Prior Caesarean Section Delivery Increases the Risk for Seroma Development in Abdominoplasty Patients: Our Experience With 746 Patients.

BACKGROUND: Complications after body-contouring surgery is a field of great interest. Recognition of patient-related characteristics contributing to a greater risk for complication is of the utmost importance in improving the quality of care and safety profile of aesthetic procedures. Prior history of cesarean section and its impact on adverse events after abdominoplasty has yet to be investigated and defined. OBJECTIVES: Evaluate the effect of prior cesarean section on the risk for adverse events in abdominoplasty. METHODS: The medical records of 746 eligible patients were reviewed and relevant information was extracted. Stratification of patients based on prior history of CS was followed by statistical analysis of differences between the groups. Relevant regression models were implemented to further understand the data. RESULTS: Seven-hundred and forty-six patients were included in the study, of which 308 (43.1%) had history of CS delivery. the group did not differ in terms of baseline demographic and surgical details, except for greater hemoglobin level (P value= 0.007).analysis of complication rates found a statistically significant increase in the risk for seroma development in the group of patients with history of CS delivery (P value= 0.031) which correlates to a 65% increase in the risk for complications (OR= 1.65, 95% CI 1.07-2.56). CONCLUSIONS: Medical history of CS increased the risk for seroma development in the postoperative period following abdominoplasty. Several potential pathogenic mechanisms exist, and further prospective research to further characterize the association.

Silicone Lymphadenopathy Following Augmentation Mammoplasty With Silicone Implants.

BACKGROUND: Silicone implants claim the predominant share in global implant usage for breast augmentation. Despite technological advancements, complications persist, with silicone lymphadenopathy (siliconoma) being a noteworthy concern. This phenomenon has been inadequately addressed in the existing literature. OBJECTIVES: To characterize axillary siliconomas and identify potential risk factors to help reduce their occurrence. METHODS: The authors conducted a retrospective observational cross-sectional study spanning between 2011 to 2021 at the Shamir-Assaf Harofeh Medical Center. Preoperative ultrasound examination was conducted, categorizing patients into those with siliconomas and those without. RESULTS: A total of 614 women (1209 breasts) met the inclusion criteria. The incidence of siliconomas was 13.6% (165 breasts). In univariate analysis, older age (age 47 years vs. 43 years, P < 0.001), older implant age (12.2 vs. 11 years, P = 0.026), ruptured implants (59.4% vs 17.7%, P < 0.001), subpectoral placement (P = 0.019), severe capsular contracture, and the use of Mentor implants (Irvine, CA; P = 0.007) and Poly Implant Prothèse implants (PIP; La Seyne-sur-Mer, France; P = 0.001) correlated significantly with the presence of siliconomas. In a multivariate analysis, implant rupture (OR = 6.342), and implant manufacturer - Mentor (OR = 3.047) and PIP (OR = 3.475), were identified as independent risk factors associated with a higher incidence of siliconomas. Severe capsular contracture was associated with higher incidence of siliconomas as well (OR = 1.65). CONCLUSIONS: Surgeons should inform candidates about the potential risk of silicone migration. Patients with ruptured implants, significant capsular contracture, Mentor and PIP implants face an increased risk for developing siliconomas. Closer monitoring for the detection of siliconomas in the axilla for these patients is advisable, potential prophylactic replacement or removal of implants may be warranted to mitigate siliconoma risk.

Updated trends of breast implant surgeries: An Israeli analysis.

