Immediate Unilateral Subpectoral Implant-Based Breast Reconstruction does not Impair Pulmonary Functions: A Preliminary Prospective Study

BACKGROUND

Implant-based breast reconstruction is one of the most common procedures among women with breast cancer undergoing mastectomy. Prosthetic devices may be positioned either beneath or above the pectoralis major muscle, which is considered an accessory muscle of ventilation. This preliminary prospective study aimed to investigate whether subpectoral unilateral implant-based breast reconstruction has any effect on patients' pulmonary functions.

METHODS

A prospective study of fourteen women who underwent immediate unilateral implant-based subpectoral breast reconstruction by a single surgeon over 10 months was conducted. Spirometry and maximal voluntary ventilation tests were conducted 1 day prior to surgery, and 1- and 3 months following breast reconstruction. ANOVA or Friedman test were used to compare pulmonary function tests before and after surgery.

RESULTS

Fourteen patients completed the study protocol. No statistically significant differences were found when comparing spirometry parameters in the three time points.

CONCLUSIONS

Pectoralis muscle release does not impair pulmonary function among patients undergoing immediate unilateral implant-based breast reconstruction following mastectomy.

LEVEL OF EVIDENCE III

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 .

Revitalizing Hands: A Comprehensive Review of Anatomy and Treatment Options for Hand Rejuvenation

Dorsal hand rejuvenation is gaining popularity as a solitary procedure and adjunct to face and neck rejuvenation treatments. As the hands age, the skin loses elasticity and becomes more translucent, the veins, joints, and tendons appear more prominent, and the bones become more noticeable. These changes are due to intrinsic and extrinsic factors. Current treatment methods include the injection of dermal fillers and autologous fat grafting. Anatomic studies to ensure the successful implementation of rejuvenation procedures identified three separate fascial layers in the dorsum, from superficial to deep. More recent re-evaluations revealed a less distinct, inseparable, sponge-like fascial layer. All authors agree that the superficial dermal layer is probably the optimal location for the injection of volumizing materials because it is free of anatomical structures. Many methods for harvesting, preparing, and injecting fat grafts to the dorsum of the hand have been described in the past three decades. Both filler and fat-graft procedures are performed on an ambulatory basis under local anesthesia. Good results with low postoperative and long-term complication rates and high patient satisfaction have been reported.

Risk factors associated with accidental fetal skin lacerations during cesarean delivery

OBJECTIVE

To identify risk factors associated with accidental fetal skin lacerations (AFL) during cesarean section (CS).

METHODS

This retrospective cohort study was obtained from the registry of two large medical centers between 2014 and 2019. The study group comprised all newborns identified with AFL. The rates of various potential risk factors were compared between the study group and a group of CS at which no AFL had occurred (the control group).

RESULTS

Of the 14 666 CS deliveries, 48 cases of AFL (0.33%) were documented, 52% of these following urgent CS. Compared with the control group (n = 14 618), the only risk factors associated with AFL were premature rupture of membranes (PROM) (odds ratio [OR] 5.38, 95% convidence interval [CI] 2.97-9.74) and meconium-stained amniotic fluid (OR 6.50, 95% CI 2.55-16.54). In subgroup analysis by CS urgency, no significance for these factors was noted in elective CS group; but higher rates of both PROM and meconium-stained amniotic fluid were noted in the AFL during urgent CS (OR 14.23, 95% CI 6.30-32.16 and OR 15.36, (95% CI 5.65-41.75, respectively).

CONCLUSIONS

During urgent CS, the surgeon should bear in mind that the presence of PROM or meconium-stained amniotic fluid should prompt extra care and application of preventive measures to decrease the rates of AFL.

Israeli Innovations in the Field of Plastic Surgery

Numerous innovations within the field of plastic surgery have been developed in Israel over the last few decades. Many of these therapeutic devices and techniques have been established globally with demonstrable efficacy and respectable safety profiles. This article offers an overview of recent Israeli cutting-edge medical therapeutic solutions contributing to the global practice of plastic surgery.

Quality of Patient-Reported Outcome Studies Utilizing the BREAST-Q: A Systematic Review

BACKGROUND

Patient-reported outcome (PRO) studies are essential in the assessment of surgical procedures in plastic surgery. One accepted and validated questionnaire is the BREAST-Q.

OBJECTIVES

The aim of this study was to assess the quality of PRO studies in plastic surgery utilizing the BREAST-Q questionnaire.

METHODS

This study involved 2 steps: (1) a systematic review of 23 key criteria assessing the quality of survey research in studies utilizing the BREAST-Q that were published between 2015 and 2018; (2) a review of current guidance for survey research in journals related to plastic surgery and breast surgery which were included in the systematic review.

RESULTS

Seventy-nine studies were included in the systematic review. Many key criteria were poorly reported: 51.9% of the studies did not provide a defined response rate and almost 90% did not provide a method for analysis of nonresponse error; 67.1% lacked a description of the sample's representativeness of the population of interest, and 82.3% did not present a sample size calculation. The methods used to analyze data were not described in 11.4% of the papers; in 27.8% the data analysis presented could not allow replication of the results. Of the 16 journals in the fields of plastic surgery and breast surgery for which the "instructions to authors" were reviewed, 15 (93.7%) did not provide any guidance for survey reporting.

