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

Mucosal Thickening of Maxillary Sinuses of CLP vs non-CLP patients

poster abstractObjectives: The objective of this retrospective radiographic study was to compare mucosal thickening of maxillary sinuses of patients with cleft lip and palate (CLP) vs. non-CLP. Methods: Following IRB approval, three-dimensional cone beam computerized tomographs (CBCT; i-CAT) of children with unilateral CLP and children without CLP (age and gender matched; 8-14yoa; n=15ea) were selected randomly from pre-existing orthodontic records. Following reliability studies, one investigator segmented both sinuses from each CBCT using Dolphin-3D Imaging software. The sinuses were separated coronally into .4mm slices anterioposteriorly. Bony sinuses and airspaces were outlined manually on each slice. Software calculated total sinus and airspace area. Areas were summed and multiplied by slice thickness to determine volume. Mucosal thickening was the difference between total sinus and airspace volumes. Percent mucosal thickening was calculated. Since no significant differences existed between cleft (left) and noncleft (right) sides of either patient group (p>.05), sinuses for each group were pooled (n=30 ea). Significant differences in total sinus, airspace, mucosal thickening volumes and % mucosal thickening were determined using paired t-tests, accepting p<0.05 as significant. Principal Component Analysis (PCA) scatterplots were used to determine patterns of multivariate variation based on group, age, and sex. MANOVA was used to confirm PCA findings. Reliability was determined using Intraclass Correlations (ICC). Results: Reliability was excellent (ICC>0.99). The CLP total sinus and airspace volume were significantly smaller and mucosal thickening and % mucosal thickening were significantly greater than non-CLP sinuses (all p<.024). PCA showed that 89.6% of sample variance was explained by PC axis 1 and 2 (group and age). Age group 8-9yrs showed more separation with 13-14yrs than with 10-12yrs. MANOVA confirmed a significant effect of sample (p=.001) and age (p=.007)

Plastic and Reconstructive Surgery Advance Online Article

Background: The aim of this study was to evaluate the efficacy, safety profile, and complications associated with mandibular distraction osteogenesis performed in infants weighing less than 4 kg with Robin sequence. Methods: An 11-year retrospective review of all infants (younger than 6 months) with mandibular distraction osteogenesis–treated Robin sequence was performed. Patients weighing less than 4 kg (experimental) and 4 kg or more (control) who underwent mandibular distraction osteogenesis were compared. Demographics, medical comorbidities, improvement in apnea/hypopnea index, need for tracheostomy, repeated distraction, and complications were evaluated. Results: One hundred twenty-one patients underwent mandibular distraction osteogenesis. Eighty-one patients weighed less than 4 kg and 40 weighed 4 kg or more. The mean follow-up was 2.8 years in patients weighing less than 4 kg and 3.0 years in the control group. Mean age and weight at the time of distraction were 23 days and 3.1 kg, respectively, in the study group; and 2.7 years and 11 kg, respectively, in the control group. There was no significant difference in success of mandibular distraction osteogenesis to treat airway obstruction in the group weighing less than 4 kg compared with the control group (92.6 percent versus 88.9 percent; p = 0.49). The most common complication in each group was surgical-site infection (9.9 percent and 20.0 percent; p = 0.15). Overall complication rates were similar between the two groups (17.3 percent versus 25.0 percent; p = 0.34). The rates of repeated distraction were similar between the two groups (6.3 percent and 13.5 percent; p = 0.28). Conclusions: Mandibular distraction osteogenesis is a safe and effective treatment modality for infants weighing less than 4 kg with severe airway obstruction. The efficacy, safety, and complication profiles are not significantly different from those of larger patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III

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

Molar-Incisor hypomineralization in controls vs CLP with primary or prior to secondary alveolar grafts

poster abstractMolar incisor hypomineralization (MIH) is a congenital defect of unknown etiology that can affect both esthetics and cariogenic susceptibility. The objective of this study was to determine whether MIH is greater in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared to CLP prior to secondary alveolar grafting (SAG) and to controls. A retrospective analysis of intraoral photographs of 13 (10M:3F; 8.9 ± 1.2 yrs) CLP patients who underwent a PAG, 27 (18M:9F;10.0 ± 2.1 yrs) CLP prior to SAG, and 60 (30M:30F; 12.4 ± 1.8 yrs) controls without CLP was performed. Mantel-Haenszel chi-square tests were used to compare the three groups for differences in MIH scores and Wilcoxon Rank Sum tests were used to compare the groups for differences in average MIH scores. A 5% significance level was used for all tests. MIH scores were significantly higher for the PAG and SAG groups compared to the control group (p<0.001). The PAG group had significantly higher incisor MIH (p=0.016) than the SAG group. MIH average scores were significantly higher for the two graft groups compared to the controls (p<0.0001). The PAG group had significantly higher average MIH score and average MIH score for incisors than the SAG group (p=0.03). The results suggest that CLP patients, in general, have significantly greater MIH compared with controls and CLP with PAGs have significantly greater MIH in the incisor region than CLP waiting for SAGs. The increased severity of MIH could be related to the grafting during the time of incisor crown formation

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

Analysis of Cases inWhich a Biopsy Specimen Is Positive and an Excised Lesion Is Negative for Nonmelanoma Skin Cancer

Nonmelanoma skin cancers (NMSCs), including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), are the most common types of cancer with the fastest-growing treatment costs in the United States.1 Standard treatment requires biopsy for histologic confirmation, followed by excision. Oftentimes, no residual carcinoma is detected, implying spontaneous clearance at rates reported to vary from 24% to 76%.2- 5 These types of lesions have been investigated by others2- 5 and are not fully understood. Our study aims to determine the lesion and patient characteristics that would most strongly predict a histologically negative result for an excised lesion after a biopsy specimen had positive margins

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

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