August 2024 Edition
- thestitchprs
- Aug 3, 2024
- 5 min read
Welcome to the August edition of The Stitch! We appreciate your continued support and readership. Don't miss our Head & Neck Anatomy Review Quiz!!
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The Stitch Editorial Board
Head & Neck Anatomy Review Quiz
1. The facial nerve travels through which salivary gland?
Bonus: What are the 5 branches of the facial nerve?
2. Which fascial layer is continuous with the fibers of the frontalis muscle superiorly and the platysma muscle inferiorly?
3. The parietal bones of the skull join at the midline and form which suture?
4. Which bones form the floor of the orbit?
5. What are the four main cartilaginous convolutions of the auricle (ear)?
6. Persistent epistaxis typically originates from which vessels?
Bonus: The anterior and posterior ethmoidal arteries are branches of what artery?
"Curve" Balls in Breast Cancer Reconstruction: Swing for the Fences or Trouble at the Ballpark?
Article Review by Kasra Rahmati, David Geffen School of Medicine at the University of California Los Angeles
Published in Gland Surgery, September 2023
Approximately 1 in 4 patients undergoing breast cancer reconstruction are obese. Considering the incidence of obesity and breast cancer are rapidly rising, it is critical to determine the optimal approach to reconstruction. This article summary is derived from a recently published literature review which compares the latest techniques for breast cancer reconstruction in the setting of comorbidities, of which I will be solely focusing on obesity. Complication rates of autologous, implant-based, and oncoplastic reconstruction were compared.
Patients with obesity who underwent autologous reconstruction presented lower failure rates and unplanned operations compared to implant-based reconstructions. Similarly, patients who underwent oncoplastic reconstruction exhibited 10x and 20x reductions in reconstruction rates and delay of adjuvant therapy, respectively, compared to implant-based or autologous approaches. However, nearly 80% of patients with obesity still undergo implant-based reconstruction. Patients with obesity, presenting higher risk-profiles, are often presented with limited treatment modalities.
Among these options, oncoplastic breast reconstruction stands out as a favorable approach over delayed breast reconstruction (e.g., implant-based, autologous) due to the single stage nature of the procedure, preserving nerve sensation while decreasing scar tissue and further need for reconstruction. The oncoplastic approach holds promise in addressing the evolving needs of an expanding patient demographic.
Early Laser Treatment of Hypertrophic Burn Scars
Article Review by Raymond Richards, University at Buffalo
Published in Lasers in Surgery and Medicine, July 2024
The effects of hypertrophic burn scars on a patient’s quality of life can be persistent and impactful, ranging from chronic pain at the site of injury to negative self-image and anxiety. Previous rationale regarding ablative treatment of hypertrophic scars was to delay treatment for 3-12 months following initial insult to allow time for natural healing. Mounting research suggests early laser treatment can be equally effective.
Slavinsky et al ran a prospective cohort study consisting of 69 patients with hypertrophic burn scars treated with fractionated CO2 laser. The study population was divided into two groups based on the age of their hypertrophic scar at the time that treatment with the laser was commenced: an early-stage group with scar age 3-6 months, and a late-stage group with scar age 6-12 months. Patients were assessed at multiple time points before treatment and after each treatment with objective evaluations including a durometer to test qualities of their scars, and a variety of subjective measures, including evaluation by members of a burn rehabilitation team.
Both the early and late intervention groups saw significant (p<0.05) improvement in most subjective measures over the course of the study. Measurements obtained with the durometer did not improve significantly in either group. Most notably, there was not a significant difference in subjective outcomes between the groups. While this study was not able to show a distinct benefit in earlier laser treatment, it does suggest that earlier treatment is non-inferior to the traditional treatment timeline. The advantage of earlier treatment is the opportunity to shorten the time that patients are suffering symptoms and to restore a higher quality of life sooner in the recovery process.
Future contributions that could improve the literature might consist of trialing earlier laser treatment combined with other therapies. The authors also mention value in the creation of novel tools to evaluate patient perceptions and expectations of burn scar treatment.
Possible evidence that antibiotic irrigation isn't a protective factor for deep infections!
Article Review by Chandler Hinson, Research Fellow at the Department of Plastic Surgery at the University of Texas Southwestern Medical Center
Published in Plastic and Reconstructive Surgery, July 2024
Antibiotic implant irrigation is often used to prevent deep infections following implant-based breast reconstruction. This retrospective cohort study analyzed the risk of deep infection among 1508 patients undergoing breast reconstruction with implants at two hospitals in Denmark between 2010 and 2019. The patients received antibiotic irrigation with gentamicin, vancomycin, or no irrigation. Logistic regression was utilized to compare infection risks and adjust for confounding risk factors.
The initial analysis indicated a significantly reduced risk of deep infection with gentamicin irrigation compared to no irrigation). However, after adjusting for various risk factors, neither gentamicin nor vancomycin showed a statistically significant reduction in infection risk compared to the control group. The study concluded that there is no significant effect of antibiotic implant irrigation when accounting for risk factors.
This article highlights that common practices in the United States might be outdated and not reflect true best practices. For example, the British National Institute for Health and Care Excellence recommends not to use antibiotic implant irrigation because of limited evidence. This highlights the importance of critically evaluating clinical practices and the necessity of robust, randomized trials to confirm the efficacy of interventions.
Head & Neck Anatomy Review Quiz Answers
1. The facial nerve travels through which salivary gland? Parotid
Bonus: What are the 5 branches of the facial nerve? Temporal, zygomatic, buccal, marginal mandibular, cervical
2. Which fascial layer is continuous with the fibers of the frontalis muscle superiorly and the platysma muscle inferiorly? Superficial musculoaponeurotic system (SMAS)
3. The parietal bones of the skull join at the midline and form which suture? Sagittal
4. Which bones form the floor of the orbit? Maxillary and zygomatic bones
5. What are the four main cartilaginous convolutions of the auricle (ear)? Helix, antihelix, tragus, antitragus
6. Persistent epistaxis typically originates from which vessels? Ethmoidal
Bonus: The anterior and posterior ethmoidal arteries are branches of what artery? Ophthalmic (from internal carotid artery)
Resources for anatomy: Netters, thePlasticsFella, Anki
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