Comparing 3 Suture Techniques After Muscle Laceration Repair.

Background: Skeletal muscle lacerations are a relatively common injury. Compared with nonrepaired lacerations, surgically repaired muscle lacerations regenerate faster, develop less scar tissue, have a higher return to baseline strength, and have lower incidence of hematomas. Despite the benefits of repair, the optimal repair technique is still unknown. The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the optimal repair. Methods: Forty-two fusiform porcine muscle specimens were dissected and used for this study. Three suture techniques were used for comparative analysis: Figure-eight, Mason Allen, and Perimeter. Each muscle was transected and then repaired using one of the 3 techniques. Fourteen muscle-tendon specimens were prepared for each group and tested for tensile failure using a material testing system. Biomechanical properties, including peak failure point and stiffness, were compared for differences between the suture groups by 1-way analysis of variance. The average time per repair technique was also recorded. Results: The Perimeter technique showed a statistically significant higher peak failure point than the Mason Allen technique (P = .03). Both the Figure-eight (P = .047) and Perimeter techniques (P < .001) were significantly stiffer than the Mason Allen technique. The repair time was comparable across all 3 techniques. Conclusions: The Figure-eight and Perimeter repairs were found to be similar in peak failure point and stiffness, whereas the Mason Allen technique showed significantly lower stiffness and peak failure point. The Figure-eight was the quickest repair to perform. The Figure-eight technique may be strongly considered for muscle laceration repairs due to its simplicity and efficiency.

Frecuencia de hipoacusia y características audiométricas en pacientes con diabetes de un hospital de la ciudad de Chiclayo, Perú, 2015 / Frequency of hearing loss and audiometric characteristics of patients with diabetes in a hospital in Chiclayo city-Peru, 2015

Introducción: La diabetes es un trastorno metabólico que afecta a más de 347 millones de personas en el mundo y aproximadamente 1,1 millones en el Perú; si bien se han estudiado sus complicaciones, poco se sabe sobre su efecto en la audición. Se han planteado algunas hipótesis para intentar explicarla, sin embargo, la relación entre diabetes mellitus y la hipoacusia es motivo aún de discusión en la actualidad. Objetivos: Determinar la frecuencia de hipoacusia y las características audiométricas en pacientes con diabetes de un hospital nivel II de la Ciudad de Chiclayo durante el año 2015. Materiales y métodos: Estudio transversal descriptivo en el que se realizaron audiometrías a 185 pacientes con diabetes atendidos en el servicio de Endocrinología. Se incluyó a pacientes entre 18 y 70 años, con diagnóstico confirmado de diabetes mellitus tipo 1 y 2, que vivan en la ciudad de Chiclayo. El muestreo fue probabilístico aleatorio simple. Se excluyó a pacientes con sordera súbita, otitis media aguda o crónica, antecedente o presencia de perforación timpánica detectados durante la exploración ótica y que utilizaran material auxiliar auditivo, consumían fármacos ototóxicos, con antecedente de hipoacusia y de exposición laboral a ruido. Los datos se registraron en una ficha de audiometría convencional en la que se agregaron las variables de interés (edad, sexo, tiempo de enfermedad y otras variables clínicas). Se describieron medidas de tendencia central y de dispersión. Resultados: El 49% de los pacientes diabéticos presentaron hipoacusia, destacando la hipoacusia leve (35%), bilateral (41%) de tipo neurosensorial (45%) y con una tendencia a tonos agudos (42%). La mayoría de los pacientes con hipoacusia tuvo un tiempo de enfermedad mayor o igual a 10 años. Conclusiones: La frecuencia de hipoacusia en pacientes con diabetes es elevada en nuestro medio. Por lo general es una hipoacusia leve, de tipo neurosensorial y bilateral, independiente del tiempo de evolución. Estos datos obligan a tener un mayor énfasis en la revisión sistemática de alteraciones a nivel auditivo en los pacientes con diabetes.

Introduction: Diabetes is a metabolic disorder that affects more than 347 million people worldwide, and approximately 1.1 million in Peru. Its complications have been studied, but there is little about its effect on hearing. Although there are some hypotheses to try to explain this, the relationship between diabetes mellitus and hearing loss is still controversial. Objectives: To determine the frequency of hearing loss and the audiometric characteristics of diabetic patients in a Level II Hospital of Chiclayo City during 2015. Materials and methods: A descriptive cross-sectional study in which audiometry was performed on 185 patients with diabetes treated in the Endocrinology Department. The patients included where between 18 and 70 years, diagnosed with diabetes mellitus type 1 and 2, and lived in Chiclayo city. Simple random probability sampling was used. Those patients with sudden deafness, acute or chronic otitis media, a history or presence of tympanic perforation detected during ear examination, using hearing aid materials, on cytotoxic drugs, family history of hearing loss, and occupational exposure to noise, were excluded. Data were recorded in a conventional audiometry table in which other variables of interest (age, gender, and duration of the disease) were added. Measures of central tendency and dispersion were described. Results: Almost half (49%) of diabetic patients had hearing loss, mainly slight (35%), bilateral (41%), sensorineural (45%), and with a tendency towards higher-pitched tones (42%). Most patients with hearing loss had more than 10 years of disease. Conclusions: The frequency of hearing loss in patients with diabetes is high in our environment. It is usually a minor, sensorineural and bilateral type, independent of duration of disease. These data show that greater emphasis should be placed on the systematic review of changes in hearing levels in patients with diabetes.

