Transdermal scopolamine for the treatment of recurrent parotid sialocele: a case report.

Recurrent parotid sialocele is rare and challenging to treat. Treatment options are limited for cases of parotid sialocele that recur despite ductal ligation. This case study presents a patient who underwent wide excision of the right buccal mucosa due to squamous cell carcinoma. During the wide excision, a segment of the parotid duct was excised, and ductal ligation was performed to prevent the occurrence of a sialocele, followed by reconstruction using a folded anterolateral thigh free flap. Twenty-two days after surgery, parotid sialocele occurred despite the initial ductal ligation and subsequent ductal ligation was performed; however, the sialocele recurred. As an alternative therapeutic option, a transdermal scopolamine patch was applied for 3 weeks, with one patch used every 3 days. The results were encouraging, with complete resolution of the sialocele. A transdermal scopolamine offers a noninvasive, convenient method of treating parotid sialocele with minimal side effects. The successful outcome of this case suggests that a transdermal scopolamine can be an effective therapeutic option for recurrent parotid sialocele in conjunction with surgical treatment.

The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot.

BACKGROUND: Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole. METHODS: This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021. RESULTS: In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm 2 . Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively. CONCLUSIONS: The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.

A Thin-Film Pinned-Photodiode Imager Pixel with Fully Monolithic Fabrication and beyond 1Me- Full Well Capacity.

Thin-film photodiodes (TFPD) monolithically integrated on the Si Read-Out Integrated Circuitry (ROIC) are promising imaging platforms when beyond-silicon optoelectronic properties are required. Although TFPD device performance has improved significantly, the pixel development has been limited in terms of noise characteristics compared to the Si-based image sensors. Here, a thin-film-based pinned photodiode (TF-PPD) structure is presented, showing reduced kTC noise and dark current, accompanied with a high conversion gain (CG). Indium-gallium-zinc oxide (IGZO) thin-film transistors and quantum dot photodiodes are integrated sequentially on the Si ROIC in a fully monolithic scheme with the introduction of photogate (PG) to achieve PPD operation. This PG brings not only a low noise performance, but also a high full well capacity (FWC) coming from the large capacitance of its metal-oxide-semiconductor (MOS). Hence, the FWC of the pixel is boosted up to 1.37 Me- with a 5 µm pixel pitch, which is 8.3 times larger than the FWC that the TFPD junction capacitor can store. This large FWC, along with the inherent low noise characteristics of the TF-PPD, leads to the three-digit dynamic range (DR) of 100.2 dB. Unlike a Si-based PG pixel, dark current contribution from the depleted semiconductor interfaces is limited, thanks to the wide energy band gap of the IGZO channel material used in this work. We expect that this novel 4 T pixel architecture can accelerate the deployment of monolithic TFPD imaging technology, as it has worked for CMOS Image sensors (CIS).

Image sensors using thin-film absorbers.

Image sensors are must-have components of most consumer electronics devices. They enable portable camera systems, which find their way into billions of devices annually. Such high volumes are possible thanks to the complementary metal-oxide semiconductor (CMOS) platform, leveraging wafer-scale manufacturing. Silicon photodiodes, at the core of CMOS image sensors, are perfectly suited to replicate human vision. Thin-film absorbers are an alternative family of photoactive materials, distinguished by the layer thickness comparable with or smaller than the wavelength of interest. They allow design of imagers with functionalities beyond Si-based sensors, such as transparency or detectivity at wavelengths above Si cutoff (e.g., short-wave infrared). Thin-film image sensors are an emerging device category. While intensive research is ongoing to achieve sufficient performance of thin-film photodetectors, to our best knowledge, there have been few complete studies on their integration into advanced systems. In this paper, we will describe several types of image sensors being developed at imec, based on organic, quantum dot, and perovskite photodiode and show their figures of merit. We also discuss the methodology for selecting the most appropriate sensor architecture (integration with thin-film transistor or CMOS). Application examples based on imec proof-of-concept sensors are demonstrated to showcase emerging use cases.

Interface-Engineered Organic Near-Infrared Photodetector for Imaging Applications.

