1.
Ann Plast Surg. 2020 Apr;84(4):446-448. doi: 10.1097/SAP.0000000000001976.
New Perspectives in Surgical Marking Since the Advent of Infrared Laser Angiography.
Abstract
INTRODUCTION:
This study investigates the utility of common surgical dyes under direct visualization and infrared laser angiography.
METHODS:
Pigments affecting light within the visual (λ = 400-700 nm) and infrared (λ = 700-1000 nm) spectra were placed on subjects spanning the Fitzpatrick scale. Photometric properties of these pigments were assessed under direct visualization and infrared laser angiography.
RESULTS:
Among patients of various Fitzpatrick classifications, black ink pigment and pigment within the violet spectrum (λ = 380-450 nm) were most distinguishable under direct visualization. Colored inks, gentian violet and methylene blue dyes, were not visualized under infrared laser angiography. Black permanent ink appeared under both direct visualization and infrared laser angiography. Indocyanine green suspended in ethyl alcohol and applied to skin as a marking pen appeared clear under direct visualization and was detectable under infrared laser angiography.
CONCLUSIONS:
Black permanent marking ink allows visualization of surgical markings under infrared laser angiography, whereas gentian violet and methylene blue did not interfere with infrared visualization. Indocyanine green suspended in ethyl alcohol is a contemporary marking pen that may be used to outline anatomical surface landmarks under infrared laser angiography.
2.
Ann Plast Surg. 2020 Apr;84(4):472. doi: 10.1097/SAP.0000000000002334.
Role of Homeodomain-Interacting Protein Kinase 2 in the Pathogenesis of Tissue Fibrosis in Keloid-Derived Keratinocytes: Corrigendum.
[No authors listed]
3.
Ann Plast Surg. 2020 Apr;84(4):390-393. doi: 10.1097/SAP.0000000000002064.
New Technique for Correcting Bony Deformity in Racquet Thumb.
Abstract
: This article aims to present a new method for correcting bony deformity in racquet thumb.
METHODS:
We operated on 37 thumbs of 32 patients (age, 17-52 years) with racquet thumb using a procedure that included narrowing the nail bed, recreating the lateral nail fold, making a bone defect in the widened proximal base, and exposing more proximal nail bed. The ratio of the length to the width of the nail was calculated.
RESULTS:
The ratio of the length to the width of the nail increased from 0.55 before surgery to 0.78 at the final follow-up visit. Most patients were satisfied with the cosmetic and functional results.
CONCLUSIONS:
This technique is simple, safe, and both cost- and time-effective and is a good option for the repair of racquet thumb.
4.
Ann Plast Surg. 2020 Apr;84(4):356-360. doi: 10.1097/SAP.0000000000002349.
Abdominoplasty With Scarpa Fascia Preservation: Prospective Comparative Study of Suction Drain Number.
Abstract
BACKGROUND:
Abdominoplasty is becoming increasingly more common, with seroma being the most frequent complication. Suction drains are used very often as a method to prevent seroma formation, and it has been suggested that techniques using Scarpa fascia preservation and closed-suction drains have lower seroma rates than other approaches. However few studies have addressed parameters that may affect drain efficiency. A prospective comparative study was conducted to determine if applying 2 or 3 closed-suction drains, after an abdominoplasty with Scarpa fascia preservation, has any effect on several outcomes.
METHODS:
This was a single-center study conducted from September 2016 to March 2019. Patients were allocated according to choice to 1 of the 2 surgeons involved in the study, each responsible for 1 group: abdominoplasty with Scarpa fascia preservation with 2 closed-suction drains placed postoperatively (group A) or with 3 closed-suction drains (group B). A comparative analysis of selected variables was done between both groups, including time to drain removal, total and daily drain output, duration of hospital stay, emergency department visit, readmission to the hospital, secondary surgical procedure, and incidence of postoperative local and systemic complications.
RESULTS:
A total of 73 abdominoplasties with Scarpa fascia preservation were performed in women (group A, 33 patients; group B, 40 patients). General characteristics of group A and B were similar. There were no statistically significant differences between groups in any of the determined variables, namely, main outcomes (total and daily drain output, time to drain removal) or complications (local or systemic).
CONCLUSIONS:
Our results suggest that using 3 closed-suction drains postabdominoplasty with Scarpa fascia preservation has no advantages in total and daily drain output, time to drain removal, or complications when compared with the usual 2 drains approach.
5.
