Does Lymphovenous Anastomosis Effect Mammalian Target of Rapamycin Inhibitor-associated Lymphedema Patients?

The mammalian target of rapamycin (mTOR) inhibitors are used to prevent organ transplant rejection and are preferred over other immunosuppressants due to its low nephrotoxicity. However, mTOR inhibitors have been associated with various adverse effects including lymphedema. Although rare in incidence, previously known treatments for mTOR inhibitor-induced lymphedema were limited to discontinuation of related drugs and complex disruptive therapy with variable results.

Analysis of flap thickness to breast projection ratio correlating to body mass index and age in east Asian women: Considerations in flap selection in breast reconstruction.

Background: Several alternative flaps have been introduced and used for autologous breast reconstruction. However, as body fat distribution is different among patients, the donor of choice for sufficient breast projection varies between patients.

Methods: Patients who underwent autologous breast reconstruction from Jan 2018 to Sep 2022 were included.

The Effect of 3-Dimensional-Printed Sequential Dual Drug-Releasing Patch on the Capsule Formation Around the Silicone Implant in a Rat Model.

Background: Implant-based breast reconstruction is associated with increased risk of early infection and late-stage capsular contracture.

Objectives: We evaluated the feasibility of a dual drug-releasing patch that enabled the controlled delivery of antibiotics and immunosuppressants in a temporally and spatially appropriate manner to the implant site.

Methods: The efficacy of a dual drug-releasing patch, which was 3-dimensional-printed (3D-printed) with tissue-derived biomaterial ink, was evaluated in rats with silicone implants.

Human-Mimic Submuscular and Premuscular Irradiated Rat Model: Histologic Characteristics of the Capsule Tissue in Contact with the Breast Implant.

Background: In this study, we established two rat models that mimic human submuscular and premuscular breast reconstruction. We analyzed the capsule formation according to surgical techniques and adjacent tissues, including the chest wall tissues, such as the ribs and acellular dermal matrices (ADMs) that come in contact with silicone implants.

Methods: This study consisted of experiments on 12 Sprague-Dawley rats that underwent implant reconstruction using ADM.

Conventional versus Robot-Assisted Immediate Breast Reconstruction: Reconstructive Outcome and Patient-Reported Outcome Measures.

Background: In this study, the authors compared conventional and robot-assisted mastectomy and breast reconstruction. To the authors' knowledge, this study is the first to report the results of robot-assisted mastectomy and breast reconstruction and provide a comparison of patient-reported outcomes.

Method: This retrospective study included 473 breasts of 423 patients who underwent conventional mastectomy and breast reconstruction and 164 breasts of 153 patients who underwent robot-assisted mastectomy and breast reconstruction from July of 2019 to October of 2021.

Comparative Study of Small Vessel (under 0.8 mm) Anastomosed Free Flap and Larger Vessel (over 0.8 mm) Anastomosed Free Flap: Does Supermicrosurgery Provide Sufficient Blood Flow to the Free Flap?

Background:  This study aimed to quantify the blood flow of free flaps and compare the blood flow of small vessel (<0.8 mm) and larger vessel (>0.8 mm) anastomosed free flaps.

Magnetic Resonance Imaging Surveillance Study of Silicone Implant-based Breast Reconstruction: A Retrospective Observational Study.

Unlabelled: This study aimed to evaluate the results of magnetic resonance imaging (MRI) surveillance of implant-based breast reconstruction in patients with breast cancer.

Methods: This retrospective observational study analyzed patients who underwent implant-based breast reconstruction and MRI surveillance by a single surgeon from March 2011 to December 2018, in a single center. All patients were informed about the recommendation of the Food and Drug Administration for MRI surveillance, and they choose to undergo MRI 3 years after surgery.

Cadaveric Study for Safe Elevation of a Profunda Artery Perforator Flap: Anatomy of the Perforators and Obturator Nerves.

Background:  This cadaveric study aimed to describe the anatomy of the profunda artery perforators (PAPs).

Methods:  In total, nine free cadavers with 18 upper thighs were dissected, 12 of which were from female cadavers, and 6 were from male cadavers. The average age of the cadavers was 84.

Difference in the Occurrence of Capsular Contracture According to Tissue Characteristics in an Irradiated Rat Model.

Background: This study was performed to evaluate the hypothesis that capsule formation varies according to the radiation dose in muscle tissues; chest wall tissues, including the ribs; and acellular dermal matrices (ADM) that are in contact with the silicone implant.

