Notes

Sodium-Glucose Co-transporter-2 Inhibitor-Induced Pruritus: Scratching pertaining to Responses.
The total Q2DW ionospheric responses consists of F-region field-aligned and meridional drifts of order ±25 ms-1 and ±5-7 ms-1, respectively, and total ion density perturbations of order (±10%-25%). It is shown that the SWs can sometimes make substantial contributions to the Q2DW winds, drifts, and plasma densities.Proteoglycans (PG) are essential for regulating water flow in the interstitium. From stage 1 of lymphostasis, there is an accumulation of interstitial PG, which regulate the increasing fluids. As the disease progresses, more PG are formed than degraded, resulting in proliferation, and increases in circumference and volume of solid tissue. The removal of this subcutaneous tissue, which is very rigid due to cross-linked PG, is a particular challenge in lymphedema surgery. Hyaluronidase has a lytic effect on these PG structures and, after subcutaneous infiltration, reduces the viscosity of the extracellular matrix, promoting diffusion and penetration of solutions into the surrounding tissue. By using hyaluronidase in our vascular-sparing surgical protocol (lymphological liposculpture), we have not observed any lymphedema recurrences even after 15 years.
The ability to diagnose and manage patients with acute hand injuries is an essential component of plastic surgery residency. This study proposes an innovative and feasible curriculum to improve hand surgery education for plastic surgery residents and ensure optimal care for patients with hand injuries.

A hand call curriculum for plastic surgery residents (n = 29) from two institutions was implemented from 2018 to 2020. In 2018 and 2019, a hand call boot camp was conducted, while additional curricular sessions for anatomy and didactic learning were added in 2019-2020. Pre and post test assessments, as well as confidence assessments were conducted in 2018 and 2019.

In 2019, after having completed the boot camp, residents indicated significantly more confidence in identifying hand emergencies and formulating a basic treatment plan, including when to enlist help (
= 0.0313). Overall, residents in earlier years (PGY 1-3) demonstrated steeper changes in confidence and readiness to take hand call than those in more senior years (PGY 4-8). Knowledge test scores improved amongst residents in both PGY groups following boot camp in both 2018 and 2019.

Findings from our study will be used to optimize the hand call curriculum following limitations with COVID-19 and consider wider implementation across other plastic surgery programs nationally.
Findings from our study will be used to optimize the hand call curriculum following limitations with COVID-19 and consider wider implementation across other plastic surgery programs nationally.
Favorable rates of meaningful recovery (≥M3/S3) of processed nerve allografts (PNAs) for mixed and motor nerve injuries have been reported, but there are few reports of patients having complete PNA failure (M0/S0). The purpose of this study was to describe the outcomes, including rate of complete failures, in a case series of patients who underwent PNA for peripheral mixed nerve reconstructions.

A retrospective review of outcomes between May 2018 to September 2020 was performed. Consecutive patients who underwent nerve reconstruction (>15 mm) with PNA for a peripheral mixed nerve injury of the upper or lower extremity were eligible. Those who returned to clinic for a 10-month postoperative visit were included in this study. The primary outcome was whether the patient was defined as having a complete failure (M0/S0).

A total of 22 patients underwent a PNA during the time period; 14 patients participated in follow-up and were included (average age 34.7 years) with a mean follow-up of 11.9 months. The average gap length was 46.4 mm (range 15-110 mm). At their 10-month postoperative visit, no patients had any motor or sensory improvement; all patients were deemed as having complete failure. Four patients underwent or were planned for subsequent revision surgery.

In this study, we demonstrated a high number of complete failures, with all 14 included patients sustaining a complete failure (100% failure rate) at a minimum 10-month follow-up visit. Failure in this case series was not observed to affect one nerve type, location, or be related to preoperative injury size.
In this study, we demonstrated a high number of complete failures, with all 14 included patients sustaining a complete failure (100% failure rate) at a minimum 10-month follow-up visit. Failure in this case series was not observed to affect one nerve type, location, or be related to preoperative injury size.A 9-year-old girl was investigated for a long-standing soft tissue swelling in her ring digit that recently developed tenderness and rapid growth within the last 3 months before presentation. Exploration of the swelling was done meticulously with total excision of the swelling from within its attachment to the digital nerve. The swelling was then sent for histopathological examination. The pathology report stated the presence of mature adipose tissue intersected by fiprocellular collagenic stroma infiltrating perineurium, epineurium, and nerve fascicles, which established the diagnosis of lipofipromatous hamartoma (LFH) of the nerve. LFH is a rare benign neoplasm that mainly affects the median nerve, but other nerves all over the body were also reported. Women are more affected than men.
Medical students receive limited exposure to the field of plastic surgery because most students will not rotate in plastic surgery, especially those at schools without dedicated plastic surgery residency programs. This study aimed to create and validate a plastic surgery learning module for medical students to dispel media-propagated myths and misrepresentation of the breadth of plastic surgery and equip students with referral-making capabilities.

