A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge

Background: Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem. Methods: This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature). Results: None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis. Conclusion: FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study

Metabolic changes after nonsurgical fat removal: A dose response meta-analysis

BackgroundObesity-induced insulin resistance leads to the metabolic syndrome. Both bariatric surgery and surgical fat removal have been shown to improve metabolic health, but the metabolic benefits of nonsurgical fat removal remain uncertain. The aim of this paper is to establish whether nonsurgical fat removal exerts measurable, lasting metabolic benefits by way of changes to serum lipid profiles. MethodsPubMed, Cochrane CENTRAL, Embase, and clinical trials registers were searched using the Polyglot Search Translator to find studies examining quantitative changes in metabolic markers after nonsurgical body contouring procedures. The MethodologicAl STandard for Epidemiological Research (MASTER) scale was adopted for the quality assessment of the included studies. The robust-error meta-regression (REMR) model was employed. ResultsTwenty-two studies and 676 participants were included. Peak body compositions measures manifest as a reduction of 2 units in body mass index (BMI), 1 kg of body weight (BW), 5 cm in waist circumference (WC) and 1.5 cm in abdominal fat thickness (FT), sustained up to 60 days postprocedure. Transient increases of 15 mg/dL in low-density lipoprotein (LDL), 10 mg/dl in triglycerides (TG), and 15 mg/dl in total cholesterol (TC) were observed at 2 weeks postprocedure. ConclusionWhile nonsurgical fat removal exerts sustained effects on body anthropometrics, changes to serum lipid profiles were transient. There is no compelling evidence at present to support the conclusion that nonsurgical fat removal is metabolically beneficial.This project was supported by the Medical Research Office at Hamad Medical Corporation (Project ID: 01–20–466) and QNRF (Projects ID: NPRP14S-0406–210153 and NPRP13S-0203–200234). The responsibility for the paper lies with the authors and there was no influence of the funder. Authors have complete access to the study data that support this publication

Metabolic changes after surgical fat removal: A dose–response meta-analysis

BackgroundBariatric surgery averts obesity-induced insulin resistance and the metabolic syndrome. By contrast, surgical fat removal is considered merely an esthetic endeavor. The aim of this article was to establish whether surgical fat removal, similar to bariatric surgery, exerts measurable, lasting metabolic benefits. MethodsPubMed, Embase, and Scopus were searched using the Polyglot Search Translator to find studies examining quantitative expression of metabolic markers. Quality assessment was done using the MethodologicAl STandard for Epidemiological Research scale. The robust-error meta-regression model was employed for this synthesis. ResultsTwenty-two studies with 493 participants were included. Insulin sensitivity improved gradually with a maximum reduction in fasting insulin and homeostatic model assessment for insulin resistance of 17 pmol/L and 1 point, respectively, at postoperative day 180. Peak metabolic benefits manifest as a reduction of 2 units in body mass index, 3 kg of fat mass, 5 cm of waist circumference, 15 µg/L of serum leptin, 0.75 pg/ml of tumor necrosis factor-alpha, 0.25 mmol/L of total cholesterol, and 3.5 mmHg of systolic and diastolic blood pressure that were observed at day 50 but were followed by a return to preoperative levels by day 180. Serum high-density lipoproteins peaked at 50 days post-surgery before falling below the baseline. No significant changes were observed in lean body mass, serum adiponectin, resistin, interleukin-6, C-reactive protein, triglyceride, low-density lipoproteins, free fatty acids, and fasting blood glucose. ConclusionSurgical fat removal exerts several metabolic benefits in the short term, but only improvements in insulin sensitivity last beyond 6 months.This project was supported by the Medical Research Office at Hamad Medical Corporation (#01-20-466) and the Qatar National Research Fund (projects #NPRP13S-0209-200315 and #NPRP14S-0406-210153). The responsibility for the article lies with the authors, and there was no influence of the funder

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients’ quality of life. Several surgical approaches have been described and reported in the literature to improve patients’ functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center’s approach to diagnosing and managing partial and GBPI cases