Eplasty最新文献

{"title":"Congenital Upper Extremity Anomalies Misdiagnosed as Ulnar Longitudinal Deficiency.","authors":"N K Sferopoulos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patients with a congenital hand plate or upper limb anomaly, a dysplastic ulna, or a syndrome may present with morphologic forms commonly misdiagnosed as ulnar longitudinal deficiency (ULD).</p><p><strong>Methods: </strong>Patients who had been misdiagnosed with ULD over the past 35 years were identified from the hospital database. Twenty-six patients with photographs and/or conventional radiographs that could be adequately reproduced were enrolled in the study.</p><p><strong>Results: </strong>In 16 unilateral cases, the final diagnosis changed to symbrachydactyly (6 cases), Poland syndrome (3 cases), transverse deficiency (1 case), radial longitudinal deficiency (2 cases), and congenital pseudarthrosis of the ulna with osteolysis in patients with neurofibromatosis type 1 (4 cases). In 10 bilateral cases, the final diagnosis changed to constriction ring sequence (3 cases), brachydactyly (6 cases), and congenital bilateral negative ulnar variance in a patient with central metacarpal medullary stenosis. This research presents the findings of the 7 most illustrative cases and focuses on their differential diagnosis. Additionally, the literature review summarizes the most common congenital anomalies included in the differential diagnosis of ULD, presenting their clinical and/or radiographic features as detected in patients referred to our service.</p><p><strong>Conclusions: </strong>A detailed evaluation of patients with even simple unilateral congenital hand or upper limb anomalies is invaluable to the diagnostic investigation. The treating pediatrician, clinician, or surgeon should also be sufficiently familiar with the clinical and radiographic features of congenital anomalies and the long list of syndrome-related deficiencies that the differential diagnostic process of ULD includes. Missed or misinterpreted findings in patients with congenital hand or upper limb anomalies, usually recorded after single diagnosis documentation, may result in a misdiagnosis of ULD and delayed detection of associated congenital, medical, or syndromal disorders.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e36"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replacing Bacitracin With Vancomycin in Adams Triple Antibiotic Solution for Irrigation in Breast Implant Reconstruction: A Retrospective Review of 277 Reconstructions.","authors":"Quinton L Carr, Colton H Connor, Ryan Cantrell, Shriya Dodwani, Alexander L Mostovych, Marcus Bennett, Samuel L Corey, Dexter W Weeks, Anthony Azzolini, Carter Prewitt, Bradon J Wilhelmi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>Breast reconstruction following mastectomy commonly involves tissue expanders to create a suitable pocket for implantation. The use of triple antibiotic irrigation during tissue expander placement aims to reduce implant-related infections. Implant infections can lead to severe complications, often necessitating revision surgeries that may delay treatment of other conditions, such as cancer. For years, the most common solution used in breast pocket irrigation was the Adams solution, which comprises 80 mg gentamicin, 1 g cefazolin, and 50 000 U bacitracin in 500 mL of normal saline. However, the discontinuation of bacitracin has prompted the search for alternative formulations. Vancomycin, like bacitracin, has been shown to provide gram-positive coverage-only better. This study aims to evaluate the utility of a triple antibiotic solution (TAS) containing gentamicin, cefazolin, and vancomycin as a replacement for bacitracin in reducing infection rates following tissue expander placement.</p><p><strong>Methods: </strong>A single-center retrospective chart review was conducted, including 152 patients who underwent a total of 277 breast reconstructions with a TAS comprising 80 mg gentamicin, 1 g cefazolin, and 1 g vancomycin from March 2020 to June 2024. Demographic and clinical data, perioperative characteristics, and postoperative outcomes-including infection rates and culture results-were analyzed.</p><p><strong>Results: </strong>Infections occurred in 6 of 277 reconstructions (2.17% of implants). Methicillin-resistant <i>Staphylococcus aureus</i> was a significant pathogen in infections (50.00%). None of the systemic side effects of vancomycin, including nephrotoxicity, ototoxicity, or vancomycin flushing syndrome, were encountered. Furthermore, no evidence of drug-resistant bacteria was reported in any of the cases.