Functional Outcomes Regarding Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects.

BACKGROUND: The surgical management and reconstruction after ablation of squamous cell carcinoma of the oral tongue and floor of mouth are quite challenging. If not reconstructed properly, the deficits resulting from the extirpation of even relatively small (T1 and T2) tumors of the tongue can impact speech and deglutition via tongue tethering and poor anterolateral mobility. Functional outcome studies regarding the utility of the pedicled facial artery musculamucosal (FAMM) flap for reconstruction of partial glossectomy defects are limited. METHODS: This is a retrospective single institutional study of patients who underwent FAMM flap reconstruction for oral cavity defects resulting from partial glossectomy (2009-2013). Follow-up data included postoperative complications, defect size, operative time, and subjective functional results (tongue mobility, speech, and swallowing capabilities).The MD Anderson Dysphagia Inventory and a limited self-assessment of speech were sent to all living patients in this initial tongue cancer cohort to assess aspects of functional status. RESULTS: Of the 21 patients studied in this initial FAMM flap cohort, 18 are currently living. The MD Anderson Dysphagia Inventory and a limited self-assessment survey of speech were sent to these individuals 6 months after treatment completion. Eight patients (44%) returned completed questionnaires. All of the respondents disagreed or strongly disagreed with the statement that they felt excluded from others because of their eating habits, 6 of the 8 of the respondents stated that they disagreed or strongly disagreed with the statement that they have to limit their food intake, and none felt that others were irritated by their eating habits. All felt that their speech was either good, very good, or excellent. No surveyed patient reported having job difficulty because of their speech. CONCLUSIONS: The FAMM flap is a reliable alternative for reconstruction of small oral tongue defects without functional deficits and a great alternative to free flap reconstruction of medium-sized defects. The encouragement of patient functional outcome studies and longitudinal follow-up studies need to be conducted in efforts to best tailor a reconstruction plan for patients with oral tongue cancers.

A Comparison of Barbed Sutures and Standard Sutures with regard to Wound Cosmesis in Panniculectomy and Reduction Mammoplasty Patients.

Cosmesis is a vital concern for patients undergoing plastic and reconstructive surgery. Many variations in wound closure are employed when attempting to minimize a surgical scar's appearance. Barbed sutures are one potential method of achieving improved wound cosmesis and are more common in recent years. To determine if barbed sutures differ from nonbarbed in wound cosmesis, we conducted a single-blinded, randomized, controlled trial of 18 patients undergoing bilateral reduction mammoplasty or panniculectomy. Patients were their own controls, receiving barbed sutures on one side and standard sutures on the contralateral side. Surgical scars were evaluated postoperatively by patient preference self-assessment and an observer. Ten patients were evaluated at 3 months postoperatively, yielding a mean Stony Brook Scar Evaluation Scale (SBSES) rating of 4.4 for barbed suture and 3.5 for regular suture (p = 0.15). At 6 months, 8 patients performed self-assessment to determine their preference; 4 preferred the barbed sutures, 1 preferred the regular sutures, and 3 had no preference. Further research with larger sample sizes is needed to determine if barbed sutures convey any advantage over standard sutures in wound healing. However, our results suggest that barbed sutures are a reasonable alternative to standard sutures particularly with regard to wound cosmesis.

Polycyclic Aromatic Hydrocarbons and Breast Cancer: A Review of the Literature.

Polycyclic aromatic hydrocarbons (PAHs) exist and persist in the atmosphere due to the incomplete combustion of fossil fuels, and are established human carcinogens. The influence of PAHs on the development of breast cancer, the most commonly diagnosed cancer in women worldwide, remains unclear. As established risk factors only account for approximately 41% of the breast cancer cases in the USA, researchers have sought to uncover environmental factors involved in breast cancer development. The breasts are particularly susceptible to aromatic carcinogenesis, and the implementation of biomarkers has provided promising insights regarding PAH-DNA adducts in breast cancer. The use of biomarkers measuring PAH-DNA adducts assesses exposure to eliminate the bias inherent in self-reporting measures in case-control studies investigating the link between PAHs and cancer. Adduct levels reflect exposure dose as well as how the body responds to this exposure, which is partially attributable to genetic variability. Evidence suggests that exposure to PAHs has a causational effect on breast cancer in humans, yet this interaction is not clearly understood. In vitro and animal-based studies have consistently revealed that exposure to PAHs deleteriously affects breast tissue, but there is no definitive link between these compounds and breast cancer.

Lymphatic mapping in the treatment of chronic seroma: a case series.

