Eplasty [JOURNAL]

Diagnosis of simple benign peripheral nerve tumors (PNT) is usually based on imaging studies and in most cases, surgical excision leads to no significant functional deficit. The clinical presentation is often asymptomati... Diagnosis of simple benign peripheral nerve tumors (PNT) is usually based on imaging studies and in most cases, surgical excision leads to no significant functional deficit. The clinical presentation is often asymptomatic with incidental imaging findings. We present an unusual clinical presentation of a benign peripheral nerve sheath tumor of the radial nerve.

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Ovine Forestomach Matrix in the Surgical Management of Complex Volumetric Soft Tissue Defects: A Retrospective Pilot Case Series.

Cormican MT, Creel NJ, Bosque BA … +3 more , Dowling SG, Rideout PP, Vassy WM

Eplasty · 2023 · PMID 38045101

BACKGROUND: Volumetric soft tissue loss is an urgent surgical issue and can frequently lead to suboptimal outcomes for patients due to significant soft tissue loss, compromised vital structures, and contamination. Ovine... BACKGROUND: Volumetric soft tissue loss is an urgent surgical issue and can frequently lead to suboptimal outcomes for patients due to significant soft tissue loss, compromised vital structures, and contamination. Ovine forestomach matrix (OFM) has demonstrated clinical success in the surgical management of soft tissue defects, especially in contaminated fields, and provides an effective option for immediate coverage of exposed vital structures before definitive closure. METHODS: This retrospective pilot case series (n = 13 defects) evaluated the clinical effectiveness of OFM (graft and/or particulate formats) in the surgical management of contaminated volumetric soft tissue defects. Patients presented with significant soft tissue loss, often with exposed viscera, tendon, bone, or muscle, and were treated with OFM as part of their inpatient surgical management. All patients had at least 1 significant comorbidity with the potential to complicate their healing trajectory. The primary study endpoint was time to 100% granulation tissue coverage (days), and the secondary endpoint was any device-related postoperative complications. RESULTS: A total of 13 volumetric soft tissue defects were evaluated in 10 patients who underwent surgical reconstruction. Mean defect age was 3.5 ± 5.6 weeks, and mean area was 217.3 ± 77.9 cm. Most defects had exposed structures (85%), and all defects were Centers for Disease Control and Prevention grade 2 or higher. Mean time to 100% granulation tissue formation was 23.4 ± 9.2 days, with a median product application of 1.0. Staged reconstruction was used in 7 of 13 defects, with the remainder (6 of 13) left to heal via secondary intention using standard wound care protocols. There were no major postoperative infections or adverse events (mean follow-up, 7.4 ± 2.4 weeks.). CONCLUSIONS: This retrospective pilot case series builds on a growing body of evidence that OFM can be utilized to facilitate the formation of functional, well-vascularized soft tissue in large contaminated volumetric soft tissue defects.

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Vascularized Sural Nerve Graft, Fascial Free Flap, and Regenerative Peripheral Nerve Interface in the Setting of Recurrent Thigh Liposarcoma: A Case Report.

