Superficial lateral arm flap for post-burn antecubital contractures.

This paper presents a new variant of the distally based lateral arm fasciocutaneous flap that involves a straightforward and easy dissection as no specific vessel identification or inclusion is needed. Ten fresh cadavers were dissected to study the vascular supply. All three recurrent arteries-radial, ulnar, and interosseus-nourish the flap. The study also identified muscular perforators from the radial recurrent artery, piercing brachioradialis, and, in addition, septocutaneous perforators from the ulnar and interosseous recurrent arteries entering the base of the flap. Clinical application in 12 patients with upper limb burns including antecubital fossa contracture is also reported. This is a reliable and reproducible flap. The clinical dissection is straightforward and easy, with no need to identify or include a specific vessel at the base of the flap. Harvest requires neither the microscope nor loupes and can be done without a tourniquet, so it can be used in even the most modest surgical settings.

Sterile necrotizing cellulitis in boat immigrants' limbs after long journeys across the ocean. / Celulitis necrosante estéril en las extremidades de migrantes marinos tras travesías prolongadas.

BACKGROUND: In the past few years, the Canary Islands received immigrants from sub-Saharan countries that arrive to the coast after long boat trips in extreme adverse conditions. The named «trench foot¼ is a previously described infectious entity developed after feet wounds that get infected by being in contact with water, urine and excrements in these small and crowded boats. We describe a new clinical entity, not published yet, that consists in massive edema in the extremities associating necrosis of the skin and subcutaneous tissue that characteristically respects the muscle and with a non-infectious etiology. MATERIAL AND METHODS: A database including 86 patients arrived by boat («patera¼) from sub-Saharan countries from September 2020 to January 2022 was made and 39 qualitative and quantitative items were analyzed. The Research Unit performed an observational prospective statistical analysis. RESULTS: A total of 16 patients developed the entity described as necrotizing cellulitis. Its physiopathology completely differs from the one described in the trench foot, since all the cultures resulted sterile. CONCLUSIONS: We postulate an inflammatory theory due to the osmotic effect from ingesting sea water and/or the aggressive fluid reposition when they arrive to the emergency room with severe dehydration and hypernatremia. Early surgical evacuation of the edema with escharotomies incisions alleviate the symptoms and prevents progression of the disorder.

Oncological outcomes of lipofilling in breast reconstruction: a matched cohort study with 250 patients.

BACKGROUND: Fat grafting is a procedure commonly used in breast reconstruction nowadays. Nevertheless, its oncological safety remains controversial. The potential risk that progenitor cells included in fat graft tissue may contribute to disease progression in patients with breast cancer is still debatable. We have designed a matching-cohort study with 250 patients with history of breast cancer trying to elucidate an answer for this question. METHODS: We selected 250 patients with a history of breast cancer in our hospital, between 2011 and 2019. A total of 125 patients (cases) had a history of breast cancer reconstructed with fat grafting. The additional 125 patients are matched controls. We analyzed the distribution of eight different variables within the cases and their matched controls: date of first oncological surgery, age, type of oncological surgery, histological subtype, Her-2 status, pN, smoking habit and diabetes mellitus. The objective of this study was to analyze the influence of fat grafting over breast cancer recurrence. RESULTS: There are not statistically significant differences in breast cancer locoregional recurrences (P=0.183), distant metastases (P=0.200) or total recurrences (P=0.065) amongst the two groups (cancer cases and matched controls). CONCLUSIONS: Our study adds more information over the oncological safety of fat grafting. These findings should encourage long-term prospective trials to provide surgeons with accurate information regarding the role of lipofilling on breast neoplasms.

Implant-based immediate breast reconstruction: failure rate when radiating the tissue expander or the permanent implant-a meta-analysis.

BACKGROUND: Implant-based immediate approach remains to be a first line option for reconstruction of mastectomy defects. When combined with post-mastectomy radiation therapy (PMRT) two different schemas are possible: radiating the temporary tissue expander (TTE) or the permanent implant (PI). The present article intends to be the biggest cohort meta-analysis to the date comparing reconstructive failure (RF) rate in these two scenarios: PMRT to TE compared with PMRT to PI. METHODS: A systematic search of the literature was performed on PUBMED/MEDLINE. The following key words were chosen: Breast Reconstruction AND Implant based AND Immediate. The time limit applied was from January 2008 to January 2019. We selected ten articles (n=1,130) to perform a meta-analysis due to the similarity of their approaches. Secondly, we did a simple literature review in order to identify some variables possibly working as predicting factors for RF. RESULTS: Previous meta-analysis are analysed. Some variables possibly working as risk factors for RF are summarized. We performed a meta-analysis in two scenarios: a fixed-effect model and a random effect model. For the random effect model an OR of 1.85 was obtained (0.96, 3.57; P=0.067). A funnel plot is performed showing no publication bias exists. CONCLUSIONS: There is a tendency towards a higher RF rate when the TTE is irradiated compared with the irradiation of the PI. Further studies trying to elucidate the influence of the suggested risk factors for RF have to be performed to stablish a consensus about the indications and contraindications of this reconstructive modality.

