查看更多>>摘要：Aim:This study isolates septal perforations due to nasal surgery for clinical analysis and their effect on bilateral mucosal flap repair.Methods:This is a retrospective review of a single surgeon's 20-year experience with endonasal perforation repair utilizing bilateral mucosal advancement flaps supported with an autologous tissue interposition graft.Patients with a minimum of 4-month postoperative follow-up were included in the study.Comparative analyses of repair failure rates and perforation size of failures between surgical and non-surgical etiologies were performed.Results:Three hundred ninety-two patients met the criteria for inclusion in the study.The incidence of perforation and prior septal surgery was 40.6%.Overall repair closure in patients with a minimum of 4 months follow-up was 94.8%.Failures were noted in 5.7%of surgical and 4.7%of non-surgical perforation etiologies(P = 0.816).Mean differences in perforation length and height in failed repairs between non-surgical and surgical etiologies(19.4 vs.13.7 and 15.5 vs.9.3 mm,respectively)were significant(P = 0.048 length,P = 0.006 height).Conclusion:Post-surgical nasal septal perforations can be repaired with a low rate of failure.However,this study found that the size of perforations in failed repairs was significantly smaller in patients with a history of septal surgery,suggesting that prior septal surgery increases the technical difficulty of a bilateral flap perforation repair.
查看更多>>摘要：Complications following amputation can be devastating for patients,including debilitating neuropathic pain,the inability to perform activities of daily living(ADLs)or gain meaningful employment.While prosthesis use allows patients to restore independence and reintegrate into daily activities,patients often abandon these devices.Despite the immense advancements in prosthetic technology,there is still a need for an interface that can provide a natural experience with accurate and reliable long-term control.The Regenerative Peripheral Nerve Interface(RPNI)is a simple surgical technique that offers real-time control of myoelectric prosthetic devices to restore extremity function.This stable,biological nerve interface successfully amplifies efferent motor action potentials,provides sensory feedback,and offers a more functional prosthetic device experience.Based on the principles of RPNI,novel surgical approaches have been developed to expand its applications and improve outcomes.This review article summarizes the utilization of the RPNI and its recent modifications of different neural interfaces in the setting of major limb amputation and musculoskeletal injuries.
查看更多>>摘要：Empty nose syndrome(ENS)is an iatrogenic condition that results from traumatic injury,often overresection,of the turbinates during sinonasal surgery.The underlying etiology is not entirely understood but is thought to have multifactorial contributions including alterations in the native nasal airway anatomy,abnormal mucosal and neural healing,and decreased trigeminal sensitivity,among other possibilities and contributors.Patients typically present with an intense fixation on their sensations of nasal obstruction and congestion despite an anatomically patent airway on examination.Because many patients with ENS have been shown to have significant psychiatric comorbidities,multidisciplinary specialist care including psychiatry and pain services is essential.Diagnosis is often difficult due to the variability of presentation and severity of symptoms,but standard assessments exist including the empty nose syndrome 6-item questionnaire(ENS6Q)and cotton test.Patients can be initially managed with conservative measures through humidification,moisturization,and psychiatric testing/referral.Procedural approaches to improve the nasal airway include submucosal implantation of temporary,semi-permanent,and permanent materials.A realistic and empathetic approach to patient communication is necessary in order to help manage patients with ENS,and all plastic surgeons performing septorhinoplasty should be aware of the risk and treatment options of the disease.
查看更多>>摘要：Patients with breast cancer-related lymphedema(BCRL)commonly present with both debilitating upper extremity symptoms and the need for breast reconstruction.By combining autologous flaps with physiologic lymphatic surgery,postmastectomy patients with BCRL can obtain aesthetic breast reconstruction and lymphedema management in a single operation.Lymph node transfer to an area of lymphatic obstruction creates a healthy lymphatic bridge and restores physiologic flow.Early success and improved understanding of vascularized lymph node transfer(VLNT)physiology have led to the rapid development of numerous flap options and modalities.Several studies have shown the efficacy of combining autologous breast reconstruction with VLNT.Chimeric flaps using inguinal nodes,lateral thoracic nodes,or omentum aim to construct an aesthetic breast and improve lymphatic function.In this article,we will detail the surgical options that accomplish autologous breast reconstruction and restore the lymphatic network in a single operation.
查看更多>>摘要：As botulinum toxin is increasingly used cosmetically and medically,it is important to understand the differences between each formulation of this product.While the active molecule in each is a 150 kDa protein that prevents neurotransmitter release,there are currently five products FDA-approved for clinical use,with a sixth currently in its Phase 3 trial and a seventh applied under FDA review,each with different nontoxic accessory proteins and varying amounts of human serum albumin.These properties affect diffusion rates and storage methods,which are outlined in this review.Common complications and recommendations to avoid them are discussed.
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