Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case.

Background: Intrathecal baclofen pump (ITBP) therapy has been successfully used to treat hypertonia in children with cerebral palsy (CP) since its Food and Drug Administration approval in 1984. CP affects multiple organ systems, leading to the accumulation of medical access and implantable devices, increasing the medical complexity of these children. The authors present the case of a patient with extreme surgical complexity and review the medical decision-making and surgical details.

Impact of Pre-pectoral Implant Placement and Radiation Modalities (Protons/Photons) in Mastectomy Patients undergoing Immediate Direct-to-Implant Breast Reconstruction.

Background: For breast cancer patients receiving mastectomy with direct-to-implant (DTI) immediate breast reconstruction, placing the implant in the pre-pectoral or subpectoral plane remains debatable; especially in settings of postmastectomy radiotherapy (PMRT).

Materials/methods: We reviewed 3,039 patients who underwent mastectomy and reconstruction at our institution between 2005 and 2020. Patients receiving DTI with and without PMRT were included.

Pre-Pectoral Tissue Expander and Acellular Dermal Matrix for a Two-Stage Muscle Sparing Breast Reconstruction: Indications, Surgical Technique and Clinical Outcomes with Histological and Ultrasound Follow-Up-A Population-Based Cohort Study.

Background: The aim of the paper is to present a single-center experience with two-stage pre-pectoral breast reconstruction using tissue expander entirely covered by acellular dermal matrix (ADM), reporting surgical indications, technique, clinical and histological outcomes.

Materials And Methods: A prospectively maintained database of consecutive patients who had undergone immediate pre-pectoral expander-based breast reconstruction with ADM over a two years period (2019-2021) was analyzed. The primary clinical outcome measures included patients' subjective assessment of satisfaction and pain.

Surgical Algorithm of Poland Syndrome Based on Thorax, Breast, and Nipple-areola Complex Classification.

Background: Poland syndrome (PS) is a rare congenital syndrome characterized by unilateral pectoralis major muscle defect. In 2016, we proposed the thorax, breast, and nipple-areola complex (TBN) classification and a subsequent treatment algorithm, which included conservative and surgical procedures. Our aim is to report the results we obtained treating all thoracic anomalies according to the proposed algorithm in a cohort of adolescents affected by PS.

Postoperative Complications of Direct-to-Implant and Two-Staged Breast Reconstruction: A Stratified Analysis.

Post-mastectomy implant-based reconstruction can be performed as direct-to-implant (DTI) or two-staged reconstruction (TSR). Rigorous studies have explored postoperative complications between TSR or DTI, yet few have stratified outcomes by relevant populations, pre-operative findings, mastectomy characteristics, or plane of implant placement. We sought to compare the outcomes between these cohorts at our institution.

Single stage direct -to- implant breast reconstruction following mastectomy (The use of Ultrapro® Mesh).

Background: Immediate breast reconstruction (IBR) with direct to implant (DTI) is the preferred method of reconstruction by many surgeons and patients, however, acellular dermal matrix (ADM) and other synthetic meshes are expensive especially in low- and middle-income countries. AIM OF THE WORK: To evaluate the technique, indications, aesthetic outcomes, and short and long-term complications of DTI breast reconstruction performed with Ultrapro®, a low-cost alternative mesh to ADM and other synthetic meshes.

Methods: Our study is a prospective cohort study that was conducted on 133 patients who experienced IBR following nipple-sparing mastectomy (NSM) or skin sparing mastectomy (SSM) using silicone implants and Ultrapro® mesh between December 2020 and December 2023.

Revision Surgeries After Proton vs Photon Postmastectomy Radiation Therapy in Prepectoral Implant-Based Breast Reconstruction.

Background: Postmastectomy radiation therapy (PMRT) improves disease-free survival in breast cancer but reduces aesthetic satisfaction. Proton PMRT has gained popularity due to fewer systemic complications. There is a lack of data regarding revision surgeries for pre-pectoral implant-based breast reconstruction (PP-IBBR) following radiation.

Abdominal Etching-A Novel Classification Method for Surgical Approach.

Background: The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe.

Does the use of Acellular Dermal Matrices (ADM) in women undergoing pre-pectoral implant-based breast reconstruction increase operative success versus non-use of ADM in the same setting? A systematic review.

Background: Breast cancer is the most common malignancy among women in the UK. Reconstruction - of which implant-based breast reconstruction (IBBR) is the most common - forms a core part of surgical management of breast cancer. More recently, pre-pectoral IBBR has become common as technology and operative techniques have evolved.

Microstructural architecture of the bony scutes, spine, and rays of the bony fins in the common pleco .

Studying scute and fin morphology are advantageous approaches for phylogenetic identification and provide information on biological linkages and evolutionary history that are essential for deciphering the fossil record. Despite this, no prior research has precisely characterized the histological structures of scutes in the common pleco. Therefore, this research investigated the microstructure and organization of bone tissue within the dermal skeleton, including the scutes and fins, in the common pleco, using light microscopy, stereomicroscopy, and scanning electron microscopy.

Early post-operative outcome of pre-pectoral implant-based immediate total breast reconstruction with Polyglactin 910 (Vicryl™) mesh - low cost solution for a low-middle income country.

Background: The incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan.

Intraoperative pectoral nerve blocks during cardiac implantable electronic device procedures.

Background: Cardiac implantable electronic device (CIED) procedures can cause significant postoperative pain. Opioid use for postoperative pain is associated with risk of persistent use. The benefits of pectoral nerve (PECs) blocks have been established for other chest wall surgeries, but adoption in electrophysiology has been limited.

Pectoral Nerve Block II for Cardiac Implantable Electronic Devices.

Aim: This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia.

Methods: PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic.

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique.

Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch.

To acellular dermal matrix or not to acellular dermal matrix?-outcomes of pre-pectoral prosthetic reconstruction after nipple-sparing mastectomy with and without acellular dermal matrix.

Background: Acellular dermal matrix (ADM) has been the go-to biomaterial in post-mastectomy breast reconstruction, particularly in pre-pectoral reconstruction. ADM is thought to decrease capsular contracture, control the pocket, and increase soft tissue, but may yield more complications. This study evaluated whether ADM is even needed.

[Post-mastectomy necrotizing fasciitis and immediate prosthetic breast reconstruction: First case report].

Necrotizing fasciitis is a rapidly progressive soft tissue infection extending from the skin to the fascia, resulting in extensive necrosis. It is a very rare but serious complication, with mortality ranging from 10 to 15%. Optimal management involves early diagnosis followed by treatment combining antibiotic therapy and wide surgical removal as soon as possible.

Three and twelve-month analysis of the PROM-Q study: comparison of patient-reported outcome measures using the BREAST-Q questionnaire in pre- vs. sub-pectoral implant-based immediate breast reconstruction.

Purpose: Implant-based breast reconstruction (IBR) is being increasingly performed with implant placed above the pectoral muscle (pre-pectoral), instead of below the pectoral muscle (sub-pectoral). Currently, there is a lack of comparative data on clinical and patient-perceived outcomes between pre- vs. sub-pectoral IBR.

Handling and Tagging Techniques for Implanting Juvenile American Shad with a New Acoustic Microtransmitter.

The use of telemetry techniques to better understand the behavior and survival of juvenile American shad (Alosa sapidissima), as they migrate through hydropower systems, has been challenging because shad are widely known to be particularly sensitive to handling. The goal of this study was to develop a tagging protocol using a new, acoustic micro transmitter that minimizes the detrimental effects of the tagging process and maximizes post-tagging survival of juvenile American shad. Limiting out-of-water handling and the use of brackish saltwater (7.