Secondary Procedures Research Articles

Empirical Evidence on the Reliability of Lateral Supramalleolar Flap over Reverse Sural Flap for Local Soft Tissue Coverage of Dorsum of the Foot and Ankle Defects.

Background Soft tissue coverage of the distal foot and ankle region has been an area of debate due to the paucity of local flap options. To provide empirical evidence on the reliability of an underreported local alternative for foot and ankle defects, we aim to compare the lateral supramalleolar flap (LSMF) to the reverse sural flap (RSF). Methods During 2016-2019, 48 patients were divided randomly into two equal groups, LSMF and RSF groups respectively. The patients' demographic, surgical, and clinical outcome details were recorded and analyzed. Results Flap necrosis was found in five patients in the group treated with RSF and none in the LSMF group. The mean total number of stages in RSF group was significantly higher than in LSMF group ( p < 0.05). The mean operative time for patients in LSMF group was 85.8 ± 18.5 and 54.2 ± 11.2 in RSF group ( p < 0.05). Five patients in the RSF group needed additional procedures following flap complications. Nine patients in the LSMF group reported satisfaction outcomes to be "excellent," five patients reported "good" whereas, in the RSF group, 14 patients reported "excellent," 5 reported "good," 3 reported "fair," and 2 reported "poor" outcomes. Compared to the RSF (46.4 ± 4.3) group, the LSMF group had significantly better foot function indices (34.03 ± 3.9). Conclusion The lateral supramalleolar flap for foot and ankle defects offers better results, reduced complications as well a lesser number of stages and secondary procedures over the traditionally used reverse sural flap.

Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement

Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary antireflux procedures (fundoplicationor gastrojejunostomy (GJ)) post gastrostomy tube (GT) placement in children with and without neurologic impairment. Children under 18 undergoing a GT placement without fundoplication between 2010 and 2020 were identified utilizing the PearlDiver Mariner national patient claims database. Children with a diagnosis of cerebral palsy or a degenerative neurologic disease were identified and compared to children without these diagnoses. The incidence of delayed fundoplication or conversion to GJ were compared utilizing Kaplan-Meier and Cox proportional hazards regression analyses. A total of 14,965children underwent GT placement, of which 3712 (24.8%) had a diagnosis of neurologic impairment. The rate of concomitant fundoplication was significantly higher among children with a diagnosis of neurologic impairment as compared to those without (9.3% vs 6.4%, p < 0.001). While children with neurologic impairment had a significantly higher rate of fundoplication or GJ conversion at 5years compared to children without (12.6% [95% confidence interval (CI): 11.4%-13.8%] vs 8.6% [95% CI 8.0%-9.2%], p < 0.001), the overall incidence remained low. Although children with neurologic impairment have a higher rate of requiring an antireflux procedure or GJ conversion than other children, the overall rate remains less than 15%. Fundoplication should not be utilized in children without clinical reflux on the basis of neurologic impairment alone.

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies—a multi-centre observational study

PurposeTeam management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches.MethodThis was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers.ResultsTwo thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology.ConclusionMulti-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

The application of buccinator flaps in secondary surgical procedures in cleft palate patients

The paper describes the indications for the use of buccinator flaps, the surgical technique, the postoperative period of patient management, the effectiveness of the secondary surgical procedure in cleft palate patients.