A Muscular Etiology for Medial Implant Malposition Following Subpectoral Augmentation.

BACKGROUND: Implant malposition is becoming an increasingly recognized complication following subpectoral breast augmentation. Although several causes of medial malposition have been previously demonstrated, medial implant malposition secondary to unintended pectoralis muscle slips has not been previously described. OBJECTIVE: The goal of this study is to describe a form of medial implant malposition caused by pectoralis major and minor musculature vectors on the implant. METHODS: The primary investigator performed a retrospective review of all patients who underwent revisional breast surgery for the diagnosis of symmastia or medial implant malposition following subpectoral augmentation. Those patients with muscular-type etiology for medial implant malposition were identified. RESULTS: Five patients with pectoralis muscle slips causing medial implant malposition were identified. The pectoralis muscle slips were successfully diagnosed on preoperative exam and corrected with specific surgical procedures aimed at balancing surrounding forces and thus correcting malposition. CONCLUSIONS: Pectoralis muscle slips contributing to medial malposition can be found in some patients after subpectoral breast augmentation. The etiology of this deformity is unknown, but theorized to be caused by anatomic predisposition, with slips inadvertently formed during subpectoral pocket formation arising from the pectoralis minor and/or incompletely released or accessory pectoralis major muscles.

Expanded indications for the deep plane cervicofacial flap: aesthetic reconstruction of large combined temporofrontal and brow defects.

The deep plane cervicofacial (DPCF) rotation advancement flap has been well described for coverage of cheek and lower eyelid defects. The extension of this flap for coverage of complex combined temporofrontal and brow defects has not been previously described. The primary investigator (E.L.C.) performed a chart review of all 7 DPCF flaps performed for reconstructive purposes at the University of Texas Medical Branch, Galveston, Tex, from November 2011 through August 2012. Three patients with complex combined temporal and brow defects were identified. Three patients underwent coverage of complex combined temporofrontal and brow defects using the DPCF flap. Adequate coverage was provided with good skin color match. No flap loss or tip necrosis was seen, despite immediate excision of the resulting cheek standing cone deformity in 2 of the 3 patients at the time of reconstruction. All patients had suture fixation of the DPCF flap to cheek periosteum. All had none or mild lateral canthal distortion, with less than 1 mm of asymptomatic ectropion at a minimum follow-up of 4 months. The DPCF flap is a safe, effective, and reliable means to provide coverage for complex combined temporofrontal and brow defects. The deep plane elevation and musculocutaneous blood supply may improve flap mobility, viability, and resistance to tension. The standing cone deformity resulting from flap advancement can be primarily excised without risking flap necrosis. With further study, indications for the DPCF flap may include adjacent areas of the face currently being reconstructed using other means.

Anatomy of the sternal origin of the pectoralis major: implications for subpectoral augmentation.

BACKGROUND: The pectoralis major typically is manipulated for implant coverage and pocket design in subpectoral breast augmentation. An understanding of its anatomy can guide successful creation of the implant pocket. OBJECTIVES: The authors evaluated the anatomy of the sternal origin of the pectoralis major to inform surgical planning, help establish a technique for subpectoral augmentation mammaplasty, and identify the most common locations of perforators. METHODS: The sternal origins of 24 pectoralis major muscles were dissected and examined in 15 female cadavers to determine the structure and width of the pectoralis major sternal origin and its relationship to the locations of internal mammary perforators. RESULTS: The average width of the sternal origin of the pectoralis major was 7.1 mm (range, 3 mm-1.8 cm). This width decreased slightly from the second rib to the second intercostal space and then increased progressively in the caudal direction toward the fifth rib. The sternal origin terminated an average of 5.4 mm (range, 1-16 mm) from the midline, with the greatest distance at the fifth rib and large variability throughout. A row of perforators from the internal mammary artery traversed the subpectoral space an average of 2.7 cm from the midline (range, 1-3.7 cm). CONCLUSIONS: The sternal origin of the pectoralis major was thin and highly variable, suggesting that its partial release for implant medialization during subpectoral augmentation is unsafe.

Anatomic relationship of the pectoralis major and minor muscles: a cadaveric study.

BACKGROUND: Although the anatomy of the individual pectoralis major and minor muscles has been described previously, never before has the anatomic relationship between these muscles been investigated. OBJECTIVE: The authors identify the anatomic relationship of the costal origins of the pectoralis major and minor muscles. METHODS: Bilateral thoracic wall dissection was completed in 102 cadavers. In each dissection, the chest wall soft tissue was removed, and the distance between costal origins of the pectoralis major and the pectoralis minor muscles was measured. RESULTS: In 49 female and 53 male cadavers, 202 pectoralis major muscles were lifted to expose the costal origins of the pectoralis major and minor muscles. Distances between pectoralis major and pectoralis minor muscles were separated into 3 categories: less than 1 cm, between 1 and 3 cm, and greater than 3 cm. Forty-nine (24%) pectoralis muscle dissections displayed a distance of less than 1 cm between costal muscle origins. Eighty-three dissections (41%) showed an intermediate distance of between 1 and 3 cm, while the remaining 70 (35%) were over 3 cm. No significant difference was observed in these percentages with regard to sex. Ten cadavers displayed asymmetry in pectoralis muscle origin distance. Eight specimens displayed shared fibers between pectoralis major and minor muscles. CONCLUSIONS: The anatomic relationship between the costal origin of the pectoralis major and minor muscles is highly variable. Understanding this spatial relationship has important implications for cosmetic and reconstructive breast surgery.