Rosenmunkholm0952

Outpatient hand surgery is often performed in the operating room, which can result in prolonged waiting times for patients when operating room resources are limited. Few studies have explored the application of ultrasound-guided nerve blocks in the setting of outpatient hand surgery. Fifty patients were enrolled in this prospective study. Ultrasound-guided peripheral nerve blocks were performed at the level of the elbow and proximal forearm for outpatient hand surgeries. A timer was used to record the time to administer the block and time to affect. A post-procedure survey was administered, which included a numerical analogue scale (0-10) and Likert rating scale questions to characterize the patients' pain experience for receiving the block and pain during the procedure pain experienced by patients receiving the ultrasound-guided nerve block(s) (0-10), mean 1.84; pain experienced by patients during a procedure (0-10), mean 0.56; surgeon satisfaction during the procedure (0-10), mean 9.78. Average time to perform the ultrasound-guided nerve block(s) was 4 minutes 58 seconds; average time from completion of the block to effect reported by patients, 5 minutes 42 seconds; the average time for performing the procedure, 21 minutes 30 seconds. Our study shows that the use of ultrasound to block peripheral nerves of the forearm is effective; less then 10% of patients required additional local anesthetic. The technique is safe; no complications were reported. The technique is efficient in an outpatient hand surgery setting.Pyoderma gangrenosum (PG) is a rare and painful inflammatory skin disorder that has been recently associated with breast surgery. It is commonly mistaken for postoperative ischemia or wound infection and does not show response to antibiotics or debridement. We describe the first case of post-surgical PG (PSPG) after alloplastic breast reconstruction involving fat grafting. A 47-year-old woman underwent bilateral mastectomy and 2-stage alloplastic breast reconstruction, with fat grafting from the abdomen. Two days post-surgery, she developed bilateral erythema with tender grouped pustules that progressed rapidly into necrotic ulcerations. She did not respond to antibiotics and serial debridement. Subsequent biopsy confirmed a diagnosis of PG. She was started on steroid therapy and responded well. She was discharged on a steroid regimen, local wound care, and eventually a T-cell inhibitor. Over the next 12 months, her wounds healed without surgical intervention. PSPG has been observed in a variety of reconstructive breast surgeries, but never reported in the setting of fat grafting. As PG involves subcutaneous fat, fat grafting may accelerate and exacerbate the course of disease. Treatment for PSPG includes systemic steroid therapy or other immunomodulatory agents (or both). Surgical management remains controversial, as serial debridement and reconstruction have shown to exacerbate and stimulate disease progression. https://www.selleckchem.com/products/cfi-400945.html A long-term follow-up is recommended to monitor for wound healing. Delayed diagnosis of PG in breast reconstruction patients can lead to severe morbidity and disfigurement. This is first case of PSPG following fat grafting in the literature.Latissimus dorsi (LD) flaps are widely used in breast reconstruction for their ease of use and minimal sacrifice of the donor site. Various strategies to increase flap volume have been suggested, but tissue volume is often insufficient for patients with little subcutaneous fat. While lumbar artery perforator (LAP) flaps are advantageous for thin patients because they allow for the addition of a large amount of fat, the vascular pedicle is short and vascular grafts are often required. To address these shortcomings, we propose here a LD-LAP chimeric flap. Specifically, the LD flap and LAP flap are elevated as one piece, and the 6th or 7th intercostal artery perforators and lumbar artery perforators, which are harvested together with the flap, are connected via intra-flap crossover anastomosis. Anastomosis for both intercostal artery perforators and lumbar artery perforators was performed about 1 cm away from the flap. Indocyanine green angiography performed after anastomosis showed improved blood flow to the LAP flap portion of the chimeric flap. The chimeric flap was used in 4 patients, with a mean flap volume of 460 ml (range, 300-690 ml) and mean duration of 439 minutes (393-484 minutes) for reconstruction surgery. During the mean follow-up period of 29.5 months (range, 16-40 months), sufficient tissue volume was obtained and none of the patients developed flap necrosis. Although our method requires vascular anastomosis and may extend operative time, it substantially increases LD flap volume and thus is likely to be an effective auxiliary component to breast reconstruction using LD flaps.This article describes the use of a lateral pectoralis major muscle flap for preemptive obliteration of axillary defects in breast cancer patients having reconstructive surgery. The muscle flap is based on a consistent lateral branch of the pectoral component of the thoracoacromial system. The flap is useful to improve axillary contour after sentinel lymph node biopsy or axillary lymph node dissection, and to cover lymphovenous anastomoses.CT angiography (CTA) is an established technique that allows preoperative planning in DIEP flap reconstruction. However, innovative technological developments with extensive amounts of information require processing of data. It also requires user knowledge to interpret findings. Descriptions by radiologists are many times disappointingly limited to caliber and exit points of the perforator from the rectus fascia. Many DIEP flap surgeons similarly fail to utilize the CTA to its full extent. This is likely due to information overload. By tracing the DIEA on the CTA on a computer screen, using an ordinary ballpoint pen and a white sheet of paper, the surgeon can create a stylistic map of the dissectional-path of the DIEA. The map illustrates unusual branching patterns, perforator caliber and location, interconnections between individual perforators (or lack thereof), length of intramuscular dissection, and also rectus abdominis muscle intersections. The mapping can help in the choice of perforator(s) and may also speed up decision-making during surgical dissection.