Ann Plast Surg. 2020 Mar 2. doi: 10.1097/SAP.0000000000002274. [Epub ahead of print]
Avulsion Fat Graft Gluteoplasty: Technique Overview.
Abstract
BACKGROUND:
The popularity of gluteoplasty has grown significantly in recent years, and there are a variety of techniques described to address gluteal aesthetic deformities. The aim of this study was to describe the avulsion fat graft gluteoplasty technique.
METHODS:
A review of all consecutive patients undergone avulsion fat graft gluteoplasty from February 2018 to March 2019 was performed. Data included demographics, operative details, and clinical outcomes.
RESULTS:
A total of 7 patients with a minimum of 6 months follow-up were analyzed and included in the study. The avulsion fat graft gluteoplasty technique is described in a step-by-step fashion and illustrated by preoperative, postoperative, and intraoperative photographs, as well as video. The average total weight of the avulsed specimen was 372 g (range, 176-596 g) per patient. The average total volume of fat grafting was 593 mL (range, 344-900 mL) per patient.
CONCLUSIONS:
The avulsion fat graft gluteoplasty is a powerful technique with consistent results and low-risk profile. It provides durable lift and augmentation and produces a predictable and aesthetic scar.
6.
Ann Plast Surg. 2020 Mar 2. doi: 10.1097/SAP.0000000000002160. [Epub ahead of print]
Reduction in Recurrence Rate by Combining Modified Hotz Procedure With Epicanthoplasty to Treat Congenital Epiblepharon.
Abstract
AIM:
To determine whether patients with congenital lower lid epiblepharon treated with a modified Hotz procedure combined with epicanthoplasty have a decreased recurrence rate.
PATIENTS AND METHODS:
Patients with epiblepharon of the lower eyelid corrected using a modified Hotz method between 2007 and 2017 were evaluated retrospectively by chart review to determine rates of complications and recurrence as well as whether the Hotz method was combined with epicanthoplasty. The recurrence rates for patients treated with the Hotz method alone or in combination with epicanthoplasty were compared.
RESULTS:
A total of 60 patients (mean age, 13.6 years) and 115 eyelids were evaluated. All patients showed improvement in their symptoms and had no complications. Across the entire group, the recurrence rate for entropion was 23.5% (27 eyes). A modified Hotz procedure combined with epicanthoplasty was performed on 43 (37.4%) eyes. The recurrence rate for the group treated with a modified Hotz procedure combined with epicanthoplasty was significantly lower than that for patients who underwent the Hotz procedure alone (7.0% vs 33.3% P = 0.0012). There was no relationship between epicanthus severity and recurrence rate (P = 0.345).
CONCLUSION:
In this study, we showed that patients who underwent a modified Hotz procedure combined with epicanthoplasty had a decreased recurrence rate. This improved outcome could be due to the simpler approach to the nasal side of the lower eyelid in epicanthoplasty, and epicanthoplasty can facilitate detachment of the upper eyelid from the lower eyelid.
7.
Ann Plast Surg. 2020 Mar 5. doi: 10.1097/SAP.0000000000002324. [Epub ahead of print]
National Trends in Hospitalization Charges for Autologous Free Flap Breast Reconstruction.
Abstract
BACKGROUND:
There is significant cost variation among patients undergoing autologous free flap breast reconstruction. Previous studies hypothesize that factors like length of stay and hospital volume are key drivers of cost; however, how these factors have affected cost have not been well studied. Our study analyzes the factors influencing hospital charges relating to these procedures and their trends over a multiyear time frame.
METHODS:
The Healthcare Cost and Utilization Project's National Inpatient Sample database was analyzed from January 2009 to December 2014. All female patients who were diagnosed with breast cancer or at a high risk for breast cancer who underwent autologous free flap breast reconstruction were included. Variables of interest included demographic data, hospital characteristics, hospitalization data, and total hospital charges. Univariate and generalized linear models were used to examine associations between selected variables and the hospitalization charges, as well as trends in these factors over the years included.
RESULTS:
There were 659,220 female patients diagnosed with breast cancer or had a high risk of breast cancer between 2009 and 2014. Of these patients, 20,050 (3.0%) received autologous free flap breast reconstruction and were included. The mean total hospital charge was US $98,839.33 (SD = US $61,532.04). Regression analysis showed that the proportion of procedures to the total population of potential patients significantly increased over the selected time frame (P = 0.02). The average total charges also increased significantly (P < 0.01), despite a decrease in length of stay (P = 0.05). Procedures performed in the west were associated with significantly higher charges when compared with other regions (US $147,855.42, P < 0.001). Higher hospital charges were also associated with urban hospitals, regardless of teaching status.
