Eplasty最新文献

Background: The opioid crisis continues to be a significant public health concern in the United States, with postoperative prescriptions contributing to the problem. Older adults face increased risks from opioid use, yet prescribing practices for hand surgery in the Medicare population remain understudied. This research aims to elucidate opioid prescription patterns among hand surgeons treating Medicare patients, focusing on national trends, regional variations, and gender differences.

Methods: A retrospective analysis was conducted using data from the Centers for Medicare and Medicaid Services Medicare Part D Prescription Drug Program Prescribers Public Use File for hand surgeons from 2015 to 2019. National trends, regional variations based on US Census Bureau divisions, state-level differences, and gender disparities in opioid prescribing patterns were examined. Key metrics included opioid prescribing rates, proportion of opioid claims to total claims, average prescription duration, and total opioid claims per surgeon.

Results: From 2015 to 2019, a total of 1752 hand surgeons were identified in the Medicare Part D database with a 5-year average of 231 405 opioid claims, comprising 53% of all claims made by hand surgeons. The median opioid prescribing rate decreased from 61.4% in 2015 to 55.3% in 2019. The proportion of opioid claims to total claims fell from 55.4% to 48.27%, and the average prescription duration decreased from 6.3 to 4.67 days. Significant regional and state-level variation was identified. Overall, the South had higher numbers of opioid prescriptions per hand surgeon and prescribed for more days compared with all other regions, but the Midwest and West regions had larger proportions of opioid claims.

Conclusions: Despite an overall decrease in opioid prescribing by hand surgeons for Medicare patients from 2015 to 2019, significant regional and gender-based variations persist. These findings underscore the need for standardized guidelines, improved prescriber education, and better integration of monitoring programs.

Background: Burned hands require special attention and prompt treatment because of their vital functional importance. With fluorescein dye, it is possible to visualize vascular dermal layers to assist with the removal of nonviable skin through tangential excision.

Methods: Within 24 to 48 hours after a burn, 5 mg of fluorescein dye was injected intradermally and a Wood light was used to determine burn depth. Under anesthesia, an Air Brown (Zimmer Biomet) or castroviejo dermatome and a free-hand or Humby knife was used to excise the burned skin. Split-thickness layers approximately 0.015 inches thick were removed until strong fluorescence was noted.

Results: Observation indicators were used to assess the quality of the skin graft outcomes. No cases of infection, seromas, hematomas, or contractures were seen. Additionally, patients experienced reasonable cosmetic and functional outcomes within weeks to months following grafting.

Conclusions: Excision and split-thickness skin grafting with fluorescein dye and tangential excision can achieve desirable results and restore both cosmetic and functional outcomes.

Introduction: There is a paucity of literature describing breast cancer prevention and screening guidelines in transgender patients. As more patients undergo gender-affirming care, breast cancer screening guidelines must be solidified for transgender patients. While there are no published incidence rates of breast cancer in the transgender population, case reports continue to underscore the prevalence of breast cancer in transgender females.

Methods: A 27-year-old transgender woman with a family history of breast cancer and personal gender-affirming hormone therapy for 9 years was diagnosed with stage 3 invasive ductal carcinoma. The patient presented with a palpable breast lump and had never undergone breast imaging.

Conclusions: Breast cancer risk in transgender patients with long-term hormone therapy use is not well understood. Individuals, both male and female, with a family history of breast cancer; increased cumulative lifetime estrogen and progesterone use; or mutations in BRCA1, BRCA2, CHEK2, PTEN, or PALB2 genes have an increased risk for breast cancer. Hormonal treatment is often used alongside gender-affirming surgeries for development of female secondary sex characteristics in male-to-female patients. Although hormone therapy can have gender-affirming benefits, the increased lifetime exposure to estrogen and progesterone can increase the risk of breast cancer. Mammography guidelines for transgender patients vary by age, familial and genetic risk, as well as duration of hormone therapy. Three current organizations have published mammographic screening guidelines for transgender patients: the University of California San Francisco, the World Professional Association for Transgender Health, and the American College of Radiology. Future research should focus on substantiating these guidelines with greater data to produce evidence-based recommendations to guide the care of transgender patients.

Background: Surgical reconstruction of complex wounds requires considerable planning to ensure optimal patient outcomes. A conservative approach utilizing the lower tiers of the reconstructive ladder is preferred, especially in patients with comorbidities lending to a higher risk of poor wound healing. A simplified, low-risk solution with a double-opposing purse-string suture (PSS) and horizontal continuous closure technique may be particularly helpful in reducing the need for more complex techniques of wound reconstruction in select patient populations.

Methods: A retrospective chart review was performed on all patients who underwent reconstruction with the double-opposing PSS technique (N = 57) by the senior author (B.J.W.) at the University of Louisville between 2019 and 2022.

Results: A total of 46 patients and 57 wounds underwent the double-opposing PSS and horizontal continuous closure technique as directed by the algorithm. The average defect size before and after was 61 and 12 cm², respectively. A 2-tailed paired t test analysis was performed to explore the relationship between the pre- and post-closure defect size (P = .0003, t (44) = 3.9, 95% CI). A total of 21 wounds required a skin graft, meaning 63% of the wounds were successfully closed without the use of skin graft as a result of the double-opposing PSS technique. In addition, of those 21 wounds, the skin grafts, as well as the donor site sizes, were smaller.

