Omental Vascularized Lymph Node Flap: A Radiographic Analysis

Background Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest. Methods Consecutive abdominal computed tomography angiography (CTA) images performed at a single institution over a 1-year period were reviewed. Right gastroepiploic artery (RGEA) length, artery caliber, lymph node size, and lymph node location in relation to the artery were recorded. A two-tailed Z-test was used to compare means. A Gaussian Mixture Model confirmed by normalized entropy criterion was used to calculate three-dimensional lymph node cluster locations along the RGEA. Results In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was significantly larger in males compared with females (p < 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was no significant gender difference in the number of lymph nodes identified. Average lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males vs. 4.5 [1.5] × 3.1 [0.5] mm in females; p < 0.001). Three distinct anatomical variations of the RGEA course were noted, each with a distinct lymph node clustering pattern. Total lymph node number and size did not differ among anatomical subgroups. Conclusion The omentum is a reliable lymph node donor site with consistent anatomy. This study serves as an aid in preoperative planning for vascularized lymph node transfer using the omental flap

Complexity of health news reporting on breast implant‐associated anaplastic large cell lymphoma

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147821/1/tbj13189.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147821/2/tbj13189_am.pd

Assessing the Necessity of Stopping Antithrombotic Agents Before Wide-Awake Hand Surgery

This review of 304 carpal tunnel release procedures examines the necessity of stopping antithrombotic medications prior to carpal tunnel release surgery

Management of the Pressure Injury Patient with Osteomyelitis: An Algorithm

Pressure injury (PI) is a common complication of inpatient care, affecting an estimated 3 million patients annually in the US. Risk factors include immobility, compromised sensation, malnutrition, urinary or fecal incontinence, and chronic medical illness. Compliance with established guidelines (pressure off-loading, skin care, and frequent inspection) is imperative for the prevention of hospital-acquired PI. Unavoidable PI does occur at times, and is often related to advanced medical illness. Pressure injury complicated by osteomyelitis (OM) can develop in patients with physiologic, behavioral, or treatment-related risk factors, despite the adherence to current standards of prevention

Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers

This study compares postcrash prevalences of neurological and head and neck injuries in motorcycle drivers and passengers, stratified by helmet use

The Veterans Affairs Medical Center's Contribution to Plastic Surgery Education

Veterans Affairs (VA) medical centers have played a major role in graduate medical education since the 1940s. Currently, the VA health system operates 168 medical centers across the United States and supports the clinical training of more than 41 200 medical residents annually. Teaching hospitals within the VA provide subspecialty medical and surgical care and perform the majority of complex and high-risk surgical procedures. The diversity of pathologic conditions requiring a plastic surgery skill set are prominent within the VA population: cancer reconstruction, hand surgery, facial fractures, and burn care. Educational opportunities are ample. Plastic surgery residents in university-based training programs typically rotate at the VA hospital for several months each year. This study examines the relationship between the plastic surgery service and resident education within the VA hospitals

Hand Surgery Resources Exceed American Health Literacy

BACKGROUND: The National Institutes of Health, American Medical Association, and US National Library of Medicine recommend that educational material for patients be written at a sixth-grade reading level. The purpose of this study is to assess the complexity of hand surgery information on academic plastic and orthopedic surgery websites. METHODS: An online search was performed for all hand surgery patient education materials provided by institutions with plastic and orthopedic surgery training programs. Readability analyses were conducted using the Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Index, Gunning Fog Score, Automated Readability Index, and Coleman-Liau Index. A 2-tailed z test was used to compare means. RESULTS: Seventy-six institutions with both plastic and orthopedic surgery training programs were identified; 42 had educational material available online. The average readability for all hand-related information was at the 11.92 grade reading level. Information regarding de Quervain tenosynovitis had the highest grade level for all plastic surgery procedures (13.45). Hand arthritis had the highest grade level for all orthopedic surgery procedures (12.82). Ganglion cysts had the lowest grade level for both plastic and orthopedic surgery (10.15 and 11.01, respectively; P = .12). Carpal tunnel release was the most commonly described procedure overall. There were no differences in text complexity among geographic regions. CONCLUSIONS: Online patient resources for common hand ailments are too complex for the average patient to understand. Efforts should be made to provide materials at the recommended sixth-grade reading level to improve patient education and improve the physician-patient relationship

Tourniquet Use in Wide-Awake Carpal Tunnel Release

Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups