The Laryngoscope

 The Laryngoscope

Establishment and verification of a mouse model of nasal wound healing

Objectives Poor wound healing as reflected by the development of synechia and osteitis after endoscopic sinus surgery may trigger disease recurrence. Animal models provide insights into the pathogenesis of poor wound healing and may aid in the development of new therapeutics. Here, we established a mouse model of nasal wound healing and confirmed its utility. Study Design Animal study. Methods Unilateral intranasal wounds were induced using a small interdental brush in 6‐week‐old C57BL/6...

The Laryngoscope

4h

Taste disorders are partly genetically determined: Role of the TAS2R38 gene, a pilot study

Objectives/Hypothesis Taste sensitivity varies greatly among individuals influencing eating behavior and health, consequently the disorders of this sense can affect the quality of life. The ability to perceive the bitter of thiourea compounds, such as phenylthiocarbamide (PTC), has been largely reported as a marker of the general taste sensitivity, food preferences, and health. PTC sensitivity is mediated by the TAS2R38 receptor and its genetic common variants. We study the role of the TAS2R38 receptor...

The Laryngoscope

4h

Somatosensory evoked potential: Preventing brachial plexus injury in transaxillary robotic surgery

Objectives/Hypothesis The potential for brachial plexopathy due to arm positioning is a major concern regarding the robotic transaxillary approach. Intraoperative nerve monitoring via somatosensory evoked potential (SSEP) has been suggested to prevent such injury. In this study, we examined the use of SSEP in detecting imminent brachial plexus traction during robotic transaxillary thyroid and parathyroid surgery. Study Design Retrospective case series. Methods A analysis was performed...

The Laryngoscope

1d

Comparative Assessment of Drug‐Induced Sleep Endoscopy Scoring Systems in Pediatric Sleep Apnea

Objectives/Hypothesis A wide variety of drug‐induced sleep endoscopy (DISE) scoring systems has been used to evaluate sites of upper airway obstruction in children and adults; however, a universally accepted DISE scoring system dedicated to children has not been developed. We evaluated the utility of DISE scoring systems in the assessment of obstructive sleep apnea (OSA) using a single cohort of pediatric patients. Study Design Retrospective chart review. Methods The medical records...

The Laryngoscope

1d

Pediatric dysphagia: Is interarytenoid mucosal height significant?

Objectives The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS). Methods A retrospective case series of 1,351 patients who underwent MDL between 2011 and...

The Laryngoscope

1d

Validation of the Chinese Velopharyngeal Insufficiency Effects on Life Outcomes Instrument

Objectives/Hypothesis To translate the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument into Chinese and test its psychometric properties. Study Design Quality of life instrument translation and validation. Methods The original English version of the VELO instrument was translated into Mandarin, back‐translated, and adapted among the Chinese population, based on the standardized guidelines for the cross‐culture adaption process. Velopharyngeal insufficiency (VPI)...

The Laryngoscope

1d

Prurigo successfully treated with duloxetine hydrochloride

Abstract

Prurigo is a common skin disease characterised by erythematous macules and papules/nodules with severe pruritus. We report here two cases with treatment‐resistant prurigo that were successfully treated with duloxetine hydrochloride, a serotonin–norepinephrine reuptake inhibitor. In vivo experiments with a mouse model of prurigo‐like inflammation showed that duloxetine hydrochloride ameliorated not only scratching behaviours, but also skin inflammation. Duloxetine hydrochloride appears to be useful for treating prurigo via modulating itch signals and immune responses.

http://bit.ly/2DvXGMh

Granular parakeratosis in an adult female secondary to exposure to benzalkonium chloride laundry rinse

http://bit.ly/2Uc36RX

Delayed immunological reaction to Integra™ skin graft

http://bit.ly/2DvaiDk

Severe in utero under-virilization in a 46,XY patient with Silver-Russell syndrome with 11p15 loss of methylation

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://bit.ly/2DvbWVo

IGF-1 assessed by pubertal status has the best positive predictive power for GH deficiency diagnosis in peripubertal children

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://bit.ly/2UaIEks

Correction to: Factors predicting long-term comorbidities in patients with Cushing’s syndrome in remission

The original version of this article unfortunately published with traditional Springer copyright instead of open access under Springer compact agreement.

http://bit.ly/2FSVrnT

Epitope spreading phenomena in dipeptidyl peptidase‐4 inhibitor‐associated bullous pemphigoid

Abstract

Dipeptidyl peptidase‐4 inhibitor‐associated bullous pemphigoid (DPP4i‐BP) has been linked to a characteristic non‐inflammatory BP phenotype and to the presence of autoantibodies directed against the midportion of BP180 ectodomain. However, DPP4i‐BP cases with clinical and immunological findings of classical inflammatory BP have also been reported.

