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Annals of Surgery Open : Perspectives... Jun 2024The aim of this observational study was to analyze trends in the incidence, mortality, and disability-adjusted life years (DALYs) of benign gallbladder and biliary...
OBJECTIVE
The aim of this observational study was to analyze trends in the incidence, mortality, and disability-adjusted life years (DALYs) of benign gallbladder and biliary diseases across high-income countries between 1990 and 2019.
BACKGROUND
Benign gallbladder and biliary diseases place a substantial burden on healthcare systems in high-income countries. Accurate characterization of the disease burden may help optimize healthcare policy and resource distribution.
MATERIALS AND METHODS
Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and DALYs data for gallbladder and biliary diseases in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. A mortality-incidence index (MII) was also calculated. Joinpoint regression analysis was performed.
RESULTS
The median ASIRs across the European Union 15+ countries in 2019 were 758/100,000 for females and 282/100,000 for males. Between 1990 and 2019 the median percentage change in ASIR was +2.49% for females and +1.07% for males. The median ASMRs in 2019 were 1.22/100,000 for females and 1.49/100,000 for males with a median percentage change over the observation period of -21.93% and -23.01%, respectively. In 2019, the median DALYs was 65/100,000 for females and 37/100,000 among males, with comparable percentage decreases over the observation period of -21.27% and -19.23%, respectively.
CONCLUSIONS
International variation in lifestyle factors, diagnostic and management strategies likely account for national and sex disparities. This study highlights the importance of ongoing clinical efforts to optimize treatment pathways for gallbladder and biliary diseases, particularly in the provision of emergency surgical services and efforts to address population risk factors.
PubMed: 38911626
DOI: 10.1097/AS9.0000000000000453 -
Annals of Surgery Open : Perspectives... Jun 2024
PubMed: 38911618
DOI: 10.1097/AS9.0000000000000449 -
Plastic and Reconstructive Surgery.... Jun 2024Lymphedema following oncologic intervention can cause significant lifelong morbidity for patients in whom conservative management fails. The associated swelling,...
Lymphedema following oncologic intervention can cause significant lifelong morbidity for patients in whom conservative management fails. The associated swelling, discomfort, pain, and recurrent cellulitis greatly diminish quality of life. Surgical procedures, including suction-assisted lipectomy, lymphovenous anastomosis (LVA), and vascularized lymph node transfers, show effectiveness in both volume reduction in affected extremities and symptom relief. However, the success of procedures like LVA is dependent on effective preoperative lymphatic mapping to identify suitable vessels for anastomosis. Traditional superficial lymphatic mapping uses near infrared fluorescence indocyanine green (ICG) imaging. Moreover, recent advances in contrast-enhanced ultrasound (CEUS) lymphography increased lymphovenous bypass target identification for LVA in the extremities. CEUS lymphography uses microbubbles as a contrast-enhancing agent injected intradermally into the affected extremity with subsequent identification of superficial collecting lymphatic vessels using ultrasound. Although a recent report noted an uptick in severe and critical adverse drug reactions to an ultrasound contrast agent injected intravenously in stress echocardiography, adverse drug reactions associated with ultrasound contrast-enhancing agents in body ultrasound are rare. The safety profile and potential complications from CEUS lymphography in the lymphedema population have yet to be fully characterized. In this case report, the authors present the first cutaneous adverse drug event following a secondary exposure to the contrast used for CEUS imaging. Mechanisms and justifications for an immune-mediated process are explored, and a review of similar manifestations in other related contrast applications is discussed.
PubMed: 38911583
DOI: 10.1097/GOX.0000000000005908 -
Plastic and Reconstructive Surgery.... Jun 2024In this systematic review, we assessed the therapeutic efficacy and safety of collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from...
BACKGROUND
In this systematic review, we assessed the therapeutic efficacy and safety of collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from subtle to pronounced lesions.
METHODS
A systematic review was performed following PRISMA guidelines for CCH and TS treatment to the thigh and gluteal regions. A proportion meta-analysis was then conducted using Stata statistical software.
RESULTS
A total of 14 studies were incorporated into the final analysis. Nine focused on TS and five on CCH injection, collectively reporting outcomes for 1254 patients. Of these, 465 received CCH injection and 789 underwent subcision. For bruising, rates were 89% [95% confidence interval (CI), 71%-96%] with CCH injection and 99% (95% CI, 85%-99%) for subcision; pain requiring analgesic was reported at 74% (95% CI, 55%-87%) for CCH and 60% (95% CI, 43%-76%) for subcision; both showed induration at 7% (95% CI, 5%-11% for CCH, 95% CI, 2%-25% for subcision), whereas skin discoloration was higher post-CCH injection at 16% (95% CI, 10%-26%) compared with 7% (95% CI, 5%-10%) postsubcision.
CONCLUSIONS
Both CCH and TS seem effective treatments for cellulite. However, upon evaluating the adverse outcomes between the two modalities, subcision demonstrated a higher incidence of bruising, albeit similar rates of induration compared with CCH injection. Conversely, the CCH injection group manifested a higher propensity for pain requiring analgesia and notably exhibited increased instances of skin discoloration compared with their subcision patient group. Further standardized research is crucial for more informed cellulite treatment decisions and for comparing efficacy, safety, and cost-effectiveness between TS and CCH.
