Removal Of Implants Research Articles

A clinical case of secondary breast augmentation after previous implants removal

The patient underwent primary breast augmentation at a different clinic. Two years later, the implants were replaced with larger breast implants (500 ml each). Three months after the procedure, inflammation of the right and left mammary glands occurred, which led to the removal of both implants. The patient was 24 years old when the surgery took place. She underwent a preoperative examination in accordance with the standards set by the Ministry of Health of Ukraine. The patient came to us for breast augmentation, correction of mammary gland contour imperfections, and management of postoperative scars. Round‑shaped and moderate‑profile implants were selected. Implant parameters: width 13 cm, projection 4.4 cm, implant texture — microtexture, volume 400 ml. We placed the implants in the retropectoral space, and used the dual‑plane method for cavity formation. The surgical procedure lasted for a total of 140 minutes. The duration of the patient’s hospitalisation was one day. No drains were used. The scars on the abdomen were also corrected and fixed in the projection of the inframammary fold. No complications occurred in the postoperative period. The patient received antibiotic therapy and took nonsteroidal anti‑inflammatory drugs. Postoperative wound management was carried out. We prescribed compression underwear for the patient to wear for two months after surgery. Mammoplasty is a commonly performed procedure in plastic surgery. It aims to produce predictable and agreed‑upon aesthetic outcomes for the patient while maintaining a low rate of complications by adhering to modern surgical standards. The patient experienced complications that led to a significant scarring process. The pectoralis major muscle had a significant deformity, and the tissue showed scarring. The lack of muscle elasticity complicated the implant placement, leading to specific challenges throughout the operation. The occurence of complications following mammoplasty invariably has a lasting impact on the capsule’s formation and increases the risk of developing both early and late postoperative issues.

Thermal implant removal in a pig jaw: a proof of concept study

ObjectivesThe aim of this study was to evaluate whether thermal implant removal of osseointegrated implants is possible using a diode laser with an specific temperature–time interval.Materials and methodsFirst, tooth extraction of the first three premolars was performed in the maxilla and mandible on both sides of 10 pig. After 3 months, implants were inserted into the upper and lower jaws of 10 pigs. After 3 more months, osseointegrated implants were heated with a laser device to a temperature of 50 °C for 1 min. After 14 days, the implant stability quotient (ISQ), torque-out values, and bone-to-implant contact (BIC) ratio were assessed using resonance frequency analysis.ResultsISQ values showed no significant differences within each group or between the control and test groups. Furthermore, torque-out and BIC value measurements presented no significant differences between the groups.ConclusionsAt 50°C, changes in the BIC values were noticeably smaller; however, these differences were not significant. Future studies should evaluate the same procedures at either a higher temperature or longer intervals.Clinical relevanceWith only 50 °C for 1 min, a dental implant will not de-integrate predictably.

Pediatric Surgical Opioid Prescribing by Procedure, 2020-2021.

Surgery is one of the most common indications for opioid prescribing to pediatric patients. We identified which procedures account for the most pediatric surgical opioid prescribing. We conducted a cross-sectional analysis of commercial and Medicaid claims in the Merative MarketScan Commercial and Multi-State Medicaid Databases. Analyses included surgical procedures for patients aged 0 to 21 years from December 1, 2020, to November 30, 2021. Procedures were identified using a novel crosswalk between 3664 procedure codes and 1082 procedure types. For each procedure type in the crosswalk, we calculated the total amount of opioids in prescriptions dispensed within 3 days of discharge from surgery, as measured in morphine milligram equivalents (MMEs). We then calculated the share of all MMEs accounted for by each procedure type. We conducted analyses separately among patients aged 0 to 11 and 12 to 21 years. Among 107 597 procedures for patients aged 0 to 11 years, the top 3 procedures accounted for 59.1% of MMEs in opioid prescriptions dispensed after surgery: Tonsillectomy and/or adenoidectomy (50.3%), open treatment of upper extremity fracture (5.3%), and removal of deep implants (3.5%). Among 111 406 procedures for patients aged 12 to 21 years, the top 3 procedures accounted for 33.1% of MMEs: Tonsillectomy and/or adenoidectomy (12.7%), knee arthroscopy (12.6%), and cesarean delivery (7.8%). Pediatric surgical opioid prescribing is concentrated among a small number of procedures. Targeting these procedures in opioid stewardship initiatives could help minimize the risks of opioid prescribing while maintaining effective postoperative pain control.