INTRODUCTION: Breast augmentation remains one of the most prevalent procedures in plastic surgery. While most patients experience high satisfaction with the outcomes, a subset may encounter various complications or dissatisfaction with achieved results necessitating subsequent surgical intervention including implant removal or exchange. MATERIALS AND METHODS: We collected information from three pivotal private medical centers in Israel where a considerable number of breast surgeries are performed. We examined the number of breast augmentations, implant exchange and implant removal surgeries with or without breast lift that were performed on a biannual basis for each center for the period 2018-2022. Trends in surgery types were analyzed and compared to registries in other countries. RESULTS: Between the years 2018 and 2022, 20,075 surgeries were done in three main private medical centers in Israel. Data show a gradual increase in implant removal surgeries from 2018 (n = 80, 2.9%) to 2019 (n = 269, 9.9%), followed by a significant increase in 2020 (n = 1436, 27.3%), and a gradual decline between 2021 (n = 1019, 22.8%) and 2022 (n = 916, 18.5%). The overall number of breast implant insertion procedures (breast augmentation procedures and exchange procedures) was 2659 in 2018 (97%), 2424 in 2019 (90.0%), 3816 in 2020 (72.6%), 3437 in 2021 (77.1%), and 4019 in 2022 (81.4%). SUMMARY: We present updated trends in breast implant surgeries in Israel. 2020 was a key year in which the rate of explantations was the highest, and the percentage rate of implantations was the lowest and a year in which the trend changed. These patterns partly align with trends seen in other countries worldwide.

Silicone breast implant rupture is more prevalent in the dominant limb side: A retrospective cohort study.

BACKGROUND: Breast implant rupture is associated with multiple risk factors such as implant age, manufacturer, and a history of trauma to the breast. However, the exact mechanism of breast implant rupture remains unclear. We hypothesize that repetitive minor mechanical forces on the implant collectively play a significant role in the cascade that eventually leads to its rupture. Therefore, we expect a more significant cumulative effect on the breast implant in the dominant upper limb side. Thus, we aim to ascertain whether laterality in silicone breast implant rupture is associated with the dominant upper limb. METHODS: A retrospective cohort study was performed on patients with silicone breast implants who underwent an elective breast implant removal or exchange. All patients had breast augmentations for cosmetic reasons. We collected data on implant rupture laterality and limb dominance together with known risk factors like patient age, implant age, implant pocket, and implant volume. RESULTS: A total of 154 patients with unilateral implant rupture were included in the study. Among patients with a dominant right limb (n = 133), an ipsilateral rupture was found in 77 patients (58%) (p = 0.036), while in patients with a left dominant limb (n = 21), an ipsilateral rupture was found in 14 patients (67%), (p = 0.036). CONCLUSIONS: The dominant limb was a significant risk factor for ipsilateral breast implant rupture. The prevailing theory that cyclic envelope movement carries an increased rupture risk is reinforced in this study. Extensive prospective studies are needed to clarify risk factors for implant rupture further.

Social Media as a Tool to Educate Plastic Surgeons on Patients' Concerns Before and After Cosmetic Breast Surgeries.

BACKGROUND: The rapid evolution of the social media platform has had a major effect on the field of medicine. OBJECTIVE: To identify patterns, trends and patients' concerns before and after aesthetic surgeries involving breast implants, by analyzing social media posts. METHODS: We examined comments posted on popular Israeli online public forums between January 2019 and May 2021, regarding: breast augmentation, mastopexy-augmentation and breast implant removal. RESULTS: During the study period, 561 comments were posted on the three forums investigated: 165 pre-operative and 396 post-operative. In the pre-operative period, the main interests were implant size, type and location, as discussed in 69 posts (42%). During the first two months post-operative, questions reflected concerns regarding post-operative instructions, wound management and asymmetry: 76 (43%), 59 (34%) and 27 (16%), respectively. These topics continued to be in focus up to one year post-operative. Beyond the first post-operative year, patients' main interests were breast implant-associated anaplastic large cell lymphoma (25 posts, 28%), capsule formation (23 posts, 26%) and systemic effects (23 posts, 26%). CONCLUSIONS: Social media harnessing to identify patterns, trends and patient concerns pre- and post-aesthetic breast surgeries is a novel approach. Misinformation was common, particularly in comments posted more than one year post-operative. Four topics that especially concerned patients in the immediate and late post-operative period were asymmetric results, breast implant-associated anaplastic large cell lymphoma, capsule removal and systemic effects. We advise surgeon and plastic surgeon societies to issue position papers on controversial subjects, to counter the dissemination of potentially misleading information. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.

Pregnancy Reverses Abdominoplasty Aesthetic Outcome: Myth or Misconception? A Cross-Sectional Study.

