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Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle.
A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis.
Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]4.2; range[r]16-48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD4.0; r7.5-27). The mean resection weight was 699.6 g (SD310.4; r125-2,385). The median follow-up was 3.9 months (interquartile range[IQR]2.8-9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]1.05, 95%-CI 0.88-1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR1.003, 95%-CI 1.001-1.005), adjusting for N-IMF and SNN distances.
Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.
15 cm. However, large resections could increase the risk of necrosis.Primary mandibular reconstruction after tumor removal or osteoradionecrosis treatment is a standard procedure. The most common reconstruction techniques are fibula, scapula, and iliac crest free flaps. Nevertheless, all patients are not eligible for microsurgery. In this study, we assess 12 years of mandibular reconstruction using an osteo-muscular dorsal scapular pedicled flap (OMDS). We included 40 patients operated on using an OMDS flap. We collected parameters such as length of hospital stay, recurrence risk, and need for secondary flap for oral cutaneous fistula (OCF) treatment. Flap bone volume was assessed by segmenting the scapula on postoperative CT-scans using dedicated software. Forty patients were included. Indications for OMDS flaps were severe cardiovascular history (27%), preoperative radiotherapy with a radiation neck and potentially unreliable blood vessel sutures (20%), previous fibula free flap failure (15%), and patient refusing free tissue transfer (8%). Aside from these medical indications, OMDS flaps were performed in 30% of cases due to organizational concerns. The mean flap length was 73±16 mm, with a maximum of 109 mm. Flap bone volume was stable over time, with negligible resorption (p = 0.761). Secondary pedicled flaps were used to treat OCF in 5 patients (12%). Secondary esthetic procedures were performed in 9 patients (22%). None of the 40 flaps were removed. Selleck Ivacaftor None of the patients had long-term scarring complications in donor sites. OMDS flaps merit consideration for mandibular reconstruction when free tissue transfer is contraindicated or impossible due to organizational issues.
Patient-based real-time quality control (PBRTQC) has gained attention because of its potential to detect analytical errors in situations wherein internal quality control is less effective. Multiple PBRTQC algorithms have been proposed. However, there is a lack of comprehensive comparison of the performance of PBRTQC algorithms on different types of analytical errors. Thus, a comparative study was conducted.
The performance of six different PBRTQC algorithms was evaluated on three types of analytical errors using 906,552 test results for outpatient serum sodium, chloride, alanine aminotransferase, and creatinine at the Department of Laboratory Medicine at Zhongshan Hospital, Fudan University in 2019. The performance results were compared and assessed.
The moving average, moving median, exponentially weighted moving average, and moving quartiles performed similarly for effectively detecting constant errors (CE) and proportional errors (PE) but not random errors (RE). The moving sum of positive patients and moving standard deviation could detect RE for serum sodium and chlorides but performed poorly on detecting the CE and PE.
This study demonstrated the importance of assessing the potential source of error of a particular analyte and the corresponding type of analytical error before choosing a quality control algorithm for implementation.
This study demonstrated the importance of assessing the potential source of error of a particular analyte and the corresponding type of analytical error before choosing a quality control algorithm for implementation.
On agarose gel electrophoresis, IgA paraprotein has a tendency to polymerise and form multiple bands on immunofixation. We decided to investigate if there are any differences in clinical parameters with monomeric vs. polymeric IgA paraprotein multiple myeloma (MM) patients.
During an 18-month retrospective and prospective cross-sectional audit review period at one Australian laboratory, we identified 92 IgA MM patients that were divided up according to monomeric or polymeric IgA paraproteins based on their appearance on IFE. Medical and pathology records were reviewed for demographic details, and laboratory data to examine for end-organ manifestations of MM.
After correcting for age, polymeric IgA MM patients had a greater degree of proteinuria and hence, higher incidence of hypogammaglobulinaemia. The patients tended to have a higher quantity of paraprotein as well. No difference in mortality was seen.
Our study is the first to stratify IgA MM patients according to the laboratory appearance of their paraprotein and may hold important prognostic and predictive clues for these patients.
