Eplasty最新文献

Background: A 72-year-old man with a history of delayed presentation for severe right lower extremity burns underwent through-knee amputation complicated by periprosthetic distal femur osteomyelitis. Subsequent transfemoral amputation was complicated by Stage IVB Cierny-Mader osteomyelitis despite appropriate medical and surgical treatment.

Methods: Due to the presence of threatened proximal femur intramedullary nail from prior intertrochanteric femur fracture, inability to further shorten femur, and lack of local soft-tissue options, we performed soft tissue reconstruction with free gracilis flap. The free gracilis flap was pulled proximally through the femoral canal to obliterate intramedullary dead space and provide distal femoral stump coverage.

Results: The stump was fully healed upon 6-month follow-up with computerized tomography demonstrating continued presence of gracilis flap within the femoral canal and no evidence of osteomyelitis. At 1-year follow-up, the patient was ambulatory using a prosthetic without recurrence of osteomyelitis.

Conclusions: Previous descriptions of intramedullary free muscle flaps for the treatment of osteomyelitis are limited in number, with its function being limited to dead-space obliteration. This report presents intramedullary free gracilis flap to be a viable option in above-knee amputees for combined dead space obliteration and stump resurfacing in the context of recurrent osteomyelitis.

Background: The development of postoperative oronasal fistulae (ONF) is a complication that plagues all cleft surgeons to varying degrees. There is extensive literature discussing the incidence, functional impact, and treatment of ONF. The goal of this article is to provide an extensive review of the literature discussing the incidence, causative factors, functional impact, classification systems, and treatment of ONF.

Methods: A literature review was performed using PubMed using the Medical Subject Heading terms "cleft palate" AND "fistula" OR "palatal fistula" OR "oronasal fistula". After review, a total of 356 articles were deemed relevant for this study.

Results: Information regarding ONF care, prevention, and management in patients with cleft palate was collected from the articles included in this review. Treatment of ONF remains a challenging problem as there is not a consensus in the available literature on the best palatoplasty techniques for their prevention and treatment. A myriad of reconstructive options and adjunctive therapies exist, and their use is guided by the size and location of the fistula.

Conclusions: Fistula treatment should be tailored to the specific needs of the patient, and consideration must be given to not only the ONF itself but also the patient's stage of growth and development. Large-scale, multicenter studies are needed in which ONF are described using standardized nomenclature, and improved outcomes reporting is necessary to better define an algorithm for a truly holistic approach to palate surgery and reduce the incidence of palatal fistula.

Background: Burn first aid treatment is any primary care provided for burn injuries prior to medical aid. Children are most vulnerable, with 17% to 18% of childhood burn injuries in Pakistan resulting in disability due to inadequate first aid. Misconceptions and incorrect instant home remedies like toothpastes and burn creams encumber the health care system with preventable ailments. This study aimed to assess and compare the knowledge scores of parents of children under the age of 13 years and non-parent adults regarding burn first aid treatment.

Methods: A cross-sectional descriptive survey was conducted on parents of children under the age of 13 years and non-parent adults. This study included 364 respondents via an online questionnaire; those under the age of 18 years and with previous workshop attendance were excluded. Results were computed in terms of frequencies and comparisons using chi-square test and student t test.

Results: Overall, knowledge among both groups remained inadequate (mean score of 4.18 ± 1.94 out of 14 with parents = 4.20 ± 1.91 and non-parent adults = 4.17 ± 1.98) with no statistically significant difference between the 2 groups (P = 0.841). From a total of 364 respondents, 148 (40.7%) confessed to using toothpaste as the best first aid, while cooling the burn was the most favored immediate step (27.5%). Running with the face covered by a wet towel was considered the safest way of escaping a burning building by 33.8% of respondents.

Conclusions: Both groups were poorly aware of burn first aid treatment, with no superiority of parents over non-parent adults. This highlights the need for educating adults, especially parents, to cater to the prevalent misconceptions in our society and help deliver authentic knowledge regarding first aid management of burns.

Background: The rise in Botox, fillers, and chemical peel procedures demands transparent online information that discloses all relevant risks and complications. This study assesses the quality of complication disclosure on the most popular cosmetic sites.

Methods: The top 50 Google search results for "Botox," "fillers," and "chemical peel" were analyzed for their reporting on relevant complications. Websites were categorized based on their origin. An overall complication, prevention, management, prevalence, and disclaimer score were assigned to each site.

Results: A total of 136 websites were analyzed. Of these websites, 31 (22.7%) did not mention any complications or risks associated with the treatment. The most commonly reported complications were bruising (67.0%) for Botox, swelling (79.0%) for fillers, and redness (58%) for chemical peels. The least-reported serious complications were toxin spread effects (31.0%) for Botox, vision loss (23.0%) for fillers, and allergic reaction for chemical peel (18.0%). Reports of serious and rare side effects were significantly lower than those of common side effects (Botox, P = .001; fillers, P = .004; chemical peels, P < .001). The overall mean (standard deviation) complication score across all websites was 2.81/5 (1.31). Online health reference and academic/hospital sites disclosed complications better than sources in most other categories (P < .001).

Conclusions: The reporting of online complications for the top 3 cosmetic procedures performed in the US is highly variable, biased, and at times, completely absent. Patients pursuing cosmetic surgery are heavily influenced by the internet and vulnerable to misinformation. Cosmetic procedure websites are in need of drastic improvement to ensure the health and safety of all patients.

