Autologous Fat Breast Reconstruction with Implant Completion-Experience with 29 Consecutive Cases and 33 Breasts.

BACKGROUND: Implant-based breast reconstruction is the most prevalent form of breast reconstruction. Autologous fat grafting (AFG) was conceptualized as an alternative to implant-based breast reconstruction and was found to be a reliable reconstruction modality. However, usually, a few grafting rounds are required to create the desired shape and size of the breast. Current literature describes ample experience with AFG as an adjunct to implant-based breast reconstruction for improving appearance. However, the utilization of breast implants following initial AFG has been sparingly described. The primary advantage of this study is the creation of new fat tissue as a breast mound. The reconstruction is then concluded by inserting an implant into this new mound. This approach reduces the overall number of fat injections needed to achieve the desired outcome, as well as the total volume of the implant. METHODS: This IRB-approved retrospective study was conducted between January 2015 and December 2021. All women who underwent delayed breast reconstruction with AFG during this timeframe and wanted to complete it with a silicone implant as a last stage were included in the study. RESULTS: A total of 29 patients (33 breasts) underwent delayed breast reconstruction with AFG and a silicone implant as the final stage. In all cases, the results were satisfying without any major complications. Minor complications were observed with one patient and included an infection. CONCLUSIONS: The findings of this study have demonstrated the effectiveness of this procedure together with patient satisfaction, thus highlighting the potential advantages that this approach offers. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Patient Journey in Facial Aesthetics: Findings from a European Consensus Meeting on Improving the Quality of Life for Patients Receiving Botulinum Toxin Injections.

Purpose: Successful treatment of facial lines with botulinum toxin is largely dependent on patient satisfaction; thus, a structured treatment journey that uses patient-reported outcomes (PROs) is helpful for maximizing botulinum toxin results. To develop a patient-centric approach for botulinum toxin injections in facial aesthetics, a group of clinicians met to provide opinions on an optimal treatment journey that uses PROs to quantify treatment benefits on patient quality of life. Patients and Methods: A multidisciplinary panel of 9 clinicians with expertise in facial aesthetic procedures convened for an advisory board that was preceded by and followed up with a structured, multistep consensus discussion. Based on current literature, the panel's expertise, structured questions, and group discussion, panelists assessed, reconciled, and agreed upon on a patient journey for botulinum toxin treatment in facial aesthetics. Results: Panelists agreed that an optimal patient journey includes screening, assessment, treatment, posttreatment, and follow-up visits. A compact, easy-to-complete, and digital PRO questionnaire should be provided before the visit. During screening, thorough assessments are integral for a successful patient journey because they provide an opportunity to understand treatment goals, address patient concerns, discuss risks and benefits, obtain medication lists/medical history, and take pretreatment photographs. Treatment strategies should include discussing and educating on the approach/choice of botulinum toxin and ensuring patients are comfortable. Posttreatment, clinicians should request intense muscle movements to enhance product uptake and be available to address patient concerns. Finally, during follow-up, PRO questionnaires can be provided to gauge patient satisfaction with treatment, and pretreatment photographs can be provided to allow patients to track their progression. Follow-ups should be scheduled with new patients or those reporting low satisfaction. Conclusion: Establishing a relationship, being aware of the patient's goals, and developing an individualized care plan allows for a structured, patient-centered treatment journey that promotes positive aesthetic outcomes.

An Innovative Surgical Device for Removal of Breast Implants.

SUMMARY: The use of breast implants is consistently on the rise owing to increases in aesthetic and reconstructive breast surgery. Implant rupture is a potential complication, the rate of which has increased over time. Therefore, implant removal or replacement is a common procedure, and needed for most breast implants at some point during the patient's lifetime. Surgical removal of ruptured implants is messy, cumbersome, time-consuming, and, overall, unpleasant. The authors have developed a custom-made device that effectively removes a silicone implant, whether ruptured or intact. To determine its efficiency, the authors conducted a prospective clinical trial of 25 women (45 breasts) undergoing removal or replacement of breast implants with the device between January of 2019 and January of 2022. Device safety and efficiency were assessed, and the need for the device was evaluated through a survey among 25 board-certified plastic surgeons. The mean implant age was 12.8 years, and mean volume was 370 g. The mean time to extract the implant with the device was 10.7 seconds. Twenty-two implants (49%) were ruptured. There were no minor or major complications during the procedure or follow-up. The mean follow-up period was 6 months. Surgeons' intention to use this device in their own practices for removal of intact and ruptured implants was very high. This novel device may prove indispensable for explantation of both intact and ruptured silicone implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Autologous Fat Grafting With CO2 Tissue Preparation (Carbo-pneumodissection): A Safe Method for Expanding and Enhancing Recipient Site Capacity and Aesthetic Outcomes.