Conclusions: This approach to wound closure demonstrates usefulness in reducing the size of or need for skin grafts in complex wound patients, particularly in those with comorbidities. The majority of patients underwent successful closure of their complex defects in various areas (eg, face, extremities) with this technique. Residual defects requiring skin graft allowed for a smaller graft and, thereby, donor site. Ultimately, this technique reduces the risk of complex complications by simplifying and reducing wound size.

Hand-held conducted energy devices, such as the TASER 7 (Axon Enterprise, Inc), are commonly used by law enforcement as a method of "non-lethal" force. However, their use may result in serious injuries. The authors report a case where a TASER 7 barb became embedded in the left supraorbital frontal bone during a field incident. Initial removal attempts were unsuccessful when the cylindrical cartridge broke off. Ultimately, the barb was successfully removed at bedside with a Kocher clamp and firm, constant in-line traction under local anesthesia at a tertiary hospital. This case highlights the potential complications associated with conducted energy devices and provides a bedside removal technique that avoids the need for operative intervention.

Porphyromonas (P.) species, typically associated with oral infections, are known for their role in causing root canal infections and endodontic abscesses. Here, the authors present the first and only reported case of P. endodontalis osteomyelitis in a long bone following a phalanx injury and subsequent dental procedure. In this case, the infection presented in the right fifth proximal phalanx of a 16-year-old boy. Despite initial conservative management and multiple negative bacterial cultures, symptoms persisted, prompting surgical intervention with debridement, biopsy, culture, and polymerase chain reaction analysis. This case underscores the aggressive and elusive nature of P. endodontalis, highlighting challenges in diagnosis and the importance of considering the Porphyromonas species in cases of osteomyelitis, particularly in those with a dental history.

Background: There is not a singular "gold standard" therapy for managing surgical wound dehiscence (SWD); rather, the goal is expediting wound closure. This study examines the feasibility of using a continuous topical oxygen (cTOT) device as part of a treatment algorithm to treat SWD of the lower extremity.

Methods: A single-center, retrospective analysis of lower-extremity SWD treated with cTOT was conducted via a retrospective chart review. Data were collected for a period of 8 months from January to August 2024. All SWD received the standard of care in addition to cTOT. Patients were seen weekly for evaluation until complete wound closure.

Results: Nine patients were included in this case review. The mean patient age was 52.6 years. SWD occurred after a variety of interventions. All patients' SWD grade was either 3 or 4 according to the World Union of Wound Healing Society Sandy Grading System. The average time from starting TOT to the SWD healing was 52.6 days. In addition, the average estimated SWD surface area based on the wound measurement at the start of delivering TOT was 19.5 cm². The average time to wound healing for all patients was 70 days. After excluding 1 outlier, the average time to wound healing was 59.5 days.

Conclusions: The positive outcomes exhibited in this case series suggest that cTOT is an effective treatment in the management of SWD in patients, regardless of specific surgical intervention. Furthermore, all the SWDs treated with cTOT progressed to wound closure without further need for surgery, hospitalization, or other costly procedures.

Background: Many amputees are left with chronic localized pain, centralized pain, and phantom limb pain or sensation, often resulting from neuromas in the residual limb. Historically, there is no reliably effective intervention for pain associated with neuroma-related residual or phantom limb pain. Targeted muscle reinnervation (TMR) is a surgical procedure first described in 2002 that involves the transfer of residual nerves from amputated limbs to new muscle targets. TMR has been shown to significantly reduce neuroma pain and facilitate the use of prostheses.

Methods: A prospective study was conducted of 61 patients who underwent TMR for neuroma treatment or prevention between 2017 and 2022. Primary outcomes included overall, phantom, and residual limb pain recorded using the Visual Analog Scale (VAS), as well as Patient-Reported Outcomes Measurement Information System (PROMIS) forms for Pain Intensity, Quality, Interference, and Behavior. Retrospective data was collected for a propensity-matched cohort of non-TMR amputees to compare pain outcomes.

Results: TMR was performed for 25 upper extremity and 35 lower extremity amputations, and 5 patients underwent TMR on multiple limbs. Significant reductions were observed in overall limb pain (-3.2 points), phantom limb pain (-2.6 points), and residual limb pain (-3.0 points) for the TMR cohort. Mean PROMIS scores for TMR patients were 49.7 for Pain Intensity, 54.0 for Pain Quality, 55.3 for Pain Interference, and 56.1 for Pain Behavior. At the 8.4-month follow-up, 43.8% of TMR patients (vs 84% of controls) remained on neuromodulators, opioids, or both, for pain control.

Conclusions: TMR improved phantom and residual limb pain in amputees, as evidenced by clinically and statistically significant reductions in pain with reduced need for long-term opioids and/or neuromodulators. These findings support the current understanding of TMR but underscore the need for continued investigation to comprehensively assess the potential of this promising technique in improving the functional outcomes and quality of life in the amputee population.