Two-dimensional (2D) layered transition-metal dichalcogenides (2DMX2) are materials with unique optoelectronic properties, high surface-to-volume ratio, and high carrier mobility. The combination of ...noble metal nanoparticles (MNPs) with 2DMX2 opens new avenues in conceiving more efficient plasmonic sensors, allowing one to optimize both electromagnetic and chemical signal enhancement. Photoinduced enhanced Raman spectroscopy (PIERS) exploits the electron migration from semiconductors to MNPs, upon UV light irradiation, to further boost the chemical enhancement in the surface-enhanced Raman scattering (SERS) of molecules deposited on hybrid 2DMX2–MNP nanostructures. Here, we propose a new PIERS sensor architecture based on tungsten disulfide (WS2) nanosheets produced by liquid-phase exfoliation (LPE) and functionalized with citrate-stabilized Au MPNs. Electron injection from WS2 to AuNPs is observed when the Au@WS2 is exposed to ultraviolet light, yielding an increase of the charge carriers’ density ≈ 1.8%. The PIERS sensor performances are tested by detecting 4-mercaptobenzoic acid at a concentration of 10 μM. The overall PIERS signal enhancement is ∼106, whereas the photoactivation of WS2 yields a signal improvement of factor 4 with respect to SERS from Au@WS2 before UV irradiation. Our sensor is of low cost, easy to fabricate, and has the potential to detect biomolecules and chemical molecules at trace levels.
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IJS, KILJ, NUK, PNG, UL, UM
Phalloplasty with the radial forearm free flap is associated with a large donor site defect.
To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness ...skin grafting vs split-thickness skin grafting with MatriDerm.
Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure. All 37 patients were evaluated by questionnaire and by careful clinical examination. Pressure perception was assessed with the Semmes-Weinstein monofilament test. Sensory recovery, skin quality, and cosmetic result also were compared. The contralateral arm was used as the control.
Pressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect.
Our findings support the hypothesis that MatriDerm can be used to preserve sensory function and decrease morbidity of the donor site.
The use of a dermal substitute decreases the morbidity of the forearm free flap donor site.
The strength of this study is its retrospective nature conducted of a prospectively maintained database of 37 consecutive radial forearm free flaps with superimposable dimensions and location performed by the same surgeon, thus limiting biases. A limitation is its small sample (particularly for the control group).
Our experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients. Watfa W, di Summa PG, Meuli J, et al. MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery. J Sex Med 2017;14:1277-1284.
Achilles tendon rupture represents one of the most common tendon ruptures. Although primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon ...exposure, require salvage procedures. This article aims to present the authors' orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open-wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October of 2018 and October of 2020. The size of the average soft-tissue defect was 126.2 cm 2 (range, 86.1 to 175.9 cm 2 ), with a tendon gap of 8.2 cm (range, 7.1 to 10.3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure, using a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft-tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using the American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey questionnaire. Mean follow-up was 18.3 months (range, 12 to 24 months). The flap survival rate was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees versus 62 degrees). The American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey scores of all patients improved significantly ( P < 0.005) at 12 months of follow-up. A microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture, providing a reconstructed tendon that achieves satisfactory anatomic shape and function.
Therapeutic, IV.
•Our study compares the clinical usefulness of nerve ultrasound and nerve conduction study in patients with Bell’s palsy.•Nerve Ultrasound may show abnormally increased facial nerve diameter in the ...acute phase of Bell’s palsy.•The predictive value of facial nerve ultrasound for incomplete recovery is lower than that of the nerve conduction study.
This longitudinal study aims at assessing the predictive value of facial nerve high-resolution ultrasound (HRUS) for incomplete clinical recovery in patients with Bell’s palsy, the most common facial nerve disease.
We prospectively enrolled 34 consecutive patients with Bell’s palsy. All patients underwent neurophysiological testing (including facial nerve conduction study) and HRUS evaluations 10–15 days (T1), one month (T2), and three months (T3) after the onset of Bell’s palsy. Patients who did not experience complete recovery within three months were also evaluated after six months (T4). We have then compared the accuracy of HRUS with that of the facial nerve conduction study in predicting incomplete clinical recovery at three and six months.
At T1, the facial nerve diameter, as assessed with HRUS, was larger on the affected side than on the normal side, particularly in patients with incomplete recovery at T2, T3 and T4. ROC curve analysis, however, showed that the facial nerve diameter at T1 had a lower predictive value than the facial nerve conduction study for an incomplete clinical recovery at three (T3) and six (T4) months. Still, the facial nerve diameter asymmetry, as assessed with HRUS, had a relatively high negative predictive value (thus indicating a strong association between normal HRUS examination and a good prognosis).
Although HRUS shows abnormally increased facial nerve diameter in patients in the acute phase of Bell’s palsy, the predictive value of this technique for incomplete clinical recovery at three and six months is lower than that of the nerve conduction study.
Nerve ultrasound has a low predictive value for incomplete clinical recovery in patients with Bell’s Palsy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A left ventricular assistance device (LVAD) is indicated in patients with end-stage heart failure. Due to the non-physiologic blood flow, a LVAD may favor pressure sores with a devastating risk of ...infection.
This work shows the prevalence and treatment of pressure sores in LVAD patients, to optimize their management.
We retrospectively investigated all LVAD implantations at the Lausanne University Hospital (CHUV) from 2015 to 2019. We detected patients who developed a pressure sore and evaluated the timeline, management, and outcomes.
Forty-two patients benefited from LVAD, among whom 5 (12%) developed a stage III/IV pressure sore, within a mean time of 25 days. Due to their poor overall condition, 4/5 patients were treated surgically and 1/5 conservatively. Half of the patients treated with surgery had major complications requiring reoperation. After flap coverage, the mean time to healing for patients was 6 weeks.