BACKGROUND: Autologous fat grafting (AFG) is commonly used as part of aesthetic and reconstruction procedures, but expanding and enhancing the recipient site capacity remains a major challenge. OBJECTIVES: The aim of this study was to describe and assess an innovative intraoperative carbon dioxide (CO2) pneumodissection (CPD) recipient site preconditioning procedure intended to improve recipient site capacity and AFG outcomes. METHODS: From June 2019 to August 2021, 53 patients after mastectomy or lumpectomy (76 breasts) underwent 96 AFG procedures as a separate stage immediately following tissue preconditioning with CPD. RESULTS: There were no systemic or major local complications. The mean number of AFG procedures required to complete the reconstruction was 1.3 per breast. The vast majority of patients achieved a final satisfactory aesthetic outcome with either 1 or 2 procedures (77.6% and 18.4%, respectively). The volume of fat graft delivered into the recipient site per session following CPD was higher than previous literature reports for all study groups. Furthermore, the CPD procedure was associated with a reduced need for subsequent AFG to complete the reconstruction. The positive effect of CPD, in terms of AFG volume delivered, was even more prominent among scarred irradiated breasts. Despite the large fat graft volumes delivered in our study, only 5.3% of breasts experienced fat necrosis following the procedure. CONCLUSIONS: CPD constitutes a safe, innovative, intraoperative method to expand and enhance recipient site capacity and fat grafting outcome. CPD allows cavernous expansion alongside preservation of the microcirculation. CPD works for both healthy and compromised tissues, in either reconstructive or aesthetic procedures.

Management Options for Linear Scleroderma ("En Coup de Sabre").

BACKGROUND: En coup de sabre (ECDS) is a form of linear-scleroderma, primarily affecting the face. Despite effectiveness of pharmacological interventions in the management of lesions, sequelae of cutaneous deformities are common. OBJECTIVE: Review the existing surgical tools for the correction of "en coup de sabre" ECDS lesions and facial deformities. MATERIALS AND METHODS: The authors conducted a literature search for reports on surgical interventions for ECDS deformations, in the electronic databases of PubMed, Scopus, and Cochrane Library Databases. RESULTS: Twenty-six publications reporting 39 patients were found in the literature. The average age of patients was 25 ± 4.7 years. Thirty-one of the patients were females. Six methods were found in the literature for surgical correction of ECDS. Fat grafting was performed in 41% of patients, surgical reconstruction in 18%, injectable fillers in 15%, implants in 10%, botulinum toxin injections in 8%, and bone/cartilage grafts in 8%. Imaging studies of the skull and face were performed in 36% of patients. Bony defects were found in 64.3% of them. CONCLUSION: Different surgical and minimally invasive options exist in the armamentarium of clinicians correcting ECDS deformities. Tailoring the method of correction to patient's needs and expectation is crucial in ensuring patient satisfaction.

What 736 Plastic Surgeons Think about Explantation and Capsulectomy: A Global Opinion Poll.

BACKGROUND: Breast implant illness, although not classified as a disease entity, has recently gained significant attention globally. The purpose of this study was to assess the status of explantation practices, discuss plastic surgeon's attitude toward requests for explantation and capsulectomy, and evaluate surgical management when accepting these challenges. METHODS: Twenty closed-ended multiple choice questions were formulated to an opinion poll. The anonymous opinion poll was distributed to members of American Society for Aesthetic Plastic Surgery and presidents of plastic surgery societies on all continents. RESULTS: A total of 736 plastic surgeons responded to the opinion poll. Although geographic variation was noted, a majority of 69.8 percent stated that explantation surgery had increased in their practice compared to the previous year. Requests for explantation without capsulectomy met with high acceptance rates among surgeons, regardless of whether patients were asymptomatic or not. Patients who also requested capsulectomy received less enthusiastic replies depending on the type of practice, years in practice, implant position, and type of capsulectomy (en bloc, total, or partial). When fat grafting was indicated, 68.7 percent stated that simultaneous lipofilling is limited when capsulectomy is performed, yet 44.5 percent stated that they would remove thin normal capsules in a symptomatic patient even when simultaneous fat grafting is requested by the patient. CONCLUSION: The opinion poll supports the hypothesis that demand for explantation and capsulectomy increased globally among symptomatic and asymptomatic patients; that attitudes toward simultaneous capsulectomy are divided; and that management may differ according to geographic location, experience, and type of practice.