BACKGROUND: The common recommendation for female abdominoplasty candidates is to conclude family planning before undergoing the procedure. However, no evidence demonstrates a correlation between aesthetic outcome compromise, risk for fetal complications, or risk for maternal complications when abdominoplasty is followed by pregnancy. OBJECTIVES: The aim of this study was to evaluate maternal, fetal, and aesthetic outcomes among pregnant females with a history of abdominoplasty. METHODS: The authors conducted an online survey among women who became pregnant after having an abdominoplasty. Participants were recruited via social media groups related to abdominoplasty. The survey included demographic-, aesthetic outcome-, and pregnancy-related questions utilizing a score from 1 (no effect) to 10 (worst effect) to assess abdominal aesthetic outcome compromise. RESULTS: Thirty-two participants completed the online survey, 15 (46.8%) of which reported their pregnancy was unplanned. Pregnancy-related findings included 5 (15.6%) late premature births (between gestational week 35 and 37), 1 miscarriage, and 1 emergency C-section. Compromised aesthetic outcomes following pregnancy included new abdominal stretch marks (50%, N = 16), widened abdominoplasty scar (28%, N = 9), abdominal skin excess (37.5%, N = 12), and abdominal bulge (25.8%, N = 8). A new hernia was reported by 2 participants (6.3%). The average abdominal aesthetic severity score was 2.7 (range, 1-8), and only 3 scores were above 5 (9.3%). Two women (6.2%) underwent abdominoplasty revision, and 18 (56.2%) stated they would recommend others to undergo abdominoplasty before pregnancy (56.3%). CONCLUSIONS: This survey shows there is room to reevaluate whether future pregnancy should be considered a relative contraindication for undergoing abdominoplasty.

Breast Implantation Rates in Israel: Is There a Change in Trend?

BACKGROUND: Breast implant illness (BII) is a rising concern among many patients. Although not fully understood, a connection between silicone breast implants and systemic diseases may be present. This connection may influence the types of breast surgeries performed. OBJECTIVES: To evaluate changing trends in breast surgeries in Israel over time, with regard to implantation, explantation, and implant exchange surgeries. METHODS: In this ecological study, we presented data from four private medical centers in Israel regarding the number of breast implant surgeries performed in the years 2018-2019. Data were collected bi-yearly. The types of surgeries included breast implantation, explantation, and breast implant exchange. RESULTS: When we summed and compared the yearly data, we saw that the number of implantations in 2018 was 2267 (80.1% of breast implant procedures that year), and 1929 (68.9%) in 2019. The number of implant exchanges in 2018 and 2019 was 482 (17.0%) and 608 (21.7%), respectively. In 2018, 80 (2.8%) explantations were performed and 262 (9.4%) in 2019. CONCLUSIONS: There appears to be a trend in the rise of implant removal surgeries in addition to a decrease in breast implantations. One possible reason may be patient concerns of BII. Another reason may be the increased public interest and discussion about systemic effects of breast implants. More research is needed in this field to achieve better understanding of the phenomenon, the reasons behind it, and the possible solutions and ways of treatment.

Inferiorly Based Preauricular Flap for Anterior Ear Reconstruction.

BACKGROUND: The anterior aspect of the auricle is a complex 3-dimensional structure. Each anatomical component in this region has an essential role in the aesthetic appearance of the ear and face. The reconstruction of defects in this region is challenging because of the lack of mobile, excess skin for primary closure, and the inability to skin graft overexposed cartilage. OBJECTIVE: The aim of the study was to present the planning and surgical technique of a simple, reproducible, 1-stage flap, for the reconstruction of the anterior aspect of the auricle. PATIENTS AND METHODS: A series of 11 patients, who underwent reconstruction of the anterior aspect of the auricle with 1-stage, inferiorly based, preauricular, cutaneous flap. All reconstructions were conducted under local anesthesia, and the defects were mainly due to tumor resections or skin necrosis after otoplasty. The average defect size was 1.5 cm. The flap was applied to different sites of the anterior auricle. RESULTS: All flaps survived except one, where there was partial flap loss. The aesthetic results were excellent, with no auricular deformity. CONCLUSIONS: The inferiorly based, preauricular flap is a versatile flap for a safe, simple, and reproducible, 1-stage reconstruction for almost every region of anterior ear defect, with excellent aesthetic results.

