Comment on “Glabella impending skin necrosis: a case report”

Correction to: Current trends in operative treatment of carpometacarpal osteoarthritis: a survey of European hand surgeons The entries in Tables 1, 2 and 3 were captured as N = 433,439 instead of N = 439.

Breast augmentation with Aquafilling: complications and radiologic features of two cases Abstract Breast augmentation with various injectable materials has been performed for decades. Aquafilling was developed in 2005 as soft tissue filler for facial contouring and recently its use for breast augmentation has gained speed in several countries. Its declared composition is 98% water and 2% copolyamide. Although not approved by the U.S. Food and Drug Administration, the procedure is increasingly applied in Turkey. Thus, familiarity with specific imaging findings and complications of this entity is important for the correct diagnosis. Possible migrated material should especially be sought for when reporting these cases. Hereby, we present two cases with a history of breast augmentation with Aquafilling, with special emphasis on MRI findings. Two female patients (ages 28 and 32) were referred for breast ultrasonography (US) with progressive swelling of the right breast (4 years after Aquafilling) and mastalgia (1 year after Aquafilling). Breast MRI at 1.5T (Siemens Espree) with 4-channel breast coil was performed. High-resolution non-fat sat T1- and T2-weighted (W) images, time of repetition-independent multislice (TRIM), and diffusion-weighted imaging (DWI), and for the silicone assessment, water-suppressed and fat-suppressed (WS-FS) sequences, were used. No contrast was administrated. Knowledge of the radiologic characteristics and migration patterns of Aquafilling material as well as related complications is very useful to make an accurate diagnosis. Level of Evidence: Level V, diagnostic study.

Reamputation in a cohort of critical limb ischemia patients surviving 2 years after minor amputation

Flexor pulley reconstruction using a transverse carpal ligament: a case report Abstract Although various techniques exist for pulley reconstruction, none are useful for all patients. We performed flexor pulley reconstruction using a transverse carpal ligament which has the advantages of a useful gliding surface, sufficient width and thickness, anatomical similarity to the pulley, and adequate durability. Cosmetically, all the surgical scars are on the volar side while functionally, we can avoid invasion to both the flexion and extension sides.

Ultrasound-assisted definition of inferior border of the trapezius muscle in lower trapezius island flap reconstruction Abstract Utilization of lower trapezius island flap (LTIF) provides an alternative in reconstruction of the select defects in head and neck region. When muscle bulk is needed under the skin paddle, it may be important to know the exact location of the inferior edge of the trapezius muscle (TM) in order to design the skin paddle accordingly. Due to the anatomic variations seen especially in the origin of trapezius muscle, there are no reliable surface landmarks to define the inferior edge of TM. We present a simple ultrasound-assisted technique of identifying the inferior border of TM preoperatively. Level of Evidence: Level V, diagnostic study.

Synchronous multifocal necrotizing soft tissue infections: a case report and literature review Abstract Necrotizing soft tissue infections are a group of conditions with a common pathophysiological basis, affecting any or all layers of the soft tissue compartment. They are rare, life-threatening diseases that require a high index of suspicion for early detection as well as urgent surgical debridement. Rarely, they can occur in more than one non-contiguous site of the body (‘multifocal’ disease), and this is associated with a much higher mortality than monofocal disease. Here, we present the case of a 46-year-old male with bilateral upper limb necrotizing soft tissue infection following an unclear history of trauma. The patient developed septic shock necessitating transfer to the intensive care unit following emergency surgery. Microbiological tests yielded Streptococcus pyogenes, Staphylococcus aureus and opportunistic Candida spp. and Actinomyces infections. A total of seven surgical debridements were performed; fortunately, the patient survived. We discuss the presentation, diagnosis and management of this case including primary reconstruction of the soft tissue defects, and review the literature on necrotizing soft tissue infections as a clinical entity, incorporating clinical updates from the latest guidelines worldwide. Level of Evidence: Level V, therapeutic study.

The free innervated latissimus dorsi flap for functional reconstruction following soft tissue sarcoma resection of the posterior compartment of the thigh Abstract Background Soft tissue sarcoma (STS) surgery has evolved significantly over the last half a century. From amputation to limb-salvage and limb-sparing surgery, reconstructive demands have continuously increased in an effort to provide the best function-preserving disease-free outcome. Given STS typically affect the limbs more so than any other region of the body, restoration of function whilst not important oncologically is critical to incorporate in the reconstructive plan of any onco-plastic team. The use of loco-regional flaps as well as free flaps provides the mainstay of reconstructive options. The next advance in the reconstructive journey in this clinical area is the use of innervated flaps to restore function. Methods Between 2011 and 2016, all patients who  underwent sarcoma extirpation from the  posterior thigh and reconstruction  using a free innervated latissimus dorsi flap were prospectively identified and a  case note review  was performed. Results In this series, 7 patients have undergone free flap reconstruction of the thigh posterior compartment achieving MRC (medical research council, UK) grade M5 power restoration in 6/7 patients. Conclusions The authors believe this technique to be hugely valuable in the surgical armamentarium of the reconstructive plastic surgeon in order to achieve the best functional outcomes in such a cohort of patients. Level of Evidence: Level IV, therapeutic study.

Thromboprophylaxis in breast microvascular reconstruction: a review of the literature Abstract Microsurgical breast reconstruction patients are at an increased risk for venous thromboembolism (VTE) due to numerous risk factors. A meta-analysis focusing on anti-thrombotics in breast microsurgery has yet to be completed. We aimed to perform a systematic review of the literature to examine the effects of thromboprophylaxis in breast microsurgical reconstruction with a focus on patient and flap complications. A PubMed, Cochrane, and Medline database search was conducted with the following keywords: “venous thrombosis, thromboprophylaxis, mechanical, pneumatic compression, aspirin, heparin, dextran, ketorolac, toradol, warfarin, and coumadin.” Results were combined with the terms “breast microsurgery” and “breast free flap.” All articles that resulted were analyzed. The reference list for each included article was analyzed for other applicable articles. Only articles that addressed pre-operative or post-operative anti-coagulation were included. For data analysis, if the article reported that there were no flap complications, it was assumed there were no operative hematomas, vessel thrombosis, or flap loss. Two hundred and fifty-seven studies were screened from the abovementioned search results and 17 fit inclusion criteria. The majority of included studies were retrospective chart reviews and the type of thromboprophylaxis and its effect on complications was rarely the primary end point. Due to lack of reporting on patient and flap characteristics that could impact outcomes, subgroup analysis was impossible. There has yet to be a consensus on the most effective way to prevent VTE in women undergoing microsurgical breast reconstruction without increasing the risk of hematoma and flap compromise. Studies published to date vary in their thromboprophylatic regimens and rarely include a control or comparison group to allow for intra- or inter-group analysis. There is a need for well-done, randomized, controlled trials in order to determine the best approach to thromboprophylaxis in these patients.

Anatomical position of umbilicus in Latin-American patients Abstract Background The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5–3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key—its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological well-being. Methods The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization. Results In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1. Conclusions Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values. Level of Evidence: Level III, risk / prognostic study.