Surgical Treatment for Primary Lymphedema: A Systematic Review of the Literature.

This is a retrospective review of surgical management for primary lymphedema. Data were extracted from 55 articles from PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials between the database inception and December 2022 to evaluate the outcomes of lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), and outcomes of soft tissue extirpative procedures such as suction-assisted lipectomy (SAL) and extensive soft tissue excision. Data from 485 patients were compiled; these were treated with LVA ( n = 177), VLNT ( n = 82), SAL ( n = 102), and excisional procedures ( n = 124). Improvement of the lower extremity lymphedema index, the quality of life (QoL), and lymphedema symptoms were reported in most studies. LVA and VLNT led to symptomatic relief and improved QoL, reaching up to 90 and 61% average circumference reduction, respectively. Cellulitis reduction was reported in 25 and 40% of LVA and VLNT papers, respectively. The extirpative procedures, used mainly in patients with advanced disease, also led to clinical improvement from the volume reduction, as well as reduced incidence of cellulitis, although with poor cosmetic results; 87.5% of these reports recommended postoperative compression garments. The overall complication rates were 1% for LVA, 13% for VLNT, 11% for SAL, and 46% for extirpative procedures. Altogether, only one paper lacked some kind of improvement. Primary lymphedema is amenable to surgical treatment; the currently performed procedures have effectively improved symptoms and QoL in this population. Complication rates are related to the invasiveness of the chosen procedure.

Quality of life assessment after microvascular head and neck reconstruction: a systematic review of available tools.

In this study, we aimed to appraise the quality and psychometric properties of quality of life (QOL) assessment tools used after microsurgical reconstruction for head and neck cancers. A systematic review of QOL assessment tools used in head and neck cancer patients after microsurgical reconstruction was performed; emphasis was placed on psychometric properties and validity. Fifty-four studies published between January 2010 and February 2023 fulfilled the criteria; in these, twenty-three different QOL assessment tools were identified. The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck version (EORTC-H&N). No assessment tool fulfilled all the quality criteria; no single tool presented evidence from all the components of validity. Almost all reported reliability coefficients were above 0.7; most papers reported an internal consistency coefficient (Cronbach's alpha) for the global score. The array of available tools allows for the choice of the most appropriate one depending on the context faced by the clinician or researcher.

Cosmetic Injection of Illicit Foreign Materials: Imaging Features and Patterns of Migration in 413 Cases.

BACKGROUND: The injection of illicit, nonregulated foreign materials is increasingly common and has negative consequences relative to the inflammatory process that ensues. OBJECTIVES: The aim of this study was to identify anatomical and imaging characteristics after the cosmetic injection of illicit foreign materials. METHODS: A retrospective review of clinical and imaging records was performed. The issues analyzed were the anatomical site, type of injected substance, imaging method for diagnosis, and patterns of migration. RESULTS: Data on 413 patients were collected. Most patients were female, with a mean age of 44 years. The most commonly infiltrated region was the buttocks (n = 284; 53.58%) followed by the breast (n = 99; 18.67%). Magnetic resonance imaging was the most common method of diagnosis in those patients who had an imaging study (159 out of 168). The most frequent depth of foreign material detected by imaging was the muscular plane (n = 103; 61.30%). Migration was detected in 56.55% of patients who had an imaging study. Most infiltrated substances were unknown; biopolymers were the most commonly identified substances. Depending on the type of substance, migration rates varied from 13% to 29%; rate differences were not statistically significant (P = .712). Migration was more common when the depth of infiltration was in muscle (77.66%) than in subcutaneous tissue (23.4%); this difference was statistically significant (P < .0001). CONCLUSIONS: Deep infiltration is related to greater migration rates, apparently regardless of the substance injected.

Autoimmune Autoinflammatory Syndrome Induced by Adjuvants (ASIA) After Injection of Foreign Materials for Cosmetic Purposes: Retrospective Analysis of 1027 Cases.

BACKGROUND: The injection of illicit, non-regulated foreign materials may trigger an autoimmune autoinflammatory syndrome induced by adjuvants (ASIA). METHODS: A retrospective review of health records was performed to identify patients' epidemiological and clinical characteristics. The issues analyzed were age and gender of cases, occupation, the person who administered the substance, anatomical site, type and volume of the injected substance, time from injection to the onset of symptoms, chief complaint, measures taken to alleviate symptoms, local complications, systemic manifestations, and imaging method to aid in diagnosis. RESULTS: More than 70% of patients were female and dedicated to household activities; the mean age was 44 years for females and 40.7 years for males. One-quarter of patients reported some comorbidity. The most commonly reported substance was mineral oil, whereas the most frequent anatomical site was the gluteal region with volumes around one liter. Signs and symptoms occurred almost exclusively at a local level, pain (40%) and swelling (18%) being the predominant manifestations with a peak incidence after three years. Treatment was mainly medical; surgery, primarily en bloc resection, was performed in 20% of patients. CONCLUSIONS: A myriad of substances may induce autoimmune autoinflammatory syndrome induced by adjuvants (ASIA) when injected for cosmetic purposes. Since effective treatments are scarce, public policies should be enforced to alert the community and limit the consequences of this healthcare problem. LEVEL OF EVIDENCE V: 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 .