We report a high-speed low dark current near-infrared (NIR) organic photodetector (OPD) on a silicon substrate with amorphous indium gallium zinc oxide (a-IGZO) as the electron transport layer (ETL). In-depth understanding of the origin of dark current is obtained using an elaborate set of characterization techniques, including temperature-dependent current-voltage measurements, current-based deep-level transient spectroscopy (Q-DLTS), and transient photovoltage decay measurements. These characterization results are complemented by energy band structures deduced from ultraviolet photoelectron spectroscopy. The presence of trap states and a strong dependency of activation energy on the applied reverse bias voltage point to a dark current mechanism based on trap-assisted field-enhanced thermal emission (Poole-Frenkel emission). We significantly reduce this emission by introducing a thin interfacial layer between the donor: acceptor blend and the a-IGZO ETL and obtain a dark current as low as 125 pA/cm2 at an applied reverse bias of -1 V. Thanks to the use of high-mobility metal-oxide transport layers, a fast photo response time of 639 ns (rise) and 1497 ns (fall) is achieved, which, to the best of our knowledge, is among the fastest reported for NIR OPDs. Finally, we present an imager integrating the NIR OPD on a complementary metal oxide semiconductor read-out circuit, demonstrating the significance of the improved dark current characteristics in capturing high-quality sample images with this technology.

A multicenter, randomized, double-blind, comparative study of a multiphasic hyaluronic acid filler and existing hyaluronic acid fillers for temporary restoration of the midface volume of Asian individuals.

BACKGROUND: Giselleligne is the world's first multiphasic gel product that evenly surrounds particles. In the current study, Giselleligne was compared with other existing fillers to evaluate their clinical use, safety, and ability to improve midface volume deficits of Asian individuals. METHODS: A comparative experiment was conducted to gain an understanding of the physical properties of Giselleligne, which is a multilayered hyaluronic acid filler, and to compare its properties with those of existing hyaluronic acid fillers. The primary outcome of this study was a Midface Volume Deficit Scale (MFVDS) score improvement at 24 weeks after the procedure. The secondary outcomes were as follows: MFVDS score improvement after the procedure; MFVDS score changes after the procedure; Global Esthetic Improvement Scale (GAIS) scores as evaluated by the operator after the procedure; the operator's satisfaction with the product; evaluation of the GAIS scores by the patient after the procedure; and pain level of the patient on the day of the procedure. RESULTS: Giselleligne exhibited properties that are expected to result in significantly superior clinical outcomes compared to existing products. Giselleligne was superior not only to the existing products but also in terms of global esthetic improvement, effect duration, and operator satisfaction. Furthermore, Giselleligne was found significantly safer than the existing products. CONCLUSION: Giselleligne is a safer, more user-friendly, and more effective alternative to existing products for improving the midfacial volume.

Role of a fluid-restrictive strategy in flap-surgery: A single center retrospective cohort study.

In this study, we evaluated the outcomes of flap surgery and the incidence of acute kidney injury (AKI) in patients who underwent flap surgery using a fluid-restrictive strategy. We retrospectively reviewed the consecutively collected medical records of patients who underwent flap surgery using the fluid-restrictive strategy of our hospital. The patients were divided into 2 groups based on the period of flap surgery: 2011 to 2014 (initiation period of the fluid-restrictive strategy) and 2015 to 2020 (implementation period). Outcomes of flap surgery and the incidence of AKI were evaluated based on percentage changes in cumulative fluid balance to initial body weight (%FO) on post-operative day 7. A total of 140 patients were enrolled in the study; 50 (35.7%) underwent flap surgery in 2011 to 2014 and 90 (64.3%) in 2015 to 2020. In 2015 to 2020, the median %FO significantly decreased from 2.7 (interquartile range [IQR]: 0.8-7.1) to 0.1 (IQR: -2.2 to 3.4%, P < .001), whereas the success rate significantly increased from 53.3% to 70.5% (P = .048) compared to 2011 to 2014. The incidence of AKI remained unchanged. In multivariate analysis, the odds ratio for success was 2.759 (95% confidence interval: 1.140-6.679) in 2015 to 2020 compared to 2011 to 2014. After successfully implementing the fluid-restrictive strategy, the success rate of flap surgery significantly increased without any further increase in the incidence of AKI. Our experience could serve as a model for implementing a fluid-restrictive strategy in flap surgery.