Penile and scrotal lymphedema associated with hidradenitis suppurativa: Case report and review of surgical options.

Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically.

El linfedema es producto de una alteración en el drenaje linfático, y su causa más frecuente en todo el mundo es la filariasis. En nuestro medio suele encontrarse asociada a procesos neoplásicos, inflamatorios, granulomatosos, secuelas por radioterapia, desequilibrios hidroelectrolíticos y procesos idiopáticos. Puede afectar a cualquier parte del cuerpo, incluyendo el pene y el escroto. El linfedema genital es una presentación infrecuente, que corresponde al 0.6% de los linfedemas. No obstante, causa graves limitaciones funcionales, sociales y emocionales para el paciente. Con mucha frecuencia se presentan dolor, infecciones recurrentes, disfunción sexual y deformidad estética, llegando incluso a limitar la movilidad y la deambulación. Aunque existen varias opciones de tratamiento, tanto médico como quirúrgico, no se ha encontrado el ideal para esta enfermedad. Presentamos el caso de un paciente de 43 años afecto de hidrosadenitis axilar e inguinal que padece linfedema penoescrotal grave que limita seriamente su actividad habitual. El paciente fue remitido a nuestro centro tras el fracaso del tratamiento con antibióticos (ciclos de doxiciclina y clindamicina). El tratamiento quirúrgico consistió en la resección de piel y tejido celular subcutáneo hasta fascia de Buck y cobertura con injertos de piel. El resultado final fue adecuado desde un punto de vista tanto funcional como estético.

Fingertip Necrosis due to Intravascular Use of Mephedrone: A Case Report.

Mephedrone is a new synthetic cathinone-derived drug. It is a sympathomimetic drug, and its structure is similar to amphetamines, although its specific pharmacokinetics and metabolism remain unknown. We performed a literature search in PUBMED with the following key words: Mephedrone AND Necrosis AND Hand. No results were found. We performed a second literature search with the following key words: Mephedrone AND Physiopathology AND Side effects, obtaining a total of 7 articles that we read before writing this case report. We will present a case report of a 28-year-old man with distal ischemia in his left hand associated to intra-arterial drug use of mephedrone. The patient ended up having superficial necrosis involving skin and subcutaneous tissue in his thumb, which was treated with wound care. Good quality healing, full range of motion, and normal sensitivity were achieved. There are no previous publications related to any side effects secondary to its intravascular use. The ultimate mechanism producing this distal fingertip necrosis remains undefined.

Penile and scrotal lymphedema associated with hidradenitis suppurativa: Case report and review of surgical options. / Linfedema penoescrotal secundario a hidrosadenitis supurativa: a propósito de un caso, revisión de las opciones quirúrgicas

Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically.

El linfedema es producto de una alteración en el drenaje linfático, y su causa más frecuente en todo el mundo es la filariasis. En nuestro medio suele encontrarse asociada a procesos neoplásicos, inflamatorios, granulomatosos, secuelas por radioterapia, desequilibrios hidroelectrolíticos y procesos idiopáticos. Puede afectar a cualquier parte del cuerpo, incluyendo el pene y el escroto. El linfedema genital es una presentación infrecuente, que corresponde al 0.6% de los linfedemas. No obstante, causa graves limitaciones funcionales, sociales y emocionales para el paciente. Con mucha frecuencia se presentan dolor, infecciones recurrentes, disfunción sexual y deformidad estética, llegando incluso a limitar la movilidad y la deambulación. Aunque existen varias opciones de tratamiento, tanto médico como quirúrgico, no se ha encontrado el ideal para esta enfermedad. Presentamos el caso de un paciente de 43 años afecto de hidrosadenitis axilar e inguinal que padece linfedema penoescrotal grave que limita seriamente su actividad habitual. El paciente fue remitido a nuestro centro tras el fracaso del tratamiento con antibióticos (ciclos de doxiciclina y clindamicina). El tratamiento quirúrgico consistió en la resección de piel y tejido celular subcutáneo hasta fascia de Buck y cobertura con injertos de piel. El resultado final fue adecuado desde un punto de vista tanto funcional como estético.

Successful hand replantation in a seafarer after long-distance helicopter evacuation. A case report.

After sustaining a clean-cut mid-carpal hand amputation on a tanker 120 miles north of Lanzarote, a 28- -year-old seafarer was evacuated by helicopter to a microsurgical unit in Gran Canaria. The amputated hand was cooled according to precise instructions. The 6-hour flight time included two refuelling stops and transfer time. The hand had been revascularized thirteen hours after the accident and was still well circulated at repatriation 3 weeks later.