CONCLUSIONS:
The overall demand for the autologous free flap breast reconstruction is increasing within the patient population, in conjunction with increasing associated hospital charges. This increase in cost is seen despite an overall decrease in length of stay, originally thought to be the main contributor to regional cost variation. Further studies should be done to develop strategies to better target increased hospitalization charges, because the overall health care burden of this procedure is expected to rise if current trends continue.
8.
Ann Plast Surg. 2020 Mar 5. doi: 10.1097/SAP.0000000000002257. [Epub ahead of print]
A New Cartilage-Sparing Procedure for Correction of the Prominent Ear Deformity: Dermal Anchor Technique.
Abstract
BACKGROUND:
Although the literature is replete with surgical techniques described for correction of the prominent ears, new techniques are still needed to minimize the recurrence rates and postoperative complications.
OBJECTIVE:
Here, the author presents a new and simple otoplasty procedure, namely, the dermal anchor technique (DAT), in which a wide planar adhesion between the opposing dermal surfaces of the deepithelized antihelical groove is used as a biological anchor for long-term maintenance of the antihelical fold without any cartilage manipulation.
MATERIALS AND METHODS:
For 12 years, this new procedure was used for correction of 76 prominent ears in 44 patients, with 17 being female and 27 being male. The ages of the patients ranged from 5 to 37 years. In 28 patients, the DAT was combined with conchal excision and/or concha-mastoid sutures as required, whereas it was used alone in the remaining 16 patients. The preoperative and postoperative distance between the ear and the head was measured at 4 points (superior helical point, superior conchal attachment, inferior conchal attachment, and lobules).
RESULTS:
All patients healed uneventfully. Except mild edema and pain, there was no postoperative problem. The mean follow-up time was 4½ years (4 months-10 years). During this time, there was no patient with surface irregularities and/or suture-related complications. Two patients required revision because of unilateral lateralization of the upper pole by time (recurrence rate, 2.63%). When the preoperative and postoperative superior helical point, superior conchal attachment, inferior conchal attachment, and lobule measurements for both ears of the patients who were operated on were compared, postoperative values were determined to be significantly decreased (P < 0.001).
CONCLUSIONS:
The DAT provides predictable and aesthetically satisfactory long-lasting results with a minimal risk of complications. Because it does not harm the cartilage tissue, it avoids the potential problems resulted from cartilage manipulations such as surface irregularities and chondritis. Covering the suture knots with a thick soft tissue layer, it eliminates the suture-related complications. Moreover, it offers a direct approach and does not require anterior dissection. Thus, it requires a shorter operative time, minimizes the risk of anterior skin necrosis and hematoma, and causes less postoperative pain, edema, and ecchymosis.
9.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002360. [Epub ahead of print]
Authors' Response to the Letter to the Editor Discussing "Analgesic Use Following Bilateral Breast Reduction".
10.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002347. [Epub ahead of print]
Submuscular Placement of Baclofen Infusion Pumps: Case Series and Technique.
Abstract
BACKGROUND:
Baclofen pumps provide treatment of symptoms of spasticity for disease processes such as cerebral palsy and traumatic brain injury. These devices provide continuous infusion or periodic dosing of intrathecal baclofen (ITB). Traditionally, these pumps have been placed subcutaneously. Subcutaneous device placement has been associated with infection and extrusion. Baclofen pumps are large and range from 8 to 10 cm in diameter and 4 to 8 cm in width. Patients requiring device placement typically have a paucity of subcutaneous tissue. Cachexia coupled with the size and bulk of these devices leads to increased protusion and friction. Submuscular placement provides a well-vascularized pocket that directs the device inward eliminating protrusion and decreasing the potential for soft tissue breakdown.
METHODS:
A retrospective chart review of ITB pump placement in a submuscular plane by a single plastic surgeon at a major academic center in conjunction with a neurosurgeon was performed. Inclusion criteria were cases of primary placement or replacement of ITB pumps and spasticity requiring ITB. Major complications included infection, extrusion, and reoperation.
