Usefulness of Glucose Measurement To Assess Tissue Perfusion of the Nipple-Areola Complex in Conservative Mastectomy: A Prospective Cohort Study Protocol.

In recent decades, the mastectomy technique has undergone progressive adaptations in order to preserve the integrity of the breast structure and the nipple-areola complex (NAC), allowing reconstruction to be performed immediately after ablation. However, mastectomy flap necrosis or NAC has become a common complication, with an incidence between 2% and 22.3%. Blood glucose measurement to monitor microsurgical flaps has been reported as a simple method for the early detection of venous compromise. In this scenario, we propose the need to use an alternative, cost-effective method to assess the vitality of NAC in conservative oncological mastectomies. This protocol describes a prospective cohort study and was approved by the Research Protocols Ethics Committee of our institution. Patients will be included after signing informed consent. The anonymity and confidentiality of the information collected will be respected according to the Declaration of Helsinki and according to local and national guidelines. Highlights: The rate of flap necrosis or nipple-areola complex (NAC) after mastectomy with reconstruction ranges from 2% to 22.3%.Glucose measurement has been reported in microsurgical flaps.This protocol seeks to determine the use of glucose as an early predictor of NAC necrosis.Participants will be recruited from a high-volume breast pathology hospital.

Reconstructive and esthetic breast surgery after solid organ transplantation - a systematic review, proposal of a novel protocol and case presentations.

INTRODUCTION: Great advancements in solid organ transplantation (SOT) have allowed patients to have better chances to survive longer and enjoy a quality life after surgery. This increasing number of SOTs and improved long-term survival rates lead to an increasing demand for plastic, esthetic and reconstructive breast procedures. MATERIAL AND METHODS: A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and using searching terms related to esthetic and reconstructive breast surgery was conducted across three databases: PubMed, Scopus and Google Scholar. Included articles were analyzed to extract data points of interest including patient age, type of surgery, organ transplanted, underlying conditions associated with organ transplantation, follow-up, immunosuppressive drugs and their side effects, perioperative management and complications related to the breast plastic procedures in SOT recipients. RESULTS: A total of 1,298 articles were retrieved from the mentioned electronic databases. Eight full articles were finally included in this systematic review. In these articles, a total of 41 cases of breast plastic surgery after solid organ transplantation were reported. Procedures were esthetic in nature in 26.83% of cases (11 of 41 cases) and reconstructive in 73.17% of them (30 of 41 cases). No deaths were reported. CONCLUSIONS: Although esthetic and reconstructive breast surgery could be performed safely in SOT recipients, the dosage of immunosuppression and patient's overall health status with regard to the length and extent of the planned procedure should always be taken into account. From the literature data analysis, it is not possible to draw a statistical conclusion that the complication rate of surgery in immunosuppressed post-transplant patients is the same as in normal, not immunosuppressed population. Further and more valid clinical studies are warranted.

Complicaciones infecciosas graves luego de la ligadura con banda elástica para hemorroides: reporte de un caso y revisión de la literatura / Acute infectious complications after ligation with elastic band for hemorrhoids: a case report and literature review

Introducción: La ligadura con banda elástica es un procedimiento efectivo y de bajo costo, para el manejo de hemorroides grado I-III, que no requiere internación. Sus complicaciones, cuando presentes, son habitualmente leves. Aunque poco comunes, existen complicaciones graves asociadas a este procedimiento. El objetivo de este estudio es realizar una revisión de las complicaciones infecciosas pelvi-perineales de la ligadura con banda elástica, características comunes de presentación y alternativas de tratamiento en aquellos que sufren estas complicaciones. Descripción del caso: Se expone el caso de un hombre de 71 años de edad que presentó una sepsis pelviana severa posterior a la realización de una ligadura con banda elástica. A las 48 horas del procedimiento consulta por dolor perianal, dificultad miccional y fiebre. Se realiza el drenaje quirúrgico de ambas fosas isquiorrectales, luego de lo cual intercurre con shock séptico, realizándose una laparotomía, drenaje de retroperitoneo, colostomía sigmoidea. Posteriormente, debido al desarrollo de un síndrome compartimental abdominal, el abdomen se dejó abierto y contenido con una malla. Discusión: Se han descripto complicaciones sépticas posteriores a escleroterapia y crioterapia hemorroidal, ligadura con banda elástica, hemorroidectomia convencional y con sutura mecánica. Se exponen 20 casos de sepsis pelviana post-ligadura con banda elástica. La relación hombre:mujer fue de 3:1, con un amplio rango de edad (27-82 años). Sólo 2 tenían antecedentes de inmunosupresión. La progresión o la persistencia del dolor asociado a fiebre, dificultad miccional, edema perineal y/o genital fueron signos y síntomas comunes que se manifestaron dentro de los 14 días posteriores a la ligadura. Tal como en el caso aquí referido como en otros ya publicados, la realización de imágenes ayudó al diagnóstico y a la planificación quirúrgica. Todos recibieron antibioticoterapia de amplio espectro y 13 requirieron además cirugía. El espectro de tratamientos quirúrgicos fue desde el drenaje incisional hasta la amputación rectal. Ante la progresión del cuadro séptico, la realización de una ostomía fue la conducta más usual. Cinco pacientes requirieron más de una cirugía, y 8 fallecieron. Conclusión: Es importante conocer las complicaciones infecciosas mayores y su presentación clínica, para realizar un diagnóstico y tratamiento precoz de las mismas, con el fin de disminuir su elevada morbilidad o mortalidad. (AU)

Background: Rubber band ligation is an effective, low-cost procedure for grade I-III hemorrhoids, and does not require hospitalization. Its complications, when present, are usually mild. Although rare, there are serious complications associated with this procedure. The purpose of this review was to identify common presenting features and treatment alternatives in those who suffer pelviperineal infectious complications after rubber band ligation. Case Report: The present case is that of a 71-year-old man who presented severe pelvic sepsis after rubber band ligation. He complained of perianal pain, voiding difficulties and fever 48 hours after the procedure. Surgical drainage of both ischiorectal fossae was carried out. He developed septic shock. Laparotomy, retroperitoneal drainage and sigmoid loop colostomy were performed. In a subsequent operation due to abdominal compartment syndrome, the abdomen was left open and contained with a mesh. Discussion: Septic complications have been described after sclerotherapy, cryotherapy, rubber band ligation, conventional hemorrhoidectomy and stapled haemorrhoidopexy. We describe 20 cases of pelvic sepsis after rubber band ligation. The male: female ratio was 3: 1, with a wide age range (27- 82 years). Only 2 had a history of immunosuppression. The progression or persistence of pain associated with fever, voiding difficulties, perineal and / or genital edema were common signs and symptoms that appeared within 14 days after rubber band ligation. In the case here referred to as in others already published, imaging studies helped the diagnosis and surgical planning. All received broad spectrum antibiotic therapy and 13 required surgery. The spectrum of surgical treatments ranged from incisional drainage to rectal amputation. In view of the progression of the septic condition, performing an ostomy was the most usual conduct. Five patients required more than one surgery, and 8 died. Conclusion: It is important to acknowledge the major infectious complications and their clinical presentation, to help with an early diagnosis and treatment, in order to reduce their high morbidity and mortality. (AU)