Eplasty [JOURNAL]
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200 papers
New Documentation System for Ulnar Longitudinal Deficiency.
Sferopoulos NK
Eplasty · 2024 · PMID 38476516
BACKGROUND: This study examines the value of a new alphanumerical documentation system to classify the whole spectrum of deformities in ulnar longitudinal deficiency (ULD). METHODS: The patients with ULD, whom were refer...
BACKGROUND: This study examines the value of a new alphanumerical documentation system to classify the whole spectrum of deformities in ulnar longitudinal deficiency (ULD). METHODS: The patients with ULD, whom were referred during a 35-year period, were identified from the hospital database. A total of 7 patients with photographs and/or conventional radiographs that could be adequately reproduced were enrolled in the study. RESULTS: Six patients could be classified with the previously proposed classifications and the new documentation system. Three of them were diagnosed with ulnar-deficient hands. One had aplasia of the fifth finger ray (phalanges and metacarpal), a second aplasia of the fourth and fifth finger rays with narrowing of the first web, and a third aplasia of the fifth metacarpal. Furthermore, a fourth patient was diagnosed with hypoplasia of the ulna and congenital wrist amputation; a fifth with hypoplasia of the ulna, dislocation of the radial head, and a bowed radius; and a sixth with partial aplasia involving the middle and distal diaphysis of the ulna. Finally, one patient with an absent ulnar styloid process and oligodactyly with thumb could be classified only with the new system. CONCLUSIONS: The proposed new alphanumerical documentation system incorporates all the most widely accepted previous classification schemes, facilitates the morphological and radiographic description of the whole spectrum of the deformities detected in patients with ULD for better communication between scientists, and secures the unrestricted inclusion of new variants in the future.
Association of Squamous Cell Carcinoma and Hyaluronan: A Scope of the Literature.
Al Ghanim K, Jaszkul KM, Simpson A … +1 more , Turley EA
Eplasty · 2024 · PMID 38476515
BACKGROUND: Nonmelanotic skin cancer (NMSC) refers to cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma. There have been many factors linked with the development of cSCC; however, ultraviolet radiation is...
BACKGROUND: Nonmelanotic skin cancer (NMSC) refers to cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma. There have been many factors linked with the development of cSCC; however, ultraviolet radiation is the most notable culprit. Mutations in signaling genes, the gene, and genes encoding components of the NOTCH signaling pathways increase the risk of developing cSCC. Many therapeutic approaches are available for cSCC, including chemotherapy, radiation therapy, targeted therapy, immunotherapy, and topical treatment. As cSCC affects millions of people worldwide, there is increasing demand to find more minimally invasive treatment approaches, such as hyaluronic acid therapy. METHODS: A narrative literature review was conducted on the available literature regarding NMSC, and various treatment strategies were identified. CONCLUSIONS: Recent research investigating whether long-lived cancer-resistant species could yield any potential clues against skin carcinogenesis has highlighted naked mole rats (). One of the proposed mechanisms associated with this tumor resistance has been the accumulation of high-molecular-weight hyaluronic acid (HMWHA) in the epidermis. Researchers were able to conclude that the CD44/HMWHA interaction mediates cancer cell apoptosis and restricts cell cycle progression as a mechanism of cancer resistance in naked mole rats.
Virtual Surgical Planning in Condyle Reconstruction of Posterior Mandibulectomy Defects.
Benedict KC, Martinez IV, McIntyre B
Eplasty · 2024 · PMID 38476514
BACKGROUND: Ameloblastoma is a rare odontogenic tumor most commonly located within the mandible. These tumors can grow to massive proportions and result in malocclusion. Segmental mandibulectomy and reconstruction with a...
