Fat Necrosis Research Articles

Case Report: Hypercalcemia, subcutaneous fat necrosis and nephrocalcinosis in neonates who undergo therapeutic hypothermia: a not so rare association, with different onset time

Subcutaneous fat necrosis (SCFN) in newborns is an uncommon and self-limiting non-infectious panniculitis. It can occur in the first weeks of life in full-term newborns with hypoxic-ischemic encephalopathy who underwent therapeutic hypothermia. Hypercalcemia may develop and has been implicated as the cause of several complications as nephrocalcinosis. Hypercalcemia has been previously reported to appear only after resolution of skin lesions. Herein, we report how hypercalcemia can be evident already at diagnosis of subcutaneous fat necrosis after therapeutic hypothermia and can be associated with an early onset developing nephrocalcinosis. We compare two cases of these uncommon findings and review the recent literature.

Liquefactive subcutaneous fat necrosis of the newborn

Liquefactive subcutaneous fat necrosis of the newborn

Risks of Autologous Abdominal Free Flap Breast Reconstruction in Patients With Elevated Body Mass Index.

Obesity is widely recognized as a significant risk factor for postoperative complications of breast reconstruction. Despite extensive research, there remains a lack of consensus regarding the specific complications and outcomes experienced by patients with obesity who undergo deep inferior epigastric perforator (DIEP) flap reconstruction. To provide a clearer understanding of the challenges faced by patients with obesity, we present a single-center outcome analysis of individuals who underwent DIEP flap reconstruction. A cohort of 194 patients who underwent at least 1 DIEP flap was retrospectively analyzed at the University of Nebraska Medical Center utilizing electronic medical records. Patients who underwent DIEP flap breast reconstruction were organized into 5 categories using World Health Organization weight status by body mass index (BMI) obtained from the day of surgery. Surgical complications within 120 days and postsurgical complication-related procedural interventions were also evaluated and compared. Comparisons of variables of interest between weight groups were assessed using Mantel-Haenszel chi-square tests or Spearman correlations. Increases in patient weight category were associated with increased length of operation (P = 0.003), increased rates of breast fat necrosis (P = 0.04), breast wound dehiscence (P = 0.01), abdominal wound dehiscence (P = 0.02), numbers of abdominal complications (P = 0.001), and rates of requiring an intervention (P = 0.03). The findings imply that higher BMI values may lead to a higher likelihood of postoperative complications and the need for intervention. It is crucial for patients with obesity to be aware of the elevated risk associated with rising BMI values.

Systemic and immunotoxicity induced by topical application of perfluoroheptane sulfonic acid (PFHpS) or perfluorooctane sulfonic acid (PFOS) in a murine model

Per- and polyfluoroalkyl substances (PFAS) are a large group of synthetic surfactants of over 12,000 compounds that are incorporated into numerous products for their chemical and physical properties. Studies have associated PFAS with adverse health effects. Although there is a high potential for dermal exposure, these studies are lacking. The present study evaluated the systemic and immunotoxicity of subchronic 28- or 10-days of dermal exposure, respectively, to PFHpS (0.3125–2.5% or 7.82–62.5 mg/kg/dose) or PFOS (0.5% or 12.5 mg/kg/dose) in a murine model. Elevated levels of PFHpS were detected in the serum and urine, suggesting that absorption is occurring through the dermal route. PFHpS induced significantly increased relative liver weight, significantly decreased relative spleen and thymus weight, altered serum chemistries, and altered histopathology. Additionally, PFHpS significantly reduced the humoral immune response and altered immune subsets in the spleen, suggesting immunosuppression. Gene expression changes were observed in the liver, skin, and spleen of genes involved in fatty acid metabolism, necrosis, and inflammation. Immune-cell phenotyping identified significant decreases in B-cells and CD11b+ monocyte and/or macrophages in the spleen along with decreases in eosinophils and dendritic cells in the skin. These findings support PFHpS absorption through the skin leading to liver damage and immune suppression.