Treatment of scars with autologous fat grafting and 1540 nm non-ablative erbium laser.

Scars may be devastating for patients. Fat grafting and non-ablative lasers are available options for improvement. The former reshapes and improves scar quality by adding volume and regenerative adipose-derived stem cells, whereas the latter facilitates synthesis and deposition of new dermal collagen. The combination may be synergic, leading to better cosmetic outcome.This was a prospective study of 16 consecutive patients treated with autologous fat grafting and non-ablative 1540-nm erbium laser for facial scars between January 2015 and December 2015. Treatment protocol included fat injection followed by five treatments with 1540-nm erbium laser (ICONTM Cynosure; Westford, MA, USA) a month later. We evaluated patients before, after treatments, and 6 months after the final treatment.Sixteen patients participated in our study. Mean patient age was 42 years (range 16-59 years). Scars were either traumatic (73%) or acne induced (27%). Traumatic scars were mainly new scars, with the majority of patients were treated within 30 days of injury. There were no reported complications. Scars improved in both texture and appearance and patient satisfaction was high in all cases.Treatment of scars with autologous fat grafting and fractional non-ablative 1540-nm erbium laser is safe and efficient and results in improved scar appearance and texture.

Hybrid Prepectoral Direct-to-Implant and Autologous Fat Graft Simultaneously in Immediate Breast Reconstruction: A Single Surgeon's Experience with 25 Breasts in 15 Consecutive Cases.

BACKGROUND: The direct-to-implant method depends on the quality of the mastectomy flaps and can be used only when the flaps are adequately perfused. Even though the method was designed to be a definitive reconstruction procedure, it has been associated with an increased likelihood that additional operative revision will be required in order to achieve the expected final cosmetic outcome. The authors describe a hybrid prepectoral direct-to-implant method that combines autologous fat grafting in the superior medial pole with immediate reconstruction. METHODS: In this prospective study, 15 patients (25 reconstructed breasts) underwent simultaneous hybrid prepectoral direct-to-implant reconstruction together with autologous fat grafting performed by a single senior plastic surgeon (Y.G). RESULTS: The mean quantity of autologous fat grafted in the superior medial aspect of the breast was 59.4 ± 12.8 cc. The mean total volume of the hybrid reconstructed breast, including implant and autologous fat graft, was 497.2 ± 89.1 cc. Satisfying final outcomes were achieved in all cases. There were no major complications, although minor complications were observed. CONCLUSIONS: The authors' hybrid approach allows the surgeon to achieve a more satisfying outcome with regard to the cleavage area. It results in a better natural appearance, an improved contour, and reduced upper pole rippling and deflation, with a lower likelihood that an additional operative revision will be required to achieve the desired final aesthetic outcome. The authors believe that their hybrid approach should be implemented as an integral part of the direct-to-implant prepectoral reconstruction procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Perforation of Abdominal Viscera Following Liposuction: A Systemic Literature Review.

BACKGROUND: Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation. METHODS: The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases. RESULTS: The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge. CONCLUSIONS: Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes. 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 .

Ophthalmic adverse events following facial injections of botulinum toxin A: A systemic literature review.

