and rated quality of evidence (QoE) using the GRADE approach.ResultsTwelve studies were eligible for review. Eight evaluated gabapentin (n=516) and four pregabalin (n=209). Gabapentin reduced pain scores in the recovery room (mean difference [MD] -1.68 on a 0-10 NRS, 95% CI -2.59 to -0.77; MID is 1-point; relative risk [RR] for mild pain (<4/10) 1.71, 95% CI 1.33 to 2.02; moderate QoE) and 24-hours postoperatively (MD -0.52, 95% CI -1.02 to -0.01; RR for mild pain 1.07, 95% CI 1.00 to 1.13; very low QoE). Pregabalin reduced pain and morphine consumption in recovery (MD -6.71 mg, 95% CI -10.73 to -2.70; low QoE). There was no difference in pain at 24-hours (MD -0.38, 95%, CI -0.96 to 0.21; moderate QoE). Neither drug reduced the rate of chronic post-surgical pain.ConclusionsGabapentin and pregabalin seem to reduce opioid consumption in the recovery room. Gabapentin, but not pregabalin, reduces pain at 24 hours after breast cancer surgery. Neither drug affects the development of chronic post-surgical pain.SignificancePregabalin and gabapentin given perioperatively in breast cancer surgery patients improves postoperative acute pain as indicated by reduction in opioid consumption. Further data is needed on reducing chronic post-surgical pain.



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Fri Jun 09, 2017 22:41
  Breast reconstruction by exclusive fat grafting: what about the breast projection?
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): J. Niddam, A. Durazzo, J.P. Meningaud




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Fri Jun 09, 2017 22:41
  “3D Bioprinting for Reconstructive Surgery: Principles, Applications and Challenges”
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Zita M. Jessop, Ayesha Al-Sabah, Matthew D. Gardiner, Emman Combellack, Karl Hawkins, Iain S. Whitaker
Despite the increasing laboratory research in the growing field of 3D bioprinting there are few reports of successful translation into surgical practice. This review outlines the principles of 3D bioprinting including software and hardware processes, biocompatible technological platforms and suitable bioinks. The advantages of 3D bioprinting over traditional tissue engineering techniques in assembling cells, biomaterials and biomolecules in a spatially controlled manner to reproduce native tissue macro-, micro- and nano-architecture is discussed, together with an overview of current progress in bioprinting tissue types relevant for plastic and reconstructive surgery. If successful, this platform technology has the potential to biomanufacture autologous tissue for reconstruction obviating the need for donor sites or immunosuppression. The biological, technological and regulatory challenges are highlighted, with strategies to overcome these using an integrated approach from the fields of engineering, biomaterial science, cell biology and reconstructive microsurgery.



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Fri Jun 09, 2017 22:41
  Determining the outcomes of post mastectomy radiation therapy delivered to the definitive implant in patients undergoing one and two stage implant based breast reconstruction: A systematic review and meta-analysis
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Louise J. Magill, Francis P. Robertson, Gavin Jell, Ash Mosahebi, Mohammad Keshtgar
BackgroundPost mastectomy radiation therapy is known to increase complication rate and implant loss in implant based breast reconstruction. The purpose of this study was to systematically review the literature regarding outcome of PMRT delivered to the permanent/definitive implant.MethodsSystematic review and meta-analysis of studies involving immediate implant based reconstruction and post mastectomy radiation therapy (PMRT) when delivered to the permanent implant.ResultsSeven studies included 2921 patients (520 PMRT, 2401 control). PMRT was associated with significant increase in capsular contracture (7 studies, 2529 patients, 494 PMRT, 2035 control, OR 10.21 95% C.I 3.74 to 27.89, p<0.00001). In addition, PMRT was associated with a significant increase in revisional surgery (7 studies, 2921 patients, 520 PMRT, 2401 control, OR 2.18 95% C.I 1.33 to 3.57, p=0.002) and reconstructive failure (6 studies, 2814 patients, 496 PMRT, 2318 control, OR 2.52 95% C.I 1.48 to 4.29, p+o.ooo7). Moreover it was associated with a significant reduction in patient satisfaction (4 studies, 468 patients, 138 PMRT, 294 control, OR 0.29 95% C.I 0.15 to 0.57, p=0.0003) and cosmetic outcome (4 studies, 1317 patients, 238 PMRT, 1009 control, OR 28 95% C.I. 0.11 to 0.67, p=0.005.)ConclusionsThis meta-analysis demonstrates that within the first five years post implant-based reconstruction for those patients who receive PMRT, the rates of adverse events is increased and there is significant reduction in patient satisfaction and cosmetic outcome.



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Fri Jun 09, 2017 22:41
  Body Contouring Procedures in Three or More Anatomical Areas are Associated with Long Term Body Mass Index Decrease in Massive Weight Loss Patients - a retrospective cohort study
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Itay Wiser, Lior Heller, Coral Spector, Ehud Fliss, Tali Friedman
Background– Massive weight loss (MWL) patients who undergo body contouring plastic surgery (BCPS) display superior long-term weight maintenance. The effect of the number of anatomical areas contoured on weight dynamics is undetermined.Objectives– To find whether body mass index (BMI) dynamics following BCPS are associated with the number of anatomical areas operated.Methods– A retrospective cohort study. Study groups were defined by the number of anatomical areas operated (1, 2 and 3+). BMI velocity was defined as a ratio between BMI change following BCPS and follow-up time. Multinominal logistic regression was performed to assess independent association to BMI velocity.Results– A total of 222 patients undergoing 513 BCPS between 2009 and 2014 were included in the study (mean age 36.8±10.9 years, 77% females). Group 3+ (N=88) had a negative mean BMI velocity compared with positive values in groups 1 and 2 (-0.11±1.0 vs. 0.44±1.4 and 0.03±1.2, respectively; p=0.03). Independent risk factors for positive BMI velocity (>0.5 kg/m2/year) included single anatomical area BCPS compared to 3 or more (OR=3.37 CI95% 1.24 – 9.14; p=0.017) and psychiatric medication use (OR=6.73 CI95% 1.15 – 39.35; p=0.034). Independent protective factors included diabetes mellitus (OR=0.094 CI95% 0.01 – 0.99; p=0.049).Conclusions– BCPS in 3 or more anatomical areas following MWL is associated with a long-term weight loss following BCPS. As part of the health strategy to maintain normal BMI values, and achieve overall quality of life improvement in MWL patients, clinicians and health policy makers should positively consider recommending BCPS in multiple anatomical areas.



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Fri Jun 09, 2017 22:41
  Post- operative alar base symmetry in complete unilateral cleft lip and palate- a prospective study
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Suresh Vyloppilli, Krishna Kumar, Shermil Sayd, Latheef Sameer, Saju V. Narayanan, Ajit Pati
In the evolution of cleft lip repair, there have been continuous attempts to minimize local trauma and to improve lip and nasal appearances. In order to obtain an aesthetically balanced development of midface, the primary surgical correction of the nasolabial area is of paramount importance. In this study, the importance of a back-cut extending cephalically above the inferior turbinate at the mucocutaneous junction which elevates the nostril floor on the cleft side for the purpose of achieving symmetry of the alar bases are analyzed by pre and post-operative photographic anthropometry. This study comprised of fifty cases of the unilateral complete cleft lip. At the time of surgery, the patient age ranged from 3-9 months. The surgeries, performed by a single surgeon, employed the standard Millard technique, incorporating Mohler modifications of lip repair. Anthropometric analysis revealed that the pre-operative mean difference between the normal side and the cleft side was 0.2056 with a standard deviation of 0.133. In the post-operative analysis, the mean difference was reduced to 0.0174 with a standard deviation of 0.141. The paired t-test showed that the p-value is <0.001, indicating high statistical significance. To conclude, in complete unilateral cleft lip and palate, the geometrically placed nasal back-cut incision has a definite role in the correction of the alar base symmetry during primary surgery



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Fri Jun 09, 2017 22:41
  Surgical correction of cryptotia combined with an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yu Xiaobo, Yang Qinghua, Jiang Haiyue, Pan Bo, Zhao Yanyong, Lin Lin
BackgroundCryptotia is a common congenital ear deformity in Asian populations. In cryptotia, a portion of the upper ear is hidden and fixed in a pocket of the skin of the mastoid. Here, we describe our method for cryptotia correction combined with an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap.Patients and MethodsWe developed a new method for correcting cryptotia using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. Following ear release, the rotation flap is rotated into the defect, and the donor site is covered by an ultra-delicate split-thickness skin graft raised in continuity with the flap.ResultsAll patients exhibited the satisfactory release of cryptotia. No cases involved partial or total flap necrosis, and postoperative outcomes using this new technique for cryptotia correction have been more than satisfactory.ConclusionsOur method of using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap to correct cryptotia is a simple and reliable technique.



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Fri Jun 09, 2017 22:41
  Laparoskopische Leberchirurgie
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Die laparoskopische Leberchirurgie hat einen festen Platz in der Behandlung von Lebertumoren eingenommen. Aufgrund der Vorteile für den Patienten im Kurz- und Langzeitverlauf stieg die Zahl der Zentren mit Erfahrung in laparoskopischer Leberchirurgie in den letzten Jahren stark an und die Komplexität der durchgeführten Eingriffe hat nahezu das Niveau der offenen Chirurgie erreicht. Dieser Artikel beschreibt den Stellenwert der laparoskopischen Leberchirurgie und diskutiert die Evidenzlage des Verfahrens. Zudem werden die Indikationsstellung bei den am häufigsten operierten Tumoren, Metastasen des kolorektalen Karzinoms und dem hepatozellulären Karzinom erläutert und auf Besonderheiten bei bestimmten Tumorlokalisationen hingewiesen. Des Weiteren erläutern die Autoren operationstechnische Aspekte und geben einen Überblick über neue Entwicklungen. Zur Veranschaulichung der Möglichkeiten laparoskopischer Leberchirurgie steht ein Video einer komplett laparoskopisch durchgeführten ALPPS („associating liver partition and portal vein ligation") -Prozedur als Begleitmaterial zur Verfügung.



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Fri Jun 09, 2017 18:40
  Sekundärer Hyperparathyreoidismus nach Magenbypass
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 09, 2017 18:39
  Wartezeit zwischen neoadjuvanter Radiochemotherapie und Resektion beim Rektumkarzinom
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 09, 2017 18:39
  Neues aus der minimalinvasiven hepatopankreatobiliären Chirurgie
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Fri Jun 09, 2017 14:37
  Minimalinvasive Optionen bei transanalen Eingriffen
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Zusammenfassung
Seit der Einführung der transanalen endoskopischen Mikrochirurgie (TEM) Anfang der 1980er Jahre wird der transanale minimalinvasive Zugang zur chirurgischen Therapie von Erkrankungen des unteren Intestinaltraktes bei gut selektierten Patienten genutzt. Als Alternative zum starren Operationsrektoskop wurde kürzlich die Verwendung von „single-ports" vorgeschlagen und diese Variante als „transanal minimally invasive surgery" (TAMIS) bezeichnet. TAMIS verknüpft die TEM mit den aus der Laparoskopie bekannten Single-Port-Zugängen. Der transanale minimalinvasive Zugang wurde sehr schnell auch für die Durchführung der totalen mesorektalen Exzision (TME) verwendet (TaTME). Wenngleich die Datenlage noch begrenzt ist, erscheint dieser innovative Zugang zur TME für selektierte Patienten mit primärem Rektumkarzinom vielversprechend. Ziel der Arbeit ist es, die aktuellen minimalinvasiven Zugänge als Optionen für endo- und extraluminale kolorektale Eingriffe darzustellen.



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Fri Jun 09, 2017 14:37
  Die paradoxen Sphinkteren und die kardinale Kontinenzfunktion des Magenfundus
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Die gastroösophageale Refluxkrankheit ist eine häufige Störung beim Menschen, die seit 67 Jahren durch die Fundoplikation nicht zufriedenstellend behandelt werden kann. Für die Verbesserung der Therapietechnik müssten physiologische und anatomische Erkenntnisse berücksichtig werden. Der Beitrag beschreibt dies anhand der paradoxen Sphinkteren und der Wirkung der NO-Signalmoleküle im Magendarmkanal.



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Fri Jun 09, 2017 14:37
  Laparoskopische Lavage bei perforierter Divertikulitis
updated on Sat Jun 10, 2017 02:47 by Alexandros G. Sfakianakis via Aesthetic
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Tue Jun 06, 2017 03:33
  Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema
updated on Tue Jun 06, 2017 07:31 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603738

Background The contribution of simultaneous breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap to the efficacy of vascularized groin lymph node transfer (LNT) for breast cancer-related lymphedema (BCRL) was investigated. Methods Patients were divided into two groups: the first group underwent groin LNT + DIEP flap surgery for simultaneous breast reconstruction (groin LNT + DIEP flap group) and the second group underwent groin LNT only (groin flap alone group). Patients with BCRL were evaluated based on indocyanine green lymphography findings. LNT was indicated only in advanced-stage BCRL cases, and groin nodes nourished by superficial circumflex iliac artery (SCIA) were used as donors. The side for the vascular pedicle(s) was decided based on our algorithm. In patients with pendulous breast, the flap was vertically transferred on the chest. Lymphatic function was assessed after LNT using imaging tests, and transferred lymph nodes were evaluated using ultrasonography. Results In this study, 27 patients with advanced-stage BCRL underwent LNT. Of them, 13 belonged to the groin LNT + DIEP flap group and 14 belonged to the groin flap alone group. Although reduction volume was not significantly different between the groups, the number of patients in whom lymphatic function was improved and the need for compression therapy could be reduced was significantly higher in the groin LNT + DIEP flap group than in the groin flap alone group. Conclusion When a patient with advanced-stage BCRL undergoes LNT based on SCIA, simultaneous breast reconstruction using DIEP flap may reduce the need for compression therapy.
[...]