OUR EXPERIENCE WITH PEC MAJOR FLAP FOR STERNOCLAVICULAR JOINT INFECTIONS

Sternoclavicular joint infections are uncommon but severe and complex condition usually in medically complex and compromised hosts. These infections are challenging to treat with risks of infection extending into the mediastinal structures and surgical drainage is often faced with problems of multiple unplanned returns to theatre, chronic non-healing wounds that turn into sinus and the risk of significant clinical escalation and death. Percutaneous aspirations or small incision drainage often provide inadequate drainage and failed control of infection, while open drainage and washout require multidisciplinary support, due to the close proximity of the mediastinal structures and the great vessels as well as failure to heal the wounds and creation of chronic wound or sinus.We present our series of 8 cases over 6 years where we used the plan of open debridement of the Sternoclavicular joint with medial end of clavicle excision to allow adequate drainage. The surgical incision was not closed primarily, and a suction vacuum dressing was applied until the infection was contained on clinical and laboratory parameters. After the infection was deemed contained, the surgical incision was closed by local muscle flap by transferring the medial upper sternal head of the Pectoralis Major muscle to fill in the sternoclavicular joint defect. This technique provided a consistent and reliable way to overcome the infection and have the wound definitively closed that required no secondary procedures after the flap surgery and no recurrence of infections so far.We suggest that open and adequate drainage of Sternoclavicular joint staged with vacuum dressing followed by pectoralis major local flap is a reliable technique for achieving control of infection and wound closure for these challenging infections.

Central Facial Soft-Tissue Defect Following Surgical Resection: An Algorithm for Reconstruction

Background: Central facial soft tissue defect poses a unique challenge for the reconstructive surgeon. The three-dimensional properties of the aesthetic facial subunit and its related function are the goals for reconstruction. Considering the prominent social role of the face, the procedure to achieve a good quality of life for patients may cost more than a single surgery. This single-center study presents an algorithm of treatment for central facial soft tissue defect and it’s proposed classification according to the authors’ experiences. Methods: A retrospective review of medical records and photos of patients who underwent central facial soft tissue defect reconstruction in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia, from 2009 to 2019. Patients who underwent free flap reconstruction were followed up, and the primary outcomes were assessed using the FACE-Q head and neck cancer (FACE-Q H&amp;N) scale. A classification system for central facial soft tissue defect with seven subtypes (1–7) based on the facial subunit and its treatment was proposed. Results: Twenty-five patients were included. The malignant tumor was the main etiology (88%), with basal cell carcinoma being the primary cancer pathology (64%). The average defect size was 120 cm2 (32-416 cm2) and most defects fell into subtype 6 of the classification (32%). Anterolateral thigh free flap (ALT) was the main flap of choice (64%), followed by radial forearm free flap (36%), with 92% of flaps succeeding rate from this series. All of the patients underwent at least one ancillary procedure following the reconstruction, while the average was 2 (1-6) procedures. FACE-Q H&amp;N outcomes, especially on the appearance and appearance distress scale, showed a low to moderate score with a 72% response rate. Conclusions: Central facial soft-tissue defect continues to challenge reconstructive surgeons. While the advances in free tissue transfer might improve the general outcomes, the numerous and costly secondary procedures do not usually end up in the best appearance. This study displayed the need for modern reconstruction modalities that provide high satisfaction in aesthetic and functional outcomes with fewer secondary procedures. Vascularized Composite Allotransplantation (VCAT) might be the future choice.

Orbital and periocular complications in patients with sinonasal tumours with orbital invasion

AimsThe purpose of this study was to determine the frequency and associated risk factors of orbital/periocular complications in patients with sinonasal tumour with orbital invasion managed with eye-sparing treatments.MethodsA retrospective...

Endoscopic third ventriculostomy for management of hydrocephalus associated with Chiari malformation type II in children

BackgroundHydrocephalus is commonly associated with Chiari malformation (CM) particularly CM type II. The traditional treatment of hydrocephalus in these patients has been cerebrospinal fluid diversion by shunts. Endoscopic third ventriculostomy (ETV) has emerged as an alternative procedure in these patients.PurposeAssessment of the clinical and radiological outcomes of ETV in the management of hydrocephalus in children with CM II.MethodsThis is a prospective study conducted on 18 patients with CM II associated with hydrocephalus admitted to Cairo University hospitals between January 2020 and June 2021. These patients had been managed surgically by ETV. Clinical outcome was assessed based on improvement of manifestations of increased intracranial pressure while radiological outcome was based on the findings of postoperative computed tomography. In cases with early failure, serial lumbar puncture (LP) was performed for 2 days.ResultsETV was performed as a secondary procedure in 4 cases. The overall success rate of the procedure was 72%, and its success rate as a secondary procedure was 100%. Serial LP was effective in decreasing early failure in 44.4% of cases. Radiological regression of hydrocephalic changes was detected in 50% of the cases.ConclusionETV is an efficient and safe procedure in the treatment of hydrocephalus in children with Chiari malformation II, particularly when performed as a secondary procedure. Serial LP following the procedure increases the success rate in patients with early failure.

