Frontal Sinus Displacement of Silicone Implant After Previous Rhinoplasty.

Rhinoplasty, a historic surgical procedure for facial esthetics, has been actively performed in Asia. The use of autologous tissues or artificial materials, such as silicone, Gore-Tex, and Medpore, is common in achieving cosmetic improvements. However, artificial material poses risks of inflammation and foreign body reactions, leading to complications like infection and necessitating material removal and antibiotic treatment. According to previous reports, various clinical aspects appear across inflammation, skin necrosis, and, in severe cases, systemic symptoms caused by implants. In this case study, the goal is to share a rare case of silicone implant migration into the frontal sinus after augmentation rhinoplasty. A 38-year-old female patient who had previously undergone rhinoplasty surgery visited the outpatient clinic complaining of headaches and a deviated nose. On computed tomography, the silicone implant moved upward, penetrating the nasoethmoid bone and invading the frontal sinus. Fortunately, there was no intracranial invasion. The authors planned the implant removal and performed the complete implant removal with capsulectomy. The patient has been undergoing follow-up without any complications after surgery. Augmentation rhinoplasty with implants, while common, carries long-term risks. This case highlights the severity of complications, emphasizing infection and migration into the frontal sinus and, in extreme cases, the brain cavity. Therefore, surgeons must continually refine operation techniques to minimize iatrogenic causes and consider modifying surgical procedures to prevent potential complications.

Hyaluronic Acid Based Adipose Tissue-Derived Extracellular Matrix Scaffold in Wound Healing: Histological and Immunohistochemical Study.

BACKGROUND: In this study, we explored the potential of human adipose tissue-derived extracellular matrix (adECM) sheets augmented with crosslinked hyaluronic acid (HA) as advanced wound dressings. We aimed to enhance healing efficacy while optimizing cost efficiency. METHODS: The adECM was processed from healthy donor tissue and combined with crosslinked HA to form ECM-HA sheets (Scaffiller, Medikan, Korea). In vitro experiments involved seeding adipose-derived stem cells (ASCs) onto these sheets and assessing cell survival and cytokine production. In vivo testing utilized a rat wound model, comparing ECM-HA sheet with HA-based dressing and polyurethane foam dressing. Re-epithelialization and collagen deposition were examined through histopathological examinations, whereas immunohistochemistry was used to assess CD31, alpha smooth muscle actin (α-SMA), and Tenascin C expression as contributing factors to wound healing. RESULTS: Results indicated that ECM-HA sheets were produced efficiently, with enhanced growth factor production and ASC survival observed in vitro. In vivo, ECM-HA sheets demonstrated accelerated wound healing, evidenced by improved epithelialization, thicker dermis, increased collagen deposition, and enhanced vascularity. Notably, they exhibited reduced myofibroblast activity and increased expression of Tenascin C, suggesting a favorable healing environment. CONCLUSION: ECM-HA sheets offer a promising approach for wound management, combining the benefits of adECM and HA. They present improved stability and cost-effectiveness while promoting essential aspects of wound healing such as angiogenesis and collagen formation. This study underscores the therapeutic potential of ECM-HA sheets in clinical applications aimed at facilitating wound repair.

Transverse division of the rectus abdominis muscle in deep inferior epigastric perforator flap elevation: A rescue technique to include more than one perforator.