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Mon Jun 05, 2017 05:13
  A quality control circle process to improve implementation effect of prevention measures for high-risk patients
updated on Mon Jun 05, 2017 09:11 by Alexandros G. Sfakianakis via Aesthetic
Abstract
The aim of the study was to analyse the influence of prevention measures on pressure injuries for high-risk patients and to establish the most appropriate methods of implementation.

Nurses assessed patients using a checklist and factors influencing the prevention of a pressure injury determined by brain storming. A specific series of measures was drawn up and an estimate of risk of pressure injury determined using the Braden Scale, analysis of nursing documents, implementation of prevention measures for pressure sores and awareness of the system both before and after carrying out a quality control circle (QCC) process.

The overall scores of implementation of prevention measures ranged from 74.86 ± 14.24 to 87.06 ± 17.04, a result that was statistically significant (P < 0.0025). The Braden Scale scores ranged from 8.53 ± 3.21 to 13.48 ± 3.57. The nursing document scores ranged from 7.67 ± 3.98 to 10.12 ± 1.63; prevention measure scores ranged from 11.48 ± 4.18 to 13.96 ± 3.92. Differences in all of the above results are statistically significant (P < 0.05).

Implementation of a QCC can standardise and improve the prevention measures for patients who are vulnerable to pressure sores and is of practical importance to their prevention and control.



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Mon Jun 05, 2017 04:13
  Qualitative correlation between postoperatively increased vertical dimension and mandibular position in skeletal class III using partial-least-square path modeling
updated on Mon Jun 05, 2017 09:11 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
This study constructed a partial-least-square path-modeling (PLS-PM) model and found the pathway by which the postsurgical vertical dimension (VD) affects the extent of the final mandibular setback on the B point at the posttreatment stage for the skeletal class III surgery-first approach (SFA).

Methods
This study re-analyzed the data from the retrospective study by Lee et al. on 40 patients with skeletal class III bimaxillary SFA. Variables were obtained from cone beam computed tomography (CBCT)-generated cephalograms. Authors investigated all variables at each time point to build a PLS-PM model to verify the effect of the VD on the final setback of the mandible.

Results
From PLS-PM, an increase in VD10 was found to decrease the absolute value of the final setback amount of the mandible, which reflects the postsurgical physiological responses to both surgery and orthodontic treatment, which, in turn, can be interpreted as an increase in postoperative mandibular changes.

Conclusions
To resolve the issue of collinear cephalometric data, the present study adopted PLS-PM to assess the orthodontic treatment. From PLS-PM, it was able to summarize the effect of increased postsurgery occlusal vertical dimension on the increased changeability of the B point position at the posttreatment stage.



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Mon Jun 05, 2017 03:33
  Amnion Membrane in Diabetic Foot Wounds: A Meta-analysis
updated on Mon Jun 05, 2017 09:11 by Alexandros G. Sfakianakis via Aesthetic
imageBackground: Amniotic membrane is tissue obtained from human placenta rich in cytokines, growth factors, and stem cells that possess the ability to inhibit infection, improve healing, and stimulate regeneration. Methods: A meta-analysis was performed examining randomized controlled trials comparing amniotic tissue products with standard of care in nonhealing diabetic foot ulcers including PubMed, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Results: A search of 3 databases identified 596 potentially relevant articles. Application of selection criteria led to the selection of 5 randomized controlled trials. The 5 selected randomized controlled trials represented a total of 311 patients. The pooled relative risk of healing with amniotic products compared with control was 2.7496 (2.05725–3.66524, P

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Mon Jun 05, 2017 03:33
  Plastic and Reconstructive Surgery in Global Health: Let’s Reconstruct Global Surgery
updated on Mon Jun 05, 2017 09:11 by Alexandros G. Sfakianakis via Aesthetic
imageSummary: Since the inception of the Lancet Commission in 2013 and consequent prioritization of Global Surgery at the World Health Assembly, international surgical outreach efforts have increased and become more synergistic. Plastic surgeons have been involved in international outreach for decades, and there is now a demand to collaborate and address local need in an innovative way. The aim of this article was to summarize new developments in plastic and reconstructive surgery in global health, to unify our approach to international outreach. Specifically, 5 topics are explored: current models in international outreach, benefits and concerns, the value of research, the value of international surgical outreach education, and the value of technology. A "Let's Reconstruct Global Surgery" network has been formed using Facebook as a platform to unite plastic and reconstructive surgeons worldwide who are interested in international outreach. The article concludes with actionable recommendations from each topic.

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Sun Jun 04, 2017 21:28
  The efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: a retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases
updated on Mon Jun 05, 2017 01:28 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 3 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alessio Stivala, Kessara Rem, Sara Leuzzi, Vivien Moris, Caroline François, Marc Revol, Sarra Cristofari
The effectiveness of radiological imaging in detecting silicone breast implant rupture is, to this day, uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture.The population taken into exam comprised 175 patients with 242 implants, among which 168 were used for breast reconstruction and 74 for aesthetic augmentation. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction, were included, regardless of any preoperative diagnosis of rupture had been made. The diagnosis of intracapsular rupture was verified intraoperatively and compared to the preoperative findings. Regarding preoperative diagnostic imaging methods, we compared Magnetic Resonance Imaging (MRI), Mammography and Ultrasonography (US).Among the 242 implants which have been explanted, 35 clinical ruptures were confirmed and compared with the related radiological findings. We reported 22 false positives and 15 false negatives. Ultrasonography was the least specific and least accurate method, due to its lowest positive predictive value (PPV) and negative predictive value (NPV). Mammography was the most specific and most accurate method with the highest PPV (96%). Surprisingly, MRI was the most sensitive, but neither the most specific nor the most accurate method despite having the highest NPV (98%).Comparing these three radiological techniques brought us to the conclusion that US associated with MRI can be useful for young patients. Mammography, which was characterized by high specificity and accuracy, could be useful in association with MRI in investigating patients over the age of 40.



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Sun Jun 04, 2017 01:58
  The efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: a retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases
updated on Sun Jun 04, 2017 06:00 by Alexandros G. Sfakianakis via Aesthetic
The effectiveness of radiological imaging in detecting silicone breast implant rupture is, to this day, uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture.The population taken into exam comprised 175 patients with 242 implants, among which 168 were used for breast reconstruction and 74 for aesthetic augmentation. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction, were included, regardless of any preoperative diagnosis of rupture had been made.

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Sun Jun 04, 2017 01:19
  Donor Site Morbidity in DIEP Free Flap Breast Reconstructions: A Comparison of Unilateral, Bilateral, and Bipedicled Surgical Procedure Types
updated on Sun Jun 04, 2017 06:00 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 3 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Taj Tomouk, Anita T. Mohan, Alex Azizi, Elena Conci, Elizabeth B. Brickley, Charles M. Malata
BackgroundThe use of abdominal tissue in post-mastectomy autologous breast reconstruction is a popular choice among reconstructive surgeons. This is the first study to evaluate donor complications comparing unilateral, bilateral and bipedicled DIEP breast reconstructions.MethodsA retrospective chart review was conducted of all women undergoing rib-preserving DIEP free flap breast reconstruction at a University Hospital between 2008 and 2015 by the senior surgeon (CMM).ResultsA total of 130 patients were included in this study and divided into three groups: unipedicled unilateral (n=93), unipedicled bilateral (n=19) and bipedicled unilateral (n=18). Relative to the unipedicled unilateral group, the age and BMI-adjusted odds of complication were almost two-fold higher in the bilateral group (Odds ratio (95% CI): 1.97 (0.63, 6.19)), and approximately halved in the bipedicled group (Odds ratio (95% CI): 0.59 (0.22, 1.61)); however, these associations were not statistically significant. Overall, 75% of complications were managed conservatively. The majority of Clavien-Dindo Grade 3 complications were observed in participants from the unipedicled unilateral group (84%), whereas no patients in the bipedicled group developed morbidity that required recourse to surgery or readmission to hospital.ConclusionsAlthough further research with greater statistical power will be valuable moving forward, the results of this investigation provide evidence that donor site morbidity of bipedicled DIEP free flap breast reconstructions is not increased compared with unipedicled unilateral and unipedicled bilateral surgical procedure types.



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Sat Jun 03, 2017 21:53
  Thoracic Outlet Syndrome after the Nuss Procedure for Pectus Excavatum―Is It a Rare Complication?
updated on Sun Jun 04, 2017 06:00 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 3 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Tomohisa Nagasao, Tadaaki Morotomi, Motone Kuriyama, Tetsukuni Kogure, Hirro Kudo, Yusuke Hamamoto, Motoki Tamai
ObjectiveThe present study aims to elucidate the frequency of thoracic outlet syndrome after the Nuss procedure for pectus excavatum and the conditions in which thoracic outlet syndrome is likely to develop.MethodsA retrospective study was conducted including 85 pectus excavatum patients (58 males and 27 females). Thoracic outlet syndrome was defined as a condition in which the patient has numbness, lassitude, or pain of the upper limbs at rest or during motion of the upper limbs. Frequency of thus-defined thoracic outlet syndrome was evaluated with the 85 patients. Age, sex, Haller Indexes and the positions of the correction bars were compared between the patients who developed thoracic outlet syndrome and those who didn't.ResultsPre-adolescent patients (18 out of 85) didn't develop postoperative thoracic outlet syndrome. 15.2 percent of adult male patients (7 out of 46) and 33 percent of adult female patients (7 out of 21) developed postoperative thoracic outlet syndrome. Haller indexes were significantly greater for patients who had postoperative thoracic outlet syndrome than for those who didn't, for both male and female groups. In patients who developed postoperative thoracic outlet syndrome, correction bars were generally placed at higher inter-costal spaces than in those who didn't.ConclusionA considerable percentage of adult patients develop thoracic outlet syndrome after the Nuss procedure for pectus excavatum. Maturity of the thoracic wall, femininity, severity of the deformity (represented by greater Haller Indexes), and placement of correction bars at superior inter-costal spaces are risk factors for postoperative thoracic outlet syndrome.



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Sat Jun 03, 2017 21:53
  Refining the Extended Circumflex Scapular Flap for Neck Burn Reconstruction: A 30-Year Experience
updated on Sun Jun 04, 2017 06:00 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 3 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Claudio Angrigiani, Guillermo Artero, Carlos Sereday, Roger K. Khouri, Zachary P. French
IntroductionNeck burn sequelae remain a major challenge for the reconstructive surgeon. To achieve satisfactory functional and aesthetic results, the anterior neck aesthetic unit must be covered as a single unit. In cases where free flaps are required, harvesting a flap of sufficient size can cause major donor site morbidity. In 1994, we published our favorable 6-year experience reconstructing neck burn sequelae with an Extended Circumflex Scapular Flap (ECSF). We have since made several modifications to the technique that improve long-term functional and aesthetic results. Herein, we present our 30-year, 150-patient experience with the ECSF flap for treatment of anterior neck burn sequelae.MethodsWe retrospectively reviewed the records of 150 consecutive patients who underwent ECSF for neck resurfacing by the senior author from 1986-2015. All cases were assessed for function, aesthetics, satisfaction, and complications.Results160 ECSFs were used in 150 patients. Ninety-nine patients were available for updated follow up [1-30 years (mean, 15.3)]. At last follow up, 92 patients regained full range of motion, and 90 patients had acceptable cerviocmental angle (<110º). Mean patient satisfaction was 4.8/5.Nine flaps (5.6%) failed completely and were successfully replaced. Twenty-two patients (15%) had distal necrosis of the flap. Fifteen of these 22 patients underwent complementary flaps to replace the necrotic area, and all 15 regained full range of motion.ConclusionsFor neck burn sequelae, the ECSF provides safe and effective long-term functional and aesthetic results with minimal donor site morbidity.



