The nerve supply to the pectoralis major: An anatomical study and clinical application of the denervation in subpectoral breast implant surgery

xlomafota13 shared this article with you from Inoreader The nerve supply to the pectoralis major: An anatomical study and clinical application of the denervation in subpectoral breast implant surgery Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 13:S1748-6815(21)00314-4. doi: 10.1016/j.bjps.2021.05.055. Online ahead of print. ABSTRACT BACKGROUND: Using the subpectoral approach, animation deformity or breast distortion due to pectoralis muscle contraction is common. Although the anatomy of the pectoral nerves has been extensively studied, only few studies have related the location of these nerves to bony landmarks. OBJECTIVE: Our aim is to clarify the anatomy and possible variations of the innervation of the pectoralis major in relation to bony landmarks useful for surgery and to identify the preferred level for (selective) denervation by 1) transecting the nerves and 2) splitting the muscle in subpectoral breast implant surgery in cadavers. METHODS: Fourteen pectoral regions (both left and right side) were dissected on 7 formaldehyde-fixed cadavers. The origin, locations, and course were mapped and (distances to) landmarks we re reported. RESULTS: The lateral pectoral nerve, medial pectoral nerve, and ansa pectoralis were identified in all cadavers. Nerve branches pierce the pectoralis minor or run along its upper or lower border. The piercing nerves vary from one to three branches and were consistently located lateral to the midclavicular line. The horizontal and vertical distances to bony landmarks varied greatly and depended on the size and location of the pectoralis minor, except for the nerve running along the upper border of the PMin, which was located consistently around 30% of the clavicular line from the acromioclavicular joint to the sternoclavicular joint. CONCLUSION: We were unable to define a fixed landmark to mark pre- or peroperatively. However, we could define guidelines that help to identify and excise or preserve nerves of interest. PMID:34247965 | DOI:10.1016/j.bjps.2021.05.055 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A multivariate analysis after preservation rhinoplasty (PR) - a prospective study

xlomafota13 shared this article with you from Inoreader A multivariate analysis after preservation rhinoplasty (PR) - a prospective study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00333-8. doi: 10.1016/j.bjps.2021.05.073. Online ahead of print. ABSTRACT BACKGROUND: Preservation rhinoplasty (PR) is considered to be an innovative approach with high patient satisfaction. However, little is known about its functional outcomes and radiological analyses. PATIENTS AND METHODS: In this prospective clinical study, 30 patients (20 female and 10 male patients, mean age 30.7 ±9.8 years) were operated on between 2017 and 2021. Radiological assessment was evaluated by cone beam computed tomography before surgery and at final follow-up. Patient assessment regarding their outcome was assessed at final follow-up using a validated questionnaire (rhinoplasty outcomes evaluation questionnaire = ROE). RESULTS: After a mean follow-up of 8.4 ± 5 months (range = 1 - 18 months), radiological analyses denoted an overall improved internal nasal valve (INV) angle after surgery (preoperative = 20.77° ± 3.2° vs. postoperative = 21.82° ± 5.7°, p = 0.18). Those results are in accordance with an overall high patient satisfaction for both function and aesthetics (ROE score 18.4 ± 4.3). CONCLUSION: Our study showed a preserved and widened INV angle after PR, along with high patient satisfaction. LEVEL OF EVIDENCE: III. PMID:34247959 | DOI:10.1016/j.bjps.2021.05.073 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical relationship between distal interosseous membrane thickness measured through magnetic resonance imaging and distal radioulnar joint stability: A retrospective study

