Surgical Written Consent in Aesthetic Plastic Surgery: A Plastic Center Audit of Surgical Consent Standards.

Background Informed consent is a fundamental aspect of modern medical practice that requires effective communication and an ample understanding of medical ethics, patient autonomy, and the legal obligations of healthcare professionals. Maintaining high-quality surgical informed consent is a crucial step in the healthcare process. Thus, we aimed to obtain surgical written consent on abdominoplasty, suction-assisted abdominal dermo lipectomy, and lower body lifting from our hospital database over three months (January to March, 2023) to assess our level across the American Society of Plastic Surgeons (ASPS) system. Results A total of 45 surgical written consents were obtained and 37 consents remained after exclusion. Bleeding, infection, and hematoma were mentioned in more than 80% of our consents. However, important complications such as ileus and umbilical malposition were never mentioned. Overall, the completion rate of written complications ranged from 14% to 56% in comparison to data from the ASPS. Conclusions Our results show a measurable inconsistency in surgical written consents at our center. Thus, establishing a comprehensive and accurate surgical written consent will aid in protecting our center against deficient surgical written consent accusations, improve the experience of patients, and enhance the quality of service provided by our center.

The Impact of Prior Obesity Surgery on Bleeding after Abdominal Body Contouring Surgery.

Background: Body contouring surgery removes excess skin and fat, often after massive weight loss. Some reports suggest that patients who have previously undergone obesity (bariatric) surgery are at excess risk of subsequent bleeding, possibly due to complex nutritional and metabolic sequelae of massive weight loss. Methods: A retrospective cohort study of intraoperative blood loss and postoperative bleeding indicators were examined for patients who had undergone abdominoplasty. Participants were categorized based on their history of previous obesity surgery, and outcome variables were compared using odds ratio, followed by subgroup comparison between a history of restrictive versus malabsorptive obesity surgery. Results: The study included 472 patients, of which 171 (36.2 %) had a history of obesity surgery. Mean age was 40.4 years, and 402 (85.1%) participant were women. Fifty-five (11.6%) patients were smokers whereas 65 (13.7%) were hypertensive. Mean body mass index before surgery was 30.2 kg per m2, and average time between obesity and body contouring surgery (if applicable) was 35.8 months. Patients with a history of obesity surgery exhibited greater intraoperative blood loss (162.2 mL versus 132.1 mL; P = 0.001), drainage volume at 24 h (155 mL versus 135 mL; P = 0.001), and total drainage volume (300ml versus 220 mL; P = 0.001). Postoperative hematoma requiring surgical re-exploration was almost three times higher following a history of obesity surgery (4.7% versus 1.7 %; P = 0.05). Conclusions: History of obesity surgery increases intraoperative blood loss, postoperative serosanguinous drainage volumes, and the risk of postoperative hematoma requiring surgical evacuation after abdominal body contouring procedures.

The Use of MartriDerm in Nail Bed Reconstruction of Thumb Injured by a Pellet.

Gunshot injuries to the hand and upper extremity can be divided into low and high-energy injuries. Nonballistic firearms such as pellet guns are generally considered low-energy guns but can be associated with serious morbidity and even mortality. Management is tailored according to the severity and type of injured structures. Here, we present the case of a 21-year-old soldier who accidently shot his thumb with an air gun while on a bird hunting trip, whose case was managed with extraction placement of bone graft and collagen matrix to prevent nail deformity. This case was written to increase the awareness about the need for safe use of such guns and to display the authors preferred way of management.

Metabolic changes after nonsurgical fat removal: A dose response meta-analysis.

BACKGROUND: Obesity-induced insulin resistance leads to the metabolic syndrome. Both bariatric surgery and surgical fat removal have been shown to improve metabolic health, but the metabolic benefits of nonsurgical fat removal remain uncertain. The aim of this paper is to establish whether nonsurgical fat removal exerts measurable, lasting metabolic benefits by way of changes to serum lipid profiles. METHODS: PubMed, Cochrane CENTRAL, Embase, and clinical trials registers were searched using the Polyglot Search Translator to find studies examining quantitative changes in metabolic markers after nonsurgical body contouring procedures. The MethodologicAl STandard for Epidemiological Research (MASTER) scale was adopted for the quality assessment of the included studies. The robust-error meta-regression (REMR) model was employed. RESULTS: Twenty-two studies and 676 participants were included. Peak body compositions measures manifest as a reduction of 2 units in body mass index (BMI), 1 kg of body weight (BW), 5 cm in waist circumference (WC) and 1.5 cm in abdominal fat thickness (FT), sustained up to 60 days postprocedure. Transient increases of 15 mg/dL in low-density lipoprotein (LDL), 10 mg/dl in triglycerides (TG), and 15 mg/dl in total cholesterol (TC) were observed at 2 weeks postprocedure. CONCLUSION: While nonsurgical fat removal exerts sustained effects on body anthropometrics, changes to serum lipid profiles were transient. There is no compelling evidence at present to support the conclusion that nonsurgical fat removal is metabolically beneficial.