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Sat Jun 03, 2017 21:53
  Impact of adjuvant anti-estrogen therapies (tamoxifen and aromatase inhibitors) on perioperative outcomes of breast reconstruction
updated on Sun Jun 04, 2017 06:00 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 3 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): R. Billon, R. Bosc, Y. Belkacemi, E. Assaf, M. SidAhmed-Mezi, B. Hersant, J.P. Meningaud, Raphaëlle Billon, Romain Bosc, Yazid Belkacemi, Elias Assaf, Mounia SidAhmed-Mezi, Barbara Hersant, Jean-Paul Meningaud
PurposeHormone (anti-estrogen) therapy (HT) plays a major role in hormone receptor-positive breast cancer management. The latest guidelines propose to extend adjuvant treatment duration from 5 to 10 years. The link between HT and thromboembolic or microvascular complications during breast reconstruction has been investigated. However, while estrogens play a crucial role in skin healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative complications, including wound healing complications. The aim of this study was to assess the impact of HT on surgical outcomes after breast reconstruction.MethodsAll patients who underwent breast reconstruction between January 2012 and December 2013 were reviewed. Rates of wound healing complications, prosthesis complications, microvascular thrombosis, flap failures and venous thromboembolism were retrospectively compared between patients treated or not with HT at the time of surgery.ResultsA total of 233 operations were performed: 78 free flaps, 12 autologous latissimus dorsi flaps, 47 implants, 42 lipofilling and 54 secondary symmetrization. At the time of surgery, 38% of patients were treated with HT. Those who received HT experienced significantly more wound healing complications (61% versus 28%; p<0.001), including fat necrosis (26% versus 8.3%; p<0.001), infections (15% versus 2.8%; p<0.001), delayed wound healing (49% versus 13%; p<0.001) and grade III/IV capsular contracture (55% versus 9.1%; p=0.001). There was no significant difference in microvascular thrombosis and venous thromboembolism.ConclusionsHT seems to be associated with an increased risk of wound healing complications. There is to date no guideline on perioperative HT discontinuation. Further investigations are required



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Sat Jun 03, 2017 21:53
  An objective assessment of Botulinum toxin type A injection in the treatment of post facial palsy synkinesis and hyperkinesis using the Synkinesis Assessment Questionnaire (SAQ)
updated on Sun Jun 04, 2017 06:00 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 2 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Catriona Neville, Vanessa Venables, Margaret Aslet, Charles Nduka, Ruben Kannan
The aim of this study is to provide reliable and valid evidence that Botulinum toxin (BTX-A) is a successful treatment for facial synkinesis in facial palsy using the synkinesis assessment questionnaire tool (SAQ). 51 patients completed questionnaires pre and post BTX-A treatment over 103 cycles of treatment. Each patient was individually assessed and then treated according to their presenting symptoms with a dosage in each injection site of between 0.5 to 5 U of BTX-A. A two-tailed, paired samples t-test was used to compare the scores for each question before and after treatment. A significant difference was found between all scores before and after treatment at the level of p < 0.05. As well as an improvement in mean score in the post treatment group there was also a smaller spread of scores in the post-treatment group compared to the pre-treatment group. The study showed that SAQ scores decreased significantly for every question on the SAQ after treatment. This indicates that BTX-A is an effective treatment for synkinesis adding further weight to current evidence. The study also indicated that BTX-A continues to be effective even after three rounds of treatment, with a significant decrease in overall scores after each treatment cycle.



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Sat Jun 03, 2017 09:11
  Free Diced Cartilage: A new application of diced cartilage grafts in primary and secondary Rhinoplasty.
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Background: Irregularities or deformities of the nasal dorsum after hump reduction account for a significant number of revision rhinoplasties. We therefore developed a technique of meticulously dicing and exactly placing free diced cartilage grafts (fDC), harvested from septum, rib, or ear cartilage. The cartilage paste is used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties. Methods: A retrospective analysis of multi-surgeon consecutive open approach rhinoplasties from January to December 2014 was conducted at a single center. We compared the outcome of three different techniques to augment or cover the nasal dorsum after an observation period of seven months: In Group I, 325 patients with fDC as the only onlay were included. In Group II, consisting of 73 patients, the dorsal onlay was either fascia alone, or in combination with fDC. 48 patients in Group III received a dorsal augmentation with the 'classical' diced cartilage in fascia (DCF) technique. Results: 446 patients with primary and secondary rhinoplasties in which one of the above-mentioned diced cartilage techniques was used were included in the study. We found revision rates for dorsal irregularities within the seven-month postoperative observation period of 5.2%, 8.2%, and 25% for Groups I-III, respectively. Conclusion: Our findings strongly support our clinical experience that the fDC technique presents an effective and easily reproducible method for camouflage and augmentation in aesthetic and reconstructive rhinosurgery. (C)2017American Society of Plastic Surgeons

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Sat Jun 03, 2017 09:11
  Dynamic Rheology for the Prediction of Surgical Outcomes in Autologous Fat Grafting.
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Background: Due to the abundance and biocompatibility of fat, lipotransfer has become an attractive method for treating soft tissue deficits. However, it is limited by unpredictable graft survival and retention. Currently, little is known about the viscoelastic properties of fat after various injection methods. Here, we assess the effects of cannula diameter, length, and shape on the viscoelastic properties, structure, and retention of fat. Methods: Human lipoaspirate was harvested using suction-assisted liposuction and prepared for grafting. A syringe pump was used to inject fat at a controlled flow rate through cannulas of varying gauge, length, and shape. Processed samples were tested in triplicate on an oscillatory rheometer to measure their viscoelastic properties. Fat grafts from each group were placed into the scalps of immunocompromised mice. After 8 weeks, graft retention was measured using micro-CT and grafts were explanted for histological analysis. Results: Lipoaspirate injected through narrower, longer, and bent cannulas exhibited more shear thinning with diminished quality. The storage modulus (G') of fat processed with 18-gauge cannulas was significantly lower than when processed with 14-gauge or larger cannulas, which also corresponded with inferior in vivo histological structure. Similarly, the longer cannula group had a significantly lower G' than the shorter cannula, and was associated with decreased graft retention. Conclusions: Discrete modifications in the methods used for fat placement can have a significant impact on immediate graft integrity, and ultimately on graft survival and quality. Respecting these biomechanical influences during the placement phase of lipotransfer may allow surgeons to optimize outcomes. (C)2017American Society of Plastic Surgeons

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Sat Jun 03, 2017 09:11
  Five Operations that give the best results after brachial plexus injury.
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Treatment of brachial plexus injuries has slowly improved over the last 45 years. Changes in strategy, techniques, microsurgical equipment and technology have expanded the surgical options to reconstruct these life altering, highly complex injuries. The surgical armamentarium includes neurolysis, nerve repair, nerve grafting, nerve transfers, tendon transfer, muscle transfer and other soft tissue and bony procedures. In this article we have selected five surgical procedures (Oberlin's procedure, Leechavengvongs' procedure, free functional muscle transfer, radial nerve tendon transfers and C5-C6 nerve grafting in obstetrical birth palsy) that have consistently given us good results in our patients who require surgical reconstruction. (C)2017American Society of Plastic Surgeons

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Sat Jun 03, 2017 09:11
  Minor suture fusion in syndromic craniosynostosis.
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Background: Infants with craniofacial dysostosis syndromes may present with midface abnormalities but without major (calvarial) suture synostosis and head shape anomalies. Delayed presentation of their calvarial phenotype is known as progressive postnatal craniosynostosis. Minor sutures/synchondroses are continuations of major sutures toward and within the skull base. We hypothesized that minor suture synostosis is present in infants with syndromic, progressive postnatal craniosynostosis, and is associated with major suture synostosis. Methods: A two-institution review of infants (

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Sat Jun 03, 2017 09:11
  Prepectoral Breast Reconstruction: A Safe Alternative To Submuscular Prosthetic Reconstruction Following Nipple Sparing Mastectomy.
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Background: Nipple sparing mastectomy (NSM) with immediate prosthetic reconstruction is routinely performed due to excellent aesthetic results, and safe oncologic outcomes. Typically, subpectoral expanders are placed, but in select patients, this can lead to significant postoperative pain and animation deformity, due to pectoralis major muscle disinsertion and stretch. Prepectoral reconstruction is a technique that eliminates dissection of the pectoralis major, by placing the prosthesis completely above the muscle with complete acellular dermal matrix (ADM) coverage. Methods: A single surgeon's experience with immediate prosthetic reconstruction following NSM from 2012 - 2016 was reviewed. Patient demographics, adjuvant treatment, length and characteristics of the expansion, and incidence of complications during the tissue expander stage were compared, between partial submuscular/partial ADM (dual-plane) cohort and prepectoral cohort. Results: Fifty-one patients (84 breasts) underwent immediate prepectoral tissue expander placement, compared to 115 patients (186 breasts) undergoing immediate partial submuscular expander placement. The groups had similar comorbidities and postoperative radiation exposure. There was no significant difference in overall complication rate between the two groups (17.9% vs 18.8%, p = 0.49). Conclusions: Prepectoral breast reconstruction provides a safe and effective alternative to partial submuscular reconstruction, that yields comparable aesthetic results with less operative morbidity. In the authors' experience, the incidence of acute and chronic postoperative pain, and animation deformity, is significantly lower following prepectoral breast reconstruction. This technique is now considered for all patients who are safe oncologic candidates, and are undergoing NSM and prosthetic reconstruction. (C)2017American Society of Plastic Surgeons

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Sat Jun 03, 2017 09:11
  Single-artery human ear graft procurement: a simplified approach.
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Background. In the field of experimental facial vascularized composite tissue allotransplantation (VCA), a human auricular subunit model, pedicled on both superficial temporal (STA) and posterior auricular (PAA) arteries was described. Clinical cases of extensive auricular replantation however, suggested that a single artery could perfuse the entire flap. In our study, variants of this single pedicle approach have been studied, aiming to develop a more versatile replantation technique, in which the question of venous drainage has also been addressed. Methods. For arterial perfusion study, we harvested 11 auricular grafts, either on a single STA pedicle (n=3) or a double STA-PAA pedicle (n=8). We then proceeded to selective barium injections, in STA, PAA or both PAA-STA. Arteriograms were acquired with a Micro-CT scan and analyzed on 3D-reconstructed images. Venous drainage was investigated in eight hemi-faces, carefully dissected after latex injection. Results. Observations showed a homogenous perfusion of the whole auricle in all arterial graft variants. Venous drainage was highly variable, with either a dominant superficial temporal vein (37.5%), dominant posterior auricular vein (12.5%) or co-dominant trunks (50%). Conclusions. We demonstrated that auricular subunit VCA can be performed on a single artery, relying on the dynamic intra-auricular anastomoses between STA and PAA branches. Potentially, this vascular versatility is prone to simplify the subunit harvest and allows various strategies for pedicle selection. Venous drainage, however, remains inconstant and thus the major issue when considering auricular transplantation. (C)2017American Society of Plastic Surgeons

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Sat Jun 03, 2017 06:06
  Intraoperative 1-Hour Electrical Nerve Stimulation Enhances Outcomes of Nerve–Muscle-Endplate Band Grafting Technique for Muscle Reinnervation
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1602824

Background Increasing evidence suggests that 1-hour electrical nerve stimulation during surgery improves nerve regeneration and functional recovery. However, it remains unknown if this approach has beneficial effects on the outcomes of our recently developed nerve–muscle-endplate band grafting-native motor zone (NMEG-NMZ) technique for muscle reinnervation. Methods In this study, NMEG-NMZ transplantation was performed in a rat model. The right sternomastoid muscle was experimentally denervated and immediately reinnervated by implanting a NMEG harvested from the ipsilateral sternohyoid (SH) muscle into the NMZ of the target muscle. Before implantation of the NMEG, the SH nerve branch innervating the NMEG was subjected to intraoperative 1-hour continuous electrical stimulation (20 Hz). Three months after surgery, the degree of functional recovery was evaluated with muscle force measurement and the extent of nerve regeneration and endplate reinnervation was examined using histological and immunohistochemical methods. Results A combination of NMEG-NMZ with electrical nerve stimulation resulted in a greater degree of functional recovery than the NMEG-NMZ alone. The mean muscle force of the treated muscles was 90% of the contralateral control. The muscle mass was recovered up to 90% of the control. The mean number and percentage of area of the regenerated axons in the treated muscles was computed to be 81 and 84% of the control muscles, respectively. On average, 83% of the denervated endplates in the treated muscles were reinnervated by regenerated axons. Conclusion Intraoperative brief nerve stimulation promotes nerve regeneration, endplate reinnervation, and functional recovery of the muscles reinnervated with NMEG-NMZ technique.
[...]


Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Sat Jun 03, 2017 04:26
  Thoracic Outlet Syndrome after the Nuss Procedure for Pectus Excavatum―Is It a Rare Complication?
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
The present study aims to elucidate the frequency of thoracic outlet syndrome after the Nuss procedure for pectus excavatum and the conditions in which thoracic outlet syndrome is likely to develop.

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Sat Jun 03, 2017 04:26
  Reliability and validity of Mamma Balance®: Novel software to assess the symmetry of the nipple-areola-complex position
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
It is important to achieve as much symmetry in the breasts as possible during breast reconstruction. The nipple-areola complex (NAC) position is an important component of a breast appearance, and it critically affects the aesthetic outcome of surgery. Mamma Balance® (MB) (Medic Engineering K.K, ver. 1.0.3) can automatically calculate and assess the degree of the NAC position's symmetry with one continuous variable. The purpose of this study was to evaluate the reliability and validity of this software to assess the NAC's symmetry.

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Sat Jun 03, 2017 04:26
  An objective assessment of Botulinum toxin type A injection in the treatment of post facial palsy synkinesis and hyperkinesis using the Synkinesis Assessment Questionnaire (SAQ)
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
The aim of this study is to provide reliable and valid evidence that Botulinum toxin (BTX-A) is a successful treatment for facial synkinesis in facial palsy using the synkinesis assessment questionnaire tool (SAQ). 51 patients completed questionnaires pre and post BTX-A treatment over 103 cycles of treatment. Each patient was individually assessed and then treated according to their presenting symptoms with a dosage in each injection site of between 0.5 to 5 U of BTX-A. A two-tailed, paired samples t-test was used to compare the scores for each question before and after treatment.

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Sat Jun 03, 2017 04:26
  Impact of adjuvant anti-estrogen therapies (tamoxifen and aromatase inhibitors) on perioperative outcomes of breast reconstruction
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Hormone (anti-estrogen) therapy (HT) plays a major role in hormone receptor-positive breast cancer management. The latest guidelines propose to extend adjuvant treatment duration from 5 to 10 years. The link between HT and thromboembolic or microvascular complications during breast reconstruction has been investigated. However, while estrogens play a crucial role in skin healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative complications, including wound healing complications.

