Pub Date : 2023-12-21eCollection Date: 2023-11-01DOI: 10.1055/s-0042-1756339
Kun Hwang
{"title":"Deep or Shallow, It's up to You.","authors":"Kun Hwang","doi":"10.1055/s-0042-1756339","DOIUrl":"https://doi.org/10.1055/s-0042-1756339","url":null,"abstract":"","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Augmentation mammoplasty is one of the most popular cosmetic surgeries, but there is a high reoperation rate (29.7%) commonly due to capsular contracture, implant malpositioning, infection, and unsatisfactory size. Although infection only accounts for 2% of cases, its management is very challenging, especially with nontuberculous mycobacteria (NTM) infection. Breast prosthetic NTM infection is a rare but is a disastrous condition with an incidence of approximately 0.013%. Immediate salvage reimplantation is usually not suggested, and most studies recommend a gap of 3 to 6 months after combination antibiotics therapy before reimplantation. However, delayed reimplantation often leads to great psychological stress and struggle between the doctor and patient. We present the case report of successful reimplantation in treating prosthetic NTM infections in a 28-year-old female. We discuss a novel technique "transaxillary capsulorrhaphy" to correct the bottoming-out deformity. One year after the combination of antibiotics and surgery, the follow-up computed tomography scan showed complete remission of NTM without recurrence. We discuss the surgical technique in detail. The 1-year follow-up assessment (photos and dynamic video) revealed good cosmesis and reliable correction using the new technique. This report is the first formal description and discussion of one-stage reimplantation following NTM infections. Transaxillary capsulorrhaphy allows for a successful salvage operation when an implant is displaced. This approach provides highly favorable result in eastern women undergoing revision augmentation mammoplasty. This study reflects level of evidence V, considering opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
{"title":"Transaxillary Capsulorrhaphy with Reimplantation to Correct Bottoming-Out Deformity in Breast Mycobacterial Periprosthetic Infection: A Case Report with Literature Review.","authors":"Tsung-Chun Huang, Jian-Jr Lee, Kuo-Hui Yang, Chia-Huei Chou, Yu-Chen Chang","doi":"10.1055/a-2119-3835","DOIUrl":"10.1055/a-2119-3835","url":null,"abstract":"<p><p>Augmentation mammoplasty is one of the most popular cosmetic surgeries, but there is a high reoperation rate (29.7%) commonly due to capsular contracture, implant malpositioning, infection, and unsatisfactory size. Although infection only accounts for 2% of cases, its management is very challenging, especially with nontuberculous mycobacteria (NTM) infection. Breast prosthetic NTM infection is a rare but is a disastrous condition with an incidence of approximately 0.013%. Immediate salvage reimplantation is usually not suggested, and most studies recommend a gap of 3 to 6 months after combination antibiotics therapy before reimplantation. However, delayed reimplantation often leads to great psychological stress and struggle between the doctor and patient. We present the case report of successful reimplantation in treating prosthetic NTM infections in a 28-year-old female. We discuss a novel technique \"transaxillary capsulorrhaphy\" to correct the bottoming-out deformity. One year after the combination of antibiotics and surgery, the follow-up computed tomography scan showed complete remission of NTM without recurrence. We discuss the surgical technique in detail. The 1-year follow-up assessment (photos and dynamic video) revealed good cosmesis and reliable correction using the new technique. This report is the first formal description and discussion of one-stage reimplantation following NTM infections. Transaxillary capsulorrhaphy allows for a successful salvage operation when an implant is displaced. This approach provides highly favorable result in eastern women undergoing revision augmentation mammoplasty. This study reflects level of evidence V, considering opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41394267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01eCollection Date: 2023-11-01DOI: 10.1055/s-0043-1772586
Yavuz Tuluy, Zülfükar Ulaş Bali, Merve Özkaya Ünsal, Aziz Parspancı, Levent Yoleri, Çağla Çiçek, Gaye Taylan Filinte
Background The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses. Methods This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study. Results Mean age was 50.2 (range, 16-75) years and mean BMI was 24.68 ± 4.02 (range, 16.5-34.7) kg/m 2 . The subfascial flap thickness was significantly thinner in male patients (16.07 ± 2.77 mm) than in female patients (24.07 ± 3.93 mm; p < 0.05), whereas no significant difference was found between male (4.28 ± 1.15 mm) and female patients (4.85 ± 1.09 mm) regarding superficial fat flap thickness ( p = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients ( r = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later. Conclusion The appropriate ALT flap plane should be selected considering the gender and BMI of the patient.