BACKGROUND: It is important to include as many perforators as possible in order to enhance the vascularity of a deep inferior epigastric perforator (DIEP) flap. However, the rectus muscle must be transected transversely, which prevents suturing and can cause a defect along the same line as the muscle-sparing procedure. When harvesting the DIEP flap, no specific method was suggested to solve these muscle defects. We found that by transecting the rectus muscle transversely, the muscle could be sutured in the tendinous area more easily while maintaining muscle function. The purpose of this study is to confirm the long-term recovery of the rectus abdominis muscle through the volume change after DIEP flap using this tendinous transection and suture method. PATIENTS AND METHODS: A retrospective review of 28 patients who underwent unilateral breast reconstruction using a DIEP flap and the tendinous transection method for multiple perforators between May 2018 and April 2020 was conducted. The preoperative and postoperative volumes of the rectus abdominis muscle were estimated both the harvest and opposite sides. RESULTS: The preoperative and postoperative muscle volumes from the harvest side were 50.08 ± 8.71 cm3 and 48.56 ± 8.61 cm3, respectively. The volume difference was 1.522 cm3 decrease, which was not statistically significant (p = .070). The preoperative and postoperative muscle volumes from the opposite side were 50.50 ± 8.15 cm3 and 50.08 ± 8.18 cm3, respectively. The volume difference was 0.434 cm3 increase and was not statistically significant (p = .064). Postoperative volume changes in the rectus muscle were not statistically significant on either side. CONCLUSION: The tendinous transection method in the DIEP flap procedure did not significantly affect postoperative rectus muscle volume. Therefore, we expect this harvest method to allow DIEP flap reconstruction that includes multiple perforators and complete donor muscle recovery.

Comparison of a coupling system and the suture method in end-to-side microvascular anastomosis in head and neck reconstruction.

BACKGROUND: Use of coupling devices in microvascular anastomosis continues to increase, but it is not yet actively used in end-to-side (ETS) anastomosis because there is no standard method. Therefore, we propose an easy and time-saving ETS micro-anastomosis method using coupling devices in head and neck reconstruction and compare it with the conventional suture method. MATERIALS AND METHODS: We retrospectively reviewed 30 consecutive cases (43 anastomoses) of ETS anastomosis in head and neck reconstruction from 2018 to 2022. Patient characteristics, operative details, and anastomosis time were evaluated. When using the coupling device, a cross incision was created in the recipient vessel to form vascular flaps. By pulling the flaps out of the ring, the intact vessel lining was fixed. Other procedures were the same as for a traditional anastomosis. RESULTS: The mean anastomosis time was 12.81 min (range, 6.7-24.87) for the suture and 4.96 min (range, 2.02-9.4) for the coupling device, a statistically significant difference (p-value <.00005). There was no venous insufficiency or flap failure with either method. CONCLUSIONS: ETS venous anastomosis using the coupling device is an easy-to-use, safe, and timesaving procedure for head and neck reconstruction.

Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects.

The anterolateral thigh (ALT) skin flap provides abundant, thin, pliable skin coverage with adequate pedicle length and calibre, and tolerable donor site morbidity. However, coverage of relatively large defects using the ALT flap alone is limited. We present our experience of using the ALT flap coupled with the vastus lateralis (VL) flap supplied by the same pedicle for large defect reconstruction. Between 2016 and 2020, ten patients with extensive lower-extremity or trunk defects were treated using the ALT/VL chimeric flap. The ALT portion was used to cover the cutaneous and joint defect while the VL part was used to resurface remnant defects, and a skin graft was performed. All flaps were based on the common descending pedicle, and branches to separate the components were individually dissected. All defects were successfully reconstructed using the ALT/VL chimeric flap. No surgery-related acute complications were observed, and the patients had no clinical issues with ambulation or running activities during the long-term follow-up period. With the separate components supplied by a common vascular pedicle, the ALT/VL chimeric flap allows us to reconstruct extensive defects with joint involvement or posterior trunk lesions. Thus, the ALT/VL chimeric flap may be a suitable alternative for extensive tissue defect reconstruction.

KAAACI Allergic Rhinitis Guidelines: Part 2. Update in Non-pharmacological Management.

Allergic rhinitis is the most common chronic disease worldwide. Various upper airway symptoms lower quality of life, and due to the recurrent symptoms, multiple treatments are usually attempted rather than one definitive treatment. There are alternatives to medical (medication-based) and non-medical treatments. A guideline is needed to understand allergic rhinitis and develop an appropriate treatment plan. We have developed guidelines for medical treatment based on previous reports. The current guidelines herein are associated with the "KAAACI Evidence-Based Guidelines for Allergic Rhinitis in Korea, Part 1: Update in pharmacotherapy" in which we aimed to provide evidence-based recommendations for the medical treatment of allergic rhinitis. Part 2 focuses on non-pharmacological management, including allergen-specific immunotherapy, subcutaneous or sublingual immunotherapy, nasal saline irrigation, environmental management strategies, companion animal management, and nasal turbinate surgery. The evidence to support the treatment efficacy, safety, and selection has been systematically reviewed. However, larger controlled studies are needed to elevate the level of evidence to select rational non-medical therapeutic options for patients with allergic rhinitis.