Total Capsulectomy Without Drains is a Safe Technique Facilitated by Pectoralis Major Muscle Repair.

The number of breast implant removal and capsulectomy procedures continues to increase rapidly. The aim of explant surgery should be to optimise patient outcomes from both an aesthetic and functional perspective. To confirm the safety of drainless total capsulectomy and to determine the role of muscle repair in explant outcomes following the removal of sub-pectoral or dual-plane cosmetic breast implants. We conducted a retrospective evaluation of our technique between January 2021 and November 2023. We report a single surgeon series of 140 consecutive cases of cosmetic breast implant removal from dual-plane or sub-pectoral pockets, all performed with total capsulectomy. In each case, meticulous repair of the Pectoralis major muscle was performed following capsulectomy. Drains were not used in any case. All patients were followed up for a minimum of 3months. Patient satisfaction was assessed a minimum of 6months post-operatively. By performing the described drainless technique, there were no cases of seroma, haematoma, pneumothorax or cosmetic breast distortion in this series. 83% of patients were treated as day cases and patient satisfaction with outcomes was high. Total capsulectomy without the use of drains is a novel and safe approach, aided by careful repair of the Pectoralis major muscle. There is no increased risk of seroma. The muscle repair may help to prevent post-explant cosmetic deformity of the breast. 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 .

Persistent racial disparities in postoperative management after tibia fracture fixation: A matched analysis of US medicaid beneficiaries

IntroductionRacial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation. MethodsPatients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted. Results5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index. DiscussionFewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.

A bioadhesive pacing lead for atraumatic cardiac monitoring and stimulation in rodent and porcine models.

Current clinically used electronic implants, including cardiac pacing leads for epicardial monitoring and stimulation of the heart, rely on surgical suturing or direct insertion of electrodes to the heart tissue. These approaches can cause tissue trauma during the implantation and retrieval of the pacing leads, with the potential for bleeding, tissue damage, and device failure. Here, we report a bioadhesive pacing lead that can directly interface with cardiac tissue through physical and covalent interactions to support minimally invasive adhesive implantation and gentle on-demand removal of the device with a detachment solution. We developed 3D-printable bioadhesive materials for customized fabrication of the device by graft-polymerizing polyacrylic acid on hydrophilic polyurethane and mixing with poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) to obtain electrical conductivity. The bioadhesive construct exhibited mechanical properties similar to cardiac tissue and strong tissue adhesion, supporting stable electrical interfacing. Infusion of a detachment solution to cleave physical and covalent cross-links between the adhesive interface and the tissue allowed retrieval of the bioadhesive pacing leads in rat and porcine models without apparent tissue damage. Continuous and reliable cardiac monitoring and pacing of rodent and porcine hearts were demonstrated for 2 weeks with consistent capture threshold and sensing amplitude, in contrast to a commercially available alternative. Pacing and continuous telemetric monitoring were achieved in a porcine model. These findings may offer a promising platform for adhesive bioelectronic devices for cardiac monitoring and treatment.

A Transient Heat Transfer Analysis of Thermal Necrosis-Aided Dental Implant Removal

A prevalent and widely favoured solution for replacing lost teeth is the use of dental implants. The removal of dental implants, even when they are osseointegrated but unsuccessful, can be traumatic, resulting in the loss of healthy bone and adding complexity to the treatment procedure. Reducing the trauma associated with implant removal can be achieved by intentionally weakening the bone-implant attachment. To achieve this objective, a suggested approach involves utilising thermal necrosis to aid in the minimally invasive removal of implants. The objective of this study was to use finite element analysis to explore the optimal power output for intentionally inducing thermal necrosis in a dental implant. SolidWorks software was utilised to create a three-dimensional model of a dental implant assembly, which includes an abutment, screw, and implant body integrated into a segment of mandibular bone. The model was subsequently analysed using ANSYS software, applying device powers ranging from 5 to 40 W in 5 W increments on the top surface of the abutment. The results of the study showed that there was a considerable elevation in the temperatures of the bone and implant, even when employing the low power settings commonly used in electrosurgical procedures. Elevating the power level has led to a decrease in the time required for the bone and implant to reach 47°C, the initial temperature at which bone necrosis occurs. However, it is crucial to take into account the significant temperature rise in the implant body at higher power levels. The implementation of lower power settings could present a viable approach to achieving controlled osteonecrosis.

The "Octopus Head" Dermoglandular Flap: A Novel Technique for Breast Tissue Rearranging after Implant Removal.