PubMed: 38911581
DOI: 10.1097/GOX.0000000000005857 -
Plastic and Reconstructive Surgery.... Jun 2024The gold standard for implant-based breast reconstruction uses acellular dermal matrices (ADMs). They provide improved inferolateral pole coverage, reduced capsular...
BACKGROUND
The gold standard for implant-based breast reconstruction uses acellular dermal matrices (ADMs). They provide improved inferolateral pole coverage, reduced capsular contracture rates, and increased primary expander fill volumes. However, ADMs are costly and have been associated with increased rates of postoperative infection, seroma, hematoma, implant malposition, and mastectomy flap necrosis (MFN). This study describes a novel autologous flap without the need of ADM, the serratus anterior external oblique rectus abdominis (SAEORA) flap, as an alternative in prosthetic-based breast reconstruction.
METHODS
A retrospective study was conducted on all patients who underwent SAEORA flap breast reconstruction by a single surgeon between January 1, 2013 and May 31, 2020 at a single institution. Patient demographics, diagnosis, treatment, tissue expander (TE) volume, implant size, complications, and results were assessed.
RESULTS
Forty-seven patients underwent 78 SAEORA flaps. Sixty-two had TEs placed, and 14 were direct-to-implant. Mean body mass index was 23.1 kg per m². Median primary TE fill volume was 150 mL, and final implant volume average was 450 mL. Mean follow-up was 14.5 months. Complications included infection/cellulitis (7.9%), seroma (6.6%), hematoma (5.2%), and MFN (7.9%).
CONCLUSIONS
The SAEORA flap is a novel autologous flap and is a viable option for prosthetic-based breast reconstruction, with an acceptable complication profile relative to ADM-based reconstructions. Additionally, SAEORA is MFN-resistant and has been used effectively in salvage of exposed implants or ADM, and in double-bubble deformity correction.
PubMed: 38911580
DOI: 10.1097/GOX.0000000000005852 -
Plastic and Reconstructive Surgery.... Jun 2024Secondary lymphedema (SL) affects 120 million people globally, posing a lifelong burden for up to 37% of cancer survivors. Chronic inflammation and progressive fibrosis...
BACKGROUND
Secondary lymphedema (SL) affects 120 million people globally, posing a lifelong burden for up to 37% of cancer survivors. Chronic inflammation and progressive fibrosis are key drivers of SL, yet detailed characterization of immune cell subpopulations across lymphedema stages is lacking. This study aimed to investigate the immunologic profile of lymphedematous skin and its association with extracellular matrix changes, which could serve as clinical biomarkers or therapeutic targets.
METHODS
This case-control study analyzed the skin from 36 patients with and without SL, using immunofluorescence to quantify T cells, B cells, macrophages, and their subpopulations. Collagen quantity and composition were examined using picrosirius red staining, and mast cell infiltration was assessed with toluidine blue staining. Early and late SL stages were compared to identify histomorphological and immunologic correlates of stage progression.
RESULTS
We found a predominance of CD4+ T cells and mast cells in SL skin (1.4/mm² versus 1.0/mm², < 0.01; 1.2/mm² versus 0.2/mm², < 0.0001) and a higher ratio of collagen III to collagen I fibers (51.6% versus 75.0%, < 0.001). M2 macrophages were more abundant in late-stage than in early-stage lymphedema (1.7/mm² versus 1.0/mm², = 0.02).
CONCLUSIONS
This study demonstrated a shift toward CD4+ T cell and mast cell infiltration in SL skin, correlating with extracellular matrix disorganization and an altered collagen III/I ratio. These findings enhance our understanding of the cellular and morphological changes in SL, potentially guiding future diagnostic and therapeutic strategies.
PubMed: 38911579
DOI: 10.1097/GOX.0000000000005906 -
Plastic and Reconstructive Surgery.... Jun 2024Topical nitrates have demonstrated efficacy in improving flap perfusion. However, evidence for nontopical nitrates in modulation of flap perfusion dynamics has yet to be...
BACKGROUND
Topical nitrates have demonstrated efficacy in improving flap perfusion. However, evidence for nontopical nitrates in modulation of flap perfusion dynamics has yet to be consolidated. Here, we review evidence regarding the use of intravascular, sublingual, and oral nitrates in modulating flap perfusion.
METHODS
We performed a review of the literature for evidence linking nontopical nitrates and flap perfusion, and included clinical studies, animal studies, and in vitro studies.
RESULTS
Evidence suggests that intravascular, sublingual, and oral nitrates exert vasodilatory properties, which may be harnessed for identification of perforators and improved flap perfusion. We also found evidence suggesting nitrates may facilitate ischemic preconditioning while reducing ischemia-reperfusion injury.
CONCLUSIONS
Nitrates delivered intravascularly, sublingually, or orally may increase flap perfusion and serve as a method for ischemic preconditioning, particularly in the intraoperative setting.
