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Objectives: The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. One of the existing challenges of the procedure is maintaining a pedicle of suitable length and diameter for flap survival. In this study, we analyzed the vascular anatomy of bipedicle DIEP flap cases in terms of the vessel diameter, the rate of secondary venae comitantes, and pedicle length to determine the efficacy of microvascular anastomosis and venous drainage. Materials and Methods: We retrospectively evaluated 108 patients who underwent immediate breast reconstruction using free bipedicle DIEP flaps between 2012 and 2019. The patient characteristics, diameters of the deep inferior epigastric artery (DIEA) and accompanying veins (DIEVs), DIEA pedicle length, vessel re-anastomosis rate, flap failure rate, and fat necrosis were recorded. Results: Comparison of the right-side and left-side diameters and pedicle lengths obtained showed no significant differences (P > 0.05). A total of 148 sides (68.52%) of flaps had double venous drainage, whereas 68 sides (31.48%) of flaps had one. Vein congestion occurred in 5 cases, and all involved with just one DIEV anastomosis. No arterial occlusions were observed. Conclusions: This is an analysis of extensive clinical data in terms of DIEA, DIEV, and pedicle length. The low vein congestion rate observed reveals that adequate venous drainage was achieved in the DIEV system for DIEP reconstruction. Adequate deep inferior epigastric vessel pedicle length and vessel size, as well as greater than 60% of flaps with secondary DIEV, may allow comfortable microsurgery with reduced complications. [ABSTRACT FROM AUTHOR]

Internationally, the impact of venous leg ulcers (VLUs) on the quality of life is well recognised; however, in Taiwan, the focus is only on chronic wound management. This cross‐sectional correlational study conducted at the cardiovascular and plastic surgery clinics of a regional teaching hospital between August 2019 and June 2020 investigates venous clinical severity, pain, fatigue, depression, sleep quality, quality of life, and related factors among 167 patients with VLUs. The potential predictors of the quality of life in terms of activities were venous clinical severity (P < 0.001), pain (P = 0.004), and fatigue (P < 0.001) after adjusting for covariates. The potential predictors of the quality of life in terms of the psychological domain were marital status (single/divorced) (P = 0.016), marital status (widowed) (P = 0.027), venous clinical severity (P < 0.001), pain (P = 0.001), and fatigue (P = 0.002). The potential predictors of the quality of life with regard to symptoms were venous clinical severity (P < 0.001), pain (P < 0.001), fatigue (P = 0.001), and depression (P = 0.038). These potential predictors can serve as the basis of interventions for patients with VLUs, such as those related to nutrition or training in wound dressing. [ABSTRACT FROM AUTHOR]

Oxidative stress is a major cause of aging related skin injuries. Hydrogen peroxide related ROS accumulation triggers increase in matrix metalloproteinases and elevated collagen degradation, which is a characteristic of skin aging. In this study, we investigated the protective effect of Poria cocos, used widely in the treatment of inflammatory diseases, against H2O2 induced oxidative stress. The aqueous extract of dried P. cocos was obtained by heating 10 g in 500 ml of distilled water. The mixture was evaporated up to 400 ml and the remaining 100 ml was filtered through muslin cloth repeatedly to obtain a clear aqueous extract of the P. cocos. Hs68 human dermal fibroblast cells were challenged with 100 μM of H2O2 for 24 h. Following H2O2 challenge, the cells were treated with increasing concentration of P. cocos extract (100–400 μg/ml) for 24 h. P. cocos extract hindered the H2O2 induced cell death significantly that was correlated with reduction in ROS accumulation. Western blot analysis show that P. cocos extract suppressed the expression of metallomatrix proteinases, inflammatory markers and skin aging markers, but increased TGF‐β1 levels and antioxidant related proteins. These data suggest that P. cocos is effective in attenuating oxidative stress associated skin aging effects and may be a potential agent in cosmetics products. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify if breast reconstruction is a surgical risk factor for axillary web syndrome (AWS) in breast cancer (BC) patients. Methods: The data of 207 patients who have been diagnosed with unilateral BC and who had mastectomy and lymph node dissection were retrospectively reviewed. Information of their clinical and pathological data, whether they had immediate -reconstruction and intraoperative radiotherapy, surgical methods, and postoperative complications during the 3 months after their surgery (AWS, lymphedema, seroma, and myofascial adhesion) were collected, and the incidence of AWS was compared between different surgical methods. -Results: The overall incidence of AWS was 48.8% in 207 patients. Of the 22 patients who received reconstruction, 19 developed AWS, yielding an incidence of 86%. Multivariate logistic regression modeling showed that patients who underwent reconstruction had a significantly higher incidence of AWS (odds ratio, 4.74), as did patients with postoperative complication of myofascial adhesion (odds ratio, 7.07). Conclusions: BC survivors after breast reconstruction are susceptible to AWS, and there is a significant association between myofascial adhesion and AWS. Our results can stimulate further investigation and provide an evidence base for the development of educational guidance for patients who plan to undergo breast reconstruction. [ABSTRACT FROM AUTHOR]

Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P >.05). There was a trend of higher drainage (P =.251) and shorter time to incision healing (P =.067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post‐surgery in the ciNPT group compared with control (P <.05). No surgical site complications were reported in the ciNPT group within the follow‐up period. In the control group, one patient developed wound edge fat necrosis requiring reoperation. In conclusion, we report that ciNPT is a useful incision management system for DIEP flap donor site incisions and it facilitated improved scar quality over standard dressings in this small pilot study. Further clinical studies are required to assess the full advantages provided by ciNPT. [ABSTRACT FROM AUTHOR]

Objectives: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). Methods: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon's experience (group B). Results: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B (P >.05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P <.001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B (P <.001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P =.002) was positive associated with the operative time. Conclusions: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective. [ABSTRACT FROM AUTHOR]

Background: Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage., Patients and Methods: We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019., Results: Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001)., Conclusion: The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control., Levels of Evidence: II., (Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)