BACKGROUND: Over the years, botulinum toxin has found its place as a neuromuscular blocking agent in numerous medical fields. Since the approval of botulinum toxin by the FDA for cosmetic indications in 2002, it had become the most commonly performed esthetic procedure worldwide, with ever-growing demand. The characteristics of the toxin, along with the facial areas it is injected to, could possibly account for a wide array of complication. METHODS: The authors conducted a literature search for reported cases of ophthalmic adverse events following Botulinum toxin facial injections in the electronic databases of PubMed and Cochrane Library databases. RESULTS: The authors found 25 publications, reporting 49 cases of ophthalmic adverse events following botulinum toxin injections. Injections for cosmetic indications accounted for 51% of all injections, treatment of blepharospasms for 22% of cases, protective ptosis for 11% of cases, and treatment of hemifacial spams for 8% of cases. The average quantity of botulinum toxin injected to a single patient ranged between 1.25 and 75 units, with a median of 13.75 units.Majority of injections for cosmetic indications were performed to the lateral canthal area (56%), followed by the glabella (28%) and the forehead (20%).Adverse events following injections included diplopia (64%), ptosis (14%), and decrease in visual acuity or vision loss (8%). CONCLUSIONS: Botulinum toxin is gaining extreme popularity in the management of a wide area of diseases and for cosmetic indications. Proper knowledge of potential adverse events is crucial for the clinician in attempt to decrease complications.

[BREAST RECONSTRUCTION WITH THE BRAVA DEVICE AND AUTOLOGOUS FAT].

AIMS: To report our experience and results in BRAVA breast pretreatment for full breast reconstruction by autologous fat grafting. BACKGROUND: BRAVA (bra like vacuum-based external tissue expander) is a method developed to expand the skin envelope, thus creating more space for the fat graft for breast reconstruction. METHODS: Since 2015 we began to perform a full breast reconstruction by BRAVA and autologous fat grafting. This is a multiprocedure breast reconstruction that includes pretreatment by using the BRAVA device for 180 hours before each surgery. We will focus on the number of procedures and time duration that was needed to complete the breast reconstruction the aesthetic results and the complication rates. RESULTS: Between the years 2015-2019 we preformed 13 late full breast reconstructions using the BRAVA. Six women were post-radiotherapy and they completed their breast reconstruction after 5.7±1.3 rounds during 20.3± 5.3 months. Non-irradiated patients completed their breast reconstruction after 2.7±0.5 rounds during 9.4±2.6 months. We grafted an average volume of 218±16.7 ml of fat per surgery. This was in comparison to an average of 100ml fat volume grafted in surgery without pre-expansion according to the literature. We had no complications and the aesthetic results were satisficing. CONCLUSIONS: The addition of BRAVA expansion procedure before autologous fat grafting leads to a larger volume of fat that can be injected in every operation and reduction of procedures. The procedure is safe and with good aesthetic results.

Innovative Surgical Approach Using a Mesh Sling for the Aging Neck.

BACKGROUND: Rejuvenation of the neck is essential to achieve a young facade. Different approaches for aging neck rejuvenation have been developed throughout the years. Most of them focus on specific elements that contribute to the aging neck. The main drawbacks of these techniques are recurrence of the platysma bands, malposition, deformations, salivary problems, and defatting. These disadvantages and limitations have led the author to create a novel surgical approach to improve the aging neck that would be suitable for most patients. Instead of dealing with each of the elements of the aging neck, the author's approach involves use of a sling to elevate all the descending elements as a whole to create a natural and longstanding result. METHODS: Since March of 2014, 10 patients have been operated on for neck lifting with this new approach. Four different types of material have been used: absorbable synthetic braided (Vicryl) in five patients, semiabsorbable synthetic braided and monofilament (Vypro) in one patient, absorbable synthetic matrix (TIGR) in three patients, and biological mesh-allograft material (AlloDerm) in one patient. Follow-up visits were made after 10 days, 3 months, 6 months, and annually. RESULTS: In all cases, the operations were uneventful. There were no major complications. Minor complication occurred in one patient with the Vypro mesh. The mesh caused stiffness and was replaced. Final aesthetic results were satisfactory in all cases. CONCLUSIONS: Current approaches for improvement of the aging neck do not fit all aging neck cases and are suitable for only a specific dominant element. The aging neck tends to reappear faster than expected because of recurrence or dominance of another element. The author's novel approach is more predictable and is suitable for most cases regardless of the dominant part causing the aging. More experience and longer follow-up are needed to choose the most appropriate material for the mesh. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Topical Nystatin Treatment for Candida Infection Following Wound Reconstruction.