Skin Necrosis: Pathophysiology and innovations in tissue regeneration

Skin, the largest organ in the human body, serves as a crucial barrier against environmental threats. However, larger skin defects or compromised wound healing can result in persistent wounds, sometimes requiring skin substitutes. Skin tissue engineering aims to create materials that can replace skin functions temporarily or permanently. The skin comprises several tissue types, including epithelial, connective, muscular, nervous, and vascular tissues. Keratinocytes, for instance, undergo a specialized process to form the cornified layer, which differentiates from apoptosis, a type of programmed cell death. Pathogenic processes often involve necrosis, a form of tissue death caused by insufficient blood supply, infections, or trauma. There are various types of necrosis, including coagulation, liquefactive, gangrenous, caseous, fat, and fibrinoid necrosis, each defined by the tissue changes and underlying causes. Necrosis can result from external factors like mechanical trauma, thermal damage, or ischemia, and internal factors such as infection or certain diseases. Necrosis is linked to autoimmune conditions, vascular diseases, and toxic exposures. Risk factors include age, alcohol abuse, infections, and conditions like diabetes and HIV. Treatment for necrosis involves removing dead tissue (debridement), managing infections, and restoring blood flow, often requiring surgery or amputation. Additional treatments like antibiotics, hyperbaric oxygen therapy, and wound dressings support healing. Alternative approaches, including homeopathy and Ayurveda, focus on stimulating natural healing processes through herbs and detoxification.

The IMAP and MICAP Flaps for Autologous Breast Reconstruction: An Anatomic, Clinical, and Outcome Study.

Local flaps for breast reconstruction are becoming recognized as a viable alternative to remote flaps. The purpose of this manuscript is to describe the anatomy and clinical outcomes using the internal mammary artery perforators and the lateral intercostal artery perforator flaps for breast reconstruction. Twelve cadaveric specimens were injected with colored latex and dissected to demonstrate the medial perforators of the 5th intercostal space. Twenty-two patients had partial or total breast reconstruction using the internal mammary artery perforator flaps that was combined with the lateral intercostal artery perforator flap in 4 patients. The study was performed at the Hospital de Clinicas Jose de San Martin that is affiliated with the Universidad de Buenos Aires in Argentina between March 2018 -December 2023. Outcomes were based on clinical evaluation and statistical analysis. Patient satisfaction was assessed on a 5-point Likert scale based on whether they were clothed or unclothed. All flaps survived without any evidence of partial flap necrosis. There were no major complications (total flap loss, partial necrosis); however, fat necrosis was demonstrated in two patients. Minor complications included a small hematoma and a minor wound dehiscence. Patient satisfaction was rated as very good or excellent in 100% of women when clothed and rated as good to very good in 93.3% of women when unclothed. Submammary perforator flaps can be raised on numerous vascular pedicles. This study has demonstrated that the internal mammary and the lateral intercostal can be successfully used for partial or total breast reconstruction in properly selected patients.

Male Chest Athletic Definition: A Comprehensive View from an Anatomical and Physiological Perspective.

In order to obtain a natural but athletic contour through liposuction, the management of the male pectoral region is constantly changing. Cutting-edge methods including mammary gland excision and fat grafting to the pectoralis major have been created. There isn't yet a single method that can handle all long-term problems, like gynecomastia with eventual loss of pectoral definition, fat graft asymmetries, and/or unnatural definition..vic. This article proposes a surgical technique to improve the male pectoral region through liposuction in specific areas, muscular volumization with objectively established fat volumes based on intracompartimental pressure measurements, and the management and prevention of gynecomastia. This approach aims to ensure the maximal survival of the fat graft with reduced fat necrosis, long-term asymmetry, and sustained results over time. Measurement of the pectoralis major pressure, following fat graft, was conducted between January 2021 and June 2023. Patients aged between 19 and 60 years at the time of surgery, with a body mass index below 30 kg/m², were included. The surgical technique is presented in this article. The two models used in this study exhibited strong explanatory power, indicating that a significant portion of the variability in fat graft resorption could be explained by the variables included in these models. Postoperative exercise, patients age, and intramuscular pressure of the transferred fat showed statistically significant results in the survival of fat grafts. BMI did not show a statistically significant relationship. This technique can treat and prevent gynecomastia while simultaneously improving the appearance of the male chest through volumization of the pectoralis major with safe fat grafts volumes. The established volumes did not exceed 8 mmHg intracompartimental pressure. Higher volumes reduced fat survival. Large volumes lead to greater postoperative asymmetry and loss of fat grafts.