Use of Secondary Iliac Branch Devices after Previous Endovascular Abdominal and Thoraco-Abdominal Aortic Aneurysm Repair

To assess the safety and effectiveness of iliac branch devices (IBDs), as secondary procedure, for the treatment of type Ib endoleak or evolution of iliac artery disease after prior endovascular aortic repair (EVAR) for thoraco-abdominal (TAAAs) or abdominal aortic aneurysms (AAAs). A multicentre observational study of three European centres. The study included 75 patients (age 71 ± 9 years, 96% men) with previous EVAR (n= 64, 85%) or fenestrated or branched (FB) EVAR (n= 11, 15%). Overall, 88 IBDs were implanted to treat aneurysmal iliac artery evolution in 40 (53%) and type Ib endoleak in 35 (47%) cases, respectively. Thirteen (17%) patients received bilateral IBDs. Internal iliac artery (IIA) catheterisation was done through a transaxillary access (n= 82, 93%) or up and over (n= 6, 7%) technique. The primary endpoint was technical success. Secondary endpoints were 30 day major adverse event, early and long term freedom from re-intervention and target vessel instability. All procedures were technically successful (100%). During hospitalisation, there were four (5%) major adverse events and three (4%) early re-interventions, but no death, stroke, or damage to previous endografts. The median follow up was 47 (interquartile range 42) months, and the five year survival rate was 78 ± 6% with no aortic related death. Cox's regression analysis showed pre-operative renal function impairment (hazard ratio [HR] 3.4; 95% confidence interval [CI] 1.1 - 10.1; p= .033), and primary TAAA repair (HR 6.1; 95% CI 1.6-22.3; p= .006) as independent factors for long term mortality. Freedom from re-interventions was 85 ± 4% at five years with 11 (12%) cases (five endoleaks, four IBD thromboses, two stenoses). IIA instability was reported in three (3%) limbs and freedom from IIA instability was 95 ± 3% after 60 months. Secondary IBD after EVAR is a safe and effective procedure with high technical success and low complication rates. The technique of choice to revascularise the IIA seems not to affect early and follow up results. Long term durability of IBD repair is acceptable with low rates of IIA re-intervention.

A Study on the Spatial Correlation Effects of Digital Economy Development in China from a Non-Linear Perspective

Accurate analysis of the spatial correlation effects, spatial aggregation patterns, and critical factors in the development of China’s digital economy is of great significance to the high-quality development of China’s economy. Based on the monthly data of “The Tencent Internet Plus” digital economy index for 31 provinces in China from 2018 to 2020, the non-linear Granger causality test and social network analysis were applied to reveal the spatial correlation effects of China’s digital economy. The quadratic assignment procedure (QAP) was used to empirically examine the factors influencing the formation of non-linear spatial association networks. The results show that the spatially linked relationships of the digital economy in 31 Chinese provinces exhibit a significant non-linear spatially correlated network structure. Block model analysis reveals that the development of the digital economy between the four major sectors is closely linked, and the national linkage effect is significant. The results of the secondary assignment procedure indicate that capital stock, information infrastructure, and geographical proximity have a significant positive impact on the formation of spatial linkages in the digital economy. In contrast, technological innovation has a significant negative impact.

