BACKGROUNDOrbital floor fracture defect size and inferior rectus (IR) rounding index are currently accepted indications for surgery to prevent late enophthalmos. The authors analyzed the positive ...predictive value (PPV) of these indications. METHODSTwenty-eight patients with orbital floor fractures presenting without enophthalmos underwent Hertel exophthalmometry at presentation and at weeks 1, 2, 3, 6, 13, 26, and 52 or more after injury. Orbital defect size and IR rounding index were measured from computed tomographic scans, and PPVs of defects of 1.5 to 2 cm 2 or larger and IR rounding index of 1 or higher for enophthalmos (≥2 mm) were calculated. RESULTSNineteen patients had isolated orbital floor fractures (group A), three had noncontinuous orbital floor and medial wall fractures (group B), and six had continuous orbital floor with medial wall fractures (group C). Mean follow-up time was 440 days. Of all patients, 20 had a defect size of 1.5 cm 2 or larger, 12 had a defect of 2.0 cm 2 or larger, and 13 had an IR rounding index of 1 or higher. Of the 28 patients, only one from group A and two from group C developed enophthalmos of 2 mm only. The PPVs of orbital floor defect size of 1.5 cm 2 or larger and 2 cm 2 or larger (groups A and B only) for late enophthalmos were 6.7% and 0%, respectively. The PPV of IR rounding index of 1 or higher for late enophthalmos (all groups) was 0%. CONCLUSIONSFor patients with orbital floor fractures presenting without enophthalmos, defects of 1.5 cm 2 or larger and 2 cm 2 or larger, and IR rounding index of 1 or higher, are weakly predictive of late enophthalmos. Furthermore, patients who do not develop enophthalmos within 3 weeks of injury are unlikely to develop significant (>2 mm) late enophthalmos. CLINICAL QUESTION/LEVEL OF EVIDENCERisk, III.
Orbital floor fracture defect size (DS) and Inferior Rectus (IR) Rounding Index are currently accepted indications for surgery to prevent late enophthalmos. Herein, we analyze the positive predictive ...value (PPV) of these indications.
28 patients with orbital floor fractures presenting without enophthalmos underwent Hertel exophthalmometry at presentation and at weeks 1, 2, 3, 6, 13, 26, and ≥52 following injury. Orbital defect size (DS) and IR Rounding Index (IR) were measured from CT scans, and PPVs of defect size ≥1.5-2cm 2 and IR Rounding Index ≥1 for enophthalmos (≥2mm) were calculated.
19 patients had isolated orbital floor fractures (Group A), 3 had non-continuous orbital floor and medial wall fractures (Group B), and 6 had continuous orbital floor with medial wall fractures (Group C). Mean follow-up time was 440 days. Of all patients, 20 had DS ≥1.5cm 2, 12 had DS ≥2.0cm 2, and 13 had IR Rounding Index ≥1. Of the 28 patients, only one from group A and two from group C developed enophthalmos of 2mm only. The PPV of orbital floor DS ≥1.5cm 2 and ≥2cm 2 (groups A and B only) for late enophthalmos was 6.7% and 0%, respectively. The PPV of IR Rounding Index ≥1 for late enophthalmos (all groups) was 0%.
For patients with orbital floor fractures presenting without enophthalmos, defect size ≥1.5cm 2 and ≥2cm 2 , and IR rounding ≥1 are weakly predictive of late enophthalmos. Furthermore, patients who do not develop enophthalmos within 3 weeks of injury are unlikely to develop significant (>2mm) late enophthalmos.
To address decision-making styles among breast cancer survivors considering breast reconstruction. .
A primary analysis of a cross-sectional sample among survivors who chose to have breast ...reconstruction to examine correlations among patient age, decision-making style, and the level of involvement of decision making. .
Hadassah Medical Center in Jerusalem, Israel. .
70 women who had undergone breast reconstruction surgery in the past five years. .
Participants completed decision-making style and demographic questionnaires and an assessment of their level of involvement in the decision-making process. .
Level of involvement in decision making, decision-making model between provider and patient, and decision-making styles were examined. .
No correlation was found between four main decision-making styles and patient age or the extent of patient decision-making involvement and age. A statistically significant correlation was found between the level of involvement in decision making and the decision-making style of the patient. .
Nurses should assess patient decision-making styles to ensure maximum patient involvement in the decision-making process based on personal desires regardless of age. .
Nurses working in breast cancer care must address the decision-making process of patients diagnosed with breast cancer, including the choice to undergo breast reconstruction after mastectomy. Nurses should understand the complex factors that influence a woman's decision-making style to best help with the decision.
