Aesthetico

Finger amputations following complex hand injuries (CHI) pose a significant challenge in hand surgery due to severe tissue trauma and neurovascular damage, necessitating precise arterial repair. While restoring arterial perfusion is critical, it remains unclear whether reconstructing both proper palmar digital arteries is required for optimal outcomes. This study evaluates whether restoring one or both arteries in finger replantation after complex injuries impacts perfusion and overall outcomes. In this retrospective, cross-sectional, follow-up study, we investigated patients with finger amputations following CHI admitted to the high-volume regional hand trauma center between January 2013 and December 2020. Perfusion has been assessed using FLIR thermal imaging and laser speckle contrast analysis. Functional outcomes and quality of life scores were measured using standardized questionnaires. Sensory assessments, along with pain and grip strength measurements were also conducted. A total of 31 patients were included in the study. Thermal imaging showed a significantly higher finger surface temperature in patients with two-artery reconstruction. Laser speckle contrast analysis confirmed better perfusion, though not statistically significant. Functional and quality-of-life scores were similar across groups, except for significantly improved temperature sensation in the two-artery group. In conclusion, reconstructing both arteries in finger replantation following CHI isn’t essential for good outcomes if one artery provides adequate perfusion, but dual reconstruction may improve perfusion and temperature sensation.

Nowadays, short fiber-reinforced composites are broadly used in modern restorative dentistry. The tensile strength, Young's modulus, density, and polymerization shrinkage of these materials are developed to mimic the original teeth tissue best. The shrinkage, however, will occur during any polymerization process, which can cause residual stress and gap formation between the tooth and the filling. These can lead to the propagation of cracks, reduction in the adhesive bond strength, or even cause separation in the restoration. During this research, a biomimetic dental restoration was created on a surgically removed third molar with EverX short-fiber reinforced dental composite by bulk-filling technique. The restored tooth sample was examined by X-ray computed tomography to obtain a 3D image of the whole restoration. The volume of the used adhesive, the material discontinuities, and internal cavities were determined. A cut-out slice was further investigated by scanning electron microscopy to examine the adhesive layer thickness, the gap formation, and the quality of the filling. Finally, microtensile specimens were machined to evaluate the bond strength between the tooth dentin and the filling material.

The paramedian forehead flap is considered the gold standard for nasal reconstruction following oncologic surgery. During the 21‐day delay in two‐stage surgery protocols, many patients report considerably reduced quality of life because of the pedicle. This prospective case series study examined the usefulness of near‐infrared (NIR) fluorescence with indocyanine green (ICG) for flap perfusion assessment and identified variables associated with time to flap perfusion. Ten patients (mean age 75.3 ± 11.6 years) with diagnosis of basal cell carcinoma (n = 9) or squamous cell carcinoma (n = 1) underwent intravenous indocyanine injection and NIR fluorescence imaging for assessment of flap vascularisation 2 to 3 weeks after stage 1 surgery. NIR fluorescence imaging showed 90% to 100% perfusion areas in all patients after 14 to 21 days. Early pedicle division occurred in two patients on postoperative days 14 and 16. One minor complication (wound healing disorder) was seen following flap takedown after 14 days. There were no associations between time to flap perfusion and defect size or flap area. NIR fluorescence imaging with ICG dye is a useful method for non‐invasive perfusion assessment when used in conjunction with clinical assessment criteria. However, a decision for early pedicle division may raise risk of complications in specific patient groups and must therefore be made with great care.

Modernism at the Barricades explore les tensions entre les ambitions utopistes de l’art avant-gardiste et le contexte dans lequel elles ont vu le jour, caractérisé par des pouvoirs politiques autoritaires et des institutions artistiques majoritairement réactionnaires. Son auteur, Stephen Eric Bronner, est philosophe politique et professeur de Sciences politiques à la Rutgers University. La relation antagoniste entre modernisme –qui est à comprendre ici comme le phénomène regroupant les arts ...

Herein, we present our latest protocol of following three operative stages for complete phalloplasty, applied in 37 female-to-male transsexuals: first, mastectomy, ovariohysterectomy, urethral lengthening, vaginectomy, colpocleisis, and neourethra prelamination; second, neophallus creation with free sensate osteofasciocutaneous fibula (n = 31) or radial forearm (n = 6) flap; and third, urethral connection, neoscrotum formation, and testicle prosthesis implantation. Occasionally, wound healing disturbance and slight asymmetry of the breasts was observed, as well as colpocleisis revision needed. Partial flap necrosis took place in 6 patients, while 12 presented urethral stricture and 6 a fistula. Despite inferior neophallus sensibility, patients whose neophallus was created using fibula flap experienced better sexual intercourse. However, overall patients' satisfaction was superior. The applied protocol demonstrates the effectiveness of such a multistage and interdisciplinary approach for female-to-male transsexuals, offering an essential improvement of their quality of life, concerning their successful integration into the reassigned gender position in the society.

A retrospective study was done on a population of 258 women who had undergone surgery for abdominal dermolipectomy between January of 1991 and May of 1996. The postoperative complications and flaws seen at long-term follow-up are discussed. The surgical techniques used, with or without lipoaspiration, were the infraumbilical plasty and full plasties with horizontal or inverted T scars. Six types of postoperative complications were noted: hemorrhage in 1.2 percent, lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in 6.6 percent, secondary dehiscence of the scar in 2.3 percent, and thromboembolic accidents in 1.2 percent. No significant difference was found in the rate of necrosis development between patients who did and did not undergo lipoaspiration. However, a statistically significant difference was seen in the rate of skin necrosis between the T-type plasty (35.5 percent) and the other two procedures (1.43 percent for infraumbilical plasties and 4.60 percent for full plasties with horizontal scar). With regard to the flaws found at long-term follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9 percent, and the rate of defective scars was 26 percent. No significant difference was found with regard to the rate of flaws. The rate of all secondary surgical procedures was 29.1 percent, but performance of secondary procedures depended on the willingness of the patient and on the surgeon's judgment. Abdominoplasty procedures involve a high risk of early complications. The rate of skin necrosis is clearly augmented in cases of T-type plasty. The need for secondary surgical correction is frequent, and the patient should be reminded of this possibility during preoperative consultation.