Extensive Cellulitic Infection and Tissue Necrosis in a Patient With Hyper IgE Syndrome: Surgical Management of a Rare Immunodeficiency.

Hyper IgE syndrome (HIES) is a rare primary immunodeficiency that is characterized by elevated serum IgE levels, recurrent sinopulmonary infections, and chronic eczema, among other symptoms. Though reports on patients with HIES exist, they primarily focus on the clinical features, diagnosis, and management of HIES without detailing surgical interventions. Here, we present the surgical management of an extensive cellulitic infection that developed into skin necrosis in an HIES patient with a history of polysubstance abuse.

Technique to Reduce Wound Size: The Double-Opposing Purse-String and Horizontal Continuous Closure Algorithm.

Background: Surgical reconstruction of complex wounds requires considerable planning to ensure optimal patient outcomes. A conservative approach utilizing the lower tiers of the reconstructive ladder is preferred, especially in patients with comorbidities lending to a higher risk of poor wound healing. A simplified, low-risk solution with a double-opposing purse-string suture (PSS) and horizontal continuous closure technique may be particularly helpful in reducing the need for more complex techniques of wound reconstruction in select patient populations.

Breast Reconstruction With Subpectoral, Air-Filled Tissue Expander Following Nipple-Sparing Mastectomy: A Safe Alternative to Saline-Filled Tissue Expanders.

Background: Compared with immediate implant-based reconstruction, staged reconstruction using tissue expanders has been reported to have decreased nipple and mastectomy flap necrosis. Immediate filling of the expander with saline can place unnecessary pressure on the mastectomy flaps, increasing the risk of ischemia. Tissue expanders come packaged pre-expanded with air.