Simple Incision Research Articles

Pediatric Cranial Vault Lesions: A Tailored Approach According to Bony Involvement.

Cranial vault lesions are common in children, with dermoid and epidermoid cysts being the most frequent. Management is debated due to their slow growth, but early resection can prevent complications and provide a definitive histological diagnosis, which is sometimes linked to systemic diseases. A retrospective study of children treated surgically for cranial vault tumors from January 2011 to April 2023 was conducted. The data collected included age, gender, symptoms, comorbidities, lesion location, radiological features, surgical techniques, histopathology, and recurrence rates. Eighty-eight children (mean age: 3.5 years, mean tumor size: 1.21 cm) underwent surgery. The most common locations were the frontal and occipital bones. The main diagnoses were dermoid cysts, myofibroma, and Langerhans cell histiocytosis. Gross total resection was achieved in 64 cases with simple skin incisions. In 13 cases, small cranioplasties with bone cement were used. Craniotomy and cranioplasty with autologous bone grafting were performed for 11 patients with lesions larger than 2 cm and full skull thickness erosion. Early resection is recommended for complete removal with minimally invasive surgery and to ensure histological diagnosis. For lesions larger than 2 cm with full skull erosion, cranioplasty with autologous bone is the preferred technique.

Simple incision and suture modeling on fixed structured grids

This paper presents a simple yet versatile approach to simulate skin incisions and suturing using nonlinear finite element analysis on a fixed structured grid with a spring-based suture model. Incisions and wounds are introduced by element removal and the sutures are discretely modeled by applying linear constraint relations pairwise to groups of nodes. Two numerical examples utilize the closing of an elliptical wound to study the influence of the number of sutures and their location, and two test cases use the Z-plasty transposition flap technique to investigate the versatility of the proposed method and for comparison with state-of-the-art results. The results indicate that the presented method is able to recreate literature results to an acceptable level of accuracy. Further, the method proves versatile due to the ability to freely introduce incisions and wounds onto the fixed grid modeling domain without remeshing. Lastly, the two main advantages of the discrete suture representation are the ability to capture local stress concentrations near the sutures and the full freedom in placing the sutures.

De Quervain's Tenosynovitis Release With Excision of the First Dorsal Compartment: Novel Surgical Technique and a Case Series.

Incision of the dorsal side of the tendon sheath in release of De Quervain's tenosynovitis has traditionally been advocated to prevent the risk of volar tendon subluxation. We describe a novel technique of complete excision, rather than simple incision, of the first dorsal compartment tendon sheath. Over a 10-year period, 147 patients (154 wrists) underwent first dorsal compartment release using this technique of complete excision of the sheath. No postoperative immobilization is used. Patients were followed for a mean of 7.0 months. Records were assessed for any complications including reoperation, tendon subluxation, recurrence, wound complications, scar tenderness, and superficial radial sensory nerve paresthesias. There were no cases of recurrence, reoperation, or tendon subluxation after release with this technique. Postoperatively, 7 (4.5%) patients had scar tenderness and 5 (3.2%) of these patients also had superficial radial sensory nerve parasthesias, which all resolved at the time of final follow-up. Mean range of motion was 73±11 degrees of flexion and 69±10 degrees of extension. In contrast to simple incision, we propose that this technique provides a more complete release of the compartment without risk of symptomatic subluxation or bowstringing and provides a complete release of a separate extensor pollicis brevis subsheath or any concomitant retinacular cysts associated with the tendonitis. There is an immediate removal of the symptomatic swelling and visible, painful bump associated with the thickened retinaculum with this technique. Furthermore, no immobilization is required after surgery.

Surgeons' Experience and Practices in Managing the Pilonidal Sinus in the Kurdistan Region of Iraq.