</p><p><strong>Conclusions: </strong>This study highlights the potential utility of vancomycin as an acceptable alternative to bacitracin in triple antibiotic irrigation solution following tissue expander placement post-mastectomy. Additional research could help to further establish vancomycin's efficacy and safety. If validated, this approach could be a temporary alternative to the Adams solution until a better long-term strategy is identified.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e35"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Surgical Complications in Staged Versus Combined Hysterectomy Approach in Masculinizing Bottom Surgery: A National Surgical Quality Improvement Program Analysis.","authors":"Oluwaseun D Adebagbo, Micaela J Tobin, John B Park, Benjamin Rahmani, Sasha Nickman, Macie Gettings, Supraja Rajagopalan, Marissa A Kent, Ryan P Cauley","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Masculinizing (female-to-male) gender-affirming bottom surgeries (GABS) commonly include hysterectomies and can be performed in a staged manner or at the time of masculinizing genital surgery. Prior studies with small patient cohorts have suggested that adopting a combined approach increases the likelihood of complications. This study aimed to characterize patients undergoing gender-affirming masculinizing genital surgery with and without concurrent hysterectomies and determine whether there were additive risks of concurrent procedures.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients with International Classification of Diseases-9/-10 gender dysphoria diagnoses who underwent masculinizing GABS (intersex for female to male, simple or complex scrotoplasty) from 2012 to 2022. Stratified by the presence of a concurrent hysterectomy, baseline characteristics, preoperative commodities, and 30-day postoperative outcomes were compared between single-stage GABS and those with concurrent hysterectomy.</p><p><strong>Results: </strong>Of the 113 total patients included, 83 (73.5%) patients had a single-stage GABS and 30 (26.6%) patients had a GABS combined with hysterectomy. Baseline characteristics, including age, gender distribution, and preoperative comorbidities, were comparable between groups. The median operative time and hospital length of stay were similar between groups. However, single-stage GABS patients had higher rates of return to the operating room (14.5% vs 0.0%, <i>P</i> = .03), wound complications (22.9% vs 0.0%, <i>P</i> = .004), and all-cause complications (27.7% vs 6.7%, <i>P</i> = .02).</p><p><strong>Conclusions: </strong>The results suggest that performing hysterectomies at the time of masculinizing GABS can be safe in appropriately selected patients. These findings highlight the potential safety benefits of combining GABS with hysterectomy and underscore the need for further research into optimizing outcomes for diverse patient populations, as a combined approach may improve efficiency, aid access to care, and improve patient satisfaction.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e34"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buccal Sulcus Approach to Septal Perforation Repair.","authors":"Kenny T Quang, Ananth Murthy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The treatment of septal perforations is a challenging endeavor. The recurrence rate ranges from 30% to 70%. Operative correction often requires wide dissection, local flaps, and septal spacers. The pediatric population poses an even greater challenge given the limited size for visualization and less tissue available to transfer. The most common and successful methods involve endoscopic and open rhinoplasty techniques. The authors present a midfacial degloving approach via a transoral, gingivobuccal approach that does not require an endonasal component or external incisions.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e33"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Outlet Syndrome: An Overlooked Diagnosis in the Pediatric Population.","authors":"Margarida Mendes, Ricardo Nascimento, Ricardo Horta, Eurico Norton, Álvaro Silva","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Thoracic outlet syndrome (TOS) results from the compression of the brachial plexus and/or subclavian vessels. The diagnosis of this disorder in children is often overlooked because of the mistaken assumption that the disorder does not affect children. There is a lack of knowledge concerning the etiology, treatment, and long-term results of this pathology among younger patients. We present a case of a 14-year-old girl with paresthesia and weakness of the upper right limb due to an ipsilateral cervical rib. The severity of her complaints motivated the use of surgical decompression by the supraclavicular approach. After a 6-month follow-up period and after an active rehabilitation and strength training program, the patient was free of symptoms. Thoracic outlet syndrome etiology, treatment choices, and outcomes in the pediatric population remain debatable. Conservative treatment is steered mainly to improving the patient's posture during the activities of daily living by mitigating the compression on the brachial plexus. Surgical decompression is the treatment of choice for patients with persistent significant symptoms.