背景 大腿前外侧(ALT)皮瓣是重建各种缺损的首选方法,可用于多种组织成分和厚度的重建。方法 本研究旨在探讨传统筋膜下 ALT 皮瓣和浅层脂肪皮瓣的厚度与年龄、性别和体重指数(BMI)的相关性。研究共纳入 42 名患者(28 名男性和 14 名女性)。结果 平均年龄为 50.2 岁(范围在 16-75 岁之间),平均体重指数为 24.68 ± 4.02(范围在 16.5-34.7 公斤/米 2 之间)。男性患者的筋膜下皮瓣厚度(16.07 ± 2.77 mm)明显薄于女性患者(24.07 ± 3.93 mm; p p = 0.13)。两种皮瓣的厚度与体重指数呈正相关,女性患者筋膜下 ALT 厚度的相关性最强(r = 0.81)。年龄对皮瓣厚度的测量没有影响。女性的大腿前侧比男性更厚,尽管这与体重指数有关。这表明皮瓣在超薄平面的抬高非常重要,尤其是如果女性患者希望使用 ALT 皮瓣进行缺损重建时皮瓣更薄。因此,单阶段重建无需在筋膜下剥离后进行脱脂手术,也无需在 3 至 6 个月后进行第二次脱脂手术。结论 应根据患者的性别和体重指数选择合适的 ALT 皮瓣平面。
{"title":"Comparison of The Thickness of Free Anterolateral Thigh Flap in Different Fascial Planes: Clinical Results of Subfascial and Superficial Fat Flap.","authors":"Yavuz Tuluy, Zülfükar Ulaş Bali, Merve Özkaya Ünsal, Aziz Parspancı, Levent Yoleri, Çağla Çiçek, Gaye Taylan Filinte","doi":"10.1055/s-0043-1772586","DOIUrl":"https://doi.org/10.1055/s-0043-1772586","url":null,"abstract":"<p><p><b>Background</b> The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses. <b>Methods</b> This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study. <b>Results</b> Mean age was 50.2 (range, 16-75) years and mean BMI was 24.68 ± 4.02 (range, 16.5-34.7) kg/m <sup>2</sup> . The subfascial flap thickness was significantly thinner in male patients (16.07 ± 2.77 mm) than in female patients (24.07 ± 3.93 mm; <i>p</i> < 0.05), whereas no significant difference was found between male (4.28 ± 1.15 mm) and female patients (4.85 ± 1.09 mm) regarding superficial fat flap thickness ( <i>p</i> = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients ( <i>r</i> = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later. <b>Conclusion</b> The appropriate ALT flap plane should be selected considering the gender and BMI of the patient.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Massive localized lymphedema (MLL) is a rare disease caused by the obstruction of lymphatic vessels with specific clinical morphological and radiological characteristics. People with morbid obesity are mainly affected by MLL. Lymphedema is easily confused with soft tissue sarcoma and requires differential diagnosis, both the possibility of an MLL and also carcinoma manifestations in the soft tissues. The possible causes of massive lymphedema include trauma, surgery, and hypothyroidism. This report is the first case of MLL treated surgically in the Russian Federation. Detailed computed tomography (CT) characteristics and an electron microscope picture of MLL are discussed. A 50-year-old woman (body mass index of 43 kg/m 2 ) with MLL arising from the anterior abdominal wall was admitted to the hospital for surgical treatment. Its mass was 22.16 kg. A morphological study of the resected mass confirmed the diagnosis of MLL. We review etiology, clinical presentation, diagnosis, and treatment of MLL. We also performed an electron-microscopic study that revealed interstitial Cajal-like cells telocytes not previously described in MLL cases. We did not find similar findings in the literature. It is possible that the conduction of an ultrastructural examination of MLL tissue samples will further contribute to the understanding of MLL pathogenesis.
