Pronator Quadratus Muscle Flap for Prevention of Flexor Tendon Rupture after Distal Radius Volar Plating.

Background: Flexor tendon rupture is a serious but rare complication that can occur after volar plating of distal radius fractures. This study aims to introduce a novel surgical technique that uses a pronator quadratus (PQ) muscle flap transposition to protect the flexor tendons from rupture or irritation and evaluate its outcomes. Methods: A retrospective review was conducted on 204 patients with unstable distal radius fractures who underwent a standard volar flexor carpi radialis approach with extended release of the PQ muscle during exposure. A PQ muscle flap was harvested and transposed over the distal edge of the plate after open reduction and internal fixation of the distal radius. Postoperatively, patients were evaluated for flexor tendon irritation and rupture. Patients who had this injury before the use of the PQ flap were compared with the patients who received the PQ flap. Results: Of the 204 patients, 119 received the PQ flap, and 85 did not. The mean follow-up time was 30.4 months. Among the patients who did not receive the PQ flap, five (5.9%) required plate removal or conservative treatment for tendon irritation or rupture. In contrast, only one patient (0.8%) who received the PQ flap required plate removal for flexor tendon irritation. Conclusions: The PQ muscle flap is a quick and effective surgical technique that reduces the risk of flexor tendon rupture or irritation during distal radius fracture fixation. The PQ muscle flap acts as a buffer between the plate and tendon and is more effective than not transposing the muscle.

Orbito-scleral-sinus invasion of basal cell carcinoma in an immunocompromised patient on vismodegib.

A 45-year-old man presented with a progressively enlarging left lower lateral eyelid lesion. The initial biopsy was inconclusive; however, a repeat biopsy 5 years later revealed infiltrative morpheaform basal cell carcinoma with sclerosis. Two years later, the patient presented with ophthalmoplegia of the left eye. Computed tomography illustrated a heterogeneous enhancing soft tissue mass in the inferolateral orbit with erosion into the globe. Despite treatment with vismodegib for 1 year, the lesion progressed to involve the entire left lower eyelid and corneal-scleral junction with adjacent maxillary sinus invasion. The patient tested positive for human immunodeficiency virus and underwent a left orbital exenteration followed by adjuvant radiotherapy. The patient remained stable with no evidence of recurrent disease or distant metastasis 2 years after exenteration. This rare case highlights a neglected basal cell carcinoma in those immunocompromised with histopathological correlation of the aggressive disease on to the globe.

Accidental Magnetic Resonance Imaging Activation of Carbon Dioxide Tissue Expanders.

Implant-based reconstruction is the most common form of breast reconstruction following mastectomy. It is most often performed in 2 stages using saline-based tissue expanders, which are then exchanged for permanent implants. Serial expansions are performed by accessing a port in the office, an inconvenient and sometimes painful process. A carbon dioxide tissue expander is a device that provides a needle-free, patient-controlled expansion utilizing a remote-controlled CO2 canister. While a patient-controlled expansion offers convenience, given that the CO2 reservoir holds approximately 1500 mL of gas, the potential for malfunction resulting in an uncontrolled expansion in unique to this device. The authors present a case report of a patient with bilateral pre-pectoral tissue expanders who underwent magnetic resonance imaging, resulting in uncontrolled expansion.

Primary selection of a pedicled rectus femoris flap for protection of aortic graft.

The rectus femoris pedicled muscle flap is a widely used option for coverage of infected vascular grafts in groin reconstruction as well as in reconstruction of abdominal wall defects. Here we present the case of primary placement of a pedicled rectus femoris flap to provide well-vascularized tissue interposed between an aortic Dacron interposition graft and bowel. This previously undescribed use of the rectus femoris proves to be an indispensable method when the more common alternatives, such as omental and rectus abdominis flaps, are not available.

Gender Affirmation Surgery From a Public Health Perspective: Advances, Challenges, and Areas of Opportunity.

Gender affirmation surgery (GAS) is sought out by approximately 20 to 40% of transgender individuals. These patients possess unique mental and physical health needs. These are compounded by prejudices and lack of education about transgender individuals within the medical system and society at large. Societal and medical barriers are associated with increased risks of violence, suicide, and sexually transmitted infections. This combination of high medical needs and barriers to accessing appropriate care may give rise to a self-perpetuating cycle of risk exposure, stigmatization, prejudice, and eventually poor health outcomes. It is imperative that plastic and reconstructive surgeons understand GAS from a public health perspective, so that they may provide the highest quality of care and help alleviate these disparities. The authors describe unique public health topics in GAS. These are specifically related to healthcare access, surgical education, cultural sensitivity, as well as mental health outcomes for patients who undergo GAS.

Multipotent Mesenchymal Stromal Cells for Pulmonary Fibrosis?

With the combination of ideologic beliefs and the will to survive, fraught patients and determined clinicians seek alternative therapies for treatment of terminal conditions, such as idiopathic pulmonary fibrosis. Unfortunately, the need for treatment has supported the growth of unapproved stem cell therapy over the years spanning across many countries. The reality, however, is that the science behind this therapy is lagging. While there have been promising results from phase I trials, there remain multiple reasons that "stem cells" are not ready for clinical application, starting from a gap in understanding at the bench research level, all the way to optimal clinical application in order to provide effective therapy.

Iatrogenic Conchal Defect Secondary to Auricular Cartilage Graft.

BACKGROUND: Cleft lip and palate are the most common craniofacial congenital malformations. Timing of the nasal repair remains somewhat controversial. Some authors perform a combined nasal and lip repair in infancy while others advocate for a staged repair with the nasal component occurring later in childhood. Frequently, secondary repair is needed to address residual nasal deformities in early adulthood. Conchal cartilage has become increasingly popular as a source of cartilage for secondary reconstruction. Donor site morbidities include hematoma formation, scar formation, and wound healing complications. To the best of the authors' knowledge, there is 1 previous report of a full through-and-through conchal defect as a complication of auricular cartilage graft harvesting. The authors report an infrequently described iatrogenic conchal defect due to cartilage harvesting managed with a single-stage reconstruction using bookend flaps. METHODS: A 19-year-old female with a history of unilateral cleft lip and palate repair underwent secondary rhinoplasty using conchal cartilage. A bolster dressing was applied to the conchal harvest site. The patient was unable to attend her postoperative clinic visit and was eventually seen 2 months postoperatively with the bolster still in place. A full-thickness conchal defect was present when the bolster was removed. RESULTS: A pressure dressing such as a bolster is commonly used to prevent hematoma formation after conchal cartilage graft harvesting. This is routinely removed during the initial postoperative visit. Prolonged placement can result in donor site complications such as a full-thickness conchal defect. CONCLUSION: A functional and aesthetic reconstruction of a full-thickness iatrogenic conchal defect was achieved with excellent results using a local posterior flap, and 2 anteriorly based bookend flaps for closure. To the best of the authors' knowledge, this report is the first to describe a single-stage reconstruction of an iatrogenic defect in the concha as a complication of conchal cartilage harvesting.