Operative Techniques in Otolaryngology
- Surgery for Vascular Laryngeal LesionsVascular lesions of the larynx are those created by phonotrauma resulting in subepithelial bleeding. These are typically divided into two categories, hemorrhagic polyps and fibrovascular lesions (vocal nodules). Both of these types of lesions can disrupt the natural vibration of the vocal folds and cause dysphonia. In those patients whose voices are their livelihood, complete removal with preservation of as much normal superficial lamina propria
- Lasers in laryngeal surgeryThe use of lasers in laryngology has evolved over the last several decades. With improving optics, instrumentation, and applications for treatment, lasers are now routinely used during laryngeal surgery performed in both the operating room and clinic settings. A variety of laser types, including carbon dioxide (CO2), potassium titanyl-phosphate (KTP), and pulsed-dye lasers, are used to treat an array of benign laryngeal lesions. Otolaryngologists
- Surgical Anatomy of the LarynxThis article provides a review of the surgical anatomy of the larynx. The external cartilaginous and bony framework of the larynx are described in relation to how these structures can be used as landmarks to identify internal features of the larynx. The overlying musculature of the larynx is also detailed. The spaces of the internal larynx are explained including the pre-epiglottic, para-glottic, and cricoid area by their borders and contents to
- Robotics in Laryngeal SurgeryWhile transoral laser microsurgery (TLM) has been the gold standard for laryngeal surgery for many years, recently transoral robotic surgery (TORS) has become a new treatment option not being restricted to a straight line of view which can be an obstacle during resection. In combination with specifically designed retractors TORS can provide a superior visualization and allows tissue manipulation especially in the narrow working space of the laryn
European Journal of Surgical Oncology (EJSO)
- Surgery in the context of kinase inhibitor therapy for locally invasive thyroid cancerPublication date: Available online 25 September 2019Source: European Journal of Surgical OncologyAuthor(s): Dana M. Hartl, Joanne Guerlain, Ingrid Bresuskin, Eric Baudin, Livia Lamartina, Julien Hadoux, Sophie Leboulleux, Martin SchlumbergerAbstractKinase inhibitors (KI) for advanced and aggressive forms of differentiated, medullary and anaplastic thyroid carcinoma have been shown to provide significant tumor response, locally and in distant meta
Plastic and Reconstructive Surgery - Current Issue
- A Matched-Pair Analysis of Prepectoral with Subpectoral Breast Reconstruction: Is There a Difference in Postoperative Complication Rate?Background: The development of acellular dermal matrices has revolutionized implant-based breast reconstruction. The most recent development has been the introduction of prepectoral breast reconstruction. However, concerns have been expressed related to the quality of soft-tissue coverage and infectious complications. Thus, the authors felt it prudent to perform a matched-pair analysis of clinical outcomes following prepectoral and subpectoral
- A Simplified Cost-Utility Analysis of Inpatient Flap Monitoring after Microsurgical Breast Reconstruction and Implications for Hospital Length of StayBackground: The number of free flap take-backs and successful salvages following microsurgical breast reconstruction decreases as time from surgery increases. As a result, the cost of extended inpatient monitoring to achieve a successful flap salvage rises rapidly with each postoperative day. This study introduces a simplified cost-utility model of inpatient flap monitoring and identifies when cost-utility exceeds the thresholds established fo
- Safety of Postoperative Opioid Alternatives in Plastic Surgery: A Systematic ReviewSummary: With the growing opioid epidemic, plastic surgeons are being encouraged to transition away from reliance on postoperative opioids. However, many plastic surgeons hesitate to use nonopioid analgesics such as nonsteroidal antiinflammatory drugs and local anesthetic blocks because of concerns about their safety, particularly bleeding. The goal of this systematic review is to assess the validity of risks associated with nonopioid analgesi
- Preoperative Perforator Mapping in SGAP Flap: Does Magnetic Resonance Imaging Make the Difference?Background: Preoperative vascular mapping has emerged as an excellent adjunct to perforator flap surgery, improving operative time while aiding the surgeon in the selection of the ideal perforator. This study evaluated the effect of preoperative vascular mapping by magnetic resonance imaging to identify tissue for a superior gluteal artery perforator (SGAP) flap on total operative time and compared radiologic mapping by magnetic resonance imag
- Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels: Technique, Safety, and Outcomes after 250 FlapsBackground: The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. In bilateral cases, both flaps are often anastomosed to the internal mammary vessels on either side of the sternum. The authors propose a method in which both flaps are anastomosed to only the right side internal mammary artery and vein. Methods: Between November of 2009 and March of 2018, 125 patient
- Immediate Breast Reconstruction in The Netherlands and the United States: A Proof-of-Concept to Internationally Compare Quality of Care Using Cancer Registry DataBackground: Studies based on large-volume databases have made significant contributions to research on breast cancer surgery. To date, no comparison between large-volume databases has been made internationally. This is the first proof-of-concept study exploring the feasibility of combining two existing operational databases of The Netherlands and the United States, focusing on breast cancer care and immediate breast reconstruction specifically