{"title":"Massive Localized Abdominal Lymphedema: A Case Report with Literature Review.","authors":"Badri Gogia, Irina Chekmareva, Anastasiia Leonova, Rifat Alyautdinov, Grigory Karmazanovsky, Andrey Glotov, Dmitry Kalinin","doi":"10.1055/a-2140-8589","DOIUrl":"10.1055/a-2140-8589","url":null,"abstract":"<p><p>Massive localized lymphedema (MLL) is a rare disease caused by the obstruction of lymphatic vessels with specific clinical morphological and radiological characteristics. People with morbid obesity are mainly affected by MLL. Lymphedema is easily confused with soft tissue sarcoma and requires differential diagnosis, both the possibility of an MLL and also carcinoma manifestations in the soft tissues. The possible causes of massive lymphedema include trauma, surgery, and hypothyroidism. This report is the first case of MLL treated surgically in the Russian Federation. Detailed computed tomography (CT) characteristics and an electron microscope picture of MLL are discussed. A 50-year-old woman (body mass index of 43 kg/m <sup>2</sup> ) with MLL arising from the anterior abdominal wall was admitted to the hospital for surgical treatment. Its mass was 22.16 kg. A morphological study of the resected mass confirmed the diagnosis of MLL. We review etiology, clinical presentation, diagnosis, and treatment of MLL. We also performed an electron-microscopic study that revealed interstitial Cajal-like cells telocytes not previously described in MLL cases. We did not find similar findings in the literature. It is possible that the conduction of an ultrastructural examination of MLL tissue samples will further contribute to the understanding of MLL pathogenesis.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57823338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30eCollection Date: 2023-11-01DOI: 10.1055/a-2130-2113
Wei F Chen, Ying C Ku, Takumi Yamamoto, Sonia K Pandey
{"title":"Is Lymphedema Cure a Clinical Reality?","authors":"Wei F Chen, Ying C Ku, Takumi Yamamoto, Sonia K Pandey","doi":"10.1055/a-2130-2113","DOIUrl":"10.1055/a-2130-2113","url":null,"abstract":"","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41258790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30eCollection Date: 2023-11-01DOI: 10.1055/s-0043-1772587
Martin Morales-Olivera, Erik Hanson-Viana, Armando Rodríguez-Segura, Marco A Rendón-Medina
Background Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. Methods This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. Results We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m 2 ; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. Conclusion Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.