Background Despite pilonidal sinus disease being a prevalent issue, there are still many challenges and controversies regarding its management. This study aimed to evaluate the experiences and practices of surgeons in the Kurdistan region of Iraq in the management of the pilonidal sinus and determine the most preferred treatment method, recurrence rates, and other complications related to different treatment methods. Methods This cross-sectional study was conducted on a convenience sample of 104 surgeons in the Kurdistan region of Iraq from January to February 2024 using an online survey based on Google Forms. A questionnairewas developedfor data collection that included data on the experience and practice of pilonidal sinus treatment. Results The most common procedure followed by the study participants to manage the pilonidal sinus included primary open (n = 61/104, 58.7%), followed by primary closure (n = 20/104,19.2%). The most common reasons or advantages for performing specific procedures to manage the pilonidal sinus were a lower recurrence rate (n = 73/104, 70.2%), safer procedures (n = 60/104, 57.7%), shorter operation times (n = 57/104, 54.8%), and shorter hospital stays (n = 53/104, 51.0%). The primary open method was the most commonly used method (n = 46/104, 44.3%), followed by simple incision and drainage (n = 25/104, 24.0%), primary closure (n = 23/104, 22.1%), and off-midline closure (n = 10/104, 9.6%). Most of the participants agreed that the primary open had the lowest recurrence rate (n = 68/104, 65.4%), while simple incision and drainage (n = 50/104, 48.1%) and primary closure (n = 29/104, 27.9%) were associated with frequent recurrence. Conclusions Standard treatment of pilonidal sinus disease is still not available. Most surgeons in the Kurdistan region of Iraq prefer the open method, which is the easiest, safest, and least recurrent yield method. However, it is the most painful and has the longest recovery time.

Excision of Giant Cervicomediastinal Parathyroid Cyst: Case Report and Literature Review.

While excision for parathyroid cysts remains as the standard of management, surgical approach in the context of massive cervicomediastinal parathyroid cysts can be challenging. We report a rare giant parathyroid cyst in anterior mediastinum successfully resected from a simple standard Kocher's collar incision. Various surgical approach will also be deliberated.

Application of retroauricular sulcus incision in the operation of benign tumors in the deep lobe of parotid gland

Objective: To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. Methods: From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People's Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision. Results: Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin's tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances. Conclusion: The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.

Minimally invasive longitudinal intravital imaging of cellular dynamics in intact long bone.

Intravital two-photon microscopy enables deep-tissue imaging at high temporospatial resolution in live animals. However, the endosteal bone compartment and underlying bone marrow pose unique challenges to optical imaging as light is absorbed, scattered and dispersed by thick mineralized bone matrix and the adipose-rich bone marrow. Early bone intravital imaging methods exploited gaps in the cranial sutures to bypass the need to penetrate through cortical bone. More recently, investigators have developed invasive methods to thin the cortical bone or implant imaging windows to image cellular dynamics in weight-bearing long bones. Here, we provide a step-by-step procedure for the preparation of animals for minimally invasive, nondestructive, longitudinal intravital imaging of the murine tibia. This method involves the use of mixed bone marrow radiation chimeras to unambiguously double-label osteoclasts and osteomorphs. The tibia is exposed by a simple skin incision and an imaging chamber constructed using thermoconductive T-putty. Imaging sessions up to 12 h long can be repeated over multiple timepoints to provide a longitudinal time window into the endosteal and marrow niches. The approach can be used to investigate cellular dynamics in bone remodeling, cancer cell life cycle and hematopoiesis, as well as long-lived humoral and cellular immunity. The procedure requires an hour to complete and is suitable for users with minimal prior expertise in small animal surgery.

Recurrence of follicular dendritic cell sarcoma in tonsils after 7 years: a rare case report

Dystrophic calcifications are pathological mineral precipitates which occur in degenerative or dead tissue, despite normal serum calcium and phosphate levels, mostly seen in subcutaneous tissues secondary to infection or trauma. Chronic inflammation of the tonsils may lead to the formation of calcifications called tonsilloliths. The prevalence amongst the population is 2% to 16%, in age groups ranging from 10 years to 77 years of age, with a male/female ratio of 1:1. These calcifications display radiopaque images that are single or multiple, round or irregular, unilateral or bilateral and are superimposed upon the mandibular ramus. Computed tomography (CT) can be the investigation of choice for definitive diagnosis. The treatment of tonsilloliths is dependent on the size and presence of symptoms. It’s preferable to remove a single, large tonsillolith, as they can cause recurrent episodes of tonsillitis. Usually manual compression, curettage or a simple incision to release the calcified body should suffice for the relief. In case of numerous tonsilloliths, an attempt to remove them individually is not a feasible approach. Hence, bilateral tonsillectomy is opted.