BACKGROUND: Ameloblastoma is a rare odontogenic tumor most commonly located within the mandible. These tumors can grow to massive proportions and result in malocclusion. Segmental mandibulectomy and reconstruction with an osteocutaneous free flap are frequently required. Virtual surgical planning (VSP) aids the surgeon in creating precise anatomic reconstruction when there is preoperative malocclusion due to tumor size. In this study we seek to further examine reconstruction of posterior mandibulectomy defects inclusive of condylar resection. METHODS: Retrospective review of patients treated for giant ameloblastoma (tumor >4 cm) was examined; 3 patients with posterior tumors requiring ramus and condylar resection were included. Reconstruction in all patients was performed using fibula free flaps and VSP custom-made mandibular reconstruction plates. In these patients the reconstructed ramus was shortened and precise contouring done with a burr to recreate the native condylar surface. Intermaxillary fixation was used to maintain occlusion for 1 month postoperatively. Inferior alveolar nerve repair with allograft and nerve connectors was performed for all 3 patients. RESULTS: All patients underwent successful mandibular reconstruction with preservation of mandibular function and improved occlusion postoperatively. Inferior alveolar nerve repair using nerve allograft allowed for neurosensory recovery in the mandibular division of trigeminal nerve distribution in 2 of the 3 patients. CONCLUSIONS: Giant ameloblastoma involving the mandibular condyle can be successfully treated with the fibula free flap utilizing mandible reconstruction plates and VSP. This technique allows for excellent restoration of occlusion and neurosensory recovery when paired with reconstruction of the inferior alveolar nerve at time of reconstruction.
Burn Size Estimation: A Critical Component of Burn Care.
Milner SM
Eplasty · 2023 · PMID 38234708
Abstract loading — click title to view on PubMed.
Cultured Epithelial Autograft.
Milner SM
Eplasty · 2023 · PMID 38234707
Abstract loading — click title to view on PubMed.
Utility of a Synthetic Hybrid-Scale Fiber Matrix in Surgical Soft Tissue Reconstruction.
Chowdhry S
Eplasty · 2024 · PMID 38234677
BACKGROUND: Large wounds, regardless of etiology, can be difficult to close and often require advanced treatment. The complexity of healing these wounds increases when underlying structures such as tendon and muscle are...
BACKGROUND: Large wounds, regardless of etiology, can be difficult to close and often require advanced treatment. The complexity of healing these wounds increases when underlying structures such as tendon and muscle are exposed. These structures are difficult to granulate tissue over, and successful wound closure, whether through secondary intention or via a split-thickness skin graft or flap, is dependent on sufficient coverage of the exposed bone or tendon. Given these challenges, new treatment options should be explored to achieve successful outcomes in this patient population. A resorbable synthetic hybrid-scale fiber matrix, with a structure similar to that of native human extracellular matrix, is gaining popularity in the treatment of soft tissue defects. METHODS: A retrospective case series was conducted via review of medical charts. Patients included in this review were treated with the synthetic hybrid-scale fiber matrix to manage large, deep wounds with exposed structures. Twenty-two patients with deep surgical wounds of various etiologies were treated with the synthetic hybrid-scale fiber matrix to granulate the wound bed in preparation for a split-thickness skin graft or flap closure or until complete re-epithelialization of the wound. RESULTS: The average patient age was 59.3 years old, and the average initial wound size was 210.3 cm. All wounds had exposed structures, which included muscle, fat, fascia, or tendon. Wounds were closed utilizing healing by secondary intent (23%), bridging to a split-thickness skin graft (63%), or bridging to a flap closure (14%). All wounds achieved total closure within an average of 41.4 days with no reported complications. CONCLUSIONS: The synthetic hybrid-scale fiber matrix demonstrated efficacy encouraging granulation tissue over exposed structures and should be considered as a novel treatment option for complex soft tissue reconstruction.
Prophylactic Muscle Free Flap for Total Ankle Arthroplasty With Vascular Risk Factors.
Olsson SE, Fijany AJ, Downey MW … +1 more , Pekarev M
Eplasty · 2024 · PMID 38234676
Total ankle arthroplasty (TAA) is a treatment for ankle arthritis that preserves the joint's mobility. Conditions causing poor peripheral blood flow are contraindications for TAA. A 63-year-old man with posttraumatic ank...
Total ankle arthroplasty (TAA) is a treatment for ankle arthritis that preserves the joint's mobility. Conditions causing poor peripheral blood flow are contraindications for TAA. A 63-year-old man with posttraumatic ankle osteoarthritis who was considered high-risk for TAA due to obesity, history of trauma, tobacco usage, chronic venous stasis, lymphedema, and hypertension subsequently underwent TAA followed by a prophylactic muscle free flap to improve peripheral blood flow and soft tissue integrity. He recovered with no pain and excellent ankle mobility. This case highlights the potential usage of prophylactic muscle free flaps to mitigate vascular risk factors in high-risk patients undergoing TAA.
