Eplasty最新文献

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.

Background: Breast conservation therapy typically consists of lumpectomy, which often leads to poor cosmetic outcomes. Concurrent oncoplastic reductions are performed to maximize aesthetics and patient outcome. We present an oncoplastic breast reconstruction in a breast re-reduction case in this study.

Methods: A 62-year-old female was diagnosed with invasive ductal carcinoma of the left upper outer breast by core needle biopsy. The patient had a prior bilateral breast reduction using a superior-central pedicle approach 15 years ago and desired breast conservation therapy.

Results: The oncoplastic reconstruction technique used was a superomedial pedicle Wise-pattern bilateral breast reduction. The lump was excised lateral to the pedicle after initial de-epithelialization and incision of the superomedial pedicle's lateral aspect. The remainder of the pedicle was developed, and the same procedure was performed on the right breast at the same time. Excess tissue was excised bilaterally from the medial, superior, and inferior, and the optimal new nipple position was obtained. Both nipples were viable and well perfused following closure of the incisions.

Conclusions: Breast cancer is uncommon in patients who have had bilateral breast reductions. Oncoplastic reduction is an uncommon procedure used in patients who want to preserve their breasts while maintaining their aesthetic appearance. There is currently no agreement on the most effective and safest surgical technique for breast re- reduction surgery, and no reports on oncoplastic reconstruction in patients requiring breast re-reductions. In an oncoplastic reconstruction case, we achieved an acceptable outcome with our superomedial pedicled Wise-pattern bilateral breast reduction technique.

Background: The prevailing trend for the treatment of lateral epicondylitis (LE) is nonsurgical. Although many providers consider LE surgery controversial, others consider surgical intervention in patients with recalcitrant symptoms. The purpose of this study is to analyze epidemiological changes in LE surgery over a 9-year period prior to the coronavirus pandemic in 2019.

Methods: A cross-sectional analysis of the Texas health care database from 2010 to 2018 was performed. We analyzed all procedures performed for LE during the set time period using Current Procedure Terminology (CPT) codes. Statistical analyses included procedures performed, patient demographics, zone of residence, and insurance designation.

Results: There were a total of 12802 records of LE with 1 or more associated surgical procedures. Lateral epicondylar debridement (with/without tendon repair) was the most common procedure recorded, followed by arthroscopic procedures and tendon lengthening. Overall incidence remained low and did not significantly change during the studied period; however, surgical case volumes were significantly higher in metropolitan areas and increased at a faster rate when compared with those of more rural regions. Commercial insurance was the most prevailing form of payment. The incidence was significantly higher in the age group between 45 and 64 years old and most commonly performed in Caucasian females.

Conclusions: The benefit of surgery for the treatment of LE has yet to be completely elucidated; however, surgical intervention continues to be offered. Although the incidence of surgery for the treatment of LE remained low over the study period, the volume of cases in metropolitan areas increased at a fast rate between 2010 and 2018. The results of this study found that surgery is still a treatment option in some patients despite the controversy.

Level of evidence: Economic/Decision Analysis, Level IV.

Objective: To determine the effectiveness of a native type I collagen matrix plus polyhexamethylene biguanide antimicrobial (PCMP) and a cryopreserved cadaveric skin allograft (CCSA) for use in diabetic foot ulcers (DFUs).

Methods: A real-world data study was conducted on 989 DFUs analyzed digitally. Of these, 325 and 664 DFUs were treated with PCMP and CCSA, respectively. Non-inferiority testing for equivalence of PCMP and CCSA was performed at a level of significance of P < .05.

Results: Cox proportional hazards regression analysis for healing for PCMP and CCSA at weeks 4, 8, 12, and 24 was 12% vs 10%, 27% vs 24%, 39 % vs 37%, and 60% vs. 64%, respectively. No statistically significant differences were shown; P = .95. The median time to healing was 18 and 17 weeks for PCMP and CCSA, respectively; P = .95. The probability of healing was statistically equivalent between PCMP and CCSA; hazard ratio = 0.99; 95% CI (0.85, 1.17). Non-inferiority statistical testing results showed P = .01.

Conclusions: Using non-inferiority hypothesis testing at a level of significance of P <.05, we showed that PCMP was equivalent to CCSA; P = .01. PCMP vs CCSA demonstrated no statistically significant differences in median time, percentage, and probability of healing. Data from real-world data comparative effectiveness assessment studies can help guide clinicians to limit overuse of ineffective therapies and underuse of effective therapies.

Background: The options for treating pseudogynecomastia are limited, and there is a growing demand for noninvasive breast fat reduction. We evaluated the efficacy and safety of a laser-assisted lipolysis (LAL) device emitting 1444 nm for the treatment of pseudogynecomastia.

Methods: A total of 9 male patients diagnosed with pseudogynecomastia underwent laser procedure with a Nd:YAG laser emitting at 1444 nm. The goal was to generate adequate heat propagation and thermal action in the dermis as homogeneous as possible to induce fat cell lipolysis. The results were clinically evaluated by comparing pictures at baseline and 4 months later.

Results: An independent comparison of baseline and post-treatment pictures by a physician evaluator 4 months after treatment revealed significant improvement in all patients. Three subjects (33%) showed grade 4 improvement; 4 (44%) showed grade 3 improvement, and 2 (22%) showed grade 2 improvement. Breast sizes decreased in all patients 4 months after 1444-nm LAL. All patients experienced an incident-free postoperative period.

Conclusions: The LAL procedure performed in this study using 1444-nm Nd:YAG laser appears to be a very effective/comfortable outpatient solution to the problem for patients. It has proven a safe procedure, and all subjects in the study experienced a significant clinical improvement regarding their pseudogynecomastia, with a decrease in breast volume and visible skin contraction.

Background: Aneurysmal bone cysts (ABCs) are aggressive, expansile, and locally destructive vascular lesions. The exact etiology of ABCs is currently unknown and hypothesized to be related to vascular malformations or disruption of osseous vascularity. To date, there have been no reports describing the development of pubic ABCs following penile inversion vaginoplasty (PIV).

Methods: This report describes the development of a pubic ABC in a transgender patient who had previously undergone PIV, possibly indicating a very rare complication of this gender-affirming operation.

Results: A 37-year-old transgender female was initially referred to the orthopedic oncology clinic for evaluation of a 12-month history of left hip and groin pain. She had undergone gender-affirming PIV about 19 months prior to presentation. Magnetic resonance imaging (MRI) with contrast revealed a low T1 signal intensity and heterogenous T2 hyperintensity 7.5 × 4.9 × 4.3-cm destructive mass in the left superior pubic ramus extending across the pubic symphysis into the right superior pubic ramus. A needle core bone biopsy demonstrated a variably cellular spindle and round lesion with islands of osteoid formation and focal necrosis. The cells were negative for CD34, S100, and desmin. There was no evidence suggesting osteosarcoma, and final review favored the diagnosis of an ABC. Given the highly destructive nature of the mass, it was resected, and the resulting wound was reconstructed with a biologic dermal mesh.

Conclusions: Although it is impossible to distinguish coincidence from causation in this case, the patient's recency of PIV and development of a rare ABC in a nearby bone warrants the speculation and discussion provided in this report.