INTRODUCTION: Wound infection is an important cause of nonhealing wounds and graft rejection. OBJECTIVE: A series of 5 patients (4 females, 1 male; median age, 50; age range, 1.5-83 years) with nosocomial Candida infection of burns and chronic wounds that were reconstructed with split-thickness skin grafts is presented. MATERIALS AND METHODS: This case series was carried out between February 2011 and June 2014. Based on tissue cultures, wounds were treated with 100 000 units/mL of nystatin and 25 mg in 500 cc normal saline of mafenide acetate, which resulted in regression of wound infection symptoms and improvement of skin graft take. CONCLUSIONS: The authors propose this simple, nontoxic, and economic topical treatment for wounds and skin grafts with positive Candida cultures.

Atopic Dermatitis in Israeli Adolescents from 1998 to 2013: Trends in Time and Association with Migraine.

BACKGROUND: Recent data have shown an increasing occurrence of atopic dermatitis (AD) in children and adolescents, as well as in adults. Most of the epidemiologic research on AD is limited to pediatric and youth populations and is based on self-reported questionnaires. METHODS: A nationwide, population-based, cross-sectional retrospective study of adolescents with AD was performed to estimate its prevalence, trends, and association with demographic factors and comorbidities. The study included all Israeli teens going through medical evaluation as part of the assessment before being conscripted into the military from 1998 to 2013. RESULTS: A total of 1,187,757 adolescents were included in the study population, with an overall prevalence of AD of 0.64% in boys and 0.9% in girls. Over the study period, the prevalence of AD steadily increased, especially in the mild disease group. A greater risk of AD was found in subjects with high predicted socioeconomic status (male: odds ratio [OR] 1.14 [95% confidence interval {CI} 1.11, 1.16]; female: OR 1.08, [95% CI 1.05, 1.10]) and Israeli-born subjects (male: OR 1.34 [95% CI 1.21, 1.48]; female: OR 1.12 [95% CI 1.01, 1.23]). Allergic conditions such as asthma, conjunctivitis, and contact dermatitis were more prevalent in subjects with AD. There was a significantly higher prevalence of migraine in patients with AD (male: OR 1.35 [95% CI 1.18, 1.54]; female: OR 1.51 [95% CI 1.30, 1.74]). CONCLUSION: This large cross-sectional study demonstrates the increasing prevalence of AD in adolescents and its relation to other allergic diseases and migraine. It is hoped that greater awareness of the distinctive epidemiologic characteristics of this population will lead to better recognition and management of the disease and its comorbidities.

Post-burn breast reconstruction using an artificial dermis-a long-term follow-up.

BACKGROUND: Full thickness burns of the chest in childhood are a devastating problem that requires challenging reconstructive options. Integra is a bilaminate artificial dermis composed of shark chondroitin 6-sulfate and bovine collagen. The dermal matrix serves as a scaffold for fibroblasts and endothelial cells. Vascularization of the matrix begins after 2-3 weeks, and eventually, the matrix incorporates with the tissue to create a new dermis. The main advantage of the Integra is that the neodermis is of the same quality as a native dermis. CASE PRESENTATION: In this case report, we present post-burn breast reconstruction of a 12-year-old girl using Integra, with a long follow-up of 7 years. To the best of our knowledge, there is no published follow-up of breast development after reconstruction with Integra from its beginning point at the age of puberty until after the growing process has terminated. CONCLUSIONS: Integra is a reliable reconstructive tool for burned breast. If done before puberty, it can help in getting normal developing tissue with satisfying esthetic results of size, shape and symmetry.

Analysis of 109 Consecutive Explanted Breast Implants: Correlation Between Suspected Implant Rupture and Surgical Findings.

INTRODUCTION: The use of breast implants is on the rise due to increases in breast reconstructive and aesthetic surgery. Implant rupture is a possible complication. Among assessment modalities for implant rupture detection, MRI is considered the gold standard. METHODS: We conducted a prospective analysis of 57 women after breast augmentation or postmastectomy reconstruction (109 implants), admitted to our department between 2010 and 2015 due to suspected implant rupture. We correlated surgical findings with symptoms, physical examination, imaging, and device specifications. RESULTS: Seventy-four explanted implants were preoperatively suspected as ruptured. Over a third were intact and unjustifiably explanted. MRI evaluation was the most accurate modality. Interestingly, 61 % of ruptured implants were left-sided. Patient's age, comorbidities, smoking, medications, presenting symptoms, implant duration, and volume did not correlate with implant rupture. CONCLUSIONS: Our study confirmed preexisting data regarding the importance of imaging diagnosis, with MRI being the most accurate modality in both diagnosing and ruling out implant rupture. Interestingly, our study showed that MRI was accurate in detecting all intact implants, unlike lower detection rates reported in previous studies, thus preventing unnecessary explantation. Another unique finding was that the left-sided implants were significantly prone for rupture. As iatrogenic damage is the most common cause of implant rupture, with most surgeons being right-handed, awareness during surgery must be augmented, with further investigation required for potential causes of this unexpected difference. Our study emphasizes the importance of understanding the causes of rupture and the need for evidence-based indications regarding imaging and replacement of implants. 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 .