Osteocutaneous Fibular Flap for Reconstruction of Composite Metacarpal Defects Due to Gunshot Wounds.
Zor F, Bayram Y, Kulahci Y
Eplasty · 2023 · PMID 38229968
BACKGROUND: Gunshot wounds of the hand are challenging, as these injuries include bones, tendons neurovascular structures, and soft tissue. The osteocutaneous fibula flap has shown to be an excellent option for treating...
BACKGROUND: Gunshot wounds of the hand are challenging, as these injuries include bones, tendons neurovascular structures, and soft tissue. The osteocutaneous fibula flap has shown to be an excellent option for treating the composite defects, including bone and soft tissue. In this study, reconstructions of gunshot injuries of the metacarpal bones with a fibular flap are presented. METHODS: Six patients with gunshot injuries to the hand were treated with free fibula flap. All patients had composite defects reconstructed with osteocutaneous fibula flap. Because of the size mismatch between fibula and metacarpal bone, a longitudinally split fibula was used in 2 patients. In 1 patient, the flap was used in a double-barrel fashion to reconstruct 2 metacarpal bone losses. Tendon repairs were performed either primarily or with tendon graft. All patients received hand rehabilitation. Hand function of the patients was evaluated by grip and pinch strength tests and Jebsen hand function test. RESULTS: All flaps survived with no major postoperative complications. The mean follow-up period was 18 months. Web releasing and an arthrodesis procedure was performed in 1 patient, and tenolysis was performed in 2 others. All flaps adapted well to the recipient area. With respect to routine daily activities, overall hand function measured by grip and pinch strength tests and Jebsen hand function test was considered satisfactory in all patients. CONCLUSIONS: The fibular flap is a good alternative for reconstruction of the injured hand with composite defects, including metacarpal bone and soft tissue. It can be used longitudinally or transversely. Osteotomies can be performed to obtain split fibular flap or double-barrel fibular flap according to the bone defect.
Role of the Plastic Surgeon in Tuberculosis Treatment.
Mendes M, Almeida A, Costa R … +6 more , Paiva A, Jarnalo M, Gandra G, Machado P, Horta R, Coelho R
Eplasty · 2023 · PMID 38229967
BACKGROUND: Tuberculous empyema is rare. Its treatment requires oral antituberculous drugs, empyema drainage, and in severe cases, decortication and pneumectomy. In the presence of tuberculosis, lung resection has a high...
BACKGROUND: Tuberculous empyema is rare. Its treatment requires oral antituberculous drugs, empyema drainage, and in severe cases, decortication and pneumectomy. In the presence of tuberculosis, lung resection has a high risk of postoperative bronchopleural fistula (BPF) and empyema. Treatment includes drainage, fistula occlusion, dead space obliteration, and infection control. Muscle flap transfer allows BPF occlusion and dead space obliteration. METHODS: This report presents a case of a 63-year-old man with tuberculosis and postoperative BPF with empyema after pleural decortication and left lower lobe resection. The empyema was drained, and antituberculous drugs were started. The BPF was occluded with a latissimus dorsi and serratus anterior chimeric muscle flap, and the remaining thoracic dead space and chest wall defect were reconstructed with a pedicled pectoralis major myocutaneous flap. RESULTS: Healing occurred uneventfully, and the patient was discharged from the hospital after 2 weeks. CONCLUSIONS: This type of thoracic defect is rare nowadays, especially in the setting of tuberculous infections. Although workhorse flaps like latissimus dorsi or pectoralis major flaps have been progressively surpassed by more elegant solutions like fasciocutaneous pedicled flaps and free flaps, they must still be considerations in the decision-making process of a reconstructive surgeon, and flap choice must be made on a case-by-case basis.
The "Domino Flaps" Concept: Functional Composite Reconstruction for Traumatic Transmetacarpal Thumb Amputation.