Melanisation in Salmonid Skeletal Muscle: A Review.

Melanisation can occur in the musculature of fish. A well-known form is the melanised focal changes, or 'black spots', in the fillet of farmed Atlantic salmon (Salmo salar). The aetiology of black spots has not been fully determined, though recent research has emphasised the role of fat necrosis in their development. The initial stages of the changes are observed as focal haemorrhages or 'red spots', and these can progress into melanised focal changes (MFCs). The focal haemorrhages are acute changes characterised by necrotic myocytes and adipocytes and diffuse haemorrhage in the tissue. These changes evolve into a chronic inflammation dominated by fibrosis, encapsulated lipid droplets or pseudocysts, presence of epithelioid cells, granulomas of varying character, giant cells and melano-macrophages, whose presence accounts for the discolouration. The inflammation ranges from mild to severe, and the severity of the lesion has been associated with localised piscine orthoreovirus 1 (PRV 1) replication in macrophages and melano-macrophages within granulomas. The possibility of a genetic impact on the condition has not been supported by available data. The lipid composition and the antioxidative properties of the feed have been shown to affect the development of the changes. Physiological and environmental factors are also believed to influence the prevalence and severity of the condition. Here, we review the current state of knowledge concerning melanisation in fish skeletal musculature, with a special emphasis on the MFCs in Atlantic salmon.

Vascular Endothelial Growth Factor Expression of Adipose-Derived Stromal Cells and Adipocytes Initiated from Fat Aspirations.

Fat grafting is frequently employed in aesthetic and reconstructive plastic surgery with a low complication rate. However, fat necrosis may occur in dependence of the mode of fat aspiration, processing of the tissue and graft size. Graft survival is critically dependent on the contained adipose-derived stromal cells (ADSCs), adipocyte precursors and their potential for vascular supply. This work investigated the potential role of the expression of vascular endothelial growth factor A (VEGF) and various cytokines by ADSCs and differentiated adipocytes as key factors of fat grafting. Adipokine expression of ADSCs and differentiated adipocytes were assessed using Proteome Profiler Arrays that detect 58 relevant proteins. Collected fat grafts could be categorized according to their adipokine expression into VEGFhigh and VEGFlow ADSCs groups, the former exhibiting higher content of VEGF-related angiopoietin-like 2, nidogen-1/entactin, CCL2/MCP-1 and elevated expression of IGFBPs in association with a fourfold higher VEGF expression. Differentiation of ADSCs into adipocytes increased VEGF concentrations in VEGFlow ADSCs but not in ADSCs exhibiting initial high VEGF concentrations. The adipocytes revealed high expression of HGF, leptin, CCL2/MCP-1, nidogen-1/entactin, M-CSF but lower induction of angiopoietin-like 2. Half of the ADSCs from fat grafts express high concentrations of VEGF and other adipokines that support angiogenesis and survival of this tissues following transfer. Differentiation of ADSClow cells to adipocytes may make up for the initially low VEGF expression, but this activation is 7-10 days delayed compared to the VEGFhigh ADSC cells and may fail to support angiogenesis from the beginning. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Disparities in Breast Reconstruction After Mastectomy in Southeast Asia: A Systematic Review.

Breast cancer is the most commonly diagnosed cancer among women in Southeast Asia. However, significant disparities in access to postmastectomy breast reconstruction persist due to cultural, economic, and healthcare-related factors. These disparities result in unequal access to care, impacting patient outcomes, and overall quality of life. A systematic review was conducted following PRISMA guidelines to assess trends, disparities, and outcomes in breast reconstruction across Southeast Asia. The review included 15 studies published between 2000 and 2023 from countries including Singapore, Malaysia, Vietnam, Thailand, and Brunei. Data extracted focused on disparities related to ethnicity, socioeconomic status, geographic location, and surgical outcomes. Statistical analysis included summarizing key variables across studies. Significant cultural and economic barriers to breast reconstruction were identified. Cultural beliefs influenced uptake, with Malay women preferring autologous tissue reconstruction (92.3%), while Chinese women had lower reconstruction rates due to traditional beliefs. Economic constraints limited access to advanced techniques like the DIEP flap, which had a median cost of SGD 11 009.38, significantly higher than the TRAM flap (SGD, 300.51, p < 0.001). Geographic disparities further restricted access, especially in rural areas. Complication rates were higher in obese patients, with total flap loss at 6% and fat necrosis at 10%. Studies from Vietnam and Thailand reported 5-year overall survival rates of 95% and disease-free survival rates of 80.7% for early-stage breast cancer patients undergoing reconstruction. Breast reconstruction disparities in Southeast Asia are driven by complex interactions between cultural, economic, and healthcare-related factors. Efforts to reduce these disparities must focus on increasing patient education, expanding reconstructive options, and addressing systemic healthcare inequalities. Targeted interventions, including policy changes to subsidize reconstruction and improve surgeon training in rural areas, are critical to ensuring equitable access and improving patient outcomes across the region.