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e31"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Extrasphincteric Enterocutaneous Fistula After Scrotal Reconstruction for Fournier Gangrene: Use of a Novel Salvage Technique.","authors":"Micaela J Tobin, John B Park, Tricia Mae Raquepo, Mohammed Yamin, Helen Xun, Adam Jac, Kristen T Crowell, Marissa A Kent, Ryan P Cauley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anocutaneous and rectocutaneous fistulas are associated with high morbidity and mortality, and complex fistulas often pose challenges to surgical repair. Here, the authors report a case of a rare 7-cm extrasphincteric fistula that extended from the base of the phallus to the external anal canal in a patient with a history of scrotal reconstruction after Fournier gangrene. Despite the anterior location of the cutaneous sinus tract and initial concern for penile urethral involvement, intraoperative instillation of methylene blue revealed a long extrasphincteric anocutaneous fistula. With colorectal surgery co-involvement, the mature tract was dissected free from the urethra, base of the penis, and scrotum, and redirected inferiorly and diverted to a new position anterior to the anal sphincter complex. This technique created a significantly shorter tract that salvaged the scrotal reconstruction, preserved the sphincter complex, and minimized risk of infection to the scrotal reconstruction. This novel technique can be used as either a temporary or permanent solution to complex mature fistulas in high-risk patients.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e32"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extreme Injury of Multiple Hand Extensor Tendons (Zones II to VII) Combined With an Extensive Degloving Injury of the Dorsal Hand: Staged Reconstruction Utilizing Silicon Rods and a Groin Flap.","authors":"Christos Gakis, Ioannis Michalis","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Extensive injuries of hand extensor tendons combined with soft tissue loss represent a reconstructive challenge. Single- or multiple-stage reconstruction cannot be principally adopted, and a single surgical plan cannot uniformly treat every patient.</p><p><strong>Methods: </strong>The authors present a complex case of dorsal hand degloving injury accompanied by extensor tendons injury of the second, third, and fourth digits in zones II to VII, as well as radial wrist extensor tendons injury. The patient was treated in stages. Coverage was provided by a pedicled groin flap. Radial wrist extensors were reconstructed with a palmaris tendon graft, and the extensor digitorum communis was reconstructed with silicon rods and fascia lata grafts.</p><p><strong>Conclusions: </strong>A most satisfactory reconstruction was achieved.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e30"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Prescription Patterns in Hand Surgery: A Medicare Part D Analysis.","authors":"Sabrina M Wang, Steven L Zeng, Victoria Wu, Emmanuel O Emovon, J Andres Hernandez, William M Tian, Cynthia Feltner, Suhail K Mithani","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The opioid crisis continues to be a significant public health concern in the United States, with postoperative prescriptions contributing to the problem. Older adults face increased risks from opioid use, yet prescribing practices for hand surgery in the Medicare population remain understudied. This research aims to elucidate opioid prescription patterns among hand surgeons treating Medicare patients, focusing on national trends, regional variations, and gender differences.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using data from the Centers for Medicare and Medicaid Services Medicare Part D Prescription Drug Program Prescribers Public Use File for hand surgeons from 2015 to 2019. National trends, regional variations based on US Census Bureau divisions, state-level differences, and gender disparities in opioid prescribing patterns were examined. Key metrics included opioid prescribing rates, proportion of opioid claims to total claims, average prescription duration, and total opioid claims per surgeon.