Metabolic changes after surgical fat removal: A dose-response meta-analysis.

BACKGROUND: Bariatric surgery averts obesity-induced insulin resistance and the metabolic syndrome. By contrast, surgical fat removal is considered merely an esthetic endeavor. The aim of this article was to establish whether surgical fat removal, similar to bariatric surgery, exerts measurable, lasting metabolic benefits. METHODS: PubMed, Embase, and Scopus were searched using the Polyglot Search Translator to find studies examining quantitative expression of metabolic markers. Quality assessment was done using the MethodologicAl STandard for Epidemiological Research scale. The robust-error meta-regression model was employed for this synthesis. RESULTS: Twenty-two studies with 493 participants were included. Insulin sensitivity improved gradually with a maximum reduction in fasting insulin and homeostatic model assessment for insulin resistance of 17 pmol/L and 1 point, respectively, at postoperative day 180. Peak metabolic benefits manifest as a reduction of 2 units in body mass index, 3 kg of fat mass, 5 cm of waist circumference, 15 µg/L of serum leptin, 0.75 pg/ml of tumor necrosis factor-alpha, 0.25 mmol/L of total cholesterol, and 3.5 mmHg of systolic and diastolic blood pressure that were observed at day 50 but were followed by a return to preoperative levels by day 180. Serum high-density lipoproteins peaked at 50 days post-surgery before falling below the baseline. No significant changes were observed in lean body mass, serum adiponectin, resistin, interleukin-6, C-reactive protein, triglyceride, low-density lipoproteins, free fatty acids, and fasting blood glucose. CONCLUSION: Surgical fat removal exerts several metabolic benefits in the short term, but only improvements in insulin sensitivity last beyond 6 months.

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach.

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients' quality of life. Several surgical approaches have been described and reported in the literature to improve patients' functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center's approach to diagnosing and managing partial and GBPI cases.

Diffuse Type Neurofibroma of the Forearm.

Nerve sheath tumors comprise 5% of soft tissue masses of the upper limb in adults. Neurofibromas are divided into three types: localized, diffuse, and plexi- form. The diffuse type is rare and is typically found in the head and neck region. We present a rare case of diffuse type neurofibroma found in the forearm, presented to our clinic as a slowly enlarging mass of the left forearm of 3 years duration. The lesion was suspicious in the magnetic resonance imaging, and biopsy revealed diffuse type neurofibroma. We opted for total excision of the lesion that was found to be not possible due to involvement of the major nerves. The final pathology report showed no malignancy. Nerve tumors of the upper limb can be either benign or malignant. Neurofibroma associated with neurofibromatosis has malignant potential. The diffuse type is rare, and it most commonly occurs in the head and neck region. It has a low malignant transformation rate. Magnetic resonance imaging is the diagnostic modality of choice; however, it can be inconclusive. Biopsy should be taken to confirm the diagnosis and plan for management. Our case was managed by near total excision in order to preserve the major forearm nerves because of high clinical suspicion.

A Rare Anatomical Finding of Undescribed Accessory Palmaris Longus in the Distal Forearm: A Case Report.

Upper limb muscle anomalies and their clinical implications have been described frequently in the literature reviews. In this article, we are presenting a case of aberrant forearm muscle that had not been described before, and could be considered as a palmaris longus muscle variation. A 24-year-old man presented to the emergency department, Hamad General Hospital, Doha, Qatar, with right forearm laceration with multiple cut structures for which he was admitted for exploration and repair. Intraoperatively, flexor digitorum superficialis of the third, fourth, and fifth digits, flexor carpi radialis, and palmaris longus were injured' and all of them were repaired. We noticed an aberrant muscle-which was also injured-that originated from the distal third of the radius on its medial aspect to insert into the palmar fascia; pulling this muscle's tendon resulted in tightening of palmar fascia' same as the palmaris longus. Along with the importance of deep knowledge of typical human anatomy, hand surgeons must be aware that an aberration from normal anatomy might be anticipated, to provide the best care to our patients.

A Rare Presentation of Hand TB Extending to the Space of Parona.

Most cases of hand infections are caused by gram-positive cocci and gram-negative bacilli. Atypical hand infections are rare and are caused by uncommon pathogens like Mycobacterium tuberculosis (TB). Musculoskeletal tuberculosis accounts for 20% of TB cases, and only 2% of these cases involve the hand and foot. In this article, we describe a case of hand TB that had spread from the thenar space to the space of Parona. The patient was treated with a combined surgical and medical approach. A 29-year-old male patient presented to our clinic with the complaint of pain and swelling of the right hand that had been worsening for 4 months before presentation. It was associated with mild weakness and night sweats. On physical examination, he had two separate swellings: one at the thenar eminence and one at the volar side of the wrist. He was taken for incision, which showed caseous material on both sites. It was sent for culture that revealed mycobacterium tuberculosis. The patient was placed on anti-TB medications for a total of 6 months. Tuberculous infection of the hand is a rare condition; the most common musculoskeletal sites are the spine, hip, and knee. Early diagnosis and treatment of TB infection in hand are essential for retaining optimal function. The diagnosis usually depends on the clinical presentation supported by laboratory tests and imaging studies. Treatment consists of medical, surgical, or combined treatment. Surgical intervention should aim to remove all the infected material in addition to debridement of the involved tissues.

