Use of high flow nasal cannula in critical burn patient during deep sedation in enzymatic bromelain debridement (nexobrid): a single center brief report.

The use of new oxygen supports associated to non-invasive respiratory strategies is well-established in clinical practice, especially after its extensive application in the management of Covid-19 respiratory failure. The use of high flow nasal cannula (HFNC) in patients undergoing procedural sedation and analgesia (PSA) is dramatically increasing. Enzymatic debridement in critical burn patients is a painful treatment that requires an optimal burn pain control protocol as well as a deep sedation for the entire duration of the procedure.

Reepithelialization of partial thickness porcine burns treated with silver sulfadiazine, triple antibiotic or petrolatum.

Topical antibiotic application and occlusive dressings stand as the current standard of care for partial thickness burn (PTB) treatment. Silver sulfadiazine (SSD) is the most widely used topical antimicrobial agent for acute burn management worldwide. Despite its antimicrobial benefits, there is emerging evidence that SSD might delay wound reepithelialization.

Role of Free Flaps in Facial Burn Reconstructions.

Traditionally, burn reconstructions have been performed by the use of skin grafting or local flaps. Recently free flaps are being used with increasing frequency. Although not very common in the head neck region, free flaps are mostly used for secondary reconstructions of cervicofacial contractures.

Multiple Free Flaps and Second Toe Transfer to Salvage Grasp Function in Bilateral Complete Degloved Hands.

A 21-year-old male laborer sustained bilateral degloving injury of the hands with multiple digital amputations and devascularized digits. After X-rays, preliminary debridement was done, when digital amputations were completed, including index ray amputation on both sides. The next day, two anterolateral thigh (ALT) flaps and one second toe transfer were done to restore coverage in the palm and the web and reconstruct the lost thumb.

Minimal Access Retromandibular Approach to Fractures of Vertical Segment of the Mandible: A Versatile Technique.

 Fractures of the condylar region of the mandible, although fairly common, also generate the most debate regarding management-both closed and open treatment options have been recommended and shown to yield good results. We present our experience with a minimal access retromandibular approach to fractures of the vertical mandible.  This is a retrospective study of all patients who underwent open reduction and internal fixation for fractures of the vertical mandible (condyle, subcondylar region, ramus) using a retromandibular approach at a tertiary care hospital in a metropolitan city in India between January 2022 and July 2023.

Pelvic Ring Reconstruction with an Osteocutaneous Fibula Flap for Abdominal Wall Repair in Adults with Bladder Exstrophy.

Abdominal wall repair in adults with bladder exstrophy is challenging. We present a case of a 46-year-old woman with bladder exstrophy presenting with a large midline incisional hernia associated with a 13-cm hypoplasia of both pubic rami that precluded fixation of any abdominal mesh. A two-stage approach was adopted.

The Keystone Design Perforator Flap: A Flap to Simplify Complex Reconstructive Issues.

 The keystone design perforator island flap (KDPIF) was first described by Behan in 2003 as a pliable flap, suitable for all body areas thanks to its curvilinear shape, which made it apt to fit mostly all cutaneous defects.  In this article, we aim to share our experience using KDPIF for the reconstruction of different defects. A retrospective analysis of patients who underwent cutaneous excision after trauma or tumor resection and reconstruction with a KDPIF at our department from 2020 to 2023 was performed.

A case of subcutaneous metastatic malignant melanoma of the left medial ankle: a case report and review of literature.

Background: Although rare, melanoma confined to the dermis or subcutaneous tissue without evidence of a primary cutaneous site should provoke consideration of melanoma of unknown primary. This diagnosis carries a favorable prognosis when compared with cutaneous metastatic melanoma. Several hypotheses have been proposed for how melanoma of unknown primary develops, two of which were considered in our patient case: (1) spontaneous regression of the primary tumor following metastasis or (2) the traumatic implantation of ectopic melanocytic cells in other tissues, such as the subcutaneous tissue.

Assessing the Causes of Acceptance or Refusal of Breast Cosmetic Procedures Among Saudi Women When They Get to Age of Menopause: A Cross Sectional Study-Saudi Arabia.

Introduction: Cosmetic breast surgery encompasses a variety of procedures aimed at enhancing breast appearance and is increasingly popular globally. Despite this trend, the acceptance of such surgeries among Saudi women approaching menopause remains understudied. This research aims to explore the attitudes and perceptions toward cosmetic breast surgery in this demographic, considering cultural and religious influences in Saudi Arabia.

True Grit: The Tale of American Integrated Plastic Surgery Residency Applicants.

Introduction: Selecting candidates for plastic and reconstructive surgery (PRS) residency is complex, involving academic metrics and intrinsic personal qualities. "Grit"-perseverance and passion for long-term goals may be one of these valued qualities. This study investigates how grit scores relate to securing a PRS residency, hypothesizing that higher grit correlates with greater matching success.

The pectoralis major myocutaneous pedicled flap-Its past and current practice in a dedicated microsurgery service. Review of the literature, and debunking controversies.