In the September issue of the BJD, Mai et al reported three cases of DPP4i‐BP. Initially, all patients had a non‐inflammatory BP with negative anti‐BP180 NC16A autoantibodies but evolved to an inflammatory BP along with the appearance of positive antibodies against the BP180 NC16A.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Rbv9PJ

Experimentally Induced Arterial Embolism by Hyaluronic Acid Injection: Clinicopathological Observations and Treatment

BACKGROUND: Although major complications of hyaluronic acid (HA) injection rarely occur, with the rapidly growing number of procedures performed and their expanding applications, such complications warrant greater attention. Our study was designed to explore optimal treatment methods for HA-related vascular occlusion. METHODS: Part I: Thirty rats were given intra-arterial HA injected into the bilateral inferior epigastric arteries to establish an animal model and were euthanized at different post-injection time points. The inferior epigastric artery was retrieved for pathological examination. Part II: Bilateral abdominal flaps supplied by the inferior epigastric artery were elevated in six groups of rats, and HA was injected into the right side, with each group receiving a different intervention. The flap-survival rate was calculated and analyzed. RESULTS: Part I: Pathological examination revealed that the composition of the emboli caused by arterial HA-induced occlusion changed from pure HA to an HA-thrombus mixture. Part II: Flap-survival rates (mean percentages): Group A: 43.29±9.28%, Group B: 54.17±10.86%, Group C: 59.27±13.40%, Group D: 64.37±8.61%, Group E: 71.92±19.06%, Group F: 57.47±13.64% Group A differed significantly from groups B, C, D, and E (p0.05). CONCLUSION: The combined use of intravenous or subcutaneous hyaluronidase and urokinase was most effective in treating HA injection-related arterial embolism after 45 min and 24 h. This treatment may be ineffective after 48 h. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. The study is not supported by any funding source. Acknowledgements: None This article has not been presented at any meeting or conference. Corresponding author: Prof. Sheng-Kang Luo1,2 ©2019American Society of Plastic Surgeons

http://bit.ly/2CFxWv7

“Collagenase Clostridium Histolyticum for Dupuytren Contracture: Comparing Single and Concurrent Injections.”

Background: The U.S. FDA approved collagenase Clostridium histolyticum (CCH) for treatment of Dupuytren contracture in 2010, and approved CCH for the concurrent treatment of up to two cords in 2014. Although outcomes and adverse events (AEs) have been well described for single injections, comparative data on concurrent injections is lacking. Methods: We reviewed 121 concurrent CCH injections and compared these with 177 single CCH injections over eight years. All injections were performed by a single surgeon, our senior author. A retrospective cohort model was used to compare clinical outcomes and AEs (skin tears, spontaneous cord rupture, tendon rupture, lymphadenopathy, blood blisters, and ecchymosis) between groups. Results: There were no statistical differences between groups in clinical success rate or change in contracture per joint. The rate of skin tears per joint in concurrent injections (27/121, 22.3%) was not statistically different from that of single injections (33/177, 18.6%; p = 0.46), and was consistent with previously reported rates. The rate of skin tears did not change significantly over time in either group. Concurrent CCH injection was not found to influence the incidence of skin tears in a dose-dependent manner (RR 1.20). Patients receiving concurrent injections experienced a higher rate of lymphadenopathy compared to those receiving single injections (57/121, 47% vs. 51/177, 29%; p = 0.001). Conclusion: Our results show that concurrent CCH injections for Dupuytren contracture have a similar safety profile and treatment efficacy when compared to single injections. We did not find a dose-dependent relationship between skin tears and CCH injected. Financial Disclosure Statement: Dr. Friedman is a speaker for Endo Pharmaceuticals, manufacturer of collagenase Clostridium histolyticum. Dr. Cook, Dr. Waughtel, Dr. Andreoni, and Dr. Sakharpe have nothing to disclose. No funding was received for this article. This study was approved by the Cleveland Clinic Foundation institutional review board (FLA 16-085). Presented at: Plastic Surgery the Meeting (ASPS) 2017 in Orlando, Florida. Financial Disclosure Page: Financial Disclosure Statement: Dr. Friedman is a speaker for Endo Pharmaceuticals, manufacturer of collagenase Clostridium histolyticum. Dr. Cook, Dr. Waughtel, Dr. Andreoni, and Dr. Sakharpe have nothing to disclose. No funding was received for this article. Statement of Authorship: Dr. Cook, Dr. Waughtel, Dr. Andreoni, Dr. Sakharpe, and Dr. Friedman contributed equally to the development of this manuscript. Corresponding author: Jonathan Cook, MD, Department of Plastic Surgery, 2950 Cleveland Clinic Boulevard, Weston, FL 33331 USA. cookj11@ccf.org ©2019American Society of Plastic Surgeons

