Cosmetic Complications Research Articles

Management of pinna haematoma study (MaPHaeS): A multicentre retrospective observational study

To assess current variation in the management of pinna haematoma (PH) and its effect on outcomes. Multicentre retrospective observational record-based study. Eleven hospitals around the UK. Eighty-three patients above the age of 16 with PH. The primary outcome measure was recurrence rate of PH over a 6-month period post-treatment, assessed by treatment type (scalpel incision vs needle aspiration). Secondary outcome measures assessed the impact of other factors on recurrence, infection and cosmetic complications of PH over a period of 6months. After adjusting for confounding factors, involvement of the whole ear, and management within an operating theatre were associated with a lower rate of recurrence of pinna haematoma. The drainage technique, suspected aetiology, choice of post-drainage management, grade and specialty of practitioner performing drainage, the use of antibiotic cover and hospital admission did not affect the rate of haematoma recurrence, infection or cosmetic complications. Where possible PH should be drained in an operating theatre. Multicentre randomized controlled trials are required to further investigate the impact of drainage technique and post-drainage management on outcome.

Problems, difficulties, and surgical complications of cubitus varus

Cubitus varus is a frequent sequela to supracondylar fractures of the humerus in the pediatric population. Often is it viewed as a cosmetic complication only, which may be an oversimplification and underestimation of the problem. We reviewed the literature to find the reported preoperative problems, intraoperative difficulties, and complications encountered by the patient and the surgeon in cubitus varus. Our review shows that there are a surprisingly large number of challenges, problems, and complications associated with this deformity. The surgeon should be aware of the problems a patient with cubitus varus faces as well as the potential difficulties in operative intervention.

Le complicanze della chirurgia mini-invasiva dell’avampiede

There is increasing interest in and use of minimally invasive foot surgery (MIFS), as it involves short operating time, quicker recovery, reduced hospital stays, better cosmetic results and fewer complications compared to open surgery. However, limited evidence is available in relation to complications associated with MIS for forefoot deformity correction. Available publications lack of homogeneity in terms of case series, patient selection and clinical indicators, mostly being retrospective observational studies with insufficient randomised control trials. The aim of this study was to report the complications following MIFS. In this evaluation, as the Author conceived it as a feasible tool of current clinical practice, complications can be broadly divided into three categories: (1) those related to the learning curve; (2) typical postoperative clinical conditions, such as oedema and haematoma; and (3) true complications. MIFS procedures are safely performed in a range of clinical settings, on varying degrees of digital deformity, resulting in an overall low complication rate compared to conventional open surgery. Long-term safety and efficacy of these techniques need further scientific validations as well as future treatment algorithms to guide clinical decision making.

Cirsoid Aneurysm of the Scalp: A Case Report

Cirsoid aneurysms (arteriovenous malformations [AVMs]) of the scalp are rarely encountered in neurosurgical practice. Patients with AVM of the scalp present clinically at times with headache and a small innocuous-looking subcutaneous scalp lump or a large, pulsatile mass with or without bruit, which has a propensity to massive hemorrhage. Complex vascular anatomy and interconnections, high shunt flow, and possible cosmetic complications tend to make their management difficult. We report a rare case of young man who presented with progressively enlarging swelling over left fronto-temporo-parietal and occipital region of the scalp since 8 years. Digital subtraction angiography of internal and external carotid vessels revealed high-flow, complex left parietal scalp AVM supplied by multiple tortuous feeders from left superficial temporal artery (STA), left middle meningeal artery, left occipital artery with collateral supply from right occipital artery, and right STA. Drainage into external jugular vein through multiple tortuous frontal, temporal, and occipital scalp veins with venous varix. Being high-flow shunt and because of suspected cosmetic complications, surgical excision was considered.

Commentary on: Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients.