Koenig ZA, Blanks W, Williams HJ … +1 more , Gelman JJ

Eplasty · 2023 · PMID 38045100

BACKGROUND: There is no clear consensus in the literature regarding clinical indications for vascularized nerve grafts. Most studies indicate that vascularized nerve grafting, rather than non-vascularized nerve grafting,... BACKGROUND: There is no clear consensus in the literature regarding clinical indications for vascularized nerve grafts. Most studies indicate that vascularized nerve grafting, rather than non-vascularized nerve grafting, is indicated for nerve gaps of greater than 7 cm. Vascularized nerve grafts are superior to non-vascularized nerve grafts because they possess an independent blood supply. However, not all nerve injuries can be repaired via vascularized nerve grafts. METHODS: A 32-year-old female received a fascial free flap and vascularized sural nerve graft after having multiple reresections of a recurrent thigh liposarcoma. RESULTS: A 25-cm segment of the sural nerve was isolated alongside the lesser saphenous vein and intervening fascia. The free fascial flap was subsequently reversed and placed into the thigh. Vascular anastomoses were created, and the sural nerve was anastomosed to the peroneal nerve. A small portion of muscle from the thigh was wrapped around tibial nerve fascicles of the sciatic nerve to create a regenerative nerve interface. CONCLUSIONS: Benefits of vascularized sural nerve graft compared with other vascularized nerve grafts include negligible sensory loss at the donor site and a nerve graft that can be designed on itself due to its vast length. Additionally, vascularized sural nerve grafts provided a better rate of axonal regeneration, rate of electromyographic return, and motor and sensory outcome compared with non-vascularized sural nerve grafts.

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Diversity of Leadership and Its Influence on Diversity of Integrated Plastic Surgery Residency Cohorts: A Study in the Virtual Era.

Benaroch D, Oleru OO, Dietz H … +3 more , Gyasi A, Seyidova N, Yao AS

Eplasty · 2023 · PMID 38045099

BACKGROUND: In the aftermath of COVID-19, the residency application process has largely remained in the virtual space, introducing a new challenge to prospective integrated plastic surgery residents. Many programs enhanc... BACKGROUND: In the aftermath of COVID-19, the residency application process has largely remained in the virtual space, introducing a new challenge to prospective integrated plastic surgery residents. Many programs enhanced their online presence to address this challenge, but both programs and applicants are still limited to a virtual snapshot when determining "fit." An important influence of fit is the ability to racially, ethnically, and/or culturally identify with the program. The aims of this study are to: (1) better understand the online information that residency programs are making available to prospective applicants, (2) characterize the racial diversity of programs, and (3) investigate the effect of program leadership on racial diversity. METHODS: A cross-sectional study of US integrated plastic surgery residency programs was performed in August 2022. Data on race were collected for residency program directors and resident cohorts and compared with self-reported data from the Association of American Medical Colleges (AAMC). Relationships between these groups were analyzed. RESULTS: Racial data were collected on 82 program directors and their corresponding residency cohorts, representing a total of 1174 individuals. These data closely matched the AAMC data on race/ethnicity in plastic surgery programs. By race, the smallest percentage of resident groups are Black/African American (3.4%) and Hispanic (4.2%). Though not statistically significant, more residents of a given race are in programs with a director of the same race. CONCLUSIONS: Online information about residency programs and their cohorts is robust. The racial diversity of a residency cohort is positively associated with racial diversity of program directors.

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Biomechanical Evaluation of Additional Surgical Maneuvers to Improve Symmetry in Performing Nuss Procedure for Asymmetric Pectus Excavatum.

Nagasao T, Miyanagi T, Wu L … +3 more , Akaike M, Hosokawa A, Sakamoto Y

Eplasty · 2023 · PMID 38045098

BACKGROUND: Severing part of the thorax prior to bar placement is effective to improve outcomes in performing the Nuss procedure for asymmetric pectus excavatum. This study aims to elucidate the patterns of severing to p... BACKGROUND: Severing part of the thorax prior to bar placement is effective to improve outcomes in performing the Nuss procedure for asymmetric pectus excavatum. This study aims to elucidate the patterns of severing to provide an ideal outcome. METHODS: Three-dimensional biomechanical computer models were produced simulating the thoraxes of 10 actual patients with asymmetric pectus excavatum. Virtual surgical operation was performed on the 10 models in 4 patterns: group 1-no part of the thorax was severed (default group). Group 2-The sternum was severed (sternum-severing group). Group 3-The ribs on the affected side were severed (rib-severing group). Group 4-Both the sternum and ribs on the affected side were severed (sternum/rib-severing group). After performing this preparation, simulation of bar placement was performed. Comparing the pre- and postoperative shapes of the models, we examined whether symmetry improved for each group. RESULTS: Symmetry of the chest wall improved for rib-severing group and sternum/rib-severing group. Asymmetry remained for default group and sternum-severing group. CONCLUSIONS: Performance of the Nuss procedure for asymmetric pectus excavatum does not greatly improve symmetry of the chest wall. Severing the ribs as an additional maneuver is effective to improve symmetry.

