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Aesthetic Surgery Journal. Open Forum 2022Textured breast implants have been used in aesthetic breast surgery to decrease rates of malposition and capsular contracture. Recent concerns regarding breast...
BACKGROUND
Textured breast implants have been used in aesthetic breast surgery to decrease rates of malposition and capsular contracture. Recent concerns regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)'s link to textured devices have prompted many physicians to reevaluate their use.
OBJECTIVES
The authors aimed to create an algorithm for when to use smooth vs micro-textured breast implants and provide their rationale for when micro-textured implants may be more beneficial.
METHODS
In total, 133 patients received primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants and 49 patients received micro-textured implants. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared between groups.
RESULTS
No significant difference in the prevalence of implant-related complications was found (3.57% for smooth devices and 2.04% for micro-textured devices [-value 0.621257; 95% CI -0.06100 to 0.007467]). There were no cases of BIA-ALCL. A comparison of scar malposition rates between the smooth and micro-textured groups also revealed no statistically significant difference (15.4% for smooth devices and 8.16% for micro-textured devices [-value 0.226156; 95% CI -0.1200 to 0.007467]). Patients in the micro-textured group proportionately had more anatomical risk factors for malposition.
CONCLUSIONS
Micro-textured breast implants continue to be a safe and effective choice for patients. Micro-textured implants show a trend toward decreased scar malposition, although not statistically significant. Patients at high risk for malposition with micro-textured breast implants give similar results to patients at average risk for malposition with smooth implants.
PubMed: 35601234
DOI: 10.1093/asjof/ojac020 -
Journal of Vascular Surgery Jan 2013Malposition, embolization, fracture, and migration of endovascular devices are unfortunate consequences of endovascular intervention and will be encountered at some... (Review)
Review
Malposition, embolization, fracture, and migration of endovascular devices are unfortunate consequences of endovascular intervention and will be encountered at some point by nearly every practitioner. The existing literature on foreign body retrieval consists of large single-institution series and case reports. We provide an overview of this recent literature, clarifying what devices are being lost, what symptoms occur as a result, and how retrieval is being performed. We have identified all case series and case reports since the year 2000, summarized the results, and made some general observations and recommendations that may be useful to the practitioner faced with the prospect of retrieving a fractured medical device, malpositioned coil, or migrated inferior vena cava filter.
Topics: Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Device Removal; Endovascular Procedures; Foreign Bodies; Foreign-Body Migration; Humans; Iatrogenic Disease; Prosthesis Failure; Reoperation; Stents
PubMed: 23140798
DOI: 10.1016/j.jvs.2012.09.002 -
Plastic and Reconstructive Surgery.... May 2020Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and...
UNLABELLED
Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and risk factors for implant malposition in this setting.
METHODS
Retrospective review of a single surgeon's prosthetic breast reconstructions was performed. Variables collected included age, BMI, radiation, chemotherapy, implant characteristics and malposition location (inferior or lateral). Binary logistic regression identified risk factors for malposition. Chi-square test assessed malposition rate as a function of implant volume to BMI subgroups.
RESULTS
Of 836 breasts, 82 (9.8%) exhibited implant malposition. Risk factors for any malposition were older age (OR 1.05, 95% CI 1.02-1.07), BMI<25 (OR 1.64, 95% CI 1.00-2.70) and bilateral reconstruction (OR 13.41, 95% CI 8.50-21.16). Risk factors for inferior malposition were older age (OR 1.04, 95% CI 1.01-1.06), BMI<25 (OR 3.43, 95% CI 1.88-6.26) and bilateral reconstructions (OR 11.50, 95% CI 6.79-19.49), while risk factors for lateral malposition were only older age (OR 1.05, 95% CI 1.02-1.08) and bilateral reconstructions (OR 7.08, 95% CI 4.09-12.26). Post-mastectomy radiation was protective against lateral malposition (OR 0.30, 95% CI 0.10-0.88). Stratification by implant volume and BMI demonstrated patient subgroups with distinct patterns of malposition (incidence 0.0% versus 10.9%, = 0.001).
CONCLUSIONS
This is the first study to identify risk factors for implant malposition after prosthetic breast reconstruction. Different risk factors contributed to malposition in different directions. The effect of implant size on malposition was mediated through BMI, highlighting the interplay of implant and patient characteristics with respect to malposition.
PubMed: 33133885
DOI: 10.1097/GOX.0000000000002752 -
Seminars in Plastic Surgery May 2019Eyelid malposition is a challenging problem faced by surgeons. Given the delicate nature of the eyelid and its complex anatomy, eyelid repair requires both a... (Review)
Review
Eyelid malposition is a challenging problem faced by surgeons. Given the delicate nature of the eyelid and its complex anatomy, eyelid repair requires both a comprehensive understanding of eyelid anatomy along with thorough presurgical planning and surgical execution. A wide range of options is available for eyelid reconstruction but the location and extent of the deformity often dictate the type of repair. This article is a review of commonly encountered forms of eyelid malposition. Relevant reconstructive techniques and current evidence-based methods of reconstruction are discussed in detail. Anatomical considerations, the nature of specific defects, pearls of preoperative evaluation, and the reconstructive options available to the facial plastic and oculoplastic surgeon are outlined. Topics discussed include ectropion, entropion, eyelid retraction, and blepharoptosis.
