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Pintore A, Astone A, Vecchio G, Asparago G, Calabrò G, Migliorini F, Maffulli N. Percutaneous transverse pinning for metacarpal fractures: a clinical trial. Arch Orthop Trauma Surg 2024; 144:3129-3136. [PMID: 38965077 PMCID: PMC11319403 DOI: 10.1007/s00402-024-05422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. METHODS Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. RESULTS The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. CONCLUSION Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Andrea Pintore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Alberto Astone
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giampiero Calabrò
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke On Trent, England, UK.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, England, E1 4DG, UK.
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy.
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202
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Gabhane SS, Pande MS, Thosar NR, Yeluri R, Khubchandani M, Pankey N. Prosthetic Management of Congenital Palatal Defect in a Neonate: A Case Report on Obturator Efficacy. Cureus 2024; 16:e63708. [PMID: 39099894 PMCID: PMC11294489 DOI: 10.7759/cureus.63708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
Neonates with cleft palate exhibit a malformed maxillary arch since birth. Newborns with various types of clefts exhibit multiple issues, primarily associated with their feeding habits. Feeding these children is crucial, as evidence indicates that newborns with this congenital deformity exhibit a slower growth rate compared to those without this condition. To mitigate these challenges, the conventional line of treatment for these children is obturator therapy to facilitate sucking or feeding followed by various surgical procedures. The following case report describes a 2-day-old girl, who reported with her parents to the Department of Pediatric Dentistry, to seek treatment for congenital cleft present in her palate as it was interfering with her feeding habits. A feeding appliance was made with a direct technique to help the parents improve feeding habits. It also regulates milk flow by sealing the area separating the oral and nasal cavities. This feeding appliance is placed over the child's hard palate, creating a contact point that facilitates milk expression from the mother's mammary gland and making it easier for the neonate to compress the nipple. It shortens the time needed for feeding, eases feeding, and lessens nasal regurgitation.
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Affiliation(s)
- Swamini S Gabhane
- Pediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Meenal S Pande
- Pediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nilima R Thosar
- Pediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ramakrishna Yeluri
- Pediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Monika Khubchandani
- Pediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Pankey
- Pediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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203
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Vinchhi P, Wui WT, Patel MM. Healing with herbs: an alliance with 'nano' for wound management. Expert Opin Drug Deliv 2024; 21:1115-1141. [PMID: 39095934 DOI: 10.1080/17425247.2024.2388214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Wound healing is an intricate and continual process influenced by numerous factors that necessitate suitable environments to attain healing. The natural ability of wound healing often gets altered by several external and intrinsic factors, leading to chronic wound occurrence. Numerous wound dressings have been developed; however, the currently available alternatives fail to coalesce in all conditions obligatory for rapid skin regeneration. AREA COVERED An extensive review of articles on herbal nano-composite wound dressings was conducted using PubMed, Scopus, and Google Scholar databases, from 2006 to 2024. This review entails the pathophysiology and factors leading to non-healing wounds, wound dressing types, the role of herbal bio-actives for wound healing, and the advantages of employing nanotechnology to deliver herbal actives. Numerous nano-composite wound dressings incorporated with phytoconstituents, herbal extracts, and essential oils are discussed. EXPERT OPINION There is a strong substantiation that several herbal bio-actives possess anti-inflammatory, antimicrobial, antioxidant, analgesic, and angiogenesis promoter activities that accelerate the wound healing process. Nanotechnology is a promising strategy to deliver herbal bio-actives as it ascertains their controlled release, enhances bioavailability, improves permeability to underlying skin layers, and promotes wound healing. A combination of herbal actives and nano-based dressings offers a novel arena for wound management.
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Affiliation(s)
| | - Wong Tin Wui
- Non-Destructive Biomedical and Pharmaceutical Research Centre, Smart Manufacturing Research Institute, Universiti Teknologi MARA Selangor, Puncak Alam, Malaysia
| | - Mayur M Patel
- Institute of Pharmacy, Nirma University, Ahmedabad, India
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204
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Garneau JC, Rezaee R. Reverse flow anterolateral thigh free flap in a case with significant atherosclerosis: A viable alternative for arterial microvascular anastomosis. Head Neck 2024; 46:E71-E74. [PMID: 38606699 DOI: 10.1002/hed.27770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The concept of reserve flow perfusion for free flap reconstruction has been demonstrated in various applications in the literature. As it relates to the anterolateral thigh (ALT) free flap, the reserve flow principle has been primarily described to either augment or "supercharge" a large ALT to optimize skin perforator supply or lengthen the vascular pedicle. METHODS We report a case of a 77-year old male with chronic renal failure who had extensive atherosclerosis of the proximal descending lateral circumflex femoral artery (LCFA) where arterial anastomosis was unable to be performed. RESULTS We were able to circumvent this limitation by establishing reserve flow perfusion solely through the distal end of the descending LCFA. We describe our technique within the context of current literature on the topic of reverse flow perfusion in free flap reconstruction. CONCLUSION This report uniquely describes applying the distally based, reverse arterial flow principle in an ALT flap to circumvent an atherosclerotic proximal pedicle.
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Affiliation(s)
- Jonathan C Garneau
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Rod Rezaee
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals of Cleveland, Cleveland, Ohio, USA
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205
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Belza CC, Sheahan L, Becker M, Gosman AA. Geospatial and Socioeconomic Disparities Influencing the Management and Outcomes of Nonsyndromic Craniosynostosis: A Systematic Review. J Craniofac Surg 2024; 35:1334-1337. [PMID: 39042067 DOI: 10.1097/scs.0000000000010162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/19/2024] [Indexed: 07/24/2024] Open
Abstract
Geospatial and socioeconomic health disparities are potential barriers to timely diagnosis and treatment of nonsyndromic craniosynostosis. This systematic review aims to assess published literature describing disparities in craniosynostosis care and to summarize the findings surrounding patient proximity to care centers and familial socioeconomic status as predictors of surgical management and outcomes. The data sources used include PubMed, MEDLINE, and Google Scholar. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for appraisal of the quality of the studies included. Generally, the literature reviewed suggested that socioeconomic variables including race, insurance payor, and median zip code income quartile are predictors of suboptimal craniosynostosis surgical management outcomes including older age at time of surgery and more invasive surgical approach performed. The only geospatial data element assessed was the general region of the hospital where the patient was treated. The review highlighted various knowledge gaps within published literature describing health-related disparities in patients with craniosynostosis. There is a paucity of research assessing geospatial access to craniosynostosis care centers, suggesting that further research should be performed to evaluate this potential disparity. In addition, previous studies lack granularity when assessing socioeconomic factors and only one study accounted for suture fused, which is a potential confounding variable across the other published work. These considerations should be addressed in future studies addressing this topic. The limitations of this review include potential publication bias given that unpublished work was not included. An element of reviewer bias also exists considering only one reviewer screened the articles and extracted the data.
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Affiliation(s)
| | - Lucy Sheahan
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA
| | | | - Amanda A Gosman
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA
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206
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Tettelbach WH, Kelso MR, Armstrong DG. A review of the proposed draft CAMPs LCDs compared to evidence-based medicine: a letter to the MACs for consideration. J Wound Care 2024; 33:S16-S23. [PMID: 38973641 DOI: 10.12968/jowc.2024.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- William H Tettelbach
- RestorixHealth, Metairie, LA, US
- American Professional Wound Care Association, Lafayette, LA, US
- Duke University School of Medicine, Durham, NC, US
- Western University of Health Sciences - College of Podiatric Medicine, Pomona, CA, US
| | | | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), US
- Keck School of Medicine, University of Southern California, Department of Surgery, US
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207
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Brahma B, Yamamoto T, Panigoro SS, Haryono SJ, Yusuf PA, Priambodo PS, Harimurti K, Taher A. Supermicrosurgery lymphaticovenous and lymphaticolymphatic anastomosis: Technical detail and short-term follow-up for immediate lymphatic reconstruction in breast cancer treatment-related lymphedema prevention. J Vasc Surg Venous Lymphat Disord 2024; 12:101863. [PMID: 38428499 DOI: 10.1016/j.jvsv.2024.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE We describe the feasibility and short-term outcome of our surgical technique to repair the lymph vessel disruption directly after axillary lymph node dissection during breast cancer surgery. This procedure is called immediate lymphatic reconstruction to prevent breast cancer treatment-related lymphedema (BCRL), which frequently occurs after axillary lymph node dissection. The surgical technique consisted of lymphaticovenous anastomosis (LVA) or lymphaticolymphatic anastomosis. We named the procedure lymphatic bypass supermicrosurgery (LBS). METHODS This study used a retrospective cohort design of patients with breast cancer between May 2020 and February 2023. LBS was performed by making an intima-to-intima coaptation between afferent lymph vessels and the recipient's veins (LVA) or efferent lymph vessels lymphaticolymphatic anastomosis. RESULTS A total of 82 patients underwent lymphatic bypass. The mean age of patients was 50 ± 12 years, and most had stage III breast cancer (n = 59 [72%]). LVA was the most common type of lymphatic bypass (94.6%). The median number of LVA was 1 (range, 1-4) and 1 (range, 1-3) for lymphaticolymphatic anastomosis. The median follow-up time was 12.5 months (range, 1-33 months). The 50 patients who had postoperative indocyanine green lymphography described arm dermal backflow stage 0 in 20 (40%), stage 1 in 19 (38%), stage 2 in 2 (4%), and stage 3 in 9 (18%) cases. The proportion of BCRL was 11 (22%), and subclinical lymphedema was 19 (38%) in this period. Most cases were in stable subclinical lymphedema (10, 58.8%). The 1-year and 2-year BCRL rates were 14% (95% confidence interval, 4%-23.9%) and 22% (95% confidence interval, 10.1%-33.9%), respectively. CONCLUSIONS Along with the emerging immediate lymphatic reconstruction, LBS is a feasible supermicrosurgery technique that may have a potential role in BCRL prevention. A randomized controlled study would confirm the effectiveness of the technique.