</p><p><strong>Results: </strong>From 2015 to 2019, a total of 1752 hand surgeons were identified in the Medicare Part D database with a 5-year average of 231 405 opioid claims, comprising 53% of all claims made by hand surgeons. The median opioid prescribing rate decreased from 61.4% in 2015 to 55.3% in 2019. The proportion of opioid claims to total claims fell from 55.4% to 48.27%, and the average prescription duration decreased from 6.3 to 4.67 days. Significant regional and state-level variation was identified. Overall, the South had higher numbers of opioid prescriptions per hand surgeon and prescribed for more days compared with all other regions, but the Midwest and West regions had larger proportions of opioid claims.</p><p><strong>Conclusions: </strong>Despite an overall decrease in opioid prescribing by hand surgeons for Medicare patients from 2015 to 2019, significant regional and gender-based variations persist. These findings underscore the need for standardized guidelines, improved prescriber education, and better integration of monitoring programs.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e29"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescein Dye-Assisted Tangential Excision and Skin Grafting in Hand Burns: Achieving Optimal Cosmetic and Functional Outcomes.","authors":"Dylan Singh, Justin H Wong, Alan A Parsa, Fereydoun D Parsa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Burned hands require special attention and prompt treatment because of their vital functional importance. With fluorescein dye, it is possible to visualize vascular dermal layers to assist with the removal of nonviable skin through tangential excision.</p><p><strong>Methods: </strong>Within 24 to 48 hours after a burn, 5 mg of fluorescein dye was injected intradermally and a Wood light was used to determine burn depth. Under anesthesia, an Air Brown (Zimmer Biomet) or castroviejo dermatome and a free-hand or Humby knife was used to excise the burned skin. Split-thickness layers approximately 0.015 inches thick were removed until strong fluorescence was noted.</p><p><strong>Results: </strong>Observation indicators were used to assess the quality of the skin graft outcomes. No cases of infection, seromas, hematomas, or contractures were seen. Additionally, patients experienced reasonable cosmetic and functional outcomes within weeks to months following grafting.</p><p><strong>Conclusions: </strong>Excision and split-thickness skin grafting with fluorescein dye and tangential excision can achieve desirable results and restore both cosmetic and functional outcomes.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e26"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple-Positive <i>PALB-2</i> Breast Cancer in a 27-Year-Old Male-to-Female Patient.","authors":"Kelly C Ho, Kristin N Huffman, Madeline J O'Connor, Payton Sparks, Caden Bozigar, Helene Sterbling, Nora Hansen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There is a paucity of literature describing breast cancer prevention and screening guidelines in transgender patients. As more patients undergo gender-affirming care, breast cancer screening guidelines must be solidified for transgender patients. While there are no published incidence rates of breast cancer in the transgender population, case reports continue to underscore the prevalence of breast cancer in transgender females.</p><p><strong>Methods: </strong>A 27-year-old transgender woman with a family history of breast cancer and personal gender-affirming hormone therapy for 9 years was diagnosed with stage 3 invasive ductal carcinoma. The patient presented with a palpable breast lump and had never undergone breast imaging.</p><p><strong>Conclusions: </strong>Breast cancer risk in transgender patients with long-term hormone therapy use is not well understood. Individuals, both male and female, with a family history of breast cancer; increased cumulative lifetime estrogen and progesterone use; or mutations in <i>BRCA1</i>, <i>BRCA2</i>, <i>CHEK2</i>, <i>PTEN</i>, or <i>PALB2</i> genes have an increased risk for breast cancer. Hormonal treatment is often used alongside gender-affirming surgeries for development of female secondary sex characteristics in male-to-female patients. Although hormone therapy can have gender-affirming benefits, the increased lifetime exposure to estrogen and progesterone can increase the risk of breast cancer. Mammography guidelines for transgender patients vary by age, familial and genetic risk, as well as duration of hormone therapy. Three current organizations have published mammographic screening guidelines for transgender patients: the University of California San Francisco, the World Professional Association for Transgender Health, and the American College of Radiology. Future research should focus on substantiating these guidelines with greater data to produce evidence-based recommendations to guide the care of transgender patients.</p>","PeriodicalId":93993,"journal":{"name":"Eplasty","volume":"25 ","pages":"e27"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}