The adult retina is organized into three cellular layers--an outer photoreceptor, a middle interneuron and an inner retinal ganglion cell (RGC) layer. Although the retinal pigment epithelium (RPE) and Müller cells are important in the establishment and maintenance of this organization, the signals involved are unknown. Here we show that Sonic hedgehog signaling from RGCs is required for the normal laminar organization in the vertebrate retina.
Acute fluid requirements in toxic epidermal necrolysis (TEN) have neither been quantified nor reported. The purpose of this study was to examine acute fluid administration in TEN patients. A consecutive series of criteria and biopsy-confirmed cases of TEN admitted to our burn centre were selected for retrospective analysis. Charts were reviewed for demographic and resuscitation variables for the first (D0), second (D1), and third (D2) 24-hour periods after burn center admission. Twenty-one TEN cases were available for study, with a mean epidermal detachment of 53 +/- 24% TBSA. Mortality was 29%, with all deaths occurring after the study period. Average crystalloid volumes decreased from D0 (2.2 +/- 1.5 ml/kg/%TBSA) through D1 (1.6 +/- 1.1 ml/kg/%TBSA) and D2 (1.4 +/- 1.0 ml/kg/%TBSA), whereas urine output increased from D0 (1.3 +/- 0.9 ml/kg/hr) through D1 (1.4 +/- 0.9 ml/kg/hr) and D2 (1.8 +/- 1.1 ml/kg/hr). Worst base deficit (BD) corrected significantly from D0 to D1 (P = .01) and from D1 to D2 (P = .002). There was no correlation between daily crystalloid volumes and %TBSA detachment. Nonsurvivors had significantly higher severity-of-illness score for TEN and 24-hour mean and worst BDs than survivors, but did not require significantly more crystalloid or display lower urine outputs. Initial provision of approximately 2 ml/kg/%TBSA epidermal detachment to patients with TEN resulted in more than adequate urine output and significant correction of the BD. We emphasize that these data do not represent a resuscitation formula but rather a guideline for initial fluid administration, which should then be titrated to the patient's response.
Background Free tissue transfer is the most common modality for distal third lower extremity reconstruction, yet complication rates remain high. The serratus anterior muscle free flap, which can be harvested alone or as a chimeric flap, is a robust and reliable option that remains the primary modality for distal third lower extremity defects at our institution. The objective of this study was to perform a systematic review of lower extremity reconstruction with the serratus anterior free flap and provide a retrospective review of cases at our institution.
Methods A systematic review of the literature was conducted using PubMed, Embase, and Cochrane Library (PROSPERO CRD42018110692). Articles reporting reconstruction of lower extremity and foot defects using serratus anterior free flaps in adults were included. A retrospective cohort study of serratus anterior free flaps was then performed from 2012 to 2018 at our institution.
Results Thirty-seven articles meeting inclusion criteria provided data on 198 flaps: 125 (63%) serratus-only flaps and 73 (37%) chimeric flaps based on the subscapular axis. Among the serratus-only flaps, defects were primarily due to chronic wounds (51%) or acute infections (33%). Flap survival rate was 97%, and the major and minor complication rates were 5 and 9%, respectively. Of the 10 cases included in the case series, flap survival rate was 100%, there were no major complications, and the minor complication rate was 44%. The average time to flap healing was 95 days and average lower extremity functional scale score was 58/80 among five patients.
Conclusion Serratus anterior muscle free flaps are a versatile and reliable option for distal third lower extremity reconstruction.
The use of polyacrylamide hydrogel (PAAG) as an injectable filler for breast augmentation has fallen out of popularity since its first use in the 1980s, but has produced an increasing patient population presenting with complications related to PAAG injections. PAAG use was popularized most notably in China, Russia and Iran. However, given immigration trends and medical tourism, PAAG-related complications have become increasingly more common in North America. These complications can be difficult to treat, often necessitating complex surgery that includes gel removal, debridement procedures and, often, breast reconstruction. Approaches to surgical treatment and subsequent breast reconstruction are not universally defined primarily because of the limited knowledge about this group of patients. The present article presents the option of autologous free flap reconstruction for a patient with extensive muscular involvement, and aims to summarize complications and risks associated with PAAG through a case presentation and literature review.
The use of polyacrylamide hydrogel (PAAG) as an injectable filler for breast augmentation has fallen out of popularity since its first use in the 1980s but has produced an increasing patient population presenting with complications related to PAAG injections. Polyacrylamide hydrogel use was popularized most notably in China, Russia, and Iran. However, given immigration trends and medical tourism, PAAG-related complications have become increasingly more common in North America. These complications can be difficult to treat, often necessitating complex surgery that includes gel removal, debridement procedures, and often breast reconstruction. Approaches to surgical treatment and subsequent breast reconstruction are not universally defined primarily because of the limited knowledge about this group of patients. This article presents the option of autologous free flap reconstruction for a patient with extensive muscular involvement and aims to summarize complications and risks associated with PAAG through case report and a review of the literature. Résumé L'hydrogel de polyacrylamide (PAAG) utilisé comme produit de remplissage injectable pour l'augmentation mammaire a perdu toute sa popularité depuis sa première utilisation dans les années 1980, mais est responsable d'une population croissante de patientes ayant des complications liées aux injections de PAAG. L'utilisation de PAAG a surtoutété popularisée en Chine, en Russie et en Iran, maisétant donné les tendances d'immigration et le tourisme médical, les complications qui s'y rapportent sont de plus en plus courantes en Amérique du Nord. Ces complications peuventêtre difficiles à traiter, exigent souvent des opérations complexes qui comprennent l'extraction du gel, des interventions de débridement et, dans bien des cas, une reconstruction mammaire. Les approches au traitement chirurgical et la reconstruction mammaire subséquente ne sont pas universelles en première ligne, en raison des connaissances limitées au sujet de ce groupe de patientes. Le présent article présente la possibilité de reconstruction autologue par lambeau libre chez une patiente ayant une importante atteinte musculaire. De plus, les complications et les risques associés au PAAG y sont résumés dans le rapport de cas et une analyse bibliographique.
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