ERUPTION CYST OVERLYING THE CROWN OF UPPER RIGHT FIRST PREMOLAR: A CASE REPORT

Introduction: An eruption cyst is one of the odontogenic cyst involving the soft tissue, associated with the eruption of the primary or permanent tooth that lies behind the cyst. It often occurs in children; first permanent molars and maxillary incisors are the most prevalent teeth. Case: This article report an eruption cyst case in a 9-year-old female patient. The patient came with swelling on the gingiva overlying the crown of 14, and , clinically, the tooth has not erupted yet. Intraoral examination revealed the presence of smooth swelling, 1 cm x 0.8 cm, with bluish-black color. Case Management: Surgical incision under local anesthesia was performed to remove the cyst and exposed the tooth. Discussion: Eruption cyst is a soft tissue cyst. The exact aetiology remains unclear. It appears as a dome-shaped swelling, soft, transparent, bluish to blue-black color. It’s hard to distinguish eruption cyst on radiograph examination, because it’s a soft tissue cyst, no bone involvement. Histologically, it presents connective tissue covered with layer of non-keratinized squamous epithelium. A small asymptomatic eruption cyst does not require any treatment because it could rupture spontaneously. If it causes a problem, it must be removed by incision and drainage the cyst fluid contents. In this case, the cyst treated with simple incision, the tooth was exposed and could erupt normally. Conclusion: The latest knowledge and developments in diagnosis and treatment of eruption cysts are important for clinicians to understand in order to decide the right diagnosis and treatment plan.

Partial Resection of First Dorsal Compartment Extensor Retinaculum in De Quervain's Stenosing Tendovaginitis Release.

Various surgical techniques exist to treat de Quervain's stenosing tendovaginitis. Specific surgical techniques for de Quervain's are designed to avoid complications including injury to branches of the superficial branch of the radial nerve, inadequate decompression, reflex sympathetic dystrophy, and palmar subluxation of the released tendons. A simple dorsal incision through the extensor retinaculum is advocated by many as a means to release the compartment while preventing postoperative subluxation. A single incision through the retinaculum limits exposure of the compartment and could lead to reannealing of the retinaculum and recurrent symptoms. Partial resection of the extensor retinaculum provides a more complete release and has not been found to lead to palmar tendon subluxation.

Deciphering complexity of block-faulted topography – Insights from morphometric variables, drainage patterns and river profiles (Orlickie-Bystrzyckie Mountains Block, Central Europe)

The Orlickie-Bystrzyckie Mountains Block (OBMB) is a medium-size, transboundary morphostructure within the Sudetes range in Central Europe, subject to non-uniform uplift in the late Cenozoic. Geologically, it consists of Variscan basement and Permian to Cretaceous sedimentary cover. This paper attempts to unravel its morphotectonic history and decipher the spatial pattern of uplift and erosional response, using several complementary, quantitative approaches to characterize topography. The focus is on: (1) general relief properties captured by selected topographic variables; (2) fault-generated escarpments, which define the eastern and northern limits of the study area; (3) drainage patterns and its peculiarities; (4) diversity of longitudinal river profiles and valley morphology. A LiDAR-based high-resolution digital terrain model was the primary source of elevation data. An important component of the study was examination of the role of lithological diversity on relief properties. A statistical approach generally revealed a secondary role of the rock factor and provided a foundation to interpret the macro-topography of the OBMB in terms of tectonic controls. Based on geomorphometric characteristics and information about the distribution of sedimentary rocks, which can be used as marker horizons to identify vertical displacements, four major and one secondary centres of surface uplift have been recognized. They are all asymmetric, being bounded by distinct fault-generated escarpments on one side and sloping gently in the opposite direction. Erosional response to uplift has been variable and includes, apart from simple incision into rising crustal blocks, the origin of epigenetic-antecedent water gaps, drainage diversions, headward erosion, and captures. This study also reveals that morphometric indices routinely used to extract the tectonic signal from landform patterns do not necessarily provide consistent information.

Evaluating hospital consumer-friendly price-estimator tools for shoppable services within dermatology.

