Lateral Crisscross Position for Lymphaticovenular Anastomosis: Comfortable for Both the Patient and the Surgeon

J reconstr Microsurg
DOI: 10.1055/s-0038-1676602

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Obesity and Lower Extremity Reconstruction: Evaluating Body Mass Index as an Independent Risk Factor for Early Complications

J reconstr Microsurg
DOI: 10.1055/s-0038-1676538

Background The prevalence of obesity in the United States continues to grow and is estimated to affect over a quarter of the working-age population. Some studies have identified obesity as a risk factor for flap failure and complications in free flap-based breast reconstruction, but its clinical significance is less clear in nonbreast reconstruction. The role of obesity as a risk factor for failure and complications following lower extremity reconstruction has not been well described, and the limited existing literature demonstrates conflicting results. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed to identify patients undergoing local- or free-flap reconstruction of the lower extremity between 2010 and 2015. Preoperative variables and outcomes were compared between obese (body mass index ≥ 30) and nonobese patients. Chi-square analysis and Fisher's exact test were used for categorical variables and t-tests for continuous variables. Multivariate regression was performed to control for confounders. Results Univariate analysis of medical and surgical outcomes revealed that obese patients undergoing local flaps of the lower extremity required a significantly longer operative time (187.7 ± 123.2 vs. 166.2 ± 111.7 minutes; p = 0.003) and had significantly higher rates of superficial surgical site infection (SSI; 7.2% vs. 4.5%; p = 0.04). On univariate analysis, there were no significant differences in any postoperative outcomes between obese and nonobese patients undergoing microvascular free flaps of the lower extremity.On multivariate regression analysis, obesity was not an independent risk factor for superficial SSI (odds ratio = 1.01, p = 0.98) or increased operative time (β  = 16.01, p = 0.14) for local flaps of the lower extremity. Conclusions Evaluation of a large, multicenter, validated and risk-adjusted nationwide cohort demonstrated that obesity is not an independent risk factor for early complications following lower extremity reconstruction, suggesting that these procedures may be performed safely in the obese patient population.
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Promoting TERT Promoter Mutations for Prognostication in Cutaneous Oncology

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Top‐down and Bottom‐up Control of Stress‐Coping

Abstract

In this 30^th anniversary issue review, we focus on glucocorticoid modulation of limbic‐prefrontocortical circuitry during stress‐coping. This action of the stress hormone is mediated by mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) that are co‐expressed abundantly in these higher brain regions. Via both receptor types, the glucocorticoids demonstrate, in various contexts, rapid nongenomic and slower genomic actions which coordinate consecutive stages of information processing. MR‐mediated action optimizes stress‐coping, while in complementary fashion, the memory storage of the selected coping strategy is promoted via GR. We highlight the involvement of adipose tissue in the allocation of energy resources to central regulation of stress reactions, point to still poorly‐understood neuronal ensembles in the prefrontal cortex that underlie cognitive flexibility critical for effective coping, and evaluate the role of cortisol as a pleiotropic regulator in vulnerability to, and treatment of, trauma‐related psychiatric disorders.

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Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience

Abstract

Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment^1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity

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Isotretinoin′s paradoxical effects in immortalized sebocytes

Abstract

in their recently published Research Letter, Burney et al.¹ reported that the short‐term exposure of cultured SEB‐1 immortalized sebocytes to isotretinoin (13‐cis retinoic acid), the most powerful sebum‐suppressive drug promoting sebocyte apoptosis in acne patients, paradoxically increased lipogenesis and upregulated the expression of sterol regulatory element‐binding protein 1 (SREBP1)

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http://bit.ly/2EIDp7j

Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience

Abstract

Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment^1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity

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http://bit.ly/2EJXtqr