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Sat Jun 03, 2017 04:26
  Refining the Extended Circumflex Scapular Flap for Neck Burn Reconstruction: A 30-Year Experience
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Neck burn sequelae remain a major challenge for the reconstructive surgeon. To achieve satisfactory functional and aesthetic results, the anterior neck aesthetic unit must be covered as a single unit. In cases where free flaps are required, harvesting a flap of sufficient size can cause major donor site morbidity. In 1994, we published our favorable 6-year experience reconstructing neck burn sequelae with an Extended Circumflex Scapular Flap (ECSF). We have since made several modifications to the technique that improve long-term functional and aesthetic results.

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Sat Jun 03, 2017 04:26
  Donor Site Morbidity in DIEP Free Flap Breast Reconstructions: A Comparison of Unilateral, Bilateral, and Bipedicled Surgical Procedure Types
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
The use of abdominal tissue in post-mastectomy autologous breast reconstruction is a popular choice among reconstructive surgeons. This is the first study to evaluate donor complications comparing unilateral, bilateral and bipedicled DIEP breast reconstructions.

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Sat Jun 03, 2017 04:26
  The Indian Nose: An anthropometric analysis
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Anthropometric measurements of nose are of great importance in planning aesthetic nasal surgery. Abundant literature is available on anthropometric analysis of Caucasians and Orientals, without similar references on Indian nose and its regional differences. Thus, we conducted a descriptive cross sectional epidemiological study of one thousand volunteers, with equal number of subjects derived from five geographic groups namely North; Central; West; South; and Himalayan region to determine differences in nasal morphology of Indian population and amongst its various regions.

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Sat Jun 03, 2017 04:26
  Incidence and Risk Factors for Venous Thromboembolism in Bilateral Breast Reduction Surgery: An Analysis of the National Surgical Quality Improvement Program
updated on Sat Jun 03, 2017 13:14 by Alexandros G. Sfakianakis via Aesthetic
Risk of venous thromboembolism (VTE) in patients undergoing bilateral breast reduction surgery remains unknown. Aim of this study was to determine VTE incidence and risk factors in this patient cohort.

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Fri Jun 02, 2017 20:57
  Incidence and Risk Factors for Venous Thromboembolism in Bilateral Breast Reduction Surgery: An Analysis of the National Surgical Quality Improvement Program
updated on Sat Jun 03, 2017 00:59 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 2 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Gustavo A. Rubio, Yasmina Zoghbi, Charles Karcutskie, Seth R. Thaller
BackgroundRisk of venous thromboembolism (VTE) in patients undergoing bilateral breast reduction surgery remains unknown. Aim of this study was to determine VTE incidence and risk factors in this patient cohort.MethodsAmerican College of Surgeons National Surgical Quality Improvement Program (2010-2014) was used to identify women undergoing bilateral breast reduction. Demographic factors, comorbidities, and rate of postoperative venous thromboembolism (VTE) were evaluated. Bivariate and risk-adjusted multivariate logistic regression were performed to determine factors associated with the development of postoperative VTE.ResultsA total of 5,371 cases were identified. Mean age was 43.7 years (SD ± 13.9 years). Rate of VTE was 0.22%, with 0.17% rate of pulmonary embolism and 0.07% of deep venous thrombosis requiring treatment. Patients who suffered VTE were older (52.4 ± 12.8 vs. 43.7 ± 13.9 years, p< 0.05), had longer length of stay (1.7 ± 2.9 vs. 0.4 ± 2.1 days, p< 0.05), higher rates of blood transfusion (8.3% vs 0.4%, p< 0.01) and reoperation (16.7% vs. 2.0%, p< 0.01). Risk-adjusted multivariate analysis demonstrated that increasing age (OR 1.05, 95% CI 1.01-1.10), receiving a blood transfusion (OR 13.5, 95% CI 1.3-34.8), and an unplanned return to the operating room (OR 6.7, 95% CI 1.3-112.0) were independent risk factors for developing postoperative VTE.ConclusionIn bilateral breast reduction surgery, older patients and those requiring blood transfusion or return to the operating room are at increased risk of developing postoperative VTE. These factors can be considered for patient risk-stratification and perioperative decision-making regarding VTE prevention.



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Fri Jun 02, 2017 20:57
  Reliability and validity of Mamma Balance®: Novel software to assess the symmetry of the nipple-areola-complex position
updated on Sat Jun 03, 2017 00:59 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 2 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yuko Mukai, Satoko Watanabe, Mio Matsumoto, Miho Saiga, Yoshihiro Kimata
BackgroundIt is important to achieve as much symmetry in the breasts as possible during breast reconstruction. The nipple-areola complex (NAC) position is an important component of a breast appearance, and it critically affects the aesthetic outcome of surgery. Mamma Balance® (MB) (Medic Engineering K.K, ver. 1.0.3) can automatically calculate and assess the degree of the NAC position's symmetry with one continuous variable. The purpose of this study was to evaluate the reliability and validity of this software to assess the NAC's symmetry.MethodsTwenty-seven patients received nipple-sparing mastectomy followed by tissue expander reconstruction at Okayama University Hospital between August 2009 and August 2014. Three raters evaluated the NAC position's symmetry using an ordinal scale (OS) and the MB, and the inter-rater reliability and validity of each method were assessed.ResultsThe inter-rater reliabilities of each method were good (OS-ICC, 0.93; MB-ICC, 0.78). The Spearman's rank correlation coefficients of the OS and the MB were moderate-to-good (r=0.65-0.74), and the MB scores were widely dispersed among the OS scores 0, which was considered a floor effect.ConclusionThe MB was superior to the OS in terms of objective continuous variables and freedom from the floor effect. This novel software is an excellent tool for assessing the NAC position's symmetry.



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Fri Jun 02, 2017 20:57
  The Indian Nose: An anthropometric analysis
updated on Sat Jun 03, 2017 00:59 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 2 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nikhil Mehta, Rakesh K. Srivastava
Anthropometric measurements of nose are of great importance in planning aesthetic nasal surgery. Abundant literature is available on anthropometric analysis of Caucasians and Orientals, without similar references on Indian nose and its regional differences. Thus, we conducted a descriptive cross sectional epidemiological study of one thousand volunteers, with equal number of subjects derived from five geographic groups namely North; Central; West; South; and Himalayan region to determine differences in nasal morphology of Indian population and amongst its various regions. The objective was to establish a standard Indian data for guidance in nasal surgery. All measurements were deduced using photographic analysis. The mean nasal height and width of our study population was 50.48 mm and 36.59 mm. Nasal profile varied amongst all five regions of the country. North Indians had the longest (52.69mm nasal height) but narrowest nose (35.01mm width); thus having a leptorrhine nose with Caucasoid features. South Indians had the broadest noses (nasal width=38.66mm) whereas subjects from Himalayan region had shortest nose (nasal height=47.2mm). Indians on an average had a mesorrhine nose compared to leptorrhine nose in Caucasians and Orientals and platyrrhine nose in Africans.We thus conclude that Indian nose should be considered a different entity in comparison to Caucasians, Orientals and African population. There are obvious differences in the facial architecture of people from different regions within this country. Therefore, appropriate adjustments need to be made according to different racial descents during nasal surgeries so as to give patients results which blend harmoniously with other facial features.



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Fri Jun 02, 2017 15:41
  Topical equol preparation improves structural and molecular skin parameters
updated on Fri Jun 02, 2017 19:43 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Objective
Equol has been shown to improve skin health and regeneration, due to its antioxidative, phytoestrogenic and epigenetic characteristics. The effects of a topical intervention on skin structure, telomere length and epigenetic markers in skin cells were analysed.

Methods
64 participants were divided in four groups and three of them treated topically with: emulsion with Equol powder (Isoflavandiol-E-55-RS®); emulsion with microencapsulated Equol (Vesisorb® Isoflavandiol-E-55-RS®) and an emulsion with lecithin (Vesisorb® placebo). A control group of 6 volunteers did not receive any intervention. The active compound was a 0.5% equol-racemate. For 58 participants all samples were collected. Structural analysis, molecular analysis and questionnaires were done at the start of the study and after 8 weeks of intervention, twice a day. Structural skin parameters were analysed by Visioscan® VC 98 and Cutometer® dual MPA 580. Molecular analyses from epidermal cells collected by skin stripping of the forehead included telomere length and LINE-1 methylation, following DNA extraction, bisulfite conversion and qPCR as well as high resolution melting curve analysis. Effects of nutrition and lifestyle habits were evaluated with a standardized food and lifestyle questionnaire.

Results and discussion
The surface analysis showed significant improvements of skin roughness, skin texture and skin smoothness after both interventions. Cutometer® dual MPA 580 measurement revealed improvement of skin firmness and elasticity parameters for both preparations. A decrease of mean LINE-1 methylation (n.s.) and telomere length (sign. p < 0.05) was observed in the sample group with age. In the treated groups significantly longer telomeres were observed after intervention. Whether changes in telomere length reflect changes in the regulation of telomerase, epigenetic interactions or turnover of keratinocytes needs further research. Stability and availability of preparations in skin seems to be high as not many significant differences in the activity of pure or encapsulated substances were seen.

Conclusion
The results of the present study indicate that equol has beneficial effects on structural as well as molecular skin parameters and encourages further investigations to decipher the epigenetic regulation of skin aging and interactions of equol.

This article is protected by copyright. All rights reserved.



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Fri Jun 02, 2017 10:16
  The effect of age on microsurgical free flap outcomes: An analysis of 5,951 cases
updated on Fri Jun 02, 2017 14:19 by Alexandros G. Sfakianakis via Aesthetic
Background
The growing elderly population necessitates a greater number of aging patients requiring complex reconstructive surgery involving free tissue transfer. The purpose of this study was to assess the safety, efficacy, and outcomes of microsurgical free tissue transfer in elderly patients using a national multi-institutional database.

Methods
We performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients undergoing free tissue transfer. We stratified cohorts based on ages 18–49, 50–59, 60–69, 70–79, and 80+ years and analyzed primary outcomes of surgical complications, medical complications, mortality, and flap failure.

Results
A total of 5,951 patients were identified for inclusion in the analysis. Univariate analysis demonstrated progressively increasing surgical (P = .001) and medical (P < .001) complication rates with increasing age. After controlling for confounding variables, age was not significantly associated with rates of surgical (OR 1.00, 95% CI 0.99–1.01, P = .737) or medical (OR 1.01, 95% CI 0.99–1.03, P = .209) complications, flap failure (OR 1.00, 95% CI 1.00–1.02, P = .689), or reoperation (OR 1.01, 95% CI 1.00–1.03, P = 0.165). Factors associated with surgical complications included BMI (OR 1.03, 95% CI 1.00–1.05, P = .031), prolonged operative time (OR 1.001, 95% CI 1.000–1.002, P = .002), American Society of Anesthesiologists (ASA) classification of 3 or greater (OR 1.62, 95% CI 1.17–2.23, P = .003), and prolonged hospitalization (OR 1.03, 95% CI 1.02–1.04, P < .001). ASA classification of 3 or greater (OR 2.57, 95% CI 1.48-4.45, P = .001), renal history (OR 10.13, 95% CI 1.57–65.55, P = .015), and prolonged hospitalization (OR 1.06, 95% CI 1.04-1.08, P < .001) were associated with medical complications. Age was associated with increased mortality (OR 1.06, 95% CI 1.00–1.13, P = .048).

Conclusion
Age alone should not be used as an absolute or even relative contraindication in patient assessment. Rather, preoperative assessment should focus on comorbidities and assessment of physiologic age instead of chronologic age. Optimization of these comorbidities is key to sustaining favorable outcomes in microsurgical free flap reconstruction in the elderly population.



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Fri Jun 02, 2017 07:16
  Is long-term postoperative monitoring of microsurgical flaps still necessary?
updated on Fri Jun 02, 2017 14:19 by Alexandros G. Sfakianakis via Aesthetic
Autologous microsurgical flap reconstruction has become commonplace in most plastic surgery units, and the success rates of this procedure have markedly increased over recent years. However, the possibility of flap failure still needs to be considered. A review of the literature reveals that the critical period for flap-threatening complications is the first 24-to-48 postoperative hours; however, the window for the onset of these complications remains open for up to 7 days postoperatively. Here, we focus on the timing of flap complications, aiming to elucidate the time period over which meticulous flap monitoring can still contribute positively to flap salvage rates.

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Thu Jun 01, 2017 21:11
  Is long-term postoperative monitoring of microsurgical flaps still necessary?
updated on Fri Jun 02, 2017 01:14 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 1 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Giovanni Zoccali, Alexandra Molina, Jian Farhadi
Autologous microsurgical flap reconstruction has become commonplace in most plastic surgery units, and the success rates of this procedure have markedly increased over recent years. However, the possibility of flap failure still needs to be considered. A review of the literature reveals that the critical period for flap-threatening complications is the first 24-to-48 postoperative hours; however, the window for the onset of these complications remains open for up to 7 days postoperatively. Here, we focus on the timing of flap complications, aiming to elucidate the time period over which meticulous flap monitoring can still contribute positively to flap salvage rates.The relevant literature on the study topic was collated and reviewed in conjunction with the senior author's case series, which consisted of a total of 335 free flaps used during a 2-year period for breast and head and neck reconstruction or limb trauma. Patients' series were then divided into groups according to the complications timing. The correlation between the timing of complications and the flap salvage rate was investigated among the groups.Overall analysis of both the literature and our own data on 335 free flaps showed a progressive reduction in flap salvage rate during the post operative day; the correlations between the times of complication onset and the flap salvage rates in all groups were significant up to the third postoperative day. The correlations between salvage rates and later complications were not significant. Our results suggest that hourly flap monitoring should be compulsory during the first 48 postoperative hours, but clinical monitoring four times daily should be sufficient thereafter.



