Abdominoplasty Improves Low Back Pain and Urinary Incontinence.

BACKGROUND: The authors studied the incidence of low back pain and urinary incontinence in the postpartum population presenting for abdominoplasty, and the extent of improvement following the operation. METHODS: This multicenter prospective study used validated questionnaires: the Oswestry Disability Index for back pain and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form for urinary incontinence. Questionnaires were administered preoperatively and at 6 weeks and 6 months postoperatively. RESULTS: Results cover 214 patients from nine centers. The mean age was 42.1 years, the mean parity was 2.5, and the mean body mass index was 26.3 kg/m. The mean surgical statistics were as follows: weight removed, 1222 g; liposuction volume, 795 ml; and diastasis, 4.5 cm. Eighty-seven percent of the abdominoplasties were either radical, high lateral tension, or high oblique tension. The mean Oswestry Disability Index score preoperatively was 21.6 percent, and 8.8 percent had no back pain. The mean score was 8 percent at 6 weeks and 3.2 percent at 6 months. These results are statistically significant. The mean International Consultation on Incontinence Questionnaire score preoperatively was 6.5; of the patients assessed, 27.5 percent had no incontinence. This score fell to 1.6 at 6 weeks, and the same, 1.6, at 6 months. These results are also statistically significant. Preoperative predictors of back pain were body mass index greater than 25 kg/m and umbilical hernia; predictors of incontinence were age older than 40 years and vaginal deliveries. There were no significant predictors of postoperative back pain or urinary incontinence improvement at 6 months. All methods of abdominoplasty produced similar improvement. CONCLUSION: Abdominoplasty with rectus repair creates a significant improvement in the functional symptoms of low back pain and urinary incontinence. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Gore-Tex Suture in Periareolar Closure: A Modified Closure Technique.

In breast reduction and mastopexy procedures, the periareolar closure forms a vital component of the surgery. Periareolar closures completed with an absorbable suture may be prone to significant widening, hypertrophy and/or areolar distortion. In an effort to avoid this, some surgeons use a non-absorbable/permanent suture material [Franco (Arch Plast Surg 41 (6): 728-733, 2014)]. Hammond (Plast Reconstr Surg 119 (3):804-809, 2007) recommends the use of a Gore-Tex® suture for this purpose in view of the supple, pliable nature of the material; however, there remain at least occasional instances of infection and extrusion of the knot used to tie off the Gore-Tex "purse-string" [Franco (Arch Plast Surg 41 (6): 728-733, 2014); Salgarello (Aesthet Plast Surg 37 (5):1061-1062, 2013)]. We describe a method of securing the suture ends, which avoids the creation of a bulky knot, thus minimising the risk of infection and suture extrusion. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Climate challenges, vulnerabilities, and food security.

This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the "weight" of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy.

In vitro comparison of lagged and nonlagged screw fixation of metacarpal fractures in cadavers.

PURPOSE: Lag screw fixation is reported to provide the most biomechanically stable construct for fixation of oblique or spiral metacarpal fractures. Lag screws are inserted after overdrilling the proximal cortex, resulting in compression at the fracture site. Minor drilling errors can result in poor screw purchase, instability, and ultimately impaired fracture healing. In an in vitro study, we compared construct stability provided by nonlagged and lagged screw fixation. METHODS: A cadaveric human metacarpal model was used. After removing the soft tissue, long oblique osteotomies were made in 24 metacarpals, which were then randomized to lagged or nonlagged fixation. Nonlagged fixation was performed through a newly introduced reduction system. Fixed specimens were subjected to biomechanical analysis by way of cantilevered bending to failure, and calculations were made for axial stress and normalized stiffness. RESULTS: All specimens failed in a typical manner through the proximal screw site. Nonlagged compared with lagged screw fixation resulted in a higher axial stress and normalized stiffness, although the differences did not reach statistical significance. CONCLUSIONS: Nonlagged screw fixation with use of a precompression device provided comparable fracture site stiffness and biomechanical stability without use of lag screws while removing the requirement for overdrilling, thus simplifying the technique.