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Call the Bomb Squad: An Interesting Case of a Retained Explosive in the Mouth.

Barrow BE, Kachare MD, Kachare SD … +2 more , Alur AA, Little J

Eplasty · 2023 · PMID 37799323

Abstract loading — click title to view on PubMed.

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Satisfaction With Head and Neck Scar Appearance in Latin American Patients: A Cross-Sectional Study.

Restrepo S, Rojas S, Sanabria A

Eplasty · 2023 · PMID 37743968

BACKGROUND: Surgical scars have been related to poor quality of life, and this is important for head and neck scars. There is a paucity of data about the effect of scars on appearance in Latin American patients. The obje... BACKGROUND: Surgical scars have been related to poor quality of life, and this is important for head and neck scars. There is a paucity of data about the effect of scars on appearance in Latin American patients. The objective of this study was to describe the self-assessment of patient scars using the Patient Scar Assessment Questionnaire (PSAQ). METHODS: This is a cross-sectional study. The validated Spanish version of the PSAQ was used. Adult patients who underwent elective head and neck surgery were included. Demographic and clinical data were obtained from clinical charts. Univariate and multivariate analysis using a forward logistic regression was planned to assess the weight of specific subscale items on the overall subscale score for appearance and satisfaction with appearance. RESULTS: 180 patients were recruited. A total of 144 (80%) patients were female, and the most frequent type of surgery was thyroidectomy. The global appearance, the global scar consciousness and the global scar appearance satisfaction was classified as excellent/good in 72.2%, 93.9% and 87.8% of patients, respectively. The multivariate analysis showed that color (OR 5.9, 95% CI 1.7-20.8), width (OR 58.9, [4.3-807.6]), and flatness (OR 5.7, [1.3-23.6]) were the items statistically associated with a regular/bad result in the appearance subscale. CONCLUSIONS: There is a high level of satisfaction with head and neck scar appearance, and these data should be used to assess the impact of surgical interventions on cosmesis. The intrinsic characteristics of scars are the most relevant for defining scar satisfaction.

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Characteristics and Complication Rates of Mandibular Fractures Caused by Violent Mechanisms Versus Nonviolent Mechanisms.

Schwartz A, Park J, Durham D … +4 more , West W, Su R, Wainwright D, Troy J

Eplasty · 2023 · PMID 37743967

BACKGROUND: Mandibular fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of mandibular fractures a... BACKGROUND: Mandibular fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of mandibular fractures and their outcomes. METHODS: In this institutional review board-approved, retrospective study, we examined our institution's records for adult patients >18 years of age who presented with ≥ 1 mandibular fractures from January 2011 to January 2022. Violence was defined as trauma intended to hurt another or self. Demographics, fractures, mechanism, concomitant injuries, treatment, and complications were analyzed with Excel and SPSS statistical software. RESULTS: A total of 692 patients were diagnosed with mandibular fractures, with 323 of these due to violence (47%). These patients of violence (POVs) had an average fracture per patient of 1.6 ± 0.7. The majority (88%) were male and African American (33%), and the average age was 34.3 ± 13.2 years. The most common violent mechanism was a punch (68%). The POVs presented with fewer concomitant injuries, were less likely to be admitted to the intensive care unit, and were more often surgically managed with open reduction than were patients of nonviolence (PONVs) < .01). POVs were more likely to have healing complications; though not statistically significant, this population was observed to be frequently lost to follow-up ( = .12). POVs notably had a much higher proportion of hardware exposure among complications than was seen in PONVs (23% vs 9%). CONCLUSIONS: Patients with violent fracture mechanisms may tend to be predisposed to more complications compared with patients who have nonviolent fracture mechanisms despite lesser severities due to social determinants of health. Characteristics of this patient subset may tend to cause difficulties in postoperative care and follow-up. Effective discharge instruction communication, patient outreach programs, and homelessness and drug abuse screening in this subset may help reduce healing complications.

