Objective: Cranioplasty (CP) and ventriculoperitoneal shunt (VPS) are required procedures following decompressive craniectomy (DC) for craniofacial protection and to prevent hydrocephalus. This study assessed the safety and efficacy of simultaneous operation with CP and VPS after DC, and determined the preoperative risk factors for postoperative complications. Methods: Between January 2009 and December 2019, 81 patients underwent CP and VPS in simultaneous or staged operations following DC. Cumulative medical records and radiologic data were analyzed using univariate analysis to identify factors predisposing patients to complications after CP and VPS. Results: CP and VPS were performed as simultaneous or staged operations in 18 (22.2%) and 63 (77.8%) patients, respectively. The overall postoperative complication rate was 16.0% (13/81). Patients who underwent simultaneous CP and VPS were significantly more likely to experience complications when compared with patients who underwent staged operations (33.3% vs. 9.6%, p<0.01). Univariate analysis revealed that simultaneous CP and VPS surgery was the only significant predictor of postoperative complications (p=0.031). Conclusion This study provided detailed data on surgical timing and complications for CP and VPS after DC. We showed that simultaneous procedures were a significant risk factor for postoperative complications.

Background: Although rarely used at present in South Korea, saline implants accounted for most of the implants used from 1992 to 2007. However, few studies have reported on the long-term outcomes of saline implants, especially in breast reconstruction. We analyzed the long-term outcomes of patients who underwent direct-to-saline implant reconstruction. Methods: This retrospective study included patients who underwent saline implant-based immediate breast reconstruction between 2003 and 2007. The patients’ demographic information, medical history, operative/implant details, and oncologic data were collected. Early and late complications, reoperations, and final outcomes of the implant (maintenance, explantation, exchange, and autologous conversion) were analyzed to determine the long-term results and to identify factors affecting the outcomes. Results: Early complications (within 90 days) were noted in 19.5% of patients and late complications (after 90 days) occurred in 29.3% of patients. The most common early complications were skin necrosis and delayed healing, whereas the most common late complications were rippling or visibility and capsular contracture. Of the implants, 22% were replaced (12%) or converted to autologous tissue (10%). The factors that influenced the final outcomes were patient age, nipple-areola-sparing procedure, breast size, implant fill volume, and implant manufacturer. Conclusions Patients who previously received saline implants still visit the clinic for consultations. This long-term follow-up study with few dropouts reflects the real needs of reconstruction patients. Our results provide useful information for consulting with patients who already have saline implants or those who request for as much information about available implant options as possible.

BACKGROUND: Bilateral microsurgical autologous reconstruction is known to increase operating time, costs, and complications compared to unilateral procedures. This study aimed to determine whether a unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap and a unilateral deep inferior epigastric artery perforator (DIEP) free flap could be a feasible option for bilateral reconstruction in selected circumstances. METHODS: A retrospective chart review identified patients who underwent unilateral pedicled TRAM and unilateral DIEP reconstruction for bilateral breast reconstruction between 2011 and 2014. Surgical outcomes, complications, and aesthetic scale questionnaire responses were evaluated. RESULTS: Fourteen patients were included in this study. Ten patients received bilateral immediate reconstruction, while four patients with a previous history of mastectomy underwent unilateral immediate reconstruction and contralateral delayed reconstruction. All flaps survived without any major complications. A case of nipple-areolar skin necrosis on the pedicled TRAM side and a case of mild abdominal bulging at the free DIEP donor site were reported. There was no partial flap necrosis or palpable fat necrosis. On the aesthetic outcome scale, the free DIEP flaps scored significantly higher than did the pedicled TRAM flaps for overall shape, the upper medial and lower lateral quadrant, and the lateral chest wall. CONCLUSIONS: Our findings suggest that a unilateral pedicled TRAM flap together with a unilateral free DIEP flap could be performed as a bridging surgical option as institutions move toward bilateral free-flap reconstructions, as a way to reduce operating time and the risk of microsurgery-related complications with acceptable donor site morbidity and aesthetic outcomes.
Breast ; Epigastric Arteries ; Fat Necrosis ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty ; Mastectomy ; Myocutaneous Flap ; Necrosis ; Perforator Flap ; Rectus Abdominis ; Retrospective Studies ; Skin ; Thoracic Wall ; Tissue Donors

BACKGROUND: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies. METHODS: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed. RESULTS: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects. CONCLUSIONS: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.
Breast Neoplasms ; Breast ; Drug Therapy ; Electrons ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Myocutaneous Flap ; Radiotherapy ; Rectus Abdominis ; Surgery, Plastic

