Tuesday, February 15, 2022

The radial forearm snake flap: An underutilized technique for fasciocutaneous and osteocutaneous forearm flaps with primary closure

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Abstract

Background

The radial forearm free flap (RFFF) is associated with troublesome donor site morbidity related to split thickness skin grafting (STSG). The radial forearm snake flap with primary closure of the donor site may reduce donor site complications.

Methods

Single institution, retrospective cohort study comparing rates of delayed donor site wound healing and tendon exposure in 52 patients undergoing radial forearm snake flap and 95 patients undergoing conventional RFFF with STSG closure of the donor site.

Results

Tendon exposure occurred in zero (0%) patients undergoing snake flap and four (4.2%) patients undergoing conventional RFFF (0/52 vs. 4/95; p = 0.297). Delayed wound healing occurred in zero (0%) patients undergoing snake flap and 19 (20.0%) patients undergoing conventional RFFF (0/52 vs. 19/95; p < 0.001).

Conclusions

The radial forearm snake flap provides an alternative to conventional RFFF harvest, which enables primary donor site closure with reduced rates of delayed donor site healing.

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How to Maximize the Outcomes of Cochlear Implantation in Common Cavity and Cochlear Aplasia With Dilated Vestibule, the Most Severe Inner Ear Anomalies?

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Clin Exp Otorhinolaryngol. 2022 Feb 15. doi: 10.21053/ceo.2022.00164. Online ahead of print.

NO ABSTRACT

PMID:35158419 | DOI:10.21053/ceo.2022.00164

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Donor site complications and satisfaction in autologous fat grafting for breast reconstruction: A systematic review

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J Plast Reconstr Aesthet Surg. 2022 Jan 25:S1748-6815(22)00043-2. doi: 10.1016/j.bjps.2022.01.029. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most common cancer in females worldwide. One option for total breast reconstruction following total breast amputation is autologous fat transfer (AFT). However, this is still an upcoming reconstruction technique, and little is known about the donor site complications and their influence on the patient's overall satisfaction.

OBJECTIVES: This systematic review aims to review the current literature regarding donor site complications and donor site satisfaction following AFT for total breast reconstruction.

SEARCH METHODS: A literature search was performed in PubMed, Web of Science, Embase, Cochrane, TRIP pro, and Prospero. All published original literature reporting on complications or satisfaction at the donor site in patients who underwent liposuction, followed b y high-volume lipofilling was considered.

MAIN RESULTS: This systematic review resulted in the inclusion of 21 cohort studies, consisting of 2241 participants. None of the studies reported donor site satisfaction scores of any kind. The most frequently reported donor site complication was ecchymosis (268 cases), followed by pain (122 cases), haematoma (58 cases), irregularities (12 cases), burns (four cases), and infection (three cases). Reports on follow-up and management of donor site complications were generally lacking.

AUTHOR'S CONCLUSIONS: Results regarding the donor site are inconclusive. Pre-specified complications, a standardized manner of reporting, long-term follow-up, and patient-reported outcome measures are lacking in most of the studies. The impact of the donor site on quality of life after autologous fat grafting in breast reconstruction remains a blind spot. PROSPERO registration number: CRD42020222870.

PMID:35165073 | DOI:10.1016/j.bjps.2022.01.029

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New AMM: Nivolumab as an adjuvant for oesophageal and gastroesophageal junction cancer

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Bull Cancer. 2022 Feb 11:S0007-4551(22)00009-1. doi: 10.1016/j.bulcan.2021.11.018. Online ahead of print.

NO ABSTRACT

PMID:35164916 | DOI:10.1016/j.bulcan.2021.11.018

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Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

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J Clin Med. 2022 Jan 28;11(3):685. doi: 10.3390/jcm11030685.

ABSTRACT

OBJECTIVE: To determine the effects of behavioural interventions in people with oropharyngeal dysphagia.

METHODS: Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), afte r which meta-analyses were performed using a random-effects model.

RESULTS: A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training.

CONCLUSIONS: Behavioural interven tions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.

PMID:35160137 | DOI:10.3390/jcm11030685

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Secondary primary malignancy in patients with head and neck squamous cell carcinoma

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by Shih-Wei Wang, Leong-Perng Chan, Ling-Feng Wang, Che-Wei Wu, Sheng-Hsuan Lin, Tzu-Yen Huang, Ka-Wo Lee

Background

The survival rate of head and neck squamous cell carcinoma (HNSCC) patients with secondary primary malignancy (SPM) showed no significant improvement for decades, however, the impact of advances in diagnostic tools is rarely mentioned. This study investigated the clinical characteristic of HNSCC with SPM over a 27-year period especially from the perspective of diagnostic tools.

Methods

This study evaluated 157 HNSCC patients with SPM. The patients were divided into two groups according to the time of SPM diagnosis (Group A:1992–2003; Group B: 2004–2014). Age, gender, stage of first primary malignancy (FPM), SPM interval, overall survival, and disease-free survival were compared between groups.

Results

Group B had significantly more SPM developed rate (p = 0.002), more SPM patients with advanced stage of FPM (p = 0.001), synchronous SPM (p = 0.006), and shorter SPM interval (p Conclusion

Among patients diagnosed with HNSCC recently, more SPMs are diagnosed in a shorter time interval and in a more advanced stage. The overall advances in diagnostic tools cannot significantly improve SPM survival, however, it enables more patients to receive corresponding treatment.

