A hitchhiking approach to reconstruct the finger pulp and the subsequent 1st toe hemi-pulp donor site defect

xlomafota13 shared this article with you from Inoreader A hitchhiking approach to reconstruct the finger pulp and the subsequent 1st toe hemi-pulp donor site defect Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00451-4. doi: 10.1016/j.bjps.2021.09.008. Online ahead of print. ABSTRACT BACKGROUND: The free 1st toe hemi-pulp transfer for finger pulp reconstruction was acknowledged as the optimal one. However, the treatment of the 1st toe donor defect, owning to the impossibility of primary closure, was frequently oversimplified. This study presented a "hitchhiking" approach to resurface finger pulp and the subsequent 1st toe donor site defect in a one-stage procedure. METHODS: From 2014 to 2019, finger pulp amputations (13 digits in 12 patients) were reconstructed with free 1st toe pulp flaps, and the donor site was resurfaced by the 2nd toe pedicled flap with the 2nd toe's primary closure. Therapeutic evaluation of repaired fingers and toes was based on cold intolerance, two-point discrimination (2PD), and gait disturbance. RESULTS: All finger and toe pulp flaps survived uneven tfully. The average size of free 1st toe and pedicled 2nd toe flap was 3.1 cm × 2.0 cm (3.5 cm × 1.4 cm to 4.2 cm × 2.5 cm) and 3.0 cm × 1.1 cm (2.0 cm × 0.9 cm to 3.8 cm × 1.5 cm), respectively. The regained average static 2PD on the finger and 1st toe pulps was 6 mm (ranged 5-10 mm) and 4 mm (ranged 2-6 mm), respectively. All reconstructed 1st toe pulps were qualified for normal gait. One patient complained the mild cold intolerance, and hammer-toe deformities were involved in two cases. CONCLUSION: To fulfill donor site care and cost-effective rule, the toe-to-finger pulp reconstruction can't underestimate the morbidity on 1st toe donor site due to inappropriate intervention. Equally importantly, the hitchhiking pedicled 2nd toe flap should be recruited in the reconstructive scheme. PMID:34740566 | DOI:10.1016/j.bjps.2021.09.008 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

BRAF V600E mutation is associated with aggressive features in papillary thyroid carcinomas ≤ 1.5 cm

xlomafota13 shared this article with you from Inoreader BRAF V600E mutation is associated with aggressive features in papillary thyroid carcinomas ≤ 1.5 cm Via Journal of Otolaryngology - Head & Neck Surgery While some studies suggest that the BRAF V600E mutation correlates with a high-risk phenotype in papillary thyroid microcarcinoma (PTMC), more evidence is necessary before this mutation can be used to help guide ... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Airway injury from transoral endoscopic thyroidectomy vestibular approach

xlomafota13 shared this article with you from Inoreader Airway injury from transoral endoscopic thyroidectomy vestibular approach Via Head & Neck Abstract Background The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel technique that eliminates a cervical scar. This procedure carries unique risks, and data on outcomes are needed as more cases are performed. Methods We describe two cases of airway injury during the TOETVA. A description of the procedure and management of the injuries is outlined. Results In one case, a 3-mm injury in the thyrohyoid membrane was identified. The TOETVA was converted to an open approach due to significant inflammation in the setting of Graves' and the repair was performed while open. In the second case, a fracture occurred from the thyroid notch to Broyle's ligament without avulsion. A primary repair was endoscopically performed. Conclusions Airway injury is a possible complication of both open thyroidectomy and TOETVA. For TOETVA, trauma is most likely to occur in the midline during Hegar dilation and trocar placement through the central incision. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diversity in Academic Laryngology: An Evaluation of Academic Advancement and Research Productivity