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

Background: Patients with end-stage renal disease (ESRD) secondary to systemic lupus erythematosus (SLE) have historically been deterred from free flap breast reconstruction due to perceived complication risks. Numerous studies examining patients with ESRD have cited free flap complications, including increased incidences of infection and wound breakdown, with some surgeons suggesting ESRD is an independent risk factor for flap failure.¹⁵ Due to perceived risks, autologous breast reconstruction has not been extensively explored as an option in patients with ESRD on hemodialysis with comorbid connective tissue/autoimmune disorders, such as SLE. To the authors' knowledge, there are currently no published reports of successful free flap breast reconstruction in patients with ESRD due to SLE.

Methods: This case report describes a patient requiring hemodialysis for ESRD caused by SLE who underwent left mastectomy and immediate autologous breast reconstruction. Deep inferior epigastric perforator flap technique was employed.

Conclusions: This successful case report suggests the use of free flaps is a feasible option that should be considered for oncologic breast reconstruction in patients with ESRD secondary to SLE who require hemodialysis. The authors believe that further investigation is warranted to evaluate the safety of autologous breast reconstruction as an option for patients with either comorbidity. While ESRD and SLE are not explicit contraindications to free flap reconstruction, careful patient selection and appropriate indication is paramount for immediate surgical and long-term reconstructive success.

Background: An extracellular matrix (ECM) is a network of proteins and other molecules that provide support and structure to cells and tissues in the body. Since its discovery in 1930, researchers have reproduced the ECM through an array of evolving technologies, developing products that accelerate healing times, minimize scarring, and reduce pain. When selecting which ECM product to use, physicians rely on personal experience while considering wound location, type of tissue lost, exposed structures, chronicity, and even the patient's religious preferences. While comparison trials between a few different types of ECMs exist, there lacks a thorough investigation that assesses a majority of ECMs against each other.

Methods: Herein, we conducted a literature review using the PubMed database and utilized 71 articles to identify the best ECM for wound healing and positive patient outcomes. The primary search terms included extracellular matrix, xenograft, porcine, bovine, allograft, bioengineered matrix, acellularized fish skin, wounds, wound healing, and wound care. We did not exclude any specific type of research, but predominantly reviewed clinical trials, case series, and other review articles. We focused on the most popular and commonly used ECMs and constructed our results into the Table.

Results: We compared the indications, advantages, and disadvantages of each ECM and concisely illustrated these findings to provide a guide on how to select an ECM (Table). Allografts, whether they are glycerol or cryopreserved, suffice as a treatment choice and are superior to exposure healing. However, they do not produce healing at the same rate or quality as bioengineered matrices, porcine and bovine xenografts, or acellularized fish skin (AFS). Bioengineered matrices and porcine and bovine xenografts offer antimicrobial properties, low immunogenicity, cost effectiveness, and availability. The compromise with these ECMs is with healing times and cosmesis. Acellularized fish skin (AFS) provides diverse utility, antimicrobial activity, low immunogenicity, faster healing times, and cosmetic superiority. However, AFS yields a potential cost burden and is not plentiful or easily accessible in some parts of the world.

Conclusions: Our findings assist in removing the subjectivity component of selecting an ECM and suggest further comparison or head-to-head trials would yield a more algorithmic approach to wound healing. We suggest to consider implementing the Disabilities of the Arm, Shoulder, and Hand (DASH) score as an additional objective comparison method in these future trials.

Background: Efficient treatment of extensive skin defects by using skin grafting is a significant challenge because the skin available to use is limited. A mesh graft is usually used; however, the expansion ratio is small (up to 1:6) and inaccurate. The Meek technique is a method of skin grafting that processes the skin into micrografts by cutting. The advantage of the Meek technique is its efficient use of available skin, expanding its area by up to 9 times. In 2020, Japanese insurance companies began to cover treatment using the Meek technique. This report aimed to show the usefulness of the Meek technique for treating left leg necrotizing fasciitis.

Methods: A 55-year-old male was referred to our hospital for treating necrotizing fasciitis of the left leg. Debridement was performed, and antibiotics were administered immediately. After 1 month, Meek micrografts were applied to the left knee wound. The expansion ratio of the Meek micrografts was 1:9.

Results: The skin was processed 9 times using the Meek technique, enabling effective use of a small amount of skin. Epithelialization of the Meek micrograft area was completed 1 month after skin grafting. The scar after Meek micrografting was soft and not reddish. The range of motion of the knee joint was >90 degrees.

Conclusions: The Meek technique allows expansion of limited skin efficiently. Meek micrografts can cover a larger wound with smaller skin grafts than is possible with mesh grafts. After healing with Meek micrografts, the scar was soft, and the knee joint flexed smoothly. The Meek technique is useful for treating large wounds requiring skin grafts.

Background: Tissue expansion is an effective option for soft tissue reconstruction of the scalp in the pediatric population. Unfortunately, this approach carries a high risk of such complications as infection and expander exposure. While bacterial infection of alloplastic materials is most frequent, when fungal infections occur, the outcomes can be devastating.

Purpose: To inform the management of fungal tissue expander infections, this report describes a case of expander-based scalp reconstruction complicated by Aspergillus terreus infection in a pediatric patient.

Methods: A patient who had blunt-force head trauma presented with soft tissue injury and depressed skull fracture requiring emergent craniectomy. After stabilization, a paucity of soft tissue coverage required further surgical intervention before reconstructive cranioplasty. Six months after her injury, two remote port subgaleal tissue expanders were placed. Subsequently, purulent drainage developed from the surgical incision.

Results: Infection resulted in expander exposure requiring device removal and treatment with clindamycin and ceftazidime while awaiting culture results. Intraoperative cultures were positive for Aspergillus terreus and methicillin-sensitive Staphylococcus aureus, for which she received systemic voriconazole for 23 days and cephalexin for 10 days.

Conclusions: Though tissue expansion remains a viable reconstructive option, fungal infection can be disastrous, requiring systemic antifungal therapy, surgical debridement, and expander removal.