Sub-muscular plane for augmentation mammoplasty patients increases silicone gel implant rupture rate.

BACKGROUND: Breast augmentation is one of the most common aesthetic procedures performed worldwide. One of the worst associated complications is implant rupture, a topic that will be addressed in the present study. The risk of developing silicone gel breast implant rupture following breast augmentation is associated with multiple factors, including: older generation implant, increased implant age, implant type, specific manufacturer, severe capsular contracture (Baker grade III or IV), and the presence of local symptoms. We hypothesize that the plane of the implant placement may also play a role in the development of implant rupture due to differences in opposing forces upon the implant between submuscular and subglandular planes. OBJECTIVES: To assess the effect of potential risk factors on breast prosthesis rupture rate, focusing on implant pocket selection, capsular contracture and implant volume. METHODS: A retrospective cohort study was performed on patients with silicone breast implants in either subglandular or submuscular plane, who underwent an elective breast implant exchange, with or without mastopexy, between January 2012 and June 2017. Data collected included patient's age, implant age, implant pocket, implant volume, capsular contracture grade, and implant status (ruptured or intact). RESULTS: Data was collected on 362 women (700 breasts). A total of 284 women (542 breasts) met the inclusion criteria. The average age of the subjects was 43.4 ±â€¯10.4 years. Average implant age during exchange was 10 ±â€¯6.1. There was no difference between the characteristics of the submuscular group and the subglandular group, except from patient age. In a univariant analysis, patient's age (46.4 vs. 41.8, p < 0.001) and implant age (12.2 vs. 8.92 years, p < 0.001) were associated with significantly higher rupture rate. Among ruptured implants, the relative proportion of submuscular to subglandular implants was 64%, compared to 48% among non-ruptured implants (p < 0.0001). When controlling for potential confounders, submuscular pocket (OR = 0.1835, CI95% 1.25-2.69, p = 0.002) as well as implant size (OR = 1.004, CI95% 1.001-1.007, p = 0.005) were found to be a risk factor for implant rupture. CONCLUSION: A sub-muscular implant pocket was identified as a significant risk factor for implant rupture. The prevailing theory that larger size implant carries an increased risk of complications, is also reinforced in this study. Large prospective studies are needed to further clarify risk factors for implant rupture.

Preoperative Implant Size Is Strongly Associated With Alternations of Implant Size During Secondary Breast Augmentation.

BACKGROUND: Breast augmentation is one of the most popular cosmetic surgeries performed worldwide. In turn, there has been an increasing number of secondary breast augmentation procedures in recent years. Implant selection at secondary breast augmentation can be a challenge and is affected by a number of factors. The aim of this study was to assess the main factors affecting the decision-making process with regard to implant volume determination prior to implant exchange. METHODS: Women who underwent elective breast implant exchange between 2012 and 2016 were included in this study. Medical records were used to acquire implant and patient data. The patient's desires, as well as medical considerations, were taken into account during the implant selection process. RESULTS: Two hundred forty-five women with an average age of 43 years (range, 21-69 years) were included in the study. The mean time between primary augmentation and implant exchange was 10 ± 5.7 years. Overall, 192 implants (38.9%) were exchanged with larger implants, 84 implants (17%) were exchanged with smaller implants, and 218 implants (44.1%) were exchanged with implants similar to the preoperative size (±25 mL). In patients who received smaller implants, the mean reduction in implant volume was found to be 78.88 mL. Women were more likely to receive a smaller implant during implant exchange if the preoperative implant volume was larger than 367 mL (P = 0.00006). Among patients who received larger implants, no correlation was found between preoperative and postoperative implant size. A positive correlation was found between the implant age and a reduction in implant size (P = 0.036). However, no correlation was found between the patient's age and the decision to reduce or enlarge implant size upon revision. CONCLUSIONS: Almost half of patients receive similarly sized implants during elective implant exchange. Among those who did decide to change their implant size, more than twice as many patients opted for a larger implant as opposed to a smaller one. Relatively large preoperative implant size and longer time since primary augmentation were associated with the selection of smaller implants during exchange. Further studies should be conducted to reinforce these results.

