Argon–Helium Cryoablation for Cutaneous Squamous Cell Carcinoma in the Elderly

Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant neoplasm in non-melanoma skin cancer (NMSC). Most cases of simple cSCC are considered curable by surgical removal of the lesion. However, clinical treatments for cSCC with medium- or large-sized lesions are difficult. Meanwhile, the effectiveness of the treatments is not guaranteed, especially for elderly patients, because of an intolerance to surgical resection or other adjuvant modalities. In such cases, safe and effective treatments with excellent aesthetic outcomes are urgently needed. In this study, we reported 6 elderly cSCC patients with medium- or large-sized lesions treated with argon–helium cryoablation. The average age of all 6 patients was 78 years (range 72–85 years). They were all diagnosed with cSCC with a median tumor size of 5.8 cm (range 2.5–15.5 cm) and dermal invasion. Complete ablation was achieved in all cases after a single ablation session (2 freeze–thaw cycles). Patients experienced mild pain and hemorrhage after ablation, but the symptoms were manageable. One patient developed infection and fever because of extensive necrosis of the tumor, which was eventually cured after treatment. All patients obtained good cosmetic outcomes, and their quality of life improved significantly. In the 5-year follow-up study, 4 patients were alive while 2 patients died of unrelated diseases 3 years after cryotherapy. None of the 6 patients had a recurrence. These results suggested the feasibility of argon–helium cryoablation as a novel therapeutic strategy for elderly cSCC with medium- or large-sized lesions.

Lateral versus posterior surgical approach for the treatment of supracondylar humeral fractures in children: a systematic review and meta-analysis

Background: Supracondylar humeral fracture (SHF) is the most common type of fracture in children. Moreover, lateral and posterior surgical approaches are the most frequently chosen approaches for open reduction surgery in displaced SHF when C-arm is unavailable. However, previous literature showed mixed findings regarding functional and cosmetic outcomes. Currently, no systematic review and meta-analysis has compared these two procedures. Methods: Our protocol was registered at PROSPERO (registration number CRD42021213763). We conducted a comprehensive electronic database search in MEDLINE, EMBASE, and CENTRAL. Two independent reviewers screened the title and abstract, followed by full-text reading and study selection based on eligibility criteria. The quality of the selected studies was analyzed with the ROBINS-I tool. Meta-analysis was carried out to compare the range of motion (functional outcome) and cosmetic outcome according to Flynn’s criteria. This systematic review was conducted based on PRISMA and Cochrane handbook guidelines. Results: Our initial search yielded 163 studies, from which we included five comparative studies comprising 231 children in the qualitative and quantitative analysis. The lateral approach was more likely to result in excellent (OR 1.69, 95% CI [0.97-2.93]) and good (OR 1.12, 95% CI [0.61-2.04]) functional outcomes and less likely to result in fair (OR 0.84, 95% CI [0.34-2.13]) and poor (OR 0.42, 95% CI [0.1-1.73]) functional outcomes compared to the posterior approach. In terms of cosmetic results, both approaches showed mixed findings. The lateral approach was more likely to result in excellent (OR 1.11, 95% CI [0.61-2.02]) and fair (OR 1.18, 95% CI [0.49-2.80]) but less likely to result in good (OR 0.79, 95% CI [0.40-1.55]) cosmetic outcomes. However, none of these analyses were statistically significant (p> 0.05). Conclusion: Lateral and posterior surgical approaches resulted in satisfactory functional and cosmetic outcomes. The two approaches are comparable for treating SHF in children when evaluated with Flynn’s criteria.

Trapezius fasciocutaneous flap for burn reconstruction

This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.

Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery

BackgroundEndoscopic thyroidectomy and robotic thyroidectomy are effective and safe surgical options for thyroid surgery, with excellent cosmetic outcomes. However, in regard to lateral neck dissection (LND), much effort is required to alleviate cervical disfigurement derived from a long incision. Technologic innovations have allowed for endoscopic LND, without the need for extended cervical incisions and providing access to remote sites, including axillary, chest–breast, face-lift, transoral, and hybrid approaches.MethodsA comprehensive review of published literature was performed using the search terms “lateral neck dissection”, “thyroid”, and “endoscopy OR endoscopic OR endoscope OR robotic” in PubMed.ResultsThis review provides an overview of the current knowledge regarding endoscopic LND, and it specifically addresses the following points: 1) the surgical procedure, 2) the indications and contraindications, 3) the complications and surgical outcomes, and 4) the technical advantages and limitations. Robotic LND, totally endoscopic LND, and endoscope-assisted LND are separately discussed.ConclusionsEndoscopic LND is a feasible and safe technique in terms of complete resection of the selected neck levels, complications, and cosmetic outcomes. However, it is recommended to strictly select criteria when expanding the population of eligible patients. A formal indication for endoscopic LND has not yet been established. Thus, a well-designed, multicenter study with a large cohort is necessary to confirm the feasibility, long-term outcomes, oncological safety, and influence of endoscopic LND on patient quality of life (QoL).