RESULTS:
Five patients during a 5-month period were treated with submuscular placement of ITB pumps. Average age of patients included was 18.4 years. Average preoperative body mass index was 18.8 kg/m, with values ranging from 15.8 to 20.1 kg/m. Medical histories of patients included diagnoses of cerebral palsy and traumatic brain injury causing spasticity. The most frequently cited reason for plastic surgical consultation preoperatively was cachexia. Two patients had previous baclofen pumps placed subcutaneously. Average follow-up was 6 months and ranged from 3 to 13 months. There were no major complications. One patient had a small seroma that spontaneously resolved. No patient had wound healing problems, and there were no extrusions of implanted devices or reoperations.
CONCLUSION:
Submuscular placement of baclofen pumps provides a well-vascularized and stable environment for device placement that minimizes the dangers of pump extrusion and infection. Patients who require treatment with ITB commonly have severe cachexia, which makes subcutaneous device placement high risk. Submuscular placement should be performed in all patients with body mass index less than 20 kg/m.
11.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002340. [Epub ahead of print]
Incidence of Gastroesophageal Reflux Disease in Children With Cleft Lip and Palate and an Evaluation of Its Impact on Weight Gain.
Abstract
Patients with cleft lip and/or palate have higher rates of failure to thrive (FTT), decreased growth, and more often experience feeding difficulties as compared with the general pediatric population (J Child Health Care. 2014;18:72-83). Although insufficient nursing, excessive air intake, and incorrect feeding methods have been established in the literature, the role of gastroesophageal reflux disease (GERD) as a contributing factor in cleft patients has not been thoroughly examined. Presently, there is a paucity of literature analyzing the incidence and effect of GERD on this unique population. Furthermore, no studies have evaluated the effect of GERD therapy on improvement of weight gain and FTT in cleft patients. The purpose of this retrospective review was to identify the incidence of GERD in the orofacial cleft population and to see if appropriate treatment was effective in improving weight gain. Fifty patients with cleft lip, cleft lip and palate, and isolated cleft palate were identified from a single surgeon's experience at a large academic medical center from 2015 to 2019. The data show that a significantly higher percentage of patients with cleft lip/and or palate have clinical evidence of GERD, which required treatment as compared with published reports of less than 1% in the noncleft population. The data also suggest that the patients diagnosed with GERD who received pharmacologic treatment showed improved weight gain as compared with those who did not. Given our findings, the diagnosis of GERD should be considered in orofacial cleft patients exhibiting signs of feeding difficulty or those with FTT. The early diagnosis and treatment of GERD in patients with orofacial clefts may improve weight gain.
12.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002318. [Epub ahead of print]
Changes in Opioid Prescribing Patterns: A Survey of the Florida Society of Plastic Surgeons.
Abstract
INTRODUCTION:
With thousands of people in the United States dying of opioid overdose each month, the opioid epidemic has become a serious public health concern. Legislators have attempted to address this problem at various levels of the government. Evaluation of outcomes of these measures is a necessary part of resolving the epidemic. Our survey was designed to evaluate the impact of measures enacted in Florida State in 2018 upon prescribing practices of plastic surgeons.
METHODS:
The survey was prepared electronically using the online Qualtrics platform. Survey questions were multiple choice and inquired regarding changes in prescribing practices after enactment of mandatory query of the prescription drug monitoring program database and prescribing limits in Florida. The survey was distributed by e-mail 1 year after these laws took effect. Two survey reminder e-mails were sent at 2-week intervals after the initial message. Results were collected for an additional 3 weeks after the final correspondence.
RESULTS:
Thirty-two survey responses were received after distribution to the 156 members of the Florida Society of Plastic Surgeons, for a response rate of 20.5%. Twenty-two respondents reported changing their prescribing practices. The most common change reported was decreased number of tablets prescribed. Most respondents reported they believe that mandatory prescription drug monitoring program query and prescribing limits will be effective. This included 17 (53.1%) and 18 (56.3%) respondents, respectively.
CONCLUSIONS:
Results from our survey indicate that Florida plastic surgeons have adjusted their prescribing practices in response to recently enacted legislation. Most plastic surgeons reported decreased number of tablets of opioids prescribed. Many also reported incorporating nonopioid analgesics. Further study will be necessary to determine the impact of these changes on rates of opioid overdose.
13.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002315. [Epub ahead of print]
Granulocytic Sarcoma: A Rare Cause of Wrist Pain.