http://bit.ly/2RN02iC

Patient Reported Outcome Measures for Toe-to-Hand Transfer: a Prospective Longitudinal Study

Background: Patient reported outcome measures (PROMs) are an important metric in evaluating treatment efficacy of reconstructive surgery. Toe-to-hand transfer can restore vital prehensile function however this surgery is complex, extensive rehabilitation is required, and there are concerns about donor site morbidity. This study longitudinally explores the benefits of this procedure, from the patients' perspective, using PROMs. Methods: 23 patients who underwent free toe-to-hand transfers from 2012 to 2015 were evaluated pre- and post-operatively using the following validated questionnaires; the Michigan Hand Outcomes Questionnaire (MHQ), the 36-Item Short Form Health Survey (SF-36), and the Lower Limb Outcomes Questionnaire (LFQ). Subgroup analysis was performed between dominant and non-dominant reconstructed hands. Results: Mechanism of injury was crush in 83%; the remainder sustained cutting, avulsions, and burn injuries. 34 toes were transferred; nine great toes, 20 second toes and five third toes. All patients required secondary procedures for aesthetic and/or functional improvement. MHQ results showed significant improvement in overall activities of daily living, work, aesthetics, and patient satisfaction (p

http://bit.ly/2CBo7hG

“Headache in operated isolated sagittal synostosis.”

Background: This study investigates the relationship between headache and the occurrence of signs associated with intracranial hypertension (ICH) such as ophthalmic signs, restricted skull growth and a vertex bulge in children who were operated for sagittal synostosis. Methods: A total of 94 patients (aged 6-18 years) with sagittal synostosis were asked to indicate the headache frequency. Based on their age at referral, the patients had undergone either a fronto-biparietal remodeling (FBR) or an extended strip craniotomy (ESC). Data on fundoscopy, optical coherence tomography (OCT), occipitofrontal head circumference (OFC), and presence of vertex bulge on X-ray were collected retrospectively. Results: Univariate analysis showed that ESC, the occurrence of ophthalmic signs, and a smaller OFC at last follow-up, were related to more frequent headaches (p=0.01, p=0.04, and p

http://bit.ly/2RHFEiG

Long-term functional upper-extremity outcomes in adults with Apert Syndrome

Background: The goal of this study was to determine upper extremity function and health-related quality of life in a cohort of adults with Apert Syndrome. Methods: Twenty-two adults with Apert Syndrome completed the Disabilities of the Arm, Shoulder, and Hand (DASH) survey, the Short Form 36 (SF-36), and a semi-structured interview. One surgeon administered the Jebsen Hand Function Test (JHFT) and measured sensation, joint motion, and strength. Results: Median DASH score was 16.9 (IQR: 4.17-24.2) which indicated slightly greater disability than the population norm of 10.1. Median SF-36 scores were 54.5 (IQR: 43.0-61.0) for mental health and 57.0 (IQR: 46.0-59.0) for physical health – both more favorable than population norms. Total JHFT scores for dominant hand were 69.2 seconds for males and 64.7 seconds for females versus 37.8 seconds for population norms of both genders. Average lateral pinch strength was 61% of norms in males and 90% of norms in females. Average chuck pinch strength was 48% of norms in males and 78% of norms in females. More complex syndactyly resulted in worse metacarpophalangeal joint motion but no significant difference in DASH, SF-36, or other functional results. There was no difference in self-reported outcomes between patients with four (n = 8) versus five digits (n = 14) in each hand. Conclusions: In this cohort of adults with Apert syndrome, self-reported assessment of disability was more favorable than measured functional data would suggest. Despite significant functional deficits, the participants in this study had adapted remarkably well. Please note that Amir Taghinia and Rachel Yorlets are co-first authors. Corresponding Author: Amir H. Taghinia, MD, MPH, MBA, Boston Children's Hospital, Department of Plastic & Oral Surgery, 300 Longwood Avenue, Boston, Massachusetts 02115 USA. amir.taghinia@childrens.harvard.edu, +1 (617) 355-3421 Financial Disclosure Statement: We have nothing to disclose. No funding was received for this manuscript. Authorship Contributions: AHT conceived of the study, performed functional assessments on enrolled patients, and contributed to writing the manuscript. RRY analyzed the data. RRY and MD recruited and enrolled subjects, created the interview guide, collected all non-functional data, created figures, and contributed to writing the manuscript. BIL contributed to the design of the study and writing of the manuscript. JU contributed to the design of the study, identification of participants, procurement of figures, writing of the manuscript, and provided high-level guidance on clinical applicability. All authors provided critical revisions. Acknowledgements: The authors thank the study subjects who participated in the study. ©2019American Society of Plastic Surgeons