Comparison of Cardiovascular Procedure Rates in Patients With Supplementary vs Basic Insurance in Switzerland

Switzerland's mandatory health insurance provides universal coverage, but residents can opt for supplementary private insurance for nonessential, nonvital amenities. It is debated whether people with supplementary private insurance receive overtreatment due to financial incentives. To assess whether incidence rates of cardiovascular procedures in people with supplementary private insurance are higher than in those with basic insurance only. A population-based weighted cohort comparative effectiveness study, using administrative claims data from Switzerland assessing incidence rates (IRs), was conducted in adults undergoing a nonemergency cardiovascular inpatient procedure from January 1, 2012, to December 31, 2020. Analysis included primary or secondary discharge procedure codes for 1 of the following: percutaneous transluminal coronary angioplasty (PTCA), left atrial appendage (LAA) occlusion, patent foramen ovale (PFO) closure, transcatheter aortic valve replacement (TAVR), mitral valve clip implantation, cardiac pacemaker implantation, and atrial fibrillation/atrial flutter ablation. Supplementary private health insurance. Incidence rates of cardiovascular procedures between insurance groups calculated by negative binomial regression adjusted by inverse probability weights. Of 590 919 admissions (median age, 68 years; IQR, 57-77 years), 55.5% male, 15.7% non-Swiss nationality), 70.1% had basic insurance only. Independent of insurance status, IR for all cardiovascular procedures steadily increased over the study years. In general, people with supplementary private insurance received cardiovascular procedures more frequently (IR ratio [IRR], 1.11; 99% CI, 1.10-1.11) than people with basic insurance only. There was also an increase for every procedure: PTCA (IRR, 1.12; 99% CI, 1.12-1.13), LAA closure (IRR, 1.15; 99% CI, 1.13-1.16), mitral valve clip implantation (IRR, 1.08; 99% CI, 1.07-1.09), TAVR (IRR, 1.04; 99% CI, 1.03-1.06), PFO closure (IRR, 1.01; 99% CI, 1.00-1.02), pacemaker implantation (IRR, 1.08; 99% CI, 1.07-1.09), and atrial fibrillation/atrial flutter ablation (IRR, 1.12; 99% CI, 1.11-1.12). Sensitivity analyses, including side procedures, stratification by length of stay, and propensity score matching, suggested robustness of the results. This study found an association between supplementary private insurance and a higher likelihood of receiving nonemergency cardiovascular procedures. Whether this higher rate of procedures in people with supplementary private insurance is based on clinical reasoning or due to financial incentives warrants further exploration.

Distally-based (Reverse) Medial Hemi-flexor Hallucis Brevis Muscle Flap in a Series of High-risk Patients: Retrospective Case Series.

In this case series, an uncontrolled, retrospective review of the medical records was performed, identifying patients with diabetes who underwent an rmFHB muscle flap performed by a single surgeon. Outcomes measured included the need for secondary soft-tissue procedures at the index surgery; complications; percentage and time to wound healing, defined as epithelialization of wound site; and short-term survival rate (12 months). Healing was demonstrated at a mean of 12 weeks, and the preservation of the distal first ray was achieved in 94% of those patients (12/13). One patient went on to first ray amputation and two were deceased before healing. All patients ambulated in shoes with custom molded inserts without complication postoperatively. No recurrence of ulceration was encountered at 12 months follow-up. This study demonstrates that the rmFHB muscle flap may serve as an option for distal first ray soft-tissue defects when local flap coverage is needed due to exposed deep or avascular structures not amenable to skin grafting or conservative wound care techniques. No cases of recurrence of ulceration occurred during this study.

Patient-Specific Implants and Fat Grafting for Contour Deformities Post Craniosynostosis Reconstruction: A Therapeutic Approach.

