David A. Jansen

Surgical site infection after breast reconstruction is associated with increased length of hospital stay, readmission rates, cost, morbidity, and mortality. Identifying methods to reduce surgical site infection without the use of antibiotics may be beneficial at reducing antimicrobial resistance, reserving the use of antibiotics for more severe cases. Quaternary ammonium salts have previously been shown to be a safe and effective antimicrobial agent in the setting of in vitro and in vivo animal experiments. A retrospective study was conducted to investigate the antimicrobial properties of a quaternary ammonium salt, 3-trimethoxysilyl propyldimethyloctadecyl ammonium chloride (QAS-3PAC; Bio-spear), at reducing surgical drain site colonization and infection after breast reconstruction (deep inferior epigastric perforator flap reconstruction or tissue expander placement). Twenty patients were enrolled, with 14 surgical drains covered with nonimpregnated gauze and 17 surgical drains covered with QAS-3PAC impregnated gauze, for the purposes of investigating bacterial colonization. Antibiotic sensitivity analysis was also conducted when bacterial cultures were positive. The overall incidence of bacterial colonization of surgical drains was lower in the treatment group compared with the control group (17.6% vs 64.3%, respectively; P = 0.008). QAS-3PAC impregnated gauze reduced the incidence of bacterial colonization of surgical drains during the first (0.0% vs 33.3%) and second (33.3% vs 87.5%; P = 0.04) postoperative week. Furthermore, no enhanced antibiotic resistance was noted on drains treated with QAS-3PAC impregnated gauze. The results of this study suggest that QAS-3PAC impregnated gauze applied over surgical drains may be an effective method for reducing the incidence of bacterial colonization.

Membrane vesicles released by neoplastic cells into extracellular medium contain potential of carrying arrays of oncogenic molecules including proteins and microRNAs (miRNA). Extracellular (exosome-like) vesicles play a major role in cell-to-cell communication. Thus, the characterization of proteins and miRNAs of exosome-like vesicles is imperative in clarifying intercellular signaling as well as identifying disease markers.

Craniosynostosis (CSS) results from the premature closure of one or more cranial sutures, leading to deformed calvaria at birth. It is a common finding in children with an incidence of one in 2000 births. Surgery is required in order to release the synostotic constraint and promote normal calvaria growth. Cranial vault remodeling is the surgical approach to CSS repair at our institution and it involves excision of the frontal, parietal, and occipital bones. The purpose of this article is to describe the post-operative course of infants and children admitted to our PICU after undergoing cranial vault remodeling for primary CSS.

Background: Soft-tissue fillers have become increasingly prominent in the practice of facial aesthetic medicine. The authors sought to evaluate the long-term clinical efficacy and safety of a calcium hydroxylapatite-based filler (Radiesse) for facial soft-tissue augmentation. Methods: A total of 609 subjects received calcium hydroxylapatite injections in several facial areas: the nasolabial folds, marionette lines, oral commissure, cheeks, chin, lips, and radial lip lines. Follow-up patient satisfaction surveys were conducted at 6 months and again between 12 and 24 months. Treatment satisfaction was based on a scale of 1 (least satisfied) to 5 (most satisfied) using subjective self-evaluation of preoperative photographs. Subjects were also asked whether they would use the treatment again. Adverse events were recorded immediately after treatment and at follow-up visits. Results: Of the total number of survey requests, 155 subjects provided 6-month follow-up data and 112 subjects provided long-term 12- to 24-month data. The average satisfaction rating at 6 months was 3.94. A total of 138 of 155 subjects (89 percent) at 6 months and 83 of 112 (74 percent) at 12 to 24 months stated that they would use the treatment again. The only side effect observed was the development of easily treated nodules, reported by 42 of 338 of lip mucosa augmentation subjects (12.4 percent) and six of 163 of subjects (3.7 percent) who had treatment for radial lip lines. The proportion of subjects with lip nodules decreased to 8.8 percent when the implant volume was decreased. Conclusions: The calcium hydroxylapatite-based implant is a safe, long-lasting, highly effective, and well-tolerated agent for many areas of facial soft-tissue augmentation.

Each year the plastic surgery industry has a newer, better, soft tissue filler. Most plastic surgeons are very skeptical about the newest product. The goal is always an injectable, affordable, long-lasting filler. We have recently witnessed a dramatic increase in the available fillers for use in perioral rejuvenation. Thus, it is necessary to discuss state-of-the art fillers now available, the techniques used, potential pitfalls in use, and results. Solutions to problematic areas in perioral rejuvenation are presented. There does not appear yet to be an ideal filler; instead most plastic surgeons have an algorithm for modest, moderate, and dramatic improvement in facial soft tissue needs. Our practice has more recently focused on various combinations of Alloderm™, fat, and hydroxylapitate injectable microspheres (Radiance™) to fill most of these needs. We strongly suggest that plastic surgeons become facile with three or four fillers to address a wider range of soft tissue needs. We present an in-depth discussion of the most common available fillers and show the risks and benefits we have experienced with each.

Some variation in breast size is normal and is common in most women. When this variation becomes large and appreciable asymmetry develops—greater than a one‐cup size difference—the asymmetry often di...