The Versatility of Atherosclerotic Cardiovascular Disease Risk Score in Determination of Popliteal Artery Branches Patency in Computed Tomography Angiography.

The atherosclerotic cardiovascular disease (ASCVD) risk score is used to estimate coronary artery disease and stroke risk. Atherosclerosis affects arteries throughout the body, including the legs, causing peripheral arterial disease. Atherosclerosis causes luminal stenosis in popliteal artery branches, which affects operative decisions such as intravascular surgery, and lower limb reconstruction. The objective was to investigate the relationship between the ASCVD risk score and degree of stenosis among the popliteal artery and its branches. Methods: The data regarding all patients who underwent computed tomography angiography (CTA) of the legs during 2016-2021 with complete data for ASCVD risk score assessment were recruited. The association between luminal stenosis from CTA and calculated ASCVD risk score was analyzed. Results: A total of 383 limbs of 117 men and 81 women, averaged 66.5 years old, were studied. Common comorbidities included hypertension (84.3%), diabetes mellitus (61.1%), and chronic kidney disease (34.3%). Average 10-year ASCVD risks in the greater than or equal to 50% stenosis group of popliteal, anterior tibial, and posterior tibial arteries were significantly higher than the less than 50% stenosis group (P < 0.01). The peroneal artery had no significant difference between stenosis groups. The popliteal artery had significantly higher lifetime ASCVD risks than in the greater than or equal to 50% stenosis group (P < 0.01), but the other arteries showed no statistically significant difference. Conclusions: The 10-year ASCVD risks showed significant higher values in the greater than or equal to 50% stenosis group of popliteal, anterior tibial, and posterior tibial arteries. These findings can establish the further study on how ASCVD risks can be applied to predict the stenosis of these arteries and guide the rationale of preoperative leg CTA for FFF harvest.

Immediate inguinal lymphaticovenous anastomosis following lymphadenectomy in skin cancer of lower extremities.

BACKGROUND: Secondary lymphedema following inguinal lymph node dissection in lower extremities skin cancer reduce the patients' quality of life. Immediate lymphaticovenous anastomosis (LVA) at groin is a procedure intended to prevent secondary lymphedema. The data regarding the long-term efficacy and safety of this procedure was limited. Therefore, we evaluated the long-term outcomes of immediate LVA in patients with melanoma and non-melanoma skin cancer of the lower extremities. METHODS: The retrospective data review of patients with melanoma or squamous cell carcinoma of the lower extremities underwent oncologic tumor resection with groin node dissection between December 2013 and December 2016 was performed. Seven patients underwent immediate LVA (intervention) at groin after node dissection and 22 acted as controls. The occurrence of lymphedema and oncologic outcomes were followed up to 7 years. RESULTS: Fifteen patients (51.7%) developed postoperative lymphedema, which were three patients in the intervention group and twelve patients in the control group (p = 0.68). The intervention group had significant lower 2-year (57.1% versus 77.3%) and 5-year overall survival (14.3% versus 54.5%) (p = 0.035). The intervention group had reduced 2-year (28.6% versus 86.4%) and 5-year (28.6% versus 68.2%) Recurrence Free Survival (RFS) (p = 0.013). The intervention group also had reduced 2-year (0% versus 90%) and 5-year (0% versus 70%) Metastasis Free Survival (MFS) (p = 0.003). CONCLUSION: Immediate inguinal LVA following groin node dissection in lower extremity skin cancer patients did not reduce the incidence of lymphedema. Unfortunately, it was associated with lower overall survival and an increase in tumor recurrence and metastasis.

The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps.

Computer-assisted surgery (CAS) has been introduced to mandible reconstruction with fibular-free flap in cutting guide placement. When CAS cooperates with different plate fixations, the results show various degrees of errors by which this study aimed to evaluate. Mock surgeries were conducted in 3D-printed mandibles with 2 types of defects, limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of fixations, miniplate, manually bending reconstruction plate, and patient-specific plate, are tested, each of which was performed 3 times in each type of defect, adding up to 18 surgeries. One with the least errors was selected and applied to patients whose 3D-printed mandibles were derived. Finally, in vivo errors were compared with the mock. In limited defect, average errors show no statistical significance among all types. In extensive defect, patient-specific plate had a significantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively). When patient-specific plate was applied in vivo , the errors were not significantly different from the mock. Patient-specific plates that cooperated with CAS showed the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.

Autologous Fat Transfer in Lupus Panniculitis Facial Lipoatrophy.

Lupus panniculitis (LP) often presents with tender nodules and intermittent ulcers that then heal with scarring and lipoatrophy. The current mainstay of treatment is medical treatment. Research regarding the treatment of lipoatrophy from LP with autologous fat grafting is limited. We would like to share our experience in this rare case, which was treated with autologous fat transfer. A 48-year-old female presented with erythematous plaque, tender nodules, and ulcers following by a depression of the lesion at the left temporal area. The patient also had indurated erythematous plaque at her left cheek. Both lesions were aggravated by sunlight exposure. After several investigations, she was diagnosed as LP with secondary lipoatrophy and tumid lupus erythematosus at her left temporal and left cheek, respectively. She received antimalarial drug and topical steroids. The patient underwent two sessions of autologous fat transfer. She was satisfied with the volume and contour improvement in the scar following the injection of 8 and 3.7 mL of fat. Furthermore, the patient reported the remission of tender nodules and ulcers since the first fat graft injection. In conclusion, the autologous fat transfer is a simple and effective treatment for lipoatrophy and scar secondary to LP with promising results.