National examination for medical residency admission: academic performance in a high-stakes test and the need for continuing education.

INTRODUCTION: Performance and selection rate of non-newly graduated physicians in a medical residency admission test as an indicator for the need of continuing education. METHODS: A database comprising 153 654 physicians who took a residency admission test in the period 2014-2018 was analysed. Performance and selection rates were assessed in relation to year of graduation and performance in medical school. RESULTS: The whole sample scored at a mean of 62.3 (SD ±8.9; range 1.11-91.11). Examinees who took the test in their year of graduation performed better (66.10) than those who took the test after their year of graduation (61.84); p<0.001.Selection rates differed accordingly; 33.9% for newly graduated physicians compared with 24.8% in those who took the test at least 1 year after graduation; p<0.001. An association between selection test performance and medical school grades was established using Pearson's correlation: r=0.40 for newly graduated physicians and r=0.30 for non-newly graduated physicians. There were statistically significant differences in selection rates for every ranking group of grades in medical school based on the χ2 test (p<0.001). The selection rates are decreased years after graduation even for candidates with high grades in medical school. DISCUSSION: There is an association between performance in a medical residency admission test and academic variables of the candidates: medical school grades and time elapsed from graduation to test taking. The evidence of decrease in retention of medical knowledge since graduation highlights the pertinence of continuing education interventions.

Intrafamilial transmission and clustering of COVID-19: a socioepidemiological perspective.

INTRODUCTION: The dynamics of COVID-19 transmission occurring in familial clusters may be related to sociodemographic and epidemiological characteristics of cases and contacts. The aim of this study was to identify the dynamics of COVID-19 transmission in families with more than one documented case. METHODOLOGY: Data of about 58 familiar clusters of COVID-19 was gathered and followed up clinically and by telephonic interview. Age, gender, social security plan, comorbidities, occupation, incubation, and symptoms were analyzed using Students' t-test and Chi squared test. RESULTS: The contacts were younger and healthier than cases, and students were predominant (28%). Among the symptomatic contacts, reverse transcription polymerase chain reaction yielded a positive rate of 69%. There were 2.93 contacts per case. Families with clustered cases had more family members when compared to families without clustered cases (4.2 vs. 3.3; p = 0.022). Mean age of contacts in families with clustered cases compared to families without clustered cases also showed differences (29.5 vs. 35.7; p = 0.047). CONCLUSIONS: Characterization of cases and contacts amidst a pandemic is essential for the effective implementation of health policies and research perspectives.

The Versatility of the DCIA Free Flap: A Forgotten Flap? Systematic Review and Meta-Analysis.

BACKGROUND: Studies reporting on the deep circumflex iliac artery (DCIA) free flap are restricted to a limited number of patients and areas of application. The aim of this review was to assess the reliability and versatility of the DCIA free flap during reconstruction. METHODS: A comprehensive review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, Web of Science, Cochrane CENTRAL, and SCOPUS. A critical analysis of pooled data was performed to assess outcomes employing the DCIA free flap. RESULTS: A total of 445 DCIA free flaps were included. The main recipient sites were head and neck (72.35%), lower extremity (20.67%), and upper extremity (6.74%). The main indications for reconstruction were tumor resection (73.8%) and trauma (17.43%). Fifty non-DCIA flaps were required to finalize the reconstruction of several defects. The pooled flap failure rate using the DCIA free flap was 4% (95% confidence interval: 1-8%). No significant heterogeneity was present across studies (Q statistic 22.12, p = 0.14; I 2 = 27.68%, p = 0.139). Complication rates for head and neck and limb reconstruction were 57.37 and 40.16%, respectively. The average length and surface area of bone flaps were 7.79 cm and 22.8 cm2, respectively. The area of the skin paddles was 117 cm2. CONCLUSION: The DCIA free flap has shown to be a versatile reconstructive alternative for head and neck and short-medium size limb defects. However, the complexity of functions, the recipient site location, and a potential large defect can detract from the use of the DCIA free flap as an initial reconstructive option for head and neck and extensive limb defects.

Myelomeningocele defect reconstruction with keystone flaps: vascular rationale for the design and operative technique.

BACKGROUND: Myelomeningocele is a frequently seen condition at tertiary care hospitals. Its treatment involves a variety of plastic reconstructive techniques. Herein, we present a series of myelomeningocele patients treated using keystone flaps. METHODS: We gathered information regarding soft tissue reconstruction and the use of bilateral keystone flaps to treat myelomeningocele patients. We obtained data from clinical records and recorded the demographic characteristics of mothers and children with the condition. The size, level of defect, and complications detected during the follow-up were analyzed. RESULTS: A series of seven patients who underwent bilateral keystone flaps for myelomeningocele closure was analyzed. There were no cases of midline or major dehiscence, flap loss, necrosis, surgical site infections, or cerebrospinal fluid leakage. No revision procedures were performed. Minor complications included one case with minimal seroma and three cases with areas of peripheral dehiscence that healed easily using conventional measures. CONCLUSIONS: The use of keystone flaps is an adequate option for closure of dorsal midline soft tissue defects related to myelomeningocele. This technique offers predictable results with an acceptable spectrum of complications. Robust blood flow can be predicted based upon anatomical knowledge.

Ultrathin free flaps for foot reconstruction: impact on ambulation, functional recovery, and patient satisfaction.

BACKGROUND: Plantar reconstruction is a complex procedure due to the paucity of tissue around the foot. Tissues used for reconstruction should provide similar properties, which can be accomplished by using ultra-thin flaps. Validated functional scales may provide essential information regarding patients' evolution. METHODS: Information concerning a series of 12 cases of plantar reconstruction using ultra-thin free flaps was gathered retrospectively by the authors. Data from preoperative functional scores in Lower Extremity Functional Scale and American Orthopaedic Foot and Ankle Society scale were obtained from clinical records; these were compared to postoperative scores assigned prospectively during follow-up. Differences were determined using Student's t-test for paired samples. Objective measurements concerning evolution (ulceration, footwear usage, sensation), as well as patient satisfaction, were also explored. RESULTS: The mean follow-up duration was 16.5 (range 12 to 24) months. The Lower Extremity Functional Scale scores mean modified from 39.1 to 60.2, p = 0.004; the American Orthopaedic Foot and Ankle Society scale mean modified from 42.2 to 53.4, p = 0.012. No patient showed plantar ulceration. Protective sensation was achieved in 75% of the patients, and 10 out of 12 could use regular footwear. All patients reported satisfaction with the surgical procedure. CONCLUSIONS: Ultra-thin flaps for foot reconstruction are related to improvement in functional scales, high rates of patient satisfaction, and use of regular footwear as well as a limited range of complications.

Head and Neck Reconstruction of the Vessel-Depleted Neck: A Systematic Review of the Literature.

BACKGROUND: Damage of the vascular system secondary to radical neck dissection and/or radiotherapy or other treatments has a negative impact on microsurgical reconstruction. The search for adequate recipient vessels is hindered by the complexity of previous procedures. METHODS: A systematic review of microsurgical head and neck reconstruction in the vessel-depleted neck was performed. The issues analyzed were indications for surgery, more frequently performed flaps, vascular systems used as recipient vessels, outcomes, and complications. RESULTS: The eligibility criteria were fulfilled by 57 studies published between September 1993 and January 2020. In 8235 patients, 8694 flaps were performed, 925 of which were for a vessel-depleted neck. The most commonly used flap was the anterolateral thigh flap, used in 195 cases (30%), followed by the radial forearm free flap, used in 157 cases (24%). The potential recipient vessels were numerous for arteries (26 options) and veins (31 options). For the 712 flaps with an identifiable recipient artery, the superficial temporal artery was the most commonly used vessel (n = 142, 20%). The superficial temporal vein was the most commonly used vessel for 639 flaps with an identifiable recipient vein (n = 118, 18.5%). Complications amounted to 11%; 80 out of 716 flaps in papers that reported them. Flap losses were reported in 2% of cases. CONCLUSIONS: Major microsurgical head and neck reconstruction for postoncologic defects depends on appropriate recipient vessels. Vein availability is paramount. Understanding the complexity of this problem is useful for preoperative planning, precise decision-making, and an accurate surgical approach.

National examination for medical residency admission: academic variables and performance among different schools / Examen Nacional de Aspirantes a Residencias Médicas: tipo de escuela y desempeño obtenido

Abstract: Objective: To identify medical school characteristics associated with performance in a medical residency admission test. Materials and methods: Performance and selection rates according to type of medical school (Student´s t-test, Chi-squared test), accreditation status (Student´s t-test) and geographic regions (Anova) were analyzed from a database comprising 153 654 physicians who took the residency admission test Examen Nacional de Aspirantes a Residencias Médicas (ENARM) in the period 2014-2018. Results: Performance was 62.5% for accredited programs and 61.4% for non-accredited programs (p<0.001); public schools reached 62.3% and private schools 62.2% (p<0.001). Northern regions performed above 63% while South-Southeast at 58.9% (p<0.001). Selection rate was 26.2% for accredited programs and 22.9% for non-accredited (p<0.001); 26.6% for public schools and 23.6% for private schools (p<0.001). North-East and North-West reached 31% while South-Southeast 20.7%. Conclusions: Type of school, accreditation status and geographic region may influence performance and selection rate.

