The combined use of pedicled profunda artery perforator and bilateral gracilis flaps for pelvic reconstruction: A cohort study

xlomafota13 shared this article with you from Inoreader The combined use of pedicled profunda artery perforator and bilateral gracilis flaps for pelvic reconstruction: A cohort study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00128-5. doi: 10.1016/j.bjps.2021.03.038. Online ahead of print. ABSTRACT The result of an extra-levator abdominoperineal excision of the rectum (ELAPE) is a composite three-dimensional defect. This is performed for locally advanced anorectal cancer, and may involve partial excision of the vagina. The aim of reconstruction is to achieve wound healing, restore the pelvic floor and to allow micturition and sexual function. We aim to evaluate the concurrent use of profunda artery perforator (PAP) and bilateral gracilis flaps for vaginal and pelvic floor reconstruction. We performed a retrospective case note review of patients undergoing pelvo-perineal reconstruction with combined gracilis and PAP flaps between July 2018 and December 2019. Eighteen pedicled flaps were performed on six patients with anal or vulval malignancies. All underwent pre-operative radiotherapy. Four patients h ad extended abdominoperineal tumour resections, while two patients underwent total pelvic exenteration. The median age was 57 (range 47-74) years, inpatient stay was 22 (11-47) days and the follow-up was 10 (5-21) months. Four patients developed partial perineal wound dehiscence, of which one was re-sutured. One patient had a post-operative bleed requiring radiological embolisation of an internal iliac branch and had subsequent 1cm PAP flap loss. All other flaps survived completely. Median time to heal was 4 (1-6) months. This is the first series reporting combined bilateral gracilis and PAP flaps for pelvic reconstruction. The wound dehiscence rate and healing times were expected in the context of irradiation and radical pelvic tumour resection. This is a reliable technique for perineal and vaginal reconstruction with minimal donor site morbidity. PMID:33952435 | DOI:10.1016/j.bjps.2021.03.038 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Computer-assisted mandibular curved osteotomy: An automatic method to design the new aesthetic gonion and osteotomy line

xlomafota13 shared this article with you from Inoreader Computer-assisted mandibular curved osteotomy: An automatic method to design the new aesthetic gonion and osteotomy line Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 6:S1748-6815(21)00157-1. doi: 10.1016/j.bjps.2021.03.067. Online ahead of print. ABSTRACT BACKGROUND: Digital technology has been widely used in mandibular curved osteotomy to improve accuracy. However, the planning process still highly dependent on the experience and judgement of the surgeon. This study describes an automatic method to design the new gonion and osteotomy line based on the aesthetic standards in attractive women, and assesses its clinical outcomes. METHODS: An automatic surgical planning method for mandibular curved osteotomy was developed based on our previous research of mandibular angle aesthetics. A prospective clinical study was conducted from April 2016 to April 2018. Twenty-five female patients with prominent mandibular angle were enrolled. Pre- and postoperative skull computed tomography (CT) was performed. Three-dimensional (3D) CT data were obtained and processed by Mimics 18.0. Surgical templates were designed according to the automatic surgical planning method and 3D printed for the surgery. Preoperative measurements, surgical simulation and postoperative measurements were taken to evaluate the surgical outcomes. RESULTS: There were significant differences between the preoperative and the postoperative groups' results (p < 0.01). There was no difference between the surgical simulation and the postoperative results. All postoperative measurements were consistent with aesthetic features of mandibles. Patients were satisfied with their outcomes in terms of outline, symmetry and lower facial width. CONCLUSIONS: Our study developed an automatic method to position the new aesthetic gonion and osteotomy line for prominent mandibular angle patients. We proved that this method is safe, effective and reliable. PMID:33952433 | DOI:10.1016/j.bjps.2021.03.067 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neurilemmoma of the Nasal Cavity and Paranasal Sinuses

xlomafota13 shared this article with you from Inoreader Neurilemmoma of the Nasal Cavity and Paranasal Sinuses Via ear nose throat Ear Nose Throat J. 2021 May 5:1455613211007947. doi: 10.1177/01455613211007947. Online ahead of print. ABSTRACT OBJECTIVES: Neurilemmoma in the nasal cavity and paranasal sinuses is very rare. The study aimed to improve the understanding of neurilemmoma in the nasal cavity and paranasal sinuses. MATERIALS AND METHODS: The clinical data of 10 patients with neurilemmoma in the nasal cavity and paranasal sinuses treated from January 2014 to June 2019 in our hospital were retrospectively studied. RESULTS: There were 6 females and 4 males patients in our study. The mean age was 49.5 years (range 37-77 years), and the most common clinical symptom was unilateral nasal obstruction. The site of tumor included the nasal cavity, maxillary sinus, ethmoid sinus, and sphenoid sinus. There were 2 cases with malignant neurilemmoma. Nine patients underwent functional endoscopic sinus surgery (FESS); however, 1 patient underwent FESS combined with the lateral rhinotomy for complete resection of the tumor. Two patients with malignant neurilemmoma received postoperative radiotherapy. The mean follow-up was 3.82 years (range 2-7 years). There were no incidences of tumor recurrence during the study period. CONCLUSIONS: Neurilemmoma in the nasal cavity and paranasal sinuses is a mainly benign tumor. Complete surgical excision by FESS is the only treatment option for neurilemmoma in the nasal cavity and paranasal sinuses; while malignant neurilemmoma needs p ostoperative radiotherapy. PMID:33951978 | DOI:10.1177/01455613211007947 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fluorescence Imaging to Identify Occult and Ectopic Parathyroid Glands—Revealing the Unseen

