Delayed Abdominal Flap for Upper Extremity Soft Tissue Coverage.

Unlike other body parts, the upper extremity has critical structures close to the skin, making soft tissue injuries more complex. These injuries can result from various causes, including trauma and necrotizing soft tissue infections, necessitating reconstruction. Historically, pedicled flaps from the groin and abdomen were commonly used for upper extremity reconstruction, but they had limitations, such as the need for flap division and debulking, patient discomfort, and stiffness. Free flap reconstruction has become the preferred method, but it still faces challenges like patient and facility issues, the absence of recipient vessels after injury, and multi-surface wounds. This case report describes a 67-year-old patient with a severe necrotizing soft tissue infection in the right upper extremity. After multiple debridement procedures, the patient underwent hand amputation and soft tissue coverage using an abdominal wall-based flap. The objectives of achieving stable soft tissue coverage while preserving maximal length of the upper extremity were successfully achieved, and the patient expressed satisfaction with the outcomes. Inadequate management of upper extremity wounds can lead to amputation and psychological distress. The reconstructive ladder is used to approach upper extremity soft tissue defects, with free tissue transfer being the standard for larger defects. However, abdominal flaps still have indications when free tissue transfer is not feasible or contraindicated. It is imperative that plastic surgeons have these techniques in their armamentarium to provide a service to the ever more complex patient with an upper extremity wound.

Functional Rhinoplasty.

The nose is composed of intricate intranasal anatomy to serve its sophisticated functions. Although it only occupies a small area, it is the central focal point of the face and demands the highest level of understanding of the delicate interplay of form and function. Functional rhinoplasty, as opposed to aesthetic rhinoplasty, primarily aims to enhance nasal breathing and olfaction without altering the nose's appearance. The goal of this study is to describe the anatomy and physiology of the nose as well as the pathophysiology of nasal obstruction and the surgical approaches available for functional rhinoplasty. Whether when performed alone or combined with cosmetic rhinoplasty, functional rhinoplasty is a procedure that can bring significant benefits and improve the quality of life of our patients. Understanding nasal anatomy and physiology is key for successful management and outcomes. To provide optimal treatment for the patients, plastic surgeons must be familiarized with various techniques that have been documented.

Surgical Approach to Orbital Floor Fractures: Comparing Complication Rates Between Subciliary and Subconjunctival Approaches.

BACKGROUND: There are multiple approaches to repairing orbital floor fractures. This study compares the postoperative complications of the subciliary and transconjunctival approaches. METHODS: The electronic medical records from 2 hospitals were screened for CPT codes associated with orbital floor reconstruction. A total of 184 patients were identified and included in the study. Patient characteristics and complications were compared by surgical approach. RESULTS: Of the 184 patients, 82 (44.6%) were in the subciliary group and 102 (55.4%) were in the transconjunctival group. The overall postoperative complication rate was 25.5%. The most common of these were diplopia (11.4%), corneal injury (7.1%), proptosis (5.4%), and enopthalmos (4.9%). The complication rate was not statistically significant between the 2 groups. CONCLUSION: Subciliary and transconjunctival approaches to orbital floor repair are equally safe. This study is limited by a smaller sample size, and a larger study will likely be necessary to fully address this question.

Gender-based differences in hemostatic responses.

AIM: Recent reports indicate increased mortality in women owing to cardiovascular diseases necessitating more gender-based studies. It is hypothesized that women have variable hemostatic responses to anticoagulant drugs. MATERIALS & METHODS: The hemostatic responses in healthy males (n = 10) and females (n = 10) were evaluated by performing various assays in the presence of anticoagulant drugs. Citrated whole blood from healthy volunteers (n = 20) was supplemented with rivaroxaban (final concentration [FC] = 0.3 µg/ml) and enoxaparin (FC =5 µg/ml). RESULTS: Differences between males and females were noted in the whole blood activated partial thromboplastin time (p = 0.0442) and Heptest® (p = 0.0345) assays in the saline control values. In the plasma system, rivaroxaban at a FC of 0.3 µg/ml and enoxaparin at 5 µg/ml showed a gender-based difference in the Heptest (p = 0.0423). Females showed faster fibrin formation than males. In the plasma system, plasminogen activator inhibitor-1 and domain-dimer assays (American Diagnostica, CT, USA) were performed with domain-dimer showing differences (p = 0.035). In the von Willebrand factor multimers, only band 5 showed differences (p = 0.032). Gender-based differences were observed. CONCLUSION: Careful adjustment of the dosages of anticoagulant drugs may be necessary to avoid bleeding or thrombosis.