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Thu Jun 01, 2017 20:36
  The Columella Retraction Suture
updated on Fri Jun 02, 2017 01:14 by Alexandros G. Sfakianakis via Aesthetic
This report presents the columella retraction suture as a way to control dead space after correction of the nasolabial and columella-tip complex.

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Thu Jun 01, 2017 20:36
  Early Division of the Forehead Flap Pedicle
updated on Fri Jun 02, 2017 01:14 by Alexandros G. Sfakianakis via Aesthetic
This cost-effectiveness analysis examines the costs associated with takedown of the paramedian forehead flap pedicle after 2 weeks using angiography with indocyanine green.

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Thu Jun 01, 2017 17:26
  Neoadjuvanz vs. primäre Resektion beim resektablen Pankreaskarzinom
updated on Fri Jun 02, 2017 01:14 by Alexandros G. Sfakianakis via Aesthetic
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Thu Jun 01, 2017 17:26
  Gemcitabin und Capecitabin als neuer Standard der adjuvanten Therapie beim Pankreaskarzinom
updated on Fri Jun 02, 2017 01:14 by Alexandros G. Sfakianakis via Aesthetic
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Thu Jun 01, 2017 17:26
  Chirurgische Strategien zur „Pouch-Rettung“
updated on Fri Jun 02, 2017 01:14 by Alexandros G. Sfakianakis via Aesthetic
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Zusammenfassung
Die restaurative Proktokolektomie mit ileo-J-Pouch-analer/-rektaler Rekonstruktion hat sich zum Goldstandard der chirurgischen Therapie der Colitis ulcerosa entwickelt. Trotz einer dramatischen Verbesserung der Lebensqualität der betroffenen Patienten, muss die ileo-J-Pouch-anale Rekonstruktion in ca. 5–10 % aller Patienten wieder aufgegeben werden. Die Gründe hierfür sind chronische Pouchitis, Inkontinenz, sekundäre Diagnose eines M. Crohn, Fisteln, schwere chirurgische Komplikationen, zu lang belassener Rektumstumpf, Fisteln, chronischer Abszess und chirurgisch technische Fehler. Nicht in allen Fällen bedeutet dies generell das Versagen der Methode. Anhand der Literatur und des eigenen Krankengutes von insgesamt 887 Fällen werden Behandlungsmöglichkeiten aufgezeigt. Eine Korrektur, Fistelverschluss und in Einzelfällen auch eine komplette Pouch-Neuanlage können in ca. 75 % aller Fälle eine gute Pouch-Funktion wiederherstellen. Verschiedene Indikationen, Techniken und Ergebnisse werden dargestellt.



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Thu Jun 01, 2017 09:39
  Transient ischemic attacks on turning the head to one side, with immediate remission of symptoms when the head returned to the neutral position.
updated on Thu Jun 01, 2017 13:41 by Alexandros G. Sfakianakis via Aesthetic
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http://medicine-greece.blogspot.com/2017/05/transient-ischemic-attacks-on-turning.html


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Thu Jun 01, 2017 09:26
  The extended medial plantar artery (EMPA) free flap for plantar foot defects
updated on Thu Jun 01, 2017 13:41 by Alexandros G. Sfakianakis via Aesthetic
Abstract
The medial plantar artery (MPA) flap was first introduced by Mir y Mir in 1954 and used to reconstruct a heel defect. The sole of the foot is designed to bear body weight and absorb the shocks of a bipedal gait. The properties of the plantar skin and deeper tissues are therefore highly specialised, and if normal function is to be restored, it is essential to replace "like with like" which is a fundamental principle of reconstructive surgery.

The aim of this article is to introduce the concept of an extended medial plantar artery (EMPA) free flap for plantar foot defects. The advantage of the extended version of the MPA flap in the presented cases is the harvest of a larger bulk of tissue and thus the possibility of covering larger defects in the weight-bearing area of the foot.

Level of Evidence: Level V, therapeutic study.



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Thu Jun 01, 2017 01:41
  Copyright
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3





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Thu Jun 01, 2017 01:41
  Contributors
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3





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Thu Jun 01, 2017 01:41
  Contents
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3





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Thu Jun 01, 2017 01:41
  Forthcoming Issues
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3





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Thu Jun 01, 2017 01:41
  Volume 1: Rescue, Resuscitation, and Resurfacing
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Charles Scott Hultman, Michael W. Neumeister




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Thu Jun 01, 2017 01:41
  Burn Care: Rescue, Resuscitation, and Resurfacing
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Charles Scott Hultman, Michael W. Neumeister




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Thu Jun 01, 2017 01:41
  Index
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3





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Thu Jun 01, 2017 01:41
  Burn Injuries
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Ernest J. Grant


Teaser
Each year in the United States and Canada, thousands of individuals seek medical care for a burn injury. Some individuals are burned significantly enough they require treatment at specialized burn care facilities. Most of these injuries are preventable. This article presents an historical perspective related to burn prevention and elements of successful burn prevention programs and explores ways in which the plastic surgeon can promote burn prevention through education, advocacy, and the legislative process. Prevention efforts undertaken by the surgeon can increase awareness, ensure a safe environment, and reduce burn injuries.


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Thu Jun 01, 2017 01:41
  Negligent and Inflicted Burns in Children
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Zachary J. Collier, Michelle C. Roughton, Lawrence J. Gottlieb


Teaser
One in 4 American children have been abused and up to 5 children die per day from abuse. Children are vulnerable and error or lag in diagnosis may lead to further injury or death. In contrast, misdiagnosis of abuse is also unacceptable. Burns are a leading cause of abuse-related fatality and determination of cause can be difficult. It is critical that clinicians distinguish between burns of abuse (inflicted) and neglect and those received accidentally (noninflicted). Discordant narratives, use of alcohol and illicit substances, characteristics of the burn wound, and concomitant injury are all red flags for inflicted and negligent burns.


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Thu Jun 01, 2017 01:41
  Global Burn Care
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Anna Schoenbrunner, Wone Banda, Amanda A. Gosman


Teaser
Burns are an often-overlooked health indicator in global health literature, but account for a significant global health burden in lower middle income countries. This article provides an overview of burn injury from the global health perspective. It focuses on education and research, emphasizing the appropriate role of volunteerism.


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Thu Jun 01, 2017 01:41
  Management of Pulmonary Failure after Burn Injury
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Apoorve Nayyar, Anthony G. Charles, Charles Scott Hultman


Teaser
This article highlights the challenges in managing pulmonary failure after burn injury. The authors review several different ventilator techniques, provide weaning parameters, and discuss complications.


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Thu Jun 01, 2017 01:41
  Clinician’s Guide to Nutritional Therapy Following Major Burn Injury
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Christina Rollins, Franziska Huettner, Michael W. Neumeister


Teaser
This article provides a clinician's guide to nutritional support of the burn patient. The authors review the assessment and management of the needs of the thermally injured patient and provide recommendations on replacement and supplementation with calories, protein, carbohydrates, lipids, fluids, and minerals. Furthermore, the authors compare and contrast enteral versus parenteral delivery of nutrition.


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Thu Jun 01, 2017 01:41
  Venous Thromboembolism in Patients with Thermal Injury
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Christopher J. Pannucci, Andrea T. Obi, Benjamin H. Timmins, Amalia L. Cochran


Teaser
Venous thromboembolism (VTE) can be a life-threatening or limb-threatening complication of thermal injury. The severity of burn injury can be used to predict VTE risk among patients with thermal injury, and a weighted risk-stratification tool has been developed. This article reviews the incidence, diagnosis, and management of thromboembolic events in patients with burns. The article particularly focuses on identifying those patients who are at highest risk for VTE and provides recommendations on mechanical and chemical prophylaxis.


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Thu Jun 01, 2017 01:41
  Burn Center Care of Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Robert Cartotto


Teaser
Stevens-Johnson syndrome and toxic epidermal necrolysis are rare, life-threatening, cutaneous drug reactions. Medications are the most common cause, although an infection may be responsible. A link between genetics and certain medications has been established. Clinical diagnosis should be confirmed with biopsy. When the area of epidermal detachment approaches 30%, burn center care is advisable. An ophthalmologist should be consulted to optimize ocular care. Pharmacologic interruption has been sought but there is little consensus on the most appropriate agent and no high-quality studies have been conducted to demonstrate if any of these agents lead to improved survival.


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Thu Jun 01, 2017 01:41
  Pediatric Burn Care
updated on Thu Jun 01, 2017 05:45 by Alexandros G. Sfakianakis via Aesthetic
Publication date: July 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 3
Author(s): Amita R. Shah, Lillian F. Liao


Teaser
Severe pediatric burns require a multidisciplinary team approach at a specialized pediatric burn center. Special attention must be paid to estimations of total body surface area, fluid resuscitation and metabolic demands, and adequate analgesia and sedation. Long-term effects involve scar management and psychosocial support to the child and their family. Compassionate comprehensive burn care is accomplished by a multidisciplinary team offering healing in the acute setting and preparing the child and family for long-term treatment and care.


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Wed May 31, 2017 20:03
  Forearm skin aging: characterization by instrumental measurements
updated on Thu Jun 01, 2017 00:04 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
The intrinsic aging and photoaged skin presents biomechanical and morphological differences, which are reflected in the appearance of roughness, superficial and deep wrinkles, atrophy, reduced elasticity, hypo and hyperpigmentation and actinic keratosis

Objective
To evaluate and compare the characteristics of the flexor (with a predominance of intrinsic aging) and extensor (chronically exposed to sunlight and other environmental factors, with a predominance of photoaging) skin surfaces of the forearms

Methods
Interventional, prospective, diagnostic study, including 23 females, aged over 60 years. The extensor and flexor faces of forearms were compared in relation to clinical parameters and non-invasive instrumental measurements, such as skin surface, elasticity, hydration as well as dermal thickness and echogenicity

Results
Regarding the water content of the stratum corneum, the flexor face presented an average value higher than the extensor face. The average of measures obtained through images of high frequency ultrasound demonstrated greater echogenicity of flexor face compared to the extensor face. The measurements of the skin surface showed significant differences between the faces. The roughness and scaliness were lower in the flexor face. Regarding the wrinkles depth, there was no significant difference between the faces. The average of the measurements was slightly higher in the flexor face, which demonstrated that wrinkles are present in the intrinsic aging and photoaging. The presence of elastosis and the reduction of elasticity in the clinical aspect of the photoaged face of forearms were according to results of the non-invasive measurements

Conclusion
Meaningful differences in the biophysical characteristics of the extensor and flexor faces of the forearms were detected. Because the non-invasive instrumental measurements correlated with clinical findings, they may represent useful tools to assess efficacy and safety of skin aging treatments in clinical research.

This article is protected by copyright. All rights reserved.



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Wed May 31, 2017 14:53
  A new treatment for reliable functional and esthetic outcome after local facial flap reconstruction: a transparent polycarbonate facial mask with silicone sheeting
updated on Wed May 31, 2017 18:56 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
Facial flap surgery predominantly leads to good functional results. However, in some cases, it can cause unsatisfactory esthetic results. They include persistent erythema, pincushioning, and development of hypertrophic scars. Conservative, reliable treatment for facial flaps is lacking. Pressure and silicone therapy have proven to result in significant improvement in scar erythema, pliability, and thickness in postburn hypertrophic scars. By combining these therapies in a facial mask, the esthetic outcome of facial flaps could be improved. In this retrospective study, the efficacy of a unique transparent face mask containing silicone sheets on the esthetic outcome of postsurgical facial flaps is assessed.

Methods
Twenty-one patients were assigned to facial pressure mask therapy after they underwent facial flap surgery between July 2012 and September 2015. Patients were treated for a mean duration of 46 weeks. The effects of pressure mask therapy were examined by means of the Patient and Observer Scar Assessment Scale (POSAS).

Results
All POSAS components showed a reduction between start and end of therapy, while itchiness, pigmentation, pliability, thickness, and relief of the flap improved significantly (P < 0.05). Mean total and patient score showed significant reduction between start and end of therapy.

Conclusions
This study shows that a facial pressure mask layered with silicone results in noticeable flap improvement with a long-lasting result.

Level of Evidence: Level III, therapeutic study.



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Wed May 31, 2017 11:33
  Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?
updated on Wed May 31, 2017 18:56 by Alexandros G. Sfakianakis via Aesthetic
Translate article
No abstract available

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Wed May 31, 2017 04:28
  Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation
updated on Wed May 31, 2017 08:30 by Alexandros G. Sfakianakis via Aesthetic
J reconstr Microsurg
DOI: 10.1055/s-0037-1603351

Introduction Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.
[...]


Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Tue May 30, 2017 14:18
  Flap Basics I
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 30 May 2017
Source:Facial Plastic Surgery Clinics of North America
Author(s): Sidney J. Starkman, Carson T. Williams, David A. Sherris


Teaser
In many cases of complex facial defects, because of advanced cutaneous malignancies, primary wound closure is impossible. In these instances, ideal results can be obtained through recruitment of adjacent tissue with the use of local flaps. Advances in local flap techniques have raised the bar in facial reconstruction; however, acceptable results to surgeon and patient require high levels of planning and surgical technique. Defects resulting from Mohs surgery and other traumatic injuries can typically be repaired with local flaps. A well-planned and executed local flap can lead to excellent cosmetic results with minimal distortion of the surrounding facial landmarks.


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Tue May 30, 2017 14:18
  Reconstruction of Cutaneous Nasal Defects
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 30 May 2017
Source:Facial Plastic Surgery Clinics of North America
Author(s): Gregory S. Dibelius, Dean M. Toriumi


Teaser
Mohs micrographic surgery has become the standard of care for the treatment of cutaneous malignancies. Reconstructing cutaneous defects of the nose can be challenging as form and function must be respected to the greatest extent possible. A wide range of reconstructive techniques are used. Secondary intent, primary closure, skin grafts, local flaps, and the interpolated workhorse flaps represent the spectrum of options, each with specific advantages and disadvantages. Vigilant postoperative care, including judicious use of adjunctive procedures, can improve outcomes. A subunit approach to reconstruction aids with surgical planning in order to achieve the best possible results.


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Tue May 30, 2017 14:18
  Anatomy of the Skin and the Pathogenesis of Nonmelanoma Skin Cancer
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 30 May 2017
Source:Facial Plastic Surgery Clinics of North America
Author(s): William D. Losquadro


Teaser
Skin is composed of the epidermis, dermis, and adnexal structures. The epidermis is composed of 4 layers—the stratums basale, spinosum, granulosum, and corneum. The dermis is divided into a superficial papillary dermis and deeper reticular dermis. Collagen and elastin within the reticular dermis are responsible for skin tensile strength and elasticity, respectively. The 2 most common kinds of nonmelanoma skin cancers are basal cell and squamous cell carcinoma. Both are caused by a host of environmental and genetic factors, although UV light exposure is the single greatest predisposing factor.


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Tue May 30, 2017 14:18
  The Physiology and Biomechanics of Skin Flaps
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 30 May 2017
Source:Facial Plastic Surgery Clinics of North America
Author(s): James B. Lucas


Teaser
Facial skin defects created by Mohs micrographic surgery are commonly reconstructed using local cutaneous flaps from surrounding skin. To provide optimal survival and aesthetic outcomes, the cutaneous surgeon must command a thorough understanding of the complex vascular anatomy and physiology of the skin as well as the imperative physiologic and biomechanical considerations when elevating and transferring tissue via local skin flaps.


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Tue May 30, 2017 14:18
  Scar Revision and Recontouring Post-Mohs Surgery
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 30 May 2017
Source:Facial Plastic Surgery Clinics of North America
Author(s): Eric W. Cerrati, J. Regan Thomas


Teaser
Following Mohs reconstruction, several options are available to improve the appearance of the resulting scars. It is critical that the patient has realistic goals before beginning any treatment because scars can be improved but never erased. The surgical and nonsurgical options aim to replace pre-existing scars with ones that are less conspicuous. This article addresses the different available options (listed in order of invasiveness) for improving scarring following Mohs reconstruction.


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Tue May 30, 2017 10:50
  Sore throat and an ache radiating from the centre of the anterior neck to the both ears and the occiput.Idiopathic Carotidynia,TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome,Vascular Neck Pain,Painful carotid artery,Inflammation of Carotid artery and neck pain,Carotidynia on ultrasound and magnetic resonance imaging,CT findings in a patient with bilateral metachronous carotidyniaContralateral recurrence of carotidynia during steroid therapy,,Carotidynia Possibly due to Localized Vasculitis,
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic

Carotidynia
From Wikipedia, the free encyclopedia

Drawing from Gray's anatomy with blue arrow showing the bifurcation area which is painful in Carotidynia.
Carotidynia is a syndrome characterized by unilateral (one-sided) tenderness of the carotid artery, near the bifurcation. It was first described in 1927 by Temple Fay.[1] The most common cause of carotidynia may be migraine, and then it is usually self-correcting. Common migraine treatments may help alleviate the carotidynia symptoms. Recent histological evidence has implicated an inflammatory component of carotidynia, but studies are limited.[2] Carotid arteritis is a much less common cause of carotidynia, but has much more serious consequences. It is a form ofgiant cell arteritis, which is a condition that usually affects arteries in the head. Due to this serious condition possibly causing carotidynia, and the possibility that neck pain is related to some other non-carotidynia and serious condition, the case should be investigated by a medical doctor.[3]Because carotidynia can be caused by numerous causes, Biousse and Bousser in 1994 recommended the term not be used in the medical literature.[4] However, recent MRI and ultrasound studies have supported the existence of a differential diagnosis of carotidynia consistent with Fay's characterization.[5][6]

References
Hill and Hastings list this reference as: Fay, Temple (1927) "Atypical neuralgia." Arch Neurol Psychiatry.
Upton, P.; Smith, J. G.; Charnock, D. R. (2003). "Histologic confirmation of carotidynia". Otolaryngology - Head and Neck Surgery. 129 (4): 443–444. doi:10.1016/S0194-5998(03)00611-9. PMID 14574303.
Hill LM, Hastings G (1994). "Carotidynia: a pain syndrome.". J Fam Pract. 39 (1): 71–5. PMID 8027735.
Biousse V, Bousser MG (1994). "The myth of carotidynia.". Neurology. 44 (6): 993–5. doi:10.1212/wnl.44.6.993. PMID 8208434.Available here
Lee TC, Swartz R, McEvilly R, Aviv RI, Fox AJ, Perry J, Symons SP. CTA, MR and MRA imaging of carotidynia: case report. Canadian Journal of Neurological Sciences. 2009 May; 36(3):373-375.
Kuhn, J.; Harzheim, A.; Horz, R.; Bewermeyer, H. (2006). "MRI and ultrasonographic imaging of a patient with carotidynia". Cephalalgia. 26 (4): 483–485. doi:10.1111/j.1468-2982.2006.01053.x. PMID 16556251.
External links
Family Practice notebook.com
Blog assessing whether carotidynia is a valid medical diagnosis.
Carotidynia condition page on PatientsLikeMe.


Retrieved from "https://en.wikipedia.org/w/index.php?title=Carotidynia&oldid=768647731"
Categories: Symptoms and signs: Circulatory systemPainCardiovascular system stubs
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Case Rep Vasc Med. doi: 10.1155/2013/585789
Carotidynia Possibly due to Localized Vasculitis in a Patient with Latent Mycobacterium tuberculosis Infection.
Cassone G1, Colaci M1, Giuggioli D1, Manfredi A1, Sebastiani M1, Ferri C1.
Author information
1Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy.
Abstract
Carotidynia is a syndrome characterized by tenderness of the carotid artery near the bifurcation due to numerous, heterogeneous causes. Here we reported the case of a 31-year-old Moroccan woman with right-sided neck pain and tenderness with irradiation to ipsilateral ear, eye, and occipital region. Clinical symptoms and imaging findings were suggestive of primary variant of carotidynia syndrome. In particular, color-Doppler ultrasonography revealed a concentric wall thickening of the distal common carotid artery, while thoracic magnetic resonance showed localized perivascular enhancement of the soft tissue in the right medial-distal common carotid artery in T1-weighted images, without intraluminal diameter variation. Moreover, careful clinicoserological and imaging investigations (cranial, cervical, and thoracic angiocomputed tomography and magnetic resonance) excluded well-known disorders potentially responsible for carotidynia syndrome. The patient was scarcely responsive to nonsteroidal anti-inflammatory drugs, but clinical symptoms resolved after three months. Of interest, the patient showed latent Mycobacterium tuberculosis infection (positive tuberculosis interferon-gamma release assay; QuantiFERON-TB Gold); this finding suggested a possible triggering role of mycobacterial antigens in the immune-mediated mechanism responsible for localized carotid injury.
PMID: 24363952

J Stroke Cerebrovasc Dis. doi: 10.1016/j.jstrokecerebrovasdis.2012.10.011
Contralateral recurrence of carotidynia during steroid therapy.
Inatomi Y1, Nakajima M2, Yonehara T3, Hirano T4.
Author information
1Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: y.inatomix@silk.ocn.ne.jp.
2Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
3Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
4Department of Internal Medicine III, Faculty of Medicine, Oita University, Oita, Japan.
Abstract
A 44-year-old woman presented with contralateral recurrence of carotidynia during steroid therapy at 1 month after onset. Carotidynia can present with a multiphasic clinical course and can affect the neck bilaterally. Therefore, patients with carotidynia should be observed even after remission.
Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

KEYWORDS:
Carotidynia; arteritis; carotid artery; magnetic resonance imaging; temporal arteritis; ultrasonography
PMID: 23253536

Wien Klin Wochenschr. doi: 10.1007/s00508-014-0633-2
A pain in the throat: a 19-year history of symptoms relating to the carotid artery.
Elkins A1, Barakate M, Henderson J, Grieve S.
Author information
1School of Medicine, The University of New South Wales, Sydney, NSW, Australia.
Abstract
A 38-year-old man presented with a 19-year history of sore throat and an ache radiating from the centre of the anterior neck to the both ears and the occiput. Computed tomography angiography revealed a tortuous submucosal right internal carotid artery, which was causing tonsillar displacement. The diagnosis of carotidynia has a controversial history within the literature and is currently not accepted as a distinct pathological entity by the International Headache Society. In this patient, the clinical and imaging features, in addition to the absence of any other pathology confers support to the diagnosis of carotidynia.
PMID: 25398291

Clin Imaging. 2015 Mar-Apr;39(2):305-7. doi: 10.1016/j.clinimag.2014.12.001
CT findings in a patient with bilateral metachronous carotidynia.
Young JY1, Hijaz TA2, Karagianis AG2.
Author information
1Northwestern Memorial Hospital, Department of Radiology, Neuroradiology Section, 251 East Huron Street, Chicago, IL, 60611. Electronic address: joseph.y.young@gmail.com.
2Northwestern Memorial Hospital, Department of Radiology, Neuroradiology Section, 251 East Huron Street, Chicago, IL, 60611.
Abstract
Carotidynia is a self-limiting, idiopathic clinical syndrome characterized by acute unilateral neck pain and tenderness of the carotid artery. We describe a unique case of bilateral carotidynia that occurred metachronously, with each incident resolving without long-term sequelae. Knowledge of this entity is important to properly interpret the imaging findings and to not mistake this finding as an ill-defined tumor, thus avoiding unnecessary biopsy.
Copyright © 2015 Elsevier Inc. All rights reserved.KEYWORDS:CT; Carotidynia; inflammation; neck; pain.PMID: 25575581

J Mal Vasc. 2015 Dec;40(6):395-8. doi: 10.1016/j.jmv.2015.06.001
Comparative evolution of carotidynia on ultrasound and magnetic resonance imaging.
Behar T1, Menjot N2, Laroche JP3, Böge B3, Quéré I3, Galanaud JP3.
Author information
1Clinical investigation center and department of internal medicine, hôpital de Montpellier, university hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France. Electronic address: t-behar@chu-montpellier.fr.
2Department of neuroradiology, university hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.
3Clinical investigation center and department of internal medicine, hôpital de Montpellier, university hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.
Abstract
Carotidynia is rare and associates neck pain with tenderness to palpation usually over the carotid bifurcation, the diagnosis of which is based on magnetic resonance imaging (MRI). Ultrasounds (US) are also frequently used but their accuracy in predicting the course of the disease is unknown. We are reporting the case of a 52-year-old man who presented a typical carotidynia. Clinical symptoms, ultrasound and MRI imaging evolution were closely correlated. Our case suggest that after a first MRI to set a positive diagnosis of carotidynia and exclude differential diagnoses, US which is more widely available and less expensive could constitute the imaging of reference for the follow-up.
Copyright © 2015 Elsevier Masson SAS. All rights reserved.KEYWORDS:Carotidynia; Carotidynie; Follow-up; Imagerie par résonance magnétique; Magnetic resonance imaging; Suivi; Ultrasonography; Échographie.PMID: 26163344

Vasc Endovascular Surg. 2017 Apr;51(3):149-151. doi: 10.1177/1538574417697212.
Idiopathic Carotidynia.
Policha A1, Williams D2, Adelman M1, Veith F1, Cayne NS1.
Author information
1
1 Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY, USA.
2
2 Department of General Surgery, New York University Langone Medical Center, NY, USA.
Abstract
Idiopathic carotidynia is a syndrome characterized by pain and tenderness over the carotid artery without an associated structural luminal abnormality. Controversy exists over whether this is a distinct disease entity or merely a symptom attributable to other causes of neck pain, such as carotid dissection or vasculitis. A 50-year-old woman presented with sudden-onset right neck pain. Imaging studies demonstrated transmural inflammation of the proximal internal carotid artery, without evidence of intraluminal pathology. The patient was placed on low-dose aspirin and ibuprofen. Her symptoms resolved within a week. At 3-month follow-up, her carotid artery appeared normal on duplex ultrasonography.
KEYWORDS:
carotid artery; carotidynia; ultrasound
PMID: 2833043

AJNR Am J Neuroradiol. 2017 May 11. doi: 10.3174/ajnr.A5214
TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity.

