Mcqueentang4933

Managing cavity wounds that cannot be cleaned using standard irrigating solution is challenging. An immunocompromised patient with a horseshoe perianal abscess was selected to represent a heavy infection in cavity wounds. Diluted povidone-iodine was initially used to lavage the wounds, but the fever persisted and the irrigation was painful. Hypochlorous acid was then used to irrigate the wound. One day after administration of the hypochlorous acid, the fever began to subside, suggesting that this solution was able to adequately destroy the infecting microorganisms. The patient rated his pain during this procedure as 2/10. The infection had cleared within 2 weeks, and a swab culture found no microbial growth. The wound volume was reduced by more than 90% after 5 weeks, and final wound closure was achieved after 6 weeks. By comparison, another patient with a horseshoe perianal abscess who underwent traditional irrigation with diluted povidone-iodine and wet-to-dry dressing faced similar problems, but the fever in this case did not subside, and the wound became more complicated. He complained of pain during the irrigation with diluted povidone-iodine, giving the procedure a pain score of 10/10. Wound care was also difficult due to fecal contamination. As a result, the patient had to undergo colostomy to divert feces to the abdomen, thus preventing it from contaminating the wound. Time to final wound closure was 10 weeks. These cases illustrate the effectiveness of hypochlorous acid in dealing with infection in wound cavities. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.The patient is a 31-year-old woman with a history of prior resection of a presumed keloid scar around her Pfannenstiel incision found to be endometrial tissue on final pathology. check details She presented 5 years later with recurrence of pain and a mass associated with menses despite maximal medical therapy for endometriosis. Computed tomography of her abdomen and pelvis demonstrated an infiltrative soft tissue mass measuring 8.8 cm × 4.0 cm. Surgical oncology conducted an en bloc resection of the mass and obstetrics and gynecology performed a concomitant total abdominal hysterectomy and bilateral salpingo-oophorectomy. Plastic and reconstructive surgery completed the repair of the final 23 cm × 10 cm full-thickness abdominal wall defect with bridging biologic mesh, complex layered closure, and incisional negative-pressure wound therapy. Final pathology confirmed a diagnosis of endometriosis. Patient's hospital course was uncomplicated, and follow-up at 6 months does not demonstrate clinical or radiographic evidence of bulge or hernia recurrence. Abdominal wall endometrioma is a well-documented occurrence in prior cesarean scars; plastic surgeons can contribute to a multidisciplinary approach in reconstruction when resection compromises abdominal wall integrity, necessitating expertise in complex repairs. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.An 83-year-old Japanese man who had been aware of a tumor near his anus for 2 years underwent tumor resection. Although he was diagnosed with basal cell carcinoma (BCC), extramammary Paget disease (EMPD) was also accidentally found in the same specimen. In the pathological histology of EMPD, there were large round cells with ample cytoplasm spread in the epidermis; these cells were positive for cytokeratin 7 and gross cystic disease fluid protein 15. No signs that are typically associated with EMPD, such as erythema or leukoderma, were observed near the anus. There have been only 4 reports in which BCC and EMPD developed in the same area, and the authors present the fifth case. In the reported case, no clear evidence was found for the corelative development of BCC and EMPD. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.Massive localized lymphedema of the abdomen is a rare condition resulting from a neglected lower abdominal pannus associated with significant disability and morbidity. Compared to other surgical procedures, postbariatric surgery is usually considered a financial drain. In the United Kingdom, this requires National Health Service approval and delays may lead to sequelae that adversely impact on patients' quality of life with increased morbidity. We present a wheelchair-bound patient whose body mass index increased from 53 to 82, while awaiting funding approval increasing her anesthetic and surgical risks. A multidisciplinary approach is mandatory for preoperative, intraoperative, and postoperative care for these patients including anesthetic input and high dependency unit care. Managing this patient was a significant anesthetic and surgical challenge with 47-kg resected tissue. The planning and perioperative measures to minimize morbidity are discussed. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.Nail bed and fingertip injuries are the commonest hand injuries in children and can lead to profound functional and cosmetic impairments if not appropriately managed. Fingertip injuries can present with subungual hematomas, simple or stellate lacerations, crush, or avulsion injuries, often with associated fractures or tip amputations. The fundamentals of managing nail bed injuries concern restoring the form and function of a painless fingertip. However, there are controversies surrounding the optimal management of each of these injuries, which has led to nonuniformity of clinical practice. Methods The PubMed database was searched from March 2001 to March 2019, using a combination of MeSH terms and keywords. Studies evaluating children ( less then 18 years of age) and the fingertip (defined as distal to the distal interphalangeal joint) were included following screening by the authors. Results and Conclusion The evidence base for the diverse clinical management strategies currently employed for fingertip injuries in the pediatric population is limited.