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Maintaining Functionality in Temporal Skin Tumor Surgery: A Focus on Nerve Injury and Excision Margins 保持颞部皮肤肿瘤手术的功能:关注神经损伤和切除边缘
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005642
Firas Al-Aswad, O. Fernandez-Diaz, Mohamed Abdelrazek, Mutaz Al Naser
Background: Operating on temporal cutaneous tumors is challenging because of the intricate facial nerve system, particularly the frontal branches, and the possibility of brow dysfunction. Surgery for deep margin clearance is difficult because of the fragile and sensitive soft tissue in the temporal region. To address this research gap, this study assessed clearance margins, types of skin tumors, and nerve injuries in this critical anatomical position. This retrospective study assessed temporal skin cancer surgery, malignancy types, and clearance margins in patients with frontal-branch facial nerve injuries. Methods: Forty-five patients with temporal skin carcinoma biopsies were analyzed. The deep and peripheral excision margins of skin malignancies were examined. Medical records were reviewed for clinically injured frontal nerve. Results: Thirty-four patients were men (75%), and basal cell carcinoma was the most prevalent histological malignancy, followed by squamous cell carcinoma. The mean age of the patients was 77.8 years (39–107 years). Two patients experienced damage to the frontal branch nerve. Twenty-six percent of the skin malignancies had inadequate deep margin excision. Conclusions: Removing temporal skin lesions is difficult. We discovered a 26% and 4% probability of inadequate deep margin excision and frontal branch facial nerve injury, respectively. Temporal skin lesions must be removed safely by surgeons to preserve the branches of the facial nerves. Insufficiently removed tumors require multidisciplinary teamwork and patient discussions regarding the advantages and risks to improve results.
背景:对颞部皮肤肿瘤进行手术具有挑战性,因为面部神经系统错综复杂,尤其是额部分支,而且可能出现眉部功能障碍。由于颞部软组织脆弱而敏感,因此很难进行深部边缘清除手术。针对这一研究空白,本研究评估了这一关键解剖位置的清创边缘、皮肤肿瘤类型和神经损伤情况。这项回顾性研究评估了额支面神经损伤患者的颞部皮肤癌手术、恶性肿瘤类型和切除范围。研究方法对 45 例颞部皮肤癌活检患者进行了分析。检查了皮肤恶性肿瘤的深部和周边切除边缘。审查了临床额神经损伤的病历。结果34名患者为男性(75%),基底细胞癌是最常见的组织学恶性肿瘤,其次是鳞状细胞癌。患者的平均年龄为 77.8 岁(39-107 岁)。两名患者的额支神经受到损伤。26%的皮肤恶性肿瘤切除深度不够。结论:切除颞部皮肤病变非常困难。我们发现深缘切除不充分和额支面神经损伤的概率分别为 26% 和 4%。外科医生必须安全地切除颞部皮损,以保留面神经分支。切除不充分的肿瘤需要多学科团队合作,并与患者讨论其优势和风险,以提高手术效果。
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引用次数: 0
Safety and Outcomes in Multiplane Facial Rejuvenation with Tranexamic Acid: A Cohort Study 使用氨甲环酸进行多平面面部年轻化的安全性和效果:队列研究
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005653
O. R. Ziegler Rodríguez, Gabriel De la Cruz Ku, Marcelo Chávez Díaz, Gonzalo Javier Ziegler Rodríguez, Otto Enrique Ziegler Gutiérrez
Background: Tranexamic acid (TXA) has demonstrated promising outcomes in plastic surgery. Our aim was to assess the effect of TXA in intraoperative bleeding, operative time, and complications among patients undergoing facial surgical procedures. Methods: A retrospective cohort study of patients who underwent multiplane facial rhytidectomy from January 2018 to September 2022 at the Clinica Ziegler, Lima, Peru. Patients were divided into two groups according to the use of intravenous plus local infiltration of TXA. We performed the chi square test to assess associations among categorical variables, the Student t test and Mann–Whitney U test for categorical with continuous variables, and Pearson correlation for quantitative variables. Results: A total of 100 patients were included with 50 patients in each group. The median age was 59.5 years and the majority were women (88%). The median operative time was 288.5 minutes. The TXA group presented less intraoperative bleeding (40 versus 90 mL, P < 0.05) and shorter operative time (237 versus 353 minutes, P < 0.05); no differences in the development of hematoma (2% versus 12%, P = 0.11), less ecchymosis (2% versus 36%, P < 0.05), edema (2% versus 100%, P < 0.05), and time to drain removal (3 versus 6 days, P < 0.05). Conclusions: TXA improves the short- and long-term outcomes of patients who undergo multiplane facial rhytidectomy. It also decreases intraoperative bleeding by more than half and reduces the operative time by one third. Moreover, patients receiving TXA presented significantly less ecchymosis, edema, and time to drain removal.