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Affiliation(s)
- Bayu Brahma
- Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Sonar Soni Panigoro
- Oncology Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Samuel Johny Haryono
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Prasandhya Astagiri Yusuf
- Department of Medical Physiology and Biophysics/Medical Technology IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Purnomo Sidi Priambodo
- Department of Electrical Engineering, Faculty of Engineering, Universitas Indonesia, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Division of Geriatrics/Clinical Epidemiological Unit, Department of Internal Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Akmal Taher
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Swanepoel HF, Matthews HS, Claes P, Vandermeulen D, Oettlé AC. A statistical shape model for estimating missing soft tissues of the face in a black South African population. J Prosthodont 2024; 33:565-573. [PMID: 37589169 DOI: 10.1111/jopr.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/30/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Facial disfigurement may affect the quality of life of many patients. Facial prostheses are often used as an adjuvant to surgical intervention and may sometimes be the only viable treatment option. Traditional methods for designing soft-tissue facial prostheses are time-consuming and subjective, while existing digital techniques are based on mirroring of contralateral features of the patient, or the use of existing feature templates/models that may not be readily available. We aim to support the objective and semi-automated design of facial prostheses with primary application to midline or bilateral defect restoration where no contralateral features are present. Specifically, we developed and validated a statistical shape model (SSM) for estimating the shape of missing facial soft tissue segments, from any intact parts of the face. MATERIALS AND METHODS An SSM of 3D facial variations was built from meshes extracted from computed tomography and cone beam computed tomography images of a black South African sample (n = 235) without facial disfigurement. Various types of facial defects were simulated, and the missing parts were estimated automatically by a weighted fit of each mesh to the SSM. The estimated regions were compared to the original regions using color maps and root-mean-square (RMS) distances. RESULTS Root mean square errors (RMSE) for defect estimations of one orbit, partial nose, cheek, and lip were all below 1.71 mm. Errors for the full nose, bi-orbital defects, as well as small and large composite defects were between 2.10 and 2.58 mm. Statistically significant associations of age and type of defect with RMSE were observed, but not with sex or imaging modality. CONCLUSION This method can support the objective and semi-automated design of facial prostheses, specifically for defects in the midline, crossing the midline or bilateral defects, by facilitating time-consuming and skill-dependent aspects of prosthesis design.
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Affiliation(s)
| | - Harold S Matthews
- Laboratory for Imaging Genetics, Department of Human Genetics, Katholieke Universiteit, Leuven, Belgium
- Medical Imaging Research Center, Universitair Ziekenhuis, Leuven, Belgium
- Facial Sciences, Murdoch Children's Research Institute, Parkville, Australia
| | - Peter Claes
- Laboratory for Imaging Genetics, Department of Human Genetics, Katholieke Universiteit, Leuven, Belgium
- Medical Imaging Research Center, Universitair Ziekenhuis, Leuven, Belgium
- Facial Sciences, Murdoch Children's Research Institute, Parkville, Australia
- Department of Electrical Engineering, Katholieke Universiteit, Leuven, Belgium
| | - Dirk Vandermeulen
- Medical Imaging Research Center, Universitair Ziekenhuis, Leuven, Belgium
- Department of Electrical Engineering, Katholieke Universiteit, Leuven, Belgium
| | - Anna C Oettlé
- Department of Anatomy, University of Pretoria, Pretoria, South Africa
- Anatomy and Histology Department, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Kanjoor JR, Khan TM. Chest Feminization in Transwomen with Subfascial Breast Augmentation-Our Technique and Results. Aesthetic Plast Surg 2024; 48:2447-2458. [PMID: 37945759 DOI: 10.1007/s00266-023-03726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The increasing population of this minority community is approaching plastic surgeons more frequently to achieve their dream of becoming a phenotypic female, the breast being the single sure identity. After undergoing the bottom surgery (SRS) which is essential for them to gain entry into the transgender community, very few take up hormone therapy; the rest approach plastic surgeons for chest feminization which includes breast augmentation. METHODS A total of 177 transgenders underwent subfascial breast augmentation between 2014 and 2023. They were followed up for 10 years. Their demographics were documented. Operative details and postoperative complications were analyzed. Patient-related outcome measures were performed for size, appearance and cleavage. RESULTS A well-performed surgery in our cohort had a good aesthetic outcome even after many years. Only three patients were dissatisfied with the size; revision surgeries of 12 patients done elsewhere had many complications like wound dehiscence and exposure, scar hypertrophy, low placed axillary scars, capsular contracture, asymmetry, and nonspecific pain. All of them had submuscular placement. CONCLUSIONS The subfascial placement of implants in transwomen had good aesthetic outcomes with fewer complications and good acceptance. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Aldaghi N, kamalabadi-Farahani M, Alizadeh M, Alizadeh A, Salehi M. Enhancing pressure ulcer healing and tissue regeneration by using N-acetyl-cysteine loaded carboxymethyl cellulose/gelatin/sodium alginate hydrogel. Biomed Eng Lett 2024; 14:833-845. [PMID: 38946815 PMCID: PMC11208367 DOI: 10.1007/s13534-024-00378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/27/2024] [Accepted: 03/31/2024] [Indexed: 07/02/2024] Open
Abstract
Prolonged pressure on the skin can result in pressure ulcers, which may lead to serious complications, such as infection and tissue damage. In this study, we evaluated the effect of a carboxymethyl cellulose/gelatin/sodium alginate (CMC/Gel/Alg) hydrogel containing N-acetyl-cysteine (NAC) on the healing of pressure ulcers. Pressure ulcers were induced by applying a magnet to the dorsum of rat skin. The wounds were then treated with sterile gauze, ChitoHeal Gel®, and CMC/Gel/Alg hydrogel dressings with or without NAC for the other groups. We evaluated the morphology, weight loss, swelling, rheology, blood compatibility, cytocompatibility, antioxidant capacity, and wound scratch of the prepared hydrogel. MTT assay revealed that the optimum concentration of NAC was 5 mg/ml, which induced higher cell proliferation and viability. Results of the histopathological evaluation showed increased wound closure, and complete re-epithelialization in the hydrogel-containing NAC group compared to the other groups. The CMC/Gel/Alg/5 mg/ml NAC hydrogel dressing showed 84% wound closure at 14 days after treatment. Immunohistochemical results showed a decrease in the level of TNF-α on day 14 compared day 7. Results of the qPCR assay revealed that NAC hydrogel increased the expression of Collagen type I and TGF-β1 and decreased MMP2 and MMP9 mRNA on the 14th day. The results suggest that the CMC/Gel/Alg/5 mg/ml NAC hydrogel with antioxidant properties is an appropriate dressing for wound healing.
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Affiliation(s)
- Niloofar Aldaghi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Morteza Alizadeh
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Akram Alizadeh
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Tissue Engineering and Applied Cell Sciences, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
- Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
- Health Technology Incubator Center, Shahroud University of Medical Sciences, Shahroud, Iran
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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211
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Farsi S, Held M, Brannon M, Eckard P, King D, Vural E, Sunde J, Moreno M. The Microvascular Anastomotic Coupler for Venous Anastomosis in Head and Neck Reconstruction: An Institutional Experience. Cureus 2024; 16:e64467. [PMID: 39135832 PMCID: PMC11318639 DOI: 10.7759/cureus.64467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 08/15/2024] Open
Abstract
Background This study aimed to identify outcome predictors with the GEM microvascular coupler system (GEM Coupler) in a series of patients undergoing free flap reconstruction for head and neck defects. Methodology In this retrospective chart review of 218 consecutive microvascular procedures performed on 204 patients at an academic tertiary care center, demographics, comorbidities, surgical data, and outcomes were retrieved. The endpoints for the analysis were microvascular revision surgery and flap survival. Results The study included 142 (70.2%) males and 62 (29.8%) females, with a mean age of 56 years, primarily treated for malignancy (76%). The anterolateral thigh and fibula were the most commonly used flaps (40.4% and 27.1%, respectively). In 21 (9.6%) cases, a double venous anastomosis was performed. There were nine flap failures requiring microvascular revision surgery; the flap was salvaged in four of these cases yielding an overall success rate of 97.7%. Factors associated with total flap loss included a history of a thrombotic or embolic event (p = 0.017), deep circumflex iliac artery flap (p < 0.001), and absence of monitoring skin paddle (p < 0.001). Conclusions Prothrombotic conditions, buried flaps, and flap type are outcome predictors in patients undergoing microvascular reconstruction with GEM Coupler.
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Affiliation(s)
- Soroush Farsi
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Michael Held
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Madalyn Brannon
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Peter Eckard
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Deanne King
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Emre Vural
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jumin Sunde
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Mauricio Moreno
- Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
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Zaccardelli A, Harb JL, Papathanasiou E, Scott AR. Presentation, Management, and Outcomes of Pathologic Scars Within a Pediatric Otolaryngology Practice. Laryngoscope 2024; 134:3127-3135. [PMID: 38308543 PMCID: PMC11182727 DOI: 10.1002/lary.31320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES This study aims to review the spectrum of scarring that may present to an urban, pediatric otolaryngology practice and determine if associations exist between race, scar location, treatment modality, and outcomes following interventions for scarring. METHODS Retrospective cohort study among 115 pediatric patients with 138 unique keloids or hypertrophic scars (HTS), and 141 children presenting for tonsillectomy at Tufts Medical Center. Age at presentation and sex assigned at birth were collected for both populations. For those presenting for pathologic scars, income quintile, self-identified race/ethnicity, anatomical location, treatment number and type, and clinical outcome were also analyzed. Multivariate analyses calculated adjusted odds ratios (aORs) and 95% confidence intervals to assess associations between scar subsite, intervention type, and persistence after treatment. RESULTS Compared to individuals presenting for tonsillectomy, a disproportionate percentage of patients presenting for scarring identified as Black (26.6% vs. 13.5%) or Asian (17.4% vs. 7.1%, p = 0.016) or were male (61.7% vs. 49.7%, p = 0.053). Individuals identifying as Black or Asian were more likely to present with ear lobe and neck scars, respectively (50.0% vs. 45.5%, p = <0.001). Ear scars were significantly more likely to receive excision at initial treatment (aOR = 5.86 [1.43-23.96]) compared to other subsites, and were more likely to require >1 treatment (aOR = 5.91 [1.53-22.75]). CONCLUSION Among pediatric patients presenting with keloids or HTS, children who identified as Black or Asian were more likely to present with ear and neck scars, respectively. Ear scars were frequently treated with excision and appear more likely to require adjuvant treatments and multiple interventions. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3127-3135, 2024.
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Affiliation(s)
- Alessandra Zaccardelli
- Department of Otolaryngology-Head and Neck, Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Jennifer L Harb
- Division of Pediatric Otolaryngology and Facial Plastic and Reconstructive Surgery, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Evangelos Papathanasiou
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, Massachusetts, U.S.A
| | - Andrew R Scott
- Department of Otolaryngology-Head and Neck, Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Division of Pediatric Otolaryngology and Facial Plastic and Reconstructive Surgery, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
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213
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Kalmar CL, Carlson AR, Bartlett SP. Double-Reversed Costal Cartilage Graft for Nasal Reconstruction. Plast Reconstr Surg 2024; 154:170e-174e. [PMID: 37257119 DOI: 10.1097/prs.0000000000010776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
SUMMARY Costal cartilage provides the ideal graft for reconstruction of the nasal dorsum and tip because of its abundant supply and flexural strength. Nevertheless, autologous costal cartilage grafts can experience warping. Several techniques have been devised to offset the intrinsic warping effects of cartilage, but current techniques have several disadvantages. The authors present a multimedia demonstration of the double-reversed technique for costal cartilage reconstruction. This strategy is unique in its dual axis of rotation to offset warp in all dimensions. This technique can be performed with conventional instruments, does not introduce foreign material, and provides robust support to counteract the often scarred and contracted soft-tissue envelope.