PURPOSE: To investigate trends in blood pressure (BP) and hypertension prevalence in Korea. MATERIALS AND METHODS: Based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005), IV (2007–2009), V (2010–2012), and VI (2013–2014), 56077 participants (23974 men and 32103 women) were included. RESULTS: Mean systolic BP (SBP) and diastolic BP (DBP) decreased in both sexes (male SBP: 128.1 to 120.2 mm Hg, male DBP: 82.0 to 78.5 mm Hg; female SBP: 125.7 to 116.0 mm Hg and female DBP: 77.4 to 73.2 mm Hg from the KNHANES I–VI). The age-standardized prevalence of hypertension was significantly decreased in both sexes (male; 33.3% to 30.3%, female; 28.7% to 22.7%, all p for trend < 0.001). Regardless of taking anti-hypertensive medication or not, SBP and DBP declined universally in both sexes. Compared to the KNHANES I, the odds ratios (95% confidence intervals) of the KNHANES II to VI for less-than-normotensive and less-than-hypertensive BP increased in both sexes. CONCLUSION: Mean BP levels in both sexes and hypertension prevalence showed downward trends during the 16-year period.
Adult* ; Blood Pressure* ; Epidemiology ; Female ; Humans ; Hypertension* ; Korea ; Male ; Nutrition Surveys ; Odds Ratio ; Prevalence*

BACKGROUND: The aim of this study was to investigate the relationship between serum ferritin and diabetes mellitus (DM) in the Korean population. METHODS: This cross-sectional study included 9,576 subjects (4,264 men, 2,394 pre-menopausal women, and 2,918 post-menopausal women) older than 19 years using data from the 2010-2012 Korean National Health and Nutrition Examination Survey. DM was defined as fasting plasma glucose ≥126 mg/dL, glycosylated hemoglobin ≥6.5%, or use of any glucose-lower medication including insulin therapy. RESULTS: The overall prevalence of DM was 12.0, 3.6, and 17.3% in men, pre-menopausal women, and post-menopausal women, respectively. DM prevalence was greater with ferritin levels from Q1 to Q4: 10.3, 10.2, 12.7, and 14.8% in men; 2.0, 2.8, 2.8, and 6.4% in pre-menopausal women; and 13.9, 14.4, 18.1, and 22.9% in post-menopausal women, respectively. Compared with participants in Q1, the odds ratios (95% confidence intervals) for DM among participants in Q4 were 1.67 (1.20-2.32) in men, 2.06 (0.91-4.66) in pre-menopausal women, and 1.60 (1.09-2.35) in post-menopausal women after adjusting for age and other covariates. CONCLUSION: Serum ferritin concentration was positively associated with a higher risk of DM in adult men and post-menopausal women.
Adult ; Blood Glucose ; Cross-Sectional Studies ; Diabetes Mellitus* ; Fasting ; Female ; Ferritins* ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Insulin Resistance ; Male ; Nutrition Surveys ; Odds Ratio ; Prevalence

BACKGROUND: Topical anesthetics, such as eutectic mixture of local anesthetics (EMLA) cream, can be applied to reduce pain before minor procedure. This trial evaluated EMLA as pretreatment for facial lacerations and compared pain, discomfort and overall satisfaction. METHODS: This trial included consecutive emergency department patients > or =16 years of age who presented with simple facial lacerations. At triage, lacerations were allotted to either the routine processing group or EMLA pretreatment group according to date of admission. Initially, the emergency department doctors inspected each laceration, which were dressed with saline-soaked gauze. In the pretreatment group, EMLA cream was applied during wound inspection. The plastic surgeon then completed primary closure following the local injection of an anesthetic. After the procedure, all patients were given a questionnaire assessing pain using the 10-point visual analog scale (VAS) ("no pain" to "worst pain"). All questionnaires were collected by the emergency department nurse before discharge. RESULTS: Fifty patients were included in the routine processing group, and fifty patients were included in the EMLA pretreatment group. Median age was 39.9 years, 66% were male, and the average laceration was 2.67 cm in length. The EMLA pretreatment group reported lower pain scores in comparison with the routine processing group (2.4 vs. 4.5 on VAS, P<0.05), and lower discomfort scores during the procedure (2.0 vs. 3.3, P=0.60). Overall satisfaction was significantly higher in the EMLA pretreatment group (7.8 vs. 6.1, P<0.05). CONCLUSIONS: Pretreating facial lacerations with EMLA topical cream aids patients by reducing pain and further enhancing overall satisfaction during laceration treatment.
Anesthetics ; Anesthetics, Local ; Emergency Service, Hospital ; Humans ; Lacerations* ; Male ; Triage ; Visual Analog Scale ; Wounds and Injuries ; Surveys and Questionnaires