xlomafota13 shared this article with you from Inoreader Clinical relationship between distal interosseous membrane thickness measured through magnetic resonance imaging and distal radioulnar joint stability: A retrospective study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 25:S1748-6815(21)00327-2. doi: 10.1016/j.bjps.2021.05.065. Online ahead of print. ABSTRACT BACKGROUND: Cadaveric studies suggest that a thick part of the distal interosseous membrane (DIOM), known as the distal oblique bundle (DOB), contributes to the distal radioulnar joint (DRUJ)'s stability. We hypothesized that the DIOM thickness, measured through magnetic resonance imaging (MRI), has a clinically significant association with DRUJ stability. METHODS: We retrospectively reviewed patients, from February 2018 to April 2019, who underwent wrist MRI examination with physical examination for DRUJ stability. We evaluated the correlation between their MRI findings (i.e., triangular fibrocartilage complex [TFCC] tears and presence of the DOB) and DRUJ instability. RESULTS: Out of 85 patients with an average age of 42 years, 45 (53%) had foveal TFCC tears, 29 (34%) had a DOB, and 38 patient s (45%) had clinical DRUJ instability. Patients with DRUJ instability had a significantly higher incidence of foveal TFCC tears (30/38, vs 15/47, p < 0.001), while DOB was absent (36/38 vs. 20/47, p < 0.001). Among 45 patients with foveal TFCC tears, only 1 out of 13 patients with a DOB had DRUJ instability, whereas 29 out of 32 patients without a DOB had DRUJ instability (p < 0.001). The odds ratio for DRUJ instability was 11.7 (95% CI 2.9-47.5, p = 0.001) for foveal TFCC tear and 54.2 (95% CI 8.2-358.2, p < 0.001) for the absent DOB. CONCLUSIONS: Clinical DRUJ instability was less common when the DOB is present in patients with foveal TFCC tears, which supports DOB's role as a secondary DRUJ stabilizer. PMID:3 4247961 | DOI:10.1016/j.bjps.2021.05.065 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prospective clinical trial comparing barbed dermal suture and interrupted suture closure of the anterolateral thigh flap donor site in a Taiwanese population based on the Vancouver scar scale and the patient and observer scar assessment scale

xlomafota13 shared this article with you from Inoreader Prospective clinical trial comparing barbed dermal suture and interrupted suture closure of the anterolateral thigh flap donor site in a Taiwanese population based on the Vancouver scar scale and the patient and observer scar assessment scale Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 27:S1748-6815(21)00350-8. doi: 10.1016/j.bjps.2021.06.015. Online ahead of print. NO ABSTRACT PMID:34247963 | DOI:10.1016/j.bjps.2021.06.015 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study

xlomafota13 shared this article with you from Inoreader Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 22:S1748-6815(21)00299-0. doi: 10.1016/j.bjps.2021.05.048. Online ahead of print. ABSTRACT BACKGROUND: Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8). METHODS: A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-relat ed, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models. RESULTS: Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population. CONCLUSIONS: Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification. PMID:34247960 | DOI:10.1016/j.bjps.2021.05.048 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of islanded scrotal raphe flap employment for skin shortage in complicated hypospadias repair

xlomafota13 shared this article with you from Inoreader Outcomes of islanded scrotal raphe flap employment for skin shortage in complicated hypospadias repair Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 9:S1748-6815(21)00275-8. doi: 10.1016/j.bjps.2021.05.023. Online ahead of print. ABSTRACT BACKGROUND: Ventral skin deficiency in complicated hypospadias is a difficult problem to treat. The aim of our study is to report our technique and outcomes of vascularized islanded scrotal raphe flap for ventral skin deficiency in complicated hypospadias. METHODS: A retrospective review was conducted at Northwest General Hospital & Research Centre, Peshawar, from January 2012 to January 2019. Complicated hypospadias patients who underwent two-stage surgery employing islanded scrotal flap were identified. Patients underwent surgery in two stages: scar tissue removal, chordee correction and buccal mucosal graft in the first stage; neourethral tubularization, water proofing, and skin coverage with vascularized islanded scrotal raphe flap in the second stage. The primary outcome was 6-month flap survi val rate. Secondary outcomes were 6-month complication rate (fistula, persistent chordee, distal stenosis) and end-of-follow-up patient self-reported satisfaction rate. RESULTS: A total of 1845 patients underwent hypospadias surgery, of which 380 patients had complications. Scrotal raphe flap was used in 45 patients. Mean age was 14.09 (±8.02) years. Mean follow-up was 29.78 (±12.18) months. Mean number of previous surgeries was 4.31 (±2.59). The flap survived in all cases. Nine patients (20%) developed complications. One patient (2.2%) developed distal stenosis. Eight patients (17.8%) developed fistulas, one of whom additionally had persistent chordee. Five fistulas closed spontaneously within 3 months, while the rest were repaired surgically after 6 months. All patients self-reported satisfaction with results at end-of-follow-up. CONCLUSIONS: Islanded Scrotal Raphé flap is a promising option for treating complicated hypospadias when there is significant ventral def iciency of skin, as it not only provides vascularized pliable skin but also fascia as a waterproofing layer. PMID:34247964 | DOI:10.1016/j.bjps.2021.05.023 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sutureless venous microanastomosis using thermosensitive poloxamer and cyanoacrylate: experimental study on a rat model

