Eplasty [JOURNAL]

BACKGROUND: Reduction mammaplasty is a common procedure that is performed for both aesthetic reasons and quality-of-life improvement. It is performed largely to help the patient achieve a proportionate breast size for th... BACKGROUND: Reduction mammaplasty is a common procedure that is performed for both aesthetic reasons and quality-of-life improvement. It is performed largely to help the patient achieve a proportionate breast size for their individual body type, with the goal of restoring anatomical proportionality and psychological wellness while reducing chronic neck, back, and shoulder pain. The common risks of breast reduction include bleeding, scarring, infection, poor wound healing, fat necrosis, nipple necrosis, and/or seroma. This study is designed to show that patients with a body mass index (BMI) of >30.0 kg/m are at higher risks for all complications. METHODS: This retrospective study analyzed medical records of 236 patients who underwent breast reduction mammaplasty from January 2015 to February 2022 by a single surgeon at a single institution. Patients were divided into 2 groups based on their BMI: the non-obese group with a BMI ≤29.9 kg/m and the obese group with a BMI ≥30.0 kg/m and above. This study compares postsurgical outcomes and complications in relation to patient BMI. RESULTS: Of 236 total patients, 104 (44%) had complications specified by predetermined criteria. Of those 104 patients with complications, 94 (90.38%) had a BMI ≥30.0 kg/m. Predetermined complications were as follows: 24 patients (23.08%) experienced wound dehiscence, 23 of whom had a BMI ≥30.0 kg/m; 9 patients (8.65%) experienced hematomas, all of whom had a BMI ≥30.0 kg/m; 37 patients (35.58%) were found to have superficial wounds, 32 of whom had a BMI ≥30.0 kg/m; 39 (37.5%) were found to have a seroma, 35 of whom patients were found to have a BMI ≥30.0 kg/m; 25 patients (24.04%) experienced fat necrosis, 24 of whom had a BMI ≥30.0 kg/m; 3 patients (2.88%) experienced nipple necrosis, all of whom had a BMI ≥30.0 kg/m; 20 patients (19.23%) experienced infection, 19 of whom had a BMI ≥30.0 kg/m. CONCLUSIONS: On the basis of data gathered and the statistics performed, patients with a BMI ≥30.0 kg/m were 4.86 times more likely to have postsurgical complications than those with a BMI <30.0 kg/m.

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Pigtail-Assisted Distal Canalicular Repair in a Child: An Innovative Technique for Bicanalicular Intubation With Single Monocanalicular Stent.

Lokdarshi G, Shameer Shamanzil A

Eplasty · 2024 · PMID 39224417

OBJECTIVE: Repair of medial canthus injury involving canaliculus is an emergency indication for canalicular intubation to restore lacrimal drainage. Herein, the author has described an innovative but simple technique for... OBJECTIVE: Repair of medial canthus injury involving canaliculus is an emergency indication for canalicular intubation to restore lacrimal drainage. Herein, the author has described an innovative but simple technique for this reconstruction. METHOD AND RESULT: A small, blunt pigtail probe was gently passed through the opposite canaliculus in a rotational manner. A silicon stent was threaded inside canaliculi by reverse rotation of the pigtail in an atraumatic way. The technique was used on 4 pediatric cases without any postoperative complication or epiphora. CONCLUSIONS: This technique of intubation is simple, cheap, and useful in canalicular emergencies, including "distal" canaliculus lacerations.

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Decreased Use of Anti-Inflammatory Medications in Autoimmune Connective Tissue Disease Patients Following Breast Implant Removal: A National Analysis.

Shah JK, Najafali D, Fung E … +6 more , Rowley M, Thawanyarat K, Cevallos PC, Makarewicz N, Raman KS, Nazerali R

