Postoperative bleeding after mastectomy is rarely a life-threatening complication. However, it can be fatal without treatment, particularly in patients taking antithrombotic medications. We present a case of 84-year-old woman with atrial fibrillation and apixaban medication, who developed breast cancer requiring mastectomy. The patient experienced severe post-operative bleeding on the fifth postoperative day, with first symptoms being disorientation, stomachache, and unstable hemodynamics. A contrast-enhanced computed tomography revealed an active bleeding site superficially in the skin flap. Unfortunately, the patient had to face a two-hour delay before emergency surgery could be performed and the on-call surgeon decided to attempt an unconventional treatment. The source of the bleeding was pinpointed using Doppler ultrasound in the emergency room, and the artery was occluded with a large needle and a figure-of-eight suture.

We aimed to investigate how the thickness of removed skin grafts affects the healing time at the donor site, with a focus on the depth of the donor wound and the normal thickness of the scalp. We examined the outcomes of the donor sites of thick split-thickness skin grafts using hairy scalp skin in 102 Korean patients. We measured the thickness of the scalp donor skin using preoperative ultrasonography, histometric thickness of normal scalp skin in 61 patients, and histometric thickness of the thickest part of the grafted skin after surgery. The mean normal ultrasound thickness of the scalp donors was 1.711 mm, with a mean histometric normal scalp thickness of 1.926 mm (61 cases), mean dermatome depth set of 0.569 mm (22/1000 inches, 22 mils), and mean histometric harvested skin thickness of 0.677 mm. The relationship between healing time and percentage of histometric graft thickness per ultrasonographic normal scalp skin thickness was statistically significant and correlated positively. Healing of the partial portion of the scalp was delayed in 9 donors due to infection and folliculitis. Scalp donor wounds healed during postoperative days 6 and 15, except for the ones with infected portions. Patients in this study successfully achieved scarless regenerative healing of their scalp donor wounds. Furthermore, adequate wound dressing can prevent alopecia and scarring of infected donor wounds. The results of this study offer valuable insights into the advantages of using scalp skin in grafts, underscoring its potential as a preferred option for achieving optimal regenerative healing.

Symptomatic macromastia is a debilitating condition that affects millions of women worldwide. Although reduction mammoplasty is the gold standard treatment, the association between estrogen levels and wound healing has been established in literature. Hence, this study aimed to compare the postoperative outcomes and complications between menopaused and non-menopaused women after reduction mammoplasty. This study offers a retrospective multimodal observation and analysis comparing menopaused and non-menopaused women. Using data collected from January 2018 to May 2024, patients who met the selection criteria were divided into 2 groups. Complications following reduction mammoplasty were recorded and analyzed. A total of 110 patients were included in this study, among them 80 patients were in the non-menopaused group and 30 in the menopaused group. Our statistical analysis indicated that the hospital stay was significantly longer in the menopaused group (P=0.008). Additionally, postoperative dog ears were significantly more frequent in the menopaused group (P=0.034). Conversely, scar hypertrophy occurred more frequently in non-menopaused patients (P=0.02). Although menopaused women undergoing single or bilateral reduction mammoplasty had longer duration of hospital stay, they did not have higher risk of postoperative complications, except for higher rate of developing dog ears, which may be ascribed to the faltering estrogen levels of this population. Non-menopaused women had a higher rate of hypertrophic scars.

The excision of oropharyngeal carcinoma of more than 50% of the soft palate followed by static reconstruction may result in functional deficits, including velopharyngeal insufficiency, swallowing, and speech difficulties. We describe a functional soft palate reconstruction technique aimed at restoring aeromechanical and acoustic functions, enabling swallowing without nasal regurgitation and speech with low nasalance. We developed a new operative technique, using muscle transfer and a free flap to create a dynamic reconstruction. To prove the distinct nerve innervation of the two digastric bellies and the feasibility of the technique, we first performed an anatomical study, and then implemented the technique in our clinic. The surgical technique included transfer of the anterior and posterior bellies of the digastric muscle in association with a folded radial forearm free flap. A retrospective analysis of patients who underwent this soft palate functional reconstruction after cancer resection between 2007 and 2017 was performed, and a subjective analysis of nasalance and swallowing was done to evaluate the functional outcomes. Eight patients (six males, two females) with a mean age of 56 years (range 43-69) who were affected by oropharynx carcinoma (stage T1-3) infiltrating the soft palate were included. Analysis of the reconstruction showed that seven of the eight patients had satisfactory swallowing function, and all patients were able to speak in an understandable manner with minimal nasalance. Our surgical approach provided a functional reconstruction with outcomes close to normality, making it a suitable technique for patients with large soft palate defects.

These findings suggest that using Xeroform may promote better wound healing than using silver sulfadiazine. In addition, patients with Xeroform can be discharged with their dressings in place for grafting in the outpatient setting, during which time they are in closed dressings without frequent changes and associated discomfort.