Utilizing the Subunit Concept to Achieve Better Outcomes in Lower Limb Reconstruction: A Clinical Experience in an Asian Population.

Background: The goals of reconstruction have progressed from filling a defect to enhancing function and aesthetic appearance. We aimed to achieve better aesthetic and functional outcomes in terms of shoe fitting and mobility. This is accomplished via a classification of the subunits and aesthetic considerations of the lower limb. Methods: Between April 2017 and December 2021, 66 cases of lower extremity free fasciocutaneous flap reconstruction cases were included in this retrospective study. Data parameters include age, sex, comorbidities, etiology of lower limb wounds, choice of free flap reconstruction, recipient arterial vessels, complications of flap reconstruction, and need for secondary debulking procedures. Physiotherapy records were also examined to determine the time to independent ambulation. Results: In total, 66 subjects were identified. The mean age was 48.6. An estimated 74.2% (n = 49) were men, 50% (n = 33) had diabetes, and 16.6% (n = 11) had peripheral vascular disease. Of the total wounds, 65.1% (n = 43) were caused by infection, whereas the remaining 34.9% (n = 23) were due to trauma. Of the cases, 72.7% (n = 48) had free anterolateral thigh flap reconstruction, 25.8% (n = 17) were reconstructed with superficial circumflex iliac artery perforator flaps, and 1.5% (n = 1) was reconstructed with medial sural artery perforator flaps. Cases that required secondary debulking procedures comprised 7.6% (n = 5). Conclusions: Free fasciocutaneous flaps are useful in lower extremity reconstruction. Based on the subunit principle and aesthetic considerations for lower limb reconstruction, it can aid in optimizing functional rehabilitation and decreasing secondary procedures.

The Evolution of Patients' and Surgeons' Perspectives Towards the Role of the Internet and Social Media in Breast Augmentation Over 5 Years.

BACKGROUND: The influence of the internet and social media (SoMe) in the decision-making of patients is recognized. Plastic surgeons are aware of this trend but are entangled between ethics, professionalism, and business acumen. OBJECTIVES: In this study, the authors presented the evolution of perspectives of patients and surgeons recruited through a private clinic over 5 years. METHODS: A questionnaire was administered to patients consulting for primary breast augmentation in 2014, 2017, and 2019. Plastic surgeons who worked at or visited the Akademikliniken in 2014, 2017, and 2019 completed a separate questionnaire. RESULTS: In total, 1646 patient responses were collected. Patients who started their information gathering with the internet increased from 68.0% to 72.9%, and 94.1% of patients looked for information about aesthetic surgery on the internet before their consultation. Patients who read about aesthetic surgery on SoMe increased 29.1%. Of 462 surgeons recruited, 62% opined that the majority of patients had gathered information online before consultation. Fewer surgeons in 2019 thought that the internet and SoMe led to better information (down from 61.7% to 35.2%). An increase from 38.3% to 65.3% of surgeons attributed it to unrealistic expectations. However, only 9.7% of surgeons would support removal of plastic surgery material from SoMe compared with 21.9% in 2014. CONCLUSIONS: The increased utilization and influence of the internet and SoMe on patients and surgeons is rapid. Aesthetic plastic surgeons must equip themselves to cope with the risks and capitalize on the opportunity for patient engagement and public education.

Transitioning From Conventional Textured to Nanotextured Breast Implants: Our Early Experience and Modifications for Optimal Breast Augmentation Outcomes.

BACKGROUND: Nanotextured breast implants were hailed as an innovation that may address capsular contracture and breast implant-associated anaplastic large cell lymphoma and may provide the sweet spot between smooth and conventional textured implants. OBJECTIVES: This study aimed to evaluate the introduction of nanotextured implants alongside conventional textured implants and to compare early complications. METHODS: Patients who underwent breast augmentation from the introduction of nanotextured implants in the author's practice with at least 1 year of follow-up were included. They were divided into nanotextured and conventional textured implant groups and then into 3 chronological subgroups. Patient characteristics, implant specifications, operative factors, and complication rates were compared. RESULTS: A total 415 cases with a mean follow-up of 26.9 months were identified, of which 38.8% utilized nanotextured implants and 61.2% conventional textured implants. Utilization of nanotextured implants increased from 26.9% in period 1 to 54.5% in period 3. Complication rates for the conventional textured group were 0.8% at 1 year and 3.5% on overall follow-up, with mostly capsular contractures; for the nanotextured group, complication rates were 6.8% and 8.7%, respectively, and "bottoming out" was most common. When analyzed across chronological subgroups, complication rates decreased for nanotextured implants by period 3. CONCLUSIONS: A learning curve and associated complications are expected for early adopters of new implants. In our series, nanotextured implants were associated with higher complication rates at 1 year and on overall follow-up. Modifications in patient selection, intraoperative techniques, and postoperative care reduced complications in the later period.

Mitochondrial permeability transition as a source of superoxide anion induced by the nitroaromatic drug nimesulide in vitro.

Nimesulide, a widely used nonsteroidal anti-inflammatory drug containing a nitroaromatic moiety, has been associated with rare but serious hepatic adverse effects. The mechanisms underlying this idiosyncratic hepatotoxicity are unknown; however, both mitochondrial injury and oxidative stress have been implicated in contributing to liver injury in susceptible patients. The aim of this study was, first, to explore whether membrane permeability transition (MPT) could contribute to nimesulide's mitochondrial toxicity and, second, whether metabolism-derived reactive oxygen species (ROS) were responsible for MPT. We found that isolated mouse liver mitochondria readily underwent Ca2+-dependent, cyclosporin A-sensitive MPT upon exposure to nimesulide (at >or=3 microM). Net increases in mitochondrial superoxide anion levels, determined with the fluorescent probe dihydroethidium, were induced by nimesulide only in the presence of Ca2+ and were cyclosporin A-sensitive, indicating that superoxide production was a consequence, rather than the cause, of MPT. In addition, nimesulide caused a rapid dissipation of the inner mitochondrial transmembrane potential (at >or=3 microM), followed by a concentration-dependent decrease in ATP biosynthesis. Because nimesulide, unlike the related nitroaromatic drug nilutamide, did not produce any detectable ROS during incubation with mouse hepatic microsomes, we conclude that mitochondrial uncoupling causes MPT and that ROS production is a secondary effect.