Lecler A1, Obadia M2, Savatovsky J2, Picard H2, Charbonneau F2, Menjot de Champfleur N2, Naggara O2, Carsin B2, Amor-Sahli M2, Cottier JP2, Bensoussan J2, Auffray-Calvier E2, Varoquaux A2, De Gaalon S2, Calazel C2, Nasr N2, Volle G2, Jianu DC2, Gout O2, Bonneville F2, Sadik JC2.
Author information
1
From the Departments of Radiology (A.L., J.S., F.C., J.C.S.), and Neurology (M.O., G.V., O.G.), and Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France; Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France; Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France; Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France; Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France; Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France; Diagnostic and Interventional Neuroradiology Department (E.A.-C.) and Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France; Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France; Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France; Departments of Neuroradiology (C.C., F.B.) and Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France; and Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. alecler@for.paris.
2
From the Departments of Radiology (A.L., J.S., F.C., J.C.S.), and Neurology (M.O., G.V., O.G.), and Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France; Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France; Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France; Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France; Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France; Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France; Diagnostic and Interventional Neuroradiology Department (E.A.-C.) and Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France; Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France; Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France; Departments of Neuroradiology (C.C., F.B.) and Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France; and Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Abstract
BACKGROUND AND PURPOSE:
The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity.
MATERIALS AND METHODS:
From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets.
RESULTS:
The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others.
CONCLUSIONS:
Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.
© 2017 American Society of Neuroradiology.

PMID: 28495942 DOI: 10.3174/ajnr.A5214

Vascular Neck Pain–A Common Syndrome Seldom Recognized
Cleveland Clinic Journal of Medicine.
LEONARD L. LOVSHIN, M.D.
Department of Internal Medicine
Abstract

A YOUNG or middle-aged women reported to her physician because of a sore throat, without fever or other constitutional manifestations, which may have been present for weeks or months. The patient believes that the glands in the neck are swollen. These "swollen glands" are said to act strangely: sometimes the swelling lasts only a few hours, sometimes it persists for weeks; it disappears mysteriously and recurs frequently. During the course of the physical examination the physician finds no abnormality, but when he re-examines the neck and follows the directions given by the patient, he finds a tender swelling that could be an inflamed lymph node.

The patient then is treated with a sulfonamide or with penicillin, and, when no relief ensues, a course of one of the broad-spectrum antibiotics is administered. This therapeutic program also is unsuccessful, and the harried physician begins to think of other possibilities. Since the patient has "swollen glands," feels weak, tired, and run-down, and antimicrobial therapy has not helped, a diagnosis of infectious mononucleosis may be considered. But, results of a heterophil antibody test are negative, and the diagnosis is changed to possible viral infection.

After several weeks or months of having diagnoses changed, the nervous patient can sense that her physician is uncertain, and she begins to worry about the looming possibility of cancer. She keeps poking in the region of the soreness, and the area becomes even more tender. In desperation, further investigations are carried out and nothing definitely abnormal is found. Teeth . . .
http://journals.sagepub.com/doi/abs/10.1177/0009922816677040?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
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Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Tue May 30, 2017 09:08
  Giant cell tumor in the sphenoid sinus and ethmoid sinus during childhood, and it is thought that optic atrophy was caused by compressive optic neuropathy.
updated on Tue May 30, 2017 18:21 by Alexandros G. Sfakianakis via Aesthetic
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http://orlhealth.blogspot.com/2017/05/giant-cell-tumor-in-sphenoid-sinus-and.html


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon May 29, 2017 19:43
  Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal
updated on Mon May 29, 2017 23:46 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
Lipofilling or autologous fat transfer is an established technique in plastic surgery. Herein, we describe the lipofilling effects after implant-based breast reconstruction in post-radiation patients and propose an algorithm for indication of lipofilling.

Methods
Forty patients with a history of breast cancer were included in this retrospective analysis. Patients had undergone either breast conserving therapy or mastectomy. Twenty-six patients underwent additional radiation therapy. Patients were assessed using a post-radiation skin scoring classification.

Results
In total, 68 lipofilling procedures were analyzed. Scar release, skin softening, improved quality of life, and improvement of post-radiation findings are results of lipofilling with a closed filtration system. In all patients with post-surgical radiation, an improvement of tissue quality was observed. Staging revealed that lipofilling improved mean post-radiation skin scores of 2.40 ± 0.89 to 1.21 ± 0.76 (p ≤ 0.000). There was no recurrence of breast cancer in our study patients.

Conclusions
This study introduces an algorithm using lipofilling in reconstructive breast surgery and especially in post-radiation patients with low risks as well as very high acceptance in patients with various indications for this procedure. A regenerative aspect was also detectable in patients following radiation therapy and reconstruction. Lipofilling is a safe and effective procedure with a low incidence of minor complications. It is therefore a feasible method to resolve volume deficiencies and asymmetric results after oncologic breast surgery. Nevertheless, a prospective study has now been initiated focusing on the oncologic safety of lipofilling including ultrasound and radiological examinations to validate the findings of this initial study.

Level of Evidence: Level IV, therapeutic study.



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Mon May 29, 2017 19:43
  Microvascular reconstruction with free fibula osteocutaneous flap in mandibular ameloblastomas—an institutional experience
updated on Mon May 29, 2017 23:46 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Background
Surgical resection is the mainstay for mandibular ameloblastomas. Optimal reconstruction and rehabilitation is important for a satisfactory outcome.

Methods
We retrospectively reviewed all cases of mandibular ameloblastoma who underwent resection and/or reconstruction at our institute over a period of 5 years and conducted an outcome survey. Our institutional protocol in such patients and results of the review are presented.

Results
Fifty-four cases were included in the study. Forty four cases had not undergone prior treatment, 8 underwent resection elsewhere while 2 were referred following recurrence after conservative resection. Fifty-five percent of the patients had a lateral segment defect and mean defect size was 7.4 cm. Only 13 cases underwent further dentoalveolar rehabilitation. We found that more than 90% patients were satisfied with respect to resolution of symptoms, speech, facial symmetry, walking, and overall improvement in social activity. Satisfaction regarding chewing (84%) and donor site appearance (77%) was lesser.

Conclusions
Segmental resection with adequate margins followed by reconstruction with free fibula flap is closest to the most ideal form of treatment available. Dentoalveolar rehabilitation is recommended in all such patients to improve final outcome.

Level of Evidence: Level IV, therapeutic study.



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Mon May 29, 2017 15:43
  Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction
updated on Mon May 29, 2017 23:46 by Alexandros G. Sfakianakis via Aesthetic
Introduction
Radial forearm free flap (RFFF) tube-in-tube phalloplasty is the most performed phalloplasty technique worldwide. The conspicuous donor-site scar is a drawback for some transgender men. In search for techniques with less conspicuous donor-sites, we performed a series of one-stage pedicled anterolateral thigh flap (ALT) phalloplasties combined with RFFF urethral reconstruction. In this study, we aim to describe this technique and assess its surgical outcome in a series of transgender men.

Patients and Methods
Between January 2008 and December 2015, nineteen transgender men (median age 37, range 21–57) underwent pedicled ALT phalloplasty combined with RFFF urethral reconstruction in one stage. The surgical procedure was described. Patient demographics, surgical characteristics, intra- and postoperative complications, hospitalization length, and reoperations were recorded.

Results
The size of the ALT flaps ranged from 12 × 12 to 15 × 13 cm, the size of the RFFFs from 14 × 3 to 17 × 3 cm. Median clinical follow-up was 35 months (range 3–95). Total RFFF failure occurred in two patients, total ALT flap failure in one patient, and partial necrosis of the ALT flap in one patient. Long-term urinary complications occurred in 10 (53%) patients, of which 9 concerned urethral strictures.

Conclusions
In experienced hands, one-stage pedicled ALT phalloplasty combined with RFFF urethral reconstruction is a feasible alternative surgical option in eligible transgender men, who desire a less conspicuous forearm scar. Possible drawbacks comprise flap-related complications, difficult inner flap monitoring and urethral complications.



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Mon May 29, 2017 08:28
  Sometimes pain originating from a non-odontogenic pathologic condition is mistaken as endodontic illness, leading to misdiagnosis.
updated on Mon May 29, 2017 12:29 by Alexandros G. Sfakianakis via Aesthetic
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http://otorhinolaryngology-crete.blogspot.com/2017/05/adenoid-cystic-carcinoma-of-maxillary.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Mon May 29, 2017 08:26
  Subclinical hypothyroidism (SCH) has been associated with atherosclerosis and increased risk of ischemic stroke.
updated on Mon May 29, 2017 12:29 by Alexandros G. Sfakianakis via Aesthetic
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http://otorhinolaryngology-crete.blogspot.com/2017/05/subclinical-hypothyroidism-and-risk-of.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
alsfakia@gmail.com
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Sun May 28, 2017 20:48
  Physical Mechanical characterization of cosmetic formulations and correlation between instrumental measurements and sensorial properties
updated on Mon May 29, 2017 00:49 by Alexandros G. Sfakianakis via Aesthetic
Abstract
Objective
The correct choice of raw materials in the development of cosmetic formulations is essential for obtaining stable and pleasant skin care products. Therefore, rheological, texture and sensory analyses are important to understand the behavior and stability of the formulations. In this context, the aim of the present study was to develop cosmetic formulations containing or not (vehicle) UV filters and chicory root extract, to evaluate their stability as well as to characterize their physical and texture properties and correlate them with the sensory attributes.

Methods
Four formulations containing organic UV filters and chicory extract, each alone or in combination, were developed and evaluated for 180 days with a cone and plate rheometer, a texture analyzer and consumer's sensorial analysis. Thus, the data obtained were correlated in order to observe the different influences.

Results
The developed formulations remained stable after 180 days regarding macroscopic aspects, organoleptic characteristics and pH values. The addition of the UV filters alone and in combination with the active substance resulted in significant increases in rheology, viscosity and consistency. The formulation with the active ingredient showed significant decreases in the texture parameters after 180 days, mainly due to its polysaccharide Inulin. All formulations obtained high scores in sensorial parameters. A strong correlation was mainly found between spreadability and work of shear, and between the texture parameters.

Conclusion
The raw materials strongly influenced the physical, texture and sensorial parameters. Finally, the UV filters showed a greater influence on the results of the formulations than the chicory root extract. In conclusion, the association of the mentioned methods allows the correct choice of ingredients and their combinations.

This article is protected by copyright. All rights reserved.



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Sun May 28, 2017 20:13
  The Combined Vaginoplasty Technique for Male-to-Female Sex Reassignment Surgery: Operative Approach and Outcomes
updated on Mon May 29, 2017 00:49 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nikolaos A. Papadopulos, Dmitry Zavlin, Jean-Daniel Lellé, Peter Herschbach, Gerhard Henrich, Laszlo Kovacs, Benjamin Ehrenberger, Hans-Guenther Machens, Jürgen Schaff
BackgroundSeveral therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive aesthetics and fully functional genitals.The goal of this study was to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort.MethodsThe authors included 40 MTF transgender patients undergoing two-stage sex reassignment surgery (SRS) in an observational prospective study between September 2012 and January 2014. Demographic characteristics, medical and surgical history, operative details, and outcomes after surgery were documented. Postoperatively, 23 patients received a pelvic exam following standardized protocol.ResultsMeasured vaginal depth was 11.77 - 14.99 cm depending on dilator size used (25-40mm). Vaginal, clitoral, and labial sensitivity was intact and favorable in all examined patients. 19 women (47.5%) opted for breast augmentations to achieve feminine cosmesis making it the most common non-genital operation. Complications were mostly minor and temporary. Severe adverse events, such as wound infections (n = 3), colon injuries (3), short (1) or narrow (1) vaginas, or partial clitoral necroses (1), were rare and immediately addressed by the surgical team. No vaginal construction was lost and no secondary reconstructive approaches were required.ConclusionSatisfactory physical results and favorable low rates of complications endorse our combined technique for MTF SRS. These findings, however, need to be confirmed by other research groups as well. Therefore, in our opinion, MTF SRS remains an evolving area of development whose research is aiming to establish a state of the art surgical technique.



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Sun May 28, 2017 09:53
  Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes–depleted Patient
updated on Sun May 28, 2017 13:56 by Alexandros G. Sfakianakis via Aesthetic
imageBackground: The greater omentum is supplied by the right, middle, and left omental arteries, which arise from the right and left gastroepiploic arteries. All or part of the greater omentum can be harvested based on this blood supply for free tissue transfer. It has stimulated new interest in its use as the donor site in the treatment of lymphedema. For patients who have failed other management options or have limited peripheral lymph node donor sites, the greater omental lymph node flap may offer the best chance for lymphedema treatment. Methods: We report a 59-year-old woman with a history of left breast cancer who was treated with left modified radical mastectomy and axillary lymph node dissection and developed left upper extremity Grade IV lymphedema. She received vascularized groin lymph node transfer and lymphaticovenous anastomosis, but the result was not satisfactory. She also had nasopharyngeal cancer that was treated with radiotherapy to the head and neck, making use of the submental lymph nodes flap impossible. Due to a lack of other options of lymph node donor sites, the split greater omental lymph node flap (GOLF) was used. Results: After surgery, it showed an arm circumference reduction of 42.9% above the elbow and 36.4% below the elbow at an 8-month follow-up. There was no intraabdominal complication. Conclusions: The split GOLF has shown good results in a peripheral lymph node–depleted lymphedema patient. Using a laparoscopic technique for flap harvest has less risk of donor site morbidity and hides scarring.