Eplasty · 2024 · PMID 39224416

BACKGROUND: Recent case studies demonstrate resolution of rheumatologic symptoms following implant explantation, raising concern around breast implant illness and associated inflammatory symptomatology. In patients with... BACKGROUND: Recent case studies demonstrate resolution of rheumatologic symptoms following implant explantation, raising concern around breast implant illness and associated inflammatory symptomatology. In patients with connective tissue disorders (CTD) and breast implants, we quantified the number of anti-inflammatory medications as a proxy for inflammation and disease burden before and after implant removal. METHODS: Using the Clinformatics Data Mart Database, adult female patients from 2003 to 2021 were queried. codes were used to identify patients who underwent implant-based reconstruction and subsequent implant removal. (ICD-9) and (ICD-10) codes identified patients with CTD. Filled prescriptions of anti-inflammatory drugs were quantified for each patient during the preoperative, perioperative, and postoperative windows surrounding breast implant removal. RESULTS: Of 1015 patients meeting criteria (mean age 56 ± 12 years), 821 (81%) filled prescriptions during the preoperative window, 753 (74%) filled during the perioperative window, and 735 (73%) filled during the postoperative window. Patients filled significantly fewer postoperative prescriptions than preoperative prescriptions ( < .001).Statistically significant predictors of the number of anti-inflammatory prescriptions filled in the postoperative window included additional anti-inflammatory prescriptions filled in the preoperative ( < .001) and perioperative ( < .001) windows. Experiencing a complication was not associated with the number of prescriptions filled in the postoperative window ( = .935). CONCLUSIONS: We found a significant decrease in filled anti-inflammatory prescriptions in patients with known CTD following implant removal, suggesting that breast implant removal may help diminish inflammatory symptomology in predisposed patients.

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The Bilobed Flap - Critical Analysis and New Mathematically Precise Design.

Pathan I

Eplasty · 2024 · PMID 39224415

BACKGROUND: A bilobed flap is a workhorse flap to reconstruct the lower third of the nasal defect. It has been described as a double transposition flap. Various changes have been proposed to reduce the drawbacks of this... BACKGROUND: A bilobed flap is a workhorse flap to reconstruct the lower third of the nasal defect. It has been described as a double transposition flap. Various changes have been proposed to reduce the drawbacks of this flap. Most of the modifications pay attention to flap width and length without emphasizing the pivot point. In this article, the classic Zitelli design is tested for its mathematical precision, and the key role of the pivot point is discussed. METHOD: The bilobed flap was designed with accurate mathematical measurement on simple drawing software. Its design and flap movement were studied and critically analyzed. The biogeometry of the flap was investigated with multiple diagrams and various mathematical principles. RESULTS: The classic description carries some mathematical errors. The author describes a new design that is more precise mathematically. A proper pivot point location is vital for accurate design and flaps movement. Putting the pivot point at a distance 2.6 times the radius of the defect makes the movement of the flaps precise. In a proper design, the extension of secondary flap length is an optional step, and the dog-ear so formed can be tackled separately. This new design of the bilobed flap only needs rotation advancement movement. CONCLUSIONS: The bilobed flap is one of the major tools for lower third nasal reconstruction. A perfectly designed bilobed flap is primarily a rotation flap. A slight modification of classic design by putting the pivot point at a distance 2.6 times of the radius of the defect makes it more perfect mathematically.

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Meta-Analysis Comparing Outcomes of Two Different Closed Incision Negative Pressure Systems in Breast Surgery and Implications to Cost of Care.

Singh DP, Gabriel A, Silverman R … +2 more , Bongards C, Griffin L

Eplasty · 2024 · PMID 39224414

BACKGROUND: Surgical site complication (SSC) rates in breast surgery have been reported between 2.25% and 53%. Use of incision management may help reduce the risk of SSCs. The potential of 2 closed incision negative pres... BACKGROUND: Surgical site complication (SSC) rates in breast surgery have been reported between 2.25% and 53%. Use of incision management may help reduce the risk of SSCs. The potential of 2 closed incision negative pressure therapy (ciNPT) systems to mitigate surgical site complications (SSC) and surgical site infections (SSI) in breast surgery were assessed. METHODS: A systematic literature review for breast surgery studies was conducted comparing ciNPT use against standard of care (SOC). SSC, SSI, and dehiscence rates were examined. SSCs were defined as all surgical site complications including SSI, dehiscence, seroma, hematoma, and necrosis. Risk ratios and random effects models were used to assess the effect of ciNPT with multilayer absorbent dressing (ciNPT-MLA) and ciNPT with foam dressing (ciNPT-F) compared with SOC. RESULTS: Eight articles were included in the meta-analysis. No significant differences in SSC rates ( = .307) or SSI rates ( = .453) between ciNPT-MLA and SOC were observed. ciNPT-MLA use was associated with a reduction in dehiscence compared with SOC (RR = 0.499, 95% CI = 0.303, 0.822; = .006). A significant reduction in SSC rates (RR = 0.498, 95% CI = 0.271, 0.917; = .025) was observed with ciNPT-F use. Similarly, dehiscence rate reduction was associated with ciNPT-F use (RR = 0.349, 95% CI= 0.168, 0.725; = .005). A trend towards reduction of SSI rates with ciNPT-F use compared with SOC was also noted ( = .053). CONCLUSIONS: Compared with SOC, ciNPT-MLA significantly reduced rates of dehiscence, while ciNPT-F use resulted in significantly reduced SSC and dehiscence rates with a trend toward reducing SSI.