Safe and effective thrombolysis in free flap salvage: Intra-arterial urokinase infusion.

Despite the high success rate in reconstruction using free tissue transfer, flap failure is often caused by microvascular thrombosis. In a small percentage of cases with complete flap loss, a salvage procedure is performed. In the present study, the effectiveness of intra-arterial urokinase infusion through the free flap tissue was investigated to develop a protocol to prevent thrombotic failure. The retrospective study evaluated the medical records of patients who underwent salvage procedure with intra-arterial urokinase infusion after reconstruction with free flap transfer between January 2013 and July 2019. Thrombolysis with urokinase infusion was administered as salvage treatment for patients who experienced flap compromise more than 24 hours after free flap surgery. Because of an external venous drainage through the resected vein, 100,000 IU of urokinase was infused into the arterial pedicle only into the flap circulation. A total of 16 patients was included in the present study. The mean time to re-exploration was 45.4 hours (range: 24-88 hours), and the mean quantity of infused urokinase was 69,688 IU (range: 30,000-100,000 IU). 5 cases presented with both arterial and venous thrombosis, while 10 cases had only venous thrombosis and 1 case had only arterial thrombosis; in a study of 16 patients undergoing flap surgery, 11 flaps were found to have survived completely, while 2 flaps experienced transient partial necrosis and 3 were lost despite salvage efforts. In other word, 81.3% (13 of 16) of flaps survived. Systemic complications, including gastrointestinal bleeding, hematemesis, and hemorrhagic stroke, were not observed. The free flap can be effectively and safely salvaged without systemic hemorrhagic complications using high-dose intra-arterial urokinase infusion within a short period of time without systemic circulation, even in delayed salvage cases. Urokinase infusion results in successful salvage and low rate of fat necrosis.

KAAACI Allergic Rhinitis Guidelines: Part 1. Update in Pharmacotherapy.

The prevalence of allergic rhinitis (AR) and the socioeconomic burden associated with the medical cost and quality of life (QOL) of AR have progressively increased. Therefore, practical guidelines for the appropriate management of AR need to be developed based on scientific evidence while considering the real-world environment, values, and preferences of patients and physicians. The Korean Academy of Asthma, Allergy and Clinical Immunology revised clinical guidelines of AR to address key clinical questions of the management of AR. Part 1 of the revised guideline covers the pharmacological management of patients with AR in Korea. Through a meta-analysis and systematic review, we made 4 recommendations for AR pharmacotherapy, including intranasal corticosteroid (INCS)/intranasal antihistamine (INAH) combination therapy, oral antihistamine/INCS combination therapy, leukotriene receptor antagonist treatment in AR patients with asthma, and prophylactic treatment for patients with pollen-induced AR. However, all recommendations are conditional because of the low or very low evidence of certainty. Well-designed and strictly executed randomized controlled trials are needed to measure and report appropriate outcomes.

Long-term Outcomes of Turbinate Surgery in Patients With Allergic Rhinitis: A Systematic Review and Meta-analysis.