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Use of a Novel Adhesive Suture Retention Device in Non-traumatic Diabetic Lower Extremity Amputations: A Multicenter Case Review.

Cole W, Butto DN, Sipala DA … +4 more , Haniuk EE, Kadakia AR, McKanna A, Karwal A

Eplasty · 2023 · PMID 37743966

BACKGROUND: Amputations in the diabetic foot are commonly associated with complications, including delayed wound healing, surgical site dehiscence, and the need for additional amputations. Use of a novel adhesive suture... BACKGROUND: Amputations in the diabetic foot are commonly associated with complications, including delayed wound healing, surgical site dehiscence, and the need for additional amputations. Use of a novel adhesive suture retention device (ASRD) has been previously shown to support improved linear closure outcomes. The purpose of this retrospective case review was to determine if the adoption of the ASRD in 5 podiatric surgical practices would reduce postoperative complications in patients with diabetes undergoing foot amputations including surgical site dehiscence and the need for additional amputation. METHODS: A 5-center retrospective chart review was performed to assess the difference in postoperative surgical site dehiscence and reamputation rates for patients with diabetes undergoing minor and major lower extremity amputations before and after adopting the use of the ARSD. RESULTS: Adoption of the adhesive retention suture device was associated with an overall decrease in wound dehiscence of 81% ( < .01). Additionally, there was an 89% reduction in progression to higher level amputation in the ARSD cohort ( = .015). CONCLUSIONS: Utilization of the ARSD decreased the incidence of postoperative wound dehiscence and reamputation in this patient cohort, thus lessening patient morbidity and decreasing the overall cost of care.

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Buccal Fat Pad Herniation, Repositioning Versus Excision: A New Algorithm of Treatment.

Cuartero-Castro G, Márquez EA, Robledo P … +1 more , Vélez-Palafox M

Eplasty · 2023 · PMID 37743965

BACKGROUND: Traumatic herniation of the buccal fat pad can be treated with repositioning or excision. This report describes a case of a child with traumatic herniation of the buccal fat pad treated with excision. A compr... BACKGROUND: Traumatic herniation of the buccal fat pad can be treated with repositioning or excision. This report describes a case of a child with traumatic herniation of the buccal fat pad treated with excision. A comprehensive review of the literature was performed with the objective of establishing treatment criteria for the decision-making involved in choosing between repositioning versus excision. METHODS: A systematic review of the literature was performed through searches of PubMed, Ovid, Elsevier, Cochrane, ResearchGate and Google Scholar for reports published from 1968 through May 2021. The search keywords used were and We included only those studies that included patients with intraoral buccal fat pad herniation. RESULTS: We found and included 39 articles (44 patients). Time since trauma, size of the fat pad herniated, and presence of necrosis were the most important characteristics considered for treatment decision; on the basis of these factors, we created a treatment algorithm. We present a case report of a 2-year-old boy diagnosed with traumatic herniation of buccal fat pad and, according to our algorithm, the appropriate treatment was to perform excision. A follow-up examination at 11 months showed no complications. CONCLUSIONS: Because traumatic herniation of buccal fat pad is very rare, this algorithm can be an easy and effective tool to guide decision-making when choosing between repositioning versus excision.

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Negative Pressure Wound Therapy With Instillation and Dwell Time: Mechanisms of Action Literature Review.