The DERMIS Study: Methodologies, Results, and Implications for the Future.

Ongoing innovation in diabetes technologies has led to the development of advanced tools such as automated insulin delivery (AID) systems that adjust insulin delivery in response to current and predicted glucose levels, residual insulin action, and other inputs (eg, meal and exercise announcements). However, infusion sets continue to be the "Achilles heel" of accurate and precise insulin delivery and continued device use. A recent study by Kalus et al (DERMIS Study) revealed higher vessel density and signals of inflammation by optical coherence tomography (OCT), in addition to increased inflammation, fat necrosis, fibrosis, and eosinophilic infiltration by histopathology. Although the study provided a comprehensive description of what was happening, the results raise important questions that require additional research. On February 29, 2024, the Leona M. and Harry B. Helmsley Charitable Trust sponsored a conference to begin addressing these issues. This article summarizes the DERMIS study findings and testing methodologies discussed at the conference and proposes the next steps for developing insulin infusion sets that reduce the variability in insulin delivery and extend wear.

Use of the Thermal Camera to Assess the Perfusion of the Nipple-Areola Complex and Lower Adipoglandular Flap in Post-Explantation Mastopexy.

Thermography is a valuable tool for assessing tissue temperature. In recent years, explantation surgery has increased due to the fact that, despite technological advancements, breast implants have a limited lifespan and eventually require explantation, whether for pathological, aesthetic, or personal reasons. Among the complications that can arise in breast surgery are necrosis of the nipple-areola complex (NAC) and fat necrosis of the lower dermoglandular flap, which may affect the outcomes. Considering that the blood supply and perfusion of the breast were altered during the initial surgical procedure, and the technique previously used is often unknown, it is crucial to ensure adequate vascularization of the NAC and the flap. This study demonstrates the usefulness of the thermal camera for intraoperative and postoperative monitoring of the NAC and the lower adipoglandular flap, with the goal of determining tissue perfusion and identifying hypoperfused areas for immediate management, thus providing a new safety parameter in breast surgery.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quantitative and Morphology-Based Deep Convolutional Neural Network Approaches for Osteosarcoma Survival Prediction in the Neoadjuvant and Metastatic Settings.

Necrosis quantification in the neoadjuvant setting using pathology slide review is the most important validated prognostic marker in conventional osteosarcoma. Herein, we explored three deep-learning strategies on histology samples to predict outcome for osteosarcoma in the neoadjuvant setting. Our study relies on a training cohort from New York University (NYU; New York, NY) and an external cohort from Charles University (Prague, Czechia). We trained and validated the performance of a supervised approach that integrates neural network predictions of necrosis/tumor content and compared predicted overall survival (OS) using Kaplan-Meier curves. Furthermore, we explored morphology-based supervised and self-supervised approaches to determine whether intrinsic histomorphologic features could serve as a potential marker for OS in the neoadjuvant setting. Excellent correlation between the trained network and pathologists was obtained for the quantification of necrosis content (R2 = 0.899; r = 0.949; P < 0.0001). OS prediction cutoffs were consistent between pathologists and the neural network (22% and 30% of necrosis, respectively). The morphology-based supervised approach predicted OS; P = 0.0028, HR = 2.43 (1.10-5.38). The self-supervised approach corroborated the findings with clusters enriched in necrosis, fibroblastic stroma, and osteoblastic morphology associating with better OS [log-2 hazard ratio (lg2 HR); -2.366; -1.164; -1.175; 95% confidence interval, (-2.996 to -0.514)]. Viable/partially viable tumor and fat necrosis were associated with worse OS [lg2 HR; 1.287; 0.822; 0.828; 95% confidence interval, (0.38-1.974)]. Neural networks can be used to automatically estimate the necrosis to tumor ratio, a quantitative metric predictive of survival. Furthermore, we identified alternate histomorphologic biomarkers specific to the necrotic and tumor regions, which could serve as predictors.

