Sensate immediate breast reconstruction.

As breast cancer therapies and associated oncologic outcomes continue to improve, greater attention has been placed on quality-of-life issues after breast cancer and breast cancer risk-reducing treatments. The loss of sensation that typically occurs after mastectomy can have significant negative psychological, sexual, and functional impact on patients after surgery. Further, injury of nerves not only leads to numbness, but can also cause chronic neuropathic pain, which can be very debilitating to affected patients.

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery.

Background: Modern surgical therapy of chronic headaches/migraines is essentially based on the release/neurolysis of extracranial nerves, which, when compressed or inflamed, act as trigger points and, as such, trigger headache attacks. The aim of this article was to describe a novel maneuver we use as an aid in the preoperative planning of occipital trigger sites.

Methods: In the period of January 2021-September 2023, we operated on 32 patients (11 men, 21 women, age range: 26-68 years), who underwent migraine surgery for occipital trigger point release.

Pearls for Starting a Headache Surgery Practice in Academic and Private Practice.

There has been a growing body of evidence indicative of the effectiveness of headache surgery in treating patients with refractory headache disorders. The American Society of Plastic Surgeons issued a Policy Statement in 2018 stating that peripheral nerve decompression surgery for the treatment of refractory chronic headache disorders in select patients is considered a standard of care treatment. This endorsement sparked the interest of numerous plastic surgeons into initiating their own headache surgery practices.

Sensory Outcomes after Neurotization in Nipple-sparing Mastectomy and Implant-based Breast Reconstruction.

Background: Mastectomy and breast reconstruction techniques continue to evolve to optimize aesthetic and reconstructive outcomes. However, the loss of sensation after mastectomy remains a major limitation. This article describes our evolution of a novel approach that we first described in 2019, combining recent advances in breast oncologic, reconstructive, and peripheral nerve surgery to optimize sensory outcomes.

Anatomic Anomalies of the Nerves Treated during Headache Surgery.

Background: Headache surgery is a well-established, viable option for patients with chronic head pain/migraines refractory to conventional treatment modalities. These operations involve any number of seven primary nerves. In the occipital region, the surgical targets are the greater, lesser, and third occipital nerves.

Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes.

Introduction: Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs.

In-Depth Look at the Anatomical Relationship of the Lesser Occipital Nerve, Great Auricular Nerve, and Spinal Accessory Nerve and Their Implication in Safety of Operations in the Posterior Triangle of the Neck.

Background: Migraine surgery is an increasingly popular treatment option for migraine patients. The lesser occipital nerve is a common trigger point for headache abnormalities, but there is a paucity of research regarding the lesser occipital nerve and its intimate association with the spinal accessory nerve.

Methods: Six cadaver necks were dissected.

Nerve Preservation and Allografting for Sensory Innervation Following Immediate Implant Breast Reconstruction.

While newer breast reconstruction approaches utilizing nipple-sparing mastectomy (NSM) techniques and immediate reconstruction can provide excellent aesthetic outcomes, absent postoperative sensation remains a major limitation. Here, we present a novel technique for implant reconstruction combining the latest advances in breast oncologic, reconstructive, and peripheral nerve surgery to improve sensory outcomes. Sixteen women (31 breasts) underwent NSM and prepectoral, direct-to-implant reconstruction.

Automated 4-dimensional regional myocardial strain evaluation using cardiac computed tomography.

Evaluation of myocardial regional function is generally performed by visual "eyeballing" which is highly subjective. A robust quantifiable parameter of regional function is required to provide an objective, repeatable and comparable measure of myocardial performance. We aimed to evaluate the clinical utility of novel regional myocardial strain software from cardiac computed tomography (CT) datasets.

The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes.

Background: The compression/injury of the greater occipital nerve has been identified as a trigger of occipital headaches. Several compression points have been described, but the morphology of the myofascial unit between the greater occipital nerve and the obliquus capitis inferior muscle has not been studied yet.