This report1 more than most, is truly deserving of a commentary. The authors are to be commended on their clever methodology with the harnessing of what one could call a perverse effect: snagging a cache of valuable, uniquely raw complication data from surgeons who, because of the cosmetic complication insurance coverage, willingly divulged information that would otherwise have remained predominantly unreported. Then with their painstaking analysis, the authors have successfully delivered what I would call a truly “red flag” paper. And the writing on this flag is at once unambiguous and daunting. To whit: the overall complication rate increased from almost double in the simply overweight patient (body mass index [BMI] 25-30), to close to thrice, in the obese candidate (BMI 30-40), to nearly quadruple in the extremely obese individual (BMI 40+). And these statistics, as the authors point out, are only reflective of the major complications that could be insurance covered and thus reported. The numbers would have been even more stark with the inclusion of the many, not so minor complications. Yet there is a danger that their primal conclusion could sound self-evident, almost superfluous. We've all been inculcated with the fateful equation: …

Abstract P2-12-05: Trans-peri-areolar breast conservative surgery followed by endoscopic axillary lymph node dissection: A novel surgical option

Abstract Objective Endoscopic surgery currently is a standard method in most surgical fields. Although endoscopic breast surgery has been introduced since 1993, it is not widely applied due to limited benefits. Changing the conventional local treatment may require new attempts that enhance cosmetic outcomes and diminish complication rates. We report the cosmetic outcomes and postoperative complications of a breast conservative surgery (EBCS) procedure, which consists in using a 3cm peri-areolar incision to perform lumpectomy, and followed by endoscopic axillary lymph node dissection without liposuction. Patients and methods From Nov 2013 till May 2015, 53 patients diagnosed with early stage breast cancer were categorized into the conventional breast conservative surgical group (CBCS)and EBCS group. Indications for EBCS were 1.tumor/breast ratio below 20% 2.no distant metastasis 3.Tumor mass not located in the lower-inferior quadrant. Inform consents were obtained from all patients. 25 patients were enrolled in the EBCS and 28 patients in the CBCS group. Number of lymph nodes harvested, tumor size, intra-operative bleeding, drainage volume, pain score (10scale survey) were collected. The breast symmetrical score (BSS,direct distance from nipple to fovea jugularis,midclavicular, midsternal, inframammary fold and anterior axillary line of both breast was measured 3days after surgery and distance difference ratio of operated to contralateral site was calculated. BSS is the sum of each absolute value of distance difference ratio) and patient satisfaction (4scale survey) were used to evaluate cosmetic outcomes. Results There was no statistical difference in intra-operative bleeding(EBCS:36.00±17.08ml, CBCS:29.29±19.99ml,P=0.20) and drainage volume(EBCS:124.60±50.22, CBCS:120.82±74.58,P=0.832).An increased number of harvested lymph nodes was observed in the EBCS group(EBCS:17.88±6.21,CBCS:14.25±5.82,P=0.03). No statistical difference reported for lymph metastasis among two groups(EBCS:1.68±3.59, CBCS:0.96±1.45,P=0.34) .The average tumor size showed no difference(EBCS: 2.41±0.87, CBCS:1.96±0.95,P=0.07). The pain score (EBCS:3.88±1.53, CBCS:4.39±0.74, P=0.04) meanwhile BSS was significantly superior in the EBCS group(EBCS:0.097±0.084,CBCS:0.20±0.13,P=0.002). Patient satisfaction survey reported a positive feedback(EBCS:4.00±0.00,CBCS:3.68±0.48,P=0.001). Cosmetic outcomes and complications of endoscopic breast conservative surgery EBCSCBCSPbleeding36.00±17.0829.29±19.990.20drainage volume124.60±50.22120.82±74.580.832number of lymph nodes harvested17.88±6.2114.25±5.820.03pain score3.88±1.534.3±0.740.04breast symmetry score0.097±0.0840.20±0.130.002 Conclusions. We evaluated cosmetic outcome using a thorough BSS as an index plus adding the lack of scar in the axilla. EBCS patients displayed a significantly superior outcome in comparison with CBCS, which was further appraised by a considerable satisfied patient's feedback. Evaluation of long-term survival, complication rates and cosmetic results are mandatory in order to further estimate the applicability of this surgical management in treatment of breast cancer. EBCS may be a feasible surgical alternative with minimal invasiveness, suitable to patients demanding excellent cosmetic outcome. Citation Format: Yang W, Sejdinaj F, Shen L, Zhu W, Wang H, Zhang H. Trans-peri-areolar breast conservative surgery followed by endoscopic axillary lymph node dissection: A novel surgical option. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-05.

Clinical Efficacy of Herbal Medicine for Pediatric Lymphatic Malformations: A Pilot Study.