Energy Metabolite, Immunity, Antioxidant Capacity, and Rumen Microbiota Differences Between Ewes in Late Gestation Carrying Single, Twin, and Triplet Fetuses.

The objective of this study was to investigate the differences in the energy metabolites, immunity, antioxidant capacity, and rumen microbiota of ewes with different numbers of fetuses. Thirty healthy ewes were selected and divided into single- (SL, n = 10), twin- (TL, n = 10), and triplet-fetal (PL, n = 10) ewes according to the number of fetuses. Sampling was carried out on days 21 (Q21) and 7 (Q7) before lambing. The results show no differences (p > 0.05) in the DMI and BW of ewes with different numbers of fetuses, and the body condition score (BCS) of PL ewes was lower (p < 0.05) than that of SL ewes. The concentrations of β-hydroxybutyric acid (BHBA), non-esterified fatty acids (NEFA), interleukin-2 (IL-2), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) in the PL ewes were higher (p < 0.05), while the glucose (Glu), triglyceride (TG), total cholesterol (TC), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC) values were lower (p < 0.05) than those of the SL ewes. ANOSIM analysis showed that the rumen bacterial structure of the SL, TL, and PL ewes was different on days Q21 and Q7. The relative abundance of Firmicutes and Bacteroidota in the rumen was affected (p < 0.05) by the number of fetuses: the relative abundance of Firmicutes (Ruminococcus, Butyrivibrio, Christensenellaceae_R-7_group, Lachnospiraceae_AC2044_group, Lachnospiraceae_XPB1014_group, and Anaeroplasma) was higher (p < 0.05), while that of Bacteroidota (Prevotella, Prevotellaceae_UCG-003, and Prevotellaceae_UCG-001) was lower (p < 0.05) in the SL ewes than in the PL ewes. In summary, the rumen microbial structure and energy metabolites of ewes in late gestation with different numbers of fetuses were different. Triplet-fetal ewes were characterized by lower BCS and antioxidant capacity and were prone to the triggering of inflammatory responses.

Reduction Mammaplasty

Background While there is mounting evidence that closed suction drains are not necessary, there is a paucity of literature to demonstrate that drains are harmful after breast reduction. The purpose of this study was to investigate the effect of drains on postoperative seroma, hematoma, and infection, as well as elucidate any risk factors that may be implicated in the development of these complications. Methods A retrospective cohort study was conducted of all reduction mammaplasty procedures at our university medical center between 2010–2020. Pedicle type, skin incision, drain utilization, breast excision mass, sternal notch to nipple distance, and inframammary fold to nipple distance were analyzed with postoperative outcomes including hematoma, seroma, infection, dehiscence, nipple necrosis, and fat necrosis. Results This study included 944 female patients undergoing reduction mammaplasty. Median age was 39.0 years, median body mass index was 31.9 kg/m2, and median breast mass resected was 742 grams per side. Drain utilization did not significantly reduce postoperative hematoma (P = 0.196), seroma (P = 0.185), nipple necrosis (P = 0.511), or fat necrosis (P = 0.113), but drain utilization significantly increased postoperative surgical site infection (P = 0.011). Patients with breast mass removed over 1500 g had significantly higher risk of hematoma (P = 0.002), fat necrosis (P &lt; 0.001), and nipple necrosis (P &lt; 0.001) compared to patients with less than 1500 g removed. In patients with greater than 1500 g resected, drain utilization did not significantly decrease risk of hematoma (P = 0.086) or seroma (P = 0.497). Conclusions Breast reduction greater than 1500 g per side significantly increased risk of hematoma, nipple necrosis, and fat necrosis. Drain utilization did not demonstrate any advantageous effects, rather it increased risk of infection. Future multicenter study will be needed to confirm these findings across different patient referral networks and practice patterns.