Color Vision Deficiency and Functional Disorders Among Israeli Male Adolescents Between 2007 and 2013.

Color vision deficiency has been associated with educational difficulties among male children, as well as attention-deficit hyperactivity disorder (ADHD). We examined the association of color vision deficiency with functional conditions, including ADHD, irritable bowel syndrome, enuresis and somatoform disorders, in a large population of male adolescents. We included all Israeli male adolescents that underwent medical and cognitive examinations during conscription between the years 2007 and 2013. The prevalence of ADHD, irritable bowel syndrome, enuresis, and somatoform disorders among color vision deficiency patients was compared to a control group. The study included 305 964 males aging 17 ± 0.6, of which 7584 (2.5%) had color vision deficiency. Using a multivariable analysis, the probability for irritable bowel syndrome, enuresis, and somatoform disorders among color vision deficiency patients was increased by 1.41, 1.94, and 3.87, respectively (P < .05). No significant association was found between ADHD and color vision deficiency. Color vision abnormalities are associated with functional disorders in male adolescents, including irritable bowel syndrome, enuresis, and somatoform disorders.

Fenestrated sheet split-thickness skin grafting for reconstruction of penile skin loss in pediatric population.

OBJECTIVES: We aimed to evaluate our experience with fenestrated sheet split-thickness skin grafts (STSGs) in the pediatric population. MATERIALS AND METHODS: We retrospectively studied a cohort of 17 children 2-18years old who underwent skin grafting owing to circumcision injuries (2 patients), traumatic penile injury (1) and after previous multiple hypospadias surgery (14). Fenestrated 0.012in sheet STSGs from thigh area (15 patients) and buttock area (2) were fashioned to resurface the denuded penis following reconstruction. The median follow up was 13years (range 1-19years). RESULTS: There was 94% take of the grafts. One patient required additional grafting following first graft infection. Six patients underwent concomitant surgery at the time of grafting (4 chordee repair and 2 meatoplasty). Two patients had slight chordee at 3 and 6years postoperatively, and 2 with the history of preputial tubularized island flap hypospadias repair had developed a urethral stricture, which required staged repair with buccal mucosa 12 and 14years following primary hypospadias repair. Six sexually active patients reported normal sexual intercourse and sensation following grafting. None of the patients demonstrated shrinkage of the STSGs over the follow up period. CONCLUSIONS: Our data demonstrated that the use of fenestrated sheet STSGs in patients with penile skin loss yields satisfactory functional and cosmetic outcomes. The buttocks might be considered as a preferable donor site in terms of avoiding a visible scar.

Is Male Migraine Associated With Color Vision Deficiency? Findings Among Israeli Adolescents Between 2007 and 2013.

OBJECTIVE: Accumulating clinical and experimental evidence has shown that migraine patients tend to suffer from color vision abnormalities. The aim of this study was to examine whether color vision deficiency is associated with male migraine in a large population of adolescents. METHODS: The study population included all Israeli male adolescents who underwent medical and cognitive examinations as part of their recruiting process between the years 2007 and 2013. Migraine prevalence among patients with color vision deficiency was compared to that of males without substantial color vision abnormalities. RESULTS: The study population included 305 964 male adolescents at the age of 17 ± 0.6, of whom 7584 (2.5%) had color vision deficiency, as determined by the Farnsworth Panel D-15 color blindness test. Males with color vision deficiency had a 32% increased prevalence of migraine as compared with the control group (odds ratio 1.32, 95% confidence interval 1.18-1.48, P < .001), after adjusting for multiple variables. CONCLUSIONS: The authors found an association between color vision deficiency and migraine in male adolescents. The study results lay the basis for further research into male migraine, as well as the visual aspects of migraine.