A recent mandate by the Centers for Medicare and Medicaid Services (CMS) required hospitals to publish prices online. This study examined the utility of CMS-mandated price estimators for dermatology procedures. Chargemasters and price-estimator tools from the five largest hospitals in each state (n = 250) were reviewed for accessibility. Price estimators were also searched for the presence of dermatologic procedures and their estimated prices. Of the 250 hospitals included, 89.6% of chargemasters and 92.8% of price estimators were accessible. Of the available chargemasters and price estimators, 98.7% and 63.8% contained pricing data on dermatologic procedures, respectively. The most common dermatology procedures listed were debridement of subcutaneous tissue (CPT 11042) with a median price of $1,135.50 (IQR $577-$3533.67; n = 80), followed by simple incision and drainage of skin abscess (CPT 10060) with a median price of $956.00 (IQR $465.50-$6506.00, n = 79), and single punch biopsy of skin (CPT 11104) with a median price of $506.06 (IQR $356.50-$922.08, n = 29). Although price estimator tools are widely available in patient-friendly and searchable formats, they are not optimized for shoppable dermatologic services. Adding more dermatologic procedures to patient-friendly price-estimator tools can help patients directly realize savings from price shopping.

Abnormal patellar loading may lead to femoral trochlear dysplasia: an experimental study of patellar hypermobility and patellar dislocation in growing rats

BackgroundThis animal study aimed to explore the effects of patellar hypermobility and patellar dislocation on the developing femoral trochlea.MethodsSeventy-two 3-week-old Wistar rats were randomly divided into three groups. The sham group (SG) underwent simple incision and suture of the skin and subcutaneous tissue; the patellar hypermobility group (PHG) underwent medial and lateral retinacular release and pie-crusting technique for the patellar ligament; the patellar dislocation group (PDG) underwent plication of the medial patellofemoral retinaculum. Twelve rats in each group were euthanized at 3 and 6 weeks postoperatively, respectively, and specimens were collected. The bony sulcus angle (BSA), cartilaginous sulcus angle (CSA), trochlear sulcus depth (TSD), and thickness of the cartilage on the lateral facet (CTL), medial facet (CTM), and center (CTC) of the trochlea were measured on hematoxylin and eosin-stained sections.ResultsIn the PHG and PDG, the femoral condyles became blunt, the trochlear groove became shallower, and cartilage became thicker compared with the SG. Compared with the SG, the PHG and PDG had significantly larger BSA and CSA values at 3 (p < 0.05) and 6 weeks (p < 0.005), and a significantly shallower TSD (p < 0.05). At 3 weeks, all cartilage thicknesses in the PHG and the CTC and CTM in the PDG were significantly thinner than in the SG (PHG vs. SG: p = 0.009 for CTL, p < 0.001 for CTM, p = 0.003 for CTC; PDG vs. SG: p = 0.028 for CTC, p = 0.048 for CTM). At 6 weeks, the CTC was thicker in the PHG and PDG than the SG (PHG vs. SG: p = 0.044; PDG vs. SG: p = 0.027), and the CTL was thinner in the PDG than the SG (p = 0.044).ConclusionPatellar hypermobility and patellar dislocation may result in trochlear dysplasia that worsens with age. Excessive or insufficient loading leads to trochlear dysplasia.

Обзор современных техник хирургической коррекции короткой уздечки полового члена.

Introduction. Short frenulum of the penis (frenulum breve) is a condition associated with a decrease in the length of the frenulum of the penis and/or a decrease in its elasticity. A number of different techniques have been proposed for the surgical treatment of a short frenulum of the penis, from a simple incision (frenulotomy) to complex frenuloplasty and frenulum grafting techniques. Purpose of the study. To assess the results of various surgical techniques in the treatment of frenulum brevis by examining the current evidence base in the world literature. Materials and methods. A search was made for publications in the international database MEDLINE on the platform PubMed, in the scientific electronic library eLibrary.ru and in the Google Scholar search engine. Results. A total of 12 publications were selected. Selected publications were represented by retrospective cohort studies and case series. 3 studies evaluated the results of frenulotomy (frenulectomy), 8 – different methods of frenuloplasty and one – circumcision in the treatment of a short frenulum of the penis. Conclusion. The results of the literature review showed that all techniques of surgical correction of the short frenulum of the penis demonstrate excellent early functional and aesthetic results, with a minimum number of postoperative complications. The best results in the treatment of a short frenulum of the penis can be achieved by choosing the optimal surgical technique in each case.

Seroma of Auricle.

