Use of Dermal Substitute Matrices for Coverage of Exposed Limb Vascular Repairs: A Literature Review.

Background: Prompt coverage of vascular repairs in the extremities is needed to protect from desiccation and trauma. In the absence of local soft tissues to provide early coverage pending demarcation of the tissues and the zone of injury, there is no clear data in the literature on the ideal coverage method. This article is the first to review the use of dermal substitutes for temporary coverage of extremity vascular repairs pending definitive coverage. Methods: We conducted a review of the literature to identify previous articles indexed in PubMed and Ovid using these search terms: [(skin) OR (artificial skin) OR (Integra) OR (dermal substitute) OR (dermal substitute matrix) OR (dermal regeneration) OR (dermal regeneration matrix) OR (dermal regeneration template)] AND [(bypass) OR (graft) OR (vascular surgery) OR (revascularization) OR (salvage) OR (limb salvage) OR (vascular repair) OR (artery repair) OR (arterial repair)] AND [(limb) OR (extremity) OR (leg) OR (arm) OR (vascular injury) OR (amputation)]. Results: Of the 32 articles retrieved for initial review, five case reports with six patients of dermal substitute use for direct coverage of extremity repairs were identified. In all cases, the dermal substitute was able to provide stable coverage pending definitive coverage or was allowed to heal secondarily. Conclusions: Dermal substitute matrices are a potential means of temporary coverage of exposed extremity vascular repairs when there is a paucity of local soft tissues pending more definitive coverage.

The NIU (Nipple - Inframammary Fold - Upper Breast Border) Principle: A New Tool to Predict the Ideal Nipple/Areola Complex Position during Augmentation Mastopexy Preoperative Markings.

BACKGROUND: While the beauty of the breast depends on aesthetic proportions, the position of the nipple-areola complex on the breast mound and in relation to the implant during breast augmentation or mastopexy augmentation is critical [1][2][3]. In fact, lack of nipple position determination in relation to the breast footprint is a deficiency of most currently applied measurements and evaluation tools.We hereby present a simple formula that allows accurate and proper prediction of the ideal nipple areola complex (NAC) positioning for every patient depending on the chosen implant in case of mastopexy augmentation, or revision mastopexy with exchange of implants. METHODS: A prospective Level IV analysis of all consecutive patients undergoing primary mastopexy augmentation or revision mastopexy with exchange of implants was performed between January 2021 and January 2022.48 consecutive patients were included in the study. The "NIU" (Nipple - Inframammary Fold - Upper Breast Border) principle was applied to all patients to determine the ideal position of the NAC.Patients were photographed preoperatively and postoperatively in a standardized manner.The main end point was to determine if the NAC is located at the most projected point of the breast upon follow up. RESULTS: The NIU principle has been applied to 48 patients between January 2021 and January 2022. Of those patients, 27 underwent primary augmentation mastopexy, while 21 underwent revision augmentation mastopexy with exchange of implants.The mean follow up duration was 9.2 months (6-18 months). All patients demonstrated proper NAC positioning upon follow up. CONCLUSION: The NIU principle is a simple and reliable method to determine the ideal NAC position during mastopexy augmentation or mastopexy with implant exchange.

Lower limb amputation following venous cannulation for VA-ECMO: a case report.

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

Planejamento e marcação simplificados de mastopexia e mamoplastia redutora: o padrão circunvertical "Matryoshka" / Simplified planning and marking of mastopexy and reduction mammoplasty: the circumvertical "Matryoshka" pattern

■ RESUMO Introdução: Como a maioria dos outros procedimentos estéticos, particularmente em órgãos pareados para os quais a simetria é crítica, o resultado bem-sucedido da mastopexia e mamoplastia redutora é amplamente determinado pelo planejamento pré-operatório. Ao considerar cuidadosamente o desenho da ressecção da pele e escolher e desenhar um pedículo apropriado, a necrose da pele, cicatrizes inestéticas e distorção da forma podem ser minimizadas. Métodos: Apresentamos uma técnica original de marcação de pele que combina as vantagens do uso de um template Wise como base para marcação de pele com aquelas do padrão de mamoplastia vertical junto com uma excisão periareolar limitada de pele para encurtar a cicatriz vertical subareolar. Resultados: O design de marcação circunvertical da pele que propomos imita a silhueta de uma boneca russa, a "Matryoshka". Conclusão: Incorporar uma marcação pré-operatória mensurável e com base geométrica certamente oferece um grande grau de controle e consistência.

■ ABSTRACT Introduction: Like most other aesthetic procedures, particularly in paired organs for which symmetry is critical, the successful outcome of mastopexy and reduction mammoplasty is greatly determined by pre-operative planning. By carefully considering the design of the skin resection and choosing and designing an appropriate pedicle, prevention of skin necrosis, unsightly scars, and shape distortion can be minimized. Methods: We present an original skin marking technique that combines the advantages of using a Wise template as the basis for skin marking with those of the vertical mammoplasty pattern together with a limited circumareolar skin excision to shorten the subareolar vertical scar. Results: The circumvertical skin marking design we propose mimics a Russian doll silhouette, the "Matryoshka." Conclusion: Incorporating a geometrically based and measurable pre-operative marking certainly offers a great degree of control and consistency.