PubMed: 38911578
DOI: 10.1097/GOX.0000000000005918 -
Plastic and Reconstructive Surgery.... Jun 2024Within the last few years, artificial intelligence (AI) chatbots have sparked fascination for their potential as an educational tool. Although it has been documented...
BACKGROUND
Within the last few years, artificial intelligence (AI) chatbots have sparked fascination for their potential as an educational tool. Although it has been documented that one such chatbot, ChatGPT, is capable of performing at a moderate level on plastic surgery examinations and has the capacity to become a beneficial educational tool, the potential of other chatbots remains unexplored.
METHODS
To investigate the efficacy of AI chatbots in plastic surgery education, performance on the 2019-2023 Plastic Surgery In-service Training Examination (PSITE) was compared among seven popular AI platforms: ChatGPT-3.5, ChatGPT-4.0, Google Bard, Google PaLM, Microsoft Bing AI, Claude, and My AI by Snapchat. Answers were evaluated for accuracy and incorrect responses were characterized by question category and error type.
RESULTS
ChatGPT-4.0 outperformed the other platforms, reaching accuracy rates up to 79%. On the 2023 PSITE, ChatGPT-4.0 ranked in the 95th percentile of first-year residents; however, relative performance worsened when compared with upper-level residents, with the platform ranking in the 12th percentile of sixth-year residents. The performance among other chatbots was comparable, with their average PSITE score (2019-2023) ranging from 48.6% to 57.0%.
CONCLUSIONS
Results of our study indicate that ChatGPT-4.0 has potential as an educational tool in the field of plastic surgery; however, given their poor performance on the PSITE, the use of other chatbots should be cautioned against at this time. To our knowledge, this is the first article comparing the performance of multiple AI chatbots within the realm of plastic surgery education.
PubMed: 38911577
DOI: 10.1097/GOX.0000000000005929 -
Plastic and Reconstructive Surgery.... Jun 2024This article introduces a reproducible strategy for complex reconstruction scenarios that require the use of two flaps. It specifically focuses on the utilization of the...
This article introduces a reproducible strategy for complex reconstruction scenarios that require the use of two flaps. It specifically focuses on the utilization of the superficial circumflex iliac artery perforator (SCIP) flap as a secondary flap, particularly in complex cases where available arterial options are limited. In the first scenario, the SCIP flap is elevated simultaneously during elevation of a fibula bone flap. The pedicle of the fibula flap will be anastomosed to the recipient vessels, and the pedicle artery of the SCIP flap, the superficial circumflex iliac artery, will be anastomosed to the distal end of the peroneal artery. The SCIP flap pedicle offers greater length compared with a cutaneous flap sourced from the peroneal artery, thus providing increased flexibility for the flap inset. In the second scenario, the SCIP flap is combined with the anterolateral thigh (ALT) flap to manage a significant defect. The pedicle of the ALT flap is anastomosed to the recipient vessels, and the superficial circumflex iliac artery is anastomosed to the distal end of the pedicle artery of the ALT flap, the descending branch of the lateral circumflex femoral artery. The SCIP flap can be harvested simultaneously with a fibula flap or an ALT flap from the same side, and its arterial anastomosis can always be established with the distal ends of the arterial pedicle of these two flaps. This efficient and reproducible method can also contribute to minimal donor site morbidity and will be particularly valuable in settings where recipient artery choices are limited.
PubMed: 38911576
DOI: 10.1097/GOX.0000000000005899 -
Plastic and Reconstructive Surgery.... Jun 2024The aim of this study was to compare the use of pedicled local (PFs) versus random pattern flaps (RpFs) in foot and ankle reconstruction in patients with chronic,...
BACKGROUND
The aim of this study was to compare the use of pedicled local (PFs) versus random pattern flaps (RpFs) in foot and ankle reconstruction in patients with chronic, nonhealing wounds.
METHODS
A single-center, retrospective review of 204 patients with 118 PFs and 86 RpFs was performed. The primary outcome included rates of limb salvage.
RESULTS
PFs were used more often in the hindfoot (44.1% versus 30.2%, = 0.045), lateral and medial surface (39.8% versus 18.6%, = 0.001), and wounds containing exposed bone and hardware (78.8% versus 62.8%, = 0.018). RpFs were used more for forefoot (19.8% versus 10.2%, = 0.053) and plantar defects (58.1% versus 30.3%, = 0.000). RpFs had a higher rate of immediate success (100% versus 95.8%, = 0.053), with no significant differences in rate of long-term limb salvage (77.1% versus 69.8%, = 0.237). PFs had higher rates of ischemia requiring intervention (11.0% versus 3.5%, = 0.048). RpFs had a higher rate of minor amputations (15.12% versus 6.8%, = 0.053) but similar rates of major amputation (15.1% versus 16.1%, = 0.848). There were no significant differences in rates of mortality or ambulatory status.
CONCLUSIONS
Both RpFs and PFs remain reliable options to reconstruct defects of the foot and ankle. Optimizing the use of each flap type should consider wound characteristics. RpFs are preferred for dorsal and plantar defects, whereas PFs are protective for minor infections and preferred for deeper wounds despite a higher rate of partial necrosis.
PubMed: 38911575
DOI: 10.1097/GOX.0000000000005921