The pseudocyst of the auricle is an intracartilaginous lesion defined as the accumulation of sterile, straw-coloured fluid in a cyst unlined by epithelium. It is more common in males. The most common site of lesion is the scaphoid fossa and right ear. Though the aetiology remains unclear, it may be associated with mechanical irritation, repeated minor injuries and chronic trauma. If left untreated, it can lead to permanent deformity of the auricle. Pseudocyst of the auricle is a rare and challenging condition. Medical management has unfortunately shown no practical results. Hence, surgical treatment modalities are the best option. The universal aim of treatment is the conservation and restoration of the anatomical structure of the pinna, removal of cystic lesions and prevention of recurrence. Simple aspiration or incision and drainage alone lead to reaccumulation of cystic fluid in most cases. The technique of incision and drainage is the easiest but has a high recurrence rate. Conservative treatment often results in recurrence and unsatisfactory results. Other treatment modalities include incision and drainage with daily irrigation, auricular splinting, aspiration with intralesional steroid injection, aspiration followed by compression dressing, or aspiration with intralesional steroid injection followed by compression dressing and surgical deroofing, surgical deroofing followed by compression with buttons or sheet or sandwich method. Cysts with a diameter less than 1 cm are dealt with through non-surgical treatment modalities, while for cysts having a diameter greater than 1 cm, surgery is considered as first choice therapy. These treatment options have shown promising results. Various modifications in the traditional techniques have reduced the recurrence rate, successfully treated the condition and shown good cosmetic results. This review article aims at providing a holistic collection of various conventional treatment modalities and novel modifications introduced, which can be used in a sequence of definitive treatments of seroma of the auricle.

Surgical Outcome of Limberg’s Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital

Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps.&#x0D; Objective To evaluate the efficacy and outcome of Limberg’s flap reconstruction in a community hospital.&#x0D; Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018.&#x0D; Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence.&#x0D; Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures

Acute Bartholin’s gland abscess treatment by simple needle aspiration: A prospective study

ObjectiveThis study aim was to examine the success rate of simple needle aspiration for acute Bartholin’s gland abscess and compare it to incision and drainage treatment. Study designThis was a non-randomised prospective study conducted at the academic Hospital of La Conception, Marseille, France. We included 202 women who presented with acute Bartholin’s gland abscess between June 2013 and October 2017. The study cohort was subdivided into two treatment groups, simple needle aspiration (134 women) or incision and drainage (42 women), according to the women’s preference. Success was considered as the absence of surgical treatment within one year of the initial treatment. ResultsThe success rate was 68/134 (51% (95% CI: 42–59%)) in the simple needle aspiration group and 25/42 (60%) in the incision drainage group (RR: 0.85, 95% CI: 0.63–1.15, P = 0.3). Among 122/134 (91%) women who completed the satisfaction survey, 99/122 (81%) were satisfied with the simple needle aspiration. ConclusionsSimple needle aspiration can be offered as first-line treatment for acute Bartholin’s gland abscess. Simple needle aspiration can be performed as an outpatient procedure without general anesthesia avoiding surgical treatment in half of the cases one-year post- simple needle aspiration.

Selective U-shaped osteotomy of lateral tibial condyle for the treatment of collapse and comminuted fracture of lateral tibial plateau

