Nuances and Pearls of the Free Fibula Osteoseptocutaneous Flap for Reconstruction of a High-Energy Ballistic Injury Mandible Defect.

Unlabelled: A clinical case demonstrating the use of a free fibula osteoseptocutaneous flap for reconstruction of a high-energy ballistic mandible defect is detailed. The surgical videos highlight key nuances and pearls of flap design, harvest, dissection, and execution of microsurgical anastomosis. Attention is also given to preoperative surgical planning and postoperative care.

Treatment Outcomes following Traumatic Optic Neuropathy.

Background: Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual deficits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strategies, and identify factors associated with improved vision.

Methods: Institutional review board approval was obtained to retrospectively review patients diagnosed with traumatic optic neuropathy at a high-volume trauma center from 2004 to 2012.

Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations.

Background: Currently, there is a lack of clear guidelines regarding evaluation and management of giant juvenile fibroadenomas. The purpose of this study was to conduct a systematic review of giant juvenile fibroadenomas and to evaluate the most common diagnostic and therapeutic modalities.

Methods: A systematic literature search of PubMed and MEDLINE databases was conducted in February 2014 to identify articles related to giant juvenile fibroadenomas.

Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review.

This article aims to demonstrate an individualized approach to an elderly patient requiring scalp reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of scalp reconstruction (E. D.

The Identification of Maize and Arabidopsis Type I FLAVONE SYNTHASEs Links Flavones with Hormones and Biotic Interactions.

Flavones are a major group of flavonoids with diverse functions and are extensively distributed in land plants. There are two different classes of FLAVONE SYNTHASE (FNS) enzymes that catalyze the conversion of the flavanones into flavones. The FNSI class comprises soluble Fe(2+)/2-oxoglutarate-dependent dioxygenases, and FNSII enzymes are oxygen- and NADPH-dependent cytochrome P450 membrane-bound monooxygenases.

AllR Controls the Expression of Streptomyces coelicolor Allantoin Pathway Genes.

Streptomyces species are native inhabitants of soil, a natural environment where nutrients can be scarce and competition fierce. They have evolved ways to metabolize unusual nutrients, such as purines and its derivatives, which are highly abundant in soil. Catabolism of these uncommon carbon and nitrogen sources needs to be tightly regulated in response to nutrient availability and environmental stimulus.

Accidental Trichloroacetic Acid Burn in a Gynecology Office.

Background: Trichloroacetic acid is routinely used by gynecologists to treat anogenital diseases, and accidental exposure to the health care providers may result in serious burns. This case serves to raise awareness of accidental exposure of trichloroacetic acid and describes preventive, first aid, and treatment recommendations that may limit the incidence and severity of burn injury among gynecologists.

Case: A 32-year-old female gynecologist incurred a deep second-degree, 12×14-cm, work-related chemical burn by unintentionally spilling a container of approximately 20 mL of 80% trichloroacetic acid onto her right thigh during an outpatient procedure.

Manson's point: A facial landmark to identify the facial artery.

Introduction: The anatomy of the facial artery, its tortuosity, and branch patterns are well documented. To date, a reliable method of identifying the facial artery, based on surface landmarks, has not been described. The purpose of this study is to characterize the relationship of the facial artery with several facial topographic landmarks, and to identify a location where the facial artery could predictably be identified.

Extracapsular Mandibular Condyle Fractures Are Associated with Severe Blunt Internal Carotid Artery Injury: Analysis of 605 Patients.

Background: Mandibular condyle fractures are common following facial trauma and carry an increased risk for concomitant blunt carotid artery injuries. Further elucidation of this relationship may improve vascular injury screening and management.

Methods: A retrospective cohort study was performed for all patients sustaining condylar fractures presenting to a large trauma center over twelve years.

Intraoral Microvascular Anastomosis of an Iliac Free Flap for Maxillary Fibrous Dysplasia.

Microvascular reconstruction offers patients with facial deformities excellent composite tissue restoration and improves functional outcomes. However, such techniques require facial skin incisions, leaving the patient with unsightly scarring. Implementing an intraoral microvascular anastomosis can obviate the need for facial skin incisions, yielding aesthetically favorable results.

Microsurgical Reconstruction of Complex Scalp Defects: An Appraisal of Flap Selection and the Timing of Complications.