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Summary Background Large congenital melanocytic nevi entail significant medical and cosmetic ramifications for patients and families. Reconstruction is a challenging endeavor, especially when the ...lesion is present on the limbs. The literature describes various methods by which plastic surgeon can address reconstruction, yet to date there are no series describing a workhorse that provides consistent results with low complication rates. In this study we describe our surgical technique for reconstruction of the upper extremity after excision of large circumferential CNM with a pre-expanded bi-pedicled flap, namely the “sleeve” flap. Methods Systematic review of our database of pediatric patients treated for large and giant nevi was performed. Cases of large and giant circumferential upper extremity nevi were retrieved and charts reviewed for demographics, number of procedures performed, duration of follow-up, and complications. Results Over a course of twelve years, 8 patients with large or giant circumferential nevi of the upper extremity were treated at our institution with "sleeve" flap reconstruction. Mean follow-up time was 36 months. A single complication was seen. All reconstructions achieved satisfactory results, both functionally and cosmetically. Discussion We describe our surgical approach for treating upper extremity large and giant circumferential nevi with pre-expanded bi-pedicled “sleeve” flaps. When properly planned and executed, this technique enables successful treatment of large and giant nevi of the arm and the forearm. Although arduous and complex, the process yields excellent aesthetic results with low complication rates. This technique is strong contender for the reconstructive option of choice for these difficult lesions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Introduction
Oncoplastic breast surgery following breast conservation surgery (BCS) utilizes aesthetic breast reduction techniques, and these reconstructions entail either volume displacement or ...volume replacement depending on the size and location of the excised tumor. The anterior Intercostal flap (AICAP) for immediate reconstruction after BCS is scarcely described in the literature. In this study, we present our experience with the Anterior Intercoastal Artery Perforator flap in 16 patients with small breast sizes.
Patients and Methods
Sixteen patients underwent lumpectomy followed by immediate reconstruction with Anterior ICAP flap between 2019 and 2021 at Hadassah University Hospital. Median age was 49 (range 28–67). Breast cup size, lumpectomy to breast size ration, defect measurements and location are provided. Flap design and flap in‐setting was planned and executed according to the size and location of the defect determined at the time of surgery. Surgical technique is described. Diagram of proposed reconstruction according to defect location is proposed.
Results
Flap dimensions clinically matched the defect size or were slightly larger due to anticipated shrinkage of tissue post radiation with mean of 5.4 × 3.9 × 3.75 cm (range of 2.5–13 × 2–13.2 × 0.8–4.5 cm). Complications, namely one seroma and one mild infection, were seen in two patients. Median follow up was 3 months after completion of radiation. All reconstructions were satisfactory by both surgeon and patient at last post‐operative follow‐up visit.
Conclusion
The anterior ICAP flap is an important addition to the armamentarium of immediate reconstruction options after BCS, particularly in patients smaller size breast sizes.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Particular trends of postoperative complications following abdominoplasty are seen when patients present with a history of bariatric surgery. This study aims to analyze the risk factors for ...complications following abdominoplasty among those who did and did not undergo prior bariatric weight loss surgery.
Data of 144 patients who underwent abdominoplasty at our institution between 2009 and 2015 were reviewed. Prevalence of existing comorbidities and incidences of postoperative complications were recorded, and statistical analysis was carried out to establish differences between our cohorts.
Of 144 patients, 49 patients had prior bariatric surgery and 95 patients did not undergo surgery. There was no statistically significant difference between the groups for the prevalence of diabetes mellitus, coronary artery disease, hypertension, and anemia, although differences did exist for hypothyroidism and smoking history (p = 0.04 and 0.037, respectively). Postbariatric patients had more comorbidities than nonbariatric patients (p = 0.024). Postoperatively, there was no statistically significant difference between the groups for incidences of hematoma, necrosis, active bleeding, and symptomatic decrease in Hb, although differences did exist for infection (OR = 13.12), seroma (OR = 9.07), prolonged healing (OR = 5.28), and abundant drain secretions (OR = 5.24). Male gender and prior bariatric surgery were associated with higher overall rates of postoperative complications.