Patients with previous breast augmentation may need implant removal for mechanical complications or other causes. After prosthesis removal, the residual parenchyma can be reshaped through a mastopexy with rearrangement of breast tissue. Several techniques have been described in the literature, but none of them can be considered the gold standard. In this study, we present our preliminary experience in breast tissue rearranging after implant removal through a novel technique: the "octopus head" dermoglandular flap. From January 2019 to October 2022, nine patients (18 breasts) underwent implant removal and simultaneous breast remodeling with the tissue obtained from the dermoglandular excess of the breast and shaped like an octopus head. Patient's demographic and clinical characteristics, postoperative complications, and patient-reported satisfaction were recorded. Mean age was 46.7 years. Body mass index ranged between 22.5 and 27.6 kg per m2. The majority of patients had moderate ptosis (67%). Breast implants were removed due to bilateral capsular contracture (n = 3), unilateral implant rupture with contralateral capsular contracture (n = 2), bilateral implant rupture (n = 3), and unilateral periprosthetic seroma (n = 1). We observed two minor complications: one postoperative hemorrhage with subsequent hematoma that was managed conservatively, and one nipple-areola complex malposition that underwent revision surgery. All patients were satisfied with the aesthetic and functional result. The octopus head dermoglandular flap has proved to be a safe and reliable option for breast tissue rearranging after implant removal, providing a good and stable cosmetic result, a low complication rate, and high patient-reported satisfaction.

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation.

To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery. Retrospective cohort study. Mariner claims database. Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study. Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing. One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation. Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08-2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08-1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00-1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59-0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63-1.18, P = 0.41). Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population. Prognostic Level III.

Preliminary evidence for the safety and efficacy of a novel method for removal of contraceptive implants: a pilot RCT

Contraceptive implants are the most effective form of long-acting reversible contraception (LARC). Implant insertion is standardized; however, the recommended removal method, the pop-out method, may be problematic if the implant does not easily pop-out. We evaluated an alternative removal method with a modified incision location, the To method, in a single-blind pilot randomized control trial of 21 patients. Pain differences, success rates, and procedure time between methods were examined. Results demonstrated that the To method was faster and less painful than the pop out method. This study provides preliminary evidence to support using the To method for contraceptive implant removal.

Comparison of Four Different Dental Implant Removal Techniques in Terms of the Weight and Volume of Bone Loss.

Several approaches have been suggested for implant removal. However, further research is necessary to review data regarding the amount of bone removed and the duration of removal time for different procedures. This study evaluates and compares various implant removal techniques. Materials and methods: A polyurethane block was scanned to create an implant surgical guide. Afterward, implant-guided surgery was performed on 60 simulated bone blocks. The implants were then separated into four groups and removed utilizing the counter-torque ratchet, trephine drills, burs, and piezosurgery. For the weight of bone loss, there were significant differences in the median between the counter-torque ratchet technique (CTRT) and trephine (p < 0.01), CTRT and bur (p < 0.01), trephine and piezo (p < 0.01), and bur and piezo (p = 0.04). All groups, except CTRT and the piezo group, demonstrated a statistically significant difference (p < 0.01) in the procedure durations. Regarding the volume of bone loss, a statistically significant difference (p < 0.01) was found between each group. Conclusions: CTRT showed the least amount of bone loss. On the other hand, the trephine technique was demonstrated to be the fastest. It is essential to consider the limitations and risks when choosing the approach for implant removal.

Incidental dural tears during pediatric posterior spinal fusions

PurposeTo characterize the frequency of incidental dural tears in pediatric spine surgery, their treatment, complications, and results of long-term follow-up.MethodsA retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004–2019 at a tertiary children’s hospital was conducted. Electronic medical records were reviewed for patient demographics, intra-operative data, presence of an incidental dural tear, repair method, and patient outcomes.Results3043 PSFs were reviewed, with 99 dural tears identified in 94 patients (3.3% overall incidence). Mean follow-up was 35.7 months (range 0.1–142.5). When the cause of the dural tear was specified, 69% occurred during exposure, 5% during pedicle screw placement, 4% during osteotomy, 2% during removal of implants, and 2% during intra-thecal injection of morphine. The rate of dural tears during primary PSF was significantly lower than during revision PSF procedures (2.6% vs. 6.2%, p < 0.05). 86.9% of dural tears were repaired and/or sealed intraoperatively, while 13.1% had spontaneous resolution. Postoperative headaches developed in 13.1% of patients and resolved at a mean of 7.6 days. There was no difference in the incidence of headaches in patients that were ordered bedrest vs. no bedrest (p > 0.99). Postoperative infections occurred in 9.5% of patients and 24.1% patients were identified to have undergone a revision surgery.ConclusionsIncidence of intra-operative dural tears in pediatric spine surgery is 3.3%. Although complications associated with the dural tear occur, most resolve over time and there were no long-term sequelae in patients with 2 years of follow up.Level of evidenceLevel IV.