Lymphaticovenular anastomosis for Morbihan disease: a case report.

Morbihan disease (MD) is a very rare condition characterized by rosaceous or erythematous lymphedema on the upper twothirds of the face. A definitive management strategy for MD is lacking, and treatment is challenging. Herein, we present a case of persistent bilateral eyelid edema treated by lymphaticovenular anastomosis (LVA) and lymph node-vein bypass surgery. The patient experienced persistent bilateral eyelid edema. Indocyanine green lymphography was performed, and the diagnosis of bilateral facial lymphedema was confirmed. On the right side, a preauricular lymphatic vessel was anastomosed to a vein. On the left side, lymphostomy on the preauricular lymph node was done, with anastomosis to the transected proximal end of the concomitant vein of the transverse facial artery. Furthermore, a preauricular lymphatic vessel was anastomosed to a vein. Eyelid edema decreased and progressively improved on both sides. The outcome of this case suggests that LVA and lymph node-vein bypass surgery are appropriate for treating persistent eyelid edema related to MD.

Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center.

This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, <1 hour (<1 hour; n = 9) and over 1 hour (>1 hour; n = 8). The patient's arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery (P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.

The relationship between lymphedema severity and awareness of lymphedema surgery.

BACKGROUND: During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients' awareness of surgical treatment for secondary upper extremity lymphedema (UEL). METHODS: Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups. RESULTS: Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P<0.05) and more frequently underwent physiologic procedures than excisional procedures (P=0.003). CONCLUSIONS: If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.

Treatment of Morbihan disease.

Morbihan disease (MD) is a rare condition that involves rosaceous lymphedema or erythematous lymphedema of the middle and upper thirds of the face. It typically affects the periorbital region, forehead, glabella, nose, and cheeks. The etiology of MD remains unclear, and its diagnosis is challenging. MD often tends to be unresponsive to therapies commonly used to treat rosacea, including corticosteroids, isotretinoin, and antibiotics. Surgical treatments have therefore been attempted, but most cases showed unsatisfactory responses. These problems could have resulted from an incorrect recognition and interpretation of the pathophysiology of MD and inaccurate planning of the operation, resulting in recurrence or exacerbation of edema.

Preparation of Decellularized Kidney Scaffolds in Rats.

Tissue engineering is a cutting-edge discipline in biomedicine. Cell culture techniques can be applied for regeneration of functional tissues and organs to replace diseased or damaged organs. Scaffolds are needed to facilitate the generation of three-dimensional organs or tissues using differentiated stem cells in vivo. In this report, we describe a novel method for developing vascularized scaffolds using decellularized rat kidneys. Eight-week-old Sprague-Dawley rats were used in this study, and heparin was injected into the heart to facilitate flow into the renal vessels, allowing heparin to perfuse into the renal vessels. The abdominal cavity was opened, and the left kidney was collected. The collected kidneys were perfused for 9 h using detergents, such as Triton X-100 and sodium dodecyl sulfate, to decellularize the tissue. Decellularized kidney scaffolds were then gently washed with 1% penicillin/streptomycin and heparin to remove cellular debris and chemical residues. Transplantation of stem cells with the decellularized vascular scaffolds is expected to facilitate the generation of new organs. Thus, the vascularized scaffolds may provide a foundation for tissue engineering of organ grafts in the future.

Angiosarcoma secondary to postirradiation and chronic lymphedema: Case reports.

INTRODUCTION: Angiosarcoma secondary to post-irradiation and lymphedema is rare, but it is aggressive with a poor prognosis. It is essential to understand these patients' clinical features and distinguish them from benign diseases or other malignant tumors. PATIENT CONCERNS: Three patients who had radiotherapy for cancer treatment and chronic lymphedema admitted to the hospital with specific skin lesions at upper or lower extremities. DIAGNOSIS: Excisional biopsies revealed prominent, highly atypical cells with a vasoformative area, composed of atypical, large epithelioid cells with vesicular nuclei, prominent nucleoli, and mitoses. Immunohistochemistry revealed diffuse expression of endothelial cell markers suggestive of angiosarcoma. INTERVENTIONS: One patient had shoulder disarticulation with wide excision with adjuvant radiotherapy and chemotherapy and other 2 discontinued the treatment. OUTCOMES: After the treatment, one patient was transferred to rehabilitation department for shoulder disarticulation prosthesis fitting without recurrence sign for 1 year. Two patient refused further treatment and was lost to follow-up. CONCLUSION: In cases of patients with irratiation and chronic lymphedema, clinical findings suggestive of angiosarcoma, biopsy and imaging studies should be performed as soon as possible.