{"title":"Abdominal Hypertension after Abdominal Plication in Postbariatric Patients: The Consequence in the Postoperative Recovery.","authors":"Martin Morales-Olivera, Erik Hanson-Viana, Armando Rodríguez-Segura, Marco A Rendón-Medina","doi":"10.1055/s-0043-1772587","DOIUrl":"https://doi.org/10.1055/s-0043-1772587","url":null,"abstract":"<p><p><b>Background</b> Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. <b>Methods</b> This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. <b>Results</b> We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m <sup>2</sup> ; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. <b>Conclusion</b> Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30eCollection Date: 2023-11-01DOI: 10.1055/a-2121-7560
Horacio F Mayer, René M Palacios Huatuco, Mariano F Ramírez, Ignacio T Piedra Buena
Blunt breast trauma occurs in 2% of blunt chest injuries. This study aimed to evaluate the evidence on breast reconstruction after blunt trauma associated with the use of a seat belt. Also, we describe the first case of breast reconstruction using the Ribeiro technique. In November 2022, a systematic search of MEDLINE, EMBASE, and Google Scholar databases was conducted. The literature was screened independently by two reviewers, and the data was extracted. Our search terms included breast, mammoplasty, blunt injury, and seat belts. In addition, we present the case of a woman with a left breast deformity and her reconstruction using the inferior Ribeiro flap technique. Six articles were included. All included studies were published between 2010 and 2021. The studies recruited seven patients. According to the Teo and Song classification, seven class 2b cases were reported. In five cases a breast reduction was performed in the deformed breast with different types of pedicles (three superomedial flaps, one lower flap, one superior flap). Only one case presented complications. The case here presented was a type 2b breast deformity in which the lower Ribeiro pedicle was used successfully without complications during follow-up. Until now there has been no consensus on reconstructive treatment due to the rarity of this entity. However, we must consider surgical treatment individually for each patient. We believe that the Ribeiro technique is a feasible and safe alternative in the treatment of posttraumatic breast deformities, offering very good long-term results.
{"title":"Breast Reconstruction after Blunt Breast Trauma: Systematic Review and Case Report Using the Ribeiro Technique.","authors":"Horacio F Mayer, René M Palacios Huatuco, Mariano F Ramírez, Ignacio T Piedra Buena","doi":"10.1055/a-2121-7560","DOIUrl":"10.1055/a-2121-7560","url":null,"abstract":"<p><p>Blunt breast trauma occurs in 2% of blunt chest injuries. This study aimed to evaluate the evidence on breast reconstruction after blunt trauma associated with the use of a seat belt. Also, we describe the first case of breast reconstruction using the Ribeiro technique. In November 2022, a systematic search of MEDLINE, EMBASE, and Google Scholar databases was conducted. The literature was screened independently by two reviewers, and the data was extracted. Our search terms included breast, mammoplasty, blunt injury, and seat belts. In addition, we present the case of a woman with a left breast deformity and her reconstruction using the inferior Ribeiro flap technique. Six articles were included. All included studies were published between 2010 and 2021. The studies recruited seven patients. According to the Teo and Song classification, seven class 2b cases were reported. In five cases a breast reduction was performed in the deformed breast with different types of pedicles (three superomedial flaps, one lower flap, one superior flap). Only one case presented complications. The case here presented was a type 2b breast deformity in which the lower Ribeiro pedicle was used successfully without complications during follow-up. Until now there has been no consensus on reconstructive treatment due to the rarity of this entity. However, we must consider surgical treatment individually for each patient. We believe that the Ribeiro technique is a feasible and safe alternative in the treatment of posttraumatic breast deformities, offering very good long-term results.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47631286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30eCollection Date: 2023-11-01DOI: 10.1055/a-2125-7322
Da Hye Ryu, Oh Young Joo, Yun Ho Roh, Eun Jung Yang, Seung Yong Song, Dong Won Lee
Background Despite its many advantages, prepectoral breast reconstruction also carries the risk of implant rippling. The recent introduction of partial superior implant coverage using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction has shown the potential to minimize upper pole rippling. The purpose of this study was to identify factors associated with rippling and the effectiveness of our surgical technique. Methods In total, 156 patients (186 breasts) who underwent prepectoral DTI breast reconstruction between August 2019 and March 2021 were identified retrospectively. Patient data were analyzed from medical records. Univariable and multivariable logistic analyses were performed to contextualize the risks associated with rippling deformity relative to demographic characteristics and other clinical factors. Retrospective propensity-matched analysis was performed to identify the relationship between rippling deformity and the reconstruction method. Results Patients with body mass index (BMI; odds ratio [OR], 0.736; p < 0.001), those with a postoperative chemotherapy history (OR, 0.324; p = 0.027) and those who received breast reconstruction via the superior coverage technique (OR, 0.2; p = 0.004), were less likely to develop rippling deformity. The median follow-up period was 64.9 weeks, and there were no significant differences between patients in types of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior coverage technique-based reconstruction showed significantly reduced rippling (OR, 0.083; p = 0.017) Conclusion Patients with higher BMI and prior postoperative chemotherapy were less likely to develop rippling deformity. The superior coverage technique can be effective in minimizing upper pole rippling.