Song D, Pafitanis G, Sheng Y … +4 more , Kazzazi D, Kazzazi F, Chi Z, Feng G
Eplasty · 2023 · PMID 38229966
Complex transmetacarpal thumb amputation remains a challenging reconstructive injury. Optimal reconstructive options aim to achieve a neo-thumb with optimal length, sensitivity, stability, and an aesthetically functional...
Complex transmetacarpal thumb amputation remains a challenging reconstructive injury. Optimal reconstructive options aim to achieve a neo-thumb with optimal length, sensitivity, stability, and an aesthetically functional result. In cases when immediate replantation of the amputated digit is not possible, a temporary ectopic replantation with staged reconstruction can be deployed. We report our experience of a complex transmetacarpal thumb amputation managed with a staged "domino flap" concept. The first stage involved an ectopic replantation of the amputated digit with a second stage replantation 3 weeks later. Domino flap refers to the requirement of a further reconstruction due to the defect at the donor sites. In this case, the replant is accompanied by 2 domino flap reconstructions with the dorsalis pedis composite free flap to reconstruct the first metatarsal and an anterior tibial artery propeller perforator flap to reconstruct the composite flap donor site.
Prioritizing Native Breast Skin Preservation or Scar Symmetry in Autologous Breast Reconstruction? Using Crowdsourcing to Assess Preference.
Patel AA, Feng CL, Marquez J … +4 more , Spaw JP, Garza RM, Lee GK, Nazerali RS
Eplasty · 2023 · PMID 38229965
BACKGROUND: Recent literature on autologous breast reconstruction suggests that such factors as scar symmetry and skin paddle size impact patient preferences more than preservation of native breast skin. Since patient sa...
BACKGROUND: Recent literature on autologous breast reconstruction suggests that such factors as scar symmetry and skin paddle size impact patient preferences more than preservation of native breast skin. Since patient satisfaction with plastic surgery procedures can be largely influenced by beauty standards set by the general public, this study used a novel crowdsourcing method to evaluate laypeople's aesthetic preferences for different bilateral autologous breast reconstructions to determine the relative importance of scar and skin paddle symmetry and preservation of native skin. METHODS: Using Amazon's Mechanical Turk crowdsourcing marketplace, participants ranked images of reconstructions based on overall aesthetic appearance. Images were digitally modified to reflect 4 types of reconstruction: immediate (IR), delayed symmetric (DS), delayed asymmetric (DA), or mixed (MR). RESULTS: DS was ranked most favorably (1.74), followed by IR (1.95), DA (2.93), and MR (3.34). Friedman rank sum and pairwise tests showed statistical significance for comparisons of all 4 reconstruction types. Likert ratings were higher for IR than for DA reconstructions for skin quality ( = .002), scar visibility ( < .001) scar position ( < .001), and breast symmetry, shape, and position ( < .001). Ratings increased for all aesthetic factors following nipple-areolar-complex reconstruction ( < .001). CONCLUSIONS: More symmetric breast scars were rated aesthetically higher than nonsymmetric scarring, and our participants preferred maintenance of scar symmetry over preservation of native breast skin. These findings are consistent with previous studies that surveyed non-crowdsourced participants, which demonstrates the potential for crowdsourcing to be used to better understand the general public's preferences in plastic surgery.
Life-Threatening Bleeding Following Penile Inversion Vaginoplasty: Case Analysis and Practice Improvement.
Das RK, Assi PE, Al Kassis S
Eplasty · 2023 · PMID 38229964
BACKGROUND: Gender-affirming surgery is a medically necessary treatment for transgender and gender diverse patients experiencing gender dysphoria. Preliminary data demonstrate an association between gender-affirming surg...
BACKGROUND: Gender-affirming surgery is a medically necessary treatment for transgender and gender diverse patients experiencing gender dysphoria. Preliminary data demonstrate an association between gender-affirming surgery and improved mental health outcomes. Penile inversion vaginoplasty is the most frequently performed feminizing bottom surgery in transwomen. Importantly, complications associated with penile inversion vaginoplasty are not uncommon and can be life-threatening. Surgeons and other members of the health care team must be aware of these potential harms. However, there is a paucity of high-quality evidence reported in the literature about the management and breadth of complications regarding feminizing bottom surgery. CASE: A healthy 37-year-old woman who was assigned male at birth underwent gender-affirming orchiectomy, penile inversion vaginoplasty, and vulvar reconstruction. During routine vaginal packing removal in the postoperative period, there was an acute arterial bleed in the neovaginal canal, and hemostasis was achieved in the operating room. CONCLUSIONS: We review the associated periprostatic anatomy and describe several practice improvements to mitigate postoperative complications.