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214
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Najim Obaid M, Sabr OH, Jawad Kadhim B. The effect of MgO nanoparticle on PVA/PEG-based membranes for potential application in wound healing. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024:1-15. [PMID: 38949409 DOI: 10.1080/09205063.2024.2364526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024]
Abstract
The interest in wound dressings increased ten years ago. Wound care practitioners can now use interactive/bioactive dressings and tissue-engineered skin substitutes. Several bandages can heal burns, but none can treat all chronic wounds. This study formulates a composite material from 70% polyvinyl alcohol (PVA) and 30% polyethylene glycol (PEG) with 0.2, 0.4, and 0.6 wt% magnesium oxide nanoparticles. This study aims to create a biodegradable wound dressing. A Fourier Transform Infrared (FTIR) study shows that PVA, PEG, and MgO create hydrogen bonding interactions. Hydrophilic characteristics are shown by the polymeric blend's 56.289° contact angle. MgO also lowers the contact angle, making the film more hydrophilic. Hydrophilicity improves film biocompatibility, live cell adhesion, wound healing, and wound dressing degradability. Differential Scanning Calorimeter (DSC) findings suggest the PVA/PEG combination melted at 53.16 °C. However, adding different weight fractions of MgO nanoparticles increased the nanocomposite's melting temperature (Tm). These nanoparticles improve the film's thermal stability, increasing Tm. In addition, MgO nanoparticles in the polymer blend increased tensile strength and elastic modulus. This is due to the blend's strong adherence to the reinforcing phase and MgO nanoparticles' ceramic material which has a great mechanical strength. The combination of 70% PVA + 30% PEG exhibited good antibacterial spatially at 0.2% MgO, according to antibacterial test results.
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Affiliation(s)
- Massar Najim Obaid
- Department of Polymer and Petrochemical Industries, College of Materials Engineering, University of Babylon, Hilla, Iraq
| | - Ohood Hmaizah Sabr
- Department of Polymer and Petrochemical Industries, College of Materials Engineering, University of Babylon, Hilla, Iraq
| | - Ban Jawad Kadhim
- Department of Polymer and Petrochemical Industries, College of Materials Engineering, University of Babylon, Hilla, Iraq
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215
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Jaiswal D, Saxena B, Mathews S, Mantri M, Pilania V, Bindu A, Shankhdhar VK, Yadav P. TFL Perforator Flap Complementing and Completing the ALT-AMT Flap Axis. Arch Plast Surg 2024; 51:408-416. [PMID: 39034980 PMCID: PMC11257743 DOI: 10.1055/a-2319-1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/21/2024] [Indexed: 07/23/2024] Open
Abstract
Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator. Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021. Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed. Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT-TFL can be harvested for large, complex, multicomponent, and multidimensional defects.
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Affiliation(s)
- Dushyant Jaiswal
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Saxena
- Department of Plastic and Reconstructive Surgery, Nanavati Max Super Speciality Hospital, Mumbai, Maharashtra, India
| | - Saumya Mathews
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mayur Mantri
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vineet Pilania
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Bindu
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vinay Kant Shankhdhar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prabha Yadav
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Plastic and Reconstructive Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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216
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Shukla BK, Naithani N, Kumar A, Mishra R. A Prospective Study of Contracture of the Finger and its Management in a Tertiary Care Center. Ann Afr Med 2024; 23:482-487. [PMID: 39034576 DOI: 10.4103/aam.aam_153_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/24/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND When the range of motion between two finger segments, both active and passive, is restricted, finger contracture occurs. The aim of this study is to investigate the best procedure to eliminate finger contracture and the functional and esthetic results of the different surgical procedures. MATERIALS AND METHODS A total of 31 patients with soft-tissue abnormalities of the hand were included in this prospective study. They underwent either contracture removal with K-wire and skin grafts or various flap procedures in the department of plastic surgery. Complaints of stiffness and discomfort were classified into five categories: none, mild, moderate, marked, and severe. The difficulty a person had in picking up objects, grasping, writing, etc., was used to determine the degree of disability. Absenteeism from work and surgical site infections were also recorded. RESULTS The mean age was 20.25 years, with a mean age of 23.05 for men and 15.83 for women. Overall, most cases occurred in the age range of 3-10 years. For K-wire surgery with skin grafting, the typical time off work was 24 days. The average recovery time ranged from 15.2 days for skin grafts to 16.9 days for tenolysis, 28.33 days for groyne flaps, and 41 days for abdominal flaps. Of all cases, 12 (38.00%) had a fair result, 10 (31.04%) had a moderate result, and 9 (30.96%) had an excellent result. CONCLUSION The most feasible method for treating these situations, which offers the greatest potential for a functional and cosmetic result, is contracture reduction with skin grafting.
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Affiliation(s)
- Brijesh Kumar Shukla
- Department of General Surgery, Maharaja Suhel Dev Autonomous State Medical College and Mahrishi Balark Hospitals, Bahraich, Uttar Pradesh, India
| | - Neeraj Naithani
- Department of General Surgery, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Amit Kumar
- Department of General Surgery, Maharaja Suhel Dev Autonomous State Medical College and Mahrishi Balark Hospitals, Bahraich, Uttar Pradesh, India
| | - Ritambhara Mishra
- Department of Pathology, Maharaja Suhel Dev Autonomous State Medical College and Mahrishi Balark Hospitals, Bahraich, Uttar Pradesh, India
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Mbouche LO, Mbassi AA, Mekeme JBM, Bob DN, Ndjock JL, Tamufor EN, Tambo FM. Characteristics and management of post-circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon. BJUI COMPASS 2024; 5:681-690. [PMID: 39022657 PMCID: PMC11250727 DOI: 10.1002/bco2.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced. Patients and methods From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed. Results The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics. Conclusion Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.
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Affiliation(s)
- Landry Oriole Mbouche
- Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco‐Obstetric and Pediatric HospitalUniversity of Yaoundé IYaoundéCameroon
| | - Achille Aurèle Mbassi
- Department of Urology, Yaoundé Central HospitalHigher Institute of Health SciencesBangangtéCameroon
| | | | - Dorcas Nyanit Bob
- Department of Pediatric Surgery, Yaoundé Central HospitalUniversity of Yaoundé IYaoundéCameroon
| | - Joseph Lionel Ndjock
- Department of Urology, Yaoundé Central HospitalHigher Institute of Health SciencesBangangtéCameroon
| | - Emmanuel Njuma Tamufor
- Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco‐Obstetric and Pediatric HospitalUniversity of Yaoundé IYaoundéCameroon
| | - Faustin Mouafo Tambo
- Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco‐Obstetric and Pediatric HospitalUniversity of Yaoundé IYaoundéCameroon
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218
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Padula WV, Ramanathan S, Cohen BG, Rogan G, Armstrong DG. Comparative Effectiveness of Placental Allografts in the Treatment of Diabetic Lower Extremity Ulcers and Venous Leg Ulcers in U.S. Medicare Beneficiaries: A Retrospective Observational Cohort Study Using Real-World Evidence. Adv Wound Care (New Rochelle) 2024; 13:350-362. [PMID: 38588554 DOI: 10.1089/wound.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Objective: To compare the effectiveness of cellular tissue products (CTP) versus standard care in U.S. Medicare beneficiaries with diabetic lower extremity ulcers (DLEUs) or venous leg ulcers (VLUs). Approach: We performed a retrospective cohort study using real-world evidence from U.S. Medicare claims for DLEUs or VLUs between 2016 and 2020. There were three cohorts evaluated: viable cryopreserved placental membrane (vCPM) or viable lyopreserved placental membrane (vLPM); other CTP; and standard care. Claims were collapsed into episodes of care. Univariate and bivariate statistics were used to examine the frequency distribution of demographics and clinical variables. Multivariable zero-inflated binomial regressions were used to evaluate mortality and recurrence trends. Logistic regression compared three adverse outcomes (AOs): amputation; 1-year mortality; and wound recurrence. Results: There were 333,362 DLEU episodes among 261,101 beneficiaries, and 122,012 VLU episodes among 80,415 beneficiaries. DLEU treatment with vLPM was associated with reduced 1-year mortality (-26%), reduced recurrence (-91%), and reduced AOs (-71%). VLU treatment with vCPM or vLPM was associated with reduced 1-year mortality (-23%), reduced recurrence (-80%), and 66.77% reduction in AOs. These allografts were also associated with a 49% and 73% reduced risk of recurrence in DLEU and VLU, respectively, compared with other CTPs. Finally, vCPM or vLPM were associated with noninferior prevention of AOs related to amputation, mortality, and recurrence (95% CI: 0.69-1.14). Conclusions: DLEUs and VLUs treated with vCPM and vLPM allografts are associated with lowered 1-year mortality, wound recurrence, and AOs in DLEUs and VLUs compared with standard care. Decision makers weighing coverage of placental allografts should consider these added short- and long-term clinical benefits relative to costly management and high mortality of Medicare's most frequent wounds.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical & Health Economics, Alfred E. Mann School of Pharmacy & Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Stage Analytics, Suwanee, Georgia, USA
| | | | | | | | - David G Armstrong
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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219
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Lamorie-Foote K, Kramer DR, Sundaram S, Cavaleri J, Gilbert ZD, Tang AM, Bashford L, Liu CY, Kellis S, Lee B. Primary somatosensory cortex organization for engineering artificial somatosensation. Neurosci Res 2024; 204:1-13. [PMID: 38278220 DOI: 10.1016/j.neures.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
Somatosensory deficits from stroke, spinal cord injury, or other neurologic damage can lead to a significant degree of functional impairment. The primary (SI) and secondary (SII) somatosensory cortices encode information in a medial to lateral organization. SI is generally organized topographically, with more discrete cortical representations of specific body regions. SII regions corresponding to anatomical areas are less discrete and may represent a more functional rather than topographic organization. Human somatosensory research continues to map cortical areas of sensory processing with efforts primarily focused on hand and upper extremity information in SI. However, research into SII and other body regions is lacking. In this review, we synthesize the current state of knowledge regarding the cortical organization of human somatosensation and discuss potential applications for brain computer interface. In addition to accurate individualized mapping of cortical somatosensation, further research is required to uncover the neurophysiological mechanisms of how somatosensory information is encoded in the cortex.