Methods: Twenty fresh cadaveric heads were dissected, and the greater occipital nerve was tracked from its emergence to its passage around the obliquus capitis inferior.

Anatomic and Compression Topography of the Lesser Occipital Nerve.

Background: The surgical treatment of occipital headaches focuses on the greater, lesser, and third occipital nerves. The lesser occipital nerve (LON) is usually transected with relatively limited available information regarding the compression topography thereof and how such knowledge may impact surgical treatment.

Methods: Eight fresh frozen cadavers were dissected focusing on the LON in relation to 3 clinically relevant compression zones.

A Novel Surgical Approach to Chronic Temporal Headaches.

The targets for the surgical treatment of temporal headaches are the zygomaticotemporal branch of the trigeminal nerve and the auriculotemporal nerve. The former is often accessed by means of an endoscopic brow approach or potentially by laterally extending a transpalpebral incision. An established surgical approach, the Gillies incision, was modified to access the zygomaticotemporal nerve, as it was felt to combine the advantages of the traditional techniques.

Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma.

Introduction: In pediatric care, the role of focused abdominal sonography in trauma (FAST) remains ill defined. The objective of this study was to assess the sensitivity and specificity of FAST for detecting free peritoneal fluid in children.

Methods: The trauma registry of a single level I pediatric trauma center was queried for the results of FAST examination of consecutive pediatric (<18 years) blunt trauma patients over a period of 36 months, from January 2010 to December 2012.

Diagnosis of colon cancer differs in younger versus older patients despite similar complaints.

Background: Colon cancer is common, affecting mostly older people. Since age is a risk factor, young patients might not be given the same attention as older ones regarding symptoms that could imply the presence of colon cancer.

Objectives: To investigate whether young patients, i.

Treatment of a patient with small fiber pathology using nerve biopsy and grafting: a case report.

Small fiber pathology is a common clinical entity with a variable clinical presentation and etiology. Unfortunately, little has been described regarding its treatment because a majority of cases are idiopathic. Hence, treatment often consists of symptomatic management of pain and autonomic dysfunction.

Clinical presentation predicts the outcome of patients with colon cancer.

Aim: To elucidate the relationship between clinical presentation and outcome.

Methods: A single institution retrospective chart review of patients admitted with the diagnosis of colon cancer. We used univariate and a multivariate analysis to identify symptoms association with mortality.

Ganglioneuroma of the adrenal gland: a rare tumor in a rare location.

A 62-year-old man presented to his general practitioner complaining of non-specific back pain. He underwent a computerized tomography scan and magnetic resonance imaging that revealed a large left adrenal mass. A thorough investigation of this mass revealed it to be a non-secreting tumor.

Cecal fibromatosis (desmoid tumor) mimicking periappendicular abscess: a case report.

A 32-year-old man presented to our department with abdominal pain and fever. In an earlier hospitalization he was diagnosed with periappendicular abscess and treated with antibiotics. Due to fever and 'non-resolution' of the abscess and due to its deep location in the lower abdomen, which excluded percutaneous drainage, we elected to operate the patient.

Denervation of the periosteal origin of the adductor muscles in conjunction with adductor fasciotomy in the surgical treatment of refractory groin pull.

Background: The purpose of this study was to determine whether resection of the nerve that innervates the origin of the adductor muscle group in addition to an adductor fasciotomy will decrease pain and improve function in patients with a chronic "groin pull."

Methods: The authors conducted a retrospective multicenter chart review of 12 patients presenting with refractory groin pull. In two patients, the problem was bilateral.

The use of alloplastic materials in rhinoplasty surgery: a meta-analysis.

Background: Conventional wisdom regarding the use of alloplastic materials in rhinoplastic surgery would advise against their use because of safety and aesthetic concerns. However, autogenous tissue harvest is not without associated morbidity and may be inadequate or insufficient in some clinical situations. Prior studies examining this issue have not provided definitive recommendations regarding implant selection, ideal locations in which to use specific implants, and necessary follow-up.