Silicone Lymphadenopathy Following Augmentation Mammoplasty With Silicone Implants.

Silicone implants are by far the most widely used implant globally for breast augmentation. Despite technological advancements, complications persist, with silicone lymphadenopathy (siliconoma) being a noteworthy concern. This phenomenon has been inadequately addressed in the existing literature. The aim of this study was to characterize axillary siliconomas and identify potential risk factors to help reduce their occurrence. The authors conducted a retrospective observational cross-sectional study spanning between 2011 and 2021 at the Shamir Assaf Harofeh Medical Center, Israel. Preoperative ultrasound examination was conducted, categorizing patients into those with siliconomas and those without. A total of 614 women (1209 breasts) met the inclusion criteria. The incidence of siliconomas was 13.6% (165 breasts). In univariate analysis, older age (47 years vs 43 years, P < .001), older implant age (12.2 years vs 11 years, P = .026), ruptured implants (59.4% vs 17.7%, P < .001), subpectoral placement (P = .019), severe capsular contracture, and the use of Mentor implants (Irvine, CA; P = .007) and Poly Implant Prothèse implants (PIP; La Seyne-sur-Mer, France; P = .001) correlated significantly with the presence of siliconomas. In a multivariate analysis, implant rupture (odds ratio [OR] = 6.342), and implant manufacturer-Mentor (OR = 3.047) and PIP (OR = 3.475)-were identified as independent risk factors associated with a higher incidence of siliconomas. Severe capsular contracture was also associated with a higher incidence of siliconomas (OR = 1.65). Surgeons should inform candidates about the potential risk of silicone migration. Patients with ruptured implants, significant capsular contracture, and Mentor and PIP implants face an increased risk for developing siliconomas. Closer monitoring for the detection of siliconomas in the axilla for these patients is advisable, and potential prophylactic replacement or removal of implants may be warranted to mitigate siliconoma risk.

The Effect of Cemented Implants Placed During Initial TKA on Surgical Time and Expenses in Revision TKA.

Revision total knee arthroplasty (rTKA) is a complex procedure that often requires the removal of previous implants. There is little information evaluating the difference between removing cemented or noncemented knee prostheses in revision surgeries. The purpose of this study was to determine whether removing cemented or noncemented implants would affect surgical time and expenses incurred during revision procedures. This retrospective cohort study used a single-institution database to identify 300 patients who underwent femoral and tibial implant rTKA from 2016 to 2022 because of mechanical complications (infection cases excluded). Radiographs and surgical reports were used to confirm whether the fixation technique was cemented (N = 243) or noncemented (N = 57). The primary outcomes were surgical time and surgery costs. Secondary outcomes included readmission rates, revision implants used, stem usage, and insurance type. The average surgical time was 121 minutes for noncemented and 128 minutes for cemented procedures (P = 0.118). The 90-day readmission rates for each group were similar at 7.00% for the cemented cohort and 8.77% for the noncemented cohort (P = 0.643). For patients with Medicare Advantage, the respective surgery costs were $1,966 for noncemented and $1,968 for cemented TKA (P = 0.988). For patients with commercial insurance, the respective surgery costs were $4,854 for noncemented and $5,660 for cemented TKA (P = 0.330). Primary knee fixation type, cemented or noncemented, did not appear to influence the surgical duration or surgical costs of both-implant revision knee surgery indicated for mechanical complications.

Implants removal in children: results of a survey among Italian orthopaedic surgeons.