Resumen: Objetivo: Identificar características de las escuelas de medicina asociadas con desempeño en un examen de admisión a residencias. Material y métodos. Utilizando una base de datos con 153 654 registros de aspirantes entre 2014-2018 se analizaron el desempeño y selección en el Examen Nacional de Aspirantes a Residencias Médicas (ENARM) y su relación con tipo de escuela y estatus de acreditación, así como región geográfica. Resultados: El desempeño fue 62.5% para programas acreditados y 61.4% para no acreditados (p<0.001); 62.3% para escuelas públicas y 62.2% para privadas (p<0.001). Las regiones del norte alcanzaron 63% y Sur-Sureste 58.9% (p<0.001). La tasa de selección fue 26.2% para programas acreditados y 22.9% para no acreditados (p<0.001); 26.6% para escuelas públicas y 23.6% para privadas (p<0.001). Las regiones del norte alcanzaron 31% mientras Sur-Sureste 20.7%. Conclusiones: Las características de la escuela de medicina influencian el desempeño en el ENARM.

Comparison of Facial Proportions Between Eastern and Western Attractive Young Women.

The characteristics of what is considered a beautiful face differ between Eastern and Western countries.The authors of this study analyzed beauty pageant contestants using a three-dimensional (3D) photogrammetric analysis tool. All of the 3D photographs were taken between October and November 2016 in Seoul, Korea. The participants were 43 Miss Korea contestants (Group I) and 22 Miss Paraguay contestants (Group II).In absolute length, those in Group I had longer upper and middle faces. In the proportions of volume and length, Group I had larger upper and middle faces than Group II. Widths of the lower face and entire face were also wider in Group I. The lower facial index was larger in Group I. Group I had longer noses and wider intercanthal distance, not only in absolute length but also in proportion to the face. Group II showed thicker lips, longer chins, and wider noses relative to the face. Group II had wide eyes, in the absolute measurement and in proportion to the face. Group I participants appeared to have an increased height of eyes and had wider angles in their faces as well as wider nasofrontal, labiomental, and nasomental angles.The authors objectively established reference data for faces that are considered attractive in the East and the West. The data are expected to contribute to the clinical practice of plastic surgeons.

National examination for medical residency admission: academic variables and performance among different schools.

OBJECTIVE: To identify medical school characteristics associated with performance in a medical residency admission test. MATERIALS AND METHODS: Performance and selection rates according to type of medical school (Student´s t-test, Chi-squared test), accreditation status (Student´s t-test) and geographic regions (Anova) were analyzed from a database comprising 153 654 physicians who took the residency admission test Examen Nacional de Aspirantes a Residencias Médicas (ENARM) in the period 2014-2018. RESULTS: Performance was 62.5% for accredited programs and 61.4% for non-accredited programs (p<0.001); public schools reached 62.3% and private schools 62.2% (p<0.001). Northern regions performed above 63% while South-Southeast at 58.9% (p<0.001). Selection rate was 26.2% for accredited programs and 22.9% for non-accredited (p<0.001); 26.6% for public schools and 23.6% for private schools (p<0.001). North-East and North-West reached 31% while South-Southeast 20.7%. CONCLUSIONS: Type of school, accreditation status and geographic region may influence performance and selection rate.

Correction of Congenital Telecanthus by Extended Medial Epicanthoplasty With Skin Redraping Method.

BACKGROUND: Recently, skin-redraping medial epicanthoplasty has emerged as an extremely effective way to minimize the resultant scar. We found that the novel skin-redraping medial epicanthoplasty technique, which has been applied to aesthetic surgery, could also be suitable for the correction of congenital epicanthus and telecanthus. METHODS: We retrospectively identified patients who had an epicanthoplasty from December 2007 to August 2017. Among 47 patients, we identified 19 cases with congenital pathologies (nonaesthetic cases). Overall, 7 patients with at least 2 anthropometric measurements were selected. RESULTS: There was a mean presurgical intercanthal distance of 35.85 mm (range, 24-52 mm) and a mean intercanthal distance of 26.85 mm (range, 17-36 mm) with a mean difference of 9 mm following postsurgical revision. To better categorize this difference, statistical analysis was conducted using a paired t test, which showed a significant result with P = 0.008. CONCLUSIONS: Our results revealed that the skin-redraping medial epicanthoplasty technique could be a better option even in the reconstruction of congenital telecanthus as well as aesthetic plastic surgery. It could correct mild to severe telecanthus and minimize scar formation.