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Affiliation(s)
- Krista Lamorie-Foote
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Daniel R Kramer
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; Department of Neurological Surgery, University of Colorado School of Medicine, Denver, CO, United States
| | - Shivani Sundaram
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States.
| | - Jonathon Cavaleri
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Zachary D Gilbert
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Austin M Tang
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; Department of Neurological Surgery, University of Texas at Houston, Houston, TX, United States
| | - Luke Bashford
- Department of Biology and Biological Engineering, T&C Chen Institute for Neuroscience, California Institute of Technology, Pasadena, CA, United States; Department of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charles Y Liu
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Spencer Kellis
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Brian Lee
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
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220
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Bisoyi AD, Paikray BE, Mohanty CJ, Behera DS. COVID-19 Quarantine Stamp Contact Dermatitis: A Report of Four Cases. Indian Dermatol Online J 2024; 15:689-691. [PMID: 39050049 PMCID: PMC11265741 DOI: 10.4103/idoj.idoj_587_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/02/2023] [Accepted: 09/26/2023] [Indexed: 07/27/2024] Open
Affiliation(s)
- A. Diptiranjani Bisoyi
- Department of Dermatology, S.C.B Medical College and Hospital, Mangalabag, Cuttack, Odisha, India
| | - B. Elisha Paikray
- Department of Pharmacology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - C. Jayashree Mohanty
- Department of Dermatology, S.C.B Medical College and Hospital, Mangalabag, Cuttack, Odisha, India
| | - D. Swapnarani Behera
- Department of Dermatology, S.C.B Medical College and Hospital, Mangalabag, Cuttack, Odisha, India
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221
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Nguyen DD, Pang JY, Novakovic D. Comparison of Angiolytic Effects Between the 445-nm Blue Laser and 532-nm Pulsed KTP Laser. Laryngoscope 2024; 134:3220-3225. [PMID: 38409660 DOI: 10.1002/lary.31364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/28/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE This study aimed to compare the selective absorption of the 445-nm Blue laser (BL) and the 532-nm pulsed potassium-titanyl-phosphate (KTP) laser by blood vessels. METHODS Thirty-six chicken eggs at day 14 of incubation were dissected to expose the chick chorioallantoic membrane (CAM). Third-order vessels of the CAM were identified and irradiated using BL and KTP lasers using various settings at a laser-to-vessel distance of 3 mm using 0.4 mm fiber size. In total, 494 vessels segments were irradiated. Mean (standard deviation) number of irradiations for each setting was 26.0 (4.6), range from 15 to 39. Outcome measures included ablation rate (AR) and rupture rate (RR). RESULTS The two lasers were compared for AR and RR at long and medium pulse width (PW) associated with different power levels. At long PW (above 100 ms), BL showed significantly higher AR than KTP at high energy (600 mJ/pulse) and low energy (400 mJ/pulse); they did not show different AR and RR at medium energy levels (500 mJ/pulse). Using medium PW settings plus high and medium energy levels, BL and KTP showed relatively high AR and did not significantly differ in performance. However, at medium PW plus low energy (400-450 mJ/pulse), KTP showed significantly higher AR compared to BL. CONCLUSION At long PW, BL appeared to show higher AR than KTP at high or low energy levels, but they showed equivalent performance at medium energy. At medium PW, both performed similarly from high to medium energy, but KTP appeared to perform better than BL at lower energy settings. LEVEL OF EVIDENCE NA Laryngoscope, 134:3220-3225, 2024.
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Affiliation(s)
- Duy Duong Nguyen
- Voice Research Laboratory, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- National Hospital of Otorhinolaryngology, Hanoi, Vietnam
| | - Jing-Yin Pang
- Department of Ear-Nose-Throat, Khoo Teck Puat Hospital, Yishun Central, Singapore
| | - Daniel Novakovic
- Voice Research Laboratory, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Canterbury Hospital, Sydney, New South Wales, Australia
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Ockell J, Biörserud C, Fagevik Olsén M, Elander A, Hansson E. "Normal" breast dimensions in obese women-reference values and the effect of weight loss. J Plast Reconstr Aesthet Surg 2024; 94:187-197. [PMID: 38810359 DOI: 10.1016/j.bjps.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Breast hypertrophy may cause significant suffering, such as back- and breast pain, painful shoulder groves, and eczemas. Furthermore, women with breast hypertrophy may have lower quality of life than women without breast hypertrophy. Although 50% of the women undergoing breast reduction in the US have body mass index (BMI) >30 kg/m2, the current standard of normality is based on studies focusing on women <40 years of age and BMIs <25 kg/m2. This study aimed to present reference values for breast measurements for women with obesity and to investigate the relationship between BMI loss and each breast measurement. MATERIALS AND METHODS One hundred and six women underwent laparoscopic Roux-en-Y gastric bypass in Gothenburg, Sweden. The participants' breast anthropometrics were measured before and after bariatric surgery and their perception of the skin on their breasts was measured using the Sahlgrenska Excess Skin Questionnaire. RESULTS Breast volume, sternal notch to nipple (SNN) distance, and ptosis increased significantly with increasing BMI. For instance, women with BMIs between 30-34.9 kg/m2 have a mean breast volume of approximately 770 ml, those with BMIs of 40-44.9 kg/m2 have approximately 1150 ml, and those with BMIs above 50 kg/m2 have approximately 1400 ml. Furthermore, the percent change in the respective breast measurements relative to percent BMI change can be predicted, for instance, with a 20% reduction in BMI, the breast volume, SNN-distance, and ptosis decrease by 25%, 4%, and 20% respectively. CONCLUSIONS This article presents the first standard of normality for breast anthropometrics in women with obesity and a model for predicting the change in breast anthropometrics relative to BMI. CLINICAL TRIAL REGISTRATION This is a longitudinal observation study, registered https://fou.nu/is/gsb/ansokan/49651, No: VGFOUGSB-49651. Trial registry name: "Överskottshud efter överviktskirurgi - dess utveckling samt behov och effekt av plastikkirurgi" ("Excess skin after bariatric surgery - its development and the need and effect of plastic surgery").
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Affiliation(s)
- Jonas Ockell
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christina Biörserud
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Box 455, 405 30 Göteborg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Physiotherapy, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, The Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, The Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
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Evin N, Guray Evin S. Camouflage of Postburn Scarring Alopecia Using Nanofat Grafting and Follicular Unit Hair Transplantation. Plast Reconstr Surg 2024; 154:207-215. [PMID: 37253046 DOI: 10.1097/prs.0000000000010759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Postburn scarring alopecia on hair-bearing aesthetic subunits causes cosmetic disfiguring and psychological problems. Follicular unit extraction (FUE) hair transplantation is an effective technique for camouflaging postburn scarring alopecia. However, poorly vascularized and fibrotic scar tissue limits the viability of grafts. The mechanical and vascular characteristics of scar tissue can be improved by nanofat grafting. This study aimed to present the results of postburn scarring alopecia treatment using nanofat-assisted FUE hair transplantation. METHODS Eighteen patients who had postburn scarring alopecia in and around the beard were enrolled. Patients underwent single-session nanofat grafting and FUE hair transplantation at 6-month intervals. Twelve months after hair transplantation, the survival rate of transplanted follicular graft, scar improvement, and patient satisfaction were assessed by counting each transplanted follicle individually, using the Patient and Observer Scar Assessment Scale, and using a 5-point Likert satisfaction scale, respectively. RESULTS Nanofat grafting and hair transplantation were successfully performed without complication. All scars significantly improved in mature characteristics ( P < 0.00001 for patients; P < 0.00001 for observers). The survival and density rates of transplanted follicular units ranged from 77.4% to 87.9% (mean, 83.2% ± 2.5%) and 10.7% to 19.6% (mean, 15.2% ± 2.46%), respectively. All patients reported significantly satisfying cosmetic results ( P < 0.00001). CONCLUSIONS Scarring alopecia is an inevitable and challenging late complication of deep burned hair-bearing units. Combining nanofat injection and FUE hair transplantation is among the most innovative and effective treatments for postburn scarring alopecia. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Nuh Evin
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bezmialem Vakif University Faculty of Medicine
| | - Seyda Guray Evin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University Faculty of Medicine
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Meretsky CR, Krumbach B, Popovich J, Ajebli M, Schiuma AT. Skin and Muscle Closure Techniques Following Large-Scale Osteosarcoma Removal: A Comparative Analysis. Cureus 2024; 16:e64258. [PMID: 39130915 PMCID: PMC11315368 DOI: 10.7759/cureus.64258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Osteosarcoma (OS), the most prevalent form of bone cancer, typically arises in osteoblast cells responsible for generating new bone. The bone produced by these cancer cells is weaker compared to healthy bone. OS is an aggressive bone cancer that often requires extensive resection, leaving behind substantial soft tissue defects. Successful closure after tumor excision is critical for wound healing and postoperative recovery. However, the optimal approach varies depending on factors like defect size and location. After extensive resection of OS, restoring the integrity of the affected area demands careful closure of both the skin and underlying muscle. The appropriate closure technique depends on the size and location of the soft tissue defect. The main objective of this systematic review is to evaluate and compare different surgical techniques for closing skin and muscle layers following large-scale OS removal. Through a systematic review methodology, we conducted an extensive analysis of the existing body of literature on this topic, drawing from relevant research papers published over the past two decades. This allowed us to collectively evaluate and synthesize available data on the subject. This review found that negative pressure wound therapy (NPWT) and flap reconstruction are the main surgical approaches used to close skin and muscle following extensive OS resection, which commonly results in large soft tissue defects due to the nature of tumor removal. Furthermore, NPWT was the most widely used method for closing soft tissue defects after major OS removal, while flap reconstruction was also common when NPWT was not appropriate or the defect was too large. An integrated approach combining vacuum therapy, skin stretching, and occasional flaps seeks to primarily close large defects after OS resection through optimized healing and tension reduction to achieve the best postoperative results.
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Affiliation(s)
| | | | - Jay Popovich
- Internal Medicine, St. George's University School of Medicine, Great River, USA
| | - Mohammed Ajebli
- Biology Sciences, Moulay Ismail University, Faculty of Sciences and Technologies, Errachidia, MAR
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Sabapathy SR, Shanmugakrishnan RR, Hultman CS. Acute and Reconstructive Burn Care of the Hand. Clin Plast Surg 2024; 51:365-377. [PMID: 38789146 DOI: 10.1016/j.cps.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The hand is commonly affected in thermal injuries. Hand burns account for 39% of all burns and they are involved in 34% of instances when the total body surface area of a burn exceeds 15%. Inadequate or inappropriate treatment could result in significant morbidity. The ultimate integration of a burn patient into the society largely depends on the functionality of the hands. Hence, it is important to reduce complications by providing good care during the acute stage.
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Affiliation(s)
- Shanmuganathan Raja Sabapathy
- Department of Plastic Surgery, Hand & Reconstructive Microsurgery & Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
| | - R Raja Shanmugakrishnan
- Department of Plastic Surgery, Hand & Reconstructive Microsurgery & Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India; Department of Hand, Reconstructive Microsurgery, Faciomaxillary and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Charles Scott Hultman
- WPP Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610, USA
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226
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Patel RR, Damron TA. The Role of Surveillance in Predicting Fracture in Pediatric Patients With Incidentally Discovered Nonossifying Fibromas and Fibrous Cortical Defects: Is It Worth It? J Pediatr Orthop 2024; 44:395-401. [PMID: 38506396 DOI: 10.1097/bpo.0000000000002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Nonossifying fibroma (NOF) and fibrous cortical defect (FCDs), the most common benign pediatric bone lesions, are usually incidental x-ray findings. Surveillance of characteristic lesions has been recommended to monitor for enlargement and assess fracture risk. However, no accepted fracture risk prediction guidelines exist, so indications for prophylactic surgery are unclear. The study's purposes were to (1) characterize the timing of NOF/FCD-associated fractures, (2) quantify the resources devoted to surveillance, and (3) evaluate the potential for surveillance to prevent pathologic fracture. METHODS A single institution retrospective review was conducted to identify pediatric patients (below 18 y old) with clinical-radiographic documentation of an NOF or FCD diagnosis from 2012 to 2020. Patients who presented with fracture were tallied but excluded from the surveillance analysis. Patients without at least one follow-up visit were also excluded. Lesional radiographic features were characterized on initial imaging. The number of visits and imaging studies devoted to surveillance were tabulated. The number of fractures and prophylactic surgeries were recorded to quantify the potential of surveillance to prevent pathologic fractures. RESULTS The study population presenting without fracture consisted of 301 patients with 364 lesions with a mean follow-up of 20 months. By contrast, over the same period, 38 patients presented with NOF/FCD associated pathologic fractures. Surveillance included 1037 additional imaging tests over 1311 follow-up visits, or on average, 3.4 imaging studies and 4.4 visits per patient. During surveillance, only 2 (0.55%) lesions fractured. Another 10/364 (2.8%) patients underwent curettage and grafting, suggesting that-at best-the potential for preventing pathologic fracture by surveillance, assuming all 10 patients who underwent surgery would have subsequently fractured along with the 2 documented fractures, is 3.3% of lesions (12/364). CONCLUSIONS The small number of fractures and surgeries during the follow-up period probably does not justify additional resources for surveillance beyond the initial visit, except in symptomatic patients with large lesions. However, subsequent visits may play a role in educating patients and their families regarding the natural history of these lesions. LEVEL OF EVIDENCE Prognostic Level II-retrospective study.