Contour deformities after fronto-orbital advancement for craniosynostosis reconstruction are commonly encountered. There is a paucity of literature describing secondary procedures to correct such deformities with reported outcomes. An approach to defect analysis and procedure selection is lacking. The authors present our experience utilizing fat grafting (FG) and patient-specific implant (PSI) reconstruction as management strategies for this population. A retrospective analysis of consecutive patients who underwent secondary onlay PSI or FG for contour deformities after primary craniosynostosis reconstruction was carried out. Patient demographics, defect analysis, surgical approach, postoperative complications, and esthetic outcomes were recorded. Data were pooled across the entire cohort and presented in a descriptive manner. Fourteen patients (36% syndromic and 64% isolated) were identified that either underwent PSI (n = 7) with a mean follow-up of 56.3 weeks, FG (n = 5) with a mean follow-up of 36 weeks or a combination of both (n = 2) for deformities postcraniosynostis surgery. Supraorbital retrusion and bitemporal hollowing were the most common deformities. There were no intraoperative or postoperative complications. All patients achieved Whitaker class I esthetic outcomes and there were no additional revisions during the defined study period. The presence of a significant structural component or large (>5 mm) depression typically necessitated a PSI. Contour deformities after fronto-orbital advancement reconstruction can be successfully managed using FG and PSI either as a combination procedure or in isolation. The authors have proposed anatomical criteria based on our experience to help guide procedure selection. Future prospective studies would be beneficial in providing more objective assessment criteria.

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma.

Posttraumatic secondary deformities of facial skeleton may occur because of nonmanagement or ill management of primary injuries, whereas some unexpectedly occur even after dedicated management attempts. Orthognathic surgery (OGS) principles and techniques can be used as an efficient tool to correct posttraumatic craniomaxillofacial deformities or skeletal developmental deformities during trauma management. The aims of this study were to describe the different types of posttraumatic secondary deformity and address how to use the principles of orthognathic techniques to correct them. Patients with orthognathic surgical osteotomies during primary or secondary management of facial trauma (referred to as trauma-OGS) during the period of 2010 to 2018 were retrospectively reviewed. Variables pertaining to patients and surgery were collected, including trauma diagnosis, etiology, duration between trauma/primary surgery and secondary presentation, suggested reason for secondary deformity, intervention undertaken to address, and the surgical outcome. Twenty-seven patients were eligible and extensively reviewed. Etiological categorization of trauma-OGS could be done into posttraumatic deformities (18) and developmental deformities (9). The former group was further categorized as OGS done as primary procedure (8) that included immobile Le Fort fractures and delayed initial treatment, and OGS done as secondary procedure (10) that included complex fractures and condylar fractures. The developmental deformity group was categorized into OGS done simultaneously during trauma management (5) or done as a secondary procedure after trauma management (4). Application of principles and techniques of OGS in indicated primary or secondary management of facial trauma patients should always be considered. The categorization of scenarios presented in this article relating facial trauma and OGS may further help to understand the application.

Quality indicators in primary elective total hip and knee arthroplasty.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent a significant portion of healthcare spending and are high-priority for quality improvement initiatives. This study aims to develop quality indicators (QIs) in the care of primary elective THA and TKA patients. These QIs serve a number of purposes including documentation of the quality of care, objective comparisons of institutions/providers, facilitating pay-for-performance initiatives, and supporting accountability, regulation, and accreditation. A guideline-based approach, initially described by Kötter et al., was utilized. Eight clinical practice guidelines (CPGs) were evaluated for candidate indicators (CIs). CIs with high-quality evidence and consensus statements were extracted. Eighteen additional CIs were included from previous work that evaluated quality improvement databases. Each CI and supporting evidence was submitted for independent review by an expert panel. The RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology was utilized and items were rated based on validity, reliability, and feasibility of measurement. After two rounds of ratings and ranking, a final ranked list of QIs was obtained. Fifty-six CIs were identified from the literature and CPGs or proposed by the expert panel. Two rounds of voting resulted in 12 total QIs that were deemed appropriate measures of high-quality care. The final 12 QIs were ranked by order of importance: use of peri-operative tranexamic acid, infusion of prophylactic antibiotics prior to inflation of tourniquet, appropriate post-operative venous thromboembolic prophylaxis, complication rate, rate of secondary procedure, readmission rate, early mobilization, average change of pre- to oneyear post-operative functional status, use of multimodal analgesia, use of neuraxial anesthesia, use of peri-articular injection in TKA, and use of pre-operative PO analgesia. This study is an expert opinion based on parameters observed in modern and high-quality academic settings. Twelve QIs are proposed to assess the quality of care in the peri-operative management of primary elective THA and TKA patients.