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Reconstruction of Complex Upper Extremity Wounds With Novosorb Biodegradable Temporizing Matrix Versus Integra Collagen-Chondroitin Silicone: A Cost Analysis.

Jou C, Chepla KJ

Eplasty · 2024 · PMID 39224413

BACKGROUND: Reconstruction of upper extremity wounds with dermal matrices can reduce the length of hospitalization and surgical complexity without compromising functional outcomes. We aimed to compare costs between Novos... BACKGROUND: Reconstruction of upper extremity wounds with dermal matrices can reduce the length of hospitalization and surgical complexity without compromising functional outcomes. We aimed to compare costs between Novosorb biodegradable temporizing matrix (BTM) and Integra collagen-chondroitin silicone (CCS) bilayer. METHODS: A chart review was performed for patients with isolated upper extremity traumatic wounds who underwent reconstruction with either BTM or CCS between January 2017 and May 2022. Demographic data, surgical procedures, outcomes, and costs were collected for analysis. RESULTS: Twenty-seven patients were included: 18 BTM and 9 CCS. There were no differences in age, sex, wound size, or dermal template size. Skin grafting was required less frequently in BTM compared with CCS (44.4% vs 55.6%, = .013). Time to skin graft was longer in the BTM group (43.4 days vs 21.4 days, = .002). The BTM group experienced fewer complications (33.3% vs 55.6%, = .002). The mean number of secondary procedures required after template placement was 0.67 in BTM compared with 1.56 in CCS, = .049. When factoring in the cost of product, the cost of reconstruction with BTM was significantly lower than CCS ($1361.92 vs $3185.71, = .049). CONCLUSIONS: Novosorb BTM is a more cost-effective option when compared with CCS for reconstruction of upper extremity soft tissue defects.

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Treatment of a Congenital Melocytic Giant Naevi at Age 39 Using Split-Thickness Skin Graft Over an Artificial Dermal Scaffold Through 2-Step Operation: A Novel Technique and Literature Review.

Akin M, Akgün AE, Tuncer HB

Eplasty · 2024 · PMID 39224412

Congenital melanocytic nevus is a benign proliferation seen from birth. However, malignant transformation can be observed in later ages, so the removal of especially large and giant nevi is recommended during childhood.... Congenital melanocytic nevus is a benign proliferation seen from birth. However, malignant transformation can be observed in later ages, so the removal of especially large and giant nevi is recommended during childhood. Nevertheless, there are no cases reported in the literature regarding excision of giant congenital melanocytic nevi in advanced age. This article presents the first case of a 39-year-old patient with a giant congenital melanocytic nevus covering 10% of the total body surface area, who underwent treatment with a 2-step operation. The nevus was located on the back, covering 10% of the total body surface area. The patient underwent en-bloc excision. A bilayer dermal matrix was applied over the fascia. Subsequently, a split-thickness skin graft was applied to the entire area. Full re-epithelialization was achieved within a total of 35 days. Thanks to the applied dermal scaffold, the area became pliable.

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Mixed Neuroendocrine-Squamous Cell Carcinoma of the Hand With Metastatic Dissemination: A Case Report.

Adepoju J, Toms JA, O'Neill ES … +4 more , Grievous M, Hasan J, Tragos C, Doscher M

Eplasty · 2024 · PMID 39224411

Cutaneous manifestations of mixed neuroendocrine non-neuroendocrine neoplasms remain a diagnostic rarity. Predominantly identified within internal glandular organs, the digestive tract, and in the hepatobiliary system, t... Cutaneous manifestations of mixed neuroendocrine non-neuroendocrine neoplasms remain a diagnostic rarity. Predominantly identified within internal glandular organs, the digestive tract, and in the hepatobiliary system, this case report illustrates a unique occurrence of a mixed squamous cell and neuroendocrine tumor in the index finger of a justice-affected patient. We discuss the complexities of diagnosis and complications as well as emphasize the importance for hand surgeons to recognize presentations like this and the need for vigilant follow-up and improved care coordination.

