High Self-Reported Satisfaction After Top Surgery in Gender-Affirming Surgery: A Single-Center Study.

Purpose: Top surgery, or masculinization of the chest, is often the first and sometimes only procedure in gender-affirming surgery for transgender- and gender-diverse persons assigned female at birth. In recent years, there has been improved access to care for transgender individuals and increased demand for top surgery. Our aim was to investigate the degree of satisfaction with the postoperative outcome after top surgery in transgender men. Methods: Ninety transgender men who underwent top surgery between September 1, 2013 and August 31, 2018 were included. Patients were surveyed from 5 to 62 months after surgery. Participants' files were evaluated for complications, and 84 (response rate 93.3%) participants answered a questionnaire evaluating patient satisfaction postoperatively. Results: Patients were either satisfied or partially satisfied with the overall experience of undergoing surgery and the postoperative result in 90.5% of responses. Patients were very satisfied with their clothed appearance in 89.3% of responses, whereas only 44.1% were very satisfied with their nonclothed appearance and 46.4% partially satisfied. Patients were also very satisfied with postoperative scars in 47.6% of responses and nipple reconstruction in 48.8%. Only two patients expressed their regret. Conclusion: Satisfaction outcomes after top surgery are generally positive, especially in respect of clothed appearance, self-confidence, and self-acceptance.

[Conservative treatment of iatrogenic milk fistula].

A milk fistula is a rare condition, and only 27 cases have been reported in the latest systematic review from 2020. A fistula can be iatrogenic or spontaneous. The content of tissue factors in breast milk promotes granulation in wounds, which can lead to hypergranulation and lack of epithelialization. In this case report, a 29-year-old breastfeeding woman developed a milk fistula after surgical removal of a naevus on suspicion of being a melanoma. Hypergranulation of the wound was successfully treated with corticosteroid, which inhibits growth factor in breastmilk, and breastfeeding was continued during treatment.

[Corrosions and frostbites].

Thermal burns are by far the most frequent and account for approx. 90% of all burns, while frostbites, chemical and electrical burns (CB) cover the remaining approx. 10%. This review gives an overview of the treatment of corrosions and frostbites. CB and frostbites are relatively rare and prompt initiation of proper treatment is essential for both. CB should be diluted as soon as possible, preferably with a neutralizing solution. Treatment of systemic hypothermia comes before management of peripheral frostbite. Frostbites involve thawing in warm water, followed by vasodilation, thrombolysis and amputation if indicated.

Low Risk of Persistent Pain, Sensory Disturbances, and Complications Following Mastectomy After Gender-Affirming Surgery.

Purpose: In recent years, there has been a significant increase in referrals for gender-affirming surgery to departments of plastic surgery in Denmark. There is currently no literature on postsurgical pain in trans men after mastectomy. We aimed at investigating the prevalence and severity of postsurgical persistent pain, sensory disturbances, and complications in trans men after mastectomy. Methods: The 90 trans men who underwent bilateral mastectomy between September 1, 2013 and August 31, 2018 were included. Patients' files were evaluated for complications, and 84 (response rate 93.3%) patients answered a questionnaire (validated for women undergoing oncologic mastectomy) regarding persistent pain and sensory disturbances. Results: Twenty-three patients (27.4%) reported either unilateral or bilateral persistent pain after mastectomy. Of these, 14 (60.9%) patients categorized the pain as mild. However, 77 (95.2%) of the patients did not use analgesics and nonopioid pain medication was sufficient for the remainder. Sensory disturbances were found in 44 (47.5%) of the patients, and 4 (4.8%) patients reported clear signs of neuropathic pain. Seven (7.8%) patients developed hematomas, and areola necrosis was seen in four (4.4%) patients. Due to infection, seven (7.8%) patients received antibiotics. Conclusion: Mastectomy as a part of gender-affirming surgery is a safe procedure with a few, nonsevere, complications. Although a quarter of the patients experienced persistent pain, the majority of that pain is mild, intermittent and can be treated with nonopioid pain medication.

[Atypical presentation of lentigo maligna melanoma].

Lentigo maligna melanoma (LMM) is the most common subtype of melanoma in the face. In this case report, a 95-year-old woman had a patch of dark hair growing out of her white hair on her scalp. A punch biopsi confirmed the diagnosis of LMM. The unusual in this case is the finding of melanocytic hair growth with no obliteration of follicles in the affected area. As described, obliteration of follicles is usually seen in histology when lentigo maligna progresses. To our knowledge, no similar cases have been described in literature.

[A wooden splint under a fingernail led to subungual squamous cell carcinoma].

This case report is about a 75-year-old man, who developed a subungual squamous cell carcinoma (SCC) after having a wooden splint sitting under his fingernail for 20 years. There were no signs of infection, inflammation or tumour. The splint was removed, and histology indicated SCC. The patient underwent amputation, and histological analysis confirmed SCC without bone involvement. Subungual SCC is often misdiagnosed with delayed treatment as a consequence, and it gives a wide variety of symptoms. Treatment includes Mohs surgery and marginal excision. If SCC is diagnosed early, extensive surgery can be avoided.

[Management of burn injuries]. / Behandling af brandskader.

This paper aims to clarify the newly revised guidelines regarding burn injuries as to assist medical personnel dealing with burns. The Department of Burns at Rigshospitalet is the main burn centre in Denmark, and thus creates the National Guidelines of burns treatment. The new guidelines have targeted a simplification of the procedures to avoid complications of which especially severe hypothermia as well as an overload in fluid administration are included.

[The use of pre-hospital tourniquets in life-threatening in extremity traumas].

Tourniquets have been used for centuries. They have been called lifesavers and "an invention of the evil one". 90.9% of deaths on the battlefields result from haemorrhage. Lessons learned du-ring the wars in Iraq and Afghanistan have developed the treat-ment given to hypovolaemic patients on the battlefield. Treating bleeding and hypovolaemia is now considered as the primary intervention. The tourniquet has proven to be an indis-pensable tool treating wounded soldiers, with little risk of complications. The tourniquet might also show to be a valuable asset in a pre-hospital urban setting.

[Successful conservative treatment of coecal perforation in a patient with Ogilvie's syndrome]. / Vellykket konservativt behandlet caecumperforation ved Ogilvies syndrom.

The case report describes a 37-year-old woman who was diagnosed with Ogilvie's syndrome after caesarean section. Conservative treatment was initiated with minimal effect, and the patient was subsequently treated with IV neostigmine. A computed tomography of the abdomen revealed enlarged peritoneal cavity. However the patient was clinically unaffected without fever or signs of peritonitis. The perforation was managed with a conservative approach including antibiotics and close observation of the patient. After nine days the patient was discharged with normal gastrointestinal function and without further reported complications.