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Ditlevsen Yang posted an update 1 week, 4 days ago
The deep inferior epigastric perforator (DIEP) flap is becoming the gold standard for breast reconstruction using autologous tissue. If there are scars in the abdomen from previous surgery, it is necessary to judge the indication for using this flap carefully. Particularly in cases with vertical midline scars, the blood flow supply to the zone II can be compromised. Even when patients have a median abdominal scar, it has been reported that the blood flow can extend beyond the scar and reach several centimeters to about half of zone II. We performed breast reconstruction using DIEP flaps for 2 patients with vertical midline scars in the lower abdomen. Indocyanine green angiography was conducted intraoperatively to confirm the vascular territory with a single pedicle before cutting off the flap. One patient showed fluorescence contrast on the contralateral side across the midline scar. However, the fluorescence contrast was absent across the midline scar in the other patient. Based on this result, we investigated the possible vascular territory of a single pedicled DIEP flap in patients with vertical midline abdominal scars. We suggest that successful blood supply to zone II of a single-pedicled DIEP flap in a patient with a vertical midline abdominal scar is related to the location of the perforator and the property of the tissue in the midline near the perforator. However, because it is difficult to predict the vascular territory of a single pedicle before surgery, intraoperative evaluation using such techniques such as indocyanine green fluorescence imaging is important.There is no current literature examining iatrogenic nerve injury resulting from orthopedic procedures across subspecialties and anatomic areas. This study uses a single peripheral nerve surgeon’s experience to investigate the variable time to presentation of adult patients with iatrogenic nerve injury after orthopedic surgery. Methods A retrospective review of patients examined in Peripheral Nerve Clinic (PNC) from January 1, 2012, to April 1, 2018, at a single, private, university hospital was performed. Fifty-eight adult patients met inclusion criteria. Charts were reviewed to determine the index orthopedic procedure, peripheral nerve affected, clinical deficits, patient demographics, and time from injury to PNC presentation. Results The average patient age was 51.2 years, and the average time to PNC referral was 10.9 months after the procedure that resulted in nerve injury. The orthopedic procedures included fracture fixation (13), joint arthroplasty (10) knee arthroscopy and ligament reconstruction (9), mass excision (9), shoulder arthroscopy (7), irrigation and debridement (2), removal of deep hardware (2), tendon procedures (2), trigger digit release (2), nerve decompression (1), and release of exertional compartment syndrome (1). Time from injury to PNC presentation was substantially shorter for patients with upper extremity versus lower extremity deficits (5.9 months vs 19.8 months; P = 0.0173) and for patients with motor nerve involvement versus those with isolated sensory nerve injury (4.5 months vs 24.3 months; P = 0.0164). buy Gefitinib Conclusions Iatrogenic nerve injury is a risk across orthopedic subspecialties. Nerve injuries in the lower extremity and those with isolated sensory deficits have significantly delayed time to subspecialty presentation.Seroma following liposuction (especially mega-sessions; more than 5 L) is a common complication that causes much distress to the surgeon and the patient. This will eventually affect the overall satisfaction and patient’s experience regarding liposuction. If not detected promptly, seromas can impair the results. Methods This is a prospective analysis performed by the authors in a private practice. All our patients had mega-liposuction sessions (more than 5 L, range 8-12 L) using Power-assisted Liposuction with Lipomatic by Euromai and VASER. Tumescent infiltration was used. Fifty male patients participated after providing their informed consent. Their mean age was 35 years (range, 21-50) and mean body mass index was 29 (range, 28-33). Patients were divided into 2 groups. Group A consisted of 25 patients with no adjunctive draining procedures done, and group B consisted of 25 patients with drainage procedures done. Patients were followed up every other day for 3 weeks for detection of seroma. Results Seventeen patients had post-operative seroma 13 in group A and 4 in group B. The volume of seromas was further subdivided into mild (100 cc). Conclusions High definition liposuction is a demanding procedure by both the surgeon and the patient to achieve the best results and contour. Drainage procedures and drains placement are truly effective methods for minimizing seroma formation, enhancing the recovery, and eventually improving the results.The ReSurge Global Training Program (RGTP) is a model for building reconstructive surgery capacity in low- and middle-income countries.1 The aim of this study is to assess attitudes toward social media, to develop an initial RGTP Facebook Education Group, and to assess the early results of the group’s implementation. Methods A survey of the RGTP community assessed group demographic, interests, concerns, and familiarity with Facebook from July to August of 2018. A “secret” Facebook group was launched on October 30, 2018. Narrated lectures were posted weekly to the group. Educational cases were shared on the group’s discussion page. Facebook “Group Insights” and individual post review were used to obtain group statistics. Results Senior faculty were less likely to have an existing Facebook account (58% vs 93%, P less then 0.05). Trainees were more confident using Facebook (97% vs 54%, P less then 0.05) and favored viewing the training curriculum through Facebook (93.0%, P less then 0.05). At 6 months, the group enrolled 103 members from 14 countries. Twenty-two lectures were posted, obtaining an average of 59.4 views (range, 36-78). Fourteen cases were presented for group discussion with an average of 61.1 views (range, 43-87). Conclusions The RGTP Facebook group has continued to expand in its early months. This group allows our community to view RGTP’s training curriculum, while providing global access to expert opinion and collaboration. The secret Facebook group can be used as an effective and easy-to-use platform for educational outreach in global reconstructive surgery.