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Affiliation(s)
| | - Timothy A Damron
- Department of Orthopaedic Surgery, Upstate Medical University, Syracuse, NY
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Yadav J, Raghav P, Mishra RK, Upadhyaya DN, Prasad V, Chaturvedi CP, Singh K. Non-syndromic Cleft Lip and Palate Patients of the North Indian Population and the Association of Methylenetetrahydrofolate Reductase Gene. Cureus 2024; 16:e64812. [PMID: 39156389 PMCID: PMC11330085 DOI: 10.7759/cureus.64812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION Cleft lip and palate (CLP) is a common congenital anomaly characterized by incomplete fusion of the lip and/or palate during embryonic development. The etiology of CLP is multifactorial, involving genetics and different environmental factors. The methylenetetrahydrofolate reductase (MTHFR) gene has been proposed as a candidate gene associated with CLP due to its involvement in folate metabolism and DNA methylation processes. However, the association between MTHFR gene variants and CLP in non-syndromic patients in the North Indian population remains unclear. AIM AND OBJECTIVES This research aimed to see the association between MTHFR gene polymorphisms in non-syndromic patients with CLP in the North Indian population. MATERIALS AND METHOD A case-control observational design comprised 50 CLP patients (cases) and 50 healthy individuals without CLP (controls). Blood samples were collected from patients visiting two hospitals. Genomic DNA was extracted from collected peripheral blood samples, and the genotyping of MTHFR gene polymorphisms (specifically, C677T) was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The allelic and genotypic frequencies of MTHFR gene variants were compared between cases and controls using appropriate statistical tests. RESULT This research revealed a significant association between MTHFR gene polymorphism and CLP in the North Indian population. The odds for the genotypes reach statistical significance, suggesting that the MTHFR gene variant may play a major role in this population's susceptibility to non-syndromic CLP. CONCLUSION This study provides evidence for a linkage between the MTHFR gene C677T polymorphism and an increased risk of CLP in non-syndromic patients in the North Indian population. These findings do support the involvement of MTHFR gene variants in the etiology of CLP. In the future, more research is warranted to elucidate the underlying mechanisms linking MTHFR gene variants to CLP and to explore potential gene-environment interactions in this context.
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Affiliation(s)
- Juhi Yadav
- Department of Orthodontics and Dentofacial Orthopedics, Autonomous State Medical College, Auraiya, Auraiya, IND
| | - Pradeep Raghav
- Department of Orthodontics, Swami Vivekanand Subharti University, Meerut, IND
| | - Raj Kumar Mishra
- Department of Plastic Surgery and Reconstructive Surgery, Sushrut Institute of Plastic Surgery, Lucknow, IND
| | - Divya Narain Upadhyaya
- Department of Plastic Surgery and Reconstructive Surgery, King George's Medical University, Lucknow, IND
| | - Veerendra Prasad
- Department of Plastic Surgery, King George's Medical University, Lucknow, IND
| | - Chandra P Chaturvedi
- Stem Cell Research Center, Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Kritanjali Singh
- Department of Biotechnology, Swami Vivekanand Subharti University, Meerut, IND
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Brown S, Hind D, Strong E, Bradburn M, Din FVN, Lee E, Lee MJ, Lund J, Moffatt C, Morton J, Senapati A, Shackley P, Vaughan-Shaw P, Wysocki AP, Callaghan T, Jones H, Wickramasekera N. Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation. Health Technol Assess 2024; 28:1-113. [PMID: 39045854 DOI: 10.3310/kfdq2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Background There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. Objectives A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. Design Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. Setting Thirty-one National Health Service trusts. Participants Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. Interventions Surgery. Main outcome measures Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. Results Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. Limitations Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. Conclusions and future work Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. Trial registration This trial is registered as ISRCTN95551898. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steven Brown
- Department of General Surgery, Northern General Hospital, Sheffield, UK
| | - Daniel Hind
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emily Strong
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Farhat Vanessa Nasim Din
- Academic Coloproctology, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - Jonathan Lund
- Derby Royal Infirmary, University Hospitals of Derby and Burton, Derby, UK
| | | | - Jonathan Morton
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Asha Senapati
- St Mark's Hospital, London, UK; Queen Alexandra Hospital, Portsmouth, UK
| | - Philip Shackley
- School of Health and Related Research, Regent Court, Sheffield, UK
| | - Peter Vaughan-Shaw
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | | | - Tia Callaghan
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Nuno SL, López-López D, Gómez-Salgado J. Impact of Lymphedema on Foot-Health-Related Quality of Life: A Case-Control Investigation. Adv Skin Wound Care 2024; 37:376-381. [PMID: 38899819 DOI: 10.1097/asw.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the foot-health-related quality of life in individuals with versus without lower-limb lymphedema. METHODS A case-control study was carried out in an academic clinic in Lisbon, Portugal. Eighty participants (40 controls and 40 with lymphedema) were included in the study. The researchers examined sociodemographic and clinical data and foot-health-related quality of life in both groups. In the group with lymphedema, lower-limb lymphedema was also characterized. RESULTS Individuals with lower-limb lymphedema had significantly lower scores on all dimensions of the Foot Health Status Questionnaire in comparison with the control group. CONCLUSIONS Individuals with lower-limb lymphedema appear to have a poorer foot-health-related quality of life than the general population.
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Affiliation(s)
- Ana Júlia Monteiro
- Ana Júlia Monteiro, MSc, PT, is PhD student, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain, and Adjunct Professor, Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa, Lisboa, Portugal. Carmen de Labra, PhD, PhysC, is Associate Professor, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña. Marta Elena Losa-Iglesias, PhD, MSc, DP, RN, is Full Professor, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, Spain. Adriano Días, PhD, ELC, is Full Professor, Epidemiology, Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/UNESP, Botucatu, Brazil. Ricardo Becerro-de-Bengoa-Vallejo, PhD, MLIS, DPM, RN, DHL, FFPM, RCPS, is Full Professor, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain. Helena Silva-Migueis, PhD, MSc, PT, is External Collaborator, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña and Adjunct Professor, Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa. Sérgio Loureiro Nuno, MSc, PT, is PhD Student, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain and Adjunct Professor in Department of Physiotherapy, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal. Daniel López-López, PhD, MPH, MSc, DP, is Reader in Podiatry, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain. Juan Gómez Salgado, PhD, MPH, MSc, RN, is Full Professor, Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain, and Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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de Abranches Oliveira Santos Filho ID, Rodrigues MA, Ferreira LM, Nahas FX. Is There a Direct Effect Between the Plication of the Myoaponeurotic Layer and the Force of Inspiratory and Expiratory Muscles After Abdominoplasty? Ann Plast Surg 2024; 93:14-21. [PMID: 38885160 DOI: 10.1097/sap.0000000000003940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Abdominoplasty may generate an increase in the intra-abdominal pressure (IAP) and consequently an alteration in the pulmonary ventilation. The purpose of this study was to evaluate the potential alterations in the maximal static inspiratory pressure (MIP) and maximal static expiratory pressure (MEP) after abdominoplasty. METHODS Thirty-three female patients, aged between 18 and 60, with type III/B Nahas abdominal deformity that underwent abdominoplasty with plication of the anterior rectus and external oblique aponeurosis were selected. The MIP and MEP were measured using a mouthpiece. This is a simple way to indirectly gauge inspiratory and expiratory muscle strength. Measurements were performed before surgery and on the 2nd, 7th, 15th, and 180th postoperative day. In addition, IAP was measured before abdominoplasty and after the placement of compression garment. The MIP and MEP were compared using analysis of variance, followed by the Bonferroni multiple comparison test pairing the different points in time. Paired Student's t test was used for comparing IAP measurements. Pearson's correlation test was used to compare MIP and MEP variations with IAP variation. Results were considered statistically significant when P ≤ 0.05. RESULTS A decrease was observed in MEP on the 2nd day, with a return close to normal values on the 15th day. In opposition MIP had a surprisingly increase on the 15th postoperative day (129 cmH2O), normalizing 180 days after the operation. A leap in IAP values was revealed at the end of the surgical procedure. It was not possible to establish a positive correlation between the increase of IAP and the alterations of MIP and MEP. CONCLUSIONS There is a decrease in maximum expiratory pressure on the very early postoperative day (2nd postoperative day) and an increase in maximum inspiratory pressure on the 15th postoperative day in patients who underwent abdominoplasty. There was no correlation between the IAP and maximum respiratory pressure variations, both inspiratory and expiratory.
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231
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White A, Reilly DA. Management of the Sequelae of Skin Grafting: Pruritis, Folliculitis, Pigmentation Changes, and More. Clin Plast Surg 2024; 51:409-418. [PMID: 38789150 DOI: 10.1016/j.cps.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Scars commonly give rise to unpredictable, potentially irritating, cutaneous complications including pruritis, folliculitis, and pigment changes. These problems can be self-limiting and are prevalent in many burn cases, although their expression varies among individuals. A better understanding of the presentation, risk factors, and pathophysiology of these long-term sequelae allows for more comprehensive care of burn survivors.
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Affiliation(s)
- Anna White
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Debra Ann Reilly
- Department of Surgery (Plastic), University of Nebraska Medical Center, 1430 South 85th Avenue, Omaha, NE 68124, USA.