Indocyanine Green Lymphography and Lymphoscintigraphy Severity Stage Showed Strong Correlation in Lower Limb Lymphedema.

Background: To examine the correlation between lymphedema severity on lymphoscintigraphy and indocyanine green (ICG) lymphography in patients with secondary lower extremity lymphedema. Methods and Results: The maximal circumference difference (MCD) between the two legs was recorded. Lymphoscintigraphy and ICG lymphography images were classified into type I to V according to dermal backflow (DB) stage and MD Anderson Cancer Center (MDACC) stage based on lymphatic flow preservation and how DB was extended. Correlation between the scales was analyzed. Forty-four patients attended our hospital for evaluation of secondary lower extremity lymphedema. The most common cause of lymphedema was a postoperative complication of a malignant tumor (32 patients; 72.5%). Correlation analysis showed that lymphoscintigraphy and ICG DB (anterior) stage (r = 0.92), lymphoscintigraphy and ICG DB (posterior) stage (r = 0.94), and lymphoscintigraphy and MDACC stage (r = 0.93) exhibited very strong positive correlations. Intrarater agreement between lymphoscintigraphy and ICG DB (posterior) stage was substantial (κ = 0.65), and moderate between lymphoscintigraphy and ICG DB (anterior) stage (κ = 0.59) and lymphoscintigraphy and MDACC stage (κ = 0.52). Lymphedema severity stages and MCDs exhibited moderate positive correlations. Conclusion: Lymphoscintigraphy and ICG lymphography stage were strongly and positively correlated. These studies can work synergistically as complementary studies of lymphedema severity.

Correlation of ICG lymphography and lymphoscintigraphy severity stage in secondary upper limb lymphedema.

PURPOSE: To examine the correlation between lymphedema severity stages on lymphoscintigraphy and on indocyanine green (ICG) lymphography in patients with secondary lymphedema after breast cancer. MATERIALS AND METHODS: This retrospective study was conducted on patients who underwent both lymphoscintigraphy and ICG lymphography for the evaluation of secondary lymphedema after breast cancer. The images were classified into type I - V according to the Arm Dermal Backflow (ADB) stage and modified MD Anderson Cancer Center (MDACC) stage on ICG lymphography and lymphoscintigraphy images on the basis of how lymphatic flow was preserved and how dermal back flow was extended. The correlation between scales was analysed. RESULTS: A total of 47 patients were referred to our hospital for the evaluation of secondary lymphedema after breast cancer. There was no significant difference between lymphoscintigraphy severity scale and ADB stage (anterior and posterior). The lymphoscintigraphy severity scale and modified MDACC stage were significantly different. In the correlation analysis, lymphoscintigraphy and ADB (anterior) stage (r = 0.83), lymphoscintigraphy and ADB (posterior) stage (r = 0.86) and lymphoscintigraphy and modified MDACC stage (r = 0.85) exhibited very strong positive correlations. Intra-rater agreement between lymphoscintigraphy and ADB (anterior) stage and lymphoscintigraphy and ADB (posterior) was substantial (κ=0.62 and κ=0.69, respectively) and fair (κ = 0.36) between lymphoscintigraphy and modified MDACC stage. CONCLUSION: Lymphoscintigraphy severity stage and ADB stage on ICG lymphography showed very strong positive correlation and substantial agreement. These two modalities can work synergistically to evaluate lymphedema severity.

Effect of lidocaine on pain caused by nasal pack removal after closed reduction of nasal bone fractures.

