Many studies have demonstrated that an autologous fat graft (AFG) can be a successful alternative to prosthetic breast augmentation; however, with the increasing use of this method, there are also increasing reports of complications. We report a case of severe infection after augmentation mammoplasty with a massive AFG. A 23-year-old woman had undergone primary AFG for breast augmentation. The remaining fat was reused for secondary graft 46 days after the primary transplantation. The patient was referred to our hospital with infectious signs on both breasts. Antibiotics were administered according to the bacterial culture result of the abscess aspirated with ultrasonography (US) guidance. During antibiotic treatment, two US-guided abscess aspirations were performed. Although follow-up magnetic resonance imaging demonstrated reduced abscess and fluid collection after aspiration, the skin of the lower pole of the right breast was perforated. We performed liposuction with real-time US guidance for abscess localization. The abscess and necrotic fat tissue were removed through liposuction. Thereafter, the symptoms, signs, and laboratory and radiologic findings demonstrated complete improvement. The patient was successfully treated while maintaining the breast contour through localized abscess removal, with a much smaller liposuction scar than would have resulted from aggressive excision or drainage.
Abscess ; Anti-Bacterial Agents ; Aspirations (Psychology) ; Breast ; Cicatrix ; Drainage ; Female ; Follow-Up Studies ; Humans ; Lipectomy ; Magnetic Resonance Imaging ; Mammaplasty ; Methods ; Skin ; Transplants ; Ultrasonography ; Young Adult

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Arthroscopy ; Follow-Up Studies ; Joints ; Knee ; Lysholm Knee Score ; Magnetic Resonance Imaging ; Regeneration ; Tendons ; Transplants ; Ultrasonography

Aneurysm and pseudoaneurysm of the dorsalis pedis artery (DPA) are rare vascular entities. Pseudoaneurysms of the DPA are commonly due to blunt trauma, sharp penetrating injury, fracture, or iatrogenic injury. Herein, we report the case of a patient with a rare iatrogenic pseudoaneurysm that occurred after blood sampling. The diagnosis was suspected based on palpitation of a pulsatile mass on the dorsal foot and confirmed by color Doppler ultrasound and computed tomography angiography. Surgical treatment was successfully performed by reconstruction with an autologous venous graft. The patient recovered well, with no ischemic complications.
Aneurysm ; Aneurysm, False* ; Angiography ; Arteries* ; Diagnosis ; Foot ; Humans ; Transplants ; Ultrasonography

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.
Abdomen* ; Abdominal Wound Closure Techniques ; Aged ; Anastomotic Leak ; Extracorporeal Membrane Oxygenation ; Fistula* ; Gastrectomy ; Hemodiafiltration ; Humans ; Intestinal Fistula ; Perforator Flap* ; Skin ; Surgeons ; Surgery, Plastic ; Transplants ; Ultrasonography ; Ultrasonography, Doppler ; Ventilators, Mechanical ; Wounds and Injuries

Renal vein thrombosis is a rare but serious cause of graft loss in kidney transplant recipients that is usually associated with early surgical complications. Here, we report a rare case of sudden development of late onset renal vein thrombosis after kidney transplantation. A 32-year-old man underwent deceased kidney transplantation 2 years prior. Oliguria and pain suddenly developed at the allograft site along with an elevated serum creatinine level. Doppler ultrasound showed absence of venous flow in the transplanted kidney. Magnetic resonance imaging showed thrombosis from the allograft vein to the anastomosis with the left common iliac vein and a swollen allograft kidney. The patient underwent anticoagulation with unfractionated heparin and warfarin. Serum creatinine normalized and renal vein thrombosis disappeared after 3 months of treatment. Late-onset renal vein thrombosis is rare; however, early detection and treatment are very important to restore renal allograft function.
Adult ; Allografts ; Creatinine ; Heparin ; Humans ; Iliac Vein ; Kidney Transplantation* ; Kidney* ; Magnetic Resonance Imaging ; Oliguria ; Renal Veins* ; Thrombosis* ; Transplant Recipients ; Transplants ; Ultrasonography ; Veins ; Warfarin

The management of nonunion with severe bone loss is a challenging task to both surgeons and patients. It often requires prolonged and potentially painful treatments. Moreover, it also represents serious socioeconomic issues for patients. Inadequate fracture stability, disrupted biology, such as blood supply and soft tissue, as well as severe bone loss or presence of infection are possible reasons for nonunion. Several different treatment modalities are available, including nail dynamization, plate osteosynthesis, exchange nailing, and adjuvant alternatives, such as electrical or ultrasound stimulation. Autogenous bone graft remains the standard method to reconstruct small defects. Distraction osteogenesis and induced membrane techniques are contemporary strategies of choice for the reconstruction of larger bony defects. Herein, we attempt to describe the key techniques that may be employed in treating nonunion with severe bone loss.
Biology ; Humans ; Membranes ; Methods ; Osteogenesis, Distraction ; Surgeons ; Transplants ; Ultrasonography