Carvacrol modulates antioxidant enzymes, DNA integrity, and apoptotic markers in zearalenone-exposed fetal rat liver

Maternal exposure to zearalenone (ZEA), a mycotoxin, can impact fetal liver development. This study investigated the protective effects of carvacrol (CRV) against ZEA-induced fetal liver damage. Thirty-two pregnant rats were allocated to four groups (eight rats/group); control, CRV (75 mg/kg), ZEA (5 mg/kg), and co-treated group (ZEA + CRV). The animals were given their doses during the gestation period. Maternal exposure to ZEA revealed a significant increase in the malondialdehyde (MDA) level in the fetal liver. In contrast, glutathione S-transferase (GST), superoxide dismutase (SOD), and catalase (CAT) activities, besides glutathione (GSH) levels, were decreased in ZEA-intoxicated rats. Additionally, ZEA increased the expression of pro-apoptotic genes (P53, Bax, and caspase-9), elevated the immunoreactivity of caspase-3, decreased anti-apoptotic Bcl-2, and induced severe fatty degeneration, congestion, and necrosis in the fetal liver. The comet assays revealed significant DNA damage, as evidenced by reduced head DNA content and increased tail DNA content and tail moment in the ZEA-exposed rats. Surprisingly, co-treatment with CRV significantly mitigated fetal hepatic lipid peroxidation, antioxidant disturbance, apoptosis, and DNA damage after maternal exposure to ZEA. These findings highlight the potential of CRV as a promising approach to mitigate ZEA-associated developmental hepatotoxicity.

Perinephric myxoid pseudotumor of fat: A series of 13 cases and literature review

Perinephric myxoid pseudotumor of fat (PMPF) is a recently described and rare retroperitoneal mass-forming lesion whose clinical significance chiefly involves mimicry of a variety of soft tissue tumors. For unknown reasons, it commonly occurs in male patients with underlying non-neoplastic renal diseases and/or type 2 diabetes (DMT2). A total of 55 cases have been reported in the literature. Recently, we have encountered 13 such masses with peculiar histologic features; thus, we sought to investigate our experience and review the clinicopathologic characteristics of the literature. Our series confirms that PMPF frequently occurs in adult male patients (11/13, 85%), with an average age of 66 years, and commonly co-occurs with renal disease, such as DMT2 (2/13, 15%), end-stage renal disease (ESRD) (5/13, 39%), renal cysts (4/13, 31%), concurrent or prior renal neoplasia (2/13; 15%), and myeloma/lymphoma (2/13; 15%). Histologic evaluation shows lipomatous masses commonly showing variable amounts of fat necrosis, myxoid degeneration, lymphoplasmacytic inflammation and lacking atypical hyperchromatic stromal spindle cells. Unusual histologic features include extramedullary hematopoiesis (1/13, 8%), hemosiderin deposition (4/13, 31%), and small wisps of mature smooth muscle (6/13, 46%). All cases tested were negative for MDM2 and did not show an increased ratio of IgG4+/IgG+ plasma cells. Our study confirms the clinical and pathologic features of PMPF and expands its histologic spectrum, underscoring the importance of this entity as a benign pseudotumor which should be included in the differential diagnosis of other fat-containing retroperitoneal masses, particularly well-differentiated liposarcoma.

Neurofibroma-like Desmoplastic Melanoma: A Series of Five Cases Exploring the Role of Molecular Testing as a Diagnostic Adjunct and Highlighting the Differential Diagnosis With Diffuse-type Neurofibroma.

A subset of desmoplastic melanomas (DMs) can show extensive morphologic and immunohistochemical overlap with cutaneous diffuse-type neurofibroma. Neurofibroma-like desmoplastic melanoma (NFLDM) thus poses a significant diagnostic pitfall because the clinical implications of these 2 entities differ dramatically. A series of 17 DMs, including 5 cases of NFLDM, were compared with a cohort of 53 cutaneous diffuse-type neurofibromas to explore the utility of molecular testing in the differential diagnosis between NFLDM and neurofibroma and to determine potentially useful morphologic features in this differential diagnosis. Unlike NFLDM, cutaneous diffuse-type neurofibromas: (1) rarely feature intratumoral or peritumoral lymphoid aggregates, (2) consistently harbor an intrinsic stromal support vasculature composed of evenly spaced capillary-sized vessels, and (3) infiltrate adjacent adipose tissue in a dermatofibrosarcoma protuberans-like manner with a complete lack of chronic inflammation or fat necrosis at the leading edge of the tumor. Conversely, DMs, including NFLDM: (1) do not contain Wagner-Meissner bodies, (2) often induce fat necrosis and/or chronic inflammation at the interface with adjacent fibroadipose tissue, (3) lack the intrinsic capillary-sized stromal vasculature observed in most neurofibromas, and (4) may harbor foci of perineuriomatous differentiation, mimicking a hybrid nerve sheath tumor. Any deviation from the expected clinical or morphologic features of cutaneous diffuse-type neurofibroma should raise suspicion for NFLDM. Although not entirely sensitive or specific, molecular testing can help to support the diagnosis of NFLDM by demonstrating genetic abnormalities associated with melanoma, including a UV-light-induced mutational signature, high tumor mutational burden, and/or chromosomal copy number alterations typical of melanoma.