BackgroundLymphatic malformations (LMs) are congenital malformations of the lymphatic system that commonly affect the head and neck region and cause marked cosmetic and functional complications. In this pilot study, we present eight children with LMs treated using an herbal medicine for this indication.MethodsBetween January 2009 and May 2014, eight children (four boys, four girls) with LMs were treated using oral administration of an herbal medicine, Eppikajyutsuto (TJ‐28; Tsumura, Tokyo, Japan), as monotherapy.ResultsFour of the cases were macrocystic and four were mixed micro‐ and macrocystic. The mean treatment duration was 7.2 ± 2.9 months (range 5–12 mos). The mean LM volume shrinkage on magnetic resonance imaging was 54.5 ± 38.3% (macrocystic 73.6 ± 27.0%; mixed micro‐ and macrocystic 35.4 ± 41.5%). One of four macrocystic lesions had a marked reduction, two had a moderate reduction, and one had no response. A marked reduction was observed in three of the four mixed micro‐ and macrocystic cases; the other mixed cystic case had no response. The treatment was well tolerated, without severe adverse events.ConclusionsThis preliminary study demonstrates the beneficial effects of TJ‐28. Further evaluations of this therapeutic modality are warranted.

Efficacy of Percutaneous Ethanol Injection for Benign Neck Cyst

Received January 18, 2016 Revised March 22, 2016 Accepted March 22, 2016 Address for correspondence Jong Chul Hong, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel +82-51-240-5428 Fax +82-51-253-0712 E-mail santa@dau.ac.kr Background and ObjectivesZZAdvantages of percutaneous ethanol injection (PEI) were represented by insignificant mortality, minimal damage to normal parenchyma, relatively low cost and easy availability. The objective of the present study was to evaluate the efficacy of ethanol ablation as a minimally invasive management of cystic lesions in the neck or arising from the neck. Subjects and MethodZZBetween August 2010 and December 2015, 28 patients with cystic lesions in the neck were diagnosed and treated with percutaneous ethanol injection. We evaluated the outcome of treatment using the alteration of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. ResultsZZThe initial mean tumor volume was 21 mL (range, 1.6-36.9 mL), as shown by ultrasonography. The mean number of the treatment sessions was 3.5 (range, 1-9 sessions). At the last follow-up, the mean volume of the treated neck cyst decreased significantly from 21 mL to 2.7 mL (p<0.001). The average volume reduction rate was 82.4% with the success rate of procedure of 82%. The mean symptoms and cosmetics visual analog scale improved from 5.4 to 2.4 and from 4.8 to 1.5 (p<0.001). No significant complications were observed during follow-ups. ConclusionZZPEI is simple, easy, safe, and effective without surgical scars and hospitalization for neck cyst patients and favorable outcomes can be achieved without significant complications. It can be used as a substitute for surgery in the treatment of benign neck cyst lesions. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(6):448-52

Complications in the Cosmetic Dermatology Patient

Over recent decades, the options available to patients for cosmetic rejuvenation have expanded dramatically. The range of options commonly available to patients now includes neuromodulators, fillers, sclerotherapy, chemical peels, lasers, lights and other energy devices, and liposculpture and continues to grow. Like all therapeutic interventions, these cosmetic dermatologic procedures are not without risk. Timely recognition of complications and intervention are paramount for optimal patient outcomes. Part 1 of this review focused on the common complications that may result from injectable cosmetic procedures. The second part will discuss the complications of chemical peels, lasers, light and energy devices, and fat removal/sculpture procedures. A MEDLINE search was performed on cosmetic dermatology complications from 1989 to 2015, and results are summarized. Practical considerations of these complications are also provided. Reports of complications after neuromodulator, injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate, sclerotherapy, fat transfer, liposuction, cryolipolysis, chemical peels, lasers, and light sources, such as Q-switched laser, intense pulsed light, and nonablative and ablative resurfacing lasers, were found. Review of the literature revealed multiple management options for potential complications of the multitude of cosmetic dermatology procedures now available to patients.

Complications in the Cosmetic Dermatology Patient: A Review and Our Experience (Part 1).