- Health Insurance Coverage of Gender-Affirming Top Surgery in the United StatesBackground: Despite the medical necessity, legislative mandates, and economic benefits of gender-affirming surgery, access to treatment remains limited. The World Professional Association for Transgender Health (WPATH) has proposed guidelines for transition-related surgery in conjunction with criteria to delineate medical necessity. The authors assessed insurance coverage of “top” gender-affirming surgery and evaluated the differences between
- Reconstruction of Gustilo Type IIIC Injuries of the Lower ExtremityBackground: Gustilo type IIIC open tibia fractures are characterized by an ischemic limb requiring immediate arterial repair. In this patient population, the decision between primary amputation and limb salvage can be challenging. This study aims to evaluate the reconstructive outcomes of patients with Gustilo type IIIC injuries. Methods: A single-center retrospective review of 806 lower extremity free flaps from 1976 to 2016 was performe
- Early Postoperative Application of Botulinum Toxin Type A Prevents Hypertrophic Scarring after Epicanthoplasty: A Split-Face, Double-Blind, Randomized TrialBackground: Postoperative hypertrophic scarring of the medial canthal area is a common phenomenon and deterrent for patients considering epicanthoplasty. Botulinum toxin type A has been reported for hypertrophic scar and keloid treatment. However, there is a lack of high-level evidence regarding the effects of botulinum toxin type A in the medial canthal area. Methods: In this split-face, double-blind, randomized trial, 43 consecutive con
- Change Is Happening: An Evaluation of Gender Disparities in Academic Plastic SurgeryBackground: Gender disparities in academic plastic surgery are known; however, recently, professional societies have endorsed a culture of gender diversification. This study aims to evaluate the effects of these changes at faculty and leadership positions. Methods: A cross-sectional study was conducted in June of 2018 to evaluate gender representation among U.S. academic plastic surgery faculty, and compare career qualifications, years of
- Removal of Nasal Silicone Implant and the Impact of Subsequent CapsulectomyBackground: Little is known about contributory factors of unremoved periimplant capsule causing nasal deformities after postrhinoplasty silicone implant extraction. This study investigated the impact of retained capsule causing contracture deformity and effect of subsequent capsulectomy in preventing and correcting the deformity. Methods: A total of 103 patients underwent secondary surgery for silicone implant removal and grafted cartilag
- A Prospective, Multicenter, Randomized, Evaluator-Blinded, Split-Hand Study to Evaluate the Effectiveness and Safety of Large-Gel-Particle Hyaluronic Acid with Lidocaine for the Correction of Volume Deficits in the Dorsal HandBackground: Hand rejuvenation has become increasingly popular, but there are few reports published on the use of hyaluronic acid gels for correction of volume deficits in the dorsal hand. Methods: This study evaluated the efficacy and safety of large-gel-particle hyaluronic acid with lidocaine, a 20-mg/ml hyaluronic acid gel with 0.3% lidocaine, compared to no treatment for the correction of volume deficits in the dorsal hand. This was a
- Abdominoplasty in the Overweight and Obese Population: Outcomes and Patient SatisfactionBackground: Abdominoplasty is a safe, efficacious body contouring procedure commonly performed on patients after massive weight loss or pregnancy, or because of general aging. However, complication rates and patient satisfaction levels remain largely unexplored for the overweight and obese patient population. The purpose of this study was twofold: to determine the complication rate and to gauge the psychological impact of abdominoplasty in the
- Recognizing Racial Heterogeneity in the Latino Nose: Aesthetic Concepts for an Individualized ApproachBackground: Latinos are one of the fastest growing ethnic groups in the United States, and there is a growing demand for aesthetic rhinoplasty in these patients. The authors provide an individualized, systematic approach for evaluation and improvement of surgical outcomes in Latino patients. Methods: A retrospective review of patients identified as Latino who underwent primary rhinoplasty and those who did not but had documented nasal pho
- Reevaluating the Current Model of Rhinoplasty Training and Future Directions: A Role for Focused, Maneuver-Specific SimulationBackground: Rhinoplasty is known for its complexity in planning and execution. For trainees, knowledge acquisition is often adequately attained. The mastery of skills, however, occurs by means of hands-on exposure, which continues to be a challenge. This article discusses the positive progress made in rhinoplasty training, and objectively demonstrates a need for more hands-on rhinoplasty exposure for residents. Methods: A systematic revie
- Extracellular Vesicles from Human Adipose-Derived Stem Cells for the Improvement of Angiogenesis and Fat-Grafting ApplicationBackground: The efficacy of autologous fat transplantation is reduced by fat absorption and fibrosis that are closely related to unsatisfactory vascularization. Extracellular vesicles are key components of the cell secretome, which can mirror the functional and molecular characteristics of their parental cells. Growing evidence has revealed that adipose-derived mesenchymal stem cells have the ability to enhance vascularization, which is partly
