Immediate Versus Overnight-Delayed Digital Replantation: Comparative Retrospective Cohort Study of Survival Outcomes.

PURPOSE: Ischemia time has been traditionally considered a critical factor in replantation survival rate. The objective of this study was to compare the survival rate between immediate and overnight-delayed digital replantation. METHODS: We performed a retrospective cohort study of all digital replantations performed at our clinic between 2005 and 2016. The survival rate was compared between the immediate digital replantation group (immediate replantation group) and those that were replanted the morning after they were admitted to the hospital (overnight-delayed replantation group). The decision to delay the replant was made in cases admitted in the evening with less than 12 hours of previous ischemia time and without farm-related contamination. RESULTS: Five hundred ninety-seven digital replantations (456 patients) were analyzed. One hundred eighty-five (31%) digital replantations were performed the following day (delayed replantation group) and 412 (69%) digital replantations were performed the same day that they were admitted to the hospital (immediate replantation group). The overall survival rate was 91.9% (549 of 597). In the immediate replantation group, the survival rate was 91.2% (376 of 412) and in the delayed replantation group, the survival rate was 93.4% (174 of 185). There were no statistically significant differences between the immediate and the delayed replantation groups with respect to age, zone of amputation, or presence of multiple amputations. CONCLUSIONS: Our study suggests that overnight delay is a safe approach for digital replantation when performed by experienced microsurgeons. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

The Pyramidal Flap: an Innovative Technique for DIEP Flap Refinement.

DIEP flap is considered the gold standard technique for breast reconstruction. One of the most frequent contour deformities after breast reconstruction with DIEP flap is a step-off deformity at the interface between the native chest wall and the reconstructed breast. Different techniques have been used to address this problem. We describe the pyramidal flap as a simple, single stage and low risk procedure, which specifically corrects the step-off or tapering deformity of the reconstructed breast with DIEP flap.

Prelaminated Fascia Lata Free Flap for Oronasal Fistula Reconstruction.

Oronasal fistulae are frequently symptomatic due to rhinolalia and regurgitation of solid food and liquids through the palate.1 When asymptomatic, fistulae can be managed with conservative therapies. Local flaps are useful to close small fistulae but cannot be used in bigger ones and cases with bad-quality surrounding tissues. Ideally, a thin double-layer mucosal tissue is required, but there are no suitable donor sites for this tissue in the human body. We report a palate fistula reconstruction with prelaminated fascia lata free flap.

Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.

BACKGROUND: The purpose of this study was to determine whether the aesthetic results of subpectoral augmentation mammaplasty using anatomically shaped versus round prostheses are differentiable. METHODS: Thirty observers (i.e., plastic surgeons and nurses) assessed preoperative and postoperative photographs (frontal and oblique views) of 30 patients who had undergone subpectoral augmentation mammaplasty with cohesive silicone gel implants, with an average implant volume of 295 cc (range, 220 to 340 cc). The observers classified each case as round or shaped on two different occasions with a 12-week time interval. A statistical concordance analysis was performed, calculating the overall concordance rate, the interobserver, the intraobserver, and the overall intraobserver kappa indexes, to evaluate the expert observers' capacity to differentiate the implant type. RESULTS: Among the total of 1800 observations (30 observers assessed 30 cases on two occasions), the overall concordance rate was 50.33 percent (95 percent CI, 47.99 to 52.67). The interobserver kappa value was 0.010 (95 percent CI, 0.0025 to 0.04). The overall intraobserver kappa value was 0.0602 (95 percent CI, 0.0025 to 0.123). The observers were unable to recognize the type of implant used, nor was interobserver concordance noted. An agreement was not reached before the different observers, nor was an intraobserver concordance seen between the first and second classifications of the same cases by each observer. CONCLUSION: The results obtained from subpectoral augmentation mammaplasty using anatomically shaped and round prostheses with a volume of 340 cc or less are indistinguishable, not justifying the systematic use of anatomically shaped implants in this patient. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.