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The Extent of Thyroid Surgery in Differentiated Thyroid Cancer Patients with Low and Intermediate Risks of Recurrence

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Clinical Thyroidology, Volume 34, Issue 2, Page 63-66, February 2022.
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Predisposition to and Prognosis of Thyroid Cancer May Not Be Affected by Graves’ Disease, But Some Questions Still Remain

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Clinical Thyroidology, Volume 34, Issue 2, Page 59-62, February 2022.
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Diagnostic Value of Preoperative Serum Calcitonin Levels in Medullary Thyroid Carcinoma

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Clinical Thyroidology, Volume 34, Issue 2, Page 85-88, February 2022.
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Herpes Zoster of The Larynx: A Narrow Diagnostic and Therapeutic Window

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Ear Nose Throat J. 2022 Feb 15:1455613221077594. doi: 10.1177/01455613221077594. Online ahead of print.

ABSTRACT

We hereby present a rare case of laryngeal zoster presenting with unilateral odynophagia and hemifacial pain in an immunocompetent host. Visualization of the characteristic vesicles is challenging given their short-lived and at times delayed appearance; thus, laryngeal zoster may be a largely unrecognized cause of laryngitis and cranial neuropathies. Heightened aw areness may improve prompt diagnosis, referral and initiation of antiviral therapy, while guiding patient counselling on the associated long-term sequelae such as voice and swallowing impairments, and post-herpetic neuralgia.

PMID:35166603 | DOI:10.1177/01455613221077594

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The clinicopathological and prognostic characteristics of mucinous micropapillary carcinoma of the breast

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Histol Histopathol. 2022 Feb 15:18436. doi: 10.14670/HH-18-436. Online ahead of print.

ABSTRACT

BACKGROUND: Mucinous micropapillary carcinoma (MMPC) is a unique subtype of breast cancer, and there is as yet no detailed report on the clinical characteristics of MMPC.

METHODS: MMPC, pure mucinous breast carcinoma (PMBC), and invasive micropapillary carcinoma (IMPC) samples were enrolled simultaneously, and immunohistochemistry analysis was performed to explore the clinicopathological attributes of MMPC. Moreover, survival analyses of MMPC were performed among the MMPC, PMBC, and IMPC groups and within the MMPC group.

RESULTS: The results showed that MMPC demonstrated distinct pathological features and that vascular invasion and lymph node metastasis were two significant clinical attributes of MMPC. MMPC leads to a shorter survival time than PMBC but an increased survival time compared to IMPC, while the tumor-node-metastasis stage and lymph node metastasis were identified as two independent prognostic elements for disease-free survival in discerning the MMPC prognosis.

CONCLUSIONS: The gathered data implied that further understanding and classification of MMPC may provide better individualized therapeutic strategies for MMPC treatment.

PMID:35166367 | DOI:10.14670/HH-18-436

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Quantitative lateral flow immunoassay for rapid detection and monitoring of cerebrospinal fluid leakage following incidental durotomy

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Anal Chim Acta. 2022 Mar 1;1196:339544. doi: 10.1016/j.aca.2022.339544. Epub 2022 Jan 25.

ABSTRACT

Cerebrospinal fluid (CSF) leakage due to incidental durotomy is an inherent complication of spine surgery. With appropriate treatment, complications of CSF leakage, such as headache and even meningitis, can be reduced. CSF leakage could be detected on the basis of correlated clinical symptoms; diagnosis should be based on these symptoms and appropriate imaging studies. However, the diagnosis of CSF leakage remains a challenge, especially if incidental durotomy is unrecognized during surgery; even if incidental durotomy is detected and repaired intraoperatively, the severity of the leakage and quality of the primary dural repair are difficult to evaluate postoperatively. Rapid, inexpensive, and safe methods of detecting CSF-containing samples are currently lacking; hence, the development of a point-of-care test (POCT) method to improve diagnostic efficiency is necessary. We developed a high-sensitivity lateral flow immunoassay with a stacking pad (sLFIA) for quantitative detection of β-trace protein (BTP), a specific CSF marker. The BTP concentration in 39 clinical samples was calculated using a calibration equation for test-line intensity and evaluated by a standard laboratory method. To avoid the hook effect, we diluted each sample prior to testing. The correlation coefficient between the enzyme-linked immunosorbent assay and our BTP sLFIA method was 0.991 A 75-fold sample dilution was applied owing to the hook effect point, identified as 175 ng mL-1. We established an optimal sample-specific cutoff point at a value of 4.0 μg mL-1 for CSF leakage in subfascial drainage samples following spinal posterior decompression. The sensitivity and specificity of the BTP sLFIA method were 90% and 97%, respectively, according to a receiver operating characteristic curve analysis. In addition, clinical samples from patients who underwent primary dural repair intraoperatively were tested, and CSF leakage was successfully diagnosed using our method. Finally, the quantitation of BTP in samples collected daily provided an accurate assessment of the severity of the residual leakage. Our results demonstrate that the BTP sLFIA method possesses the potential to serve as a POCT method for screening and monitoring postoperative CSF leakage.

PMID:35151406 | DOI:10.1016/j.aca.2022.339544

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