Importance: Turbinate surgery is an effective treatment for allergic rhinitis (AR) refractory to medical treatment. However, the long-term outcomes of turbinate surgery are still unclear and have not yet been confirmed by a meta-analysis and systematic review of the literature. Objective: To investigate the long-term outcomes and safety of turbinate surgery in AR by performing a meta-analysis. Data Sources: MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through April 2021. Study Selection: Studies that analyzed turbinate surgery alone, had a follow-up period of more than 1 year, examined long-term efficacy of turbinate surgery, used current turbinate surgery methods, and were published in a peer-reviewed journal were included. Full-text reviews were performed by 2 independent reviewers. Conflicts were resolved by a third reviewer. Data Extraction and Synthesis: Descriptive and quantitative data were extracted; weighted mean difference (WMD) was synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and the I2 metric. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Main Outcomes and Measures: The long-term outcomes of turbinate surgery on subjective nasal symptoms and objective parameters. Results: Of the 3962 citations retrieved, 18 studies comprising 1411 patients were included. Findings showed significantly decreased symptom scores in nasal obstruction (WMD, 4.60, 95% CI, 3.43-5.76), rhinorrhea (WMD, 3.12; 95% CI, 1.97-4.28), sneezing (WMD, 2.64; 95% CI, 1.74-3.54), itching (WMD, 1.75; 95% CI, 1.20-2.30), and nasal resistance (WMD, 0.16; 95% CI, 0.08-0.24) and a significant increased total nasal volume (WMD, 0.96; 95% CI, 0.73-1.19). There was no significant difference in the occurrence of any complication. More than 1 year after surgery, the improvements in nasal obstruction (WMD, 5.18; 95% CI, 3.00-7.37), rhinorrhea (WMD, 3.57; 95% CI, 1.78-5.37), and sneezing (WMD, 2.95; 95% CI, 1.58-4.32) were maintained. Conclusions and Relevance: In this systematic review and meta-analysis, turbinate surgery was associated with positive outcomes in AR and maintained the association during long-term follow-up. The rate of complications is also low. These findings can guide the preoperative counseling of patients with AR being considered for turbinate surgery.

Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions.

Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracodorsal vascular pedicle or muscle insertion is difficult from the lateral approach, causing inefficiency and surgeon fatigue. We propose the 'anterior-first' approach in LDMC flap reconstruction, where the landmark structures are first approached from the supine-anterior position through the mastectomy incision. Methods: From January 2014 to December 2020, 48 patients who received immediate breast reconstruction with LDMC flap were included in the study. Patients received reconstruction with the conventional approach (n = 20), or anterior-first approach (n = 28). Demographic factors and the operative outcomes were retrospectively analyzed and compared between the two groups. Results: Compared to the conventional approach group, the anterior-first approach group showed improved efficiency in the duration of total reconstruction (228 versus 330 min, p < 0.001), and flap elevation (139 versus 200 min, p < 0.001). No difference in complication rate and time to drain removal was observed (p = 0.14 and >0.9, respectively). Conclusion: The anterior-first approach for breast reconstruction with LDMC flap provides surgeons with an enhanced surgical exposure and superior ergonomics, leading to a safer and more efficient flap elevation.

Two-team-approached free flap reconstruction for plantar malignant melanoma: An observational (STROBE-compliant) trial.

Reconstructive treatments of heel defects usually involve regional flap techniques such as medial plantar flap procedures due to the limited availability of adjacent soft tissues. Although free flaps have advantages in terms of function and aesthetics, they remain challenging due to the longer operation time required than for regional flaps. Thus, we introduce an appropriate 2-team surgical protocol to reconstruct plantar defects after wide excision of malignant melanoma using free flap coverage. From 2015 to 2020, a retrospective study was performed including 21 patients who underwent free flap surgeries to reconstruct defects due to plantar malignant melanoma. Lymphoscintigraphy was performed to localize sentinel lymph nodes, and the procedure was carried out by 2 teams working together, a tumor-ablative team and a reconstructive team. The present study is adhered to the STROBE guidelines for cohort studies. The average operation time was 241.4 minutes and was not significantly different even in cases with inguinal dissection (P value: 0.641). All flaps survived after 2 cases of venous insufficiency and 1 case of hematoma were resolved by immediate revision surgery. The 2-team approach to surgically reconstruct heel defects after wide excision of malignant melanoma using free flap coverage offers favorable results and lower morbidity than regional flap approaches.

Super-thin ALT flap elevation using preoperative color doppler ultrasound planning: Identification of horizontally running pathway at the deep adipofascial layers.