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232
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Han Y, An M, Zilundu PLM, Zhuang Z, Chen J, Jiang Z, Gu L, Yang J, Wang D, Xu D, Zhou LH. Anatomical variations of the brachial plexus in adult cadavers: A descriptive study and clinical significance. Microsurgery 2024; 44:e31182. [PMID: 38798147 DOI: 10.1002/micr.31182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/24/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Brachial plexus injury is recognized as one of the most severe clinical challenges due to the complex anatomical configuration of the brachial plexus and its propensity for variation, which complicates safe clinical interventions. This study aimed to ascertain the prevalence and characterize the types of brachial plexus variations, and to elucidate their clinical implications. MATERIALS AND METHODS We conducted meticulous dissections of 60 formalin-fixed cadavers' upper arm, axilla and lower neck to reveal and assess the roots, trunks, divisions, cords, and branches of the brachial plexus. The pattern of branching was noted by groups of dissecting medical students and confirmed by the senior anatomists. The variations discovered were record and photographed using a digital camera for further analysis. RESULTS Variations in the brachial plexus were identified in 40 of the 60 cadavers, yielding a prevalence rate of 66.7%. These variations were classified into root anomalies (2.1%), trunk anomalies (8.5%), division anomalies (2.1%), and cord anomalies (4.3%). Notably, anomalies in communicating branches were observed in 39 cadavers (83.0%): 14 with bilateral anomalies, 14 with anomalies on the left side, and 11 on the right side. These communicating branches formed connections between the roots and other segments, including trunks, cords, and terminal nerves, and involved the median, musculocutaneous, and ulnar nerves. CONCLUSION The frequency and diversity of brachial plexus variations, particularly in communicating branches, are significant in cadavers. It is imperative that these variations are carefully considered during the diagnostic process, treatment planning, and prior to procedures such as supraclavicular brachial plexus blocks and nerve transfers, to mitigate the risk of iatrogenic complications.
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Affiliation(s)
- Yueyin Han
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Mingjie An
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Prince L M Zilundu
- Basic Medical and Dental Sciences Department Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Zhuokai Zhuang
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Junyu Chen
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhen Jiang
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Liqiang Gu
- Department of Microsurgery and Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jiantao Yang
- Department of Microsurgery and Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Dong Wang
- Department of Orthopedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Dazheng Xu
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li-Hua Zhou
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
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Kuncorojakti S, Pratama AZA, Antujala CA, Harijanto CTB, Arsy RK, Kurniawan PA, Tjahjono Y, Hendriati L, Widodo T, Aswin A, Diyantoro D, Wijaya AY, Rodprasert W, Susilowati H. Acceleration of wound healing using adipose mesenchymal stem cell secretome hydrogel on partial-thickness cutaneous thermal burn wounds: An in vivo study in rats. Vet World 2024; 17:1545-1554. [PMID: 39185045 PMCID: PMC11344119 DOI: 10.14202/vetworld.2024.1545-1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/21/2024] [Indexed: 08/27/2024] Open
Abstract
Background and Aim The intricate healing process involves distinct sequential and overlapping phases in thermal injury. To maintain the zone of stasis in Jackson's burn wound model, proper wound intervention is essential. The extent of research on the histoarchitecture of thermal wound healing and the application of mesenchymal stem cell (MSC)-free-based therapy is limited. This study aimed to assess the efficacy of MSC-secretome-based hydrogel for treating partial-thickness cutaneous thermal burn wounds. Materials and Methods Eighteen male Wistar rats were divided into three groups, namely the hydrogel base (10 mg), hydrogel secretome (10 mg) and Bioplacenton™ (10 mg) treatment groups. All groups were treated twice a day (morning and evening) for 7 days. Skin tissue samples from the animals were processed for histological evaluation using the formalin-fixed paraffin-embedded method on days 3 and 7. Results This study's findings showed that secretome hydrogel expedited thermal burn wound healing, decreasing residual burn area, boosting collagen deposition and angiogenesis, guiding scar formation, and influencing the inflammation response facilitated by polymorphonuclear leukocytes and macrophages. Conclusion The secretome hydrogel significantly improves healing outcomes in partial-thickness cutaneous thermal burn wounds. The administration of secretome hydrogel accelerates the reduction of the residual burn area and promotes fibroblast proliferation and collagen density. The repairment of histo-architecture of the damaged tissue was also observed such as the reduction of burn depth, increased angiogenesis and epidermal scar index while the decreased dermal scar index. Furthermore, the secretome hydrogel can modulate the immunocompetent cells by decreasing the polymorphonuclear and increasing the mononuclear cells. Thus, it effectively and safely substitutes for thermal injury stem cell-free therapeutic approaches. The study focuses on the microscopical evaluation of secretome hydrogel; further research to investigate at the molecular level may be useful in predicting the beneficial effect of secretome hydrogel in accelerating wound healing.
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Affiliation(s)
- Suryo Kuncorojakti
- Division of Veterinary Anatomy, Department of Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
- Research Centre for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | | | - Cahya Asri Antujala
- Department of Pharmaceutics Faculty of Pharmacy, Widya Mandala Catholic University, Surabaya, Indonesia
| | | | - Rozak Kurnia Arsy
- Department of Pharmaceutics Faculty of Pharmacy, Widya Mandala Catholic University, Surabaya, Indonesia
| | - Putut Andika Kurniawan
- Department of Pharmaceutics Faculty of Pharmacy, Widya Mandala Catholic University, Surabaya, Indonesia
| | - Yudy Tjahjono
- Department of Pharmaceutics Faculty of Pharmacy, Widya Mandala Catholic University, Surabaya, Indonesia
| | - Lucia Hendriati
- Department of Pharmaceutics Faculty of Pharmacy, Widya Mandala Catholic University, Surabaya, Indonesia
| | - Teguh Widodo
- Department of Pharmaceutics Faculty of Pharmacy, Widya Mandala Catholic University, Surabaya, Indonesia
| | - Ahmad Aswin
- Research Centre for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Diyantoro Diyantoro
- Research Centre for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | - Andi Yasmin Wijaya
- Research Centre for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Watchareewan Rodprasert
- Veterinary Stem Cell and Bioengineering Innovation Center, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Helen Susilowati
- Research Centre for Vaccine Technology and Development, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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234
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Fukuyama S, Lo LJ. Cranial Nerve Injuries in Orthognathic Surgery: A Review of Literature. Ann Plast Surg 2024; 93:124-129. [PMID: 38720195 DOI: 10.1097/sap.0000000000003943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
ABSTRACT Orthognathic surgery is increasingly utilized to correct facial deformities and dental malocclusions, as well as to enhance facial aesthetics. Significant advancements in surgical planning and execution have made it more widespread and accessible. However, unfavorable outcomes or complications can occur, leading to potentially severe and possibly long-term consequences, such as cranial nerve injuries. This literature review investigates the cranial nerve complications associated with orthognathic surgery. We conducted an extensive search across available databases, analyzing relevant studies published up to September 30, 2023. Two authors independently selected articles for full-text review based on their titles and abstracts. The eligible studies reported cranial nerve injuries in individuals who had undergone orthognathic surgery. Our findings highlight the risk of cranial nerve injuries, their possible mechanism, management, and outcomes. It is imperative for surgeons to remain vigilant and informed and to communicate such information during preoperative patient consultation.
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Affiliation(s)
- Sotatsu Fukuyama
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Lun-Jou Lo
- Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan
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235
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Wang L, Ma C, Shen Y, Haugen TW, He Y, Sun J. Application of tensor fascia lata perforator flap in head and neck reconstruction. Int J Oral Maxillofac Surg 2024; 53:551-557. [PMID: 38228464 DOI: 10.1016/j.ijom.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024]
Abstract
The aim of this study was to describe the authors' experience in head and neck reconstruction with the tensor fascia lata perforator flap (TFLPF). Between April 2009 and August 2020, 16 patients underwent head and neck reconstruction with a TFLPF. The flaps were designed in a vertical or transverse fashion based on perforators traveling along the medial or lateral aspect of the posterior edge of the tensor fascia lata muscle. Clinical details and postoperative results were recorded and analyzed. The size of the flap ranged from 7 × 5 cm2 to 25 × 9 cm2. The perforators were mostly septocutaneous (11 patients), allowing a simple and straightforward dissection of the perforator and TFLPF in most patients. There were either one or two perforators in all cases. The overall flap survival rate was 100%. All of the flaps healed uneventfully with no delayed wound healing or donor site dysfunction. Follow-up ranged from 18 to 120 months, during which all patients experienced satisfactory functional and aesthetic results, without serious complications at either the recipient or donor site. The TFLPF is a pliable and reliable flap that could be a first choice in selected head and neck reconstruction cases.
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Affiliation(s)
- L Wang
- Department of Oral and Maxillofacial - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C Ma
- Department of Oral and Maxillofacial - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Shen
- Department of Oral and Maxillofacial - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - T W Haugen
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Y He
- Department of Oral and Maxillofacial - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Sun
- Department of Oral and Maxillofacial - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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236
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Adekunle AA, James O, Olanbiwonnu AO, Adeyemo WL. A Review of the Use of Buccal Fat Pad in Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:1116-1124. [PMID: 36760091 DOI: 10.1177/10556656231155768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. METHODS This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. RESULTS A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. CONCLUSION The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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237
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Alonso A, Kirkegaard JB. Learning optimal integration of spatial and temporal information in noisy chemotaxis. PNAS NEXUS 2024; 3:pgae235. [PMID: 38952456 PMCID: PMC11216223 DOI: 10.1093/pnasnexus/pgae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
We investigate the boundary between chemotaxis driven by spatial estimation of gradients and chemotaxis driven by temporal estimation. While it is well known that spatial chemotaxis becomes disadvantageous for small organisms at high noise levels, it is unclear whether there is a discontinuous switch of optimal strategies or a continuous transition exists. Here, we employ deep reinforcement learning to study the possible integration of spatial and temporal information in an a priori unconstrained manner. We parameterize such a combined chemotactic policy by a recurrent neural network and evaluate it using a minimal theoretical model of a chemotactic cell. By comparing with constrained variants of the policy, we show that it converges to purely temporal and spatial strategies at small and large cell sizes, respectively. We find that the transition between the regimes is continuous, with the combined strategy outperforming in the transition region both the constrained variants as well as models that explicitly integrate spatial and temporal information. Finally, by utilizing the attribution method of integrated gradients, we show that the policy relies on a nontrivial combination of spatially and temporally derived gradient information in a ratio that varies dynamically during the chemotactic trajectories.