http://bit.ly/2CBnODy

“Intramedullary Screw Fixation of Metacarpal Fractures Results in Excellent Functional Outcomes: A Literature Review”

Background: Intramedullary fixation of a comminuted subcapital metacarpal fracture using a headless compression screw was first described in 2010. The purpose of this study was to identify and evaluate all studies reporting clinical outcomes of intramedullary screw fixation of metacarpal fractures. Methods: A comprehensive search of the literature was performed under PRISMA guidelines to identify all relevant studies. Variables included patient and fracture characteristics, surgical approach, and rehabilitation practices. Outcome measures included mean follow-up, complications, evidence of radiographic union, functional outcomes, and quality of life measures. Results: Nine articles for a total of 169 metacarpal fractures were identified. Average patient age was 32 years and predominantly male (86.5%) with the majority of fractures occurring in the small finger (74%). Most fractures occurred in the neck (n=66), followed by shaft (n=31), and head (n=10). The average follow-up was 11 months with an average metacarpophalangeal joint flexion of 86°(n=83) and digit total active motion of 251° (n=72). All but one study measured radiographic union, and all (n=132) resulted in 100% union at or before the latest follow-up. Grip strength was assessed in four studies, which showed an average of 96% of the contralateral hand. No serious complications were reported. Nine minor complications were reported including four cases of hardware removal in asymptomatic patients. Conclusion: The review of the literature suggests intramedullary fixation of metacarpal neck and shaft fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option resulting in excellent clinical outcomes. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at: Plastic Surgery the Meeting (ASPS) October 8, 2017 in Orlando, FL Corresponding Author: Christina M. Beck, PhD, Icahn School of Medicine at Mount Sinai, 50 East 98th Street , New York, NY, 10029, USA. Christina.beck@icahn.mssm.edu ©2019American Society of Plastic Surgeons

http://bit.ly/2RP91jr

Symmetrical Philtral Column Repair for Unilateral Cleft Lip

Background: When treating a patient with a unilateral cleft lip, the goal is to try and achieve a result that is the least perceivable at conversational distance.The end result should be a balanced and symmetrical lip with scars that are hidden or are placed in natural anatomical lines.Several methods have been described to repair the lip . The most popular repairs at present are the rotation-advancement or its modifications and the various versions of the straight line repair. Method: In our unit we have evolved a method that we title the Symmetrical Philtral Column (SPC) repair.In this method we attempt to achieve a philtral column that mirrors the philtral column on the normal side and to producing a balanced appearing lip.This method has been used for the last 14 years in over 500 patients. Results: The results have been satisfying with a lip revision rate of 6%. Conclusions: The SPC repair of a unilateral cleft lip is an effective and safe repair.The repair is easy to understand and produces results that minimises the stigmata of a cleft lip deformity. Corresponding Author: Anil Madaree, M.D., FCS (SA) , FRCS (Eng) , Inkosi Albert Luthuli Central Hospital Durban, SOUTH AFRICA ©2019American Society of Plastic Surgeons

http://bit.ly/2CFeKO8

“Cost-Effectiveness Analysis of Virtual Surgical Planning in Mandibular Reconstruction.”