Poly Implants Prosthèse Breast Implants: A Case Series and Review of the Literature.

BACKGROUND: Silicone breast implants from the French manufacturer Poly Implants Prosthèse (PIP) were recalled from the European market after the French regulator has revealed the implants contain non-medical-grade silicone filler. In December 2011, following a large increase in reported rupture rate and a possible cancer risk, the French Ministry of Health recommended consideration of the PIP explantation, regardless of their condition. In 2012, the Israel Ministry of Health recommended to replace the implants only upon suspected implant rupture. OBJECTIVES: The aims of this study were to characterize breast-augmented Israeli patients with PIP implants, compare their outcomes with those of breast-augmented patients with different implant types, and review the current PIP literature. METHODS: Breast-augmented patients who underwent an elective breast implant exchange in Israel between January 2011 and January 2017 were included in the study. Data were collected from electronic and physical medical files. RESULTS: There were 73 breast-augmented female patients with 146 PIP breast implants included in this study. Average implant age was 6.7 ± 2.79 years. Mean implant size was 342.8 ± 52.9 mL. Fourteen women (19 implants [16%]) had a high-grade capsular contracture (Baker grade 3-4). During exchange, 28 implants were found to be ruptured (19.2%). CONCLUSIONS: Less than 10 years following breast augmentation, PIP implants demonstrated higher rupture rate compared with other implants. Our data are comparable to overall available rupture rate. Among patients with definitive rupture diagnosis, an elective implant removal should be recommended. In cases of undamaged implants, plastic surgeons should also seriously consider PIP implant explantation. When the patient does not desire to remove the implant, an annual physical examination and breast ultrasound are recommended, beginning a year after augmentation.

Suction drains in esthetic breast implant exchange are associated with surgical site infections: A retrospective cohort study.

BACKGROUND AND OBJECTIVE: Surgical site infection (SSI) following esthetic breast implant exchange occurs in up to 2% of procedures. The effect of suction drains on SSI risk in these cases remains controversial. This study aimed to assess the SSI risk in the presence of suction drains after esthetic exchange of breast implants. METHODS: This is a retrospective cohort study of patients undergoing esthetic breast implant exchange between 2012 and 2015. SSI was determined according to the definition of the Center for Disease Control and Prevention. Multivariate analysis using a logistic regression model to identify independent risk factors for SSI was performed. RESULTS: A total of 256 women (504 breasts) met the inclusion criteria and were included in the study. The mean age was 44 ± 11 years. The mean operative time was 93 ± 40 min. The mean implant age at the time of the exchange was 10.3 ± 6.5 years. Suction drains were used in 229 breasts (45.4%) and were removed after 6 ± 7 days. Twenty (4%) breasts were diagnosed with SSI, of which 17 had suction drains. Suction drain use and days until drain removal were associated with a higher risk of SSI (85.0% vs. 43.8%, p < 0.001; 6.97 days vs. 12.07 days, p < 0.001, respectively). The use of suction drains remained an independent risk factor for SSI after adjustment for age, smoking, and previous capsular contracture (OR = 10.66, CI 95% 2.42-46.82). CONCLUSIONS: Suction drain use in esthetic breast implant exchange is associated with an increased risk of SSI. Surgeons should carefully consider using suction drains in selected cases only.

A novel short-scar breast reduction technique in large breasts.