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Affiliation(s)
- Albert Alonso
- Niels Bohr Institute, University of Copenhagen, Copenhagen 2100, Denmark
| | - Julius B Kirkegaard
- Niels Bohr Institute, University of Copenhagen, Copenhagen 2100, Denmark
- Department of Computer Science, University of Copenhagen, Copenhagen 2100, Denmark
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238
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Mirza A, Mirza J, Zappia L, Thomas TL, Corabi J, Talay R. Single-Portal Antegrade Endoscopic Trigger Finger Release: Cadaveric and Clinical Outcomes. Hand (N Y) 2024; 19:823-830. [PMID: 36726337 PMCID: PMC11284983 DOI: 10.1177/15589447221150512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study aimed to examine the relationship between anatomical surface landmarks in fresh frozen cadavers as related to in vivo endoscopic trigger finger release (ETFR) and present clinical outcomes after a single-portal antegrade ETFR technique. METHODS Endoscopic trigger finger release was performed on 40 cadaveric digits. Each digit was dissected and the following measurements were recorded: distance from palmar digital crease and A1 pulley, length of the A1 pulley, percentage of A1 pulley released, and injury to vulnerable anatomy. A retrospective chart review was performed on 48 patients (62 digits) treated with ETFR. Outcome measures included grip and pinch strength, range of motion, Disability of Arm, Shoulder, and Hand (DASH) questionnaires, and Visual Analog Scale (VAS) pain scores. RESULTS Release of the A1 pulley was achieved in 33 of the 40 cadaveric digits (83%) with an A2 pulley laceration rate of 25%. No flexor tendon or neurovascular injuries occurred. Gross grasp, lateral pinch, 3-jaw chuck, and precision pinch strength had 85%, 90%, 82%, and 90% recovery, respectively. At the final follow-up, average metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint range of motion were within the normal limits. Mean VAS scores decreased from 5.7 preoperatively to 1.0 postoperatively and mean DASH score at the final follow-up was 4.8. CONCLUSIONS With the use of anatomical surface landmarks, ETFR may be performed in an efficient and reproducible manner. Patients treated with ETFR had low complication rates, good functional recovery, and improved pain at short-term follow-up. Further study of long-term outcomes and cost-effectiveness of ETFR is warranted.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
- Stony Brook University, NY, USA
| | - Justin Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
- Stony Brook University, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | - Luke Zappia
- Mirza Orthopedics, Smithtown, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | - Terence L. Thomas
- Mirza Orthopedics, Smithtown, NY, USA
- Thomas Jefferson University, Philadelphia, PA, USA
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239
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Zhuang J, Chen Y, Zheng X, Wang C, Hu J, Liu T. The Application of Blood Products in Plastic Surgery: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6005. [PMID: 39050033 PMCID: PMC11268820 DOI: 10.1097/gox.0000000000006005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024]
Abstract
Background Due to their minimal trauma and relative safety, blood products are becoming increasingly popular in medical aesthetics. In recent years, research on the application of blood products has also been increased. This article will summarize the research progress of emerging blood products in plastic surgery in recent years. Methods We searched the PubMed database for literature related to the application of blood preparation in plastic surgery over the past 5 years and summarized them. Results Commonly used in plastic surgery are platelet-rich plasma, platelet-rich fibrin, concentrated growth factor, platelet-poor plasma, and mesenchymal stem cells derived from blood products. They can be used for wound repair and skin and autologous fat transplantation, and can be combined with laser therapy and facial rejuvenation. Conclusions Understanding the application pathways of blood products in plastic surgery and their respective advantages and disadvantages can help us better choose and use them.
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Affiliation(s)
- Jun Zhuang
- From the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Chen
- Department of Endocrinology, Air Force Medical Hospital, Beijing, China
- Graduate School of China Medical University, Shenyang, China
| | | | - Cheng Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jintian Hu
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tun Liu
- From the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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240
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Goulas S, Karamitros G. The Perceived Impact of COVID-19 on Graduate Medical Education and Recommendations for Bridging the Educational Gap. J Surg Res 2024; 299:237-248. [PMID: 38781733 DOI: 10.1016/j.jss.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION COVID-19 generated a system-wide shock causing an unbalanced equilibrium between producing adequately trained physicians and meeting extraordinary operational needs. Previous studies report the experience of surgical residents during COVID-19 at a regional level. This study measures the learning losses related with the redeployment of highly specialized medical professionals to the care of COVID-19 patients, while we systematically investigate proposed remedial strategies. METHODS We administered an online cross-sectional survey in 67 countries capturing training inputs (i.e., surgeries and seminars residents participated in) before and during the pandemic and retrieved residents' expected learning outputs, career prospects and recommended remedial measures for learning losses. We compared responses of residents working in (treatment group) and out (control group) of hospitals with COVID-19 patients. RESULTS The analysis included 432 plastic surgery residents who were in training during the pandemic. Most of the learning losses were found in COVID-19 hospitals with 37% and 16% loss of surgeries and seminars, respectively, per week. Moreover, 74%, 44%, and 55% of residents expected their surgical skill, scientific knowledge, and overall competence, respectively, to be lower than those of residents who graduated before COVID. Residents in COVID-19 hospitals reported participating in significantly (P < 0.001) fewer surgeries and having significantly (P < 0.001) lower surgical skill relative to those not in COVID-19 hospitals. CONCLUSIONS The perceived lower competence and the fall-off in surgical skill and scientific knowledge among future surgeons suggest that health-care systems globally may have limited capacity to perform specialized and costly procedures in the future.
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Affiliation(s)
- Sofoklis Goulas
- Economic Studies Program, Brookings Institution, Washington, District of Columbia; World Bank, Washington, District of Columbia; Aletheia Research Institution, Palo Alto, California; Hoover Institution, Stanford University, Stanford, California
| | - Georgios Karamitros
- Medical School, University of Ioannina, Ioannina, Greece; Department of Plastic Surgery, University Hospital of Ioannina, Ioannina, Greece.
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241
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Gupta R, Weisberger J, Herzog I, Roth J, Lee ES. Utilization of the gastrocnemius flap for post-traumatic knee reconstruction: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2255-2261. [PMID: 38634884 PMCID: PMC11291595 DOI: 10.1007/s00590-024-03938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE High-energy injuries to the knee may lead to extensive soft tissue loss, fractures, and potential loss of extensor function. The gastrocnemius flap is a prominent reconstructive option for patients with injuries involving the knee and proximal third of the lower extremity. To the best of our knowledge, there has not been an informative review that has evaluated outcomes of patients who have undergone post-traumatic knee reconstruction with a pedicled medial or lateral gastrocnemius flap. The goal of this study is to assess outcomes in patients who have undergone gastrocnemius flap reconstruction after traumatic injuries to the knee. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. Four databases were utilized including PubMed, Cochrane Reviews, Embase, and CINAHL. Our search criteria consisted of the following keywords: gastrocnemius, flap, knee, and traum*. RESULTS A total of 204 studies were imported for screening, from which five papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were case series followed by retrospective chart reviews. In total, 43 patients with traumatic soft tissue knee defects were included with an average patient age of 27.28 years. All patients had successful and clinical viable flaps post-operatively, and there were a total of five patients who had complications. CONCLUSION The gastrocnemius flap has demonstrated to be an effective option for individuals undergoing post-traumatic knee reconstruction. Infection rates, loss of mobility, and scarring represent a minority of complications that may be seen when this reconstructive technique is utilized. Still, additional randomized controlled trials and retrospective studies are required in order to further evaluate for other potential complications that may occur in this patient population.
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Affiliation(s)
- Rohun Gupta
- Oakland University William Beaumont School of Medicine Auburn Hills, Rochester, MI, USA
| | | | | | | | - Edward S Lee
- Department of Plastic Surgery, University Hospital, Newark, NJ, USA
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242
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Aboelsayed KMS, Abdel Razek MK, Assal S, Habib AMA, Negm RA. Effect of prosthetic management and its timing on otological and audiological outcomes in infants with cleft lip and palate: A clinical trial. J Prosthodont 2024; 33:533-540. [PMID: 38689452 DOI: 10.1111/jopr.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To evaluate how prosthetic management affects the otological and audiological state of infants with cleft lip and palate by preventing or treating otitis media (OM). MATERIALS AND METHODS Thirty infants with cleft lip and palate (L/P) were assigned to three equal groups according to the age of prosthetic intervention; Group I: immediately after birth, Group II: 2 months old, Group III: 5 months old. Assessment of middle ear function by tympanometry and hearing quality by auditory brainstem response (ABR) under natural sleep was conducted before and after prosthetic treatment every month till 10 months of age. Data from the study groups were compared. RESULTS No statistically significant differences were found between Gp I and Gp II in the 2nd, 3rd, and 4th months for right and left ears (p > 0.05). In the 5th month, statistically significant differences between the three groups were found in tympanometry for right (p = 0.011) and left (p = 0.024) ears also, in ABR for right (p = 0.007) and left (p = 0.011) ears. Tympanometric readings starting from the 6th till the 10th month showed no statistically significant differences between the three groups (p >0.05). The final ABR outcomes of the 10th month indicated statistically significant differences between the three groups for both ears (p = 0.027). CONCLUSIONS Early prosthetic care could delay the development of OM, so it could potentially improve the otological and audiological state in infants with cleft L/P. However, prosthetic treatment may not be able to completely prevent or eliminate middle ear disorders.
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Affiliation(s)
- Kamel M S Aboelsayed
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Samir Assal
- Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M A Habib
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rana A Negm
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Bhingardeo AV, Amlan A, Chandrupatla M, Prabhala S, Somalwar S. An anomalous pseudoganglion associated with high division of sciatic nerve. Anat Cell Biol 2024; 57:320-323. [PMID: 38415311 PMCID: PMC11184415 DOI: 10.5115/acb.23.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/10/2023] [Accepted: 01/10/2024] [Indexed: 02/29/2024] Open
Abstract
Sciatic nerve (SN) is the thickest and longest nerve of the body. Deviations from the normal anatomical origin and level of bifurcation of SN have been frequently reported. In the present case, we are presenting a unique scenario of origin of terminal branches of the SN-tibial nerve (TN) and common peroneal nerve (CPN) in the pelvic region itself from divisions arising directly from the lumbosacral plexus. This variation was associated with origin of posterior femoral cutaneous nerve from the superior division of CPN with anomalous communicating branches between pudendal nerve and TN. The unique characteristics of the present case are the presence of 'pseudoganglion' found on the inferior division of TN. The present case stands out as the first of its kind to mention such pseudoganglion. Knowledge of some unusual findings like presence of pseudoganglion and intercommunications between nerves have clinical implications in anesthesiology, neurology, sports medicine, and surgery.
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Affiliation(s)
| | - Ayush Amlan
- Department of Anatomy, AIIMS Bibingar, Bibingar, India
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Zdilla MJ. Anatomy of the clitoris: the corona of the glans clitoris, clitoral coronal papillae, and the coronopreputial frenulum. Anat Cell Biol 2024; 57:183-193. [PMID: 38720630 PMCID: PMC11184429 DOI: 10.5115/acb.24.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/20/2024] [Accepted: 04/06/2024] [Indexed: 06/14/2024] Open
Abstract
The corona of the glans clitoris is a clinically important yet poorly understood anatomical structure. There has been longstanding confusion regarding the prevalence of the corona of the glans clitoris and, moreover, its very existence. Therefore, this anatomical study assesses the prevalence of the corona of the glans clitoris and the gross anatomy of the proximal glans clitoris. Anatomy was assessed in 104 female donor bodies ranging in age from 50 to 102 years with an average age-at-death of 78.1±10.9 years (mean±SD). All clitorises (100%; 104:104 dorsums and 100%; 208:208 sides) were found to have a well-defined clitoral corona. Three of 104 (2.9%) coronas possessed grossly visible, outward-projecting, bluntly rounded papillae. Some donors possessed a coronopreputial frenulum. Clitoropreputial adhesions were common and associated with clitoral pearls. Clitoral pearls were identified in 37.8% (14:37) of unembalmed donors and observed to create clitoral craters, structural deformations in the surface of the corona and glans. The results of this study suggest that the corona of the glans clitoris is a ubiquitous anatomical structure. The clitoral coronal papillae and coronopreputial frenulum are novel, previously undescribed, anatomical structures. This study identifies that the corona of the glans clitoris is prone to pathological processes such as clitoral pearl formation and clitoral deformation. In addition to novel anatomical findings, the results of this study call attention to the need for life-long clitoral examinations. Furthermore, the corona of the glans clitoris should be regularly included in anatomical texts and accurately depicted in anatomical illustrations.
