Functional Outcomes Regarding Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects
BACKGROUND:The surgical management and reconstruction after ablation of squamous cell carcinoma of the oral tongue and floor of mouth are quite challenging. If not reconstructed properly, the deficits resulting from the extirpation of even relatively small (T1 and T2) tumors of the tongue can impact speech and deglutition via tongue tethering and poor anterolateral mobility. Functional outcome studies regarding the utility of the pedicled facial artery musculamucosal (FAMM) flap for reconstruction of partial glossectomy defects are limited. METHODS:This is a retrospective single institutional study of patients who underwent FAMM flap reconstruction for oral cavity defects resulting from partial glossectomy (2009-2013). Follow-up data included postoperative complications, defect size, operative time, and subjective functional results (tongue mobility, speech, and swallowing capabilities).The MD Anderson Dysphagia Inventory and a limited self-assessment of speech were sent to all living patients in this initial tongue cancer cohort to assess aspects of functional status. RESULTS:Of the 21 patients studied in this initial FAMM flap cohort, 18 are currently living. The MD Anderson Dysphagia Inventory and a limited self-assessment survey of speech were sent to these individuals 6 months after treatment completion. Eight patients (44%) returned completed questionnaires. All of the respondents disagreed or strongly disagreed with the statement that they felt excluded from others because of their eating habits, 6 of the 8 of the respondents stated that they disagreed or strongly disagreed with the statement that they have to limit their food intake, and none felt that others were irritated by their eating habits. All felt that their speech was either good, very good, or excellent. No surveyed patient reported having job difficulty because of their speech. CONCLUSIONS:The FAMM flap is a reliable alternative for reconstruction of small oral tongue defects without functional deficits and a great alternative to free flap reconstruction of medium-sized defects. The encouragement of patient functional outcome studies and longitudinal follow-up studies need to be conducted in efforts to best tailor a reconstruction plan for patients with oral tongue cancers.
The Double-reverse Wedge Excision Technique: A Novel Approach to Reconstruction of Stahl's Ear Deformity
Stahl's ear deformity presents with an abnormal third crus of the antihelix and varying degrees of severity. This paper aims to describe a novel technique for reconstruction of Stahl's ear involving a double-reverse wedge excision of the third crus cartilage and skin, as well as use of MustardÃ© sutures to recreate the superior crus and Furnas sutures to complete the auricular setback. This novel technique for correction of Stahl's ear deformity produces a more stable aesthetic result versus classic otoplasty with desired auricular setback, minimal reduction in the size of the ear, and limited scarring on the anterior auricular surface. Reconstruction of Stahl's ear deformity can be accomplished using this double-reverse wedge excision technique of the third crus cartilage and skin with MustardÃ© and Furnas sutures to recreate the superior crus and complete auricular setback, effectively restoring anatomic harmony to the ear.
Bilateral Sciatic Neuropathy following Gluteal Augmentation With Autologous Fat Grafting [Case Report]
As gluteal augmentation continues to gain in popularity among patients seeking aesthetic enhancements, a thorough knowledge of the postoperative complications associated with this procedure is crucial. This case report concerns a 31-year-old woman who suffered bilateral foot drop secondary to sciatic neuropathy and as a result was wheelchair-bound for several months, following gluteal autologous fat grafting in the Dominical Republic. One year later, the patient had persistent left foot drop and sensory deficits. This is a devastating but seldom reported complication that all plastic surgeons need to be aware of when performing this operation.
Robotic Assisted Abdominosacral Excision of Presacral Cyst
Woodbury CT : Cine-Med, 2018
Extent: 1 DVD (10 min)
Current Techniques for Burn Reconstruction: Using Dehydrated Human Amnion/Chorion Membrane Allografts as an Adjunctive Treatment Along the Reconstructive Ladder
The reconstructive ladder is a term coined by reconstructive plastic surgeons to describe levels of increasingly complex management of wounds. The first rungs of the ladder is allowing the wound to heal by secondary intention, advancing up the ladder to direct tissue closure, with skin grafting and tissue transfer (flaps) comprising the higher rungs. Skin grafting and tissue transfer (flaps) at the middle and higher rungs of the ladder are often necessary for the treatment of complex burn injuries. Our purpose is to describe how dehydrated human amnion/chorion membrane allografts may be used as an adjunctive treatment.
Polycyclic Aromatic Hydrocarbons and Breast Cancer: A Review of the Literature
Polycyclic aromatic hydrocarbons (PAHs) exist and persist in the atmosphere due to the incomplete combustion of fossil fuels, and are established human carcinogens. The influence of PAHs on the development of breast cancer, the most commonly diagnosed cancer in women worldwide, remains unclear. As established risk factors only account for approximately 41% of the breast cancer cases in the USA, researchers have sought to uncover environmental factors involved in breast cancer development. The breasts are particularly susceptible to aromatic carcinogenesis, and the implementation of biomarkers has provided promising insights regarding PAH-DNA adducts in breast cancer. The use of biomarkers measuring PAH-DNA adducts assesses exposure to eliminate the bias inherent in self-reporting measures in case-control studies investigating the link between PAHs and cancer. Adduct levels reflect exposure dose as well as how the body responds to this exposure, which is partially attributable to genetic variability. Evidence suggests that exposure to PAHs has a causational effect on breast cancer in humans, yet this interaction is not clearly understood. In vitro and animal-based studies have consistently revealed that exposure to PAHs deleteriously affects breast tissue, but there is no definitive link between these compounds and breast cancer.