Background: Due to the complex nature of osteocutaneous free flap mandibular reconstruction, modern technologies, such as Virtual Surgical Planning (VSP), have become popularized to refine the procedure. Compared with usual care, VSP has been suggested to reduce operative time and improve accuracy of postoperative reconstructive outcomes. The aim of this study is to examine the cost-effectiveness of virtual surgical planning versus usual care in mandibular reconstruction. Methods: A decision-analytic model was constructed to comparatively understand cost-effectiveness of VSP and usual care treatments based on additional costs of VSP, and costs attributed to probabilities of post-operative complications. Model structure was informed through qualitative clinical interviews from University of North Carolina (UNC) at Chapel Hill, and supported through UNC-Chapel Hill clinical data and literature. Costs and complication probabilities were estimated from the literature. Sensitivity analyses of all uncertain model parameters were performed, and distributional parameters selected based on best practices. Results: Results of base-case analysis indicated that VSP was more costly compared to usual care by a difference of US $7,099 per person. In addition, VSP did not reduce the risk of complications or flap loss. VSP cases had an increased incidence of flap loss by 0.6% and an increased incidence of mandibular infection by 6.5%. Conclusions: VSP has upfront expenses that do not necessarily translate into downstream reduction in complications or improved outcomes. Clinical decision-makers would benefit from future research to identify thresholds whereby VSP may result in more cost-savings for particular types of patients. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at: North Carolina Society of Plastic Surgeons Annual Meeting; Charleston, SC. November 2016. Corresponding author: Jeyhan S. Wood, MD, Division of Plastic and Reconstructive Surgery, 7033 Burnett-Womack Bldg, CB 7195, Chapel Hill, NC 27599-7195, jeyhan_wood@med.unc.edu ©2019American Society of Plastic Surgeons

http://bit.ly/2RIk7X6

Skin Hydration Level as a Predictor for Diabetic Wound Healing: A Retrospective Study

Background: Xerosis, defined as abnormal skin dryness and scaling, is a common disorder in patients with diabetes. The skin may crack and develop fissures, potentially allowing bacterial entry and increasing vulnerability to ulceration and infection. Therefore, maintaining adequate skin hydration may be crucial for diabetic wound healing. However, no clinical study has addressed this issue. This study aimed to determine and compare the effect of the skin hydration level on diabetic wound healing with that of the tissue oxygenation level, which is recognized as the most reliable parameter in predicting diabetic wound healing. Materials and Methods: This retrospective study included 263 diabetic patients with forefoot ulcers. Skin hydration and transcutaneous oxygen pressure (TcPO2) data collected before and after percutaneous transluminal angioplasty (PTA) were analyzed. Skin hydration and tissue oxygenation were graded as poor, moderate, or acceptable. Wound healing outcomes were graded as healed without amputation, minor amputation, or major amputation. Wound healing outcomes were compared using four parameters: skin hydration at baseline, TcPO2 at baseline, skin hydration post-PTA, and TcPO2 post-PTA. Results: Each of the four parameters exhibited statistically significant correlations with wound healing outcomes. In the concurrent analysis of both skin hydration and TcPO2, skin hydration was a dominant parameter (p = 0.0018) at baseline, whereas TcPO2 was a dominant parameter (p

http://bit.ly/2CEjALE

Postoperative Outcomes in Obese Patients that Undergo Ventral Hernia Repair vs. Ventral Hernia Repair with Concurrent Panniculectomy

Background: The safety of concurrent panniculectomy during ventral hernia repair (VHR-PAN) remains a widely debated topic. This study aims to compare outcomes in obese patients who undergo VHR-PAN versus ventral hernia repair (VHR) alone to guide surgeons on whether to perform a panniculectomy during ventral hernia repair. Methods: An eight-year retrospective cohort study was performed on obese patients who underwent VHR. Patients were divided into those who received a concurrent panniculectomy and those who did not. Postoperative complications were compared between these groups. Complications were subdivided into surgical site occurrences (SSO), surgical site occurrences that required an intervention (SSOPI), unplanned return to the operating room, and hernia recurrence. Results: A total of 223 patients were analyzed; 122 in the VHR-PAN group and 101 in the VHR-only group. Median follow-up duration was 141 days. Patients in the VHR-PAN group had more SSO (57% vs. 40%, p=0.012). Both groups had similar rates of SSOPI (39% vs 31%, p=0.179), unplanned return to the operating room (25% vs 18%, p=0.173), and hernia recurrence (23% vs 29%, p=0.326). Multivariate analysis showed that concurrent panniculectomy increased the risk of SSO by two-fold, however it did not increase the risk of SSOPI or return to the operating room. Conclusions: The addition of a panniculectomy to ventral hernia repair increases surgical site occurrences however does not increase complications that require an intervention. As such, VHR-PAN can be considered in obese patients with a symptomatic panniculus who wish to have a single-stage operation and the lifestyle benefits of a panniculectomy. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: Yvonne M. Rasko, MD, 22 South Greene St, S8D18, Baltimore, Maryland 21201 USA YRasko@som.umaryland.edu ©2019American Society of Plastic Surgeons