In the treatment of paediatric limb disorders, the use of metal implants has been increasing over the last decades. Recent studies have addressed the decision of orthopaedic surgeons regarding the removal of implants after the treatment of fracture, and there is a growing consensus within the scientific community supporting the choice of not removing implants in children. This survey aimed to investigate the rationale behind the Italian orthopaedic community's decision regarding metal implant removal in paediatric patients. An electronic questionnaire was sent to all members of the Italian Paediatric Orthopaedic and Traumatology Society, Italian Orthopaedic and Traumatology Society, Italian Club of Osteosynthesis, and South Italy Society of Orthopaedic and Traumatology. The survey comprised 34 questions about hardware removal after the treatment of long bone fractures, epiphyseal growth plate injuries, slipped capital femoral epiphysis (SCFE), and flat foot. Of the 3500 orthopaedic surgeons who received the questionnaire, 5.5% responded. The leading indications for implant removal were the patient's intolerance, pain, ROM limitations, and hardware breakage. Removal of elastic nails for long bone fractures, cannulated screws for growth plate injuries, and SCFE and screws for arthroereisis for flat foot correction were analysed in detail. The consensus among Italian Orthopaedic Surgeons is to remove elastic nails and cannulated screws in cases of pain, intolerance, or breakage and to reduce further risks during patient growth. An increasing number of physicians, however, are endorsing and advocating the growing trend in the literature of not routinely removing the hardware.

Evaluation of Effect of Different Insertion Speeds and Torques on Implant Placement Condition and Removal Torque in Polyurethane Dense D1 Bone Model.

The aim of this study was to evaluate the effect of two different insertion speeds at eight different insertion torque values ranging from 25 to 60 during implantation in a dense polyurethane (PU) D1 bone model on the placement condition and removal torque of dental implants. In this study, 50 pcf single-layer PU plates were used. In the study, a total of 320 implant sockets were divided into two groups, Group 1 (30 rpm) and Group 2 (50 rpm), in terms of insertion speed. Group 1 and Group 2 were divided into eight subgroups with 25, 30, 35, 40, 45, 50, 55 and 60 torques. There were 20 implant sockets in each subgroup. During the implantations, the implant placement condition and removal torque values were assessed. There was a statistically significant difference between the 30 and 50 rpm groups in terms of overall implant placement condition (p < 0.01). It was found that the removal torque values at 50 rpm were statistically significantly higher than those at 30 rpm (p < 0.01). This study showed that in dense D1 bone, the minimum parameters at which all implants could be placed at the bone level were 50 torque at 30 rpm and 40 torque at 50 rpm.

Abstract PO2-20-12: Breast Implant-associated Squamous Cell Carcinoma

Abstract A 54-year-old female with a history of bilateral breast implants presented with intermittent left breast pain for 6 months. She first had bilateral breast implants placed in 1996 and had no reported issues until 2010, when she had bacteremia and seeding infection with subsequent removal of both implants. She then had a second set of silicone-based implants placed in 2012 with no issues for 10 years. Family history was negative for breast cancer or any other malignancy. She had no prior smoking history. Vital signs and laboratory values were unremarkable. On exam, the left breast appeared larger than the right, dense, thickened, and slightly edematous. No lymphadenopathy was palpated. Both mammogram and ultrasound of bilateral breasts, done at the onset of her pain, were normal. Given the patient’s symptoms, an MRI of the breasts was done, with findings concerning an infection or lymphoma. It revealed an irregular fluid collection in the left breast. The fluid collection was rim-enhancing with frond-like areas of enhancing tissue, extending through the inferior aspect of the capsule into the subcutaneous tissue of the lower outer quadrant of the left breast. Enhancement and edema extended off of the superior and posterior aspect of the prosthesis into the pectoralis muscle. It was particularly prominent along the medial aspect of the prosthesis where it extended in the chest wall between the sternum and the costal cartilage. There were 3 mildly enlarged left intramammary lymph nodes measuring up to 7 mm in short axis, with diffuse edema seen within the breast. No axillary adenopathy was seen in the MRI. She was referred to surgery and had both right and left breast implants removed, and a left breast JP drain was placed. The pathology from the left breast capsule excision revealed squamous cell carcinoma, well-differentiated and invasive, associated with a scar and extending to the surgical margin. She was diagnosed with a rare case of breast implant-associated squamous cell carcinoma (BIA-SCC). Subsequent staging imaging showed postsurgical inflammatory changes with no nodal metastatic disease. She continued to follow up outpatient with plans of multidisciplinary meeting to discuss long-term treatment options. Most patients undergoing breast augmentation experience no serious complications. Previously, rare incidences of breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) had been reported, with 1234 cases as of 2022. More recently, cases of BIA-SCC have been seen. Primary SCC of the breast is extremely rare in both augmented and non-augmented women. 19 cases of BIA-SCC are reported in the literature as of 2022, all seen in females, typically arising from capsular tissue around the breast implant. It is a rare and potentially aggressive malignancy, with unclear etiology and undefined therapy regimen due to a paucity of data. Suggested treatments include resection with a negative margin, although this could require an extensive and complex reconstruction, including plastic surgery soft tissue coverage of the resection defect. Definitive radiation to obtain local control can be considered in an organ-sparing approach. Consideration can also be given to either chemosensitization with agents such as cisplatin or combining radiation with immunotherapy. Citation Format: Farhan Azad, Ajay Siva, Prutha Patel, Clive Miranda, Matthew Gravina. Breast Implant-associated Squamous Cell Carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-20-12.