Extensor Mechanism Centralization Using Autograft Hamstring for Laterally Dislocating Patella.

Patellofemoral complications following total knee arthroplasty (TKA) are some of the most commonly cited complications in the literature, accounting for up to 50% of secondary procedures in the literature. Lateral dislocation of the patella, while rare, is one of many causes of extensor mechanism dysfunction. We sought to evaluate a novel patellar centralization procedure by comparing patients' pre- and postoperative clinical and radiographic data. A retrospective case-series study was performed on 12 patient knees (5 male and 7 female) presenting with ambulatory dysfunction due to laterally dislocating patella. All of the knees had component revision combined with hamstring autograft tendon weave and medial reefing of the retinaculum and vastus medialis. The results revealed reliable stabilization of the patella and improved extensor lag at a mean 2.2±2.2 years' short-term follow-up, which correlated with improved postoperative radiographic measurements. Range of motion in both flexion and extension was improved postoperatively. Improvements in radiographic measures of patellar tilt and patellar displacement were statistically significant, with reductions in the mean patellar tilt from 41.5°±25.9° to 3.9°±13.7° (P=.004), and in the mean patellar displacement from 2.8±2.1 cm to 0.8±0.9 cm (P=.012). Our study findings support the use of the extensor mechanism centralization procedure with autograft hamstring in management of laterally dislocating patella after TKA. [Orthopedics. 2023;46(3):e186-e188.].

Traumatic divergent dislocation of the elbow in the adults

PurposeThis retrospective study aimed to investigate the clinical outcomes of DDE in adults.MethodsFrom September 2010 to March 2020, adult patients with traumatic DDEs admitted to Beijing Chaoyang Hospital and Beijing Jishuitan Hospital were included in this study. Each patient underwent operative or conservative treatment during hospitalization. The clinical and radiological examinations were followed up. The primary outcomes included the Mayo Modified Wrist Score (MMWS), the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey functional index, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Visual Analogue Scale (VAS) score that were performed. Post-operative complications and secondary surgery details were also collected.ResultsOf the fourteen patients, clinical and radiographic results were reviewed at a mean of 53.2 months (18 to 110 months) postoperatively. There were 11 men and three women with an average age of 31.5 years (17 to 51 years). At the final follow-up, the average MMWS, MEPS, Broberg and Morrey functional index, and DASH scores were 91.4 points, 93.4 points, 92.6 points, and 10.7 points. The mean VAS at rest and during activities was 0.4 and 1.7 points. Two patients required a secondary procedure due to radial malalignment and elbow contracture, respectively. In addition, two patients were found degeneration.ConclusionsWithin the context of high-energy DDE combined with simultaneous upper limb injuries, our study recommended obtaining the mechanical benefit of the forearm ring with concentric elbow stability. Despite the various and complicated traumatic patterns of DDE, great clinical results could be acquired based on adequate surgical treatments and early rehabilitation training.

An Update on Tissue Contraction in Immediate Breast Reconstruction Using an Adjustable Implant Partially Filled With Air.