背景:氨甲环酸(TXA)在整形手术中显示出良好的效果。我们的目的是评估氨甲环酸对面部手术患者术中出血、手术时间和并发症的影响。研究方法对2018年1月至2022年9月期间在秘鲁利马齐格勒诊所接受多平面面部皱襞切除术的患者进行回顾性队列研究。根据静脉注射和局部浸润 TXA 的使用情况,将患者分为两组。我们对分类变量之间的关联性进行了卡方检验,对分类变量和连续变量进行了Student t检验和Mann-Whitney U检验,对定量变量进行了皮尔逊相关检验。结果共纳入 100 名患者,每组 50 人。中位年龄为 59.5 岁,大多数为女性(88%)。手术时间中位数为 288.5 分钟。TXA组术中出血较少(40毫升对90毫升,P<0.05),手术时间较短(237分钟对353分钟,P<0.05);血肿发生率(2%对12%,P=0.11)、瘀斑(2%对36%,P<0.05)、水肿(2%对100%,P<0.05)和引流管拔除时间(3天对6天,P<0.05)无差异。结论:TXA能改善多平面面部皱襞切除术患者的短期和长期疗效。它还能将术中出血减少一半以上,将手术时间缩短三分之一。此外,使用 TXA 的患者瘀斑、水肿和移除引流管的时间都明显减少。
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引用次数: 0
Effective Collaboration in the Surgical Management of Macroglossia in Beckwith–Wiedemann Syndrome 贝克维特-韦德曼综合征巨舌症手术治疗中的有效合作
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005635
Alhanouf Binhezaim, Abdullah A Al Qurashi, Sami Alissa, Ibtesam A. Alyazeedi
Summary: Beckwith–Wiedemann syndrome (BWS) is a complex congenital overgrowth disorder necessitating a multidisciplinary approach for effective management. A 5-year-old Saudi girl with BWS received comprehensive care involving various specialists, including a plastic surgeon who performed a keyhole technique tongue reduction to address macroglossia. The intervention resulted in significant improvements in speech and quality of life, with no postoperative complications. Intensive speech therapy further enhanced speech development. This case report emphasizes the importance of a multidisciplinary approach and the critical role of the plastic surgeon in managing BWS patients with macroglossia to achieve optimal outcomes.
摘要:贝克维茨-韦德曼综合征(BWS)是一种复杂的先天性发育过度症,需要采用多学科方法进行有效治疗。一名患有贝克维德曼综合征的 5 岁沙特女孩接受了多位专家的综合治疗,其中包括一名整形外科医生。手术后,她的语言能力和生活质量都有了明显改善,而且没有出现术后并发症。强化言语治疗进一步促进了患者的言语发育。本病例报告强调了多学科方法的重要性,以及整形外科医生在管理巨舌症 BWS 患者以获得最佳治疗效果方面的关键作用。
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引用次数: 0
Repair of an Occipital Meningocele and Scalp Soft-tissue Reconstruction in a Newborn Patient 修复一名新生儿的枕骨脑膜瘤并重建头皮软组织
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005663
Jonathan D. Freedman, Michael B. Gehring, Brent R. O’Neill, Brooke M. French, David Y. Khechoyan
Summary: The differential diagnosis of large congenital scalp defects includes aplasia cutis and encephalocele, among others. Treatment includes conservative management with dressings or operative management with dermal substitutes, skin grafting, local flaps, and free flaps. This case report discusses the technical considerations and reconstructive strategies for repair of a meningocele in a newborn with a large 5.5-cm scalp defect. The key strategies include preemptive cerebrospinal fluid (CSF) diversion with external ventricular drain to reduce the risk of CSF leak and mitigate wound-healing complications; careful identification and avoidance of key anatomic structures, such as the superior sagittal sinus, as anatomy may be significantly distorted due to the presence of a meningocele and after CSF diversion; and careful, thoughtful design of the local scalp flaps to maximize blood supply and to avoid tension on the final reconstruction.