Abstract
Septic, inflammatory, or crystal-induced arthritis are common etiologies of wrist pain without antecedent trauma associated with pain, loss of motion, swelling, redness, and warmth. In this report, we detail the case of granulocytic sarcoma of the wrist that presented as acute wrist pain, swelling, and limitation in motion. Granulocytic sarcoma is an exceedingly rare extramedullary tumor associated with acute myeloblastic leukemia. It may be found in any part of the body; however, upper extremity involvement is uncommon. To our knowledge, this is the first description of granulocytic sarcoma occurring in the wrist joint.
14.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002316. [Epub ahead of print]
Prediction of Conservative Treatment Failure for Isolated Unilateral Mandibular Condylar Fractures Using Quantitative Measures: Suggestion of Indications for Intervention.
Abstract
BACKGROUND:
Interest in the treatment of mandibular condyle fracture in cases of maxillofacial trauma has been a huge concern for decades because of a diversity of opinions on the topic and the relatively few studies conducted on individuals treated by physiotherapy or rehabilitation with or without intermaxillary fixation (IMF).
METHODS:
We measured fracture gaps between bone ends over an 8-year period from 2012 to 2019. The study cohort was composed of only conservatively treated patients. This retrospective study was conducted to identify factors that influence treatment failure by comparing a functional treatment (physiotherapy) group with an IMF group in terms of fracture gaps and other variables. In addition, an algorithm was devised to enable clinicians to determine promptly whether IMF is needed for mandibular condylar fractures.
RESULTS:
Significant correlations were observed between several parameters and malocclusion. Multiple regression analysis resulted in the following coefficients: 0.072 for fracture gap (P = 0.006) and 0.006 for age (P < 0.05) in functional treatment group. However, in the IMF group, correlations with malocclusion were 0.063 for fracture gap (P = 0.000) and 0.003 for age (P = 0.083).
CONCLUSIONS:
We proposed a diagnostic algorithm for isolated unilateral mandibular condyle fractures that provides guidance regarding surgical correction. If indications for surgical correction, as regards anatomical location, fracture level, fracture gap between bone ends, and patient cooperability, are not satisfied, clinicians should select IMF or functional treatment (rehabilitation). If the fracture gap is less than 6 mm and the patient is cooperative, functional rehabilitation would be more suitable than IMF.
15.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002276. [Epub ahead of print]
Prepectoral Breast Reconstruction: A Fad or Here to Stay?
Wong L1.
Abstract
Prepectoral breast reconstruction has rapidly gained attention as a new technique for implant-based breast reconstruction. It is essentially a modernization of an old technique made possible by the use of marketable products, primarily dermal matrices and cohesive silicone gel implants. The rapid dissemination of its benefits, not only to physicians, but also to the general public and referring physicians, leading to widespread adoption, is in part due to a combination of marketing and social media/Internet influences. This review will summarize the recent peer-reviewed literature to provide facts for the reconstructive surgeon to decide whether this technique is a fad or a useful option in implant-based breast reconstruction.
16.
Ann Plast Surg. 2020 Mar 7. doi: 10.1097/SAP.0000000000002204. [Epub ahead of print]
Forequarter Amputation and Reconstructive Options.
Abstract
OBJECTIVE:
This study aimed to present the results of a series of forequarter amputations (FQAs) and to evaluate the reconstructive methods used.
SUMMARY BACKGROUND DATA:
Although FQA has become a rare procedure in the era of limb-sparing treatment of extremity malignancies, it is a useful option when resection of a shoulder girdle or proximal upper extremity tumor cannot be performed so as to retain a functional limb.
METHODS:
Thirty-four patients were treated with FQA in 1989 to 2017. Various reconstructive techniques were used, including free fillet flaps from the amputated extremity.
RESULTS:
All patients presented with intractable symptoms such as severe pain, motor or sensory deficit, or limb edema. Seventeen patients were treated with palliative intent. Chest wall resection was performed in 9 patients. Free flap reconstruction was necessary for 15 patients, with 11 free flaps harvested from the amputated extremity. There was no operative mortality, and no free flaps were lost. In curatively treated patients, estimated 5-year disease-specific survival was 60%. Median survival in the palliatively treated group was 13 months (1-35 months).
CONCLUSIONS:
Limb-sparing treatment is preferable for most shoulder girdle and proximal upper extremity tumors. Sometimes, FQA is the only option enabling curative treatment. In palliative indications, considerable disease-free intervals and relief from disabling symptoms can be achieved. The extensive tissue defects caused by extended FQA can be safely and reliably reconstructed by means of free flaps, preferably harvested from the amputated extremity.
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