Eplasty最新文献

Background: First described by Michal et al in 1972, penile revascularization for vasculogenic impotence and its outcomes has been scarcely reported in plastic surgery literature. Such injuries are often secondary to atherosclerosis of the distal internal pudendal, common penile or proximal cavernosal artery, or locoregional trauma. Various techniques have been described to restore blood flow to the cavernosal body.

Methods: In this report, we review 2 cases of penile revascularization for arteriogenic erectile dysfunction at our level 1 trauma center in 2021-2022 completed by the senior author in conjunction with urology.

Results: Both patients sustained pelvic crush injuries with resultant arteriogenic impotence minimally responsive to medical management with phosphodiesterase inhibitors and/or injection therapy. After thorough urologic and vascular workup, they underwent microsurgical revascularization of the penis utilizing the deep inferior epigastric arteries with anastomosis to the deep dorsal penile veins. Both patients demonstrated improvement in erectile dysfunction and were able to achieve sustained erection with adequate glans tumescence on minimal pharmacotherapy postoperatively. One patient noted ability to achieve penetration. Patient 1 experienced postoperative retention requiring Foley placement, and both patients experienced glans edema requiring additional urologic procedures (patient 1: dorsal slit, patient 2: completion circumcision).

Conclusions: Overall, we have demonstrated improvement of sexual function with the most common complication being prolonged penile edema requiring release of constriction by our urology colleagues. Additional research in the plastic surgery field is warranted to further refine the technique and improve outcomes.

Background: The transconjunctival approach paired with lateral canthotomy is a commonly used technique for widened exposure of the orbital floor and infraorbital rim. A major drawback of this approach is the severance of lateral canthal ligament fibers, which predisposes to potential postoperative eyelid malpositioning. To avoid these suboptimal aesthetic outcomes, a modification of this approach has been proposed in which the lower eyelid is mobilized with a paracanthal, trans-tarsal stair-step incision. In this pilot study, we describe our experience with the trans-tarsal stairstep incision for lateral extension of the transconjunctival incision and report its outcomes in a Western population.

Methods: All patients who underwent facial fracture operative fixation at a single institution by a single senior surgeon were included. Clinical variables were extracted. Patients were stratified by incision type.

Results: Compared with patients who underwent subtarsal incision (n = 20) and transconjunctival incision with lateral canthotomy (n = 4), patients who received the trans-tarsal stair-step incision (n = 10) had no incision-related complications or requirements for revision. The most common complications found in the comparison groups were ectropion and hypertrophic or irregular scarring, and 4 patients required revision.

Conclusions: Our initial experience with the transconjunctival approach with the trans-tarsal stair-step incision shows promising outcomes. Further study may promote greater utilization of this technique in Western countries.

Background: Breast cancer and melanoma are extremely common, with a growing incidence in the United Kingdom. In this case report, we present a patient with synchronous melanoma and breast carcinoma, with focus on the simultaneous use of 2 sentinel lymph node biopsy mapping techniques.

Methods: The use of 2 mapping techniques in this case is necessary to ensure the accurate identification of the correct sentinel node (for each respective primary malignancy), providing vital prognostic information and allowing for appropriate adjuvant therapy. The report describes the use of a single surgical incision to access both melanoma and breast carcinoma sentinel lymph nodes.

Conclusions: The report highlights the technical possibility of using both the radioactive isotope tracer/blue dye dual technique and the Magtrace/Sentimag system without interference or complication.

Infantile hemangiomas are commonly encountered at all levels of medical practice. Clinicians should be aware of their typical clinical history and findings in order to expedite early diagnosis and management. It is also necessary to be aware of differential diagnoses that may mimic infantile hemangiomas but have a more concerning prognosis. The objective of this report is to describe the clinical case of one such mimic, dermatofibrosarcoma protuberans. This report highlights key clinical findings of infantile hemangiomas, while also identifying "red flags" that necessitate urgent additional investigations and referral to a multidisciplinary team. Additionally, key features in the management of both infantile hemangiomas and extremity masses are discussed.