BACKGROUND: Pain caused by nasal pack removal after closed reduction of nasal bone fractures is a common problem. This study investigated the effect of infiltrating lidocaine into nasal packs on the pain caused by pack removal after closed reduction of nasal bone fractures. METHODS: Seventy-five patients who underwent closed reduction of nasal bone fractures between March 2016 and March 2018 were enrolled in this prospective, randomized, single-blind study. Merocel (hydroxylated polyvinyl acetate) packs were applied bilaterally and retained for 5 days. Twenty minutes before removal, both packs were rehydrated with 6 mL of 2% lidocaine in 26 patients and with 6 mL of saline in 24 patients; the packs were not rehydrated in 25 patients. Visual analog scale (VAS) scores for pain on removal were recorded. RESULTS: The mean VAS score was 5.3±2.0 in all patients, 3.8±1.5 in the lidocaine group, 5.8±1.4 in the saline group, and 6.3±2.1 in the non-rehydrated group. There was a significant difference in the pain score between the lidocaine and saline groups (P<0.001) but not between the saline and non-rehydrated groups (P=0.186). CONCLUSIONS: Infiltration of lidocaine into Merocel packs reduced the pain caused by pack removal after closed reduction of nasal bone fractures.

Nasal tip plasty using three-dimensional printed polycaprolactone (Smart Ball®).

BACKGROUND: Rhinoplasty is one of the most commonly performed cosmetic surgery procedures. Most Asians desire elevation of their relatively flat nasal dorsum and tip to make them appear more prominent. This study introduces a simple method of nasal tip plasty using three-dimensional (3D)-printed polycaprolactone (PCL) (Smart Ball®), which provides the required length and volume for this purpose and enables the creation of a nasal tip of the desired shape in a safe and simple manner. METHODS: Between September 2014 and May 2017, 22 patients participated in a survey to assess postoperative satisfaction levels. Additionally, three plastic surgeons compared patients' pre- and 1-year postoperative photographs to evaluate the results. All patients underwent 2- to 4-year postoperative follow-up. RESULTS: Levels of subjective satisfaction among patients were 3.59, 3.50, 3.82, 3.73, 3.55, and 3.82 for each of the 6 categories evaluated, with a mean of 3.67/4 points, indicating high satisfaction levels. The mean plastic surgeon-reported score for the 22 patients was 4.47/5 points, which also indicates highly successful outcomes. Postoperative nasal tip rotation and tip projection were ideal in most patients. CONCLUSION: Our novel method using 3D-printed PCL (Smart Ball®) provides the optimal length and volume required for nasal tip plasty and enables the creation of a nasal tip of the desired shape, in a safe and simple manner. An advantage of our method is that it retains the original nasal structure in contrast to structural changes observed with the use of conventional methods.

A novel technique for placing titanium mesh with porous polyethylene via the endoscopic transnasal approach into the orbit for medial orbital wall fractures.

BACKGROUND: The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. METHODS: Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. RESULTS: Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. CONCLUSIONS: We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

Investigation of the dorsolateral branch of the posterior intercostal artery for use as the pedicle of a free flap: A cadaveric study and case series.

BACKGROUND: The dorsolateral branch of the posterior intercostal artery (DLBPI) can be easily found while harvesting a latissimus dorsi (LD) musculocutaneous flap for breast reconstruction. However, it remains unknown whether this branch can be used for a free flap and whether this branch alone can provide perfusion to the skin. We examined whether the DLBPI could be reliably found and whether it could provide sufficient perfusion. METHODS: We dissected 10 fresh cadavers and counted DLBPIs with a diameter larger than 2 mm. For each DLBPI, the following parameters were measured: distance from the lateral margin of the LD muscle, level of the intercostal space, distance from the spinal process, and distance from the inferior angle of the scapula. RESULTS: The DLBPI was easily found in all cadavers and was reliably located in the specified area. The average number of DLBPIs was 1.65. They were located between the seventh and eleventh intercostal spaces. The average length of the DLBPI between the intercostal space and the LD muscle was 4.82 cm. To assess the perfusion of the DLBPIs, a lead oxide mixture was injected through the branch and observed using X-rays, and it showed good perfusion. CONCLUSIONS: The DLBPI can be used as a pedicle in free flaps for small defects. DLBPI flaps have some limitations, such as a short pedicle. However, an advantage of this branch is that it can be reliably located through simple dissection. For women, it has the advantage of concealing the donor scar underneath the bra band.