Silverman RP

Eplasty · 2023 · PMID 37743964

BACKGROUND: Negative pressure wound therapy (NPWT) is commonly used in wound management of both acute and chronic wounds. As wound care has advanced, traditional NPWT has evolved to include instillation and dwell time (N... BACKGROUND: Negative pressure wound therapy (NPWT) is commonly used in wound management of both acute and chronic wounds. As wound care has advanced, traditional NPWT has evolved to include instillation and dwell time (NPWTi-d). To better understand the potential clinical benefits of NPWTi-d, an assessment of the available literature focusing on NPWTi-d mechanisms of action in wound management was conducted. Methods. A literature search was performed for abstracts and articles published between 2010 and 2023. Published studies in English that discussed NPWTi-d mechanisms of action and included a study population larger than 10 patients were examined. RESULTS: A total of 1878 articles were identified through the literature search. After removal of duplicates and article reviews, 29 studies discussing the mechanisms of action for NPWTi-d were found. Study types included case series (n = 20), comparative study (n = 6), randomized controlled trial (n = 2), and retrospective study (n = 1). These studies included approximately 1108 patients who received NPWTi-d as part of a wound care treatment plan. NPWTi-d use was associated with improved wound and clinical outcomes through wound cleansing, removal of exudate and infectious materials, and promotion of granulation tissue development. CONCLUSIONS: The mechanisms of action for NPWTi-d helps provide wound management through wound cleansing, removal of exudate and infectious materials, and promoting the development of granulation tissue. Additional studies are warranted to fully assess the potential clinical and health economic benefits of NPWTi-d use.

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Don't Play It by Ear: Technical Considerations to Optimize Outcome and Procedural Safety of Congenital Microtia Reconstruction in a Dextrocardia Patient With Situs Inversus Totalis, Butterfly Vertebra, and Hemivertebra.

Saha S, Singh A, Mohammad A … +3 more , Chauhan S, Chinta K, Singhal M

Eplasty · 2023 · PMID 37743963

BACKGROUND: Microtia can occur as a standalone condition or as part of a genetic syndrome. We report the first case of microtia presenting in a patient with dextrocardia, situs inversus totalis, butterfly vertebra, and h... BACKGROUND: Microtia can occur as a standalone condition or as part of a genetic syndrome. We report the first case of microtia presenting in a patient with dextrocardia, situs inversus totalis, butterfly vertebra, and hemivertebra, and we present technical recommendations for optimizing anaesthetic and surgical harmony in this extraordinary case.Patients with situs inversus dextrocardia should be checked for signs of Kartagener syndrome. Dextrocardia requires mirroring the placement of electrocardiogram (ECG) leads and the use of shocking paddles for cardiopulmonary resuscitation. Central venous access should be performed under ultrasound guidance because of varied course. Cervical vertebral deformities necessitate a thorough airway assessment since neck mobility may be limited due to pain or aberrant curvature. CONCLUSIONS: In this case, Brent's approach was used to treat the microtia, but rib cartilage was harvested from the ipsilateral side to lessen the chance of damaging the pericardium due to unfamiliar anatomy. These factors must be taken into account to perform a safe surgery on such patients.

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Firecracker Powder: A Unique Source of Burn Injuries.

Gupta D, Bhatia C, Vignesh S … +1 more , Sarabahi S

Eplasty · 2023 · PMID 37743962

Firecrackers are a common cause of burns in India; large-scale use of firecrackers is seen during the festival of Diwali, and patients of all age groups present with varying patterns of firecracker burns. With the recent... Firecrackers are a common cause of burns in India; large-scale use of firecrackers is seen during the festival of Diwali, and patients of all age groups present with varying patterns of firecracker burns. With the recent ban of firecrackers in some parts of the country, we have noticed a new emerging cause of burns during Diwali where patients were attempting to prepare firecrackers at home using (sulfur) and potash by mixing the materials in a pipe gun. Explosion of this powder leads to varying degree of burns, and this series reports 12 such cases who presented to a tertiary care burn unit in North India during the 2022 festival of Diwali.