xlomafota13 shared this article with you from Inoreader Sutureless venous microanastomosis using thermosensitive poloxamer and cyanoacrylate: experimental study on a rat model Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00330-2. doi: 10.1016/j.bjps.2021.05.072. Online ahead of print. ABSTRACT INTRODUCTION: Sutureless microvascular anastomoses could simplify the microvascular field, shortening operative time and improving the final outcome. The use of thermosensitive poloxamers (TP407) together with the application of cyanoacrylate as an alternative method for conventional sutures was well-documented for arteries, but not for veins. The purpose of our study was to prove the feasibility of this technique for venous anastomoses and compare it with the traditional hand-sewn technique on a rat model. MATERIALS AND METHODS: Twenty male Sprague-Dawley rats that weighed between 265 and 310 g were used. In the sutureless group (SG), 20 left external jugular veins (LEJV) end-to-end anastomoses were performed using a T704 and cyanoacrylate glue. They were compared to 20 right external jugular veins ( REJV) anastomoses sutured with conventional 10-0 stitches (control group - CG). Diameters of veins, anastomosis time, and patency rate at 15 days were reported. Foreign body reaction was assessed histologically. RESULTS: The mean diameter of the LEJV was 0.94 ± 0.1 mm and 0.95 ± 0.09 mm for the REJV. The mean anastomosis time was 11.9 ± 1.37 min for the SG and 27.75 ± 3.31 min for the CG. In the latter group, the immediate patency rate was 95% and 90% at 15 days. For the SG group, 90% of the anastomoses were patent immediately and 85% at 15 days. CONCLUSION: TP407 and cyanoacrylate could offer a fast and reliable technique for sutureless venous anastomoses. Before human application, effectiveness of this method remains to be confirmed in larger animals in a long-term follow-up. PMID:34247962 | DOI:10.1016/j.bjps.2021.05.072 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The early years of nuclear medicine: A Retelling

xlomafota13 shared this article with you from Inoreader The early years of nuclear medicine: A Retelling Via radioactive iodine Asia Ocean J Nucl Med Biol. 2021 Spring;9(2):207-219. doi: 10.22038/AOJNMB.2020.52375.1358. ABSTRACT Nuclear medicine history has its share of captivating personalities, controversial claims, and forgotten pioneers. Publications and documents that came out relatively recently, provide us with new perspectives on its history. Primary sourced material might contradict some of the long-held beliefs of the reader who only has a casual familiarity with the events, including basics such as who discovered radioactivity. Because of the nature of the specialty, the importance of the contributions of colleagues in related fields, like physics and chemistry, cannot be overstated. Many of the important discoveries were marked by serendipity, but the pioneers must be given credit for having the necessary insights to interpret the new phenomena correctly, sometimes turning perceived "failure" into novel scientific principles. In addition, most of our pioneers had to deal with inadequate facilities and funding, religious and racial discrimination, and even misogynism. The early history of nuclear medicine is presented in this article as a series of its most interesting anecdotes, from the early work on radioactivity, to the conception of the tracer principle, until the development of radioactive iodine therapy. PMID:34250151 | PMC:PMC8255519 | DOI:10.22038/AOJNMB.2020.52375.1358 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical Treatment of Sacral Metastatic Tumors

