Reconstructive techniques for chest and breast deformities in Poland syndrome: An up-to-date systematic review.

Background: Poland syndrome (PS) is a congenital abnormality defined as aplasia or hypoplasia of the unilateral pectoralis muscle and breast tissue that may be accompanied by limb or thoracic deformities. Reconstruction of deformities associated with PS is challenging owing to the spectrum of differences. We aimed to evaluate the trends in surgical management of chest and breast anatomical anomalies associated with PS.

Paradigm Shifts in Alloplastic Breast Reconstruction: A Nationwide Analysis of Direct-to-Implant Trends.

Background: Direct-to-implant breast reconstruction is an attractive choice for appropriately selected patients, as a single-stage procedure can enhance global metrics of care. In an era of high-value health care, therefore, it is important to investigate use of such procedures. This study investigated direct-to-implant trends over the past decade on a nationwide basis.

The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction.

Background: Reinforcement of the abdominal wall with synthetic mesh in autologous breast reconstruction using abdominal free tissue transfer decreases the risk of bulging and herniation. However, the impact of the plane of mesh placement on donor site complications has not yet been investigated.

Methods: We performed a retrospective analysis of 312 patients who had undergone autologous breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps or deep inferior epigastric perforator (DIEP) flaps as well as polypropylene mesh implantation at the donor site.

Examining the Effects of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Autologous Breast Reconstruction.

Background: Postmastectomy radiation therapy (PMRT) is known to increase the risk of multiple adverse outcomes after breast reconstruction. In the context of delayed-immediate autologous breast reconstruction, PMRT is typically conducted after placement of subpectoral (SP) tissue expanders. With the re-emergence of prepectoral (PP) reconstruction, there are little data assessing the outcomes of PP reconstruction in breasts receiving PMRT.

Revision Rates in Prepectoral Versus Subpectoral Delayed-Immediate Autologous Breast Reconstruction.

Introduction: Breast reconstruction in the prepectoral plane has recently fallen into favor. Minimizing the number of revisionary procedures after reconstruction is an important factor in improving patient care, but long-term studies on the effects of prepectoral reconstruction are limited. In this study, we compare the revision rates after delayed-immediate, autologous reconstruction between prepectoral and subpectoral reconstructions.

The safety and efficacy of autologous fat grafting during second stage breast reconstruction.

Background: Patients often pursue revisions following implant-based breast reconstruction (IBR) to achieve their desired result. Fat grafting is a popular choice for patients and can be performed at second stage reconstruction or at a future date as a revisionary surgery. We investigate the best time to fat graft in IBR by comparing the outcomes of patients who received fat grafting during implant placement with those who pursued fat grafting during a tertiary procedure.

Tendon Turndown to Bridge a Tibialis Anterior Gap and Restore Active Dorsiflexion After Degloving Foot Injury in a Child: A Case Report.

Case: A child with a severe degloving injury to the dorsum of the foot and ankle had segmental loss of the tibialis anterior tendon and toe extensors. A tendon turndown procedure was used, and the repaired tendon was covered with a latissimus muscle free flap to restore active ankle dorsiflexion. Details of the procedure are described, and active dorsiflexion and functional ambulation were restored.

Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial.

Objective: To compare targeted muscle reinnervation (TMR) to "standard treatment" of neuroma excision and burying into muscle for postamputation pain.

Summary Background Data: To date, no intervention is consistently effective for neuroma-related residual limb or phantom limb pain (PLP). TMR is a nerve transfer procedure developed for prosthesis control, incidentally found to improve postamputation pain.

Evaluation of high-density, multi-contact nerve cuffs for activation of grasp muscles in monkeys.

Objective: The objective of this work was to evaluate whether nerve cuffs can selectively activate hand muscles for functional electrical stimulation (FES). FES typically involves identifying and implanting electrodes in many individual muscles, but nerve cuffs only require implantation at a single site around the nerve. This method is surgically more attractive.

Striking a Better Integration of Work and Life: Challenges and Solutions.