CONCLUSIONS

The majority of key criteria are underreported by authors publishing their survey research in peer-reviewed journals in the fields of plastic and breast surgery. There is an urgent need to construct well-developed reporting guidelines for survey research in plastic surgery, and particularly in breast surgery.

LEVEL OF EVIDENCE: 4

Different Types of Auricular Keloids and Treatment by Intralesional Cryosurgery: Best Practice for Obtaining Long-Lasting Clinical Results

BACKGROUND

Auricular keloids belong to the most perplexing medical conditions, which have significant psychosocial impact on the patient's body image and quality of life.

SUMMARY

The article is purposed to provide dermatologists and plastic surgeons with the best proven practice using intralesional cryosurgery for the treatment of the different auricular keloid types in order to obtain superior clinical results by minimizing the probability of recurrence. In the past 20 years, the authors have developed novel procedures in order to increase the effectiveness of intralesional cryosurgery on auricular keloids, including hydrodissection, warm gauze technique, and excision of dangling skin. Long-lasting clinical results with a low recurrence rate and a satisfactory aesthetic outcome are achieved with no deformation of the ear framework.

"POMELO PROJECT" - a simple and low cost simulator for harvesting skin graft by plastic surgery residents

BACKGROUND

Harvesting partial thickness skin grafts is an important technical skill the training plastic surgeon is required to hone. Historically accomplished via manual dermatome (Humby's knife) or the modern day electric dermatome.

OBJECTIVE

Presenting a means of practicing the use of Humby's knife for novice surgeons.

METHODS

15 plastic surgeons comprising 8 seniors and 7 residents, in a single tertiary center participated. Each utilised a Humby knife to harvest 4 skin grafts from a Pomelo. The graft areas were measured via computerised image processing, comparing measures of graft harvest consistency across groups of surgeons.

RESULTS

In the resident surgeon group, the average relative difference between exact graft area and encompassing area was 0.45, as compared with 0.15 in the Senior surgeon group, indicating a greater degree of inconsistency in graft harvest. Comparisons across groups yielded significant differences per each of the 4 grafts harvested (p <=0.005).

LIMITATIONS

single center and small cohort (inherent to the sparsity of plastic surgeons), marginal statistical evidence.

CONCLUSIONS

Citrus Maxima (Pomelo) is a useful substrate to instruct and practice the use of Humby knife effectively, allowing novice surgeons to practice the manual manoeuvres required therefore as well as increase confidence in its subsequent operative use.

Epidemiology of Burn Wounds Arriving to a Level 1 Trauma Center in Israel

Burn injuries have grave consequences for patients and impose a heavy economic burden on healthcare services. Studies on the epidemiology of burn injury in Israel are sparse and outdated, and improved understanding of current trends can help experts plan prevention campaigns and design effective treatment paradigms. This study sought to assess the background, clinical, and treatment characteristics of adult patients admitted with burn injury to a level 1 trauma center in Israel in 2005 to 2017. Data were retrospectively retrieved from the hard copy and electronic files as follows: patient sex and age; burn type, degree, and etiology; percentage total BSA (%TBSA) affected; and type of treatment and length of hospital stay (LOS). The cohort included 734 patients of mean age 41.79 years and a male-to-female ratio of 1.8:1. Thermal factors, particularly hot liquids, were the most common cause; second-degree burns were the most common. Mean %TBSA was 5.39%; mean LOS was 11.81 days; and mean LOS/%TBSA was 4.65. Advanced dressings alone yielded satisfactory outcome in 74.2% of patients. The relatively younger patient age and male predominance of our cohort were in line with published findings. The LOS was similar to previous studies in Israel but lower than in Europe. The LOS/%TBSA was higher than in the literature, with a decrease over time suggesting an increased effectiveness of treatment. There appears to be a decline in the rate of surgery for burn injury and increased expertise in the use of advanced dressings. National prevention campaigns should focus on scalds rather than flame-induced burns.

[SCARPA FASCIA AND ABDOMINAL WALL DEEP ADIPOSE COMPARTMENT PRESERVATION IN ABDOMINOPLASTY - CURRENT CLINICAL AND ANATOMICAL REVIEW]

During the last two decades, in parallel to the increased prevalence of bariatric procedures, there has been a marked increase in the prevalence of abdominoplasty surgery in the United States, and in accordance an increase in the scientific and clinical research related to all aspects of this technique. The most common complication of abdominoplasty is the formation of post-operative seroma. Various theories have been raised regarding the pathophysiology of seroma formation, and numerous methods for seroma prevention have been employed and tested. In the early 90's, a new theory argued that post-operative seroma formation is secondary to damage caused to the abdominal wall's lymphatic drainage during flap undermining. In light of this theory, a new surgical technique was suggested to execute the flap undermining in a more superficial plane. This enabled the preservation of the scarpa fascia and the deep adipose compartment, which preserved the integrity of the abdominal wall lymphatic collectors. This method was successful in reducing the rate of postoperative seroma formation. Recent studies have shed new light on the anatomy of the abdominal lymphatic collectors, pathophysiology of seroma formation and methods of its prevention. This new data undermines the foundations of the scarpa fascia preservation theory, and the surgical technique that was derived from it. A new theory that tries to settle the contradiction between the clinical success of the technique in reducing seromas and the new findings regarding abdominal wall's lymphatic collectors anatomy, is the presence of a 'sticky interface' between the deep adipose compartment and the flap.