PURPOSE: A native vessel is preferable to an artificial graft for dialysis access. Duplex ultrasound (DUS) is noninvasive, cost-effective modality to evaluate the vessels for dialysis. The purpose of this study was to compare the rates of utilization of native vessels after preoperative imaging with DUS and contrast venography (CV). MATERIALS AND METHODS: A retrospective review was performed on patients who received an arteriovenous fistula (AVF) or arteriovenous graft (AVG) between June 2006 and July 2010. Patients were classified into 3 groups. In group 1, CV was used to evaluate the vessel. Both DUS and CV were used in group 2. In group 3, only DUS was used. The frequency of utilization of a native vessel was analyzed in each group. The chi-square test was used for statistical analysis. RESULTS: During the study period, 173 patients received an AVF or AVG. Eighty-nine patients were male. The mean age was 60.6±14.6 years. A native vessel was used in 56/81 patients (69.1%) and 74/81 patients (91.4%) in groups 1 and 3, respectively (P<0.001). In group 2, all patients underwent access procedures using native vessels. AVG was initially planned for 2 patients in group 2 after vessel evaluation using CV, but a native vessel was successfully used because DUS identified optimal vessels for AVF. The 1-year primary patency rate was similar in 3 groups. CONCLUSION: Preoperative DUS is safe and easy to use for vessel evaluation, and can be used as a primary imaging modality for creation of access.
Arteriovenous Fistula ; Dialysis ; Humans ; Male ; Phlebography ; Renal Dialysis* ; Retrospective Studies ; Transplants ; Ultrasonography*

BACKGROUND: Few comparative studies have reported on the use of biologic grafts for irreparable massive rotator cuff tears. The purpose of this study was to assess the results of arthroscopic bridging graft in irreparable massive rotator cuff tears using an autogenic long head of biceps tendon (LHBT) or an allogenic dermal patch (ADP). METHODS: We retrospectively reviewed 24 patients treated using the LHBT (group I) and eight patients with complete rupture of the LHBT treated using an ADP (group II) since 2011. Preoperative Goutallier's fatty degeneration, range of motion (ROM), visual analogue scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed and healing failure was evaluated at 1 year after surgery by ultrasonography or magnetic resonance imaging. RESULTS: The mean fatty degeneration in groups I and II was 3.9 and 3.6 for the supraspinatus (p = 0.288), 2.7 and 2.9 for the infraspinatus (p = 0.685), 0.9 and 1.3 for the subscapularis (p = 0.314), and 1.3 and 3.0 for the teres minor (p = 0.005), respectively. Subscapularis tears were found in 8 patients (33.3%) in group I and in 7 patients (87.5%) in group II (p = 0.023). Mean ROMs and functional scores improved significantly in group I (forward flexion: 121.7° to 153.3°, p = 0.010; external rotation: 32.7° to 52.7°, p = 0.001; external rotation at 90°: 63.3° to 74.5°, p = 0.031; internal rotation: T10.5 to T9.3, p = 0.045; VAS: 7.0 to 1.1, p < 0.001; ASES score: 45.4 to 81.6, p = 0.028; and Quick DASH score: 50.0 to 14.2, p = 0.017), whereas only VAS showed significant improvement in group II (from 5.9 to 2.0, p = 0.025) and ROMs and other functional scores increased without statistical significance in the group. Healing failure was found in 13 patients (54.2%) in group I and in 6 patients (75.0%) in group II (p = 0.404). CONCLUSIONS: The surgeon should prudently choose surgical options for irreparable massive rotator cuff tears, especially in patients with severe fatty degeneration in the teres minor or combined biceps and subscapularis tears.
Adenosine Diphosphate ; Arm ; Elbow ; Hand ; Head ; Humans ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff* ; Rupture ; Shoulder ; Surgeons ; Tears* ; Tendons ; Transplants* ; Ultrasonography

BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.
Biopsy ; Echocardiography ; Heart ; Heart Transplantation ; Heterografts ; Humans ; Macaca fascicularis ; Methods ; Pathology ; Stroke Volume ; Transplantation, Heterologous* ; Transplants* ; Ultrasonography ; Wound Healing

BACKGROUND: Intima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable. METHODS: Six New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted 90° to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26. RESULTS: All anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely. CONCLUSIONS: Despite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.
Anastomosis, Surgical ; Constriction, Pathologic ; Dilatation ; Jugular Veins ; Microsurgery ; Rabbits ; Regeneration ; Transplants ; Tunica Media ; Ultrasonography ; Vascular Remodeling ; Vascular Surgical Procedures ; Veins