摘要:先天性头皮大面积缺损的鉴别诊断包括切口增生症和颅脑损伤等。治疗方法包括使用敷料进行保守治疗,或使用真皮替代物、植皮、局部皮瓣和游离皮瓣进行手术治疗。本病例报告讨论了新生儿脑膜缺损修复的技术注意事项和重建策略,该新生儿头皮缺损面积达 5.5 厘米。主要策略包括:通过脑室外引流进行先期脑脊液(CSF)转流,以降低CSF漏的风险并减轻伤口愈合并发症;仔细识别并避开关键解剖结构,如上矢状窦,因为脑膜囊的存在和CSF转流后解剖结构可能会发生明显扭曲;仔细、周到地设计局部头皮皮瓣,以最大限度地增加血液供应并避免对最终重建造成张力。
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引用次数: 0
Intraoperative Cardiac Arrest During Liposuction: A Case Report 吸脂术中的术中心脏骤停:病例报告
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005619
Lu Shu, Jian Zhou, Xue He
Background: With the popularity of liposuction surgery, more awareness should be obtained regarding complications. Liposuction has been thought of as a safe procedure with a very low incidence of major complications. However, life-threatening risks of liposuction have rarely been reported. Methods: We present a case of a 36-year-old woman who developed cardiac arrest during a liposuction procedure, and we present a literature review. Results: She was previously healthy and had no risk factors for pulmonary embolism. The diagnosis was made based on clinical presentation and the presence of an electrolyte disorder and a positive sign on computed tomography pulmonary angiogram (CTPA). Mild hypothermia treatment, symptomatic treatment, and supportive therapy were applied. As the respiratory and circulation were smooth, she was discharged to a rehabilitation hospital. Seven months after discharge, the patient was still in a coma with eye opening. Conclusions: Spinal anesthesia, pulmonary embolism, and hyperkalemia are the most probable contributors to the cardiac arrest observed during the liposuction procedure in this specific case. There is a heightened imperative to vigilantly monitor for critical incidents during these operations and to meticulously identify associated risk factors during liposuction.
背景:随着吸脂手术的普及,人们应该对并发症有更多的了解。吸脂手术一直被认为是一种安全的手术,主要并发症的发生率非常低。然而,很少有报道称抽脂手术存在危及生命的风险。方法:我们介绍了一例在吸脂过程中发生心脏骤停的 36 岁女性病例,并对文献进行了回顾。结果她之前身体健康,没有肺栓塞的危险因素。诊断依据是临床表现、电解质紊乱和计算机断层扫描肺血管造影(CTPA)阳性体征。患者接受了轻度低温治疗、对症治疗和支持疗法。由于呼吸和循环顺畅,她被送往康复医院。出院七个月后,患者仍处于睁眼昏迷状态。结论在这个特殊病例中,脊椎麻醉、肺栓塞和高钾血症最有可能导致吸脂过程中的心脏骤停。在这些操作过程中,必须高度警惕危急事件的发生,并仔细识别吸脂过程中的相关风险因素。
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引用次数: 0
Three Useful Tips and Tricks for Intraoperative Nerve Stimulation 术中神经刺激的三个实用提示和技巧
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005640
Wen-Chih Liu, Floris V. Raasveld, Maximilian Mayrhofer-Schmid, K. Eberlin, Ian L. Valerio
Summary: Disposable handheld nerve stimulators are widely used in peripheral nerve surgery. Such devices stimulate a motor nerve or the motor component of a mixed nerve by applying electrical current to the proximal region, targeting the main nerve trunk. This stimulation then travels along the motor nerve, reaching the distal end to control the corresponding muscle(s). In this study, the authors demonstrate three useful tips and tricks for handheld nerve stimulation during targeted muscle reinnervation and peripheral nerve surgery. The three tips are (1) identification of proximal muscle contraction by retrograde electrical stimulation of a distal sensory nerve; (2) graded stimulation for identifying motor nerves within fibrotic scarred tissue beds or parallel to the major motor/mixed nerve of interest; and (3) proximal stimulation for validation of adequate post-targeted muscle reinnervation coaptation(s).
摘要:一次性手持神经刺激器广泛应用于周围神经手术。这类设备通过向近端区域施加电流,以神经主干为目标,刺激运动神经或混合神经的运动部分。然后,刺激沿着运动神经到达远端,控制相应的肌肉。在这项研究中,作者展示了在靶向肌肉神经再支配和周围神经手术中进行手持神经刺激的三个有用技巧和窍门。这三个技巧是:(1)通过逆行电刺激远端感觉神经来识别近端肌肉收缩;(2)分级刺激,以识别纤维化瘢痕组织床内的运动神经或与主要运动/混合神经平行的运动神经;以及(3)近端刺激,以验证靶向肌肉再支配术后是否有足够的接合。
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引用次数: 0
Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome 隔室综合症当代诊断与管理实用评论
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005637
Amelia L. Davidson, Mason A. Sutherland, Robert C. Siska, Jeffrey E. Janis
Summary: Acute compartment syndrome (ACS) is a limb-threatening pathology that necessitates early detection and management. The diagnosis of ACS is often made by physical examination alone; however, supplemental methods such as compartment pressure measurement, infrared spectroscopy, and ultrasound can provide additional information that support decision-making. This practical review aims to incorporate and summarize recent studies to provide evidence-based approaches to compartment syndrome for both resource-rich and -poor settings among several patient populations.