Complications and Outcomes After Fixation of Lisfranc Injuries at an Urban Level 1 Trauma Center.

To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations. Retrospective cohort study. Level 1 trauma center. Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixation. Complications include infections, wound healing problems, nonunion, malunion, and posttraumatic arthrosis (PTA), and secondary unplanned procedures after a minimum of 2-year radiographic follow-up. Mean age of the included 118 patients was 40 years (range, 18-73 years) and 96 (74%) were male. Comorbidities included obesity (n = 32; 40%), diabetes mellitus (n = 12; 9%), and tobacco use (n = 67; 52%). Thirty (23%) were open injuries, and concomitant forefoot injuries were present in 47% and hindfoot injuries in 12%. Unplanned secondary procedures, including implant removals, were performed on 39 patients (33%), most often for removal of painful implants (26%) or infectious debridement (9%). Sixty-seven complications occurred, with PTA most frequent (37%). Deep infections occurred in 8%. On multivariate analysis, open injury ( P = 0.028, CI = 1.22-30.63, OR = 6.12) and concomitant forefoot injury ( P = 0.03, CI = 1.12-9.76, OR = 3.31) were independent risk factors for complication. Open Lisfranc injuries were associated with complications, with deep infections occurring in 9%. Secondary procedures were most often performed for pain relief; the most common late complication was PTA, warranting counseling of patients about potential long-term sequelae of injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB158. SOH24AB_032. A systematic review of peripheral nerve injuries associated with the insertion or removal of subdermal contraceptive implants

AB158. SOH24AB_032. A systematic review of peripheral nerve injuries associated with the insertion or removal of subdermal contraceptive implants

Is it safe and effective to leave Titanium Elastic Nail (TEN) tips outside the skin in pediatric femoral diaphyseal fractures?

Aim: In this study, we aimed to retrospectively evaluate the use of nail tips outside and under the skin in TEN (Titanium Elastic Nail) application in pediatric femur diaphyseal fractures. Patients and methods: Forty-six patients (47 fractures) who underwent TEN due to femoral diaphyseal fractures between January 2016 and July 2019 were examined retrospectively. While the patients whose TEN ends were left outside the skin were called Group 1, the patients whose TEN ends were left under the skin were called Group 2.. Age, gender, fracture side, and follow-up periods were evaluated. Clinical evaluation; hip and knee ROM (range of motion), rotational or angular deformities, pin bottoms, incision scars, infective findings; In radiological evaluation; angulation, deformity and length differences were examined on two-way radiography. Implant removal times and all complications were evaluated. Results: 21 fractures (Group 1) TEN ends were left outside the skin; In 26 fractures (Group 2), the TEN ends were left under the skin. Both groups had similar distributions in terms of age, gender and fracture sides. The follow-up period of Group 2 was significantly longer (p&amp;lt;0.05), but the minimum follow-up period in both groups was 9 months. There was a significant difference in the distribution of coronal and sagittal angulations in both groups (p&amp;lt;0.05), but all of the angulations were within acceptable limits in their age groups. Pin bottom discharge of both groups had similar distribution. (p&amp;gt;0.05) In terms of implant removal time, Group 1 achieved this in a shorter time compared to Group 2. (p&amp;lt;0.05) Union was achieved without any problems in all fractures in both groups. No notable angulation defects, rotation defects or shortness were observed in the patients. No patient developed infection in deep tissues. Conclusions: In pediatric femur diaphyseal fractures, in addition to removing the implants in a short time under outpatient clinic conditions and without the need for anesthesia by leaving the TEN ends outside the skin; leaving the implant tip outside seems to be quite advantageous, since union or angulation problems are similar to nail tips being left inside. However, nail root infection is still a serious concern; therefore, we believe that this problem can be solved with close monitoring and parental education.