Current trends in orthognathic surgery

Orthognathic surgery has steadily evolved, gradually expanding its scope of application beyond its original purpose of simply correcting malocclusion and the facial profile. For instance, it is now used to treat obstructive sleep apnea and to achieve purely cosmetic outcomes. Recent developments in three-dimensional digital technology are being utilized throughout the entire process of orthognathic surgery, from establishing a surgical plan to printing the surgical splint. These processes have made it possible to perform more sophisticated surgery. The goal of this review article is to introduce current trends in the field of orthognathic surgery and controversies that are under active discussion. The role of a plastic surgeon is not limited to performing orthognathic surgery itself, but also encompasses deep involvement throughout the entire process, including the set-up of surgical occlusion and overall surgical planning. The authors summarize various aspects in the field of orthognathic surgery with the hope of providing helpful information both for plastic surgeons and orthodontists who are interested in orthognathic surgery.

A Comprehensive Approach To Alloplastic Cranioplasty: Novel Implant Design And Refinement of Soft Tissue Management

Background: Large scale craniectomy defects are commonly reconstructed with alloplastic implants, which can restore brain protection and promote cosmesis. However, esthetic outcomes can be subpar due to skin contour abnormalities and temporal hollowing. Herein we describe a senior craniofacial surgeon’s experience using a custom composite polyetheretherketone (PEEK) and porous polyethylene (Medpor) implant for alloplastic cranioplasty. Methods: A retrospective review was conducted of all PEEK-Medpor cranioplasty cases performed over the past 2 years. Patient characteristics, intraoperative information, surgical outcomes, and cosmetic outcomes were reviewed. Results: Sixteen patients (18-70 years of age) underwent surgery. Indications for cranioplasty included craniectomy due to trauma, stroke, or tumor, and bone resorption after a prior autologous cranioplasty. Augmentation of the temporalis area using alloderm or a muscle graft was performed in 7 cases. There were no intraoperative complications. Ultimately, all implants were maintained. One implant was temporarily removed due to infection, but successfully replaced. Three minor complications occurred. At an average follow-up of 9 months, 93.8% of surgical sites showed no significant temporal hollow. Conclusion: We describe a series of 16 implants using a composite PEEK Medpor implant for alloplastic cranioplasty, which resulted in a low infection rate and improved postoperative regional contour. Use of this implant with suspension of the temporalis muscle is a new technique that may allow for better adherence of the temporalis muscle to its anatomic position, while still providing good brain protection.

Cutting-edge therapies in the treatment of surgical wounds

Wounds are inherent to being alive and also a reminder of our fragility in the face of the hostilities of this planet. Annually, it is estimated that 4511 operations are performed per 100,000 population, or 1 surgical procedure every year for every 22 people. There is an art to treating wounds. The support by the doctor for wound healing favors the early recovery of this, in addition to minimizing the risk of infection and gives an aesthetically pleasing appearance, the care that is used today ranging from the cleaning of the wound, the approximation of the edges thanks to the sutures, etc. The following is a review of cutting-edge therapies in this area of medicine, such as biotechnologies, growth factors, gene therapy, and stem cells. Projections indicate an increasing decrease in morbidity and mortality associated with surgical wounds and their repair, as well as more favorable cosmetic outcomes for patients. The results showed that all the described techniques, although not perfect, are perfectible, and with the pertinent precautions can be maximized in favor of care. There is the possibility in the near future, to be a basic part of wound care, in terms of protocols of care, but also in the individualization of treatment.

Ocular TASER Probe Injury Managed with Primary Evisceration: Case Report

A 34-year-old male presented to the emergency department with a penetrating injury of the left globe and orbit from a Thomas A Swift’s Electric Rifle (TASER^®) probe. The severity of the globe injury precluded primary closure of the globe; a primary evisceration was performed. In this article, we discuss not only the case in detail but also the TASER^® rifle and the literature to support our decision in performing an evisceration rather than an enucleation, which historically has been taught to decrease the risk of sympathetic ophthalmia (SO) in the fellow eye. We are of the opinion, after reviewing the literature, that SO is not an overwhelming reason to choose enucleation over evisceration and that evisceration has an advantage over enucleation with regard to functional and cosmetic outcomes.