Plastic surgeons are a diverse group but share a drive for excellence and dedication to their patients and the advancement of the specialty. Long hours at work and the need to be on call have limited the time that many have to spend on activities outside of the workplace. Reconciliation of the demands of surgery and private life can at times seem impossible.

Resolution of Cosmetic Buttock Injection-induced Inflammatory Reaction and Heart Failure after Excision of Filler Material.

We present a case of a 66-year-old woman who developed heart failure and severe inflammatory reaction after the illicit cosmetic injections of polymethyl-methacrylate or polyacrylamide hydrogel from a primary care provider. After medical optimization, an en bloc excision of all injectable materials and gluteus muscle was performed, which resulted in exposure of bilateral sciatic nerves. Within 10 days, the patient's heart failure resolved and inflammatory state improved.

Open repair of incisional ventral abdominal hernias with mesh leads to long-term improvement in pain interference as measured by patient-reported outcomes.

Background: The Patient-Reported Outcomes Measurement Information System was used to evaluate the effects of open incisional ventral hernia repair on hernia-related pain.

Methods: All patients who underwent elective repair of a primary or recurrent midline incisional hernia over a 3-year period completed Patient-Reported Outcomes Measurement Information System pain surveys and rated their pain intensity on a visual analogue scale. A retrospective review of these patients was performed.

Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts.

Background: Localized nerve pain in the foot and ankle can be a chronic source of disability after trauma and has been identified as the most common complication following operative interventions in the foot and ankle. The superficial location of the injured nerves and lack of suitable tissue for nerve implantation make this pain refractory to conventional methods of neuroma management. We describe a novel strategy for management using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity.

Prospective repair of Ventral Hernia Working Group type 3 and 4 abdominal wall defects with condensed polytetrafluoroethylene (MotifMESH) mesh.

Background: Treatment of clean-contaminated and contaminated ventral hernia defects remains controversial. Newer prosthetic materials may play an important role in these patients.

Methods: Ten patients with Ventral Hernia Working Group types 3 and 4 were prospectively enrolled and subsequently treated with direct supported repairs with condensed fenestrated polytetrafluoroethylene mesh.

Targeted muscle reinnervation and advanced prosthetic arms.

Targeted muscle reinnervation (TMR) is a surgical procedure used to improve the control of upper limb prostheses. Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their function. These reinnervated muscles then serve as biological amplifiers of the amputated nerve motor signals, allowing for more intuitive control of advanced prosthetic arms.

Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs.

Background: Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors' experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias.

Methods: A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.

Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury.

Targeted muscle reinnervation (TMR) was initially designed to provide cortical control of upper limb prostheses through a series of novel nerve transfers. Early experience has suggested that TMR may also inhibit symptomatic neuroma formation. We present the first report of TMR performed at the time of a traumatic shoulder disarticulation.

Targeted muscle reinnervation: a novel approach to postamputation neuroma pain.

Background: Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied.

Staged management of the open abdomen and enteroatmospheric fistulae using split-thickness skin grafts.

Background: Management of the open abdomen with polyglactin 910 mesh followed by split-thickness skin grafts allows safe, early closure of abdominal wounds. This technique can be modified to manage enteroatmospheric fistulae. Staged ventral hernia is performed in a less inflamed surgical field.

Can balloon aortic valvuloplasty help determine appropriate transcatheter aortic valve size?

Objectives: We sought to study the potential role of balloon aortic valvuloplasty (BAV) in sizing the aortic annulus in patients before transcatheter heart valve (THV) implantation.

Background: Despite clinicians' growing experience with THV procedures, the best method of annulus sizing remains unclear.

Methods: Twenty-three patients with aortic stenosis (<1.

Rapid identification of uropathogenic Escherichia coli of the O25:H4-ST131 clonal lineage using the DiversiLab repetitive sequence-based PCR system.

Several recent studies have highlighted the emergence of a globally disseminated clone of uropathogenic and invasive Escherichia coli isolates of serotype O25:H4 and sequence type 131. The ability to characterize rapidly E. coli isolates of this lineage would facilitate enhanced surveillance for this pathogen.