Background With the use of nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) techniques, utilizing a prepectoral underfilled adjustable saline implant allows for tissue contraction and thickening of the flap. This procedure allows for immediate reconstruction using an adjustable implant as a spacer with less risk of skin flap compromise and improves cosmetic outcomes. Methods A retrospective chart review of patients presenting to a single surgeon from September 2013 to September 2021 for breast reconstruction utilizing an underfilled prepectoral adjustable implant following SSM or NSM was performed. Baseline patient demographics, clinical information, postoperative complications, conversion to silicone implant, and contraction distance were recorded and analyzed. Results Fifty-four patients underwent prepectoral breast reconstruction using a Spectrum™ adjustable implant following an NSM or SSM. Tissue contraction and skin flap elevation were observed in all patients. The amount of tissue contraction averaged 4.4 cm (mean). Seven patients (12.96%) developed seromas. Four patients (7.41%) developed hematomas in the early postoperative period. Two patients (3.67%) developed capsular contracture. Two patients (3.67%) had a displaced port. After converting the air to saline, 25 patients (46.29%) opted for a secondary reconstructive procedure to exchange the saline implants for silicone gel implants. Conclusion Tissue contraction reduces the need for skin excision in ptotic breasts undergoing reconstruction procedures following NSM or SSM. The partially filled implant initially functions as a spacer to prevent flap adherence to the pectoral muscleand minimizes tension on the flap to promote flap thickening, elevation around the underfilled implant, and maximizes breast projection and overall aesthetic outcome.

Comparative study of various dressing techniques in diabetic foot ulcers in the Indian population: a single-center experience.

A prospective randomized study was conducted to evaluate and compare the efficacy of conventional dressing, foam dressing, and vacuum-assisted closure (VAC) in the management of diabetic foot ulcers (DFUs). Ninety patients with DFU were included in the study conducted between 2018 and 2021 at a tertiary care center. Group 1 patients (n = 30) were treated with conventional dressing, group 2 patients (n = 30) with foam dressing, and group 3 patients (n = 30) with VAC dressing.The duration of treatment, number of debridement, need for the secondary procedure, cost of treatment, and duration of hospital stay were compared between the three groups. There was a significant difference in the duration of treatment among the three groups with VAC being the least(group 1, 31.17days; group 2, 24.13days; group 3, 15.17days).The mean number of debridement was also significantly less in the VAC group (2.37, 2.43, and 1.60, respectively). The need for the secondary procedure, like flap or skin graft, was also the least in the VAC group, although insignificant. The mean hospital stay of the study subjects was 31.17days, 24.13days, and 15.17days in the 3 groups, respectively. The mean cost of the treatment was 3076.67 INR, 3717.33 INR, and 10,680 INR, respectively. VAC dressing is the best option amongst the available dressing modalities in terms of faster healing and a short hospital stay. Foam dressing does provide an economically viable option with better results than conventional dressing.

Farklı Anatomik Bölgelere Yerleştirilmiş Naltrekson İmplantların Opioid Tedavisine Uygunluk ve Yara Yerleşimine Göre Karşılaştırmalı Değerlendirilmesi: Plastik Cerrah Perspektifi

Objective: Today, increasing opioid substance addiction has made implantation of subcutaneous opioid antagonists (such as naltrexone) a more popular treatment modality. In the literature, although the abdominal region is generally preferred for implantation, there is no study on the ideal location of these implants. In our study, it was aimed to evaluate and compare which of the dorsal or abdominal regions is the more ideal site for implantation, treatment compliance, surgical wound site and complications in these patient groups. Material and Methods: For this purpose, 181 patients who were referred to us by the psychiatry department in our clinic for subcutaneous implant placement for the treatment of opioid addiction between 2016 and 2019 were included in the study. Demographic characteristics, how many times and in which areas implantation was performed, whether the patients discontinued the treatment, if they did, the reasons for discontinuation, presence of signs of infection, implant extrusion, and secondary interventions were examined. Results: Subcutaneous naltrexone implant was placed in the back region in 95 patients and in the abdominal region in 86 patients. Based on the area where the implants were placed, the patients were evaluated in terms of parameters such as compliance to treatment, infection, secondary procedure requirement, and implant extrusion in the postoperative period. It was determined that patients with implants in the back area adapted better to the treatment, required fewer secondary procedures, and experienced less infection and implant extrusion. Conclusion: In the light of these findings, in cases where subcutaneous implantation is planned for the treatment of opioid addiction, the back region is a more ideal area for implantation compared to the abdominal region.