Refining the Latissimus Dorsi Flap: A Useful Tool to Salvage Complex Breast Defects.

The latissimus dorsi flap has been used to reconstruct mastectomy defects for more than 100 years. It has remained relevant in breast reconstruction because of its consistent anatomy, robust vascular supply, congruent vector, and ability to cover large surface areas. With the evolution of oncologic and reconstructive techniques as well as improvements in prosthetic devices, however, this myocutaneous flap has largely fallen out of favor in primary breast reconstruction. Our experience demonstrates that the latissimus dorsi flap remains a versatile flap that may be tailored to reconstruct various oncologic breast defects and deformities in an expeditious fashion.

A Deceptive Diagnosis: Pyoderma Gangrenosum After Breast Surgery-A Case Series and Literature Review.

Postsurgical pyoderma gangrenosum is a rare neutrophilic dermatosis that presents with characteristic ulcerative lesions and systemic signs and symptoms of inflammation. It has been well documented after both cosmetic and reconstructive breast surgeries. Given its similarity to postoperative infectious processes, a high index of suspicion is necessary to initiate treatment with immunosuppression and avoid unnecessary and potentially disfiguring debridements. We present our experience with 4 cases of pyoderma gangrenosum after breast reconstruction and review the existing literature regarding pyoderma gangrenosum after breast surgery.

Dupuytren's Contracture: An Evidence Based Review.

Dupuytren's contracture, a benign condition characterized by fibrosis of the palmar and digital fascia, may be a debilitating condition that limits daily function. Several techniques exist for managing symptomatic contractures of the hand related to Dupuytren's. These techniques include the more invasive open fasciotomy or fasciectomy. More recently, less invasive techniques including administration of collagenase Clostridium histolyticum (CCH) or percutaneous needle aponeurotomy (PNA) have become part of the treatment armamentarium. A comprehensive review of the literature is performed and an algorithm for management of Dupuytren's contracture is proposed.

Is There an Association between Component Separation and Venous Thromboembolism? Analysis of the NSQIP.

BACKGROUND: Patients undergoing incisional/ventral hernia repair are at risk of developing several postoperative complications particularly venous thromboembolism (VTE), which is a major cause of morbidity and mortality. The aim of this study was to assess 30-day postoperative morbidity and mortality of patients undergoing incisional/ventral hernia repair and to determine the association between component separation and VTE. METHODS: We reviewed the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program databases to identify patients undergoing incisional/ventral hernia repair. Preoperative variables and postoperative outcomes were compared between a component separation group and a non-component separation group. The χ(2) tests and Fisher's exact test were used for categorical variables and t tests for continuous variables. Logistic regression analysis was performed to determine preoperative predictors for complications in both groups. RESULTS: Thirty-four thousand five hundred forty-one patients were included in our study; 501 patients underwent a component separation procedure. A higher rate of wound complications, minor/major morbidity, mortality, and return to the operating room occurred in the component separation group. However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively). Several risk factors were significantly associated with postoperative complications in both groups. CONCLUSIONS: Component separation is used for large and complex incisional/ventral hernia repairs to achieve tension-free midline closure. Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.

Location, location, location: cytokine concentrations are dependent on blood sampling site.

OBJECTIVE: Considerable breakthroughs in the field of sepsis have been made using animal models. Sepsis exhibits a wide array of derangements that may be evaluated in the blood, including the release of proinflammatory and anti-inflammatory cytokines. The Shock journal adheres to the ARRIVE guidelines regarding reporting in vivo results to allow reproducibility of data findings. It is generally assumed that blood cytokine concentrations collected from typical sampling sites will be similar, but there are no data validating that this is true. The main purpose of the present study was to determine if the location of blood sampling results in cytokine concentration differences following inflammatory insults. METHODS: Two different models of acute inflammation were studied. Adult, female ICR (Institute of Cancer Research) mice were injected with Escherichia coli lipopolysaccharide (n = 28) or subjected to cecal ligation and puncture (n = 16). They were killed at early time points following these inflammatory challenges for the collection of blood from the facial vein, retro-orbital sinus, and heart. Additional samples were collected in EDTA and heparin. Plasma cytokines from the same mouse were collected from each sampling site and evaluated by enzyme-linked immunosorbent assay. Clinical chemical parameters including plasma blood urea nitrogen and total protein were also analyzed. RESULTS: Regardless of model, time of collection, or cytokine measured, cytokine values from heart blood were higher than facial vein values from the same mouse. Interleukin (IL-6) collected from the heart relative to the facial vein demonstrated elevated concentrations following injection of lipopolysaccharide. In a similar manner, higher concentrations of IL-6, macrophage inflammatory protein 2, IL-10, and IL-1 receptor antagonist were found in cardiac puncture samples compared with other sampling sites 24 h after sepsis induced by cecal ligation and puncture. Similar differences were not seen when comparing blood urea nitrogen and total protein values from the two different sites. Using plasma IL-6 collected from the heart would incorrectly stratify predicted-to-live mice into the predicted-to-die category. Therefore, a simple linear regression model was developed to correctly restratify mice to their predicted fate. These data demonstrate that proinflammatory and anti-inflammatory cytokine concentrations are dramatically elevated when drawn centrally from the heart compared with collection from peripheral locations such as the facial vein. It is critical for publications to document the sampling location when evaluating plasma cytokines and attempting to compare studies.