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Limb Salvage in Extensive Necrotizing Soft Tissue Infection with Adjuvant Hyperbaric Oxygen Therapy.

Yauchi K, Shikata N, Shibaoka Y

Eplasty · 2024 · PMID 39224410

A necrotizing soft tissue infection (NSTI) can be life-threatening if not treated promptly, posing a high risk of limb amputation. Here, we report a case of an NSTI extending from the buttocks and perineum down to the le... A necrotizing soft tissue infection (NSTI) can be life-threatening if not treated promptly, posing a high risk of limb amputation. Here, we report a case of an NSTI extending from the buttocks and perineum down to the left lower limb. The case involved a 48-year-old male patient who presented with fever, altered consciousness, and limb swelling. Computed tomography showed the infection had spread to the perifascial, intermuscular, and intramuscular regions, making it difficult to save the patient's life and limb. Despite prompt surgery and antibiotic treatment, multidrug-resistant bacteria presented difficult wound management challenges. Hyperbaric oxygen therapy (HBO) was initiated, which resulted in dramatic wound improvement and successful skin grafting. Due to limb preservation, the patient was able to recover his preadmission activities of daily living and successfully reintegrate into society. Standard treatments for NSTI include early surgical treatment, antibiotics, and intensive support. The adjunctive use of HBO therapy may have contributed to the successful outcome in this case.

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Radiation-Induced Angiosarcoma in a Patient With Klippel-Trenaunay Syndrome: A Case Report.

Nehila T, Bair C, Alford N … +1 more , Dayicioglu D

Eplasty · 2024 · PMID 39224409

BACKGROUND: Klippel-Trenaunay syndrome (KTS) is a rare vascular disorder that typically presents in the lower limb with unilateral port-wine discoloration of the skin due to capillary malformations, varicose veins, and s... BACKGROUND: Klippel-Trenaunay syndrome (KTS) is a rare vascular disorder that typically presents in the lower limb with unilateral port-wine discoloration of the skin due to capillary malformations, varicose veins, and soft tissue and bone overgrowth. Radiation-induced angiosarcoma (RIAS) is a rare vascular malignancy that develops as a long-term complication secondary to radiation therapy. While there is no well-established direct relationship between KTS and development of angiosarcoma, there is literature that suggests a logical association between the 2 disorders. The present case report highlights the importance of further research into a potential connection between KTS and RIAS. METHODS: A 51-year-old female with a history of KTS was referred to the plastic surgery clinic for delayed breast reconstruction following RIAS of the left breast. It was decided that a 2-stage left latissimus dorsi musculocutaneous flap reconstruction with silicone implant would best achieve her goal of symmetry. RESULTS: The patient reported here had an unremarkable postoperative course. Of note, this patient experienced severe body dysmorphia after her mastectomy and RIAS excision due to the absence of her left breast juxtaposed with her prior large right breast augmentation. The choice of 2-stage combined autologous/implant reconstruction likely contributed to her satisfactory cosmetic outcome. CONCLUSIONS: While RIAS and KTS are distinct conditions, a link may exist between the two. More research is needed to investigate this possible relationship. Aggressive treatment of RIAS is crucial for patient recovery, and a 2-stage combined autologous/implant reconstruction is an optimal choice for post-RIAS reconstruction, especially in patients hoping to achieve a large breast size.

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Nail Bed Injury Repair: Nail Plate Replacement Versus Non-replacement.