Over recent decades, the options available to patients for cosmetic rejuvenation have expanded dramatically. The range of options commonly available to patients now includes neuromodulators, fillers, sclerotherapy, chemical peels, liposculpture, lasers, and lights and other energy devices and continues to grow. As with all therapeutic interventions, these cosmetic dermatologic procedures are not without risk. Timely recognition of complications and intervention are paramount for optimal patient outcomes. Part 1 of this review will focus on the common complications of injectable cosmetic procedures, such as neuromodulators, fillers, and sclerotherapy. The second part will discuss the complications of chemical peels, lasers, light and energy devices, and fat removal procedures. A MEDLINE search was performed on cosmetic dermatology complications from 1989 to 2015, and results are summarized. Practical considerations of these complications are also provided. Reports of complications after neuromodulator, injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate, sclerotherapy, fat transfer, liposuction, cryolipolysis, chemical peels, lasers, and light sources, such as Q-switched laser, intense pulsed light, nonablative and ablative resurfacing lasers, were found. Review of the literature revealed multiple management options for potential complications of the multitude of cosmetic dermatology procedures now available to patients.

Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair

Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These patients were treated using dilatation, fistula repair, meatoplasty, and secondary repair with the same technique, respectively. Eventually all patients had a vertical slit-like meatus on the tip of a natural looking glans. The most commonly used distal hypospadias repair techniques are glanular approximation, meatal advancement and glanuloplasty, Koff, Mathieu, Thiersch-Duplay procedure, tubularized incised plate repairs, and modifications of these techniques. Cosmetic and functional results and complication rates of ECMB-LUM technique are comparable with those of the commonly used techniques.

Use of the SMAS flap for reconstruction of the parotid lodge.

SUMMARYThe purpose of our study was to evaluate the benefits of the SMAS flap in patients with benign tumours of the parotid gland treated by superficial parotidectomy. We carried out a retrospective chart review on 123 patients suffering from benign tumours of the parotid gland admitted to our Institution between March 1997 and March 2010. A superficial parotidectomy was performed in all the cases reported. Our sample was divided in two groups basing SMAS flap reconstruction done (Group 2) or not (Group 1) after superficial parotidectomy. Reconstruction using SMAS flap was accomplished in 64 patients. Chi-square test was used to assess statistical difference between the two groups. The level of statistical significance was P < 0.05. No significant differences concerning hematoma, wound infection and facial paralysis were observed between the first and second group (3.38 vs 1.56% [P > 0.05], 8.47% vs 4.68% [P > 0.05], 5.08% vs 0.00% [P > 0.05]). Transient facial nerve weakness, fistula, dip skin and Frey's syndrome were significantly more frequent without SMAS flap reconstruction (10.16% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 20.33% vs 0% [P < 0.05] respectively). The use of the SMAS flap is able to reduce the cosmetic and functional complications that occur after the removal of a benign tumour of the parotid through the superficial parotidectomy technique, above all, it reduces the occurrence of Frey's syndrome.

Radiation Therapy After Skin Sparing Mastectomy and Implant Based Reconstruction

Purpose/Objective(s): To evaluate the long-term cosmetic results and complications, and to investigate the prognostic factors for cosmetic satisfaction in patients who received radiation therapy (RT) following skin sparing mastectomy (SSM) and implant based reconstruction. Materials/Methods: Sixty-eight breast cancer patients treated with adjuvant RT following SSM and implant based reconstruction between November 2007 and April 2014 were evaluated. Median age of the patients was 41 years (range, 28-58 years). Axillary lymph node (LN) dissection was performed in 61 patients (90%) whereas sentinel LN sampling was performed in 7 patients (10%). Three patients (4%) received neoadjuvant, and 64 patients (94%) received adjuvant chemotherapy (CT). All patients were treated with SSM including excision of the nipple-areola complex. The type of implant was a silicone implant in 63 (93%) and a permanent expander in 5 (7%) patients. Four (6%) patients received RT to reconstructed breast (RB) only encompassing the thoracic wall and skin since they had either tumors 5 cm or fascial involvement without LN metastasis. The remaining 64 (94%) patients were treated with RB and lymphatic irradiation. All patients with lymphatic RT received supraclavicular fossa and level III irradiation, while 45 (70%) of them also received internal mammary (IM) RT and 30 (47%) received full axillary RT. RT dose was 50 Gy with conventional daily fractionation in all patients. Three (4%) patients received 2-dimentional RT, 31 (46%) patients received forward planning intensity modulated radiation therapy (IMRT), and 34 (50%) patients received reverse planning IMRT. Results:Median follow-up time was 37 months (10-87 months). Two-, and 5-year overall survival (OS) rates were 100%, and 94%; and disease-free survival (DFS) rates were 100%, and 90%, respectively. Late complications were observed in 10 (15%) patients; capsular contraction occurred in 9 patients, and fat necrosis occurred in 1 patient. Two (3%) patients had malposition of the implant prior to RT. All patients were asked for rating the cosmetic result after RT and the self-evaluation of the patients revealed 66% of excellent, 15% of moderately well and 19% of unsatisfactory results. The implant had to be removed in 11 (16%) patients and a new implant was replaced in 3 of them. All the patients with a new implant replacement declared moderately well or excellent cosmetic results after the new reconstruction process. However, 8 patients without a new reconstruction declared unsatisfactory cosmetic results. Conclusion: RT after implant based reconstruction may deteriorate the cosmetic results in a small subgroup of patients. An additional reconstruction surgery increases the satisfaction rates. Author Disclosure: S. Yuce Sari: None. M. Gultekin: None. G. Ozyigit: None. M. Gurkaynak: None. F. Yildiz: None.

