Comparative Analysis of Sterile Freeze-Dried Versus Sterile Pre-Hydration Acellular Dermal Matrix in Implant-Based Breast Reconstruction.

INTRODUCTION: Implant-based breast reconstruction currently represents the most popular form of breast reconstruction. Acellular dermal matrix (ADM) is a biological scaffold which is used for inferolateral implant coverage in implant-based breast reconstruction. There are two types in the way when using ADM, freeze-dried type and pre-hydrated type. In this study, we focused on complication and aesthetic outcome resulting from freeze-dried type or pre-hydrated type. PATIENTS AND METHOD: Through retrospective chart review, we analysed 78 patients (using 26 freeze-dried type, 52 pre-hydrated type, MegaDerm; L&C BIO, Seongnam, Korea) from January 2016 to February 2019. Complications such as skin inflammation, wound dehiscence, skin necrosis, infection, nipple-areolar necrosis were assessed with medical chart review with post-operative photographic findings by two independent assessors. Drainage amount of operative site and retention period of drainage was checked. Assessment for aesthetic outcome categorized into five parts, shape, volume, symmetry, nipple-areolar complex and scar. Two independent assessors undertook visual analogue scale of 1 (very dissatisfied) to 5(very satisfied) at 1 year after the surgery. And the symmetry of breast was evaluated subjectively by the patient for the same scale. If the implant was removed, aesthetic outcome assessment has not been implemented. RESULTS: In aesthetic assessment, the category of shape assessed by clinician and symmetry assessed by patient showed higher in pre-hydrated type group with significant differences. In the pre-hydrated type group, the other aesthetic outcomes including the categories of shape, size, symmetry and texture were not statistically significant, but higher. In complication, the result showed no significant difference between the two groups. In addition, there was no difference in the amount of drainage. CONCLUSIONS: Pre-hydrated type ADM is designed to be softer than freeze-dried type. We could predict pre-hydrated type would provide better texture of breast. Indeed, in this study, the shape showed better in pre-hydrated group, which was related to the nature of texture. Also, it also showed better results in the volume, symmetry, nipple-areolar complex and scar and may be related to skin thickness or remaining soft tissue after mastectomy procedure. In future studies, it should be conducted with consideration of post-mastectomy factors. LEVEL OF EVIDENCE III: 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 .

Gluteus Maximus Muscle Flap in Tongue in Groove and Wrap Around Pattern for Refractory CSF Leakage in Extradural Cyst Patient.

Spinal extradural arachnoid cyst (SEAC) is a rare disease and has surgical challenges because of the critical surrounding anatomy. We describe the rare case of a 58-year-old woman who underwent extradural cyst total excision with dural repair and presented with refractory cerebrospinal fluid (CSF) leakage even though two consecutive surgeries including dural defect re-repair and lumbar-peritoneal shunt were performed. The authors covered the sacral defect using bilateral gluteus maximus muscle flap in tongue in groove and wrap around pattern for protection of visible sacral nerve roots and blockage of CSF leakage point. With the flap coverage, the disappearance of cyst and fluid collection was confirmed in the postoperative radiological finding, and the clinical symptoms were significantly improved. By protecting the sacral nerve roots and covering the base of sacral defect, we can minimize the risk of complication and resolve the refractory fluid collection. Our results suggest that the gluteus muscle flap can be a safe and effective option for sacral defect and CSF leakage in extradural cyst or other conditions.

Ultrasonographic Assessment of the Cutaneous Changes Induced by Topical Use of Novel Peptides Comprising Laminin 5.