- A Systematic Review and Meta-Analysis of the Pressure-Induced Vasodilation Phenomenon and Its Role in the Pathophysiology of UlcersBackground: Physiologic studies show that tissue perfusion increases during moderate amounts of tissue compression. This is attributed to sensory nerves initiating a vasodilatory cascade referred to as pressure-induced vasodilation. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies investigating perfusion during pressure exposure longer than 10 minutes. Retrieved studies were assesse
- Twenty-Four–Hour Ex Vivo Perfusion with Acellular Solution Enables Successful Replantation of Porcine ForelimbsBackground: A critical barrier to successful limb replantation and allotransplantation is the maximum allowable limb ischemia time of 4 to 6 hours. The current gold standard is to preserve amputated limbs on an ice slurry. Experimental machine perfusion has yielded promising results as an alternative. In particular, hypothermic acellular perfusion has enabled preservation of amputated limbs for up to 12 hours thus far. Methods: Amputated
- Sequelae of Facial Palsy: A Comprehensive TreatmentLearning Objectives: After studying this article, the participant should be able to: 1. Identify the different types of facial paralysis sequelae and define the several medical and surgical techniques commonly available today. 2. Develop a surgical plan to restore symmetry of the face at rest and in dynamic expressions and manage the patient during smile rehabilitation after dynamic smile reanimation with regional or free muscle transfer. 3. U
- Tissue-Engineered Soft-Tissue Reconstruction Using Noninvasive Mechanical Preconditioning and a Shelf-Ready Allograft Adipose MatrixBackground: Adipose tissue defects leading to severe functional (disability) and morphologic (disfigurement) morbidity are often treated in plastic surgery with fat grafting, which can be limited by resorption, necrosis, and cyst formation. This study aimed to assess whether adipose scaffolds could provide an environment for in situ autologous fat grafting, and to study whether adipose cell migration and proliferation (adipogenesis) within sca
- Addressing Surgeon Fatigue: Current Understanding and Strategies for MitigationSummary: Fatigue is inevitable at all stages of a surgical career. The sustained high degree of concentration required for surgery is complicated by long surgeon working hours and sleep deprivation, which force surgeons to learn to manage and mitigate the effects of physical and mental fatigue on their performance. Extensive evidence exists detailing the potentially dangerous effects of surgeon fatigue on patient safety, but few reports exist
- Recipient-Site Preconditioning with Deferoxamine Increases Fat Graft Survival by Inducing VEGF and Neovascularization in a Rat ModelBackground: The authors hypothesize that ischemic preconditioning of the recipient site with deferoxamine will increase fat graft survival by enhancing angiogenesis in a rat model. Methods: Cell viability, tube formation, and mRNA expression were measured in human umbilical vein endothelial cells treated with deferoxamine. A total of 36 rats were then used for an in vivo study. A dose of 100 mg/kg of deferoxamine was injected subcutaneous
- International and Geographic Trends in Gender Authorship within Plastic SurgeryBackground: Professional advancement in academic plastic surgery may depend on scholarly activity. The authors evaluate gender-based publishing characteristics in three international plastic surgery journals. Methods: A retrospective review of all articles published in 2016 in the following journals was undertaken: Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, European Journal of Plastic Sur
- Nationwide Cost Variation for Thumb Replantation: A Population StudyBackground: Health care reforms aimed at bundling payments attempt to contain costs. Uncovering variation in spending provides one strategy for decreasing expenditure. This study aims to investigate interhospital cost variation for thumb replantation. Methods: A retrospective cross-sectional analysis of patients undergoing thumb replantation using data from the Healthcare Cost and Utilization Project National Inpatient Sample database fro
- Elevated Preoperative Hemoglobin A1c Associated with Increased Wound Complications in Diabetic Patients Undergoing Primary, Open Carpal Tunnel ReleaseBackground: An increased rate of complications has been demonstrated with increasing hemoglobin A1c value for a variety of orthopedic procedures, including arthroplasty and spine surgery. The authors investigated the effects of elevated hemoglobin A1c value on postoperative complications at the time of carpal tunnel release. Methods: This retrospective, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value
- Relative Tissue Oxygenation and Temperature Changes for Detecting Early Upper Extremity Skin IschemiaSummary: The authors’ purpose was to determine whether there are reliable noninvasive methods of assessing upper extremity ischemia regardless of skin pigmentation. The authors conducted a study of healthy subjects classified based on skin pigmentation using the Fitzpatrick scale, the von Luschan color scale, and self-described race (two Hispanics, three Caucasians, and four African Americans). A surface temperature probe and a near-infrared s