Oxy-Matâ„¢ Mattress System Development Utilizing Simultaneous Measurement of Interface Pressure and Deep Tissue Oxygen Saturation
The development and management of pressure ulcers (PUs) among hospital and nursing home patients is one of the greatest preventable challenges to healthcare worldwide. For over 50 years, pressure mapping and subjective comfort has been the primary indicators for mattress selection. Our research demonstrates that mattress/patient interface pressure and relative blood/oxygen perfusion do not inversely correlate and pressure is not a meaningful, real-time indicator of tissue ischemia and risk of pressure ulcer development. Developed in our research is a real-time sensor system to simultaneously measure and record these parameters over the anatomical sites at risk for PUs. Measurements focused on the heel, sacrum, trochanter, ischium, scapula and occipital. A modified pressure mapping system is used for interface pressure measurements and integrated with multiple near-infrared sensors to measure specific deep tissue hemoglobin saturated oxygen or rSO2. Testing and mattress design development was done during the period of 2008 to present. Over 200 human tests of commercially available mattresses were conducted in supine, 30 degree, and 70 degree positions, ranging in times of up to four hours. During this time period, we utilized 20 test subjects-eight female and 12 male-with ages ranging from 18 to 65 years. The result of this proprietary off-loading device evaluation and design system shows that the new Oxy-Matâ„¢ (Off-Loading Technologies, Tarrytown, NY) Non-Powered Mattress System consistently provides optimized tissue perfusion as measured by natural deep tissue oxygen saturation levels. In extensive laboratory and clinical evaluations, the Oxy-Matâ„¢ was shown to be functionally superior to CMS Group 2 powered mattresses. Another outcome of our research was that a powered mattress system may not be appropriate for most sensate and semi-ambulatory patients. Further research is underway.
A novel use of integraâ„¢ bilayer matrix wound dressing on a pediatric scalp avulsion: a case report
OBJECTIVE:Soft tissue injuries with full-thickness skin involvement not amenable to local flaps may be treated with dermal matrices and subsequent skin grafting. METHODS:A pediatric patient presented with a 50-cm(2) scalp avulsion down to periosteum and outer cranial table post-vehicular trauma. After cultivating healthy cranial neodermis with Integra Bilayer Matrix Wound Dressing, a novel modification of treatment protocol was attempted by removal of the silastic layer. RESULTS:Neodermis transformation to granulation tissue followed by contraction of the wound reduced alopecia while also eliminating the need for a split-thickness skin graft to the area. CONCLUSION/CONCLUSIONS:A novel modification of treatment protocols utilizing acellular dermal matrices improved aesthetic outcomes and may present a cost-, time-, and procedure-sparing treatment option for avulsion injuries.
Lymphatic mapping in the treatment of chronic seroma: a case series [Case Report]
OBJECTIVE:Seromas or lymphoceles are common postoperative complications. This series presents 3 patients with lower extremity seromas refractory to treatment that required lymphatic mapping and lymphatic ligation for closure, and in 1 case, diagnosis. METHODS:Lymphatic mapping procedure consisted of intraoperative injection of subcutaneous tissue with methylene blue distal to the seroma with observation of dye effluence from transected or injured lymphatics draining into area of seroma. RESULTS:In 2 patients, methylene blue dye absorption into lymphatic vessels allowed for optimized visual identification of lymphatic leak and contrast against surrounding tissues. In the third patient, where no lymphocele leak was found, the study was diagnostic and helped to find an alternate etiology for the recurrent seroma. CONCLUSION/CONCLUSIONS:Lymphatic mapping with methylene blue dye is an effective tool in the evaluation and diagnosis of chronic seroma.
The correlation between ultrasound findings and clinical assessment of pressure-related ulcers: is the extent of injury greater than what is predicted?
The current staging system by the National Pressure Ulcer Advisory Panel (NPUAP) classifies the stages of pressure ulcers (PUs) based on clinical assessment and visual inspection. We postulate that patients presenting with clinically superficial PUs (Stage I and Stage II) will have a greater depth of injury than predicted. On admission, patients with sacral PUs were staged according to the NPUAP classification system. Patients who were classified as having a Stage I or Stage II ulcer or suspected deep tissue injury were assessed with high-frequency (12-MHZ) ultrasonography (US) to identify any evidence of injury to the deep tissue. The study included 20 patients undergoing US for PUs of the sacrum. All patients, regardless of PU stage were found to have some evidence of deep tissue injury upon ultrasonographic examination. In patients with suspected deep tissue injury, we have found US to be a reliable diagnostic tool that confirms the clinical suspicion of deep tissue injury. PUs classified as superficial may have a component of deeper tissue damage.