Background: The purposes of this study were to report a 7-year experience of microvascular reconstruction of scalp defects, compare flap type and outcomes, and evaluate the implications of short and long term complications.

Methods: Following institutional review board approval, a single surgeon's patients requiring microvascular scalp reconstruction were retrospectively reviewed from 2005 to 2011. Flap choice, complications, and outcomes were statistically analyzed.

A mass in the junction of the body and tail of the pancreas with negative IgG4 serology: IgG4-related disease with negative serology.

Background: Autoimmune pancreatitis is an IgG4-related fibroinflammatory condition often associated with obstructive jaundice, as most lesions are located at the head of the pancreas. IgG4 level can help in the diagnosis, but it is normal in nearly 30% of affected patients.

Case Report: A 55-year-old woman presented with a 5-month history of 20-pound unintentional weight loss and intermittent abdominal pain.

Defining the Role of Skin and Mucosal Biopsy in Facial Allotransplantation: A 2-Year Review and Analysis of Histology.

Background: The implications of allograft skin and mucosal biopsy findings on classification of rejection and treatment remain unclear.

Methods: Following facial allotransplantation, scheduled surveillance allograft skin and mucosal biopsy specimens were obtained. Clinical concern for acute rejection prompted biopsies off schedule.

Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes.

Objectives/hypothesis: The purpose of this systematic review was to critically analyze infectious complications and treatment following transcartilaginous ear piercing.

Data Sources: MEDLINE Pubmed database.

Review Methods: A MEDLINE PubMed database search using free text, including "ear chondritis," "ear perichondritis," "ear cartilage piercing," and "auricle piercing," yielded 483 titles.

Classification of mandible defects and algorithm for microvascular reconstruction.

Background: Composite mandibular tissue loss results in significant functional impairment and cosmetic deformity. This study classifies patterns of mandibular composite tissue loss and describes a microvascular treatment algorithm.

Methods: A retrospective review of microvascular composite mandibular reconstruction from July of 2005 to April of 2013 by the senior surgeon at the R Adams Cowley Shock Trauma Center and at The Johns Hopkins Hospital yielded 24 patients with a mean follow-up of 17.

Rapid aneurysm growth after transarterial chemoembolization.

Chemotherapy has been anecdotally related to aneurysm growth, but no correlation has been noted to date for localized transarterial chemoembolization. We present the case of a 64-year-old man with clearly documented accelerated aortic and iliac artery aneurysm dilation after two rounds of transarterial chemoembolization for hepatocellular carcinoma. Given the large size with rapid growth of his aneurysms and inability to be listed for transplant consideration before repair, he was offered endovascular repair and was successfully treated.

Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region.

Background: Multiple perfusion assessment technologies exist to identify compromised microvascular free flaps. The effectiveness, operability, and cost of each technology vary. The authors investigated surgeon preference and clinical behavior with several perfusion assessment technologies.

Microsurgical scalp reconstruction in the elderly: a systematic review and pooled analysis of the current data.

Background: Microvascular reconstruction is the mainstay of treatment in complex scalp defects. The rate of elderly patients requiring scalp reconstruction is increasing, but outcomes in elderly patients are unclear. The purpose of this study was to systematically review the literature pertaining to free tissue transfer for scalp reconstruction in patients older than 65 years to compare outcomes among different free flaps and determine the safety profile of treatment.

Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice.

Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third.

Severe strongyloidiasis with negative serology after corticosteroid treatment.

Background: Strongyloidiasis usually presents as a chronic and limited disease, but in some immunocompromised patients it may become a life-threatening disease.

Case Report: A 77-year-old Haitian male, with history of temporal arteritis on 40 mg of oral prednisone presented complaining of decreased oral intake, epigastric pain, and non-bloody diarrhea. He had bi-temporal wasting and a distended abdomen but without guarding or tenderness.

Acute appendicitis secondary to acute promyelocytic leukemia.

Background: The gastrointestinal tract is a rare site for extramedullary involvement in acute promyelocytic leukemia (APL).

Case Report: A 43-year-old female with no past medical history presented complaining of mild abdominal pain, fever, and chills for the past day. On examination, she was tachycardic and febrile, with mild tenderness of her right lower quadrant and without signs of peritoneal irritation.