http://bit.ly/2RKAToM

A Virtual Surgical Planning Algorithm for Delayed Maxillomandibular Reconstruction

Background: The absence of a tumor specimen, from which to obtain measurements at the time of delayed maxillo-mandible reconstruction, introduces degrees of uncertainty creating the need for substantial intraoperative guesswork by the surgeon. Using the virtual surgical planning(VSP) environment the size and shape of missing bony elements is determined, effectively "recreating the defect" in advance of the surgery. Three VSP techniques assist the reconstructive surgeon: patient-specific modeling, mirroring the normal contralateral side, and scaled normative data. To facilitate delayed reconstruction a hierarchical algorithm utilizing VSP techniques was developed. Methods: Delayed maxillo-mandible VSP reconstructions were identified from 2009-2016. Demographics, modeling techniques, and surgical characteristics were analyzed. Results: 16 reconstructions were performed for osteoradionecrosis with displacement(50.0%) or oncologic defects(37.5%). Most patients had prior surgery(81.3%) and preoperative radiation(81.3%); 4 had failed prior reconstructions. The following delayed VSP techniques were used: patient-specific modeling based on previous imaging(43.8%), mirroring normal contralateral anatomy(37.5%), and scaled normative data(18.8%). Normative and mirrored reconstructions were designed to restore normal anatomy; however, most patient-specific VSP designs(71.4%) required non-anatomic reconstructions to accommodate soft tissue limitations and to avoid the need for a second flap. One partial flap loss required a second free flap, and one total flap failure occurred. Hardware exposure was the most common minor complication, followed by infection, dehiscence, and sinus tract formation. Conclusion: VSP has inherent advantages in delayed reconstruction when compared to traditional flap shaping techniques. An algorithmic approach based on available imaging and remaining native anatomy enables accurate reconstructive planning followed by flap transfer without the need for intraoperative guesswork. * Both authors contributed equally to this manuscript and share first authorship. Presented at the American Associations of Plastic Surgeons, Austin, Texas 2017 Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Acknowledgement: This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Corresponding author: Dr. Evan Matros, 1275 York Avenue, New York NY 10065, Matrose@mskcc.org ©2019American Society of Plastic Surgeons

http://bit.ly/2CIl33t

MANAGEMENT OF HIGH OUTPUT CHYLE LEAK AFTER HARVESTING OF VASCULARIZED SUPRACLAVICULAR LYMPH NODES

Vascularized lymph node transfer (VLNT) is a physiologic microsurgical technique used for the treatment of lymphedema. As VLNT is becoming more common, it is essential that we are aware of all potential complications associated with VLNT and know how to avoid and manage them when they do occur. We recently encountered a complication after supraclavicular vascularized lymph node transfer (SCVLNT) that has not been previously reported. A patient developed a recalcitrant high output (>500 mL/day) chyle leak in the neck donor site after harvesting of SCVLNT. In this paper, we share our experience with massive chyle leak and review the management strategies of how to effectively avoid and treat this potentially dangerous complication. This review of a previously unreported complication of SCVLNT is timely and important as this procedure is increasingly being offered to patients, and surgeons performing these procedures should be familiarly with effectively managing this potentially dangerous complication. Disclosures: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this manuscript. No funding was received for the work presented in this manuscript. Corresponding Author: David W. Chang, MD, FACS, Section of Plastic & Reconstructive Surgery, The University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Ave., Rm J641, MC 6035, Chicago, IL 60637, P: 773-702-6302, F: 773-702-1634, Email: dchang@surgery.bsd.uchicago.edu ©2019American Society of Plastic Surgeons

http://bit.ly/2RJPIrn