Extracorporeal Shock Wave Therapy for Hypertrophic Scars.

Background Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars. Methods Twenty-nine patients were enrolled. All patients underwent ESWT once a week for 6 consecutive weeks. Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS), erythema index, melanin index, and scar pliability before treatment and again 4 weeks after treatment completion. Results Thirty-four hypertrophic scars in this study had persisted for between 6 months and 30 years. Most scars developed after surgical incision (55.88%). The chest and upper extremities were the predominant areas of occurrence (35.29% each). Most of the POSAS subscales and total scores were significantly improved 4 weeks after treatment ( p < 0.05). Furthermore, the pain, itching, and pigmentation subscale were improved. The pliability, melanin index, and erythema index were also improved, but without significance. The patients were satisfied with the results and symptoms alleviation, although subjective score changes were insignificant. No serious adverse events were found. The patients reported pruritus in 62.5% and good pain tolerance in 37.5%. Subgroup analyses found no differences in scar etiologies or properties at different parts of the body. Conclusion The ESWT is a modality for hypertrophic scar treatment with promising results. Most of POSAS subscales were significantly improved.

Prospective study of Q-switched Nd:YAG laser treatment of hyperpigmented split-thickness skin grafts.

Hyperpigmentation of split-thickness skin grafts (STSGs) is commonly found among Asians, and it is also challenging to treat. Although the 1064-nm Q-switched Nd:YAG laser has been used as a standard treatment for skin hyperpigmented lesions, there are limited number of reports focusing on the treatment of hyperpigmentation of STSGs. We aimed to evaluate the efficacy of 1064-nm Q-switched Nd:YAG laser for treatment of hyperpigmented STSGs. Half of each STSGs was treated with the 1064-nm Q-switched Nd:YAG laser, while the remaining was left untreated as comparison. The laser was applied for 4 times with 2-4-week interval. The treatment outcomes were compared by measurement of melanin index, erythema index, and photographs of STSGs at prior to enrollment, before each treatment session, and after 1 month of treatment completion. Five patients with 11 skin graft lesions were enrolled. The melanin index was significantly improved after the 2nd session and after treatment completion in laser-treated area (p = 0.006 and p = 0.001, respectively). There was non-significant difference in erythema index. The photographic comparison showed brightened of laser-treated area after treatment completion and improved skin texture. The 1064-nm Q-switched Nd:YAG laser can significantly reduce melanin index of STSGs and can be an alternative treatment for hyperpigmentation of STSGs.

The congenital popliteal vasculature patterns in fibular free flap reconstruction by means of surgical anatomy in cadavers.

Fibular free flap (FFF) is frequently used for reconstruction requiring vascularized bone. Thus, understanding its vasculature variation is crucial. This study investigates the popliteal artery branching variations in Thai cadavers and compares them with previous studies. One hundred and sixty-two legs from 81 formalin-embalmed cadavers were dissected. The popliteal artery branching patterns were classified. The previous data retrieved from cadaveric and angiographic studies were also collected and compared with the current study. The most common pattern is type I-A (90.7%). For the variants, type III-A was the majority among variants (6.2%). Type IV-A, hypoplastic peroneal artery, was found in one limb. A symmetrical branching pattern was found in 74 cadavers. Compared with cadaveric studies, type III-B and III-C are significantly common in angiographic studies (p = 0.015 and p = 0.009, respectively). Type I-A is most common according to previous studies. Apart from this, the prevalence of type III-A variant was higher than in previous studies. Furthermore, type III-B and III-C are more frequent in angiographic studies which might be from atherosclerosis. Thus, if the pre-operative CTA policy is not mandatory, the patients at risk for atherosclerosis and population with high variants prevalence should undergo pre-operative CTA with cost-effectiveness consideration.

Efficacy of Low-temperature Plasma for Treatment of Facial Rejuvenation in Asian Population.

BACKGROUND: Plasma, the fourth state of matter, has been widely proposed in antiaging medicine. The usage of low-temperature plasma (LTP), which converts nitrogen gas into plasma, demonstrates releasing of several growth factors and promotion of tissue regeneration. The nonchromophore-dependent property and preservation of skin architecture after treatment make LTP an interesting tool for facial rejuvenation. This study aimed to investigate the efficacy of LTP for facial rejuvenation. METHODS: A prospective cohort study involving 40 women who received full face LTP treatment once a week for 5 consecutive sessions. The melanin index, erythema index, and elasticity index were measured by Mexameter and Cutometer, respectively. The Fitzpatrick wrinkle scale and quartile grading scale were assessed by two plastic surgeons. RESULTS: All patients were between 26 and 55 years old and had mild-to-moderate Fitzpatrick wrinkle scale scores. The Fitzpatrick wrinkle scale scores showed a mean improvement of 0.47 and 0.89 at 4 and 12 weeks posttreatment (P < 0.001). Statistically significant improvements in melanin index, erythema index, and elasticity index at periorbital and perioral areas were found at 4 and 12 weeks after treatment (P < 0.001). Most subjects had quartile grading scale improvement of 51%-75% at 4 and 12 weeks after treatment. Patients reported a greater than 75% improvement in dyspigmentation, wrinkles, and elasticity in 60%, 50%, and 57.5% of subjects, respectively. CONCLUSION: LTP is another choice for facial rejuvenation, wrinkles reduction, and dyspigmentation with significantly improved results.