INTRODUCTION: Presently, super-thin ALT flap, which is elevated above the superficial fascial plane, is gaining popularity. Although there is a huge demand for thin flaps for various types of extremity reconstruction, the technique for ALT flap thinning remains controversial. In this study, we investigated the distance and vector between penetrating points of perforators in deep and superficial fascia using color duplex and clinical measurement to suggest a reliable super-thin flap elevation technique. MATERIALS AND METHODS: From June 2018 to February 2020, 44 patients with various types of defects who were treated using super-thin ALT flaps were enrolled; 69 surgically detected perforators were analyzed. All patients' flap outcomes and characteristics of the perforators were analyzed. In addition, the effects of patients' body mass index (BMI) and thickness of super-thin flap were evaluated. RESULTS: The average traveling length of perforator at the deep adipofascial layer (DAL) was 2.43 cm, and the vector of traveling was randomly arranged. The mean thickness of super-thin ALT flap was 6.8 mm. The thickness of super-thin flap was not significantly correlated with patients' BMI (ranged from 17.4 to 34.2 kg/m2; p = 0.183). CONCLUSION: The novel elevation technique for super-thin ALT might be useful, as evidenced by perforator traveling distance and vector in DAL. Preoperative color duplex ultrasonography is helpful to detect the running course of the perforators during elevating the flap. This anatomic concept must be considered to obtain the reliability of the super-thin ALT flap.

Comparison of the Incidence of Capsular Formation in Two-Stage, Implant-Based Breast Reconstruction Using an Insertion Funnel and Sizer.

PURPOSE: Capsular formation around breast implants can produce various complications, including erythema, tenderness, discomfort, and breast deformation. Moreover, the capsule is thought to be correlated with breast implant-associated anaplastic large cell lymphoma. The proposed technique of capsule reduction can prevent some of these complications. Thus, the authors suggest a no-touch technique in two-stage, implant-based breast reconstruction. Patients and Methods. This single-center retrospective study evaluated the medical records and digitalized pathological slides of patients who underwent two-stage, implant-based breast reconstruction between February 2018 and May 2019. The selected patients were divided into group A and group B. Group A underwent a no-touch technique that included the following two steps: (1) using a sizer as the frame to create the submuscular and acellular dermal matrix (ADM) pocket for expander insertion and (2) inserting the expander through the funnel. After the second stage of implant insertion, the capsule was harvested for biopsy of the ADM, chest wall, and muscle. RESULTS: This study included 33 breasts (31 patients): 18 in group A and 15 in group B. The capsular thicknesses of the ADM, the chest wall, and the muscle of group A were significantly thinner than those in group B. Pearson's correlation coefficient indicated negative correlations between capsular thickness and age; underlying disease; lesion side; interval of two-stage implant insertion; size of the expander; and radiotherapy, chemotherapy, or hormone therapy. CONCLUSION: To reduce the incidence of capsular formation following breast reconstruction using prostheses, a no-touch technique that uses a funnel and sizer to avoid implant contact is both efficient and beneficial.

A Novel Hypothesis and Characterization to Isolate Microvascular Endothelial Cells Simultaneously with Adipose-Derived Stem Cells from the Human Adipose-Derived Stromal Vascular Fraction.

BACKGROUND: Angiogenesis and vasculogenesis are essential processes for successful tissue regeneration in tissue engineering and regenerative medicine. The adipose-derived stromal vascular fraction (SVF) is not only a source of adipose stem cells (ASC) but also a suitable source of microvascular endothelial cells because it is a rich capillary network. So, we propose a new hypothesis for isolating adipose-derived human microvascular endothelial cells (HMVEC-A) from the SVF and developed a dual isolation system that isolates two cell types from one tissue. METHOD: To isolate HMVEC-A, we analyzed the supernatant discarded when ASC is isolated from the adipose-derived SVF. Based on this analysis, we assumed that the SVF adherent to the bottom of the culture plate was divided into two fractions: the stromal fraction as the ASC-rich fraction, and the vascular fraction (VF) as the endothelial cells-rich fraction floating in the culture supernatant. VF isolation was optimized and the efficiency was compared, and the endothelial cells characteristics of HMVEC-A were confirmed by flow cytometric analysis, immunocytochemistry (ICC), a DiI-acetylated low-density lipoprotein (DiI-Ac-LDL) uptake, and in vitro tube formation assay. RESULTS: Consistent with the hypothesis, we found a large population of HMVEC-A in the VF and isolated these HMVEC-A by our isolation method. Additionally, this method had higher yields and shorter doubling times than other endothelial cells isolation methods and showed typical morphological and phenotypic characteristics of endothelial cells. CONCLUSION: Cells obtained by the method according to our hypothesis can be applied as a useful source for studies such as tissue-to-tissue networks, angiogenesis and tissue regeneration, patient-specific cell therapy, and organoid chips.