Rock J, Kurland A, Congiusta DV … +3 more , Baxi O, Vosbikian MM, Ahmed IH

Eplasty · 2024 · PMID 39224408

BACKGROUND: Although nail bed injuries are common, there is no consensus on the proper course of treatment in regard to nail plate replacement. Nail plate replacement risks infection and injury of the germinal matrix. It... BACKGROUND: Although nail bed injuries are common, there is no consensus on the proper course of treatment in regard to nail plate replacement. Nail plate replacement risks infection and injury of the germinal matrix. It is our hypothesis that functional and cosmetic outcomes of the nail will not differ by nail plate replacement following nail bed repair. METHODS: This is a single institution, prospective, randomized control study comparing nail plate replacement versus non-replacement in patients undergoing nail bed repair. Primary outcome included nail growth and cosmesis using the Zook classification system. Secondary outcomes were pain, functional limitation, and patient satisfaction. Statistical significance was set at < .05. RESULTS: Fifty patients were enrolled, 26 (52%) randomized to the non-replacement group and 24 (48%) to the replacement group. All patients who followed up had nail growth by 4 months after nail bed repair (N = 28). In the non-replacement group 4 patients continued to have pain in the affected nail bed compared with 2 patients in the replacement group ( = .66). One patient in each group reported continued functional limitation related to nail pain ( = 1.00). Patient satisfaction was not statistically different between the groups ( = 1.00). As a result of patient follow- up, we have been able to score 17 patients via the Zook criteria. In the non-replacement group, 3 nails were scored as excellent, 3 very good, 3 good, 1 fair, and 2 poor. In the replacement group, the nail was classified as excellent in 4 patients and very good in 1 patient. There was no difference in the likelihood of these outcomes with regard to treatment group ( = .18). There was moderate agreement between patient satisfaction and the Zook criteria scoring (κ = .45, 95% CI: -0.15-1.00). CONCLUSIONS: Statistical and clinical differences were not identified in regard to cosmesis, pain, functional use of the hand, or patient satisfaction. There are established risks involved in nail plate replacement such as infection and injury to the germinal matrix. If outcomes are not different based on nail plate replacement following nail bed repair, non- replacement may be the preferable treatment option so as to avoid these complications.

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Unique Transligamentous Variant of the Recurrent Motor Branch of the Median Nerve.

Wulbrecht R, Doarn M

Eplasty · 2024 · PMID 39224407

This case report presents a 72-year-old female with a unique anatomical variation of the median nerve recurrent motor branch that has not been described in the literature. During her open carpal tunnel release, the recur... This case report presents a 72-year-old female with a unique anatomical variation of the median nerve recurrent motor branch that has not been described in the literature. During her open carpal tunnel release, the recurrent motor branch was found to divide from the median nerve within the carpal tunnel, pierce the proximal aspect of the transverse carpal ligament in a transligamentous fashion, and then immediately divide into one branch that pierced the thenar muscles and another branch that traveled superficial to the transverse carpal ligament before piercing the thenar muscles more distal. This variation in anatomy stresses the importance of thoughtful incision design and direct visualization of all structures during carpal tunnel release.

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Nipple Areola Complex Reconstruction: An 8-Year Experience With Modified Technique and Systematic Review.

Rice M, Colavitti G, Jackson P … +1 more , Wilson S

Eplasty · 2024 · PMID 39224406

BACKGROUND: Nipple areola complex reconstruction is often the last procedure offered to patients undergoing breast reconstruction. Although comparatively minor, this final step creates the focal point of the breast while... BACKGROUND: Nipple areola complex reconstruction is often the last procedure offered to patients undergoing breast reconstruction. Although comparatively minor, this final step creates the focal point of the breast while signifying the end of an often long and difficult journey for patient and surgeon. The literature demonstrates that nipple areolar complex (NAC) reconstruction conveys a positive impact on overall body image while defining the final aesthetic outcome. This paper presents a novel technique for NAC reconstruction developed at a UK tertiary referral center. It is supported by a systematic review of the current literature. METHODS: Between 2014 and 2022, a new technique was used to reconstruct the NAC using a modification of the C-V flap with a full-thickness skin graft (FTSG) and later nipple tattoo, if required. Patients were followed up in clinic noting complications, satisfaction, and need for revision surgery. The study was completed by conducting a systematic review of the literature assessing areolar reconstruction with skin grafts, according to PRISMA guidelines. DISCUSSION: This technique provides excellent results in terms of patient satisfaction and objective outcomes (complication rate, need for revision procedures, and loss of projection requiring further surgery). This literature review reflects alternative techniques and highlights the advantages of using a modified C-V flap with FTSG, in terms of morbidity and patient satisfaction. CONCLUSIONS: NAC reconstruction is the "cherry on top" at the end of the breast reconstructive journey. This paper advocates a technique that is reproducible, with minimal complications, excellent outcomes, and long-standing results.

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