Proximal Plate Migration After Internal Fixation of a Pediatric Distal Radius Fracture.

We present a case of a 26-year-old right-hand-dominant male stage manager who underwent open reduction internal fixation of right open both-bone forearm fractures at the age of 13. The patient presented 13 years and 8 months later with proximal hardware migration, soft tissue erosion, and subsequent hardware exposure. The patient underwent hardware removal with resolution of pain and improvement in range of motion. To the best of our knowledge, this complication has not been published before.

Vertical Abdominoplasty Technique and the Impact of Preoperative Comorbidities on Outcomes.

BACKGROUND: As the number of patients requiring bariatric surgery has increased, so has the demand for body contouring after massive weight loss. Surgery involving the abdomen in these patients is particularly challenging as both vertical and horizontal laxity if often present, making traditional abdominoplasty techniques less effective. OBJECTIVES: The aim of this study was to review the operative technique and evaluate the preoperative comorbidities and operative decisions that may impact patient outcomes in those undergoing vertical abdominoplasty. METHODS: A review of the authors' technique is described. A retrospective chart review of patients who underwent vertical abdominoplasty for significant vertical and horizontal laxity after massive weight loss by a single surgeon between June 2007 and July 2019 was performed. Preoperative parameters, operative factors, and minor and major complications were evaluated. RESULTS: Our complication rate was 81% (13/16), which were all minor. No major complications were encountered. Patients with a history of nicotine use had a 100% complication rate. There was a trend toward higher seroma formation in patients with coronary artery disease and those with a history of smoking. There was also a trend toward higher wound dehiscence in patients with renal disease. The authors found no statistically significant correlation between complications and older age, higher weight of tissue resected, higher body mass index, and medical comorbidities. CONCLUSIONS: This small series helps to elucidate the role of vertical abdominoplasty in the care of patients following massive weight loss and its associated morbidity. Proper patient selection, appropriate preoperative patient counseling, and sound surgical technique help to mitigate the negative outcomes.

Lower Extremity Flap Salvage in Thrombophilic Patients: Managing Expectations in the Setting of Microvascular Thrombosis.

Background Undiagnosed thrombophilia is a risk factor for flap failure; however, its prevalence in patients undergoing microsurgical reconstruction is unknown. We present our experience with free tissue transfer (FTT) in a high-risk population of lower extremity patients with documented thrombophilia, identified through preoperative screening. Methods Between January 2012 and April 2014, 41 patients underwent 43 free flaps for nontraumatic, lower extremity reconstruction by a single surgeon. Patients were preoperatively screened for thrombophilia using historical information and standardized laboratory testing. Demographic data, perioperative management, outcomes, and salvage rates for thrombophilic and nonthrombophilic cohorts were compared. Results Routine preoperative screening identified 52 thrombophilic traits among 25 patients in this series (61%). The most common traits were the plasminogen activator inhibitor-1 4G/5G variant (n = 12) and the methylenetetrahydrofolate reductase A1298C (n = 10) and C677T (n = 9) polymorphisms. While success rates were similar between thrombophilic and nonthrombophilic patients (84 vs. 94%; p = 0.15), thrombotic complications (25 vs. 14%; p = 0.09) and flap failure following postoperative thrombosis (100 vs. 33%; p = 0.05) appeared to be more common in patients with thrombophilia. On average, microvascular complications manifested later in the setting of thrombophilia (mean 4.8 days vs. 18 hours; p = 0.20) and were associated with a worse overall prognosis (salvage rate, 0 vs. 67%; p = 0.05). Conclusions Despite high success rates, thrombophilia appears to increase the risk of nonsalvageability following lower extremity FTT. This information should be used to help counsel patients regarding the risks and benefits of microsurgical reconstruction, as salvage rates following postoperative thrombotic events approach 0% in the presence of thrombophilia.

A Novel Peritonsillar Abscess Simulator.