A comparative study of pre- or subpectoral expander position with the fenestrated Acellular dermal matrix anterior coverage, on drainage volume and Seroma Formation after Non-Nipple-Sparing Mastectomy.

BACKGROUND: It has been reported that the use of the acellular dermal matrix (ADM) in expander-based breast reconstruction is related to an increase in seroma-related complications. The aim of this study is to compare the actual drainage volume, time to drain removal, and seroma formation rate in patients with prepectoral expander placement with anterior coverage of a fenestrated ADM to those patients with partial subpectoral expander placement with inferior coverage of a fenestrated ADM. METHODS: This is a single-surgeon retrospective review of patients who underwent prepectoral expander-based breast reconstruction following non-nipple-sparing mastectomy. Patient demographics, operative data, and complications were analyzed and multivariate linear regression analyses were conducted to evaluate the significance of factors that influences total volume of fluid formation. RESULTS: A total of 89 breasts from 87 patients were included in the study. Twenty-seven breasts had prepectoral expander reconstruction and 62 breasts had partial subpectoral expander reconstruction. Mean total volumes of fluid formation (total drainage volume + additional aspirated volume) were not significantly different (p = 0.190) in the two groups. In the subpectoral group only, high body mass index (BMI) was correlated with the total volume of fluid formation among the independent factors. (p = 0.017) CONCLUSIONS: Although total drainage volume was not significantly different between prepectoral and subpectoral groups, prepectoral positioning of the expander can be a protective factor against seroma formation in high BMI patients. Further definitive studies with larger patient numbers are warranted to corroborate these data and draw definitive conclusions.

Correction of Temporal Hollowing With the Superior Gluteal Artery Perforator Free Flap.

ABSTRACT: Temporal hollowing is most frequently an acquired deformity and can be caused by volume defects of bone, soft tissue, or both. Recently, surgical reconstruction with autogenous fat or allografts has been introduced, but these materials can be resorbed over time and may also lead to infection. Herein, the authors present 2 cases demonstrating the treatment of temporal hollowing with a superior gluteal artery perforator (SGAP) free flap. Both patients had a history of traffic accidents and subsequent craniectomy because of subdural hemorrhage, followed by cranioplasty. An SGAP free flap was selected to reconstruct the soft tissue temporal defect in both patients. Pre-operatively, computed tomography (CT) angiography was used to locate the superior temporal artery (STA). A preauricular incision provided surgical access to the STA, and a subcutaneous pocket was created. The STA and SGAP artery and vein anastomoses were performed. Before flap insetting, it was de-epithelized, and its volume and shape trimmed to fit into the temporal defect. The patients' post-operative courses were without complications, and facial symmetry was achieved. This is the first case report describing the microvascular reconstruction of temporal hollowing with an SGAP free flap. The SGAP free flap is permanent and highly vascularized with no risk of infection. These case reports illustrate a unique reconstruction technique that resulted in a satisfactory outcome for the patients.

A case of foreign bodies self-inserted into the paranasal sinus via an oroantral fistula.

Foreign bodies in the nasal cavity are rarely seen in adults, and most cases are traumatic in origin. Multiple foreign bodies in adults are particularly rare. Foreign bodies induce pain, bleeding, and infection but are easily removed in most cases. A patient presented with multiple toothpick foreign bodies in the nasal cavity, which were introduced intentionally through an oroantral fistula. We report an adult case with 37 toothpicks in the nasal cavity, which were removed successfully with a nasal endoscope. Oroantral fistula closure was achieved through oral surgery. Voluntary insertion of foreign bodies into the body by patients with mental illnesses is relatively difficult to identify. Evaluating and managing the psychiatric problems of such patients during treatment planning are necessary.

Medical data science in rhinology: Background and implications for clinicians.