BACKGROUND: Short-scar breast reduction techniques have become very popular in the last two decades. These techniques cannot be used very often in patients with exceptionally large breasts because of the excessive amounts of redundant skin. In this article we describe our new approach for dealing with the extra skin remaining in patients with very large breasts so that they may also benefit from the short-scar breast reduction procedure. METHODS: In our technique the vertical suture line is divided into two separate suture lines. The first suture line follows the natural curve of the lower pole of the breast from the nipple to the chest wall. This line is elongated by elevating and anchoring the new inframammary fold higher on the chest wall with a suspensory suture and the skin is then closed in a straight line. The second suture line attaches the extra lower skin by closing the dermis to the chest wall and then closing the skin with a purse-string suture. This technique helps to deal with the extra skin resulting from the short-scar breast reduction technique. RESULTS: The technique was used in ten patients with large breasts. Patient satisfaction was excellent and there was no increase in complications. The technique also helped to obliterate the dead space beneath the breast and reduced seroma formation. CONCLUSION: We found that this new technique can be used safely and effectively in selected patients with large breasts without any increase in complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Stretch test: effectiveness in identifying basal cell carcinoma borders.

Basal cell carcinoma (BCC) is the most common malignant tumor in the world. Total tumor ablation is the gold standard of treatment. Our aim in this study was to evaluate the effectiveness of a new clinical method, we dubbed the "stretch test," in reducing the incidence of incomplete excision of BCC. All BCCs excised between October 2001 and June 2007, by 1 plastic surgeon, served as the treatment population. Until September 2004, BCCs were excised in the traditional manner and this group served as a control. From October 2004, the stretch test was used in all patients with BCC and this group served as a study group. Overall, the incomplete excision rate was 3.7% (22/596). The rate of incompletely excised BCC until 2004 was 6.4% (16/249) and it decreased significantly (P < 0.05) from 2004 to 1.7% (6/347) in the group in which the stretch test maneuver was used. We found a significant decrease in the rate of incomplete excision of BCC when the stretch test was employed. This reduces the need for reexcision, improves patient recovery, and satisfaction, and helps reduce healthcare costs.

Triage and air evacuation strategy for mass casualty events: a model based on combat experience.

BACKGROUND: Management of combat casualties should optimize outcomes by appropriate patient triage, prehospital care, and rapid transport to the most capable medical facility, while avoiding overwhelming individual facilities. METHODS: Planning the medical support for the campaign was done by the medical department of the IDF Southern command in cohort with the medical department of the Homefront command. Data collection and analysis were done by the Trauma Branch of the Medical corp. RESULTS: 339 soldiers were injured, among them were 10 fatalities. Five hospitals received casualties, although the 2 regional hospitals received 84% of the primary evacuation load. The majority of urgently injured soldiers (90%) were evacuated by air, as opposed to 59% of non-urgently injured soldiers. CONCLUSIONS: In a cross border setting, airlifting the urgent casualties to farther away level I trauma centers provides appropriate care for them, while not crossing the "surge capacity" line for the near-by medical centers.

Effect of aspirin pre- and postburn on survival of experimental intermediate burns in rats.

BACKGROUND: Burns are a major health care problem. Early treatment increases survival of intermediate burn zones, thus decreasing morbidity, mortality, surgery, and hospitalization. Previously, aspirin was shown to improve burn perfusion and increase failing flap survival. OBJECTIVE: Owing to similarities between failing flaps and intermediate burn zones, we conducted this study to evaluate the effect of aspirin on intermediate burn zone survival. METHODS: An intermediate burn was created in 30 rats randomly divided into three experimental groups: pre- and postburn aspirin groups and a control group. Final burn survival was evaluated on day 7. RESULTS: No statistical difference was observed between the test and control groups. Both aspirin regimens failed to improve intermediate burn survival. CONCLUSION: Presumably, administration of aspirin could not prevent the noxious tissue events of burn injury that cause cell death. Possibly, different dosages or modes of administering aspirin could have a beneficial effect on burn wound survival.

QuikClot Combat Gauze use for hemorrhage control in military trauma: January 2009 Israel Defense Force experience in the Gaza Strip--a preliminary report of 14 cases.