Background: The pectoralis major myocutaneous pedicled (PMMP) flap is still considered by many a workhorse flap in head and neck (H&N) reconstruction, despite free flap surgery advancing. The authors aimed to examine this claim and associated myths and controversies by analyzing literature trends and revealing the role of the PMMP flap in a well-established microsurgery center.

Methods: The senior author's reconstructive H&N practice between 1995 and 2022 was reviewed to describe and critically judge primary and secondary PMMP flap decisions to provide invaluable lessons learned and debunk common controversies related to complex H&N reconstruction.

True-bone-ceramics / type I collagen scaffolds for repairing osteochondral defect.

In recent years, the incidence of cartilage defects has increased dramatically, and its etiology is complex and varied. Osteochondritis dissecans (OCD), as one of the main etiologies, damages both cartilage and bone tissues and can progress to severe osteoarthritis, which has been one of the difficult problems for clinicians. The vigorous development of material science and tissue engineering provides new ideas for the treatment of OCD, in which the selection of scaffold materials is particularly important.

Impact of radiotherapy-related late toxicities of skin and soft tissue in the neck on quality of life in head and neck cancer patients: a multi-institutional observational study in Japan.

Purpose: This multi-institutional observational study aimed to assess the incidence, severity, and impact of radiotherapy-related late toxicities of the cervical skin and soft tissue in head and neck cancer patients. We also explored patient interest in fat grafting as a potential treatment for skin and soft tissue sequelae.

Methods: This study was conducted across 19 institutions in Japan.

Downregulation of semaphorin 4A in keratinocytes reflects the features of non-lesional psoriasis.

Psoriasis is a multifactorial disorder mediated by IL-17-producing T cells, involving immune cells and skin-constituting cells. Semaphorin 4A (Sema4A), an immune semaphorin, is known to take part in T helper type 1/17 differentiation and activation. However, Sema4A is also crucial for maintaining peripheral tissue homeostasis and its involvement in skin remains unknown.

Combined Autologous Breast Reconstruction and Gynecologic Procedures: Does Timing Affect Clinical and Patient-Reported Outcomes?

Background: Patients with or at risk for breast cancer may opt for risk-reducing gynecologic surgeries, including bilateral salpingo-oophorectomies and/or total abdominal hysterectomy. The timing and safety of combining these procedures with autologous breast reconstruction (ABR) are debated. This study assesses the impact of concurrent ABR and gynecologic surgeries on clinical and patient-reported outcomes.

Moving Towards the Outpatient DIEP Flap: Factors Influencing Early Discharge.

Background: Enhanced Recovery After Surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay due to difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and assess safety of earlier discharge.

Improving the Evaluation of Aesthetic Outcomes in DIEP Flap Breast Reconstruction: Validation of the Aesthetic Grading Tool.

Introduction: This study aimed to develop and validate an aesthetic grading tool (AGT) for bilateral DIEP flap breast reconstruction and investigate the correlation of BREAST-Q scores with perceived aesthetic outcomes.

Methods: The AGT utilized a Likert scale to rate aesthetic outcomes based on photographs of post-reconstruction breasts. The validation involved iterative testing with healthcare providers and patients.

Autologous Fascia Nerve Wrap in a Rodent Primary Epineurial Repair Model and Preliminary Case Series.

Background: Nerve wraps composed of various autologous and bioengineered materials have been used to bolster nerve repair sites. In this study, we describe the novel use of autologous fascia nerve wraps (AFNW) as an adjunct to epineurial repair and evaluate their effect on inflammatory cytokine expression, intraneural collagen deposition and end-organ reinnervation in rats and use of AFNW in a patient case series.

Methods: Lewis rats received sciatic transection with repair either with or without AFNW, sciatic-to-common peroneal nerve transfer with or without AFNW, or sham surgery (n=14/group).

The versatility of the Supinator to Posterior Interosseus Nerve (SPIN) transfer: Indications and outcomes, a Case Series.

Background: Transfer of the supinator motor branches to the posterior interosseous nerve (SPIN) was first described as a reliable method of restoration of digit extension in cases of paralysis when there is retained function in the 5th and 6th cervical nerve roots with loss of function in the 8th cervical nerve root.

Methods: We performed a retrospective review of all the SPIN transfers that were performed in our unit which included 16 limbs in 14 patients over a 6-year period. The median age was 49 years (range 22-74).

Risk and Mortality of Cardiovascular Diseases in Patients with Dupuytren's Disease: A Nationwide Population-Based Cohort Study.

Background: Dupuytren's disease (DD) is a type of fibroproliferative disease that involves the palmar aspect of the hand. Although many benign fibroproliferative diseases have been shown to increase the risk of cardiovascular disease, the relationship between DD and myocardial infarction (MI) or stroke has not been fully elucidated.

Methods: A total of 35,909 patients with DD and a control cohort with 1,077,270 age- and sex-matched participants from the Korean National Health Insurance database were included.