Fishing-Injury-Related Flexor Tenosynovitis of the Hand: A Case Report and Review

Hand infections occurring after fishing and other marine-related activities may involve uncommon bacteria that are not susceptible to the conventional or empiric antibiotic therapy used to treat soft tissue infections. Therefore appropriate treatment is often delayed and could lead to severe hand damage. An illustrative case of fishing-related injury leading to complicated tenosynovitis and horseshoe abscess caused by Mycobacterium marinum and its treatment course is outlined. Laceration of the skin during boating is fairly common. Because of the rarity of some of the bacteria, referrals to the appropriate specialist including hand surgeons and infectious disease specialists should occur in early stages. M. marinum infections should always be considered in injuries related to seawater and fishing as this may lead to early appropriate treatment and prevent severe damage

Constriction ring syndrome

Constriction ring syndrome is a congenital anomaly with sometimes devastating consequences. Because of the unknown etiology, treatment is aimed at recovery of function and prevention of the sequelae rather than prevention of the syndrome. This paper aimed to review the theories of the etiology, the features and associated defects, and the operative management of constriction ring syndrome

Infected implants

This chapter addresses infections associated with artificial devices of a specialized nature. The rate of infection is generally low, but collectively, there are millions of these devices implanted yearly, so the infections are not rare. Optimal treatment requires participation of surgical specialists experienced in the management of these difficult infections, especially for pseudophakic endophthalmitis, in which therapy includes intraocular injections.Intraocular lens-associated infections (pseudophakic endophthalmitis)Pseudophakic endophthalmitis is thought to occur as a consequence of contamination with flora of conjunctival sac or lid margin at the time of surgery. There also have been reports of infections arising from contamination of lenses and neutralizing and storage solutions.The differential diagnosis of endophthalmitis following cataract extraction includes sterile inflammation as well as bacterial and fungal infection. The most common presenting signs and symptoms include pain in the involved eye, decreased visual acuity, red eye, lid edema, hypopyon, and absent or poor red reflex. A single bacterial strain is usually isolated; the most common pathogen is a coagulase-negative staphylococcus (approximately 50% in one large series) followed by Staphylococcus aureus. Virtually any microorganism can be implicated. Delayed onset pseudophakic endophthalmitis has been reported after uncomplicated initial cataract surgery. This entity presents one or more months after surgery and is manifest by waxing and waning ocular inflammation. The leading cause of delayed-onset pseudophakic endophthalmitis is Propionibacterium acnes. Diagnostic evaluation requires aqueous and vitreous samples for Gram stain and culture. Vitrectomy may have therapeutic as well as diagnostic value

Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction

Any surgical procedure undertaken to correct or change facial features will have a resultant effect on nasal aesthetics. Orthognathic surgery is frequently performed to correct congenital and acquired dentofacial anomalies. The resultant changes in the maxillomandibular skeleton have consequences for the overlying soft tissue envelope of the face. This article will review the concepts of nasal analysis and aesthetics. It will then discuss the expected changes to the nasal appearance with orthognathic surgery, primarily LeFort I osteotomies, including a review of the literature that has attempted to quantify and predict these changes. A discussion of surgical techniques to control these changes as well as a discussion of adjunctive rhinoplasty will follow. Surgeons performing these procedures must be aware of the potential changes that can occur to the nasal structure so that they may appropriately plan adjunctive procedures and counsel their patients on both the expected aesthetic outcome and the possible need for subsequent surgeries

Postoperative Antibiotic Prophylaxis for Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Background: The use of acellular dermal matrix in implant-based breast reconstruction has been described for improving inferolateral prosthesis coverage and support and inframammary fold reconstruction. Recommended guidelines for infection prophylaxis are the same as for any clean procedure-antibiotic administration only before surgery. Previous studies have demonstrated increased postoperative rates of infection and seroma associated with the use of acellular dermal matrix. The authors evaluated the impact of postoperative antibiotic prophylaxis on infection rates in postmastectomy expander-based breast reconstruction with acellular dermal matrix. Methods: A retrospective study reviewed data of 96 patients who underwent either immediate or delayed expander-based breast reconstruction using Allo-Derm allogenic acellular dermal matrix. Infection rates were analyzed after patients received postoperative antibiotic prophylaxis for at least 48 hours compared with those who received only perioperative antibiotics. Results: Infection rates for breast reconstructions with a postoperative antibiotic course were 7.9 and 3.2 percent. Patients with only perioperative antibiotics had an infection rate of 31.6 percent. Infections were defined by the endpoint of implant removal. Patient demographics, comorbidities, and intraoperative variables were recorded. Uncontrolled variables were time course between mastectomy and reconstruction, nodal dissection, operative history, and whether reconstruction was unilateral or bilateral. Conclusions: This study demonstrates significant differences in the rate of infection between the groups of patients undergoing the first stage of two-stage implant-based breast reconstruction who received postoperative antibiotic prophylaxis and the group that received only perioperative antibiotics. This study suggests that the optimal duration of postoperative antibiotic prophylaxis is at least 48 hours. (Plast. Reconstr. Surg. 131: 453, 2013.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III

Plastic Reconstructive and Aesthetic Surgery

Key Features:Its presentation is aligned with plastic surgery commonly encountered plastic surgery casesConcise but comprehensive presentation of a basic pool of knowledge in plastic surgeryMay be used as an adjunct for study preparationNumerous figures in the book are available in full color in the enclosed DVD-ROM