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Sun May 28, 2017 09:53
  Chronological Order of Lipofilling during Implant Exchange
updated on Sun May 28, 2017 13:56 by Alexandros G. Sfakianakis via Aesthetic
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Sun May 28, 2017 09:53
  Skin Necrosis Caused by Simple Massage Equipment
updated on Sun May 28, 2017 13:56 by Alexandros G. Sfakianakis via Aesthetic
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Sun May 28, 2017 02:03
  Sentinel node biopsy status is strongly predictive of survival in cutaneous melanoma: Extended follow-up of Oxford patients from 1998-2014
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
Sentinel lymph node biopsy (SLNB) is widely used as a key investigatory tool for cutaneous melanoma, with results incorporated into the latest AJCC staging guidelines. We present the results of our extended follow-up of sentinel lymph node biopsy for melanoma over a sixteen-year period.

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Sun May 28, 2017 02:03
  Computer generated three-dimensional modeling using passive stereophotogrammetry and structured light scanning for craniomaxillofacial imaging
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
I read with great interest the useful and insightful manuscript by Knoops et al.1 The authors highlight several techniques for three-dimensional scanning that may be useful for craniomaxillofacial imaging,2,3 and helpfully point out newly available lower-cost approaches to facial scanning which may increase the adoption of this important technology.

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Sun May 28, 2017 02:03
  WhatsApp: Improvement tool for surgical team communication
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
We would like to thank Dr Brewtser et al. for their comments (1) on our recent article entitled "WhatsApp: Improvement tool for surgical team communication"(2). This useful information made us review the Electronic Frontier Foundation (EFF) research and their conclusion about security of different smart phone communication applications (3).

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Sun May 28, 2017 02:03
  The Combined Vaginoplasty Technique for Male-to-Female Sex Reassignment Surgery: Operative Approach and Outcomes
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
Several therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive aesthetics and fully functional genitals.The goal of this study was to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort.

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Sun May 28, 2017 02:03
  Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
This study demonstrates the use of a modified free innervated DRAP flap utilizing the supermicrosurgery technique for fingertip reconstruction.

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Sun May 28, 2017 02:03
  Limitation of ischaemic tissue response in a reconstruction with short ischaemia time during free flap surgery
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
In free flap surgery, patency of the arterial and venous microvascular anastomoses is a major contributor to flap survival. Extended periods of vascular compromise may lead to ischaemic necrosis, which can only be minimized by tissue reperfusion. However, restoration of blood flow evokes ischaemia reperfusion injury. In this manuscript, a case is presented of a patient who demonstrated a normal oxygenation pattern of a deep inferior epigastric perforator (DIEP) flap. As an ischaemic response can be seen as a sign of temporal vascular compromise, we hypothesize that a short ischaemia time is feasible for tissue viability by eliminating ischaemia reperfusion injury.

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Sun May 28, 2017 02:03
  What triggers in trigger finger? The flexor tendons at the Flexor Digitorum Sublimis bifurcation
updated on Sun May 28, 2017 06:03 by Alexandros G. Sfakianakis via Aesthetic
To define the role of the flexor tendons in trigger finger, a high resolution ultrasound examination was undertaken in 20 trigger fingers and 20 normal contralateral digits in 3 digital postures: full extension, mid flexion and near-full flexion. Precise measurements of diameter and cross sectional area of the combined tendon mass were recorded at 5 clearly defined locations: summit of metacarpal head, proximal lip of proximal phalanx (PP), at 1/8, 1⁄4 and 1/2 length of PP. In the normal tendons, there was an anatomical thickening, not previously appreciated at 1⁄4 length PP, in the region of FDS bifurcation.

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Sat May 27, 2017 20:48
  Sentinel node biopsy status is strongly predictive of survival in cutaneous melanoma: Extended follow-up of Oxford patients from 1998-2014
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): David R. Thomson, Milap G. Rughani, Rachel Kuo, Oliver CS. Cassell
IntroductionSentinel lymph node biopsy (SLNB) is widely used as a key investigatory tool for cutaneous melanoma, with results incorporated into the latest AJCC staging guidelines. We present the results of our extended follow-up of sentinel lymph node biopsy for melanoma over a sixteen-year period.MethodsData were collected prospectively from June 1998 to December 2014 from a single tertiary skin cancer referral centre. Chi-squared analysis was used to analyse patient demographics and primary tumour pathology. Survival analysis was conducted using Cox regression models and Kaplan-Meier survival curves.ResultsOver a sixteen-year period 1,527 patients underwent SLNB in 1,609 basins, with 2,876 nodes harvested. 347 patients (23%) had a positive biopsy. The most common primary tumour sites for males was the back (32%); women had a significantly higher number of melanomas occurring on the lower and upper limbs (45% and 26% respectively) [all p<0.0001, Chi-squared]. Mean follow-up time was 4.9 years. Patients with a positive SLNB at diagnosis were significantly more likely to die from melanoma (subhazard ratio 5.59, p=0.000, 95% CI 3.59-8.69). Breslow thickness and ulceration were also significant predictors of melanoma-specific mortality. For patients with a primary Breslow >4.0mm ten-year disease free survival was 52% for SLNB negative and 26% for SLNB positive patients. For Breslow thicknesses of 2.01-4mm these values were 66% and 32% respectively.ConclusionsSentinel lymph node biopsy status is strongly predictive of survival across all thicknesses of primary cutaneous melanoma.



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Sat May 27, 2017 20:48
  WhatsApp: Improvement tool for surgical team communication
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Abdulrahman Al-Sahabi, Nassim Sidhoum, Nizar Assaf, Christian Herlin, Sandy Dast, Raphael Sinna




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Sat May 27, 2017 20:48
  Computer generated three-dimensional modeling using passive stereophotogrammetry and structured light scanning for craniomaxillofacial imaging
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Jonathan Kantor




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Sat May 27, 2017 20:48
  What triggers in trigger finger? The flexor tendons at the Flexor Digitorum Sublimis bifurcation
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): X.L. Chuang, C.C. Ooi, S.T. Chin, M.A. Png, S.K. Wong, S.C. Tay, D.A. McGrouther
To define the role of the flexor tendons in trigger finger, a high resolution ultrasound examination was undertaken in 20 trigger fingers and 20 normal contralateral digits in 3 digital postures: full extension, mid flexion and near-full flexion. Precise measurements of diameter and cross sectional area of the combined tendon mass were recorded at 5 clearly defined locations: summit of metacarpal head, proximal lip of proximal phalanx (PP), at 1/8, 1⁄4 and 1/2 length of PP. In the normal tendons, there was an anatomical thickening, not previously appreciated at 1⁄4 length PP, in the region of FDS bifurcation. This anatomical region moved proximally on finger flexion to the A1 pulley. In the trigger fingers, the flexor tendons had greater diameter (sagittal view) and cross sectional area than the normal side at all locations (p<0.01, p<0.001), with an even greater increase in diameter in the FDS bifurcation area (p<0.001). Trigger fingers also had thicker A1 pulleys (p<0.001). Triggering occurs on flexing the finger when the enlarged combined flexor tendon mass at the specific anatomical region of the FDS bifurcation impacts on the thickened A1 pulley, resisting its excursion.



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Sat May 27, 2017 20:48
  Limitation of ischaemic tissue response in a reconstruction with short ischaemia time during free flap surgery
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): M.A. van Onna, J. Visser, R.R.W.J. van der Hulst
In free flap surgery, patency of the arterial and venous microvascular anastomoses is a major contributor to flap survival. Extended periods of vascular compromise may lead to ischaemic necrosis, which can only be minimized by tissue reperfusion. However, restoration of blood flow evokes ischaemia reperfusion injury. In this manuscript, a case is presented of a patient who demonstrated a normal oxygenation pattern of a deep inferior epigastric perforator (DIEP) flap. As an ischaemic response can be seen as a sign of temporal vascular compromise, we hypothesize that a short ischaemia time is feasible for tissue viability by eliminating ischaemia reperfusion injury.



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Sat May 27, 2017 20:48
  Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Dajiang Song, Georgios Pafitanis, Peng Yang, Mitsunaga Narushima, Zan Li, Linfeng Liu, Zengtao Wang
IntroductionThis study demonstrates the use of a modified free innervated DRAP flap utilizing the supermicrosurgery technique for fingertip reconstruction.Materials and MethodsFrom January 2010 to February 2014, 20 cases of fingertip reconstruction were performed using a short pedicle mini innervated transverse DRAP flap. The patients demographics, the mechanism of injury, the defect size and anatomical location, the source of pedicle vessels, the recipient vessels, the nerve branch used for innervation, the follow-up and sensation outcomes are reported. Three cases are presented demonstrating different anatomical fingertip injury reconstructions.Results20 consecutive traumatic fingertip injuries (M:F-14:6) were reconstructed with a free DRAP flap from the same hand. 6 index, 6 middle, 5 ring and 3 little finger defects were included in this study. All procedures were performed under regional anaesthesia and sedation. There were no intra- or post-operative complications. The average operative time was 105 (85-120) minutes. Each flap size was matching the size of the defects. All donor sites achieved primary closure and good cosmesis. The average follow-up was 12.8 (6-28) months. Follow-up demonstrated a static two-point discrimination of the flaps with an average distance of 5.5 (4-7) mm.ConclusionThe innervated DRAP flap has proven to be an easy, reliable and effective sensate fingertip reconstruction option, utilizing the supermicrosurgery technique.Level of EvidenceLevel IV, retrospective series.



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Sat May 27, 2017 20:48
  Computer generated three-dimensional modeling using passive stereophotogrammetry and structured light scanning for craniomaxillofacial imaging
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Jonathan Kantor




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Sat May 27, 2017 20:48
  What triggers in trigger finger? The flexor tendons at the Flexor Digitorum Sublimis bifurcation
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
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Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): X.L. Chuang, C.C. Ooi, S.T. Chin, M.A. Png, S.K. Wong, S.C. Tay, D.A. McGrouther
To define the role of the flexor tendons in trigger finger, a high resolution ultrasound examination was undertaken in 20 trigger fingers and 20 normal contralateral digits in 3 digital postures: full extension, mid flexion and near-full flexion. Precise measurements of diameter and cross sectional area of the combined tendon mass were recorded at 5 clearly defined locations: summit of metacarpal head, proximal lip of proximal phalanx (PP), at 1/8, 1⁄4 and 1/2 length of PP. In the normal tendons, there was an anatomical thickening, not previously appreciated at 1⁄4 length PP, in the region of FDS bifurcation. This anatomical region moved proximally on finger flexion to the A1 pulley. In the trigger fingers, the flexor tendons had greater diameter (sagittal view) and cross sectional area than the normal side at all locations (p<0.01, p<0.001), with an even greater increase in diameter in the FDS bifurcation area (p<0.001). Trigger fingers also had thicker A1 pulleys (p<0.001). Triggering occurs on flexing the finger when the enlarged combined flexor tendon mass at the specific anatomical region of the FDS bifurcation impacts on the thickened A1 pulley, resisting its excursion.



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Sat May 27, 2017 20:48
  Limitation of ischaemic tissue response in a reconstruction with short ischaemia time during free flap surgery
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): M.A. van Onna, J. Visser, R.R.W.J. van der Hulst
In free flap surgery, patency of the arterial and venous microvascular anastomoses is a major contributor to flap survival. Extended periods of vascular compromise may lead to ischaemic necrosis, which can only be minimized by tissue reperfusion. However, restoration of blood flow evokes ischaemia reperfusion injury. In this manuscript, a case is presented of a patient who demonstrated a normal oxygenation pattern of a deep inferior epigastric perforator (DIEP) flap. As an ischaemic response can be seen as a sign of temporal vascular compromise, we hypothesize that a short ischaemia time is feasible for tissue viability by eliminating ischaemia reperfusion injury.



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Sat May 27, 2017 20:48
  Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique
updated on Sun May 28, 2017 00:46 by Alexandros G. Sfakianakis via Aesthetic
Publication date: Available online 27 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Dajiang Song, Georgios Pafitanis, Peng Yang, Mitsunaga Narushima, Zan Li, Linfeng Liu, Zengtao Wang
IntroductionThis study demonstrates the use of a modified free innervated DRAP flap utilizing the supermicrosurgery technique for fingertip reconstruction.Materials and MethodsFrom January 2010 to February 2014, 20 cases of fingertip reconstruction were performed using a short pedicle mini innervated transverse DRAP flap. The patients demographics, the mechanism of injury, the defect size and anatomical location, the source of pedicle vessels, the recipient vessels, the nerve branch used for innervation, the follow-up and sensation outcomes are reported. Three cases are presented demonstrating different anatomical fingertip injury reconstructions.Results20 consecutive traumatic fingertip injuries (M:F-14:6) were reconstructed with a free DRAP flap from the same hand. 6 index, 6 middle, 5 ring and 3 little finger defects were included in this study. All procedures were performed under regional anaesthesia and sedation. There were no intra- or post-operative complications. The average operative time was 105 (85-120) minutes. Each flap size was matching the size of the defects. All donor sites achieved primary closure and good cosmesis. The average follow-up was 12.8 (6-28) months. Follow-up demonstrated a static two-point discrimination of the flaps with an average distance of 5.5 (4-7) mm.ConclusionThe innervated DRAP flap has proven to be an easy, reliable and effective sensate fingertip reconstruction option, utilizing the supermicrosurgery technique.Level of EvidenceLevel IV, retrospective series.



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