Staphylococcus Scalded Skin Syndrome-Induced Thrombosis Leading to Free Flap Complications: A Case Report and Review.

Staphylococcal scalded skin syndrome (SSSS) is a clinical term used for a spectrum of blistering skin conditions induced by the epidermolytic toxins of the Staphylococcus aureus bacteria. The complications of SSSS include thrombosis; however, the pathophysiology of this is still poorly understood. We present a case of free anterolateral thigh (ALT) flap failure in a patient as a result of widespread flap thrombosis associated with staphylococcal scalded skin syndrome (SSSS). This is the first reported case of free flap failure associated with SSSS. Free flap failure due to acquired prothrombotic conditions, such as infection, is a rare and potentially under-reported phenomenon. This article aims to further explore the role of both thrombophilias and provoked thrombotic events in free flap failure. A review of the literature will also be presented, and cases of free flap failure in patients with infection-induced vascular complications will be summarised.

Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network Meta-Analysis.

BACKGROUND: The use of acellular dermal matrices (ADMs) and synthetic mesh as part of implant-based breast reconstruction (IBBR) has been widely adopted. The authors investigated the clinical efficacy and safety of human ADM (HADM), xenograft ADM (XADM), and synthetic mesh as part of IBBR in postmastectomy patients as compared with previous standard implant reconstruction techniques using only a submuscular pocket for coverage. METHODS: A systematic search for randomized controlled trials and observational studies was performed. A frequentist network meta-analysis was conducted using the R packages netmeta and Shiny. RESULTS: Thirty-one of 2375 studies identified met the predefined inclusion criteria. Traditional submuscular placement (no ADM or mesh) had fewer overall complications compared with HADM [OR, 0.51; credible interval (CrI), 0.34 to 0.74], but there was no significant difference between no ADM or mesh and XADM (OR, 0.63; CrI, 0.29 to 1.32) or synthetic mesh (OR, 0.77; CrI, 0.44 to 1.30). No one treatment was superior with regards to implant loss. No ADM or mesh was associated with fewer infectious complications than HADM (OR, 0.6; CrI, 0.39 to 0.89). Both no ADM or mesh (OR, 0.45; CrI, 0.27 to 0.75) and XADM (OR, 0.46; CrI, 0.23 to 0.88) had reduced seroma compared with HADM. CONCLUSIONS: Selecting the appropriate IBBR should evaluate effectiveness, adverse events, and cost. Although it is difficult to select a universal ideal IBBR, evaluation using this network analysis may help guide both physicians and patients in their choice of procedure, especially in the case of HADM, which in this study was shown to be significantly predisposed to complications of infection and seroma. Randomized data are required comparing XADM versus synthetic meshes, given the similar risk profiles but significant cost discrepancy between the techniques.

COVID-19 and cosmetic tourism: A Google trends analysis of public interests and the experience from a tertiary plastic surgery centre.

AIMS: The primary aim of this study was to highlight the burden of cosmetic tourism on the Irish healthcare system during the COVID-19 pandemic. Our secondary aim was to examine the popularity of cosmetic tourism currently through Google Trends data analysis. METHODS: Data on all patients presenting to our unit with complications of cosmetic tourism were retrospectively reviewed to determine the level of care and resources used for each case. The 'Google Trends' data analysis tool was accessed and the popularity of common plastic surgery topics was analysed over the last two years. RESULTS: Eight patients were referred for treatment after experiencing complications following elective cosmetic surgery overseas. Complications included seroma1, infected collection3, wound dehiscence5 and implant extrusion.2 Length of stay ranged from 1 to 18 days with 63% of patients requiring invasive intervention. Google trends revealed that popularity for plastic surgery topics initially decreased at each lockdown date but increased to pre-pandemic interests after a short period. Related search topics for procedures including the terms, "Turkey" and "Lithuania" increasing in popularity by more than 5000%. CONCLUSIONS: This case series shows that despite the current pandemic cosmetic tourism is imposing a significant cost on healthcare resources. Analysis of Google Trends has shown that interest in these procedures is increasing despite travel restrictions and risks associated with the pandemic. The public need to be informed of the potentially negative consequences of cosmetic tourism and be discouraged from undertaking surgery overseas during the current crisis.

The effectiveness of radiotherapy in the treatment of head and neck mucosal melanoma: Systematic review and meta-analysis.

INTRODUCTION: Mucosal melanoma (MM) is a rare condition with a poor prognosis. Surgery is the corner stone of treatment, however, radiotherapy has been commonly employed as a treatment strategy and recent studies suggesting that survival outcomes may be improving are emerging. METHODS: A systematic review and meta-analysis comparing risk ratios of radiotherapy and surgery and radiotherapy (SRT) with surgery for 5-year overall survival, local recurrence and distant metastasis in head and neck mucosal melanoma (HNMM). RESULTS: SRT has a lower risk of death compared to surgery [RR 0.93 [95% CI = 0.87, 0.98] (P = .01)] and a reduced risk of local recurrence [RR 0.63 [95% CI = 0.48, 0.82] (P = .005)]. SRT has no effect on distant metastasis. Radiotherapy has worse survival when compared to surgery [RR 1.2 [95% CI = 1.03, 1.33] (P = .0006)]. CONCLUSIONS: SRT confers a moderate survival advantage in HNMM compared to surgery. This is most likely secondary to reduced local recurrence.

Collagenase Use and a Trap for the Unwary in Patients With Upper Limb Spasticity.

Collagenase has revolutionized the treatment of Dupuytren's disease. It acts by lysing collagen in Dupuytren's cords. It can also act on collagen in tendons, leading to tendon rupture. In this letter, we highlight caution where bowstringed flexor tendons were masquerading as Dupuytren's cords in a patient with upper limb spasticity. The initial plan was to inject the cords with collagenase; however, we proceeded with an open approach. If we had proceeded with our initial plan to inject the palpable cords with collagenase, tendon rupture would have been the likely outcome. We advise that administrators of collagenase proceed with caution in patients with upper limb neurological disorders, bearing in mind that bow-stringed flexor tendons can mimic Dupuytren's cords.