BACKGROUND: Microvascular complications after free-flap breast reconstructions are potentially devastating problems that can increase patient morbidity and lead to flap loss. To date, no comprehensive study has examined the rates of salvage and the methods of microvascular revision in breast reconstruction. We reviewed the treatment of microvascular complications of free-flap breast reconstruction procedures over a seven-year period. METHODS: A retrospective review of all patients who underwent microvascular breast reconstruction at our institution between April 2006 and December 2013 was conducted. Based on their surgical records, all patients who required emergency re-exploration were identified, the rate of flap salvage was determined, the factors associated with flap salvage were evaluated, and the causes and methods of revision were reviewed. RESULTS: During the review period, 605 breast reconstruction procedures with a free lower abdominal flap were performed. Seventeen of these flaps were compromised by microvascular complications, and three flaps were lost. The overall salvage rate was 82.35%. No significant differences between the salvaged group and the failed group were observed with regard to age, BMI, axillary dissection, number of anastomotic arteries and veins, recipient vessel types, or use of the superficial inferior epigastric vein in the revision operation. Successful salvage of the flap was associated with a shorter time period between recognizing the signs of flap compromise and the take-back operation. CONCLUSIONS: The salvage rate of compromised lower abdominal flaps was high enough to warrant attempting re-exploration. Immediate intervention after the onset of flap compromise signs is as important as vigilant postoperative monitoring.
Arteries ; Breast* ; Emergencies ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty* ; Perforator Flap ; Retrospective Studies ; Salvage Therapy ; Surgical Flaps ; Veins

BACKGROUND: A closed pleural biopsy is commonly performed for diagnosing patients exhibiting pleural effusion if prior thoracentesis is not diagnostic. However, the diagnostic yield of such biopsies is unsatisfactory. Instead, a thoracoscopic pleural biopsy is more useful and less painful. METHODS: We compared the diagnostic yield of needle thoracoscopic pleural biopsy performed under local anesthesia with that of closed pleural biopsy. Sixty-seven patients with pleural effusion were randomized into groups A and B. Group A patients were subjected to closed pleural biopsies, and group B patients were subjected to pleural biopsies performed using needle thoracoscopy under local anesthesia. RESULTS: The diagnostic yields and complication rates of the two groups were compared. The diagnostic yield was 55.6% in group A and 93.5% in group B (p<0.05). Procedure-related complications developed in seven group A patients but not in any group B patients. Of the seven complications, five were pneumothorax and two were vasovagal syncope. CONCLUSION: Needle thoracoscopic pleural biopsy under local anesthesia is a simple and safe procedure that has a high diagnostic yield. This procedure is recommended as a useful diagnostic modality if prior thoracentesis is non-diagnostic.
Anesthesia, Local* ; Biopsy* ; Humans ; Needles* ; Pleural Diseases ; Pleural Effusion* ; Pneumothorax ; Syncope, Vasovagal ; Thoracoscopy

BACKGROUND: Abdominal wall free flaps are used most frequently in autologous breast reconstruction, and these flaps require intact and robust deep inferior epigastric perforator (DIEP) vessels. Pfannenstiel incisions are often present during preoperative visits for breast reconstruction and could potentially signal compromised blood supply to the lower abdominal wall. In this study, we compared the number of DIEP vessels between patients with and without Pfannenstiel incisions undergoing autologous breast reconstruction. METHODS: A retrospective review of medical records was performed for patients with (study) and without (control) Pfannelstiel incisions (n=34 for each group) between June 2010 and July 2013. In addition to patient demographics, number of caesarian sections, and outcomes of free flap reconstruction, abdominal wall vasculature was compared using the preoperative computed tomography angiographic data between the groups. For each patient, vessels measuring greater than 1 mm were counted and divided into four sections of the lower abdominal wall. RESULTS: The mean number of perforator vessels was 10.6 in the study group and 11.4 in the control group, which was not statistically different (P=0.575). Pfannenstiel incisions with history of repeat caesarian sections were not associated with decreased number of perforator vessels. CONCLUSIONS: Pfannenstiel scars are associated with neither a change in the number of DIEP vessels nor decreased viability of a free transverse rectus abdominis myocutaneous and DIEP flap. Lower abdominal free flaps based on DIEP vessels appear safe even in patients who have had multiple caesarian sections through Pfannenstiel incisions.
Abdominal Wall ; Cesarean Section ; Cicatrix* ; Demography ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty ; Medical Records ; Perforator Flap ; Pregnancy ; Rectus Abdominis ; Retrospective Studies