Evaluation of Permanent Nipple-Areolar Complex Sensitivity Loss Following Reduction Mammaplasty.

Predictors for permanent nipple-areolar complex (NAC) insensitivity after reduction mammaplasty are sparsely defined. We analyzed factors associated with NAC insensitivity over long-term follow-up. A retrospective analysis of reduction mammaplasties on 1598 breasts performed by 4 surgeons from March 2015 to February 2023 was conducted. Data on patient demographics, intraoperative factors, and postoperative complications were collected from patient records. Analysis was conducted by breast, separated into breasts with NAC insensitivity (permanent and transient) and those without. Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's chi-square test for categorical variables evaluated differences between the groups. Univariate and multivariate logistic regression analyzed the association of pedicle choice with NAC insensitivity onset and permanence. Of 1598 breasts, 9.8% had loss of NAC sensation, of which 49.0% had permanent loss. A total of 51.0% regained sensitivity, taking an average of 116 days (median 64, range 6-798) to regain sensation. NAC-insensitive breasts had longer sternal notch to NAC (P < .001) and NAC to IMF (P < .001) measurements, greater weight removed (P < .001), and fat necrosis co-complication (P = .022). Greater weight removed (P = .044) and longer sternal notch to NAC measurements (P = .011) were associated with permanent insensitivity. The superomedial pedicle was associated with an increased rate of transient NAC insensitivity, whereas the inferior pedicle had a decreased rate. There was no significant association between pedicle choices and permanent insensitivity. Transient loss of NAC sensitivity is associated with pedicle choice, and breasts with permanent insensitivity were more likely to have longer breast measurements and a greater amount of tissue removed.

Clinical Outcomes Following Profunda Artery Perforator Flap Breast Reconstruction: A Systematic Review and Meta-Analysis.

There is a lack of reliable evidence on the surgical outcomes of profunda artery perforator (PAP) flap breast reconstruction. We conducted a meta-analysis to evaluate its safety and compare it with deep inferior epigastric perforator (DIEP) flap, aiming to offer more information on whether the PAP flap was an ideal alternative for autologous breast reconstruction. PubMed, EMBASE, Web of Science and Cochrane Library were searched to retrieve relevant articles. The postoperative complication rates following PAP reconstruction were pooled. Mean differences of patients' age, BMI, mastectomy weight and flap weight between PAP and DIEP group were calculated, and relative risk was estimated to compare their incidence of complications. Twenty-four articles reporting 1612 PAP flap breast reconstructions were included. The surgical success rate was 99.6%; the incidence of total and partial flap loss was 0.4% and 0.0%; the incidence of infection, hematoma, seroma, fat necrosis and wound dehiscence in recipient sites was 0.3%, 1.4%, 1.0%, 3.3% and 0.3%, respectively; the incidence of infection, hematoma, seroma, wound dehiscence and sensory disturbance in donor sites was 2.0%, 0.9%, 3.5%, 9.2% and 0.6%, respectively. Compared to the DIEP group, the average age, BMI, mastectomy weight and final flap weight were significantly lower in the PAP group. No significant difference was observed in terms of flap failure, breast fat necrosis and donor site wound dehiscence. This systematic review demonstrates similar levels of postoperative morbidities for the PAP and DIEP flaps with some subtle differences and verifies the PAP flap as a second-line treatment for patients when the DIEP is unavailable or undesirable. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .