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Background: Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a rare autosomal recessive hereditary disease. Immunoglobulin μ-binding protein 2 (IGHMBP2) gene mutations are the main cause of SMARD1. Case presentation: Here we describe a female infant with SMARD1 carrying heterozygous mutations in IGHMBP2 genes, c.1334A > C(p.His445Pro) and c.1666C > G(p.His556Asp), which were inherited from both parents. Clinical presentations included frequent respiratory infections, respiratory failure, distal limb muscle weakness, and fat pad found at the distal toe. Conclusions: c.1666C > G(p.His556Asp) is a novel site mutation in IGHMBP2. This case expanded knowledge on the genetic profile of SMARD1 and it provides a basis for genetic testing of parents and for genetic counseling to assess the risk of fetal disease.

Background The volume and position of the buccal fat pad (BFP) change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing. Objectives The aim of this study was to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness of this approach. Methods Two cadavers were used for the dissection of the BFP and to demonstrate the surgical procedures. Forty-eight patients were treated for midfacial hollowing with the modified grafting strategy. The BFP was filled through a percutaneous zygomatic incision and an immediate amelioration in the hollow area was observed. Improvements were evaluated from measurements of the ogee line and ogee angle, FACE-Q questionnaires, and 3-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed. Results The mean [standard deviation] ogee angle was 6.6° [1.9°] preoperatively and 3.9° [1.4°] postoperatively (average reduction, 2.7°). Patients' ogee lines were smoother postoperatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and postoperative outcomes and felt 6.61 [2.21] years younger. Overall, 88%, 76%, and 83% of the cases were graded as good or excellent in improvement by surgeon, patient, and the third party, respectively. Conclusions For age-dependent midfacial hollowing in female patients, the modified percutaneous grafting technique described here was safe and efficacious in restoring BFP volume. This technique produced a smoother ogee line and a natural, younger midfacial contour. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Objectives: To describe the morphological characteristics of subfascial intermuscular adipose tissue (IMATS) in the anterior compartment of the leg, considering its developmental and functional relationship with the crural fascia. Methods: In twenty formalin-fixed cadaveric legs (13 males, 7 females), after removal of the skin and crural fascia, the IMATS was exposed and classified into four types according to its shape. Leg length was divided into eight regions. The length, width at the widest point, closest distances of the upper and lower ends to the intermalleolar line and the anterior margin of the tibia, as well as the thickness of the skin-subcutaneous tissue complex, limb and leg lengths were measured for IMATS. Results: The most common type of IMATS was the short-large type. The largest point of IMATS was located in zone 3 or 4, and this point was located in the two zones closest to the lower end of IMATS in 75% of cases. In all cases, one to three connecting vessels piercing the crural fascia (80% were in zones 2, 3 or 4) connected to the IMATS in a slightly lateral to medial oblique course of the IMATS from top to bottom. The IMATS was superficially located in the tendinous and muscular parts of the extensor digitorum longus and/or tibialis anterior muscles, loosely attached to the muscles and crural fascia, but not between the muscle fibers. Although the largest point (p=0.041) and the distance from the distal end to the anterior margin of the tibia were found to be greater in males (p=0.049), the gender difference disappeared when normalized for limb length. Conclusion: No data on IMATS morphometry could be found in the literature. A remarkable finding of the study, which is open to interpretation in terms of the function of the IMATS, is that the location of the IMATS overlaps with the crural fascia region, which is reported to be biomechanically stiffer in the transverse direction. Our data that a connecting vessel is always connected to the IMATS by a fixed spatial relationship strengthens the argument that the developmental history of both structures may intersect. [ABSTRACT FROM AUTHOR]

Background: Aspergillus empyema due to rupture of a pulmonary cavity including an aspergilloma is a serious condition especially in immunocompromised patients with various co-morbidities. Open window thoracotomy is usually performed to control infection, followed by secondary myoplasty. However, such a two-stage strategy requires long treatment period and accompanies the invasiveness of multiple operations. On the other hand, single-stage surgery is minimally invasive, and patients' activities of daily living are less impaired. We present a single-stage surgery consisting of cavernostomy and a covering procedure using both fat pad and muscle flap. Case presentation: A 28-year-old man taking 20 mg of prednisone for rheumatoid arthritis presented with right-sided chest pain. A chest computed tomography and thoracoscopy showed a perforated pulmonary cavity including an aspergilloma in the right apex of the lung. Antifungal medication was started, but the thoracic and pulmonary cavities persisted. Therefore, surgical intervention was indicated, and considering the patient's general condition and anticipated length of treatment period, we decided to conduct a single-stage operation. A cavernostomy was performed on the ruptured cavity. To reliably close the air leak and to occlude the air space to prevent recurrence of infection, a subcutaneous free fat pad was harvested and filled into the cavity. A pedicled latissimus dorsi muscle flap was further introduced into the thoracic space to cover the fat pad. There was no postoperative air leak and the patient was discharged on postoperative day 20 with no adverse events and no limitation of movement in the arm. A series of post-operative CT showed that the pedicled latissimus dorsi muscle flap and free fat pad gradually shrank with lung re-expansion, but they were still present and filled the thoracic and pulmonary cavities 10 months after surgery. Conclusion: A single-stage surgery consisting of cavernostomy and a covering procedure using both a fat pad and muscle flap was effective in sealing air leaks, filling the air space, and preventing recurrence of infection. The fat pad and muscle flap appear to have worked in a complementary way. [ABSTRACT FROM AUTHOR]

Abstract Background The peripatellar fat pads are critical for protective cushioning during movement, and their endocrine function has been shown to affect osteoarthritis. Magnetic resonance imaging (MRI) is frequently used to visualize edema of the peripatellar fat pads due to injury. In this study, we aimed to assess the relationship between peripatellar fat pad edema and patellofemoral maltracking MRI parameters and investigate the association among cases of peripatellar fat pad edema. Methods Age- and sex-matched peripatellar fat pad edema cases were identified and divided into superolateral Hoffa, quadriceps, and prefemoral groups. Images were assessed according to tibial tuberosity lateralization, trochlear dysplasia, patellar alta, patellar tilt, and bisect offset. McNemar’s test or paired t-tests and Spearman’s correlation were used for statistical analysis. Interobserver agreement was assessed with the intraclass correlation coefficient. Results Of 1210 MRI scans, 50, 68, and 42 cases were in the superolateral Hoffa, quadriceps, and prefemoral groups, respectively. Subjects with superolateral Hoffa fat pad edema had a lower lateral trochlear inclination (p = 0.028), higher Insall-Salvati (p

Background: The peripatellar fat pads are critical for protective cushioning during movement, and their endocrine function has been shown to affect osteoarthritis. Magnetic resonance imaging (MRI) is frequently used to visualize edema of the peripatellar fat pads due to injury. In this study, we aimed to assess the relationship between peripatellar fat pad edema and patellofemoral maltracking MRI parameters and investigate the association among cases of peripatellar fat pad edema. Methods: Age- and sex-matched peripatellar fat pad edema cases were identified and divided into superolateral Hoffa, quadriceps, and prefemoral groups. Images were assessed according to tibial tuberosity lateralization, trochlear dysplasia, patellar alta, patellar tilt, and bisect offset. McNemar's test or paired t-tests and Spearman's correlation were used for statistical analysis. Interobserver agreement was assessed with the intraclass correlation coefficient. Results: Of 1210 MRI scans, 50, 68, and 42 cases were in the superolateral Hoffa, quadriceps, and prefemoral groups, respectively. Subjects with superolateral Hoffa fat pad edema had a lower lateral trochlear inclination (p = 0.028), higher Insall-Salvati (p < 0.001) and modified Insall-Salvati (p = 0.021) ratios, and lower patellotrochlear index (p < 0.001) than controls. The prefemoral group had a lower lateral trochlear inclination (p = 0.014) and higher Insall-Salvati (p < 0.001) and modified Insall-Salvati (p = 0.004) ratios compared with the control group. In contrast, the patellotrochlear index (p = 0.001) was lower. Mean patellar tilt angle (p = 0.019) and mean bisect offset (p = 0.005) were significantly different between cases and controls. The quadriceps group showed no association. Superolateral Hoffa was positively correlated with prefemoral (p < 0.001, r = 0.408) and negatively correlated with quadriceps (p < 0.001, r = -0.500) fat pad edema. Conclusions: Superolateral Hoffa and prefemoral fat pad edemas were associated with patellar maltracking parameters. Quadriceps fat pad edema and maltracking parameters were not associated. Superolateral Hoffa fat pad edema was positively correlated with prefemoral and negatively correlated with quadriceps fat pad edema. [ABSTRACT FROM AUTHOR]

ABSTRACT: Intramammary infections (IMI) are common in nonlactating dairy cattle and are expected to impair mammary growth and development and reduce future milk production. The objective of this study was to histologically evaluate how IMI alter tissue structure in growing and developing heifer mammary glands. A total of 18 nonpregnant, nonlactating heifers between 11 and 14 mo of age were used in the present study. Heifers received daily supraphysiological injections of estradiol and progesterone for 14 d to stimulate rapid mammary growth and development. One-quarter of each heifer was subsequently infused with Staphylococcus aureus (CHALL) while a second quarter served as an uninfected control (UNINF). Heifers were randomly selected and euthanized either the last day of hormonal injections to observe IMI effects on mammary gland growth (GRO), or 13 d post-injections, to observe IMI effects on mammary development (DEV). Mammary tissues were collected from the center and edge parenchymal regions of each mammary gland for morphometric tissue area evaluation. For GRO tissues, CHALL quarters had less epithelial tissue area and marginally more intralobular stroma tissue area than UNINF quarters. Tissue areas occupied by luminal space, extralobular stroma, adipose, and lobular tissue were similar. For DEV tissues, area occupied by epithelium, luminal space, intralobular stroma, and extralobular stroma did not differ between quarter treatments, but UNINF quarters had more adipose tissue area and marginally less lobular area than CHALL quarters. Results indicate that IMI in growing and developing mammary glands reduces mammary epithelial growth and alters mammary gland development by impairing epithelial branching into the mammary fat pad. Taken together, these tissue changes before calving may have adverse effects on milk production. Therefore, an important focus should be placed on improving udder health in replacement heifers through management strategies that mitigate the deleterious effects of IMI and promote the positive development of the mammary gland.

The infrapatellar fat pad (IPFP) has been implicated as a source of postoperative knee pain. Imaging the IPFP is challenging in patients with total knee arthroplasty (TKA) due to metallic susceptibility artifact. Multi‐Acquisition Variable‐Resonance Image Combination (MAVRIC)‐based T2 Mapping has been developed to mitigate this artifact and can generate quantitative T2 data. Objectives of this study were to (1) measure T2 values of the IPFP in patients with TKAs using a MAVRIC based T2 mapping technique and (2) determine if IPFP T2 values are related to the degree of fat pad scarring or clinical magnetic resonance imaging (MRI) findings. Twenty‐eight subjects (10 males, 18 females, Age: 66 + 7.2 years [Mean ± standard deviations]) undergoing clinical MRIs were sequentially recruited. Morphological imaging and quantitative T2 mapping sequences were performed on a clinical 1.5 T scanner. The morphologic images were graded for the presence and severity of fat pad scarring and clinical outcomes. T2 values were calculated in the total fat pad volume, a normal regions of interest (ROI), and an abnormal ROI. T2 values were shortened in the total IPFP volume (p = 0.001) and within abnormal regions (p = 0.003) in subjects with more severe IPFP scarring. The difference between T2 values in normal−abnormal regions was greater in subjects with severe versus no scarring (+1426.1%, p = 0.008). T2 values were elevated in patients with MRI findings of osteolysis (+32.3%, p = 0.02). These findings indicate that MAVRIC‐based T2 Mapping may be used as a quantitative biomarker of postoperative IPFP scarring in individuals following TKA. [ABSTRACT FROM AUTHOR]

Intramammary infections (IMI) are common in nonlactating dairy cattle and are expected to impair mammary growth and development and reduce future milk production. The objective of this study was to histologically evaluate how IMI alter tissue structure in growing and developing heifer mammary glands. A total of 18 nonpregnant, nonlactating heifers between 11 and 14 mo of age were used in the present study. Heifers received daily supraphysiological injections of estradiol and progesterone for 14 d to stimulate rapid mammary growth and development. One-quarter of each heifer was subsequently infused with Staphylococcus aureus (CHALL) while a second quarter served as an uninfected control (UNINF). Heifers were randomly selected and euthanized either the last day of hormonal injections to observe IMI effects on mammary gland growth (GRO), or 13 d post-injections, to observe IMI effects on mammary development (DEV). Mammary tissues were collected from the center and edge parenchymal regions of each mammary gland for morphometric tissue area evaluation. For GRO tissues, CHALL quarters had less epithelial tissue area and marginally more intralobular stroma tissue area than UNINF quarters. Tissue areas occupied by luminal space, extralobular stroma, adipose, and lobular tissue were similar. For DEV tissues, area occupied by epithelium, luminal space, intralobular stroma, and extralobular stroma did not differ between quarter treatments, but UNINF quarters had more adipose tissue area and marginally less lobular area than CHALL quarters. Results indicate that IMI in growing and developing mammary glands reduces mammary epithelial growth and alters mammary gland development by impairing epithelial branching into the mammary fat pad. Taken together, these tissue changes before calving may have adverse effects on milk production. Therefore, an important focus should be placed on improving udder health in replacement heifers through management strategies that mitigate the deleterious effects of IMI and promote the positive development of the mammary gland. [ABSTRACT FROM AUTHOR]

In this experiment we have studied the bioproductives effects of energy-protein ratio at diferents levels of crude protein and methabolizable energy, concerining whith broilers age.The experiments was carried out from one day chicken which was feeded whith in three periods. First period from 1 day till 20 days, secod period from 21 dys to 30 days threed period from 31 till 48 days.The experiments was brought about in four experimental group. Each group was feeded differently concerning energy-protein ratio. At the 48 broilers was slaughtered and cutted into anatomical parts like breast in-bone,wings,thighs,back and neck and fat pad.For all period the chicken was weighted randomly periodicaily and also was estimeted feed conversion and feed consuming.

Due to their endocrine disruption properties, phthalate plasticizers such as di(2-ethylhexyl) phthalate (DEHP) can affect the hormone-dependent development of the mammary gland. Over the past few years, DEHP has been partially replaced by 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) which also have potential endocrine disrupting properties. The goal of the present study is to understand the impact of a gestational and lactational exposure to DEHP and DINCH on mammary gland development using Sprague Dawley rats. Both plasticizers altered the adipocytes of the mammary gland fat pad of adult progeny, as demonstrated by a decrease in their size, folding of their membrane, and modulations of the lipid profiles. DEHP treatments decreased the expression of Rxrα and Scd1 at the low and high dose, respectively, but did not affect any of the other genes studied. DINCH modulation of lipid metabolism could be observed at puberty by a decreased expression of genes implicated in triglyceride synthesis, lipid transport, and lipolysis, but by an increased expression of genes of the β-oxidation pathway and of genes involved in lipid storage and fatty acid synthesis at adulthood, compared with control and DEHP-treated rats. A strong upregulation of different inflammatory markers was observed following DINCH exposure only. Together, our results indicate that a gestational and lactational exposure to DINCH has earlier and more significant effects on lipid homeostasis, adipogenesis, and the inflammatory state of the adult mammary gland than DEHP exposure. The long-term consequence of these effects on mammary gland health remained to be determined. [ABSTRACT FROM AUTHOR]

A 3-year-old boy was found to have a painless mass over his right anterior lateral knee for the previous 6 months. The mass was hardly identified during knee extension and became visible upon squatting. There was no specific finding on ultrasound imaging over his right knee at the supine extended position. During squatting, ultrasound imaging showed an ill-demarcated hyperechoic mass protruding next to the cartilage overlying the distal femur towards the subcutaneous layer through a slit over the lateral patellar retinaculum. Herniation of the fat pad through a defect in the lateral patellar retinaculum was diagnosed. Our case highlights the usefulness of ultrasound examination as regards the lateral patellar retinaculum defect in pediatric knees, as well as its capability for dynamic scanning to capture the exact "pathological moment". [ABSTRACT FROM AUTHOR]

Fat pad syndrome is a knee joint condition/disease where acute or chronic inflammation occurs in the fat pad of the knee joint, and it is a cause of anterior knee pain. Fat pad syndrome usually occurs concurrently with other conditions/diseases to collectively cause anterior knee pain. No study to date has reported the treatment of anterior knee pain solely due to fat pad syndrome. Here, we report a case of fat pad syndrome of the knee joint as the sole cause of anterior knee pain in a 49-year-old woman who received integrated Korean medicine treatments (pharmacopuncture, acupuncture, herbal medicine, deep fascial meridian therapy, and chuna). Using patient-reported pain scale scores, the level of the patient’s pain was relieved, and her mobility improved. Integrated Korean medicine treatments could be effective for patients who have fat pad syndrome of the knee joint.

ObjectiveTo analyze associations of suprapatellar fat pad (SPFP) hyperintense signal alterations and mass effect with progression of patellofemoral osteoarthritis (OA) and clinical symptoms over 48 months.Materials and methodsSubjects from the Osteoarthritis Initiative (n = 426; 51.8 ± 3.8 years; 49.8% women) without radiographic tibiofemoral OA underwent 3T-MRI of their right knees and clinical evaluation using the Knee Injury and Osteoarthritis Outcome Score at baseline and at 48 months. Elevated SPFP signal was assessed on intermediate-weighted, fat-saturated turbo spin-echo (TSE) images. Mass effect was defined as a convex posterior contour. Patellofemoral cartilage, bone marrow lesions (BML), and subchondral cysts were assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of SPFP imaging findings with MRI and clinical progression were assessed using general linear models and logistic regressions.ResultsBaseline SPFP signal alterations were found in 51% of the subjects (n = 217), of whom 11% (n = 23) additionally had a mass effect. Progression of cartilage lesions was significantly higher in subjects with signal alteration versus without (adjusted mean increases, 95% CI; patella: 0.29, -0.07 to 0.64 vs -0.04, -0.40 to 0.31; p  0.18 for all).ConclusionPatellofemoral joint degeneration over 48 months was significantly increased in subjects with SPFP signal alteration, suggesting an association between SPFP abnormalities and the progression of patellofemoral OA.

The extraction of retained and completely impacted third molars is one of the most common surgical procedures performed by dental practitioners with low rates of complications. The accidental displacement during the surgeries of the maxillary third molar into adjacent anatomical spaces is one of the most critical problems that can arise. The most common sites of migration during surgical interventions are the infratemporal fossa, the pterygomandibular space, the maxillary sinus, the buccal space, and the lateral pharyngeal space. In this paper, two cases in which a maxillary third molar accidentally was displaced into the buccal space are presented, the retrieval of the tooth via intra-oral approach is explained, and the anatomical spaces implications are discussed.

Objective: The aim of this study was to evaluate thickness and elasticity of heel fat pad in patients with unilateral plantar fasciitis and to investigate the effects of age, sex, body mass index (BMI), and functional scores on plantar fasciitis. Material and Method: 70 patients who had been suffering from unilateral plantar fasciitis longer than 6 months were enrolled in the study. The thickness and elasticity of fat pad were compared between the painful and healthy feet of the patients with ultrasound. For measurement of elasticity, shear wave elastography (SWE) was used. Comparative analysis was performed for thickness and elasticity variables between the painful and healthy feet with Mann-Whitney U and independent samples t-test. Results: Average of age of the patients was 44±11.66. The average thickness of the heel fat pad was 17.9±3.1 mm on the affected side and 18.3±3.3 mm on the healthy side. The mean SWE value of the painful side was 23.9 m/s (range 9.3-32) and was 24.7 m/s (range 10.8-34) on the healthy side. Heel fat pad thickness was greater in the healthy feet than in the painful feet, but there was no statistical significance (p=0.448). The painful feet were stiffer, but the difference was statistically similar (p=0.347). BMI had a statistically significant impact on thickness of heel fat pad. Conclusion: The results showed that a decrease in the heel fat pad thickness was a supporting finding of plantar fasciitis in patients with normal BMI but not in patients with BMI>25. [ABSTRACT FROM AUTHOR]

Introduction: Anterior knee pain (AKP) is a very common problem in the community and negatively affects the patient's quality of life. Many pathologies can be the cause of this problem. The principal aim of our study was to evaluate the relationship between the magnetic resonance appearance of the suprapatellar fat pad and AKP. Methods: Knee magnetic resonance imaging of patients with and without AKP was analyzed retrospectively by two independent radiologists in two groups. The morphological structure of the anterior suprapatellar fat pad and other pathologies that may cause AKP in the knee joint were evaluated. Statistical relationships of the findings were investigated. Results: Of the 395 patients who participated in the study, 195 (49.4%) were females and 200 (50.6%) were males. The median age of the patients was 43 (18-90) years. There was no significant difference in mean age between individuals with and without AKP (p=0.376). A significant difference was found between patients with and without AKP in terms of posterior contour bowing of the anterior suprapatellar fat pad, edema, and diameter increase in the fat pad, patellar tendinopathy, quadriceps tendinopathy, and medial patellar retinaculum damage (p<0.001, p<0.001, p<0.001, p=0.015, p=0.002, and p=0.032, respectively). Discussion and Conclusion: Anterior suprapatellar fat pad syndrome is one of the pathologies involved in the etiology of AKP. The close relationship between the posterior contour bowing of the anterior suprapatellar fat pad we defined and AKP should be considered in radiological reporting. [ABSTRACT FROM AUTHOR]

The bichectomy, or buccal lipectomy, is a method for cheek contouring and midface tapering in cosmetic surgery. It is generally accepted that the long-term results of well-established conservative bichectomy approaches exhibit some limitations, and the surgery does not always deliver satisfactory results. The extended bichectomy approach includes the resection of the buccal extension of the fat pad along with the body and part of the temporal extension. When properly performed, this procedure provides the desired cheek contouring and slimming in patients who may not benefit from a conventional technique. Approaches for more defined cheek contouring are presented and discussed. [ABSTRACT FROM AUTHOR]

This case describes a minimally invasive implantation of cryopreserved human adipose tissue allograft (CAT) in a diabetic neuropathic patient with a pre-ulcerative plantar lesion. No re-ulceration or adverse events have occurred out to 9 months. CAT provides healthcare providers with an option to manage patients at risk for plantar ulcers., Competing Interests: MJR has not received any financial compensation from Britecyte. MCS and SEM are employees of Britecyte., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a rare autosomal recessive hereditary disease. Immunoglobulin μ-binding protein 2 ( IGHMBP2 ) gene mutations are the main cause of SMARD1., Case Presentation: Here we describe a female infant with SMARD1 carrying heterozygous mutations in IGHMBP2 genes, c.1334A > C(p.His445Pro) and c.1666C > G(p.His556Asp), which were inherited from both parents. Clinical presentations included frequent respiratory infections, respiratory failure, distal limb muscle weakness, and fat pad found at the distal toe., Conclusions: c.1666C > G(p.His556Asp) is a novel site mutation in IGHMBP2 . This case expanded knowledge on the genetic profile of SMARD1 and it provides a basis for genetic testing of parents and for genetic counseling to assess the risk of fetal disease., Competing Interests: The authors have no conflicts of interest to disclose., (© 2024 The Author(s).)

Introduction: Although better surgical exposure is encountered with the excision of infrapatellar pad of fat (IPPF) during total knee replacement (TKR), some studies showed an increase in anterior knee pain and other specific complications associated with such a step. The purpose of this study was to add in literature a new comparison between IPPF excision and preservation during TKR, focusing on the anterior knee pain, functional range, oxford knee score and patellar height through a randomized clinical trial Methods: This prospective randomized study was conducted from 2016 to 2019 on 90 patients with knee osteoarthritis treated with elective primary TKA by same surgeons at one hospital with the same implant design with a mean follow up of 18 month. Patients were randomized into two groups: one group including patients with IPPF complete excision and the other group include patients with IPPF preservation. No patella resurfacing was done. Pre and postoperative anterior knee pain was recorded and compared using VAS score in addition to Oxford knee score. Results: At 6 months follow-up, 10 knees and 14 knees (27%) had anterior aching discomfort with a mean postoperative extension were -5.3 and -5.2 in IPPF preservation and excision group patients, respectively. There was no statistically significant differences between both groups regarding anterior knee pain, range of motion, oxford knee score or patellar height measurement through the follow up period. No patellar complications were recorded in all cases. Conclusion: Although Infrapatellar fat pad excision in TKA resulted in a minor increase in number of patients with postoperative anterior knee pain, it was of no statistically significant difference. Hence, whenever a better surgical exposure is needed, IPPF excision should be considered. Additional large scale randomized studies should be added to the calling literature for more result validation and guidelines formulation. [ABSTRACT FROM AUTHOR]

Objectives: Point‐of‐care ultrasound (POCUS) diagnosis of distal forearm fractures relies on the identification of buckling or breach of hyperechoic bone cortex. We describe the pronator quadratus hematoma (PQH) formation visualized on POCUS, the PQH sign, as it may aid diagnosis of pediatric distal forearm cortical breach fractures. Methods: A prospective cohort of children presenting to an emergency department with isolated, clinically non‐angulated distal forearm injuries received POCUS by an expert emergency physician sonologist who identified the presence or absence of the PQH sign. They secondarily recorded the difference between the size of the pronator quadratus (PQ) muscle on both the affected and non‐affected forearms (PQ delta thickness). Children received an x‐ray subsequent to POCUS and were diagnosed based on an x‐ray reported by a radiologist masked to POCUS findings. Results: Thirty‐eight children were recruited. All 22 patients with cortical breach fracture had PQH sign present (100%; 95%CI: 85–100%), while all 16 patients without cortical breach fracture had PQH sign absent (100%; 95%CI: 79–100%). PQ delta thickness ranged from 2.1 to 10.2 mm in cortical breach fractures, 0.0 to 1.1 mm in buckle fractures, and 0.2 to 0.8 mm in patients without fracture. Conclusions: The PQH sign correctly distinguished all children with, and without, cortical breach fractures. All PQ delta thicknesses were ≧2.1 mm when cortical breach fracture was present and ≦1.1 mm when cortical breach fracture was absent. The PQH sign and PQ delta thickness are promising measurements to identify pediatric distal forearm cortical breach fractures, and their utility should be confirmed in larger studies with sonologists of different abilities. [ABSTRACT FROM AUTHOR]

The extraction of retained and completely impacted third molars is one of the most common surgical procedures performed by dental practitioner’s with low rates of complications. The accidental displacement during the surgeries of the maxillary one into adjacent anatomical spaces is one of the most critical problems that can arise. The most common sites of migration during surgical interventions is the infratemporal fossa, the pterygomandibular space, the maxillary sinus, the buccal space, or the lateral pharyngeal space. In this paper, two cases of a maxillary third molar accidentally displaced into the buccal space are presented, and the retrieval of the tooth via intra-oral approach is explained and discusses the anatomical spaces implications. [ABSTRACT FROM AUTHOR]

Background: Anterior knee pain (AKP) is a common symptom of patellofemoral osteoarthritis (PFOA). There is limited prospective evidence supporting the relationships between patellofemoral maltracking parameters, AKP, and PFOA. Thus, this prospective cross-sectional study aimed to determine the association between quadriceps fat pad (QFP) edema and patellofemoral maltracking in patients with chronic AKP and to evaluate the feasibility and diagnostic performance of a PFOA assessment using fat fraction (FF) and T2* based on Q-Dixon., Methods: This was a cross-sectional study with prospective data collection. Patients with chronic AKP were recruited from an orthopedic outpatient magnetic resonance imaging (MRI) waiting room at Shanghai Tongren Hospital between November 1, 2022, and April, 30, 2023. Exclusion criteria included age of <18 years, knee trauma, major internal derangement, prior surgery/arthroscopy, pre-existing joint diseases, and contraindications to MRI. MRI was performed using a 3.0-T instrument, and patellofemoral maltracking parameters were measured. Patellofemoral feature-relevant items, including patellar cartilage defects, patellar bone marrow lesions (BMLs), patellar osteophytes, anterior femoral osteophytes, Hoffa synovitis, and synovitis-effusion, from the semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) were measured. The Anterior Knee Pain Scale (AKPS) was used to assess pain and function. FF/T2* measurement differences between groups and their associations with maltracking metrics, osteoarthritis grading based on the Iwano grading system, MOAKS, and AKPS, were investigated. Based on Iwano grading, the participants were categorized as having no-PFOA (n=40), mild PFOA (n=40), and advanced PFOA (n=40). Chi-squared and one-way analysis of variance were used to assess potential differences between the groups. Spearman's correlation test was used to analyze the correlation between the morphological parameters, AKPS, Iwano grade, MOAKS, and MRI quantitative values. Receiver operating characteristic (ROC) curves assessed the area under the curve (AUC), sensitivity, and specificity of quantitative values for distinguishing PFOA from no-PFOA., Results: Among the 120 included patients, those in the mild (86.2±8.5) and advanced (83.9±9.5) PFOA groups had significantly lower AKPS scores than those in the no-PFOA group (88.8±7.3) (P=0.03). The mean FF and T2* values of the QFP were significantly higher in the no-PFOA group than those in the mild and advanced PFOA groups (P<0.001 for FF and P=0.02 for T2*). Quantitative data on the QFP and patellofemoral maltracking parameters showed no association. FF (r=-0.686, P<0.001) and T2* (r=-0.314, P=0.008) showed a negative correlation with the Iwano grade. The AUCs for PFOA diagnosis were 0.906 [95% confidence interval (CI), 0.853-0.960] (FF) and 0.744 (95% CI, 0.657-0.831) (T2*)., Conclusions: QFP FF and T2* were not associated with patellofemoral maltracking parameters but with increased PFOA in patients with AKP, suggesting that QFP abnormalities play a role in PFOA. Therefore, a quantitative QFP assessment (FF and T2*) based on Q-Dixon technology could be a convenient and reliable new imaging biomarker for PFOA severity during clinical diagnosis, treatment, and follow-up., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1730/coif). L.L. reports a grant from the Research Fund of Shanghai Changning District Health Commission (No. 20234Y002) during the conduct of the study. The other authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

A 3-year-old boy was found to have a painless mass over his right anterior lateral knee for the previous 6 months. The mass was hardly identified during knee extension and became visible upon squatting. There was no specific finding on ultrasound imaging over his right knee at the supine extended position. During squatting, ultrasound imaging showed an ill-demarcated hyperechoic mass protruding next to the cartilage overlying the distal femur towards the subcutaneous layer through a slit over the lateral patellar retinaculum. Herniation of the fat pad through a defect in the lateral patellar retinaculum was diagnosed. Our case highlights the usefulness of ultrasound examination as regards the lateral patellar retinaculum defect in pediatric knees, as well as its capability for dynamic scanning to capture the exact “pathological moment”.

Elbow injuries are common in the paediatric population. Diagnosing these injuries relies on X-rays taken on initial presentation in the emergency department. Interpreting these radiographs can occasionally be challenging, partly because of the sequential appearance of secondary ossification centres in the paediatric elbow. We propose a methodical approach that would help a clinician identify these injuries, especially the radiographically subtle ones. Evaluating these X-rays should start with a lateral view which identifies the majority of elbow injuries. Anterior cortical disruption, fat pad sign, and the anterior humeral line can be evaluated on this view, and if present, alerts the clinician to a possible subtle fracture. On this view also, the clinician can evaluate the radio-capitellar line and then proceed to evaluate it again on the anteroposterior view. With this approach almost all fractures and dislocations around the elbow can be identified.

• Locked Knee. • Adhesion. • Fat Pad Adhesion. • Arthroscopic debridement. A "locked" knee is defined as a knee that does not move freely after an injury. Most cases of locked knee are due to intra-articular blockade caused by an unstable meniscal tear, anterior cruciate ligament (ACL) tear, or chondral lesion resulting in a loose limb. In this study, we present a rare case of a locked knee caused by fat pad adhesion A 23-year-old male presented with a locked right knee, after sustaining an injury falling one month before. Magnetic Resonance Imaging showed loss of ACL feature, normal posterior cruciate ligament, and meniscal tear of posterior horn. Arthroscopy procedure found fat pad adhesion, immobilizing the knee's rotation. After removing all of the fat pad adhesion, the patient's knee could move freely. Clinical and radiographic examinations are important for early diagnosis of the cause of locked knee, but arthroscopic examination is the gold standard for diagnosis. [ABSTRACT FROM AUTHOR]

A 2-month-old boy who had undergone radical surgery for esophageal atresia at 10 h after birth started to present intermittent choking and coughing during suckling and sleep. Upper gastrointestinal series revealed recurrent tracheoesophageal fistula at the Th3 level. Enteral feeding via trans-jejunal tube was started and reoperation was performed at 10 months old, when he weighed 9.6 kg (+0.56SD). Thoracotomy was performed after inserting the guidewire into the fistula under both bronchoscopy and gastroscopy. The fistula was resected and both esophageal and tracheal ends were sutured. Part of the thymus was obtained and the free thymic fat pad (FTFP) was interposed between sutured sites along with the application of fibrin-glue to the affected area to prevent re-recurrence. Postoperative course was uneventful and computed tomography (CT) at 1 month following the operation demonstrated the residual FTFP. FTFP can be a feasible, useful, and effective option for interposition in recurrent TEF surgery, compared to conventional pedicled or free tissue.

Background: Buccal fat pad (BFP) is a specialized vascular tissue adequately present in buccal space and is close to the maxillary posterior quadrant. The aim of this clinical study was to evaluate the utility of pedicled BFP (PBFP) in the treatment of Class II and III gingival recession. Materials and Methods: Ten systemically healthy patients with age ranging from 35 to 55 years with Class II and Class III gingival recession in the maxillary molars were selected. Before the surgical phase, patients were enrolled in a strict maintenance program including oral hygiene instructions and scaling and root planing. A horizontal incision of 1–1.5 cm was made in the buccal sulcus of the maxillary molar region; buccinator muscle was separated bluntly to expose the BFP. The fat was then teased out from its bed and spread to cover defects adequately. It was then secured and sutured without tension. Clinical parameters such as probing depth, recession width, recession length (RL), and width of keratinized gingiva were recorded at baseline and at 6 months postoperatively, and weekly assessment was done at 1 week, 2 weeks, 3 weeks, and after 4 weeks for observations during the postoperative healing. Results: Treated recession defects healed successfully without any significant postoperative complications. Decreased gingival recession horizontal width values from 4.65 ± 0.4327 to 0.94 ± 1.350 and RL from 6.4 ± 1.075 to 0.7 ± 0.6750 were observed postoperatively (P < 0.05). Percentage of root coverage average was 89.3%. There was a statistically significant decrease in the width and depth of recession. Conclusion: Pedicled buccal fat showed promising results as the treatment modality in the management of Class II and Class III gingival recession of maxillary posterior teeth.

Background: In patients with mild superior sulcus deformity, pseudoptosis, or multiple eyelid folds, several bulky fibers can be found anterior to the orbital septum. These fibers, called preorbital septum fibers, may constrict protrusion of the fat pad and movement of the levator palpebrae muscle.Objectives: In this study, the authors illustrated the anatomy of these fibers and described the double-eyelid procedure to correct pseudoptosis, mild superior sulcus deformity, and multiple eyelid folds, which may be caused by these fibers.Methods: The bulky preorbital septum fibers were dissected and severed during upper blepharoplasty to release the orbital septum fat pad and levator palpebrae muscle. This procedure was performed between January 2016 and January 2018 in 56 patients with distinct preorbital septum fibers.Results: Of the 56 patients, 38 displayed mild to moderate upper eyelid depression and multiple eyelids, and 18 displayed pseudoptosis. Bulky fibers that existed in the superficial layer of the orbital septum were all dissected and removed. After 6 months' recovery, the superior sulcus deformity improved in all patients. No recurrence of multiple eyelids was observed. Patients with pseudoptosis showed a notable release of their upper eyelids.Conclusions: This is the first time to our knowledge that the preorbital septum fibers are described as a distinct anatomical structure. They are clinically important in upper eyelid anatomy and the improvement of sunken upper eyelids or pseudoptosis. The combination of blepharoplasty with release of these fibers is easy to perform and promote.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Objective: To determine the correlation between patellar tendon-lateral femoral condyle friction syndrome (PLFFS) and the morphological characteristics of the antero-inferior part of the lateral femoral condyle (ALFC) to explore the potential pathogenesis.Methods: A total of 170 knees of 140 patients with PLFFS (PLFFS group) were retrospectively analyzed using magnetic resonance imaging (MRI) data for a 4-year period from our database. The Insall-Salvati ratio, shape of the ALFC (SALFC, defined as two subtypes: sharp versus blunt), lateral femoral condyle angle (LFCA), lateral trochlear length (LTL), and lateral trochlear height (LTH) were measured on MRI. Two groups were enrolled as controls: pure patella alta group (n = 192) and normal group (n = 172). All the parameters of the PLFFS group were compared with those of the two control groups.Results: The LFCA was significantly lower (p < 0.001) in the PLFFS group than in the pure patella alta group. The SALFC was significantly different (p < 0.001) in these two groups, whereas the Insall-Salvati ratio, LTH, and LTL showed no significant difference. The LFCA, LTH, SALFC, and the Insall-Salvati ratio in the PLFFS group were also significantly different (p < 0.001) with the normal group. Receiver operating characteristic (ROC) analysis showed the efficacy of the Insall-Salvati ratio and SALFC was better than that of the other parameters.Conclusions: The morphological characteristics of ALFC are correlated with PLFFS. The sharp shape of ALFC may be an important causative co-factor along with patella alta in the pathogenesis of PLFFS.Key Points: • A sharp margin of the antero-inferior lateral femoral condyle is an important risk factor for the development of PLFFS in patients with patella alta. • Antero-inferior femoral condyle shape can easily be assessed with high intra- and inter-reader reliability PLFFS. • PLFFS is more common in young adults. [ABSTRACT FROM AUTHOR]

The present study describes a clinical case in which the buccal fat pad (BFP) was used to improve the contour of the peri-implant mucosa. To our knowledge, this is the first case report of such an application in the literature. A 58-year-old woman presented with teeth #2 and #3 missing and an indication for extraction of tooth #4. After clinical examination and CBCT analysis, immediate implants were placed in the region of the extracted tooth and that of tooth #2 for prosthetic rehabilitation using a three-unit fixed partial denture. There was an extensive mucosal defect in the region of tooth #3, with vertical and horizontal changes in the contour of the mucosa. As an alternative to the use of a subepithelial connective tissue graft, we opted for displacement of the BFP and its accommodation on the alveolar ridge of tooth #3 to improve the buccal tissue contour. After 5 years of follow-up, satisfactory gain and maintenance of mucosal volume were observed in the treated area, as well as improvement of buccal tissue contour. The use of BFP seems to be a feasible alternative for filling and treating peri-implant mucosal defects. [ABSTRACT FROM AUTHOR]

Background: Regardless of the technique chosen to treat the aging midface, the isolated lateral approach facelift has a limited impact on the midface volume deficit. In an effort to overcome this limitation, modern facial rejuvenation procedures incorporate an additional modality for replenishing the midface volume. Some of the author's facelift patients present with bulging buccal fat pads despite volume deficiency in the inframalar region. The author's technique is designed to utilize the buccal fat pad to replenish the inframalar volume deficit.Objectives: The author sought to present the fat pad transposition surgical technique along with objective outcome data.Methods: This study was a retrospective review of nonconsecutive cases where the sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad was performed. A total of 22 patients underwent the fat pad transposition technique by the author (O.B.) between July 2013 and December 2017. Patient data were obtained from patient records, 3-dimensional models, magnetic resonance images, and standardized photography. Preoperative differences in midface volume were assessed utilizing curvilinear surface measurements on 3-dimensional models and the Allergan midface volume deficit scale on standardized photography.Results: The average midface volume deficit score significantly improved, and the average midfacial curvilinear surface measurement significantly increased after surgery. Magnetic resonance imaging confirmed a stable position of the buccal fat pad after surgery.Conclusions: The sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad is an effective technique that can be safely employed for autologous inframalar augmentation in patients with a favorable facial morphology.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: Although many facelift techniques incorporate fat grafting with tissue repositioning and removal, the intermediate and long-term changes in facial volume after these techniques is unknown. Whereas fillers for facial volume have predictable life spans, we know little about the facial volume changes following fat grafting with facelift surgery.Objectives: The authors sought to track the short-term and long-term effects on midfacial volume change.Methods: We evaluated a subset of patients who were followed by 3-dimensional (3D) photometric imaging 18 to 24 months after facelift with fat grafting to the deep midfacial fat compartments and buccal fat pads. Volume changes were measured preoperatively and postoperatively every 1, 3, 6, 12, 18, and 24 months using the 3D photometry.Results: At the 1- to 2-month follow-up period, average facial volume was 49.60% of the initial fat injected. At the 18- to 24-month follow-up period, average facial volume was 73.64% of the initial fat injected, indicating an increase in midfacial volume. Upon graphing available photometric data, dynamic changes in facial volume were observed. In 5 midfacial zones, facial volume appeared to initially decline (average decline, 49.0% of original fat injection), troughing at 10 months (range, 2-15 months), but later inclined (average increase in volume, 95.9% of original fat injection), peaking around 16 months (range, 4-24 months).Conclusions: Progressive improvement in midfacial volume in part may be explained by the graft replacement theory of Suga and Yoshimura, which suggests that grafted adipose tissue immediately dies after transplantation and is replaced by adipose-derived stem or progenitor cells.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Introduction: The Kager fat pad is one of the largest soft tissue structures local to the ankle joint, yet it is poorly understood. It has been hypothesised to have a role in Achilles tendinopathy. This study aimed to investigate the pressure areas in the Kager fat pad adjacent to the Achilles tendon and to assess the anatomy and deformation of the Kager fat pad in cadavers.Methods: Twelve fresh frozen cadaveric ankles (mean age 44 years, range 38-51) were mounted in a customized testing rig, enabling plantar flexion and dorsiflexion of the ankle, with the Achilles tendon loaded. A needle tipped pressure sensor was inserted in two areas of the Kager fat pad under ultrasound guidance (retrocalcaneal bursa and at 3 cm proximal from Achilles insertion). Pressure readings were recorded at different flexion angles. Following testing, the specimens were dissected to expose the Kager fat pad and retrieve it for analysis. MRI images were also taken from three healthy volunteers and the Kager fat pad deformation examined.Results: Mean pressures significantly increased in all specimens at terminal ankle plantar and dorsi flexion in both regions (p < 0.05). The Kager fat pad was consistently adherent to the Achilles at its posterior aspect for a mean length of 7.7 cm (SD 0.27, 89% of KFP length). The most distal part of the Kager fat pad was the exception and it detached from the Achilles to give way to the retroalcaneal bursa for a mean length of 0.92 cm (SD 0.24, 11% of KFP length). The bursal space is partially occupied by a constant 'wedge' extension of Kager fat pad. The mean volume of the whole Kager fat pad was 10.6 ml (SD 3.37). Video and MRI demonstrated that the Kager fat pad undergoes significant deformation during plantar flexion as it is displaced superiorly by the Achilles, with the wedge being forced into the retrocalcaneal bursal space.Conclusion: The Kager fat pad does not remain static during ankle range of motion, but deforms and its pressure also changes. This observation supports the theory that it acts as a shock-absorber to the Achilles tendon and pathological changes to the fat pad may be clinically important in the development of Achilles tendinopathy. [ABSTRACT FROM AUTHOR]

Consumption of non-starch polysaccharides (NSP) is associated with reduced risk of obesity. This study aimed to compare the effects of cereals (oats) and legumes (soybean), rich in different classes of NSP, on appetite regulation and fat accumulation in rats. Soy pectin fermented more efficient than cereal arabinoxylan in rats. Soy pectin and oat β -glucan were utilized mainly in the caecum of rats. Only small amount of maltodextrin, cello-oligosaccharides and xylo-oligosaccharides were detected in the digesta. Caecal fermentation of soy pectin produced significantly higher concentration of short chain fatty acids (SCFAs) compared to the control. Retroperitoneal (RP) fat-pad weight was significantly lower for rats fed with soybean meal enriched diet than for controls. An inverse correlation between rat RP fat-pad weight and concentration (and proportion) of butyrate was observed. Consumption of soy pectin and oat β -glucan enriched foods to produce targeted SCFAs in vivo could be a potential strategy to lower fat mass accumulation and a potential tool to manage obesity. [ABSTRACT FROM AUTHOR]

Background: Buccal fat pad (BFP) excision is a procedure in which the fat pad is extracted in order to achieve a more youthful appearance.Objectives: The aim of this study was to describe an alternative technique that utilizes hydrodissection to extract the BFP.Methods: This is a controlled, prospective, randomized clinical study involving 2 groups. Group A (n = 27) underwent BFP excision with hydrodissection, during which 15 mL of a vasoconstricting anesthetic solution was injected into the BFP. Group B (n = 27) underwent BFP excision, during which 3 mL of lidocaine 2% with epinephrine was injected. All procedures were performed by the same surgeon. Variables analyzed were surgical time, intraoperative bleeding, and postoperative pain directly following surgery 2 hours after the procedure, as well as maximum pain within 72 hours of surgery and complications. Postoperative care was standardized, and patient follow-up extended over a 6-month period.Results: Pain scores for 54 patients were recorded on a visual analog scale (0-10). Mean ± standard deviation transoperative pain scores were 0.5 ± 0.8 for Group A and 1.3 ± 1.3 for Group B (P = 0.01); 2 hours postoperation the scores were 1.2 ± 0.7 for Group A and 2.6 ± 1 for Group B (P < 0.0001). Maximum pain occurred within 72 hours, and scored 1.6 ± 0.6 for Group A and 3.1 ± 1 for Group B (P < 0.0001). Mean operative time was 8:18 ± 0:47 minutes for Group A and 14:08 ± 2:28 minutes for Group B (P < 0.0001). There was a positive correlation between operative time and pain. Overall, 5.5% of patients suffered postoperative complications.Conclusions: BFP excision by hydrodissection is an effective procedure that decreases surgical times by facilitating extraction of the BFP with less manipulation, thereby resulting in decreased postoperative pain and a more tolerable recovery.Level Of Evidence:2: [ABSTRACT FROM AUTHOR]

Mammary cistern size was positively correlated with milk yield of mature dairy ewes, but the association in ewe lambs is unknown. This experiment aimed to examine the associations between mammary ultrasound measurements and the milk yield of ewe lambs at one year of age and to determine the accuracy of using maternal mammary ultrasound to predict single lamb growth rates. Single-bearing ewe lambs (n = 45) were randomly selected and 30 were milked once at weeks three (W3), five (W5), and seven (W7) of lactation. Mammary ultrasound scans were performed at day 110 of pregnancy, W3, W5, W7, and weaning (L69). Single lambs (n = 30) were weighed at birth and at each mammary scanning event. Udder measurements explained 26.8%, 21.4%, and 38.4% of the variation in milk yield at W3, W5 and W7, respectively, and 63.5% and 36.4% of the variation in single lamb growth to W3 and to L69. This ultrasound technique was more accurate in predicting single lamb growth to W3 than milk yield and may enable the identification of pregnant ewe lambs whose progeny would have greater growth rates. More research is needed to identify accurate indicators of superior milk yield and determine whether ultrasound could be used to select ewe lambs.

Inflammation plays a central role in the pathogenesis of knee PTOA after knee trauma. While a comprehensive therapy capable of preventing or delaying post-traumatic osteoarthritis (PTOA) progression after knee joint injury does not yet clinically exist, current literature suggests that certain aspects of early post-traumatic pathology of the knee joint may be prevented or delayed by anti-inflammatory therapeutic interventions. We discuss multifaceted therapeutic approaches that may be capable of effectively reducing the continuous cycle of inflammation and concomitant processes that lead to cartilage degradation as well as those that can simultaneously promote intrinsic repair processes. Within this context, we focus on early disease prevention, the optimal timeframe of treatment and possible long-lasting sustained delivery local modes of treatments that could prevent knee joint-associated PTOA symptoms. Specifically, we identify anti-inflammatory candidates that are not only anti-inflammatory but also anti-degenerative, anti-apoptotic and pro-regenerative.

Light chain amyloidosis (AL) causes irreversible multi-organ damage if not diagnosed early in the disease process. Fat pad biopsy is thought to be a highly sensitive screening test in systemic AL cases, especially if greater than three organs are involved. We present a case of a 64-year-old female who was admitted to the hospital with worsening heart and kidney failure, anasarca, increased free serum lambda light chains, and a negative fat pad biopsy for amyloidosis. Later, she developed asystole, bradycardia, severe hypotension, and respiratory distress. Because X-rays of her calvarium showed multiple osteolytic lesions, a bone marrow biopsy was planned to assess for multiple myeloma. Due to her non-reassuring vitals, the biopsy was not attempted, and she passed away several weeks later. Autopsy findings identified the cause of death as multiple system organ failure due to systemic AL. Through microscopic examination, pathologists found amyloid deposits in her heart, kidneys, rectum, thyroid, adrenals, bone marrow, liver, and spleen. Postmortem fat pad biopsy was negative; however, bone marrow biopsy demonstrated clusters of CD138-positive cells, confirming plasma cell dyscrasia. In cases with a negative fat pad biopsy, an additional superficial or involved organ biopsy should be pursued to establish a diagnosis of amyloidosis if strong clinical suspicion exists.

Background: During the course of performing abdominoplasties, a plastic surgeon will encounter a certain body habitus characterized by a thick, tethered, and excessively redundant upper skin flap. Often these patients also demonstrate diffuse and substantial fascial laxity. One approach to this problem involves direct thinning and release of the flap by resection of the sub-Scarpa's fat pad. In theory, this resection should be safe from a flap perfusion standpoint. However, the safety of the sub-Scarpa's resection has not been completely documented.Objectives: The author sought to assess the safety and efficacy of sub-Scarpa's lipectomy in abdominoplasty.Methods: A total 723 patients were retrospectively examined and divided into 2 groups: those with (Group B) and those without (Group A) a sub-Scarpa's lipectomy component to the abdominoplasty. Because of differences in the baseline characteristics between the 2 groups, data analysis was performed with a logistic regression model and with propensity score matching.Results: The sub-Scarpa's lipectomy technique allowed for substantial thinning of the flap: the average weight of the resected fat pad was 411 g. Wide undermining allowed for substantial fascial correction, and excellent results were obtainable even in challenging cases. The sub-Scarpa's lipectomy group did not demonstrate an increase in either minor (<5 cm2) or major (>5 cm2) flap necrosis. However, there was a statistically significant increase in fat necrosis and seroma formation in Group B compared with Group A. In both groups, an increasing body mass index was a risk factor for fat necrosis and major flap necrosis.Conclusions: The implementation of a sub-Scarpa's lipectomy during abdominoplasty is a useful technique to consider for selected abdominoplasty candidates. The risks of minor and major flap loss do not seem to be increased compared to the standard abdominoplasty, but the risks of fat necrosis and seroma formation may be greater.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]