Exhaled Breath Markers for Nonimaging and Noninvasive Measures for Detection of Multiple Sclerosis

Multiple sclerosis (MS) is the most common chronic neurological disease affecting young adults. MS diagnosis is based on clinical characteristics and confirmed by examination of the cerebrospinal fluids (CSF) or by magnetic resonance imaging (MRI) of the brain or spinal cord or both. However, neither of the current diagnostic procedures are adequate as a routine tool to determine disease state. Thus, diagnostic biomarkers are needed. In the current study, a novel approach that could meet these expectations is presented. The approach is based on noninvasive analysis of volatile organic compounds (VOCs) in breath. Exhaled breath was collected from 204 participants, 146 MS and 58 healthy control individuals. Analysis was performed by gas-chromatography mass-spectrometry (GC-MS) and nanomaterial-based sensor array. Predictive models were derived from the sensors, using artificial neural networks (ANNs). GC-MS analysis revealed significant differences in VOC abundance between MS patients and controls. Sensor data analysis on training sets was able to discriminate in binary comparisons between MS patients and controls with accuracies up to 90%. Blinded sets showed 95% positive predictive value (PPV) between MS-remission and control, 100% sensitivity with 100% negative predictive value (NPV) between MS not-treated (NT) and control, and 86% NPV between relapse and control. Possible links between VOC biomarkers and the MS pathogenesis were established. Preliminary results suggest the applicability of a new nanotechnology-based method for MS diagnostics.

Diagnosis and Classification of 17 Diseases from 1404 Subjects via Pattern Analysis of Exhaled Molecules

We report on an artificially intelligent nanoarray based on molecularly modified gold nanoparticles and a random network of single-walled carbon nanotubes for noninvasive diagnosis and classification of a number of diseases from exhaled breath. The performance of this artificially intelligent nanoarray was clinically assessed on breath samples collected from 1404 subjects having one of 17 different disease conditions included in the study or having no evidence of any disease (healthy controls). Blind experiments showed that 86% accuracy could be achieved with the artificially intelligent nanoarray, allowing both detection and discrimination between the different disease conditions examined. Analysis of the artificially intelligent nanoarray also showed that each disease has its own unique breathprint, and that the presence of one disease would not screen out others. Cluster analysis showed a reasonable classification power of diseases from the same categories. The effect of confounding clinical and environmental factors on the performance of the nanoarray did not significantly alter the obtained results. The diagnosis and classification power of the nanoarray was also validated by an independent analytical technique, i.e., gas chromatography linked with mass spectrometry. This analysis found that 13 exhaled chemical species, called volatile organic compounds, are associated with certain diseases, and the composition of this assembly of volatile organic compounds differs from one disease to another. Overall, these findings could contribute to one of the most important criteria for successful health intervention in the modern era, viz. easy-to-use, inexpensive (affordable), and miniaturized tools that could also be used for personalized screening, diagnosis, and follow-up of a number of diseases, which can clearly be extended by further development.

Intralesional cryosurgery for the treatment of basal cell carcinoma of the lower extremities in elderly subjects: a feasibility study

BACKGROUND

Incidences of basal cell carcinoma (BCC) on the lower extremities in elderly patients are rising. Surgical approaches to the treatment of BCC are subject to possible difficulties in healing, failure of skin grafts, and wound infection. This study assessed the efficacy of intralesional cryosurgery in the treatment of BCC of the lower limbs in elderly patients.

METHODS

This study included eight patients aged >60 years in whom a total of 10 nodular or superficial BCCs of the lower limbs were confirmed by biopsy. The patients' medical histories revealed comorbidities including hypertension, diabetes, hypercholesterolemia, venous insufficiency, and deep vein thrombosis of the legs, congestive heart failure, chronic renal failure, and ischemic heart disease. Using liquid nitrogen, an intralesional cryosurgery needle (CryoShape) was inserted into the tumor to facilitate its complete freezing. Treatment success was confirmed by biopsy taken approximately 3 months after complete healing of the cryo-wound.

RESULTS

The average size of the lesions treated was 2.49 cm(2) (16.4 × 15.2 mm). Mean recovery time was 79.9 days. Biopsies were obtained at a mean of 85.3 days after the wound had healed. All 10 biopsies verified the complete destruction of the tumor. There was no evidence of wound infection or tumor recurrence over a follow-up period of 28 months.

CONCLUSIONS

This study demonstrates that a single intralesional cryosurgery session can completely eradicate BCC on the lower extremities in elderly patients. This technique is associated with relatively minor complications, is well tolerated, and represents a safe and effective therapeutic modality for BCC of the lower limbs.