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Preliminary Study of Wound Oxygenation Comparing Skin Substitutes and Dressings.

Woodroof A, Moote J, Polansky J … +2 more , Haith LR, Hickerson WL

Eplasty · 2023 · PMID 37743961

BACKGROUND: Improving oxygen delivery to challenging wound types has been shown to optimize and accelerate several key contributors to healing. This study aims to compare selective skin substitutes and primary dressings... BACKGROUND: Improving oxygen delivery to challenging wound types has been shown to optimize and accelerate several key contributors to healing. This study aims to compare selective skin substitutes and primary dressings and evaluate their ability to transfer oxygen to the wound. METHODS: Visual and quantitative methods were employed to measure gas and fluid movement across several skin substitutes, including a bilayer nylon and silicone dressing coated with porcine gelatin and aloe vera (CNS), a porous bovine collagen-glycosaminoglycan (GAG) matrix dressing coated with silicone (UBC), and a urethane biodegradable temporizing matrix (PFD). RESULTS: Fluids did not move across solid silicone membranes or urethane foam while oxygen movement across solid silicone membranes was inversely proportional to the thickness of the membrane. Oxygen moved across the coated nylon and silicone dressing 5.63 times faster than across the bovine-GAG scaffold and 2.0 times faster than the biodegradable temporizing matrix of polyurethane. CONCLUSIONS: The coated nylon and silicone matrix functioned like a membrane oxygenator, potentially augmenting atmospheric oxygen delivery to healing wounds.

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Half-Dose tPA for Massive Pulmonary Thromboembolism After Liposuction.

Colkesen Y, Bektas CI

Eplasty · 2023 · PMID 37743960

BACKGROUND: The most aggressive preventive strategies may fail to prevent pulmonary embolism (PE) after liposuction. PE can cause serious life-threatening consequences and death. If hemodynamic detoriation occurs, treatm... BACKGROUND: The most aggressive preventive strategies may fail to prevent pulmonary embolism (PE) after liposuction. PE can cause serious life-threatening consequences and death. If hemodynamic detoriation occurs, treatment is systemic or catheter-directed fibrinolytic therapy and, if failed, surgical embolectomy. A latent risk exists for catastrophic hemorrhage when thrombolytic is administered after surgery. Thus, the use of tissue plasminogen activator (tPA) has never been studied in postoperative patients, and the safety of this medicine is unknown. In this case study, a 31-year-old obese woman was evaluated for complaints of shortness of breath, palpitations, and hypotension in the first postoperative day after liposuction. CONCLUSIONS: Successful management of massive PE with a half-dose regimen of tPA (alteplase 50 mg over 2 hours) is reported.

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Lower Extremity Microsurgery in a Patient With Combined Sickle Cell Disease and Hemophilia: A Case Report and Literature Review.

Garbuzov AE, Katira K, Sugalski C … +1 more , Mautner J

Eplasty · 2023 · PMID 37743959

The combination of hemophilia and sickle cell disease poses unique challenges in the perioperative management of patients requiring free tissue transfer (FTT). Extremity FTT requires mitigation of risk factors related to... The combination of hemophilia and sickle cell disease poses unique challenges in the perioperative management of patients requiring free tissue transfer (FTT). Extremity FTT requires mitigation of risk factors related to perioperative bleeding and microvascular thrombosis. This case report highlights the nuances of managing an open ankle fracture in a patient with both sickle cell trait and severe hemophilia A. The narrative and discussion highlights the importance of a multidisciplinary team with regard to executing a limb salvage plan in the setting of complex medical decision-making.

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Correction to: Closed Incision Negative Pressure Therapy Versus Standard of Care Over Closed Plastic Surgery Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-Analysis of Comparative Studies.

Eplasty · 2023 · PMID 37674972

[This corrects the article e22 in vol. 23, PMID: 37187870.]. [This corrects the article e22 in vol. 23, PMID: 37187870.].

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Eplasty [JOURNAL]

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