Rare Presentation of Apocrine Hidrocystoma Along the Nasolacrimal Duct.
Sahu SK, Poddar C, Parija S … +1 more , Moharana B
Eplasty · 2023 · PMID 38229963
Hidrocystomas are rare benign cystic tumors of the sweat glands, with no cases of hidrocystoma of nasolacrimal duct previously reported. We present a case of a 28-year-old female with no prior significant medical history...
Hidrocystomas are rare benign cystic tumors of the sweat glands, with no cases of hidrocystoma of nasolacrimal duct previously reported. We present a case of a 28-year-old female with no prior significant medical history presenting with an enlarging mass medial to her right lower eyelid for 2 years. Computed tomography scan showed nodular soft tissue in the middle part of the right nasolacrimal duct. Following complete excision of the cyst, histopathology reported an apocrine hidrocystoma, which is very rare.
Patient-Reported Mental Health Outcomes After Single-Digit Non-thumb Traumatic Amputation in Adults.
Bettlach CLR, Skladman R, Gibson E … +5 more , Daines JM, Payne ER, Vuong LN, Merrill CM, Pet MA
Eplasty · 2023 · PMID 38229962
BACKGROUND: Though traumatic digital amputations are common, outcomes data are scarce. The FRANCHISE study clarified functional outcomes after digital amputation, but little information is available regarding mental heal...
BACKGROUND: Though traumatic digital amputations are common, outcomes data are scarce. The FRANCHISE study clarified functional outcomes after digital amputation, but little information is available regarding mental health outcomes. The aims of this study were to document patient-reported mental health outcomes after traumatic digital amputation, elucidate the relationship between mental health and functional outcomes, and determine which patient/injury attributes conferred risk of unfavorable mental health outcomes. METHODS: This was a descriptive, retrospective study of 77 patients with history of single digit, non-thumb traumatic amputation. Eligible patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, Pain Interference, Anger, Anxiety, and Depression computer adaptive tests, and a short questionnaire recorded handedness, demographics, and worker's compensation status. RESULTS: Correlation across the 3 PROMIS mental health domains (Anger, Anxiety, Depression) was uniformly strong and statistically significant. Correlation between the PROMIS mental health and functional (Upper Extremity and Pain Interference) scores was statistically significant but much weaker. Multivariable analysis revealed younger age and a worker's compensation claim had independent statistically significant predictive value for worse PROMIS Anger, Anxiety, and Depression scores. Female sex was also found to independently predict PROMIS Anxiety. CONCLUSIONS: By identifying patients at increased risk for feelings of anger, anxiety, and depression after digital amputation, anticipatory counseling can be provided. Anger, anxiety, and depression are very likely to coexist in the same patient; when responding to a patient who exhibits 1 element of this triad, the surgeon should be aware that the other 2 elements are likely to be present, even if not obvious.
Novel Reconstructive Ladder for Reestablishing Functional Skin Graft Coverage in Chronic Lower Extremity Wounds.
Abeshouse M, Horn C, Fierro A … +1 more , Lantis JC
Eplasty · 2023 · PMID 38229961
BACKGROUND: Chronic lower extremity (LE) wounds frequently require significant interventions to close. The success of any method depends on an adequately prepared wound bed, while factors including wound size, perfusion,...