Long Term Health Consequences of Polycystic Ovarian Syndrome

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. It affects multiple systems, and requires a comprehensive perspective on health care for effective treatment. Its metabolic derangements and associated complications include insulin resistance, diabetes, hyperlipidemia, hypertension, fatty liver, metabolic syndrome and sleep apnea. Reproductive complications are oligomenorrhea or amenorrhea, subfertility, endometrial hyperplasia and cancer. Cosmetic complications include acne & facial hair growth. Associated psychosocial concerns are depression and disordered eating. Anxiety, depression and reduced quality of life are also common in this condition. Diagnosis is clinical and is supported by lab findings. Regular exercise, healthy foods, and weight control are the key treatments for PCOS. Pharmacological treatments can reduce unpleasant symptoms and helps to prevent long-term health problems. Guidelines are needed to aid early diagnosis, appropriate investigation, regular screening and treatment of this common condition. The aim of this review is to provide clear and up to date information about the consequences of the syndrome.

Handling medical cosmetic complications: what are the key issues for nurses?

According to a survey recently conducted by the British Asssociation of Cosmetic Nurses and Hamilton Fraser, aesthetic nurses are in need of more guidance on managing complications. To assist this group of often isolated practitioners, the Journal of Aesthetic Nursing will be publishing a series of articles by claims expert Naomi Di-Scala on obtaining treatment-specific consent and monitoring patient expectations

Fractional carbon dioxide laser ablation for the treatment of microcystic lymphatic malformations (lymphangioma circumscriptum) in an adult patient with Klippel-Trenaunay syndrome.

Lymphangioma circumscriptum (LC) is a rare, benign, vascular malformation of dilated superficial lymphatic channels. Treatment is typically undertaken for cosmetic reasons or complications such as fluid drainage, pain, and infection risk that can negatively impact quality of life. Management of LC remains challenging because of high recurrence rates, regardless of the treatment modality chosen. Treatment of LC with the fully-ablative carbon dioxide (CO2 ) laser has been reported widely, however, treatment with the fractionated CO2 laser has been limited to one case in the pediatric population. Our objective was to test the usefulness of the fractionated 10,600-nm CO2 laser in the management of symptomatic LC in an adult. We report a case of a 27-year-old female with Klippel-Trenaunay Syndrome (KTS) who presented with a 5-year history of well-circumscribed lesions on the right lateral and anterior thigh that drained clear lymphatic and serosanguineous fluid, respectively. These lesions caused her significant emotional distress because of extensive drainage. After only one treatment utilizing the fractionated 10,600-nm CO2 laser, the patient had improvement with cessation of fluid drainage, and the lesions are still asymptomatic 6 months since initial treatment. The favorable results observed in our patient suggest that fractionated CO2 laser may be an additional well-tolerated, low downtime option for palliation of symptoms in patients with LC. We recognize that short-term follow-up cannot conclusively demonstrate effectiveness and durability of this treatment and that, given the high risk of recurrence, a longer-term observation is needed before making definite conclusions. Lasers Surg. Med. 47:539-541, 2015. © 2015 Wiley Periodicals, Inc.