xlomafota13 shared this article with you from Inoreader Diversity in Academic Laryngology: An Evaluation of Academic Advancement and Research Productivity Via The Laryngoscope Background Diversity within the medical profession with respect to sex and racial minorities has been shown to have a positive effect on health and healthcare. Characterization of a field is key to evaluating trends and the advancement of diversity in an otolaryngology subspecialty. Study Design Observational study. Methods A comprehensive list of all the academic laryngologists was compiled from the Accreditation Council for Graduate Medical Education accredited otolaryngology residency programs in 2020. The last 20 past presidents of the American Laryngological Association (ALA) and American Broncho-Esophogological Association (ABEA) were analyzed. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables. Results There are 184 academic laryngologists in the 124 programs. The majority of the population is Caucasian 76.6% (141/184), followed by Asian 16.3% (30/184), African American 4.34% (8/184), and then Hispanic 1% (2/184). There are 47 full professors with 83% Caucasian, 14.1% Asian, and 2.1% African American and 91.5% male and only 8.5% female. Past ALA presidents were 90% male and for the ABEA 75% male. H-index revealed a statistically significant difference between Caucasian and African American colleagues [P value (<.0005)]. Conclusions Minorities are disproportionately underrepresented in laryngology. Women are less likely to be in leadership roles in laryngology and become full professors. Laryngology lags behind other surgical specialties in the representation of minorities and women. Continued efforts should be made to increase diversity in the field of laryngology, especially in regard to underrepresented minorities. Level of Evidence N/A Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

xlomafota13 shared this article with you from Inoreader Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data Via The Laryngoscope Objectives/Hypothesis To characterize and identify predictors of 30-day adverse events in patients undergoing laryngeal framework surgery (LFS). Study Design This study is a retrospective analysis of the National Surgical Quality Improvement dataset. Methods LFS cases were identified from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2018. Demographic variables, patient comorbidities, and perioperative outcomes (any adverse event, 30-day readmission, 30-day reoperation, and unplanned intubation) were extracted. Patient-specific and surgery-specific factors associated with perioperative adverse events were examined using descriptive statistics and univariate logistic regression (LR). Results Of 283 patients who underwent LFS, 225 underwent laryngoplasty medialization, 56 underwent laryngoplasty medialization with arytenoidectomy or arytenoidopexy via an external approach, and 2 underwent local myocutaneous or fasciocutaneous advancement flap along with laryngoplasty. Medical comorbidities were present in 33.6% of patients and 57.9% were American Society of Anesthesiologists (ASA) Class III/IV (57.9%). LFS was performed as same-day surgery in 30.7% of cases. Fourteen patients (4.9%) suffered an adverse condition within 30 days following surgery. In univariate LR, ASA Class III or IV (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.2–30.1) was the only predictor associated with any adverse event. Arytenoid adduction (AA) was associated with increased risk of reoperation within 30 days of the initial surgery (OR 6.4, 95% CI 1.0–49). Conclusions LFS is a generally safe procedure with infrequent perioperative adverse events. In the ACS-NSQIP database, ASA classification of III or IV was associated with a higher risk for any 30-day adverse event and AA was associated with a higher risk for 30-day reoperation. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis

xlomafota13 shared this article with you from Inoreader A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background The aim of this study was to assess the perioperative and pathologic outcomes of robotic distal pancreatectomy compared with a laparoscopic approach. Methods A total of 121 robotic distal pancreatectomies and 992 laparoscopic distal pancreatectomies were retrospectively evaluated, comparing the demographic, perioperative and pathologic outcomes. After 1:2 propensity score matching with 11 demographic variables, the factors were analyzed again. Results Following propensity score matching, 104 robotic distal pancreatectomy patients were compared with 208 laparoscopic distal pancreatectomy patients. The operation time and proportion of spleen preservation were not different between the groups. The rates of open conversion were lower, whereas the hospital costs were higher in the robotic group. Other perioperative outcomes and pathologic factors did not differ between the groups. Conclusions Although robotic distal pancreatectomy is more expensive, this operation is feasible, with a higher probability of proceeding with the planned operation and with low open conversion rate. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lip angioedema after indirect contact with a sea anemone

xlomafota13 shared this article with you from Inoreader Lip angioedema after indirect contact with a sea anemone Via ear nose throat Ear Nose Throat J. 2021 Nov 3:1455613211055704. doi: 10.1177/01455613211055704. Online ahead of print. ABSTRACT Sea anemones are marine animals that can produce toxins causing severe angioedema. Swimmers and divers should be aware of sea anemone species that can cause local and systemic toxic reactions and avoid indirect or direct skin contact. High index of suspicion, full laboratory workup, and treatment with steroids and antibiotics are imperative for an uneventful recove ry. PMID:34732103 | DOI:10.1177/01455613211055704 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.