Methods: In this study, 20 Sprague-Dawley rats underwent submuscular plane implant reconstruction using ADM. They were divided into four groups: an unradiated control group ( n = 5), nonfractionated radiation at a dose of 10 Gy ( n = 5), nonfractionated radiation at a dose of 20 Gy ( n = 5), and fractionated radiation at a dose of 35 Gy ( n = 5).

Comparative Study of DIEP and PAP Flaps in Breast Reconstruction: Reconstructive Outcomes and Fat Necrosis.

Background:  This study compared the reconstructive outcomes and fat necrosis of the profunda artery perforator (PAP) flap with those of the deep inferior epigastric perforator (DIEP) flap.

Methods:  Data on all DIEP and PAP flap breast reconstructions performed between 2018 and 2021 at Asan Medical Center were compared. The overall reconstructive outcomes and presence of fat necrosis were analyzed through ultrasound evaluation performed by a board-certified radiologist.

The Fate of Sensation in Noninnervated Perforator Free Flaps in the Lower Extremity.

Background: The recovery of sensation for noninnervated perforator flaps is not well understood. This prospective study aims to evaluate the quality, tendency, and related factors for recovery of sensation.

Methods: A total of 187 patients over a 6-year period were evaluated at intervals of 3, 6, 12, and +24 months for demographic data and sensory tests [Semmes-Weinstein (SW) monofilament test, static two-point discrimination, temperature, and pain] on peripheral and central regions of the flap.

Maximizing the Versatility of Thin Flap from the Groin Area as a Workhorse Flap: The Selective Use of Superficial Circumflex Iliac Artery Perforator (SCIP) Free Flap and Superficial Inferior Epigastric Artery (SIEA) Free Flap with Precise Preoperative Planning.

Background:  This study aimed to evaluate the usefulness of the selective use of the superficial circumflex iliac artery perforator (SCIP) and the superficial inferior epigastric artery (SIEA) flap as a workhorse flap from the groin area with precise preoperative surgical planning.

Methods:  A total of 79 free flap reconstructions were performed in the study period; 35 SCIP free flaps and 19 SIEA free flaps were performed in the study period. Detailed preoperative surgical planning was performed using computed tomography (CT) angiography and color Doppler ultrasound.

Comparative Analysis of Preoperative High Frequency Color Doppler Ultrasound versus MR Lymphangiography versus ICG Lymphography of Lymphatic Vessels in Lymphovenous Anastomosis.

Background:  Despite the extensive use of various imaging modalities, there is limited literature on comparing the reliability between indocyanine green (ICG) lymphography, MR Lymphangiogram (MRL), and high frequency color Doppler ultrasound (HFCDU) to identify lymphatic vessels.

Method:  In this study of 124 patients, the correlation between preoperative image findings to the actual lymphatic vessel leading to lymphovenous anastomosis (LVA) was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and simple detection were calculated.

Using Duplex Ultrasound for Recipient Vessel Selection.

Background:  Among the many factors involved in reconstructive microsurgery, identifying a good recipient vessel is one of the key elements leading to a successful result.

Methods:  Multiple modalities have been used to identify recipient vessels from simple palpation of axial arteries to hand-held Doppler, duplex ultrasound, computed tomography angiograms, and other advanced techniques. Although these various modalities bring their own unique advantages, using the duplex ultrasound can provide far superior and real-time information based on the anatomy and physiology of the recipient vessel.

The Use of Color Duplex Ultrasound for Local Perforator Flaps in the Extremity.

Background:  The local flaps, especially perforator and keystone flaps, are used as first-line treatment option in reconstruction of small tomoderate-sized defect of the extremity. However, the high complication rate associated with these flaps may hinder this usage.

Methods:  This article reviews the technical and clinical aspect of using color duplex ultrasound )CDU) in the preoperative, intraoperative, and postoperative period for propeller and keystone flaps.

Maximizing the Flap Inflow in a Foot Reconstruction: Ultrasonographic Evaluation of Artery Flow in Accordance with the Angle of the Ankle.

Adequate arterial inflow is mandatory for a successful free tissue transfer. Maximizing this inflow appears to be especially important during distal lower extremity reconstruction, where perfusion pressures can be significantly lower than in the trunk or head and neck. In the current study, the authors used color and pulsed-wave Doppler ultrasonography to analyze blood flow volumes in the foot in accordance with the ankle position.