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Affiliation(s)
- Matthew J. Zdilla
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, WV, USA
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Vahabzadeh-Hagh AM, Lindenmuth L, Feng Z, Custodio JG, Patel SH. A Tracheostomy Support Device to Reduce Tracheostomy-Related Pressure Injury. Respir Care 2024; 69:839-846. [PMID: 38626951 DOI: 10.4187/respcare.11160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
BACKGROUND Tracheostomies provide many advantages for the care of patients who are critically ill but may also result in complications, including tracheostomy-related pressure injuries. Research efforts into the prevention of these pressure injuries has resulted in specialized clinical care teams and pathways. These solutions are expensive and labor intensive, and fail to target the root cause of these injuries; namely, pressure at the device-skin interface. Here we measure that pressure directly and introduce a medical device, the tracheostomy support system, to reduce it. METHODS This was a cross-sectional study of 21 subjects in the ICU, each with a tracheostomy tube connected to a ventilator. A force-sensing resistor was used to measure baseline pressures at the device-skin interface along the inferior flange. This pressure was then measured again with the use of the tracheostomy support system in the inactive and active states. Resultant pressures and demographics were compared. RESULTS Fifteen male and 6 female subjects, with an average age of 47 ± 14 (mean ± SD) years, were included in this study. Average pressures at the tracheostomy-skin interface at baseline in these 21 ICU subjects were 273 ± 115 (mean ± SD) mm Hg. Average pressures were reduced by 59% (median 62%, maximum 98%) with the active tracheostomy support system to 115 ± 83 mm Hg (P < .001). All the subjects tolerated the tracheostomy support system without issue. CONCLUSIONS Despite best clinical practice, pressure at the tracheostomy-skin interface can remain quite high. Here we provide measures of this pressure directly and show that a tracheostomy support system can be effective at minimizing that pressure.
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Affiliation(s)
- Andrew M Vahabzadeh-Hagh
- The Department of Otolaryngology/Head and Neck Surgery, University of California, San Diego, La Jolla, California
| | - Luke Lindenmuth
- The Jacobs School of Engineering, University of California, San Diego, La Jolla, California
| | - Zeyu Feng
- The Jacobs School of Engineering, University of California, San Diego, La Jolla, California
| | - Jaycee G Custodio
- Respiratory Care, University of California, San Diego, La Jolla, California
| | - Shiv H Patel
- Patel is affiliated with the School of Medicine, University of California, San Francisco, San Francisco, California
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246
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Stanton EW, Manasyan A, Roohani I, Kondra K, Magee WP, Hammoudeh JA, Urata MM. A National Analysis of Craniosynostosis Demographic and Surgical Trends Over a 10-Year Period. J Craniofac Surg 2024:00001665-990000000-01732. [PMID: 38940557 DOI: 10.1097/scs.0000000000010434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
The pathogenesis of craniosynostosis, characterized by the premature fusion of calvarial sutures, is multifaceted and often the result of an amalgamation of contributing factors. The current study seeks examine the possible contributors to craniosynostosis development and its surgical trends over time. A multicenter/national retrospective cohort study was conducted of patients who underwent surgical repair of craniosynostosis (n=11,279) between 2012 and 2021 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Main outcome measures included risk factors and trends relating to surgical repair of craniosynostosis. Nationwide reports of craniosynostosis in the NSQIP-P database have increased between 2012 and 2021 by 195%. The prevalence of craniosynostosis per overall cases has remained between 1.0% and 1.3%. There were predominantly more White male patients in the craniosynostosis cohort (P<0.001). Craniosynostosis patients had significantly greater birth weights, gestational ages, and were less likely to be premature (P<0.05). Linear regression demonstrated that operative time, anesthesia time, and length of stay significantly decreased over the study period (P<0.001). This national data analysis highlights trends in craniosynostosis repair indicating potential improvements in safety and patient outcomes over time. While these findings offer insights for health care professionals, caution is warranted in extrapolating beyond the data's scope. Future research should focus on diverse patient populations, compare outcomes across institutions, and employ prospective study designs to enhance the evidence base for craniosynostosis management. These efforts will help refine diagnostic and treatment strategies, potentially leading to better outcomes for patients.
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Affiliation(s)
- Eloise W Stanton
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - Artur Manasyan
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - Idean Roohani
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - Katelyn Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - William P Magee
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
- Division of Oral and Maxillofacial Surgery, University of Southern California
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
- Division of Oral and Maxillofacial Surgery, University of Southern California
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
- Division of Oral and Maxillofacial Surgery, University of Southern California
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
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247
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Wang D, Gu S, Shen H, Li T, Yin E, Wang X, Gao W, Liao Y. The therapeutic value of vacuum external fixation in polytrauma patients with multiple ribs fracture. Postgrad Med J 2024; 100:496-503. [PMID: 38366645 DOI: 10.1093/postmj/qgae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Multiple displaced rib fractures often result in a poor prognosis. Open reduction and internal fixation has been shown to provide benefits for patients with displaced rib fractures and flail chest. Nevertheless, for patients who are unwilling or unsuitable for surgery, the therapeutic options are limited. We developed a novel plastic vacuum device for rib fractures external stabilization. This study aims to compare the therapeutic efficacy of this device against a traditional chest strap in polytrauma patients with multiple rib fractures. METHODS A retrospective investigation was conducted on polytrauma patients with multiple rib fractures admitted to our trauma center between March 2020 and March 2023. Patients were categorized into two groups: vacuum external fixation and chest strap. Comparative analysis was conducted on baseline parameters, injury characteristics, and clinical outcomes between the two groups. RESULTS In this study, 54 patients were included, with 28 receiving chest strap and 26 undergoing vacuum external fixation. Results showed that, at 3 days and 7 days postintervention, the vacuum external fixation group had significantly lower visual analog scale scores during deep breathing and coughing (P < .05). Vacuum external fixation also reduced pleural drainage duration and volume, as well as lowered the risk of pneumonia and other complications (P < .05). Furthermore, the vacuum external fixation group demonstrated notable improvements in vital capacity, tidal volume, blood-gas test results, and a shorter hospital length of stay. CONCLUSIONS According to the study findings, vacuum external fixation appears to offer benefits to patients with multiple rib fractures, potentially reducing the risk of complications and improving overall clinical outcomes.
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Affiliation(s)
- Dongfang Wang
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Shuaipeng Gu
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Huaqing Shen
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Tonghan Li
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Enzhi Yin
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Xiang Wang
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Wei Gao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Yiliu Liao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
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Currie RV, Clements JD, Dustagheer SM. Unique Idea: Using the KliniTray "Breast Board" for Immobilization of Digital Amputates During Replantation. Tech Hand Up Extrem Surg 2024:00130911-990000000-00105. [PMID: 38934540 DOI: 10.1097/bth.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
The KliniTray "breast board" used by many oncological breast surgeons is an innovative idea to succor microsurgical digital replantation. This piece of sterile equipment is readily available and provides excellent immobilization and retraction of the skin of digital amputates with minimal trauma. The fine metal pins are the key to its efficacy. They provide the flexibility to alter the position of the amputated part and alter the retraction of skin edges as many times as necessary. The construct acts as a tremor-free assistant for a single surgeon to efficiently prepare the amputated part of a digit, saving time including expensive theatre time.
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Affiliation(s)
- Rachel V Currie
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Dundonald, Belfast, Northern Ireland, UK
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249
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Epanomeritakis IE, Eleftheriou A, Economou A, Lu V, Khan W. Mesenchymal Stromal Cells for the Enhancement of Surgical Flexor Tendon Repair in Animal Models: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2024; 11:656. [PMID: 39061739 PMCID: PMC11274147 DOI: 10.3390/bioengineering11070656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Flexor tendon lacerations are primarily treated by surgical repair. Limited intrinsic healing ability means the repair site can remain weak. Furthermore, adhesion formation may reduce range of motion post-operatively. Mesenchymal stromal cells (MSCs) have been trialled for repair and regeneration of multiple musculoskeletal structures. Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons. A PRISMA systematic review was conducted using four databases (PubMed, Ovid, Web of Science, and CINAHL) to identify studies using MSCs to augment surgical repair of flexor tendon injuries in animals compared to surgical repair alone. Nine studies were included, which investigated either bone marrow- or adipose-derived MSCs. Results of biomechanical testing were extracted and meta-analyses were performed regarding the maximum load, friction and properties relating to viscoelastic behaviour. There was no significant difference in maximum load at final follow-up. However, friction, a surrogate measure of adhesions, was significantly reduced following the application of MSCs (p = 0.04). Other properties showed variable results and dissipation of the therapeutic benefits of MSCs over time. In conclusion, MSCs reduce adhesion formation following tendon injury. This may result from their immunomodulatory function, dampening the inflammatory response. However, this may come at the cost of favourable healing which will restore the tendon's viscoelastic properties. The short duration of some improvements may reflect MSCs' limited survival or poor retention. Further investigation is needed to clarify the effect of MSC therapy and optimise its duration of action.
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Affiliation(s)
| | - Andreas Eleftheriou
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (A.E.); (A.E.); (V.L.)
| | - Anna Economou
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (A.E.); (A.E.); (V.L.)
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (A.E.); (A.E.); (V.L.)
| | - Wasim Khan
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
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Stasiłowicz-Krzemień A, Gościniak A, Formanowicz D, Cielecka-Piontek J. Natural Guardians: Natural Compounds as Radioprotectors in Cancer Therapy. Int J Mol Sci 2024; 25:6937. [PMID: 39000045 PMCID: PMC11241526 DOI: 10.3390/ijms25136937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Cancer remains a significant global health challenge, with millions of deaths attributed to it annually. Radiotherapy, a cornerstone in cancer treatment, aims to destroy cancer cells while minimizing harm to healthy tissues. However, the harmful effects of irradiation on normal cells present a formidable obstacle. To mitigate these effects, researchers have explored using radioprotectors and mitigators, including natural compounds derived from secondary plant metabolites. This review outlines the diverse classes of natural compounds, elucidating their roles as protectants of healthy cells. Furthermore, the review highlights the potential of these compounds as radioprotective agents capable of enhancing the body's resilience to radiation therapy. By integrating natural radioprotectors into cancer treatment regimens, clinicians may improve therapeutic outcomes while minimizing the adverse effects on healthy tissues. Ongoing research in this area holds promise for developing complementary strategies to optimize radiotherapy efficacy and enhance patient quality of life.
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Affiliation(s)
- Anna Stasiłowicz-Krzemień
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.); (A.G.)
| | - Anna Gościniak
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.); (A.G.)
| | - Dorota Formanowicz
- Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806 Poznan, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (A.S.-K.); (A.G.)
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