A Simple Option Added for Reconstruction of Posterior Neck Defects.

Background: Posterior neck defects are uncommon and are mainly caused by infections or tumors. Consequently, the reconstruction options are limited in the literature. They vary according to the size and type of the defect, and options range from grafts to free flaps. In this article, we present a series of cases where we used a transpositional locoregional flap as a simple and effective way for the coverage of posterior neck defects. Materials and Methods: In a series of 11 patients, we designed locoregional transpositional flaps unilaterally or bilaterally, according to the defect size. Dissection was carried on a subfascial plane. Results: All flaps survived without necrosis. We had two incidents of minimal wound gaping that healed without any intervention. Conclusion: In this series, we introduce a new option and its algorithm to reconstruct moderate-sized posterior neck defects using locoregional transpositional flaps, either unilaterally or bilaterally. It is simple, easy to conduct, and has a better color match and less complication rate than other options mentioned in the literature.

Our Experience in Using Lateral Chest Flap to Treat Axillary Hidradenitis Suppurativa.

Hidradenitis suppurativa is a chronic inflammatory condition that affects apocrine gland-bearing areas' causing abscesses and sinuses. Multimodality treatment is suggested for management. The surgical option is becoming more widely used, especially in drug-resistant cases. In this article, we describe a series of bilateral axillary hidradenitis cases which we treated with wide local excision and immediate reconstruction with lateral chest flap. Methods: Fourteen patients presented to our clinic with bilateral hidradenitis suppurativa of the axilla. The cases were all resistant to medical treatment. They were managed by excision and simultaneous reconstruction with lateral chest flaps. Results: At 3 months postoperatively, all patients had full shoulder range of motion and were completely satisfied with the aesthetic outcome, except for one patient who complained of the bulky look of his axilla. Liposuction was performed for him' with a pleasant resultant outcome. Conclusions: Our patients underwent wide local excision of bilateral disease plus reconstruction with lateral chest flaps in the same session. Our aim was to introduce a treatment option for moderate to severe axillary hidradenitis suppurativa that offers good aesthetic and functional outcomes.

Unusual Presentation of Extensor Tendon Rupture Caused by a Dorsal Wrist Synovial Cyst.

Synovial cysts are juxta-articular-fluid-filled collections that are lined by synovial cells, distinguishing them from a very close cystic lesion, which is the ganglion cyst. They usually present with pain and unpleasant appearance; here we present a case of wrist synovial cyst that caused extensor tendon rupture. A 50-year-old woman presented to our clinic with a cystic lesion on the dorsum of her wrist, with an inability to extend her index finger. The lesion was found intraoperatively engulfing the extensors of the index and causing a rupture. The cyst was excised and the tendon was reconstructed; pathology report confirmed the lesion as synovial cyst. Synovial cysts and ganglion cysts are two different entities but they have been used interchangeably in the literature; pathology is the only way to differentiate between them because they usually present with identical scenarios. None of them were reported to cause extensor tendon rupture, as presented in our article. Synovial cysts can cause rupture to extensor tendons if they arise from the sheath, and it is better to anticipate synovial cyst and remove it surgically before causing any further damage, if the lesion appeared to rise from the tendon sheath on further imaging.

A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge.

Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem. METHODS: This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature). RESULTS: None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis. CONCLUSION: FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.

Case report: Ectopic Cushing's syndrome in a young male with hidden lung carcinoid tumor.

INTRODUCTION: Ectopic Cushing syndrome is a form of Cushing's in which a tumor outside the pituitary gland produces adrenocorticotropic hormone (ACTH). Small cell carcinoma and carcinoid of the lung comprises half of its cases. The main purpose of this study is to present a case of ectopic Cushing syndrome caused by a hidden lung carcinoid and how to manage it. PRESENTATION OF CASE: Here we present a case of a 26year old young male complains of increased weight and appetite, proximal muscle weakness, easy bruising and appearing of purple striae on his abdomen, with a final diagnosis of ACTH secreting lung carcinoid. DISCUSSION: The diagnosis was made by non-invasive radiological procedures (CT scan and MRI) and serological tests. The management consisted of medical treatment which was not useful, then bilateral adrenalectomy to limit the patient symptoms. The ectopic spot was finally detected and excised surgically through thoracotomy. After six months of follow up there was no recurrence, signs and symptoms of Cushing syndrome begin to disappear. CONCLUSION: Ectopic cushing syndrome is a complicated medical problem especially when it comes to identification of the ectopic spot. The surgical treatment could be curative when the spot is determined.