PubMed: 31037045
DOI: 10.1055/s-0039-1685473 -
Revista Brasileira de Medicina Do... 2019Musculoskeletal complaints of the arm, neck and/or shoulder not attributed to acute trauma or any systemic disorder (CANS) are characterized by symptoms such as pain,...
BACKGROUND
Musculoskeletal complaints of the arm, neck and/or shoulder not attributed to acute trauma or any systemic disorder (CANS) are characterized by symptoms such as pain, numbness and paresthesia which may reach severe and disabling levels and thus significantly interfere with the performance of work and daily living activities. Computer use at work considerably increased in recent years, being attended with a substantial elevation of the prevalence of CANS among individuals who use computers at work.
OBJECTIVE
To investigate biomechanical and psychosocial risk factors, scapular static imbalance and functional impact on work and daily living activities of upper limb complaints among workers who use computers.
METHODS
We analyzed ergonomic and psychosocial risk factors by means of MUEQ-Br, scapular static malposition with the SICK-scapula protocol, and functional impairment in work and daily living activities with DASH. The sample comprised 109 employees of a private institution who use computers at work.
RESULTS
The average scores on body posture and control over tasks were significantly higher among the symptomatic participants. Scapular malposition did not differ between the symptomatic and asymptomatic participants, but functional impairment did.
CONCLUSION
Awkward posture at work and poor control over tasks seem to contribute to the occurrence of CANS among office workers who use computers. Scapular malposition is not systematically present among individuals with CANS, but the opposite is true. Individuals with CANS exhibited functional impairments.
PubMed: 32685744
DOI: 10.5327/Z1679443520190329 -
Frontiers in Medicine 2022Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine... (Review)
Review
Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.
PubMed: 36590949
DOI: 10.3389/fmed.2022.1071254 -
Journal of Cranio-maxillo-facial... Sep 2021The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included...
The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included patients who underwent orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type, surgery and implant-related variables, and postoperative implant position were analyzed. The overall revision surgery rate was 6.5% (15 of 232 surgeries). The rate was highest in combined midfacial fractures with rim involvement (14.0%), lower in zygomatico-orbital fractures (8.7%), and lowest in isolated blowout fractures (3.8%). Fracture type, orbital rim fixation and implant malposition predicted revision. The best positioning was achieved with patient-specific milled titanium implants (mtPSI) and resorbable materials, whereas the poorest with preformed three-dimensional titanium plates. Combined midfacial fractures with rim involvement in particular have a high risk for orbital revision surgery. Within the limitations of the present study, mtPSIs should be preferred in the reconstruction of primary orbital fractures if possible.
Topics: Dental Implants; Humans; Orbital Fractures; Orbital Implants; Plastic Surgery Procedures; Reoperation; Retrospective Studies
PubMed: 33985870
DOI: 10.1016/j.jcms.2021.04.008 -
Frontiers in Cardiovascular Medicine 2022This study was to assess the mid-term results of the one-and-a-half ventricular repair (hemi-Mustard and bidirectional Glenn procedures combined with the Rastelli...
OBJECTIVES
This study was to assess the mid-term results of the one-and-a-half ventricular repair (hemi-Mustard and bidirectional Glenn procedures combined with the Rastelli procedure) and Fontan pathway for correcting congenitally corrected transposition of great artery (ccTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malposition.
METHODS
In this retrospective study, 74 consecutive ccTGA with LVOTO and cardiac malposition underwent the one-and-a-half ventricular repair (group A; 33 cases) and Fontan operation (group B; 41 cases) between October 2011 and March 2018. The Median follow-up time was 49 (20-84) and 42 (7-85) months in groups A and B, respectively. To estimate excise tolerance the 6-min walk test (MWT) was performed.
RESULTS
No in-hospital death. Compared with group A, group B have significantly less CPB, mechanical ventilation time, and intensive care unit stay, but prolonged pleural effusions developed more frequently in Group B. The survival probability was 90.2% (95% CI, 80.2-100%) and 97.2% (95% CI, 92-100%) at 7 years ( = 0.300) in group A and B. The probability of freedom from re-intervention were 80.6% (95% CI, 66.5-97.6%) and 97.2% (95% CI, 92-100%) at 7 years ( = 0.110). Longitudinal repeated measured echo data at every follow-up time shows that group A has more systemic ventricular EF% ( < 0.001) and less moderate systemic ventricular valve regurgitation ( < 0.001) compared with group B. Estimated by 6 MWT, group A has better outcomes for 6-min walk distance.
CONCLUSIONS
For correction of ccTGA with LVOTO and cardiac malposition, the one-and-a-half ventricular repair had superior midterm heart function and excise tolerance.
PubMed: 36324751
DOI: 10.3389/fcvm.2022.938118 -
Respiratory Care Sep 2018Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT...
BACKGROUND
Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines.
METHODS
In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as ± 0.25, ± 0.50, or ± 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or >6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and ≥1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence ( < .05, significant).
RESULTS
We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 < 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence ( = .54).
CONCLUSIONS
In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Topics: Chi-Square Distribution; Child; Child, Preschool; Female; Guideline Adherence; Humans; Incidence; Infant; Intubation, Intratracheal; Male; Medical Errors; Radiography; Random Allocation; Trachea
PubMed: 30018176
DOI: 10.4187/respcare.06024