Correction: Autologous Muscle-Derived Nerve Wrap for Prevention of Symptomatic Microneuromas in Primary Nerve Repair.

[This corrects the article DOI: 10.7759/cureus.22513.].

Solar Burns to the Reconstructed Breast: A Rare Complication following Breast Reconstruction.

Burns to the breast are a rare complication after breast reconstruction. Decreased sensation and radiation therapy may contribute to the development of burns. Solar burns may also be related to wearing dark-colored clothing. This literature review aims to analyze the incidence of solar burns on alloplastic and autologous breast reconstruction following mastectomy. Also included is the first published report of a delayed breast burn years after alloplastic reconstruction. Methods: A PubMed literature search of articles was performed using the search formula "burns" AND "breast reconstruction." Abstracts were evaluated for relevance based on inclusion and exclusion criteria. Pertinent reference bibliographies were then screened for additional relevant resources. Results: The PubMed search resulted in 598 articles, of which 12 met inclusion criteria with 22 cases of solar burns to reconstructed breasts (23 including the addition of our case report). Five occurred following alloplastic reconstruction with 80% of these patients radiated and 100% wearing dark clothing. The remaining 18 patients had autologous reconstruction with 50% wearing dark clothing. Twenty-two percent of patients in the autologous group required surgical debridement as compared to 40% of the alloplastic group. Conclusions: Solar burns in autologous and alloplastic breast reconstruction, while rare, pose significant complications in the reconstructed breast and appear to be exacerbated by radiation and dark-colored clothing. Patients should be counseled accordingly with discussion of this potential risk in a comprehensive informed consent, and precautions should be recommended to avoid this type of injury.

Autologous Muscle-Derived Nerve Wrap for Prevention of Symptomatic Microneuromas in Primary Nerve Repair.

Regeneration of peripheral nerves after repair is incomplete. Painful microneuromas may form at the site of an appropriately performed primary microsurgical nerve repair leading to a persistent Tinel's sign and hypersensitivity in that location. Here, we describe an autologous option using a free muscle-derived nerve wrap with the intent to capture axonal escape at the site of primary nerve coaptation. We demonstrate this technique on a patient undergoing primary nerve repair of a laceration to the superficial branch of the radial nerve using extensor digitorum communis muscle as a donor graft. This has become our preferred technique over commercially available nerve wraps as the muscle wrap is autologous, not limited by cost, and has the potential to limit microneuroma formation at the coaptation site.

Adjuvant and Neoadjuvant Therapeutics for the Treatment of Cutaneous Melanoma.

Adjuvant therapy plays an integral role in the treatment algorithm for stage III and stage IV cutaneous melanoma. Current ongoing clinical trials are exploring the effects of neoadjuvant therapeutics, specifically for the presurgical treatment of high-risk, borderline resectable disease. In both the adjuvant and neoadjuvant settings, the early chemotherapeutic and biochemical antitumor agents are making way to newer immune therapies, mutation-specific targeted therapies, and oncolytic vaccines that are transforming the treatment of malignant melanoma. The use of these systemic therapies in addition to surgical resection has been shown to increase both overall and progression-free survival.

Melanoma in Pregnancy and Pediatrics.

Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment.

Stretching and Strength Training to Improve Postural Ergonomics and Endurance in the Operating Room.

Plastic surgeons report the highest prevalence of chronic musculoskeletal pain and fatigue among surgical subspecialties. Musculoskeletal pain impacts daily life, career longevity, and economic burden secondary to occupational injury. Poor postural awareness and ergonomic set up in the operating room represent the most common etiology. METHODS: A literature review was performed to highlight the ergonomic set-up, postural pitfalls, occupational injuries, and musculoskeletal pain in the operating room. An institutional survey was administered among resident and attending surgeons regarding musculoskeletal pain, posture, ergonomic education, and future improvements. Literature results, survey data, and intraoperative photographs were analyzed in collaboration with physical therapists and personal trainers. RESULTS: Survey results demonstrated that 97% of resident and attending respondents experienced musculoskeletal pain and 83% reported a lack of education in posture and ergonomics. The main postural pitfalls included head forward and flexed positioning, abduction and internal arm rotation, and kyphosis of the thoracic spine. The collaborators developed instructional videos to assess posture and biomechanics and demonstrate targeted stretching and strength exercises to address specific neck, back, and shoulder pain. CONCLUSIONS: Poor posture is unavoidable in the operating room at times. These educational videos should be utilized for self-motivated and prophylactic conditioning outside of the operating room to maintain physical well-being throughout a career in plastic surgery. Future focus should be aimed at implementing dedicated ergonomic education and physical wellness programs early in surgical resident training.

Ischemic Pain.

This article discusses the pathophysiology, presentation, cause, and treatment of ischemic pain in the surgical patient. Causes of ischemic pain vary but all fundamentally cause local acidosis in the peripheral tissues, which causes signals to be passed through ascending pain pathways to the thalamus and eventual cerebral cortex where it is interpreted as ischemic pain. Ischemic pain is classically associated with an insidious onset but can present in the acute or chronic setting. Treatments are aimed at improving perfusion to the affected tissue. Surgical options include repairing damaged vessels, bypassing diseased vessels, performing thrombectomy, or embolectomy. Numerous conservative therapies exist.

Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) has been described as pain a patient feels that is disproportionate to the inciting event. CRPS is also associated with autonomic dysfunction, swelling, dystrophic skin changes, stiffness, functional impairment, and eventual atrophy. This hyperalgesic disease affects musculoskeletal, neural, and vascular structures more commonly in the upper extremity than the lower extremity. Although the etiology behind the pathophysiology of CRPS is unknown, the pain pathway extending from peripheral nociception to central nervous system modulation of stimuli is highly sensitized and overactive, disrupting the surrounding autonomic response. The diagnosis and treatment of CRPS are reviewed.

Effects of acute buspirone administration on inhibitory control and sexual discounting in cocaine users.

OBJECTIVE: Cocaine users display deficits in inhibitory control and make impulsive choices that may increase risky behavior. Buspirone is an anxiolytic that activates dopaminergic and serotonergic systems and improves impulsive choice (i.e., reduces sexual risk-taking intent) in cocaine users when administered chronically. We evaluated the effects of acutely administered buspirone on inhibitory control and impulsive choice. METHODS: Eleven subjects with a recent history of cocaine use completed this within-subject, placebo-controlled study. Subjects performed two cued go/no-go and a sexual risk delay-discounting task following oral administration of buspirone (10 and 30 mg), triazolam (0.375 mg; positive control), and placebo (negative control). Physiological and psychomotor performance and subject-rated data were also collected. RESULTS: Buspirone failed to change inhibitory control or impulsive choice; however, slower reaction times were observed at the highest dose tested. Buspirone did not produce subject-rated drug effects but dose-dependently decreased diastolic blood pressure. Triazolam impaired psychomotor performance and increased ratings of positive subject-rated effects (e.g., Like Drug). CONCLUSIONS: These findings indicate that acutely administered buspirone has little impact on behavioral measures of inhibitory control and impulsive sexual decision-making. Considering previous findings with chronic dosing, these findings highlight that the behavioral effects of buspirone differ as a function of dosing conditions.