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A penciled map also eases a round-table discussion, if multiple surgeons are involved in the operation. The map can also easily be brought to the operating room for guidance. Tracing is a user-friendly, time-efficient, intuitive, low-cost, and low-tech method that generates data that are easy to interpret, easy to share, and easy to discuss with other surgeons. The method is also not dependent on a radiologist for interpretation.The requirement for postmastectomy radiation therapy (PMRT) at the time of mastectomy is often unknown. Autologous reconstruction is preferred in the setting of radiotherapy by providing healthy vascularized tissue to the chest. To maximize mastectomy skin preservation, tissue expander (TE) placement maintains the breast pocket until definitive reconstruction. This study aims to compare outcomes of skin-preserving delayed versus standard delayed autologous breast reconstruction in the setting of PMRT.
A retrospective review of a prospective database was performed of two patient cohorts at a single center between 2006 and 2016. Inclusion criteria were locally advanced breast cancer patients who completed PMRT and free autologous reconstruction. Primary outcomes were major intraoperative and postoperative TE and flap complications.

Over 10 years, 241 patients underwent mastectomy and PMRT. Standard delayed autologous breast reconstruction was performed in 131 breasts (non-TE group). Skin-preserving delayed a risk of TE loss and higher rates of flap thrombosis.Thrombosis is a serious complication of a hyaluronic acid-based filler injection. Little is known about the late-onset complications of fillers; therefore, an optimal complication management is necessary. In this case report, we describe a rare complication of thrombosis after a filler injection. Apoptozole cost A 35-year old woman was admitted to the emergency department, with swelling on her forehead in association with recurrent pain and light flashes in her right eye. Sonographic examination showed a thrombosis of the right frontal vein. The patient reported that a hyaluronic acid filler injection had been administered on the forehead 3 months ago. After several weeks of anticoagulation with heparin and apixaban, the symptoms persisted. The vein with thrombosis was ultimately resected under local anesthesia. Histological findings showed a chronic inflammatory reaction of the tissue to hyaluronic acid. Vascular complications may appear as late-onset complications even several months after the filler injection. Subcutaneous application of low molecular weight heparins is the therapy of first choice. If this treatment is not effective, resection of the thrombosis may be performed.For secondary alveolar bone grafting in cleft patients, the success of bone graft take is dependent upon creating an ideal environment for both bony and soft tissue healing. This is particularly challenging in patients with existing fistulas, wide clefts, and bilateral alveolar clefts, where large soft tissue mobilization is required to get a tensionless repair, and micro-motion around the bone graft is significantly higher. Herein we describe our method for manufacture and placement of a custom postoperative maxillary splint following secondary alveolar bone grafting. Our splint encompasses the palate and alveolus to stabilize the maxillary arch and protect the incision lines during healing. We find our splint to be a useful adjunct to facilitate postoperative healing following secondary alveolar bone grafting.Need for amputation is a potential complication when limb salvage is attempted. The present study aimed to develop a risk assessment tool to predict the risk of future amputation when counseling patients about their reconstructive options.
All patients undergoing a free flap lower extremity soft tissue reconstruction by the senior author from 2005 to 2019 were retrospectively identified. Patient's demographics, comorbidities, and technical aspects of the operation were extracted. Logistic regressions were used to create a predictive scoring system for future amputation.

A total of 277 patients were identified. Of these patients, two-thirds (183) were used to derive the scoring system and one-third (94) were used to validate the score. In total, 25 of 183 patients (14%) underwent an amputation. A stepwise forward logistic regression identified age > 55 years, smoking, acute wound, aggressive fluid resuscitation intra-operatively, inability to use a superficial vein for drainage, and inability to use the posterior tibialis artery for anastomosis as independent predictors of need for future amputations. The beta co-efficients were used to create the scoring system, and the patients were categorized into mild, moderate, and severe risk based on their cumulative score. The validity of the scoring system was verified by using the one-third validation cohort.

In patients undergoing free flap reconstruction of the lower extremity, the need for future amputation is 14%. The use of a scoring system can guide the surgeon's and patient's decision regarding limb salvage.
In patients undergoing free flap reconstruction of the lower extremity, the need for future amputation is 14%. The use of a scoring system can guide the surgeon's and patient's decision regarding limb salvage.This case describes a healthy 37-year-old woman who presented with bilateral breast pain and nodules years after receiving free silicone injections to her breasts. Mammogram revealed extremely dense breasts with innumerable bilateral masses of various sizes. Ultrasound was non-diagnostic due to poor penetration and artifact from silicone. Histologic examination revealed vacuolated histiocytes and innumerable cystic spaces containing material consistent with silicone. Patient underwent bilateral nipple-sparing mastectomy with immediate reconstruction using tissue expanders. This case highlights the potential for serious complications developing years after free silicone injections as well as our team's surgical management of these complications.Surgical treatment of ear carcinomas needs the selection of the appropriate reconstructive techniques, which depends on the location and the dimensions of the defect after excision of the cancer and the quality of blood supply to the peri-lesional skin. The aim of this study was to evaluate the efficacy and reliability of a new axial island retroauricular flap (middle-retroauricular island flap M-RIF) for coverage of non-helical ear defects with direct donor site closure.
All patients, from January 2013 to January 2020, with skin tumors of the non-helix region and undergoing a combined skin-cartilage excision with M-RIF local flap reconstruction under local anesthesia, were enrolled in the study.

18 patients (14 men and 4 women) underwent auricle skin-cartilage excision and M-RIF flap reconstruction. The mean age was 65 years (range, 60-85); the type of primary lesions were 12 BCC and 6 SCC. One flap wound dehiscence and one donor site infection and partial necrosis of the posterior auricular skin occurred; no other complications were recorded.
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