INTRODUCTION: In response to the growing demand for a peritonsillar abscess simulator, we developed a novel model to teach needle aspiration as well as incision and drainage of this common oropharyngeal disorder. The objectives of this study were to describe the construction of the simulator and to assess its realism and usefulness in the acquisition of drainage skills. METHODS: The training model was created with reusable and readily available materials. During an otolaryngology emergencies boot camp, expert otolaryngologists performed abscess drainage and subsequently instructed novice learners on the techniques of the procedure. Each participant completed a questionnaire using a 5-point Likert-type scale to assess simulator realism and training usefulness. RESULTS: A peritonsillar abscess drainage model was created using readily available materials. A total of 18 experienced attending otolaryngologists and senior otolaryngology residents (postgraduate year 4 and postgraduate year 5) participated in this study. All participants rated the trainer realistic, and 94% agreed that the model correlates with the essential skills needed for peritonsillar abscess management. All participants felt that this model would be useful in residency training to help develop dexterity, accuracy, and precision with peritonsillar abscess drainage instruments. CONCLUSIONS: An easily reproducible peritonsillar abscess simulator was highly rated as a means of teaching peritonsillar abscess anatomy and provided opportunity for hands-on learning of drainage skills.

Effect of hormone replacement and selective estrogen receptor modulators (SERMs) on the biomechanics and biochemistry of pelvic support ligaments in the cynomolgus monkey (Macaca fascicularis).

OBJECTIVE: To evaluate the effect of selective estrogen receptor modulators and ethinyl estradiol on the biomechanical and biochemical properties of the uterosacral and round ligaments in the monkey model of menopause. STUDY DESIGN: A randomized, double-blind, placebo-controlled study on 11 female macaque monkeys. Ovariectomized monkeys received 12 weeks of placebo, raloxifene, tamoxifen, or ethinyl estradiol. Biomechanical step-strain testing and real-time polymerase chain reaction was performed on the uterosacral and round ligaments. RESULTS: Tamoxifen and raloxifene uterosacrals expressed differing collagen I/III receptor density ratios, but both selective estrogen receptor modulators showed decreased tensile stiffness compared to ethinyl estradiol and controls. CONCLUSION: These findings support a possible effect of selective estrogen receptor modulators on biomechanical and biochemical properties of uterosacrals. This may play a role in pelvic organ prolapse.

Association of the C8orf13-BLK region with systemic sclerosis in North-American and European populations.

OBJECTIVE: Genetic studies in the systemic sclerosis (SSc), an autoimmune disease that clinically manifests with dermal and internal organ fibrosis and small vessel vasculopathy, have identified multiple susceptibility genes including HLA-class II, PTPN22, IRF5, and STAT4 which have also been associated with other autoimmune diseases, such as systemic lupus erythematosus (SLE). These data suggest that there are common autoimmune disease susceptibility genes. The current report sought to determine if polymorphisms in the C8orf13-BLK region (chromosome 8p23.1-B lymphoid tyrosine kinase), which is associated with SLE, are associated also with SSc. METHODS: Two variants in the C8orf13-BLK region (rs13277113 & rs2736340) were tested for association with 1050 SSc cases and 694 controls of North Americans of European descent and replicated in a second series 589 SSc cases and 722 controls from Spain. RESULTS: The "T" allele at rs2736340 variant was associated with SSc in both the U.S. and Spanish case-control series (P = 6.8 x 10(-5), OR 1.27, 95% CI 1.1-1.4). The "A" allele at rs13277113 variant was associated with SSc in the U.S. series only (P = 3.6 x 10(-4), OR 1.32, 95% CI 1.1-1.6) and was significant in the combined analyses of the two series (P = 2.0 x 10(-3); OR 1.20, 95% CI 1.1-1.3). Both variants demonstrated an association with the anti-centromere antibody (P = 2.2 x 10(-6) and P = 5.5 x 10(-4), respectively) and limited SSc (P = 3.3 x 10(-5) and P = 2.9 x 10(-3), respectively) in the combined analysis. Peripheral blood gene expression profiles suggest that B-cell receptor and NFkappaB signaling are dysregulated based on the risk haplotype of these variants. CONCLUSION: We identify and replicate the association of the C8orf13-BLK region as a novel susceptibility factor for SSc, placing it in the category of common autoimmune disease susceptibility genes.