Background Frozen section histology is widely used to aid in the diagnosis of periprosthetic joint infection at the second stage of revision arthroplasty, although there are limited data regarding its utility. Moreover, there is no definitive method to assess control of infection at the time of reimplantation. Because failure of a two-stage revision can have serious consequences, it is important to identify the cases that might fail and defer reimplantation if necessary. Thus, a reliable test providing information about the control of infection and risk of subsequent failure is necessary.Questions/purposes (1) At second-stage reimplantation surgery, what is the diagnostic accuracy of frozen sections as compared with the Musculoskeletal Infection Society (MSIS) as the gold standard? (2) What are the diagnostic accuracy parameters for the MSIS criteria and frozen sections in predicting failure of reimplantation? (3) Do positive MSIS criteria or frozen section at the time of reimplantation increase the risk of subsequent failure? Methods A total of 97 patients undergoing the second stage of revision total hip arthroplasty or total knee arthroplasty in 2013 for a diagnosis of periprosthetic joint infection (PJI) were considered eligible for the study. Of these, 11 had incomplete MSIS criteria and seven lacked 1-year followup, leaving 79 patients (38 knees and 41 hips) available for analysis. At the time of reimplantation, frozen section results were compared with modified MSIS criteria as the gold standard in detecting infection. Subsequently, success or failure of reimplantation was defined by (1) control of infection, as characterized by a healed wound without fistula, drainage, or pain; (2) no subsequent surgical intervention for infection after reimplantation surgery; and (3) no occurrence of PJI-related mortality; and diagnostic parameters in predicting treatment failure were calculated for both the modified MSIS criteria and frozen sections.One author (WB) has received research support in the amount of USD 100,001 to USD 1,000,000 from grants from Stryker (Kalamazoo, Conclusions On the basis of our results, both frozen section and MSIS are recommended at the time of the second stage of revision arthroplasty. Both frozen section and modified MSIS criteria had limited screening capabilities to identify failure, although both demonstrated high specificity. MSIS criteria should be evaluated at the second stage of revision arthroplasty because performing reimplantation in a joint that is positive for infection significantly increases the risk for subsequent failure. Level of Evidence Level III, diagnostic study.MI123 Clin Orthop Relat Res (2016) 474:1619-1626 DOI 10.1007/s11999-015-4673-3 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® Results At the time of second-stage reimplantation sur

Within the setting of increased applicant competitiveness, the authors recommend maximizing subjective qualities in order to differentiate themselves from a highly eligible applicant pool. In addition, applicants should diversify the types of programs at which they interview to maximize their chances of matching.

Renal failure requiring dialysis remains a serious complication, particularly in patients with pulmonary hypertension and previous renal dysfunction. Our logistic risk model allows the prediction of renal failure requiring dialysis, based on the individual presentation of risk factors and, therefore, helps to determine the perioperative risk in cardiac surgery patients.

Abstract Background Rebound bleeding during facelift surgery is a major cause of facelift hematomas. Subcutaneous infiltration of tranexamic acid combined with lidocaine and epinephrine was recently retrospectively shown to decrease rebound bleeding. No study has prospectively examined the effect of subcutaneous TXA on intraoperative and postoperative bleeding during facelift surgery. Objectives To prospectively demonstrate that TXA with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage. Methods Prospective, single surgeon, case control study from July 2019 to March 2020. Thirty-nine patients underwent facelift surgery alone or in combination with facial rejuvenation procedures. All patients were injected subcutaneously with 1-2mg/mL TXA + 0.5% Lidocaine/1:200,000 Epinephrine. Patient demographics, TXA dose, time to hemostasis, drain output, minor and major complications were examined. Results Thirty-nine patients (35 female and 4 male; mean age, 64.9 years; age range, 49-80 years). Mean time to hemostasis was 6.4 min for the left and right sides each. Average POD 0 drain outputs were 13.9cc (left) and 10.1cc (right). Average POD 1 drain outputs were 15.1cc (left) and 15.6cc (right). Drains were removed on POD 1 or 2 for all patients. Complications included 2 minor (flap necrosis + infection and marginal mandibular neuropraxia) and 0 major. Conclusions Rebound bleeding associated with epinephrine is a problematic occurrence in facelift surgery. TXA safely and effectively decreased bleeding, OR time, and drain output compared to traditional local anesthetic techniques. Future goal is to determine if epinephrine can be completely removed from the local anesthetic and replaced with TXA for facelift surgery.

Titanium mesh offers a durable repair of isolated bone defects. However, in high-risk patients with soft-tissue defect, the outcomes are significantly worse. In these cases, free tissue transfer for soft-tissue coverage tends to be more successful, especially when using a myocutaneous or fasciocutaneous free flap. This is the first study to identify a high complication rate of this popular material, especially when it is combined with a locoregional scalp flap or free muscle flap. Therefore, in these cases, titanium mesh should be used with caution.

Therapeutic, III.

No abstract

Background Extremity lymphedema is a dreaded complication of ilioinguinal or axillary lymphadenectomy. In conventional lymph node dissection, no effort is performed to maintain or reestablish extremity lymphatic circulation. We hypothesized that immediate lymphatic reconstruction (ILR) could be a reproducible procedure to maintain functional lymphatic flow after ilioinguinal and axillary lymphadenectomy in patients with malignant melanoma. This is the first report describing prophylactic ILR in patients with melanoma who underwent complete lymph node dissection for gross nodal disease. Patients and Methods We report a case series of 22 malignant melanoma patients who had axillary or ilioinguinal lymph node dissection for bulky locoregional invasion with immediate lymphatic reconstruction. A novel method to identify and select lymphatics with high flow using fluorescent lymphangiogram with indocyanine green dye gradient software is described. Surgical details, common difficulties, as well as indications are discussed. Instructional videos are also provided. Results Our technique is reproducible, since we have successfully completed immediate lymphatic reconstruction in 22 cases consecutively. Intradermal indocyanine green injections allowed for visualization of 1 to 3 transected lymphatics after lymphadenectomy. An average of 1.8 lymphaticovenous bypass (range 1–3) was performed per patient. Conclusion Reestablishment of lymphatic circulation after ilioinguinal or axillary lymphadenectomy in patients with melanoma characterizes a novel method that may reduce the problem of upper and lower extremity iatrogenic lymphedema. This is particularly important given the emergence of new adjuvant treatment modalities that considerably improve patients' survival after lymphadenectomy.