To explore methods and clinical effects of selective U-shaped osteotomy of lateral tibial condyle in treating collapse and comminuted fracture of lateral tibial plateau. From January 2014 to October 2019, 15 patients with collapse and comminuted fracture of lateral tibial plateau were treated by selective U-shaped osteotomy of lateral tibial condyle, including 9 males and 6 females. The age of patients ranged from 25 to 70 years old, with an average age of (38.5±7.7) years old. According to ABC classification of condyle fracture of tibial plateau lateral, there were 2 cases of type A, 6 cases of type B, 4 cases of type BC and 3 cases of type C. Five patients were combined with medial plateau fracture, 8 patients were combined with left knee fracture and 7 patients of right knee fracture. The time of treatment after injury ranged from 1 day to 14 days with an average of (3.4±1.2) days. CT of all patients showed that lateral tibial plateau collapsed more than 2 mm, more than 2 pieces of bones were crushed and broken, and lateral tibial condyle cortex was intact. At follow-up of 12 months after operation, Rasmussen's anatomical grading system was used to evaluate fracture reduction. Rasmussen's functional grading system were used to evaluate knee joint function. Selective U-shaped osteotomy was successfully complated in 15 patients at one time, and operation time ranged from 55 to 110 min, with an average time of (85.6±20.0) min. The lateral plateau operation ranged from 20 to 60 min with an average time of(30.5±10.5) min. All patients were followed up for 12 to 24 months with an average of (14.6±2.5) months. Fracture healing time was 12 to 24 weeks, with an average of (13.6±3.6) weeks. At follow-up 12 months after operation, by Rasmussen's grading system, anatomical score of knee joint ranged from 14 to 18 points, with an average score of (17.5±0.3) points, of which 13 cases were excellent and 2 cases were good. The functional score ranged from 13 points to 30 points, with an average score of (26.8±2.5) points. Among them, 12 cases were excellent, 1 case was good, 2 cases were fair. Two patients suffered 2 mm and 4 mm loss of lateral tibial plateau, 1 case of knee joint 5 ° valgus, 1 case of stiff joints (10 ° to 100 °). No common peroneal nerve injury, important vascular injury, postoperative infection, internal fixation failure and other serious complications was found. The use of selective lateral tibial condyle "U"- shaped osteotomy approach is an effective and reliable method to treat the collapse and comminuted fracture of the lateral tibial plateau. It has the advantages of simple surgical incision, direct fracture exposure, accurate repositioning and fixation, short operation time and few complications.

Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report

The sternoclavicular joint (SCJ) is an uncommon location for septic arthritis to occur in. Due to the rarity of the condition and the nonspecific symptoms, SCJ septic arthritis can be missed or mislabeled as osteoarthritis or muscle strain. Accurate history and physical examination is crucial for recognizing this condition. With the potential life-threatening complications that may ensue, SCJ septic arthritis has traditionally been managed surgically. This ranges from simple incision and drainage to resection of the joint. However, in cases where there is not enough fluid for incision and drainage, a trial of medical management with antibiotics can be attempted. We herein describe a case of a 58-year-old male who presented with nonspecific anterior chest wall and neck pain. Chest X-ray and ultrasound of the anterior chest wall was normal; however, magnetic resonance imaging (MRI) of the chest showed a small effusion without other complications. His blood cultures grew extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, rendering this as his hematogenous source of septic arthritis. The ESBL was from a left-sided obstructing kidney stone that resulted in pyelonephritis, which was confirmed via computed tomography of the abdomen. His effusion was too minimal to drain; therefore, he was managed medically with intravenous (IV) antibiotics along with a left ureteral stent placement, and he had a full recovery. This case represents the ability for SCJ septic arthritis to be managed medically with IV antibiotics, especially when the diagnosis is caught early without complications. The role of MRI is indispensable for coming to the diagnosis, as it is capable of detecting complications that ultimately dictate management. Additionally, this case highlights the unique microorganism, ESBL-producing E. coli causing the SCJ septic arthritis, a finding that has been rarely reported in the literature as the majority of microorganisms that have been previously documented are either Staphylococcus aureus or Pseudomonas aeruginosa.

Auto-Augmentation Mastopexy: Inferiorly Based Parenchymal Flap Technique and Evaluation of Outcomes Using BREAST-Q After 151 Consecutive Patients.

Mastopexy is one of the most performed annual plastic surgery procedures; hence, various techniques are described over the last decades. It varies from simple skin incisions to internally shaped pedicle designs. In this study, the authors present their modified auto-augmentation mastopexy technique and the resulting patient satisfaction. For this retrospectively conducted study, 151 female patients were included. The average age was 40.6 years (range, 27-72 years). All patients underwent auto-augmentation mastopexy which is a combination of a superior pedicle for the nipple-areola complex and an inferiorly based soft-tissue flap which is shaped like an implant. Additionally, the BREAST-Q for Reduction/Mastopexy was used to analyze patient-reported satisfaction and quality of life after mastopexy. All breast corrections were successfully performed. General complication rate was 9%, and no major complication was observed. In two patients, local surgical revision due to hypertrophic scarring and nipple asymmetry was necessary. Analysed surveys of the BREAST-Q showed statistically significantly improved results. Depending on the breast-shape and the grade of ptosis, the selection of mastopexy technique is crucial. Our described mastopexy procedure is a safe and easily reproducible technique for almost all shapes of ptotic breasts which fulfill patient desires as well as aesthetic satisfaction and quality of life. 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.