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis.

Background:  Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging.

Patients And Methods:  This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis.

Geometric Measurements of Nipple Position in Breasts Reconstructed with Transverse Rectus Abdominis Musculocutaneous Flap: A 5-Year Prospective Study.

Background: After breast reconstruction, nipple position and other long-term changes in the reconstructed breast relative to the contralateral breast remain poorly understood. In this prospective cohort study, the authors performed serial nipple position measurements over 5 years in patients who had undergone breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap. The effects of adjuvant radiotherapy on nipple position over time were also investigated.

Comparative Study of 2 Different Innervation Techniques in Facial Reanimation: Cross-face Nerve Graft-Innervated Versus Double-Innervated Free Gracilis Muscle Transfer.

Recently, 1-stage double innervation with the masseter nerve and the cross-face nerve graft (CFNG) has gained popularity owing to its outcomes of powerful and synchronous muscle contraction. In this study, we compared CFNG- and double-innervated free gracilis muscle transfer (FGMT) for facial palsy reconstruction.A total of 49 patients with facial palsy who underwent facial reanimation surgery from August 2013 to January 2017 were enrolled.

Changes in Blood Cell Morphology and Number of Red Spotted Grouper, in Response to Thermal Stress.

Rising of water temperature due to global warming is a great concern to aquaculturists and fishery biologists. Hence, the present study aimed to investigate the effects of high water temperature on juvenile red spotted grouper, based on the evaluation of stress responses in blood. juveniles were exposed to different thermal conditions (25℃, 28℃, 31℃, and 34℃) for 6 weeks following 2 weeks of acclimation at 25℃.

Impact of Venous Outflow Pattern on Flap Compromise in Head and Neck Reconstruction: Review of 309 Radial Forearm Free Flaps.

There is ongoing controversy regarding the most appropriate venous drainage pattern for anastomosing the radial forearm free flap in head and neck reconstruction. Although the various perforator flaps have been used in our practice, the authors evaluated the impact of venous outflow pattern on the incidence of only the radial forearm free flap compromise for minimizing the bias. The authors retrospectively reviewed 309 radial forearm free flaps used for head and neck reconstruction following cancer ablation (January 2005 to December 2015), and evaluated the association between the incidence of venous insufficiency and the choice of venous system in the flap and at the recipient site, the number of venous anastomoses, and the combination of flap and recipient venous systems.

Comparison Between Intermaxillary Fixation With Screws and an Arch Bar for Mandibular Fracture.

Purpose: Intermaxillary fixation (IMF) using the arch bar has been the standard technique for a long time in the management of mandibular fracture. But because of several complications, intermaxillary fixation with screws has been introduced and adopted to use. This investigation compared the outcomes and complications between the traditional IMF and modified intermaxillary fixation with screws techniques in terms of the malocclusion, surgical time, root injury, and screw or arch bar failure.

Facial reanimation with masseter nerve-innervated free gracilis muscle transfer in established facial palsy patients.

Background: The masseter nerve is a useful donor nerve for reconstruction in patients with established facial palsy, with numerous advantages including low morbidity, a strong motor impulse, high reliability, and fast reinnervation. In this study, we assessed the.

Results: of masseter nerve-innervated free gracilis muscle transfer in established facial palsy patients.

Direct-to-Implant as a Frontline Option for Immediate Breast Reconstruction: A Comparative Study With 2-Stage Reconstruction.

Background: Immediate single-stage direct-to-implant breast reconstruction requires caution owing to the possibility of skin necrosis and implant failure. Nevertheless, this method has been performed widely for breast reconstruction. This study aimed to analyze the safety of single-stage implant reconstruction by comparing it with 2-stage reconstruction (TSR).

Comparison of Facial Proportions Between Beauty Pageant Contestants and Ordinary Young Women of Korean Ethnicity: A Three-Dimensional Photogrammetric Analysis.

Background: Although the harmony of facial proportions is traditionally perceived as an important element of facial attractiveness, there have been few objective studies that have investigated this esthetic balance using three-dimensional photogrammetric analysis.

Objectives: To better understand why some women appear more beautiful, we investigated differences in facial proportions between beauty pageant contestants and ordinary young women of Korean ethnicity using three-dimensional (3D) photogrammetric analyses.

Methods: A total of 43 prize-winning beauty pageant contestants (group I) and 48 ordinary young women (group II) of Korean ethnicity were photographed using 3D photography.