Eplasty最新文献

Background: Many institutions have implemented universal hemoglobin A1c (HbA1c) screening for all preoperative patients in an effort to reduce rates of surgical complications. However, the usefulness of HbA1c screening for predicting complications after implant-based breast reconstruction has yet to be determined. The purpose of this study was to investigate the predictive value of HbA1c screening on postoperative complications following implant-based breast reconstruction.

Methods: A retrospective cohort study of patients who underwent implant-based breast reconstruction at a single institution was conducted. All patients required an HbA1c screening preoperatively. Patients were categorized into 2 groups: normal HbA1c (<5.7%) or abnormal HbA1c (≥5.7%). The 2 groups were propensity score matched for baseline characteristics and compared for complication rates after the first- and second-stage procedures.

Results: In this study, 203 patients who underwent first-stage breast reconstruction were divided into normal HbA1c (n = 135) and abnormal HbA1c (n = 68) cohorts. A propensity score weighted analysis demonstrated increased risk of incisional dehiscence in the abnormal group (P = .050). Ninety-nine patients who underwent second-stage breast reconstruction were divided into normal HbA1c (n = 55) and abnormal HbA1c (n = 44) cohorts. The abnormal HbA1c group demonstrated marginally higher rates of implant loss (P = .059). Otherwise, no statistically significant differences were noted in rates of surgical site infection, seroma or hematoma formation, or implant rupture.

Conclusions: Patients with abnormal HbA1c on preoperative screening demonstrated higher rates of incisional dehiscence after first-stage breast reconstruction and higher rates of implant loss following second-stage breast reconstruction. Obtaining routine preoperative HbA1c screening should be considered as an adjunct to guide discussions about surgical risk for patients undergoing breast reconstruction.

Background: Incidence and prevalence data for congenital upper extremity anomalies in the literature are scarce due to lack of reporting requirements, absence of a centralized database, and insufficient referral networks. As the state's only pediatric hospital and congenital hand clinic, the University of Mississippi Medical Center (UMMC) is uniquely positioned to report the per capita rate of congenital upper extremity anomalies.

Methods: Pediatric patients presenting from 2015 to 2020 were identified using International Classification of Diseases codes in the UMMC electronic medical record. Exclusion criteria included age older than 18 years at presentation and defects secondary to trauma. Diagnoses included polydactyly, syndactyly, reduction defects, club hand malformations, and syndromes with upper limb anomalies. Demographic data were collected including age, race, sex, maternal age, family history of extremity anomalies, geographic location, and insurance status. Geographic trends were identified, and results were presented in incidence of disease per 10,000 births.

Results: A total of 477 pediatric patients presented with a congenital upper extremity anomaly from 2015 to 2020. The average rate of congenital upper extremity anomalies in Mississippi was 21.5 per 10,000 births. The 3 most common upper extremity anomalies were polydactyly (13.1 per 10,000 births), congenital trigger thumb (2.67 per 10,000 births), and syndactyly (1.66 per 10,000 births). The polydactyly group was further divided into preaxial (1.98 per 10,000 births) and postaxial (10.9 per 10,000 births) polydactyly. There was a male predominance in presentation with 60.4% (n = 288) of patients being male.

Conclusions: In the past 5 years, only New York State has published similar findings delineating the incidence of congenital hand anomalies through their Birth Defect Registry. The prevalence of upper extremity defects presenting to UMMC from 2015 to 2020 was 21.5 per 10,000 births; however, 5 specific counties had a significantly higher prevalence, ranging from 53.65 to 63.97 per 10,000 births. To develop effective programs to comprehensively treat these pediatric patients, accurate reporting and data collection mechanisms are critical.

Background: Breast infections associated with nipple piercings present a unique puzzle for clinicians because of the lack of sterile regulations surrounding the procedure. As a result, providers must consider wider ranges of infectious etiologies and have a low threshold for initiating broad spectrum antibiotic therapy and operative intervention to prevent detrimental complications.

Methods: The authors present the case of a 39-year-old female who developed a methicillin-resistant Staphylococcus aureus right-breast abscess approximately 7 weeks following bilateral nipple piercings.

Results: Management included ultrasound-guided aspiration for the diagnosis and confirmation of the abscess, incision and drainage in the operating room, and both intravenous and oral antibiotic therapy. The patient recovered appropriately without recurrence of infection 6 weeks postoperatively.

Conclusions: Given the rise in intimate body piercings, it is imperative to document complications to improve clinician treatment protocols and guide governmental bodies to make this practice as safe as possible.

A novel technique that requires a single-stage operation utilizing an intramedullary device is presented for metacarpal lengthening in setting of traumatic malunions. The patient desired surgical correction due to malrotation with full fist formation and a 25-degree extensor lag. Following single-stage lengthening with osteotomy, bone graft, and intramedullary screw, length was restored and the patient had full passive range of motion. The patient's graft site incorporated well with robust callus formation with mild resorption and collapse. Clinically, he maintained appropriate rotation and had a 5-degree extensor lag with the ability to make a composite fist. The patient was satisfied with his result and returned to normal activities.

Introduction: Regenerative peripheral nerve interfaces (RPNI) can be used to mitigate neuropathic pain resulting from nerve injury or neuroma formation following trauma, surgery, or amputation. Most of the current literature discusses the utility of RPNI for the treatment of neuropathic pain in the upper and lower extremities; however, RPNI can also improve neuropathic pain in non-extremity regions. Our objective was to characterize and describe patient cases of non-extremity RPNIs.