{"title":"Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction.","authors":"Da Hye Ryu, Oh Young Joo, Yun Ho Roh, Eun Jung Yang, Seung Yong Song, Dong Won Lee","doi":"10.1055/a-2125-7322","DOIUrl":"10.1055/a-2125-7322","url":null,"abstract":"<p><p><b>Background</b> Despite its many advantages, prepectoral breast reconstruction also carries the risk of implant rippling. The recent introduction of partial superior implant coverage using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction has shown the potential to minimize upper pole rippling. The purpose of this study was to identify factors associated with rippling and the effectiveness of our surgical technique. <b>Methods</b> In total, 156 patients (186 breasts) who underwent prepectoral DTI breast reconstruction between August 2019 and March 2021 were identified retrospectively. Patient data were analyzed from medical records. Univariable and multivariable logistic analyses were performed to contextualize the risks associated with rippling deformity relative to demographic characteristics and other clinical factors. Retrospective propensity-matched analysis was performed to identify the relationship between rippling deformity and the reconstruction method. <b>Results</b> Patients with body mass index (BMI; odds ratio [OR], 0.736; <i>p</i> < 0.001), those with a postoperative chemotherapy history (OR, 0.324; <i>p</i> = 0.027) and those who received breast reconstruction via the superior coverage technique (OR, 0.2; <i>p</i> = 0.004), were less likely to develop rippling deformity. The median follow-up period was 64.9 weeks, and there were no significant differences between patients in types of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior coverage technique-based reconstruction showed significantly reduced rippling (OR, 0.083; <i>p</i> = 0.017) <b>Conclusion</b> Patients with higher BMI and prior postoperative chemotherapy were less likely to develop rippling deformity. The superior coverage technique can be effective in minimizing upper pole rippling.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10736204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48609491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kearns Sayre syndrome (KSS) is a rare mitochondrial disease that affects young adults, due to a deletion of mitochondrial DNA and characterized by the triad: age of onset lower than 20 years, chronic progressive external ophthalmoplegia and an atypical pigmentary retinopathy. It’s also characterized by other endocrine, neurological and especially cardiac impairment with a very high risk of cardiac complications during surgical procedures under all types of anesthesia. We report a case of KSS revealed by sever bilateral ptosis and confirmed by a muscle biopsy with “ragged red fibers”. The ptosis was surgically managed by cautious Frontal suspension under local anesthesia “Frontal nerve block”. Through this case we discuss challenges in the management of KSS patients.
