Advances in surgical management of chronic lymphedema: current strategies and future directions.

Lymphedema is a chronic condition caused by the accumulation of protein-rich fluid in the interstitial tissue, resulting in edema and a diminished quality of life. When first-line treatments like complete decongestive therapy (CDT) fail, surgical options are considered. These include physiological procedures like lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), which aim to restore lymphatic function, as well as reductive procedures such as liposuction and excisional techniques, which reduce limb volume.

The Psychosocial Impact of Atopic Dermatitis.

Atopic dermatitis is a chronic skin condition that has significant psychosocial and quality-of-life impact. The condition causes physical discomfort, emotional distress, embarrassment, social stigma, and daily activity limitation. In an effort to assess these aspects of disease burden, quality-of-life measurement tools were developed.

Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease.

Perineal hernia is a rare complication of pelvic surgeries that can occur in patients with perianal Crohn's disease (pCD) as a long-term outcome of surgeries for complex fistula treatment. We present a case of a symptomatic pCD male patient with multiple perianal surgeries who presents with anal pain, diarrhea, and discharge. Magnetic resonance imaging showed a perineal hernia in the ischioanal fossa violating the convergence of the left external sphincter complex.

Rapid Implementation of a 3-Dimensional-Printed Patient-Specific Titanium Sacrum Implant for Severe Neuropathic Spinal Arthropathy and Guide to Compassionate US Regulatory Approval.

Background And Objective: Rapid design and production of patient-specific 3-dimensional-printed implants (3DPIs) present a novel opportunity to restore the biomechanically demanding integrity of the lumbopelvic junction. We present a unique case of a 61-year-old patient with severe neuropathic spinal arthropathy (Charcot spine) who initially underwent a T4-to-sacrum spinal fusion. Massive bone destruction led to dissociation of his upper body from his pelvis and legs.

Immediate Dental Implant Placement in the Oncologic Setting: A Conceptual Framework.

Historically, immediate dental implants have been reserved for patients with benign disease, with full dental rehabilitation rarely being accomplished in the oncologic setting due to concerns related to implant survival, flap compromise, and delay in initiation of adjuvant therapy. Recent developments in technology have made immediate dental implants using virtual surgical planning safe and reliable. At Memorial Sloan Kettering Cancer Center, we have implemented a workflow for immediate dental implant placement in the oncologic patient population that has become a routine part of maxillary and mandibular reconstruction.

State-of-the-Art Lymphedema Surgery Treatment Program.

The purpose of this article is to describe the multidisciplinary lymphedema surgery treatment program at Washington University in St. Louis. In this article, we discuss our collaboration with colleagues in medicine and therapy for conservative management and lymphedema staging.

Does Realism Matter? A Randomized Controlled Trial Comparing Models for Medical Student Suture Education.

Background: We hypothesized that medical students trained in suturing using high-fidelity models (cadaveric tissue) would demonstrate greater proficiency when compared with those trained using low-fidelity models (synthetic tissue).

Methods: Forty-three medical students were randomized into 2 groups. Group 1 consisted of students taught to perform simple interrupted sutures using synthetic tissue, and group 2 consisted of those taught using human cadaveric tissue.

Occurrence of Symptomatic Hypotension in Patients Undergoing Breast Free Flaps: Is Enhanced Recovery after Surgery to Blame?

Background: Enhanced recovery after surgery (ERAS) initiatives improve postoperative function and expedite recovery, leading to a decrease in length of stay. The authors noted a high rate of postoperative symptomatic hypotension in patients undergoing abdominal free flap breast reconstruction and wished to explore this observation.

Methods: Subjects undergoing abdominal free flap breast reconstruction at the authors' institution from 2013 to 2017 were identified.

The Effect of Enhanced Recovery after Surgery Pathway Implementation on Abdominal-Based Microvascular Breast Reconstruction.

Background: Although Enhanced Recovery after Surgery (ERAS) pathways are becoming the standard of care in microvascular breast reconstruction, evidence supporting their use is limited or based on small sample sizes. We hypothesized that improvements in postoperative outcomes would persist when examining the largest cohort of patients undergoing abdominal-based microvascular breast reconstruction, to date.