Background Laminin 5, which is found in the basement membrane of dermal-epidermal junction (DEJ), is a major adhesive component and associated with proliferating and migrating keratinocytes. In this study, we hypothesized that the topical application of the skin care products containing the novel peptides might restore the DEJ structure by deriving deposition of laminin 5 and promoting the keratinocyte migration. Here, we evaluated the restoration of DEJ by measuring the skin thickness. Methods Single-center retrospective analysis was performed on a total of 13 patients who underwent skin care using Baume L.C.E. (France, Laboratories d' Anjou) between January and March 2021. All patients applied the skin care agent for 2 weeks only on their left hand dorsum. Before the initiation of the application and after 2 weeks, both their hands were evaluated on photography and ultrasound. And the patients were asked to rate their satisfaction with the questionnaire after 2 weeks. Results There was no obvious improvement in photographic assessment and questionnaire. The post-pre difference of skin thickness in ultrasound images was, in left hand, 0.1 ± 0.37 in distal point and 0.1 ± 0.35 in proximal point; and, in right hand, 0 ± 0.17 in distal point and 0 ± 0.15 in proximal point, respectively. The pre-post difference was statistically significant in proximal point ( p = 0.035). Conclusion Topical application of novel peptide derivative comprising laminin 5 demonstrated cutaneous changes including skin thickness, as assessed by ultrasound. Further studies using other modalities including dermal density measurement, three-dimensional photography, optical coherence tomography, or skin biopsy would be helpful to determine the skin-improving effects.

Speech Outcomes of Treatment for Velopharyngeal Insufficiency: Combined Use of an Overlapping Intravelar Veloplasty and Dynamic Sphincter Pharyngoplasty.

BACKGROUND: Velopharyngeal insufficiency involving a large velopharyngeal gap and poor lateral wall movement is referred to as a "black hole" and remains a challenging problem for cleft surgeons. The effect of the pharyngeal flap on this form of velopharyngeal insufficiency is still debatable because a wide pharyngeal flap is associated with a high incidence of airway obstruction. The present study aimed to evaluate the speech outcomes of combined overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency. METHODS: Between March 2016 and June 2019, 15 patients with velopharyngeal insufficiency were treated with a combination of overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty. Preoperative speech evaluation was performed on the basis of perceptual speech evaluation, nasometry, and nasoendoscopy. Postoperative speech evaluation using the same approach as that used preoperatively was performed after completion of speech therapy. RESULTS: All 15 patients achieved satisfactory velopharyngeal port closure and speech phonation after completion of speech therapy. No additional procedures were performed to improve velopharyngeal port closure and speech production. The preoperative and postoperative results of perceptual speech evaluation, nasometry, and nasoendoscopy evaluation were significantly different (P < 0.01). CONCLUSION: Combined treatment with overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty can correct the velopharyngeal insufficiency "black hole" with highly reliable results and minimal risk of airway obstruction.

Impaction of a continuous glucose monitoring sensor.

A 33-year-old man presented to the plastic surgery department for foreign body removal 1 month after the insertion of a continuous glucose monitoring (CGM) sensor (Dexcom G5) in the left upper arm. The patient had used the CGM system for 5 years, and the insertion was done in the usual manner. The entire sensor wire was visible on simple radiography and ultrasonography. In the operating room, and the sensor wire was identified in the intermuscular septum and removed. No foreign body reaction or inflammatory signs were found around the CGM, and the extracted wire measured 2.5 cm. Thus, it was assumed that the whole sensor wire was detached from the transmitter, not fractured. No remnant foreign body was observed on follow-up simple radiography.

The Application of Ball Shaped Diced Conchal Cartilage Wrapped With Dermofat in Tip Plasty.

BACKGROUND: Based on previous reports, in comparison with Caucasian, nose anatomy has features that have to be considered by surgeons during the tip augmentation in Asian patients. Weak alar cartilages, thick soft-tissue envelope, and bifid-like tip in most cases. This case report demonstrates our experience of using ball-shaped diced conchal cartilage during the tip plasty in Asian patients. CASE REPORT: Twenty-seven-year-old female patient underwent tip plasty augmentation with ball shaped diced cartilage wrapped with dermofat. There were no complications in postoperative period. DISCUSSION: Based on the Asian nasal anatomy features, surgeons commonly use septal extension graft in tip projection and derotation. However, it is still challenging to perform it in patients with septal cartilage insufficiency. In this case report, the authors introduce the alternative surgical option for nasal tip augmentation. The ball shaped cartilage autologous implant can be successfully used in tip plasty.