xlomafota13 shared this article with you from Inoreader Surgical Treatment of Sacral Metastatic Tumors Via leak of cerebrospinal fluid Front Oncol. 2021 Jun 25;11:640933. doi: 10.3389/fonc.2021.640933. eCollection 2021. ABSTRACT OBJECTIVE: This study intends to retrospectively analyze the data of patients with sacral metastases in our center, and analyze the treatment methods and therapeutic effects of sacral metastases. METHODS: 73 patients with sacral metastases treated in our hospital from June 2013 to June 2019 were retrospectively analyzed. There were 54 cases of neurological symptoms, 42 cases of sacroiliac joint instability, 24 cases of lower limb muscle weakness and 19 cases of abnormal urination and defecation. Four patients with tumors below S3 underwent complete tumor resection, 23 patients with tumors above S3 and without sacroiliac joint instability underwent tumor curettage and nerve root lysis, 34 patients with tumors above S3 and sacroiliac joint instability underwent tumor curettage, nerve root release and screw rod reconstruction. 12 patients with mul tiple metastases underwent percutaneous radiofrequency ablation and sacroplasty. VAS was used to evaluate the preoperative and postoperative pain scores, and the postoperative pain relief, neurological function, bowel function, wound healing and complications were evaluated. RESULTS: There were no perioperative death, 8 cases of poor wound healing, 5 cases of nerve injury, postoperative sensory and motor loss of lower limbs. Cerebrospinal fluid (CSF) leak in 7 cases. The patients were followed up for 6-25 months (mean 12 months). The VAS scores of patients with pain symptoms were 7 points before operation and 1.44 points after operation, In 19 patients with abnormal urination and defecation function, 12 patients recovered to normal 3-6 months after operation, 5 cases had no significant change compared with preoperative, and 2 cases had aggravated symptoms; 17 cases of patients with lower limb muscle strength were significantly recovered after operation, and the average muscle strength was increased by 2 grades; 30 cases of patients with unstable sacroiliac joint got internal fixation had significantly pain relief. Pain symptoms of 9 patients were significantly relieved after percutaneous radiofrequency ablation. CONCLUSION: the operation of sacral metastases mainly adopts a relatively conservative surgical method, which can effectively improve the quality of life of patients with sacral metastases by retaining the nerve function and relieving the pain of patients, combining with radiofrequency ablation, sacroplasty and targeted drugs. PMID:34249683 | PMC:PMC8267802 | DOI:10.3389/fonc.2021.640933 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Validation of European Organization for Research and Treatment of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35) Across Languages: A Systematic Review

xlomafota13 shared this article with you from Inoreader Validation of European Organization for Research and Treatment of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35) Across Languages: A Systematic Review Via Otolaryngology Indian Abstract The purpose of this review was to identify cross-cultural and psychometric characteristics of the European Organization for Research and Treatment of Cancer Head and neck cancer questionnaire (EORTC QLQ-H&N35) in various languages. A literature search was performed for original papers in PubMed, EMBASE, and Google scholar electronic databases on validation, psychometric properties of the EORTC-H&N35 questionnaire for patients with head and neck cancer. A total of 17 papers had been reviewed systematically. The studies were conducted in 28 countries and EORTC QLQ-H&N35 questionnaire was validated in 21 different languages. The majority of papers reported high reliability having Cronbach's coefficient above 0.70. Low reliability was reported for senses and speech problems, pain, and less sexuality. Moderate to good convergent validity was found as the correlation coefficient was above 0.40 except for speech problems and social contact trouble. Discrimin ant validity (weak correlations < 0.70) was confirmed in 14 papers. This review provides comprehensive information on cross-cultural and psychometric properties of EORTC QLQ-H&N35 and can be recommended to implement in oncological practice. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Safety and Complications of Sedation Anesthesia during Pediatric Auditory Brainstem Response Testing

xlomafota13 shared this article with you from Inoreader Safety and Complications of Sedation Anesthesia during Pediatric Auditory Brainstem Response Testing Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Objective: The auditory brainstem response (ABR) test has been widely used in childhood. Although it is a painless procedure, sedation can be needed in pediatric patients. Thus, this study aimed to evaluate safety and complications of sedation anesthesia applied in pediatric patients during ABR testing. Methods: Medical records of 75 children who underwent ABR testing between 2018 and 2020 were evaluated retrospectively in terms of applicability, safety, and compli cations of sedation anesthesia. Results: The ages ranged from 3 to 9 (mean 6.2) years. Comorbidity was detected in 20% (n = 15); 3 had multiple comorbidities, and the most common comorbidity was Down syndrome (4%). The drugs used in sedation anesthesia were midazolam in 81.3% (n = 61), a combination of propofol and ketamine in 14.7% (n = 11), and only propofol in 4% (n = 3) of the patients. An additional drug use was needed in 44% (n = 33). The mean procedure time was 40 (range 30–55) min. The mean anesthesia duration was 45 (range 35–60) min. The mean recovery time was 10 (range 5–15) min. Complications related to anesthesia developed in 4 (5.33%) of the patients; respiratory distress, agitation, cough, and nausea-vomiting were seen in one of the patients, respectively. Complications like bradycardia and respiratory or cardiac arrest were not seen at all. Conclusions: The complication rate of sedation anesthesia p erformed during ABR testing of pediatric patients is quite low. It may be more beneficial to use combinations of sedation drugs instead of using a single sedation drug. Although sedation anesthesia appears to be safe in general, the potentially life-threatening complications of sedative agents should be remembered, especially in children who have comorbidities. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.