Prospective comparison of primary wound closure with tissue- adhesive versus suture materials

Background and Objectives: Nowadays the final outcome of wound closure using tissue adhesives and suture material is making a real competition for better results. Cosmetic outcome is regarded as the first demand for the patients. The aim of this study was to make a comparison between the two closure methods in terms of cosmetic outcome, complication and patients’ satisfaction. Method: A prospective comparative study was conducted at Rizgary Teaching Hospital and West Erbil Emergency Hospital in Erbil city from March 2012 to March 2013. A total of 105 patients were included in the study. The method of closure was selected alternatively between tissue adhesive (octylcyanoacrylate) and suture material. Analysis for cosmetic outcome, complications and patients’ satisfaction were done using the statistical package for the social sciences (version 19). Results: The complications were 25% (13 patients) in the tissue adhesive group and 18% (9 patients) in the sutured group. Of the 44 patients in the tissue adhesive group, 86.4% (38 patients) were satisfied; while of the 61 patients in the sutured group, 88% (54 patients) were satisfied with the end result. Excellent cosmetic outcome achieved in 77.3% in the tissue adhesive group and 80.3% in the sutured group. Conclusion: Tissue adhesive (octylcyanoacrylate) is effective and reliable in primary skin closure, yielding similar cosmetic results to standard suturing method. Tissue adhesive is faster and offers several practical advantages over suture repair.

Percutaneous versus conventional approach for antegrade femoral nailing, which technique should be the standard one?

Background The standard (conventional) approach (CA) for antegrade femoral nailing was accused for many functional and cosmetic complications, while the minimal reports about the percutaneous approach (PA) revealed better results. The purpose of this study was to compare prospectively both approaches trying to determine which technique should be the standard one.

Therapeutic superiority of combined propranolol with short steroids course over propranolol monotherapy in infantile hemangioma.

Infantile hemangiomas are the most common benign childhood tumor that may have functional and/or cosmetic complications. We aimed to compare the clinical efficacy of propranolol alone and propranolol primed with systemic corticosteroids on the outcome of infantile hemangioma. A prospective randomized study included 40 infants aged less than 9 months with cutaneous hemangiomas. Patients were randomly assigned into two groups: group A were given oral prednisolone for the initial 2 weeks combined with oral propranolol, while group B were given oral propranolol alone for 6 months. The median age of the studied patients was 4.5 months (ranged 4 weeks-8 months). Sequential determination of the dimensions of the hemangiomas based on direct measurement and photographic analysis were performed. A significant reduction in the size of the lesions was found in group A in the 2-, 4-, and 8-week evaluation compared to group B (p < 0.001) with no statistical difference in the ultimate 6 month response (p = 0.134). Multiple logistic regression showed that early treatment before 6 months of age (OR 9.82, p = 0.007) and combined treatment with propranolol and prednisolone (OR 10.71, p = 0.006) were the predictors of best response. Combining propranolol with corticosteroids gives a faster response and should be considered in treating life- or function-threatening hemangiomas.

Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma: combined single-stage rhinosurgical and neurosurgical approach.

Although intracranial extension of juvenile nasopharyngeal angiofibroma (JNA) occurs commonly, intradural penetration is extremely rare. Management of such tumors is a challenging issue in skull-base surgery, necessitating their removal via combined approaches. In this work, we share our experience in management of extensive intradural JNA. In a university hospital-based setting of 2 tertiary care academic centers, retrospective chart of 6 male patients (5 between 15 and 19 years old) was reviewed. Patients presented chiefly with nasal obstruction, epistaxis, and proptosis. One of them was an aggressive recurrent tumor in a 32-year-old patient. All cases underwent combined transnasal, transmaxillary, and craniotomy approaches assisted by the use of image-guided endoscopic surgery, with craniotomy preceding the rhinosurgical approach in 3 cases. Adding a transcranial approach to the transnasal and transmaxillary endoscopic approaches provided 2-sided exposure and appreciated access to the huge intradural JNAs. One postoperative cerebrospinal fluid leak and 1 postoperative recurrence at the site of infratemporal fossa were treated successfully. Otherwise, the course was uneventful in the remaining cases. Management of intracranial intradural JNA requires a multidisciplinary approach of combined open and endoscopic-assisted rhinosurgery and neurosurgery, because of greater risk for complications during the dissection. Carotid rupture and brain damage remain 2 catastrophic complications that should always be kept in mind. A combined rhinosurgical and neurosurgical approach also has the advantage of very modest cosmetic complications.