RESUMEN
Background: Among aesthetic procedures, abdominoplasty is associated with an increased complication rate. In general, postoperative nausea and vomiting is frequently experienced. As vomiting increases the intraabdominal pressure and blood pressure, and results in an increased mechanical friction on the abdominal wall, intraoperatively ligated vessels are prone to reopen. However, previous studies have not investigated the impact of postoperative emesis on postoperative hematoma in patients undergoing abdominoplasty. Methods: We performed a retrospective analysis on all patients who underwent abdominoplasty between 2017 and 2019 in our institution. Patients were divided into two groups, group 1 including patients experiencing postoperative vomiting and group two including patients without postoperative vomiting. Data extraction focused on patient characteristics, intraoperative characteristics, and postoperative complications, particularly the proportion of patients developing postoperative hematoma. Finally, statistical analysis was performed to analyze the impact of postoperative vomiting on the risk to develop a postoperative hematoma. Results: We identified 189 patients fitting our inclusion criteria. Overall, the proportion of postoperative hematoma was 13.7%. Thereby, a statistically significant difference was found between both groups: 62.5% of patients in group 1 (vomiting group) and only 9.25% in group 2 (nonvomiting group) developed a postoperative hematoma [odds ratio: 16.4 (95% confidence interval, 5.3-50.9), P < 0.000001]. Conclusion: In patients undergoing abdominoplasty, postoperative vomiting increases the risk to develop a postoperative hematoma.
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Migraine affects more than 1 billion people globally, with distinct genetic variations influencing susceptibility. Thereby, genetic variations play a key role in the probability of developing migraine. However, personalized genetic analysis-based treatment options in migraine treatments are limited. Notably, surgical deactivation of extracranial trigger has shown efficacy in the treatment of migraine patients with identifiable trigger points in specific anatomical locations in the head and neck region. We present the first case of monozygotic twin sisters, both experiencing occipital and temporal-triggered migraine headaches with identical history and characteristics and without response to conservative migraine treatments. After surgical intervention, targeting the greater and lesser occipital nerves as well as auriculotemporal nerves, both twin sisters exhibited an over 99% reduction in symptoms without postoperative complications. This case suggests a potential correlation between genetic background, irrespective of environmental factors, and the effectiveness of surgical deactivation of trigger points in migraine management.
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BACKGROUND: The deep circumflex iliac artery (DCIA) perforator flap is an established method to reconstruct osteocutaneous defects. However, the cutaneous perforators come with a great anatomic variability. To deal with this problem, we used a sequential chimeric osteocutaneous free flap for reconstruction. PATIENTS AND METHODS: A 58-year-old man presented with an open tibial fracture after an avalanche accident resulting in an extended osteocutaneous defect in the lower extremity. The injury required osteocutaneous free flap coverage. We reconstructed the defect with a sequential chimeric osteocutaneous DCIA-perforator-SIEA flap. RESULTS: The preservation of the ascending branch of the deep circumflex iliac vessels offered us the possibility to effectively cover an extended osteocutaneous defect in the lower extremity with a sequential chimeric osteocutaneous DCIA-perforator-SIEA flap. In our patient, the sequential chimeric osteocutaneous DCIA-perforator-SIEA flap healed without complications. A small hernia developed at the inguinal donor site area, but it healed without further complications after surgical treatment. The patient regained an adequate function and returned to daily life and physical exercise. CONCLUSION: While preparing the DCIA-perforator free flap, it is important to preserve the ascending branch of the deep circumflex iliac vessels and the vessels needed to harvest either a SIEA or SCIP flap.
Asunto(s)
Fracturas Abiertas , Arteria Ilíaca , Fracturas de la Tibia , Humanos , Masculino , Persona de Mediana Edad , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Arteria Ilíaca/cirugía , Arteria Ilíaca/trasplante , Fracturas Abiertas/cirugía , Colgajo Perforante/irrigación sanguínea , Trasplante Óseo/métodos , Colgajos Tisulares Libres/irrigación sanguínea , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Microcirugia/métodos , Trasplante de Piel , Procedimientos de Cirugía Plástica/métodosRESUMEN
Soft-tissue defects of the lateral heel remain a challenge for reconstructive surgeons. Although a reliable vascular supply for free flap anastomosis is available anteriorly from the anterior tibial vessels and medially from the posterior tibial vessels, the vascular anatomy of the lateral side lacks suitable donor vessels for free flap anastomoses. Although the pedicle can be passed either ventrally beneath the skin or dorsally between the Achilles tendon and calcaneus, these passages are hardly applicable for lateral heel defects. We identified the space between the plantar surface of the calcaneus and the plantar aponeurosis as an innovative approach for reconstruction. Therefore, we propose the subcalcaneal fat pad as an alternative and reliable route for the passage of the flap pedicle to the posterior tibial vessels in free flap reconstruction of soft-tissue defects in the lateral calcaneal region. Consequently, the vascular pedicle can be safely anastomosed to the posterior tibial vessels. This approach provides a new option for recipient vessels in free flap reconstruction.
RESUMEN
The reconstruction of complex dorsal hand injuries can be challenging. For coverage of dorsal hand defects, thin flap tissue is preferred. In addition, it is ideal to raise flaps with minimal donor-site morbidity and a discrete scar. In a 65-year-old obese man, we successfully reconstructed a soft-tissue defect measuring 7 × 5 cm at the dorsal hand with an omental free flap harvested through single-port laparoscopy. Our patient regained hand function and is satisfied with the aesthetic results. We propose the single-port laparoscopic omental free flap to be a suitable option for free flap dorsal hand reconstruction, especially in obese patients with small defects. The technique provides a thin free tissue with a concomitant negligible donor-site scar.