{"title":"Management of ptosis in Kearns Sayre syndrome (KSS): a case report and Literature review on Management of ptosis in KSS","authors":"MOULAY OMAR MOUSTAINE, Zakaria Azmour, Mohamed Frarrchi, Othman Benenda, Hicham Nassik, Mahdi Karkouri","doi":"10.1055/a-2207-7587","DOIUrl":"https://doi.org/10.1055/a-2207-7587","url":null,"abstract":"Kearns Sayre syndrome (KSS) is a rare mitochondrial disease that affects young adults, due to a deletion of mitochondrial DNA and characterized by the triad: age of onset lower than 20 years, chronic progressive external ophthalmoplegia and an atypical pigmentary retinopathy. It’s also characterized by other endocrine, neurological and especially cardiac impairment with a very high risk of cardiac complications during surgical procedures under all types of anesthesia. We report a case of KSS revealed by sever bilateral ptosis and confirmed by a muscle biopsy with “ragged red fibers”. The ptosis was surgically managed by cautious Frontal suspension under local anesthesia “Frontal nerve block”. Through this case we discuss challenges in the management of KSS patients.","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135291321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven Zeng, Gloria Zhang, Denisse Fimbres, Caitrin Curtis, Adam Glener, Andres J Hernandez, William Tian, Emmanuel O Emovon, Brett Phillips
BACKGROUND Applying into plastic surgery is competitive. Lacking a home residency program (HRP) is another barrier. Our goal is to characterize challenges faced by plastic surgery (PS) applicants without HRPs and identify solutions. METHODS Surveys were designed for current integrated PS residents and applicants in the 2022 Match without HRPs. Surveys were distributed electronically. Only U.S. allopathic graduate responses were included. RESULTS Of 182 individuals surveyed, 74 responded (39%, 33-residents, 41-applicants). Sixty-six percent reported feeling disadvantaged due to lacking an HRP. 76% of applicants successfully matched. Of these, 48% felt they required academic time off (research year) vs 10% of unmatched applicants. 97% of matched applicants identified a mentor vs 40% of unmatched applicants (p<0.05). Matched applicants identified mentors through research (29%) and cold calling/emailing (25%). Matched vs unmatched applicants utilized the following resources: senior students (74vs10%), (p<0.05) and social media (52vs10%), (p<0.05). Among residents, sixteen had PS divisions (48%). Thirty-six percent with divisions felt they had opportunities to explore PS, compared to 12% without divisions. Residents without divisions felt disadvantaged in finding research (94vs65%, p<0.05), delayed in deciding on PS (50vs28%), and obtaining mentors (44vs35%) and letters of recommendation (LOR) (31vs24%). CONCLUSIONS PS residents and applicants without HRPs reported feeling disadvantaged when matching. The data suggest access to departments or divisions assists in matching. We identified external outreach and research were successful strategies to obtain mentorship. To increase awareness for unaffiliated applicants, we should increase networking opportunities during local, regional, and national meetings.
{"title":"Identifying Barriers Faced by Applicants without a Home Residency Program when Matching into Plastic Surgery","authors":"Steven Zeng, Gloria Zhang, Denisse Fimbres, Caitrin Curtis, Adam Glener, Andres J Hernandez, William Tian, Emmanuel O Emovon, Brett Phillips","doi":"10.1055/a-2202-9219","DOIUrl":"https://doi.org/10.1055/a-2202-9219","url":null,"abstract":"BACKGROUND Applying into plastic surgery is competitive. Lacking a home residency program (HRP) is another barrier. Our goal is to characterize challenges faced by plastic surgery (PS) applicants without HRPs and identify solutions. METHODS Surveys were designed for current integrated PS residents and applicants in the 2022 Match without HRPs. Surveys were distributed electronically. Only U.S. allopathic graduate responses were included. RESULTS Of 182 individuals surveyed, 74 responded (39%, 33-residents, 41-applicants). Sixty-six percent reported feeling disadvantaged due to lacking an HRP. 76% of applicants successfully matched. Of these, 48% felt they required academic time off (research year) vs 10% of unmatched applicants. 97% of matched applicants identified a mentor vs 40% of unmatched applicants (p<0.05). Matched applicants identified mentors through research (29%) and cold calling/emailing (25%). Matched vs unmatched applicants utilized the following resources: senior students (74vs10%), (p<0.05) and social media (52vs10%), (p<0.05). Among residents, sixteen had PS divisions (48%). Thirty-six percent with divisions felt they had opportunities to explore PS, compared to 12% without divisions. Residents without divisions felt disadvantaged in finding research (94vs65%, p<0.05), delayed in deciding on PS (50vs28%), and obtaining mentors (44vs35%) and letters of recommendation (LOR) (31vs24%). CONCLUSIONS PS residents and applicants without HRPs reported feeling disadvantaged when matching. The data suggest access to departments or divisions assists in matching. We identified external outreach and research were successful strategies to obtain mentorship. To increase awareness for unaffiliated applicants, we should increase networking opportunities during local, regional, and national meetings.","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135972910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}