BACKGROUND: Chronic lower extremity (LE) wounds frequently require significant interventions to close. The success of any method depends on an adequately prepared wound bed, while factors including wound size, perfusion, contamination, or exposed tissue structures can thwart efforts. We propose a standardized algorithm of care utilizing an acellular dermal matrix, split-thickness skin graft (STSG), and negative pressure wound therapy (NPWT) for the treatment of LE wounds. METHODS: This was a single-center, retrospective cohort study examining patients who underwent LE wound debridement, placement of fetal bovine dermis (FBD), and STSG between 2016 and 2022. The primary outcome was wound closure, while secondary outcomes were wound infection and amputation-free survival. RESULTS: Twenty patients (mean age 59 years, M:F 12:8)-including 24 LE venous ulcers (29.4%), amputation sites (29.4%), diabetic foot ulcers (25.0%), and atypical wounds (16.7%) with an average area of 39.15 cm-underwent debridement and FBD placement followed by STSG a median of 61 days thereafter. Of these patients, 83.3% received NPWT after FBD and STSG with 86% closure. There was successful engraftment in 92% of wounds whose FBD placement was within 2 months of STSG. Of wounds that had <50% engraftment, 75% had a STSG placed over 2 months after FBD placement. Of those patients with post-STSG infection, 75% had the graft placed >2 months after FBD placement, one of which required proximal amputation. CONCLUSIONS: By following a treatment plan including debridement with treatment of infection, application of FBD with placement of STSG within 2 months thereafter, and reinforcing NPWT, chronic wounds will have an increased rate of successful reepithelialization. Many cases experienced delays from FBD engraftment until STSG application due to schedule and insurance impediments, which led to less favorable outcomes. Therefore, a protocol that involves scheduling the placement of STSG 4 weeks after successful engraftment of FBD has been adopted.
Breast Paraffinoma: A Case Report of 20-Year-Old Mineral Oil Injection in a Male Patient.
Koussayer B, Moffitt S, Moore MG … +2 more , Kuc A, Laun J
Eplasty · 2023 · PMID 38229960
BACKGROUND: Mineral oil injection represents a dated practice of rapid and inexpensive breast augmentation. After a latency period, surrounding tissue becomes inflamed and fibrotic. Breast paraffinoma is well-documented...
BACKGROUND: Mineral oil injection represents a dated practice of rapid and inexpensive breast augmentation. After a latency period, surrounding tissue becomes inflamed and fibrotic. Breast paraffinoma is well-documented in women; however, only 3 cases of such masses in male patients exist in the literature. METHODS: We present a case of paraffinoma in a 63-year-old man from Puerto Rico who, desiring breasts, serially injected mineral oil into each breast daily for 13 years. Conservative management was initially attempted due to cardiac comorbidities and insurance authorization issues. The patient ultimately developed erosive wounds and therefore underwent excision of the bilateral breast masses as an en bloc specimen weighing 2.17 kg. RESULTS: Pathology indicated sclerosing lipogranulomatosis (paraffinoma). The quality of the wounds remaining warranted negative pressure wound therapy with serial debridement. The patient went on to successful reconstruction with a reverse abdominoplasty preserving periumbilical and intercostal perforators. CONCLUSIONS: Plastic surgeons must educate patients against using exogenous injected materials for augmentation of the breasts, penis, or buttocks. Although uncommon in the US, certain populations like body builders and foreign immigrants are at higher risk for current or prior injection practices. Reverse abdominoplasty is a viable reconstructive modality for the large resulting defect.
Negative Pressure Wound Therapy in Surgical Site Infections of Sternotomy Wounds - A Case Series Study in Neonates and Infants.
Renish MK, Krishnakumar KS, Pati AK … +2 more , Sunoj KS, Menon R
Eplasty · 2023 · PMID 38229959
This case series, performed by the department of plastic and reconstructive surgery at our institution, reports the management of sternal wound dehiscence in newborns and children after cardiac surgery with the help of a...
This case series, performed by the department of plastic and reconstructive surgery at our institution, reports the management of sternal wound dehiscence in newborns and children after cardiac surgery with the help of a negative pressure wound therapy treatment system. Three neonatal patients with poststernotomy wound problems were treated with a negative pressure wound therapy (VAC) system. Negative pressure therapy was started with negative pressure at 50 mm Hg, continuously. All children achieved healing of the sternal wound and a subsequent closure after a mean length of treatment of 33 days (range, 21-49 days). In conclusion, negative pressure therapy with pressure adjusted to lower values as compared with adults in combination with radical surgical debridement was found to be safe and effective, as well as being tolerated well in neonatal and infant patients with extensive or localized poststernotomy wound dehiscence.
"Spare Parts" for Foot Wound Reconstruction: A Report of 2 Cases.