BACKGROUND: An important challenge of big data is using complex information networks to provide useful clinical information. Recently, machine learning, and particularly deep learning, has enabled rapid advances in clinical practice. The application of artificial intelligence (AI) and machine learning (ML) in rhinology is an increasingly relevant topic. PURPOSE: We review the literature and provide a detailed overview of the recent advances in AI and ML as applied to rhinology. Also, we discuss both the significant benefits of this work as well as the challenges in the implementation and acceptance of these methods for clinical purposes. METHODS: We aimed to identify and explain published studies on the use of AI and ML in rhinology based on PubMed, Scopus, and Google searches. The search string "nasal OR respiratory AND artificial intelligence OR machine learning" was used. Most of the studies covered areas of paranasal sinuses radiology, including allergic rhinitis, chronic rhinitis, computed tomography scans, and nasal cytology. RESULTS: Cluster analysis and convolutional neural networks (CNNs) were mainly used in studies related to rhinology. AI is increasingly affecting healthcare research, and ML technology has been used in studies of chronic rhinitis and allergic rhinitis, providing some exciting new research modalities. CONCLUSION: AI is especially useful when there is no conclusive evidence to aid decision making. ML can help doctors make clinical decisions, but it does not entirely replace doctors. However, when critically evaluating studies using this technique, rhinologists must take into account the limitations of its applications and use.

Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction.

BACKGROUND: In microvascular anastomosis, size discrepancy is common and can increase thrombotic complications. If size differences can be predicted, then vessels of the appropriate size can be selected. This study documented the difference in diameter between the thoracodorsal (TD) vessel and deep inferior epigastric perforator (DIEP) pedicle in each patient who underwent breast reconstruction using free tissue transfer. Patients and Methods. This retrospective study included 32 anastomoses (27 breasts including five cases of supercharged anastomosis) of breast reconstruction with the free DIEP flap and TD recipient between August 2018 and June 2019. In the microscopic view, the caliber of the TD vessel, the largest branch to the serratus anterior muscle, the descending branch, the largest and the second largest branches to the latissimus dorsi muscle, and the DIEP pedicle were measured. RESULTS: The diameter of the deep inferior epigastric artery was similar to that of the descending branch, and their anastomosing rate was 56.3%. The diameter of the deep inferior epigastric vein was similar to the branch to the serratus anterior muscle and the descending branch, and their anastomosing rates were 29.3% and 29.3%, respectively. All flaps were survived; however, in one case, a reoperation was needed to remove the hematoma, in which case fat necrosis occurred as the only complication. CONCLUSION: TD branches of similar size to the DIEP pedicle were prioritized in anastomosis. The descending branch and the branch to the serratus anterior muscle are expected to be good candidates as recipients in breast reconstruction with DIEP free flap. Moreover, supercharged anastomosis of DIEP pedicles can be achieved within TD branches.

Cryopreservation of lipoaspirates: in vitro measurement of the viability of adipose-derived stem cell and lipid peroxidation.

As the storage time of the fat tissue passes by, lipid peroxidation and creation of by-products may take place. The objective of this study was to evaluate the cell viability and functional changes of adipose-derived stem cells (ADSCs) in the cryopreserved lipoaspirates at different temperatures in accordance with lipid peroxidation. Lipoaspirates acquired from liposuction were divided into four different temperature groups and stored at 4°C, -20°C, -80°C, and -196°C. After isolating ADSC from each sample, gross cell morphology and cell viability were compared with doubling time and colony-forming unit (CFU) formation ability. Acid value, that is, thiobarbituric acid value was measured to assess lipid peroxidation. No viable ADSC was observed in -20°C and -196°C samples for past 1 week and a superior number of the live cells were detected in the 4°C group compared with the -80°C group. However, the persistence of cell division and CFU formation after 1 week was only observed in adipocytes stored at -80°C. Lipid peroxidation mainly occurred at 4°C and -20°C storage samples. If the lipoaspirates were planned to be cryopreserved, it is advised to store at -80°C. However, the number of actually functional ADSCs is very low. Furthermore, even in the cryopreserved status, continuous lipid peroxidation and by-product creation took place, suggesting shorter preservation period as possible in the clinics.