摘要:急性腔室综合征(ACS)是一种危及肢体的病理现象,必须及早发现和处理。通常仅通过体格检查就能诊断出急性肢体隔室综合征;然而,隔室压力测量、红外光谱和超声波等辅助方法可提供更多信息,为决策提供支持。这篇实用综述旨在纳入和总结近期的研究,为资源丰富和资源匮乏的环境中的多个患者群体提供以证据为基础的隔室综合征治疗方法。
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引用次数: 0
Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids 瘢痕疙瘩区域内切除术可减少复发:对 608 例瘢痕疙瘩现有文献的元分析研究
Pub Date : 2024-03-01 DOI: 10.1097/GOX.0000000000005652
Nathan Lawera, Jules L. Madzia, Liann C. Casey, Rodney L. Guyton, Kiersten C. Woodyard De Brito, Alexandra Kinzer, R. Ulma, Brian S. Pan, A. Schwentker, Angelo A. Leto Barone
Background: The objective of this meta-analysis was to examine the effectiveness of keloid intralesional excision (KILE) in preventing recurrence. Treatment of keloids using surgical excision alone leads to high rates of recurrence. To date, there are no widely accepted guidelines for keloid treatment, and a multitude of adjunctive therapies are used to reduce recurrence. Despite these efforts, recurrence remains high. In this study, we conducted a meta-analysis of the existing literature on KILE to determine its role in recurrence reduction. Methods: A literature review using PubMed, Scopus, and Web of Science databases was performed. Two authors independently evaluated studies for eligibility. Incidence of keloid recurrence was recorded, and a comprehensive meta-analysis was performed to assess the pooled keloid recurrence rate, as well as the effect of additional therapies. Results: Twenty-two studies evaluating intralesional excision of 608 keloids were included in the study. Average time to follow-up was 19.2 months (range 6–35 months). A meta-analysis of proportions was conducted, demonstrating a pooled recurrence rate of 13% (95% confidence interval, 9%–16%). There was no evidence that using therapies in addition to KILE had a significant effect on the overall pooled recurrence rate. Conclusions: A meta-analysis of 608 keloids shows that KILE is an effective technique in preventing keloid recurrence, with a pooled recurrence rate of 13% compared with previously reported rates of 45%–100% after complete excision. Although there are no standard guidelines for keloid treatment, our meta-analysis shows that KILE is promising in recurrence reduction.
背景:本荟萃分析旨在研究瘢痕疙瘩内部切除术(KILE)在预防复发方面的有效性。单纯使用手术切除治疗瘢痕疙瘩会导致很高的复发率。迄今为止,瘢痕疙瘩的治疗还没有得到广泛认可的指南,许多辅助疗法被用来减少复发。尽管如此,复发率仍然很高。在本研究中,我们对有关 KILE 的现有文献进行了荟萃分析,以确定其在减少复发方面的作用。研究方法使用 PubMed、Scopus 和 Web of Science 数据库进行文献综述。两位作者独立评估了研究的资格。记录瘢痕疙瘩复发率,并进行综合荟萃分析以评估瘢痕疙瘩复发率以及其他疗法的效果。结果:22项研究评估了608个瘢痕疙瘩的区域内切除术。平均随访时间为 19.2 个月(6-35 个月)。研究对比例进行了荟萃分析,结果显示总复发率为13%(95%置信区间,9%-16%)。没有证据表明,在 KILE 之外使用其他疗法会对总复发率产生显著影响。结论对 608 例瘢痕疙瘩进行的荟萃分析表明,KILE 是预防瘢痕疙瘩复发的有效技术,与之前报道的完全切除后 45%-100% 的复发率相比,KILE 的总复发率为 13%。虽然目前还没有瘢痕疙瘩治疗的标准指南,但我们的荟萃分析表明,KILE在减少复发方面大有可为。
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引用次数: 0
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Plastic and Reconstructive Surgery Global Open
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