The plastic surgery learning module was created using Articulate Storyline 360 (New York, N.Y.). Student participants were recruited from a single medical school across all four classes. Pre- and postmodule surveys were administered via Qualtrics (Provo, Utah). Scores were computed for the general surgical knowledge section and for each specialty referral question.

Twelve students completed usability testing and edits were subsequently made to optimize the module. The module took on average 66 minutes to complete. Sixty-five students (19 MS1, 16 MS2, 15 MS3, 15 MS4) completed efficacy testing. In the premodule survey, students were nearly 100% accurate in identifying breast-related referrals, unlike pediatric/craniofacial (avg 68%), reconstruction/microsurgery (avg 64%), and hand/upper extremity (avg 30%) referrals. Students of all classes exhibited significant improvement in all testing categories except for the breast category, with the most improvement in the hand referrals category. Prior exposure to plastic surgery (57%) correlated with higher premodule hand (
= 0.003) and breast/cosmetic (
= 0.01) referral scores.

The plastic surgery learning module shows promise to be a comprehensive yet affordable and time-efficient tool for medical students to learn about basic surgical principles and the scope of plastic surgery.
The plastic surgery learning module shows promise to be a comprehensive yet affordable and time-efficient tool for medical students to learn about basic surgical principles and the scope of plastic surgery.Nasal reconstruction can be a difficult task to perform. It is a challenge when the defect to be reconstructed is extensive and involves the entire thickness of the nose. The difficulty is further increased when a recurrent tumor is removed, where other flaps were previously used to reconstruct the initial defect. A therapeutic option is microsurgical reconstruction; however, sometimes this cannot be performed. Furthermore, free flaps such as the anterolateral thigh or the antebrachialis radial tend to be very thick for the integuments of the face. Therefore, it is important to think of another reconstructive option to solve this problem. We present a case of nasal reconstruction with a prelaminated temporoparietal osteofascial flap, after full-thickness excision for recurrent carcinoma.The deep inferior epigastric artery perforator (DIEP) flap is a safe and reliable autologous breast reconstruction option for patients undergoing surgical treatment for breast cancer. Success of the procedure relies on adequate flap perfusion from perforators that travel within the subcutaneous layer of the abdominal wall. Patients who have undergone invasive abdominal wall procedures such as suction-assisted liposuction may therefore be at increased risk of postoperative complications such as flap loss and fat necrosis. In recent years, noninvasive fat-reduction techniques such as cryolipolysis have grown immensely in popularity. However, there are no data regarding outcomes for patients who have undergone DIEP flap breast reconstruction after having previously undergone abdominal cryolipolysis. The current case demonstrates that free flap breast reconstruction can be performed safely in this patient population, and that adjunct imaging modalities may improve clinical decision-making.
There is a growing interest in the application of hyaluronic acid (HA) derivatives in skin quality improvement. The aim of this study was to confirm safety and effectiveness of cohesive polydensified matrix-hyaluronic acid + glycerol (CPM-HA20G; Belotero Revive) in revitalization of early-onset photodamaged facial skin.

A total of 159 subjects with early signs of facial photodamaged skin were randomized in a 21 ratio to multiple- or single-dose treatment with CPMHA20G. Effectiveness assessments included biophysical measurements of skin hydration; elasticity, firmness, and roughness; investigator- and subject-assessed Global Aesthetic Improvement Scales; and FACE-Q Skin Changes and Treatment Satisfaction questionnaires.

In both treatment groups, skin hydration improved from baseline to all follow-up visits in subjects with dry or very dry skin. This improvement was significant at week 16 after initial treatment in the multiple-dose group (
0.0013). Investigator- and subject-reported outcomes showed thaphotodamaged skin.
Preoperative CTA is widely used and extensively studied for planning of DIEP flap breast reconstruction. However, its utility in planning robotic DIEP harvest is undescribed.

The authors conducted a retrospective study of consecutive patients presenting to the clinics of select plastic surgeons between 2017 and 2021 for abdominally based autologous breast reconstruction. CTA measurements of intramuscular perforator distance and perforator-to-external iliac distance were used as predicted robotic and open fascial incision lengths, respectively. SAHA It was documented if the predicted robotic incision would avoid crossing the arcuate line. Operative notes were reviewed for fascial incision length and number of perforators harvested. Predicted and actual robotic fascial incision lengths were compared.

CTAs were reviewed for 49 patients (98 hemiabdomens). Inadequate or no perforators were identified on CTA in 18% of hemiabdomens. Mean predicted robotic and open DIEP fascial incisions were 3.1 cm and 12.2 cm, respectively, giving robotic approach fascial incision benefit of 9.
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