The rapid development of deep pressure sores seen in 12% of patients may be a manifestation of the maladaptive blood flow induced by LVADs, combined with their bedridden condition. Initial signs of pressure sores should be considered seriously, as they are rapidly evolving and needing an aggressive surgical treatment whenever possible (80%). Complication rate was similar compared to standard pressure sore flap treatment. All patients benefiting from flap surgery achieved effective coverage after a mean follow-up of 24 months. No patient developed a LVAD infection.
Surgery must be considered early in this population to prevent potential device infection.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The lympho-venous shunt using the distal vein of ALT flap pedicle allowed at the same time the coverage of the inguinal defects and to perform lymphovenous shunt into a run-in vein of the descending ...branch of the lateral circumflex femoral pedicle, draining the lymph through the flap pedicle. Surgical technique, complications and final outcomes (both clinical and lymphoscintigraphic) are reported.
Five patients (45.8 y.o.22-70) with groin soft tissue loss with lymphatic leakage or lower limb lymphedema, benefited of the described technique. The ALT flap was used to cover the defect and, at the same time, we could perform a lymphovenous shunt between afferent lymphatics to the thigh and the descending branch of the lateral circumflex femoral pedicle, distal to the perforator nourishing the flap. Clinical and lymphoscintigraphic assessment of the limbs, cease of lymphorrhea or cellulitis/lymphangitis episodes, eventual downstaging of physiologic/physical therapy were recorded. LYMphatic Quality Of Life in leg (LYMQoLLeg) and patient satisfaction were evaluated.
Average flap size was 88.8cm
2
(range 84-126). The mean number of multi-lymphovenous anastomosis (MLVA) performed was 1.8 (range 1-3) per patient with 1-3 lymphatics shunted into each vein. Only one hemato-seroma requiring surgical revision. Mean improvement of perometer values was 48.2% (range 27.7-67.7) with an average follow-up of 13.6 months (range 12-17). Lymphoscintigraphy showed disappearing of the lymphatic leak and lymphedema with a high satisfaction of LYMQoL score.
The combination of pedicle flap with lympho-venous bypass as lymphatic derivation concept, improving the chronic morbidity scenarios of lymphatic complications.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
19.
Chin Augmentation Techniques: A Systematic Review Oranges, Carlo M; Grufman, Vendela; di Summa, Pietro G ...
Plastic and reconstructive surgery (1963),
05/2023, Volume:
151, Issue:
5
Journal Article
Peer reviewed
Open access
Chin augmentation has maintained a high level of popularity among patients and facial plastic surgeons. Several procedures exist to enhance the appearance of a small chin. The aim of this study was ...to perform a systematic literature review to determine outcomes and complications associated with the different techniques described.
MEDLINE, PubMed, PubMed Central (PMC), and Cochrane Central Registry of Controlled Trials (CENTRAL) databases were screened using a search algorithm. The techniques were classified, and related outcomes and complications tabulated and analyzed.
A total of 54 studies on primary chin augmentation published from 1977 to 2020 met inclusion criteria, representing 4897 treated patients. Six main surgical techniques were identified: chin augmentation with implants (silicone, Gore-Tex, Mersilene, Prolene, Medpor, Proplast, hard tissue replacement, porous block hydroxyapatite, or acrylic; n = 3344), osteotomy ( n = 885), autologous grafts (fat, bone, derma, or cartilage; n = 398), fillers (hyaluronic acid, hydroxyapatite, or biphasic polymer; n = 233), local tissue rearrangements ( n = 32), and a combination of implant placement and osteotomy ( n = 5). All techniques provided consistently satisfactory cosmetic outcomes. The overall complication rate of the most represented groups was 15.7% for implants and 19.7% for osteotomy, including 2.4% and 16.4% cases of transient mental nerve-related injuries, respectively.
All described chin augmentation techniques achieved good outcomes with high patient satisfaction. Thorough knowledge of each technique is essential to minimize each procedure's specific complications. Caution is generally needed to avoid nerve injuries and potential overcorrection or undercorrection.
•Nerve Ultrasound reveals enlarged nerves in Friedreich’s Ataxia.•Nerve abnormalities correlate with clinical disability scales.•Nerve ultrasound can provide useful information where nerve conduction ...study is no longer informative.
In Friedreich's ataxia research, the focus is on discovering treatments and biomarkers to assess disease severity and treatment effects. Our study examines high-resolution nerve ultrasound in these patients, seeking correlations with established clinical markers of disease severity.
Ten patients with Friedreich’s Ataxia underwent a comprehensive clinical assessment with established scales (SARA, FARS, mFARS, INCAT, ADL 0-36, IADL). Additionally, they underwent nerve conduction studies and high-resolution nerve ultrasound. Quantitative evaluation of nerve cross-sectional area, conducted at 24 nerve sites using high-resolution nerve ultrasound, was compared with data obtained from 20 healthy volunteers.
All the patients had a severe sensory axonal neuropathy. High-resolution nerve ultrasound showed significant increase, in cross sectional area, of median and ulnar nerves at the axilla and arm. The cumulative count of affected nerve sites was directly associated with clinical disability, as determined by SARA, FARS, mFARS, ADL 0-36, and INCAT score, while displaying an inverse correlation with IADL.
Our study shows that high-resolution ultrasound reveals notable nerve abnormalities, primarily in the upper limbs of patients diagnosed with Friedreich’s Ataxia. The observed correlation between these nerve abnormalities and clinical disability scales indicates the potential use of this technique as a biomarker for evaluating disease severity and treatment effects.
Nerve Ultrasound is a potential biomarker of disease severity in Friedreich’s Ataxia.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