Methods: We retrospectively reviewed medical records of patients treated with RPNIs for non-extremity neuropathic pain by the senior author at a single institution between February 2020 and October 2023.

Cases: Seven patients were treated with RPNI in non-extremity regions. For 1 patient, RPNI was performed prophylactically following discovery of injured peripheral nerves during a surgery and the patient did not report any neuropathic pain in the related regions afterwards. Six patients presented with nerve pain in multiple regions, including the scalp, face, trunk, and groin, that began either after a trauma or previous surgery. The nerve pain of 5 patients completely resolved after the creation of an RPNI.

Discussion: The creation of an RPNI is relatively straightforward and can relieve or prevent peripheral nerve pain caused by injured nerves. While RPNIs have mainly been used for the treatment or prevention of neuromas in extremities, this case series demonstrates efficacy in non-extremity areas as well. Surgeons can, therefore, consider RPNI for patients who have neuropathic pain due to suspected nerve injury that has been refractory to other treatments.

A 55-year-old right-handed male presented acutely with inability to flex at the distal interphalangeal (DIP) joint of the right small finger after feeling a pop while moving heavy furniture. Avulsion of the flexor digitorum profundus (FDP) tendon at its insertion, or "jersey finger," was suspected. During operative exploration, the insertion on the distal phalanx was intact, and the rupture was noted proximally at the level of the lumbrical origin. There are cases in the literature describing attritional ruptures of the tendon proximally due to metacarpophalangeal or intercarpal arthrosis, but this is the first case of a closed, proximal tendon rupture due solely to trauma. Imaging may be helpful to diagnose the level of tendon rupture. We propose surgeons perform an A1 pulley incision to determine the level of rupture prior to planning the surgical exposure for tendon repair.

Background: Intraoperative expansion with air, as compared with saline, has been associated with fewer first-stage complications in 2-stage expander-implant breast reconstruction. However, longitudinal reconstructive outcomes, postoperative medication use indicating pain or discomfort, as well as patient-reported outcome measures after intraoperative air versus saline fill have not yet been investigated.

Methods: This is a retrospective cohort investigation of 69 patients who underwent 2-stage expander-implant prepectoral breast reconstruction with acellular dermal matrix in 2017 and 2018. Patients underwent intraoperative tissue expander (TE) fill with air or saline during stage 1 of reconstruction and underwent expander-implant exchange in stage 2. Air versus saline cohorts were compared with regards to time to definitive reconstruction and postoperative pain/opioid use.

Results: Of the 69 patients studied, 47 (68.1%) had tissue expanders filled with air and 22 (31.9%) filled with saline. In multivariable regression analysis, air-filled TEs were associated with significantly lower odds of requiring an opioid prescription refill (adjusted odds ratio [aOR] = 0.27; P = .009) and breast pain (aOR = 0.10; P < .001). The use of air instead of saline TEs also had no adverse impact on the length of time or number of office visits between stages.

Conclusions: Intraoperative air versus saline TE fill appears to impact longitudinal reconstructive outcomes in expander-implant based reconstruction. Our results demonstrated that air-filled TEs were associated with significantly lower odds of opioid refills and breast pain. Our study also indicates that timing and office visits between stages do not appear to be affected by TE fill medium.

Background: Injuries to the long thoracic nerve (LTN) and upper trunk of the brachial plexus (UTBP) can occur simultaneously and cause scapular winging and shoulder instability. The literature has not documented the concurrent occurrence of UTBP and LTN injuries in these patients. We show an upper trunk injury in patients whose preoperative electromyography (EMG) did not show injury to the UTBP.

Methods: We screened patients with traumatic brachial plexus injuries and associated nerve injuries and identified 50 patients (29 men and 21 women; 31 right side and 19 left side; mean age 34 years, range 16-63 years) with winged scapula and shoulder instability who had undergone neurolysis and decompression of the UTBP and LTN with the lead author and surgeon, R.K.N. We measured and compared the compound motor action potentials (CMAPs) of the upper limb nerves before and after neurolysis during intraoperative neurophysiological monitoring (IONM) and compared it with surgical outcomes.

Results: After surgery, IONM showed a significant increase in CMAPs for all 4 muscles: serratus anterior (295 ± 291 to 886 ± 937), supraspinatus (237 ± 216 to 618 ± 423), deltoid (344 ± 446 to 936 ± 1015), and biceps (492 ± 656 to 1109 ± 1230, P < .0001). The CMAPs of the 4 upper extremity (UE) muscles showed a positive correlation before and after surgery (R = 0.6, 0.28, 0.59, 0.57, respectively; P < .0001). Preoperatively, all patients had severe to moderate scapular winging and 15° - <170° in active range of motion (shoulder forward flexion and abduction). Scapular winging, shoulder flexion, and abduction improved significantly in 98% (n = 49) of the patients with a postoperative average of 168° ± 11° and 165° ± 16°, respectively, compared with the preoperative average of 127° ± 30° and 122° ± 29°, respectively, (P < .0001) with a mean follow-up of 1.3 years. Postoperatively, no patient experienced a worsening of their preoperative symptoms.

Conclusions: Our article presents the first documented occurrence of a long thoracic nerve injury coinciding with a brachial plexus upper trunk lesion in 50 patients with scapular winging whose preoperative EMG did not show injury to the UTBP. Neurolysis of the UTBP and LTN immediately increased the nerve conduction to the UE muscles evaluated intraoperatively.