- Flexor Tendon: Development, Healing, Adhesion Formation, and Contributing Growth FactorsSummary: Management of flexor tendon injuries of the hand remains a major clinical problem. Even with intricate repair, adhesion formation remains a common complication. Significant progress has been made to better understand the mechanisms of healing and adhesion formation. However, there has been slow progress in the clinical prevention and reversal of flexor tendon adhesions. The goal of this article is to discuss recent literature relating
- New Strategies for Tragus and Antitragus Complex Fabrication in Lobule-Type Microtia ReconstructionBackground: The creation of a high-defining tragus and antitragus complex remains a demanding challenge during staged lobule-type microtia reconstruction. The success of the complex carving relies greatly on proper operation of the cartilage, which is commonly residual cartilage of various sizes. The authors discuss the relevant details for sculpting the tragus and antitragus complex based on cartilage remnants in various conditions. Methods
- Efficacy of Ear Molding in Infants using the EarWell Infant Correction System and Factors Affecting OutcomeBackground: One-third of infants have ear anomalies, and less than one-third self-correct. Correction of ear deformities by molding exploits the plasticity of the auricular cartilage because of circulating maternal estrogen during infancy. In this study, the authors assess the efficacy of the EarWell Infant Correction System in the correction of ear deformities and determine the factors that affect its outcome. Methods: The authors conduc
- Intraoperative Surgical Navigation Reduces the Surgical Time Required to Treat Acute Major Facial FracturesBackground: Assessing bone reduction and implant placement in facial fractures is time-consuming because of limited visibility. An intraoperative navigation system allows real-time confirmation of bone positioning and implant placement on the patient’s computed tomographic scan. This circumvents the visibility problem and therefore appears to shorten the surgery time. The goal of this study was therefore to determine whether intraoperative nav
- Onset and Resolution of Chiari Malformations and Hydrocephalus in Syndromic Craniosynostosis following Posterior Vault DistractionBackground: Patients with syndromic craniosynostosis have an increased incidence of progressive hydrocephalus and Chiari malformations, with few data on the relative benefit of various surgical interventions. The authors compare the incidence and resolution of Chiari malformations and hydrocephalus between patients undergoing posterior vault distraction osteogenesis (PVDO) and patients undergoing conventional cranial vault remodeling. Method
- Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-AnalysisBackground: Few treatment options exist for chronic migraine headaches, with peripheral nerve blocks having long been used to reduce the frequency and severity of migraines. Although the therapeutic effects have been observed in clinical practice, the efficacy has never been fully studied. In the past decade, however, several randomized controlled clinical trials have been conducted to assess the efficacy of greater occipital nerve block in th
- “Like a Normal Person Again”: A Qualitative Analysis of the Impact of Headache SurgeryBackground: Outcomes after migraine surgery have been previously assessed using quantitative measurements, including the migraine headache index. Qualitative methodologies offer the ability to analyze patients’ perceptions and pain experience, and may point to changes in domains not captured by quantitative instruments. The purpose of this study was to characterize individual patients’ experiences with migraines and to analyze how patients’ ex
- Appropriate Timing of Early Postoperative Botulinum Toxin Type A Injection for Thyroidectomy Scar Management: A Split-Scar StudyBackground: Botulinum toxin type A (BTxA) injection is effective for surgical scar prevention. Although some studies have aimed to confirm the efficacy of BTxA injection at different time points, none has been conducted to determine the most appropriate timing of injection for scar management. The authors predicted that the injection of BTxA at different times during the wound healing process would cause differing scar quality improvement and
- Nasal Reconstruction Using the Integra Dermal Regeneration TemplateSummary: The reconstruction of nasal defects following oncologic resection has traditionally involved the use of locoregional flaps or full-thickness skin grafts. However, these options are not always feasible because of limitations in donor tissues, defect size or shape, oncologic issues, or patient preference. Reconstruction in this setting has been limited and unsatisfactory. In this report, the authors present their experience in reconstru
- Management of Pilonidal Sinus Disease with the Aesthetically Shaped Parasacral Perforator Flap: Multicenter Evaluation of 228 PatientsBackground: The management of pilonidal sinus disease is still not standardized. Currently, the two main procedures are a lay-open excision procedure with secondary healing or coverage with local flaps. The authors present their experience with a one-stage excision-coverage with an innovative parasacral artery perforator flap propeller designed to respect the aesthetic unity of the buttocks. Methods: Study patients were managed with this
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Πέμπτη 26 Σεπτεμβρίου 2019
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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11:47 μ.μ.
Ετικέτες
00302841026182,
00306932607174,
alsfakia@gmail.com,
Anapafseos 5 Agios Nikolaos 72100 Crete Greece,
Medicine by Alexandros G. Sfakianakis
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