xlomafota13 shared this article with you from Inoreader Fluorescence Imaging to Identify Occult and Ectopic Parathyroid Glands—Revealing the Unseen Via JAMA Otolaryngology–Head & Neck Surgery Online First In this issue of JAMA Otolaryngology—Head & Neck Surgery, Kennedy and colleagues describe intraoperative molecular imaging (IMI) using the near-infrared (NIR) agent indocyanine green (ICG) to identify parathyroid glands. One of the most important contributions of this study is that it directly compares 2 methods of fluorescent imaging—use of autofluorescence ("label-free") vs use of ICG as a contrast agent. The use of IMI demonstrated superior signal-to-background ratios (SBRs) compared with autofluorescence. Excitingly, in the 2 patients who underwent reexploration parathyroidectomy, IMI successfully localized the ectopic parathyroid gland, which could not be identified by conventional methods. These results suggest that IMI is an accurate and reproducible method for localizing parathyroid glands and that ICG imaging is supe rior to autofluorescence for parathyroid gland identification. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Use of Near-Infrared Molecular Imaging For Localizing Visually Occult Parathyroid Glands in Ectopic Locations

xlomafota13 shared this article with you from Inoreader Use of Near-Infrared Molecular Imaging For Localizing Visually Occult Parathyroid Glands in Ectopic Locations Via JAMA Otolaryngology–Head & Neck Surgery Online First This proof-of-principle clinical trial examines use of intraoperative molecular imaging for localizing visually occult parathyroid glands in both anatomic and ectopic locations. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Role of Tumor‐Infiltrating Lymphocytes and Tumor Budding in Early Oral Tongue Carcinoma

xlomafota13 shared this article with you from Inoreader Prognostic Role of Tumor‐Infiltrating Lymphocytes and Tumor Budding in Early Oral Tongue Carcinoma Via The Laryngoscope Objectives/Hypothesis Occult lymph metastasis is an important prognosticator for the treatment of early oral tongue squamous cell carcinoma (SCC). The objective of this study was to evaluate the prognostic significance of tumor‐infiltrating lymphocytes (TILs) in early oral tongue SCC. The combination of the TIL subtype and intermediate‐ or high‐grade budding scores was investigated as a prognostic marker for occult neck metastases. Study Design Retrospective study. Methods Specimens from 62 patients with early oral tongue SCC treated with only primary surgery were analyzed by immunohistochemistry for CD4+, CD8+, FoxP3+, and CD45RO+ T cells and CD163+ macrophages. The highest number of each TIL subtype was counted in two areas of parenchyma and stroma in the tumor (Tumor) and peripheral stroma of the invasion margin. Results Based on multivariate analysis, a high density of Tumor CD163+ macrophages served as the poorest prognostic factor for regional control (RC) and disease‐free survival (DFS). Patients with both a high density of Tumor CD163+ macrophages and an intermediate‐ or a high‐grade budding score had a poor prognosis for RC according to the log‐rank test. Conclusions In summary, each TIL subtype may use different mechanisms during early and advanced stages of oral tongue SCC. A high density of Tumor CD163+ macrophages was determined to be a risk factor for RC and DFS as well as an additional stratification factor for RC in patients with intermediate‐ or high‐grade budding scores. Therefore, identifying TIL subtypes in daily clinical practice can help determine a more successful and individualized therapeutic approach for early oral tongue SCC. Level of Evidence Step 4 (Level 4) Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intratympanic Lipopolysaccharide Elevates Systemic Fluorescent Gentamicin Uptake in the Cochlea

xlomafota13 shared this article with you from Inoreader Intratympanic Lipopolysaccharide Elevates Systemic Fluorescent Gentamicin Uptake in the Cochlea Via The Laryngoscope Objectives/Hypothesis Lipopolysaccharide (LPS), a key component of bacterial endotoxins, activates macrophages and triggers the release of inflammatory cytokines in mammalian tissues. Recent studies have shown that intratympanic injection of LPS simulates acute otitis media (AOM) and results in morphological and functional changes in the inner ear. Here we established an AOM mouse model with LPS to investigate the uptake of ototoxic gentamicin in the inner ear, and elucidated the underlying mechanism by focusing on cochlear inflammation as a result of AOM. Study Design Preclinical rodent animal model. Methods Fluorescently tagged gentamicin (GTTR) was systemically administered to mice with AOM. Iba1‐positive macrophage morphology and inner ear cytokine profile were evaluated by immunofluorescence technique and a mouse cytokine array kit, respectively. Results We observed characteristic symptoms of AOM in the LPS‐treated ears with elevated hearing thresholds indicating a conductive hearing loss. More importantly, the LPS‐induced AOM activated cochlear inflammatory responses, manifested by macrophage infiltration, particularly in the organ of Corti and the spiral ligament, in addition to the up‐regulation of proinflammatory cytokines. Meanwhile, GTTR uptake in the stria vascularis and sensory hair cells from all the LPS‐treated ears was significantly enhanced at 24, 48, and 72‐hour post‐treatment, as the most prominent enhancement was observed in the 48‐hour group. Conclusion In summary, this study suggests that the pathological cochlea is more susceptible to ototoxic drugs, including aminoglycosides, and justified the clinical concern of aminoglycoside ototoxicity in the AOM treatment. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.