OBJECTIVE: Seromas or lymphoceles are common postoperative complications. This series presents 3 patients with lower extremity seromas refractory to treatment that required lymphatic mapping and lymphatic ligation for closure, and in 1 case, diagnosis. METHODS: Lymphatic mapping procedure consisted of intraoperative injection of subcutaneous tissue with methylene blue distal to the seroma with observation of dye effluence from transected or injured lymphatics draining into area of seroma. RESULTS: In 2 patients, methylene blue dye absorption into lymphatic vessels allowed for optimized visual identification of lymphatic leak and contrast against surrounding tissues. In the third patient, where no lymphocele leak was found, the study was diagnostic and helped to find an alternate etiology for the recurrent seroma. CONCLUSION: Lymphatic mapping with methylene blue dye is an effective tool in the evaluation and diagnosis of chronic seroma.

The correlation between ultrasound findings and clinical assessment of pressure-related ulcers: is the extent of injury greater than what is predicted?

The current staging system by the National Pressure Ulcer Advisory Panel (NPUAP) classifies the stages of pressure ulcers (PUs) based on clinical assessment and visual inspection. We postulate that patients presenting with clinically superficial PUs (Stage I and Stage II) will have a greater depth of injury than predicted. On admission, patients with sacral PUs were staged according to the NPUAP classification system. Patients who were classified as having a Stage I or Stage II ulcer or suspected deep tissue injury were assessed with high-frequency (12-MHZ) ultrasonography (US) to identify any evidence of injury to the deep tissue. The study included 20 patients undergoing US for PUs of the sacrum. All patients, regardless of PU stage were found to have some evidence of deep tissue injury upon ultrasonographic examination. In patients with suspected deep tissue injury, we have found US to be a reliable diagnostic tool that confirms the clinical suspicion of deep tissue injury. PUs classified as superficial may have a component of deeper tissue damage.

Spinal reconstruction for osteomyelitis with free vascularized fibular grafts using intra-abdominal recipient vessels: A series of three cases.

Reconstruction of bony defects in the surgical management of vertebral osteomyelitis is a challenging endeavor. Our objective is to report the use of intra-abdominal vessels as the recipient vessels for microanastomosis of vascularized bone graft and the use of a spinal cage for fixation. Three patients failed conservative treatment for vertebral osteomyelitis and suffered pathologic fracture. Their treatment consisted of staged posterior irrigation and debridement with segmental fixation, followed by a thoracoabdominal approach multiple-level corpectomy. Reconstruction was performed with a free vascularized fibular graft placed within a custom, expandable cage. The vascularized fibular graft was anastomosed to an intra-abdominal recipient vessel. All patients improved clinically with no neurologic deficits noted. All showed evidence of successful fusion. Free vascularized bone grafts continue to be an excellent option for multi-level spinal defects related to osteomyelitis. Intra-abdominal recipient vessels are appropriate recipient vessels, as their diameter, length, and accessibility allow vascularized bone graft reconstruction of vertebral column defects of the thoracolumbar region. These vessels are also easily accessible and the anastomoses can be performed in the superficial operating incision.

The use of hemoglobin saturation ratio as a means of measuring tissue perfusion in the development of heel pressure sores.

The heel is a common site of pressure ulcers. The amount of pressure and time needed to develop these wounds is dependent on various factors including pressure surface, the patient's anatomy, and co-morbidities. We studied the use of the hemoglobin saturation ratio as a means of assessing heel perfusion in various pressure settings. The mixed perfusion ratio in the heels of 5 volunteers was assessed on 3 pressure surfaces and at the time of off-load. The surfaces studied included: stretcher pad, plastic backboard without padding, and pressure reduction gel. Each surface was measured for 5 minutes with a real-time reading. On the stretcher, the average StO2% decrease for each pressure surface was 26.2 ± 10 (range 18-43). The average StO2% decrease on the backboard was 22.8 ± 12.3 (range 8-37), and 24.0 ± 4.8 (range 19-30) on the gel pad. The StO2% drop plateaued with the stretcher and gel pad, but with the backboard there was a continued slow drop at 5 minutes. This study demonstrates that hemoglobin oxygenation ratio may be effective in assessing a tissue's direct perfusion in the setting of tissue pressure and may also be beneficial to better assess the effects of pressure-reduction surfaces. Further studies will be needed to determine time to skin breakdown as it pertains to pressure and tissue oxygenation.

Low-impact trauma causing acute compartment syndrome of the lower extremities.

Compartment syndrome usually occurs in the muscles of an extremity as a consequence of trauma or reperfusion. However, it can also occur from minor injuries with resulting hematoma.We reviewed the charts of 5 individuals who presented to the emergency department after minimal or no known trauma and were ultimately diagnosed with acute compartment syndrome. None sustained fractures, and 2 had documented muscle tears. All patients were found to have hematomas in the affected compartment at the time of surgery. Low-impact trauma can cause acute compartment syndrome in the lower extremities. These cases could be the result of muscle hemorrhage and subsequent hematoma formation, rather than muscle swelling itself. Anticoagulation therapy can increase the risk of hemorrhage.