Materials And Methods: Data were retrospectively reviewed for 276 consecutive patients who underwent abdominal-based free flap breast reconstruction before and after ERAS implementation (pre-ERAS, n = 138 patients; post-ERAS, n = 138 patients).

Dermatitis artefacta.

Dermatitis artefacta, also known as factitial dermatitis, is a condition whereby self-induced skin damage is the means used to satisfy a conscious or unconscious desire to assume the sick role. It is particularly common in women and in those with an underlying psychiatric diagnosis or external stress. The diagnosis is one of exclusion, and it is often difficult to confirm, with patients rarely admitting their role in the creation of their lesions.

The Utility of Polyether-Ether-Ketone Implants Adjacent to Sinus Cavities After Craniofacial Trauma.

Purpose: Polyether-ether-ketone (PEEK) implants have become increasingly popular for use in reconstructive procedures. It is imperative to understand the consequences of using this biomaterial in anatomic sites that can pose a risk of infection. Specifically, the use of PEEK in paranasal sinus cavity reconstruction is not well documented.

The Psychosocial Impact of Atopic Dermatitis.

Atopic dermatitis is a chronic skin condition which has significant psychosocial and quality of life impact. The condition causes physical discomfort, emotional distress, embarrassment, social stigma and daily activity limitation. In an effort to assess these aspects of disease burden, quality of life measurement tools were developed.

Objective Assessment of the Interfrontal Angle for Severity Grading and Operative Decision-Making in Metopic Synostosis.

Background: The purpose of this study was to evaluate the utility of a previously validated interfrontal angle for classification of severity of metopic synostosis and as an aid to operative decision-making.

Methods: An expert panel was asked to study 30 cases ranging from minor to severe metopic synostosis. Based on computed tomographic images of the skull and clinical photographs, they classified the severity of trigonocephaly (1 = normal, 2 = mild, 3 = moderate, and 4 = severe) and management (0 = nonoperative and 1 = operative).

Delayed implant augmentation of breast free flaps.

Background: Two commonly used breast reconstruction techniques are (1) implant-based and (2) abdominal tissue-based procedures. When the two modalities are combined, the result is a unique construct that shares advantages and disadvantages of both approaches. Combining breast flaps and implants has been reported, yet the specific techniques associated with a reliable outcome remain unclear.

P75 neurotrophin receptor expression in squamous cell carcinoma.

P75 neurotrophin receptor (p75) is a transmembrane protein in the tumor necrosis receptor superfamily useful for the diagnosis of desmoplastic melanomas, desmoplastic trichoepitheliomas, and more recently used for detecting perineural invasion in oral and esophageal squamous cell carcinomas (SCCs). P75 staining in cutaneous SCCs is more controversial with initial staining reported as negative but more recent reports indicating that it may be a useful immunohistochemical marker of perineural invasion. A poorly differentiated pleomorphic epithelioid cell proliferation, which had strong p75 staining in the periphery of epithelioid cell nests, is being reported.

Targeting placental growth factor/neuropilin 1 pathway inhibits growth and spread of medulloblastoma.

Medulloblastoma is the most common pediatric malignant brain tumor. Although current therapies improve survival, these regimens are highly toxic and are associated with significant morbidity. Here, we report that placental growth factor (PlGF) is expressed in the majority of medulloblastomas, independent of their subtype.

Histologic features of nail cosmetics.

Nail cosmetics and adornments are widely used in today's society. However, their histologic features are not well characterized. Routine histologic examination and polarization of nail plate specimens in our academic dermatopathology practice at the Hospital of the University of Pennsylvania revealed 3 distinct histologic patterns of nail cosmetics: a hyperpigmented pattern with diffuse fine granular material, a layered pattern with a single linear band of polarizable material, and a hyperpigmented pattern with larger granules containing flecks of polarizable material.

Use of mobile learning by resident physicians in Botswana.

With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations.

Intramural esophageal dissection in a young man with eosinophilic esophagitis.

Intramural esophageal dissection is a rare disorder that should be considered in patients presenting with chest pain, dysphagia, and hematemesis. Although most commonly occurring in elderly women with impaired coagulation, esophageal dissection has also been observed in other demographics including in those with eosinophilic esophagitis. In our report, we present the case of a 19-year-old man who was found to have an intramural esophageal dissection in the setting of undiagnosed eosinophilic esophagitis.