Simman R, Zajac KK
Eplasty · 2023 · PMID 38229958
Soft tissue reconstruction of the foot can be a complex task to undertake when presented with challenging wounds. The foot comprises thick, glabrous skin with its own unique soft tissue anatomy that is suited to withstan...
Soft tissue reconstruction of the foot can be a complex task to undertake when presented with challenging wounds. The foot comprises thick, glabrous skin with its own unique soft tissue anatomy that is suited to withstand its necessary functional demands. "Spare parts" reconstruction provides an option for closure of complicated skin wounds encompassing areas of large, unsalvageable defects. This report presents the cases of 2 patients who underwent successful care at our institution. Each patient's approach was individualized based on the etiology and presentation of the wound while any comorbid conditions were taken into consideration. The purpose of these case reports is to highlight 2 examples involving spare parts foot reconstruction of complicated defects, both of which decreased donor morbidity and lessened the degree of amputation.
Venous Thromboembolism Prophylaxis in Plastic Surgery.
Gupta R, Bisht C, Genova R … +3 more , Ege E, Chetta M, Shaheen K
Eplasty · 2023 · PMID 38229957
BACKGROUND: In 2011, the American Society of Plastic Surgery (ASPS) formed the Venous Thromboembolism Task Force Report, which encouraged the use of the 2005 Caprini score and was amended in 2013. Still, there have been...
BACKGROUND: In 2011, the American Society of Plastic Surgery (ASPS) formed the Venous Thromboembolism Task Force Report, which encouraged the use of the 2005 Caprini score and was amended in 2013. Still, there have been several studies that have questioned the validity of the Caprini score. As a result, the goal of this study is to present our experience with chemoprophylaxis in cosmetic patients compared with the current recommendations for venous thromboembolism VTE) chemoprophylaxis endorsed by the ASPS. METHODS: A retrospective analysis was conducted in all patients operated on by a single surgeon from 2006 to 2016. Exclusion criteria were surgery length >6 hours, patients with known hypercoagulable states, or a personal history of deep vein thrombosis (DVT)/pulmonary embolism (PE). Demographic data were collected and analyzed. RESULTS: There were 1272 patients from a single institution who met the inclusion criteria. We determined that 71% of patient VTE scores were in the high to highest risk categories (n = 657), median age was 46 years, 79% of the population was Caucasian, 35% of patients had a body mass index of overweight or obese, and the average length of stay was 1 day. The rate of VTE in our patient population was found to be 0.08% (1 patient), which was uncomplicated and resolved with conservative therapy. CONCLUSIONS: This retrospective study found no significant difference in the incidence of VTE by providing chemophrophylaxis to patients without utilizing a scoring system. Our study suggests that the Caprini Scoring system might not be optimal in predicting VTE in patients undergoing aesthetic surgery.
Diagnosis and Management of a 4-Year-Old Male with Ulnar Artery Pseudoaneurysm.
Artz N, Scwartzberg H, Yoo A … +2 more , Cable M, Tuggle C
Eplasty · 2023 · PMID 38229956
BACKGROUND: Pseudoaneurysms are a rare vascular phenomenon caused by an intimal tear leading to hemorrhaging into surrounding tissue. Upper extremity pseudoaneurysms are well documented in adult patients and are attribut...
BACKGROUND: Pseudoaneurysms are a rare vascular phenomenon caused by an intimal tear leading to hemorrhaging into surrounding tissue. Upper extremity pseudoaneurysms are well documented in adult patients and are attributed to repetitive trauma. Pediatric pseudoaneurysms are rare and are frequently misdiagnosed, which could lead to serious complications. METHODS: This report presents the case of a 4-year-old male patient with an ulnar pseudoaneurysm of the right upper extremity. The pseudoaneurysm was diagnosed by ultrasound and computed tomography angiography and subsequently resected. The ulnar artery was reconstructed with an arterial graft using the descending branch of the lateral circumflex femoral artery. Patency of the end-to-end anastomosis was confirmed by strip testing and Allen's test. CONCLUSIONS: The aim of this report is to provide a background of upper extremity pseudoaneurysms and describe their rare occurrence in pediatric patients and potential for complications upon misdiagnosis. Additionally, this report aims to highlight an alternative approach to management of pediatric pseudoaneurysms and advocate for reconstruction of the affected artery regardless of collateral flow being established.
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