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OBJECTIVE: After oropharyngeal reconstruction surgery, excessive flap volume within the oral cavity may increase the risk of pharyngeal obstruction during sleep. This prospective observational study aimed to test a hypothesis that the skin-flap oropharyngeal reconstructive surgery increases nocturnal apnea-hypopnea index (nAHI, primary variable) after surgery.
METHODS: Adult patients undergoing oropharyngeal reconstruction surgery participated in this study. The hypothesis was tested by comparing the results of portable type 4 sleep study and craniofacial assessments with lateral head and neck computed tomography scout image before and after surgery. Multiple linear regression analyses were performed to identify predictors for nAHI increase after the surgery.
RESULTS: In 15 patients, a postoperative sleep study was performed at 41 (27, 59) (median (IQR)) days after the surgery. nAHI did not increase after the surgery (mean (95% CI), 13.0 (7.2 to 18.7) to 18.4 (10.2 to 26.6) events.hour-1, p = 0.277), while apnea index significantly increased after the surgery (p = 0.026). Use of the pedicle flap for the oropharyngeal reconstruction (p = 0.051), small mandible (p = 0.008), longer lower face (0.005), and larger tongue size (p = 0.008) were independent predictors for worsening of nAHI after surgery. Hospital stay was significantly longer in patients with the pedicle flap (n = 8) than in those with the free flap (n = 7) (p = 0.014), and the period of hospital stay was directly associated with increase of nAHI after surgery (r = 0.788, p < 0.001, n = 15).
CONCLUSIONS: Oropharyngeal reconstruction surgery worsens sleep-disordered breathing in some patients with craniofacial and surgical risk factors.
BACKGROUND: UMIN Clinical Trial Registry (UMIN000036260, March 22, 2019), https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260.

Background  There is a paucity of literature regarding the management of snakebite site complications. The wound complications can have debilitating sequelae, most of which may require reconstruction. Methods  This is a prospective single-institution observational study conducted from November 2019 to December 2021. Patient demographic characteristics and snakebite-related information, length of hospitalization, surgical lesions encountered, the type of treatment offered, and complications were recorded. Results  Fifteen patients (10 males and 5 females) with ages ranging from 10 to 53 years (mean: 36.5 years) were included in the study. Urgent fasciotomy was performed in three patients with compartment syndrome of the upper limb. Facial reconstruction was performed in one patient. One patient required distraction, cross-finger flap, and bone grafting of the index finger, while another patient required a pedicled groin flap for digital salvage. Below knee amputation was done for Marjolin\'s ulcer in a chronic snakebite case. Few patients required skin grafting. No major complications were encountered. Conclusions  Plastic surgeons play an important role in the management of bite site effects for restoration of form and function, which goes a long way in rehabilitating these patients back in the society. This case series presents a varied range of bite site complications and their management that would serve as a guide to plastic surgeons for better outcome.

UNASSIGNED: The modified nail folding approach, a new surgical technique, has been shown to be safe and effective for the treatment of subungual glomus tumors, providing clinicians with a new treatment option for patients with this condition.
UNASSIGNED: Glomus tumors (GTs) are rare benign tumors that originate from the glomus body in the skin of the fingertips, toes, and nail beds. GTs are more prevalent in women than in men and can occur sporadically or as part of an inherited condition known as multiple GTs. The exact cause of GTs is unknown, but it is believed that mutations in the cells of the glomus body contribute to their development. In this study, we present the efficacy of a novel surgical technique called the modified nail folding approach for treating subungual GTs. We report a case series involving 17 patients who underwent the nail folding approach for surgical removal of subungual GTs. The primary objective of this article is to provide evidence supporting the safety and effectiveness of this technique. Additionally, we aim to introduce clinicians to a new, secure, and efficient treatment option for patients with subungual GTs.

This article discusses the use of the skin-stretching technique (SST) to manage large soft tissue defects resulting from various causes. The other surgical techniques for closing such defects, such as pedicle flaps and free tissue flaps, are often associated with significant morbidity and cost. The SST involves progressively stretching soft tissue using an external device to reduce defect size or complete wound coverage. The article describes a simple, inexpensive, and readily available method for managing large wound defects using clasps and rubber bands. The article also highlights the potential complications associated with SST such as skin necrosis, pin site infection, wound dehiscence, infection, and pain. Overall, SST is a promising alternative for the management of large soft tissue defects that are not amenable to direct suturing.

Tissue loss in the forearm is a common entity. There are various etiologies to tissue loss like trauma, burn, post-surgery, etc. Coverage of defect or tissue loss of the forearm is a surgical challenge and options available for forearm coverage are limited. To bypass this difficulty, McGregor pedicled groin flap is used by us to cover large forearm defects with successful outcomes in this case series.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with distinct characteristics: chronic nature, morphology, and location. It originates from occluded and ruptured follicles, releasing keratin and bacteria into the nearby dermis. This causes an inflammatory reaction, leading to the formation of abscesses and the destruction of the pilosebaceous junction.
METHODS: We present the case 24-year-old female with a severe, stage III case of HS who had a lesion (approx. 10 × 15 cm) on her right axilla spanning 4 years. Despite some response to medical treatment, she experienced recurrent symptoms, due to this, surgical intervention was decided, using a latissimus dorsi thoracodorsal artery perforator (TDAP) flap. The lesion was successfully removed, and the flap was placed, leading to proper postoperative healing, cicatrization, and sensitivity in the patient.
CONCLUSIONS: HS poses a challenge due to its recurring course. Treatment involves pharmacological and surgical approaches, with the former suited for mild to moderate cases and the latter for severe instances. Surgical options, like TDAP flaps, show lower recurrence rates than skin grafts. TDAP flaps also offer advantages such as reduced bulkiness and favorable aesthetic and functional outcomes compared to other latissimus dorsi flaps.
CONCLUSIONS: HS represents an obstacle in terms of systemic effects and aesthetic concerns. Lattisimus dorsi flaps have emerged as an effective treatment method due to the reliable vascular supply and adequate volume to the recipient site as demonstrated by our case, where the patient showed appropriate evolution with no morbidity associated with the procedure as well as adequate aesthetic results.

We report the case of a 75-year-old diabetic patient who presented with posterior cervical necrotizing fasciitis complicating cellulitis. Medical management in intensive care and surgical drainage were undertaken; sequential excision of the necrotic tissue left a large loss of substance of the nuchal region for which we opted for directed healing in the first instance. The definitive coverage of this loss of substance by locoregional rotation flap or by thin skin grafting was discussed. However, it was refused by the patient.

Labial adhesion (LA) and vaginal destruction are very rare conditions in women. We report a 40-year-old woman with severe LA and distal vaginal stenosis after a radical hysterectomy at the age of 35. Completely destruction of vaginal epithelium, severe recurrent LA, voiding symptoms, and chronic pelvic pain occurs for her due to the repeated vaginal dilatation and low estrogen level. A combination of ileal vaginoplasty (IV) and labia majora flap was used in two surgical stages for treatment. After surgery, the patient\'s urinary symptoms and pelvic pain were relieved and she was able to have sex with her partner.

Kienböck\'s disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck\'s; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck\'s are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck\'s patients through the early, transitional, and late phases of the disease.