Our findings validate the results of prior studies that report a higher prevalence of underlying comorbidities and postoperative complications among postbariatric surgery patients undergoing abdominoplasty. Furthermore, prior bariatric surgery was found to be an independent risk factor for the presence of any (OR 4.78 and p < 0.001) and major (OR 4.050 and p = 0.018) complications after abdominoplasty.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Fixation is critical in zygomaticomaxillary complex (ZMC) fractures to avoid malunion; however, controversy exists as to how much hardware is required to achieve adequate stability. Current fixation ...regimens may not represent the minimum stabilization needed for uneventful healing. Craniomaxillofacial (CMF) computational models have shown limited load transmission through the infraorbital rim (IOR), and a previous experimental study of ZMC fractures has suggested that IOR plating does not alter CMF bone strain patterns. This study aimed to measure the impact of stabilization on fracture site displacement under muscle loading, testing the hypothesis that three-point fixation is not critical for ZMC fracture stability. Four ZMC complex fractures were simulated on two cadaveric samples and stabilized with three-point plating. Displacements simulating mouth openings of 20 mm and 30 mm were applied to the mandible using a custom apparatus. Fracture gap displacement under load was measured at multiple points along each fracture line, and bone strain was captured using a combination of uniaxial and rosette gauges. Data capture was repeated with the IOR plate removed (two-point fixation) and with the zygomaticomaxillary plate removed (one-point fixation). Fracture displacement under muscle loading was consistent, with gaps of less than 1 mm in 95% of cases (range 0.05–1.44 mm), reflecting clinical stability. Large variabilities were observed in the strain measurements, which may reflect the complexity of CMFS load patterns and the sensitivity of strain values to gauge placement. This study supports the concept of hardware reduction, suggesting that two-point (or even one-point) fixation may provide sufficient stability for a ZMC fracture under applied muscle loading.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background Tissue expansion is a common reconstructive technique that has been associated with significant complications since its inception. However, the existing literature mostly focuses ...on complications associated with pediatric tissue expansion only or describes a combined population of adult and pediatric patients, including breast tissue expansion; despite the fact that each of these groups of patients has different characteristics that may affect tissue expansion. Objective In this study we present a critical review of our experience with complications of nonbreast tissue expansion in adult and pediatric patients and compare between these groups. Methods The charts of patients who underwent nonbreast tissue expansion at Hadassah Medical Center between January 2003 and July 2012 were reviewed. Data were collected including the age of the patient, anatomical site of the expansion, indication and complications. Results A total of 202 expansion procedures were performed on 119 pediatric patients (< 16 years) and 56 expansion procedures on 44 adult patients. The overall complication rate was 18.2%, with 40 pediatric procedures having complications (19.8%) and 7 adult procedures (12.5%). The difference in complication rates between the two groups was not found to be statistically significant. There was no statistically significant difference in complication rate between the different anatomical areas of expansion in both adult and pediatric patients or between the indications for operation. Most (68%) of the cases with complications underwent subsequent successful reconstruction. Conclusions Despite the consistent high complication rate, tissue expansion can be used as a good reconstructive method in both adult and pediatric patients in all anatomic areas and for different indications.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Toxic epidermal necrolysis is a rare exfoliative disorder with a high mortality rate.
We present a 70-year-old woman of Iranian descent who presented with toxic epidermal necrolysis that was ...initially diagnosed as a scald burn. Further anamnesis prompted by spread of the lesions during hospitalization revealed that the patient had been receiving ceftriaxone for several days. To the best of our knowledge, this is the first case of ceftriaxone-induced toxic epidermal necrolysis in the English literature.
Toxic epidermal necrolysis is an acute, life-threatening, exfoliative disorder with a high mortality rate. High clinical suspicion, prompt recognition, and initiation of supportive care is mandatory. Thorough investigation of the pathogenetic mechanisms is fundamental. Optimal treatment guidelines are still unavailable.
Surgical Technique for Nasal Cleft Repair Chapchay, Katya; Zaga, Jonathan; Billig, Allan ...
Annals of plastic surgery,
2019-March, 2019-03-00, 2019-3-00, 20190301, Volume:
82, Issue:
3
Journal Article
Peer reviewed
BACKGROUNDCongenital nasal cleft is a very rare yet challenging deformity to reconstruct. Atypical craniofacial clefts that involve the nasal ala are designated as number 1 and number 2 under the ...Tessier classification system. These clefts typically present as notches in the medial one-third of either nasal ala and may be accompanied by a malpositioned cartilaginous framework. Nasal clefts are smaller and far less common than familiar clefts of the lip and palate, but they pose equally challenging reconstructive planning.
METHODSOur described technique relies on usage of existing nasal tissue near the cleft. Local tissue rearrangement using a laterally based rotational alar flap, a medially based triangular flap, and a nasal wall advancement flap restores normal anatomy and provides an aesthetically pleasing result.
RESULTSFive children with isolated nasal cleft were treated by the senior author (A.M.) between 2010 and 2017. All patients presented with clefts of the soft tissue with no underlying cartilaginous involvement. There were no postoperative complications. Excellent aesthetic outcome was achieved in all patients.
CONCLUSIONIsolated nasal cleft can be properly corrected with the described procedure in a single stage and with optimal result.
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