Search

Background: The nipple-sparing mastectomy (NSM) offers a reconstruction option to patients who wish for a more subtle scar pattern and to retain their native nipple-areolar complex. Traditionally used acellular dermal matrix (ADM) has been linked to potential complications including seroma, hematoma, and infection, as well as increased operative costs. Our study examines whether using partial ADM to cover the lower pole of the breast implant during NSM prepectoral reconstruction offers comparable, or even better, rates of postoperative complications while minimizing operative costs. Methods: A retrospective chart review of patients who underwent prepectoral nipple-sparing implant-based reconstruction (IBR) using partial ADM (June 2019 – October 2020) was performed. Demographic, perioperative, and post-operative complication information was collected and described using means, standard deviations, and frequencies. Results: Ninety-eight patients (183 breasts) met inclusion criteria, with smoking history (36.73%), prior breast surgery (18.58%), and obesity (18.37%) cited as the most common comorbidities. 12.57% of patients experienced a complication following stage one of reconstruction, with infection as the most common complication (5.46%). Complication rate following stage two was 7.10%, with dehiscence cited as the most common complication (4.92%). Conclusions: The average cost of ADM for breast reconstruction is upwards of $5,000. While our institution does not utilize full ADM coverage in NSMs, historical trends in the literature demonstrate overall complication rates of 5.9% to as high as 35%. Our study demonstrates that utilizing partial ADM coverage in the setting of NSM offers comparable, if not lower, complication rates at a fraction of the cost. Level of Evidence: Level III, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Background/Objectives: To evaluate how the surgical technique and type of implanted intraocular lens influence the postoperative visual acuity and complications in ectopia lentis associated to Marfan syndrome patients. Materials and Methods: The medical records and videos of ectopia lentis surgeries in patients (children and adults) with Marfan syndrome, were retrospectively reviewed and compared. The study included 33 eyes that underwent four different intraocular lens implantation (IOL) techniques: IOL in conjunction with a simple capsular tension ring, IOL in conjunction with a Cionni modified capsular tension ring (m-CTR), two-point scleral IOL fixation and IOL with one haptic in the bag and one haptic sutured to the sclera. Results: Vision significantly improved from a mean preoperative visual acuity of 0.1122 to a mean postoperative visual acuity of 0.4539 in both age groups (p < 0.0001), with no difference in the primary outcome between children and adults. The most common surgical technique used in both age groups was IOL in conjunction with an m-CTR. There was only one major postoperative complication requiring additional surgery. Conclusions: Zonular weakness mainly influenced by age was the most important selection criterion for the surgical approach. Regardless of the technique employed, the postoperative visual acuity was improved in both adults and children. [ABSTRACT FROM AUTHOR]

Purpose: The epitendinous suture is a critical part of flexor tendon repair. In addition to smoothing the repair site, it augments repair strength and increases gap resistance. This study aimed to determine whether increasing the number of passes or increasing suture caliber would improve the strength (primary outcome), 2 mm gap resistance, or stiffness of a simple running epitendinous suture., Methods: A total of 30 flexor pollicis longus (FPL), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) tendons were harvested from three cadavers, and transverse tendon lacerations were produced. Tendons were repaired with only an epitendinous suture (no core suture) in three groups: 6-0 Prolene with six passes, 5-0 Prolene with six passes, or 5-0 Prolene with six passes. Epitendinous repair strength was tested using a materials testing machine., Results: The use of eight passes had significantly greater ultimate tensile strength than six passes (21 +/- 7 N vs 14 +/- 5 N). Although 5-0 suture had a higher average ultimate tensile strength than 6-0 suture, this difference was not statistically significant (14 N +/- 5 vs 10 N +/- 3). Failure mode for all groups was most often suture tear-through., Conclusions: A simple epitendinous suture using eight passes provides almost 50% more epitendinous repair strength and greater 2 mm gap resistance than six passes when using 5-0 Prolene., Clinical Relevance: When performing a simple running epitendinous repair to augment a core flexor tendon repair, the surgeon should consider the additional strength and gap resistance provided by eight passes compared to six., Competing Interests: Conflicts of Interest This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Acetylsalicylic acid (ASA) has been used in reconstructive microsurgery since the inception of the field. However, when compared to placebo groups, its efficacy is not confirmed. In our study, we hypothesize that the utility of ASA postoperatively in microvascular surgery is not associated with improved outcomes., Methods: A systematic review of the literature was conducted using PubMed, Google Scholar, and SCOPUS according to PRISMA guidelines. Documentation of antiplatelet regimens and postoperative complications were the primary endpoints., Results: Four articles met inclusion criteria including a total of 1196 patients. There were 637 patients who received aspirin and 559 patients who did not. The average age was not found to be significantly different between the two groups (p > 0.05). In terms of flap type, patients undergoing DIEP had a significantly higher likelihood of receiving aspirin, whereas patients undergoing fibula flaps had a lower rate of aspirin usage (p < 0.05). TRAM, anterolateral thigh flaps, SIEA, and radial forearm flaps were equally distributed between the two groups (p > 0.05). A total of 317 complications were noted across both groups. Total complication rate, complete flap loss, and venous/arterial thrombosis rate were not found to be significantly different between the two groups (p > 0.05). Hematoma rate was found to be significantly higher in the group receiving aspirin when compared to the control (RR = 1.70, 95% CI 1.19-2.44)., Conclusion: Aspirin usage did not confer significant advantage in preventing postoperative complication rates and increased rates of hematoma formation., (© 2025 The Author(s). Microsurgery published by Wiley Periodicals LLC.)

Patients suffering from keloid scarring often face debilitating functional and psychosocial symptoms. The complex pathophysiology of keloids necessitates a patient-centered therapeutic regimen to optimize patient satisfaction and disease resolution. This is especially challenging for patients with major keloid scars that once surgically resected, leave a defect that cannot be closed primarily. The authors intended to identify existing therapeutic regimens reported for the treatment of major keloids and detail the clinical and patient-satisfaction outcomes for those approaches. A systematic review and meta-analysis was designed in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines, querying 2 databases along with a manual search for relevant literature. This review identified 10 studies, totaling 244 patents. All patients underwent surgical resection of their keloid. Subsequent therapeutic regimens included a variety of coverage techniques, including skin grafts, perforator flaps, closure with secondary intention, and skin substitute placement. Additionally, there were multiple adjuvant therapies utilized such as radiotherapy and steroids. The overall keloid recurrence rate was 21%. Patients who received wound coverage had a lower rate of keloid recurrence compared with those treated by secondary intention. When available, patients receiving local flap coverage plus adjuvant radiotherapy were found to have significantly lower keloid recurrence rates and higher patient satisfaction. Although these findings support surgical excision and radiation therapy as the mainstay treatment for major keloids, the efficacy of various wound coverage options, especially when local perforator flaps are not available, requires continued investigation. A gap exists on guidelines for postoperative adjuvant therapies., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)