BACKGROUND: Standard gauze field dressings and direct pressure occasionally are inadequate for the control of hemorrhage. QuikClot® Combat Gauze™ (QCG) combines surgical gauze with an inorganic material and is approved by the Food and Drug Administration and by the Israeli Standards Institute for external hemorrhage control. The purpose of this article is to report clinical use of this dressing during Operation Cast Lead in the Gaza strip during January 2009. METHODS: QuikClot Combat Gauze and the QCG guidelines were issued to advanced life support (ALS) providers during the preparations for the Operation. All cases of injuries involving hemorrhage were reviewed, as well as interviews with the ALS providers (physicians and paramedics) and injured soldiers. RESULTS: Fourteen uses of QCG were reported and reviewed (out of a total of 56 hemostatic interventions in 35 cases). Dressings were applied to injuries to the head, neck, axilla, buttocks, abdomen, back, and pelvis in 10 cases, and to extremities in four cases. In 13 cases (93%), injuries were caused by blast or gunshot mechanisms. The success rate was reported as 79% (11/14). Failure to control hemorrhage was reported in three cases in three different locations: neck, buttock, and thigh. All failures were attributed to severe soft tissue and vascular injuries. No complications or adverse events were reported. CONCLUSIONS: This report on the clinical field use of the QCG dressing by ALS providers suggests that it is an effective and safe product, and applicable for prehospital treatment of combat casualties. This report further suggests that QCG should be issued to medics as well as ALS providers. Larger clinical investigations are needed to confirm these findings.

Lack of complications in skin surgery of patients receiving clopidogrel as compared with patients taking aspirin, warfarin, and controls.

Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.

[Diagnostic accuracy of skin lesions excised by a plastic surgeon].

BACKGROUND: Skin tumors are the most common malignancies in the western population, with surgical excision as the definitive treatment. OBJECTIVES: The author's objectives were to estimate the precision of clinical diagnosis of skin tumors by a plastic surgeon in a community clinic. METHODS: The study includes clinical and histological data of patients operated on solely by one plastic surgeon, between November 2001 to July 2003. The sensitivity and positive predictive value were measured and compared to the literature. RESULTS: The study included 1640 patients. Out of 1806 excised skin lesions, 17.4% were malignancies. Basal cell carcinoma was the most common tumor, followed by squamous cell carcinomas and melanomas. Sensitivity for skin malignancy was 94%, and 76.5% for specific skin malignancy. Positive predictable value for any malignancy was 69.4%, and 72% for the basal cell carcinoma, the most common skin malignancy. CONCLUSIONS: Clinical examination is the main diagnostic tool for the plastic surgeon and dermatologist in the evaluation of skin lesions. Surgical excision is considered when clinical diagnosis is not productive or when malignancy is suspected. For most malignancies, diagnostic excision is therapeutic as well. Positive predictable value is a prospective index estimating the clinical diagnostic skills of the clinician. In our opinion, new technologies such as dermatoscopy should be used more often in the evaluation of skin lesions.

Effect of hyaluronic acid on random-pattern flaps in rats.

BACKGROUND: Hyaluronic acid is a common component of the extracellular matrix, has many medical applications, and is widely used as a soft tissue filler in patients who simultaneously or eventually undergo cosmetic procedures to the areas treated. OBJECTIVE: The objective was to study the effect of hyaluronic acid on wound healing and viability of random-pattern flaps in rats. METHODS AND MATERIALS: Twenty-six male rats were randomly divided into two groups. A cephalically based random dorsal flap was used-14 rats received hyaluronic acid to the bed of the flap immediately after surgery; 12 served as controls. After 1 week, flap survival was evaluated by fluorescein fluorescence. A t-test statistical analysis of survival relationships was performed. RESULTS: Flap viability in hyaluronic acid-treated rats was slightly better than in controls (average flap length survival 46.7 and 40.6 mm, respectively; p<.2). CONCLUSIONS: Although hyaluronic acid had a slight beneficial effect on flap viability, no significant improvement in flap survival was shown. The lack of any deleterious effect of hyaluronic acid on relatively ischemic tissues is further evidence of its harmless effect during surgical intervention. Further studies should be performed to clarify the potential benefit of hyaluronic acid on random flaps. The authors have indicated no significant interest with commercial supporters.