Background: Among aesthetic procedures, abdominoplasty is associated with an increased complication rate. In general, postoperative nausea and vomiting is frequently experienced. As vomiting increases the intraabdominal pressure and blood pressure, and results in an increased mechanical friction on the abdominal wall, intraoperatively ligated vessels are prone to reopen. However, previous studies have not investigated the impact of postoperative emesis on postoperative hematoma in patients undergoing abdominoplasty. Methods: We performed a retrospective analysis on all patients who underwent abdominoplasty between 2017 and 2019 in our institution. Patients were divided into two groups, group 1 including patients experiencing postoperative vomiting and group two including patients without postoperative vomiting. Data extraction focused on patient characteristics, intraoperative characteristics, and postoperative complications, particularly the proportion of patients developing postoperative hematoma. Finally, statistical analysis was performed to analyze the impact of postoperative vomiting on the risk to develop a postoperative hematoma. Results: We identified 189 patients fitting our inclusion criteria. Overall, the proportion of postoperative hematoma was 13.7%. Thereby, a statistically significant difference was found between both groups: 62.5% of patients in group 1 (vomiting group) and only 9.25% in group 2 (nonvomiting group) developed a postoperative hematoma [odds ratio: 16.4 (95% confidence interval, 5.3–50.9), P < 0.000001]. Conclusion: In patients undergoing abdominoplasty, postoperative vomiting increases the risk to develop a postoperative hematoma.

Zusammenfassung: Hintergrund Eine etablierte Möglichkeit zur simultanen Rekonstruktion von Knochen- und Weichteildefekten stellt der frei vaskularisierte osteokutane Beckenkammspanlappen mit Hautinsel dar, der durch die Arteria und Vena circumflexa ilium profunda genährt wird. Die Ausprägung dieser kutanen Perforatoren ist jedoch nicht konstant. Ein alternative Rekonstruktionstechnik bei fehlenden Hautperforatoren stellt die Verwendung der sequenziell chimären Lappenplastik dar mit dem Ramus ascendens als ausschlaggebendem Anschlussgefäß. Patient und Methode Ein 58-jähriger Mann zog sich bei einem Lawinenverschüttungstrauma eine offene Tibiafraktur mit ausgedehntem Weichteil- und Knochendefekt zu. Wir rekonstruierten diesen osteokutanen Defekt mittels sequenziellem chimären Beckenkamm-SIEA-Lappen. Ergebnisse Die Schonung des Ramus ascendens der Arteria und Vena circumflexa ilium profunda ermöglichte uns die Durchführung eines sequenziell chimären Beckenkamm-SIEA-Lappens.Dieser osteokutane sequenzielle chimäre Beckenkamm-SIEA-Lappen heilte komplikationslos ein. Bei unserem Patienten entwickelte sich im Bereich der Entnahmestelle eine Hernie, die nach chirurgischer Behandlung ohne weitere Auffälligkeiten abheilte. Der Patient erlangte eine zufriedenstellende Funktion des linken Unterschenkels und kann erneut alltäglichen und sportlichen Tätigkeiten nachgehen. Schlussfolgerung Auf die Schonung des Ramus ascendens sowie die Gefäße zur Hebung entweder eines konsekutiven SIEA- oder SCIP-Lappens ist bei der Präparation des osteokutanen Beckenkammtransplantates zu achten.

Summary: Soft-tissue defects of the lateral heel remain a challenge for reconstructive surgeons. Although a reliable vascular supply for free flap anastomosis is available anteriorly from the anterior tibial vessels and medially from the posterior tibial vessels, the vascular anatomy of the lateral side lacks suitable donor vessels for free flap anastomoses. Although the pedicle can be passed either ventrally beneath the skin or dorsally between the Achilles tendon and calcaneus, these passages are hardly applicable for lateral heel defects. We identified the space between the plantar surface of the calcaneus and the plantar aponeurosis as an innovative approach for reconstruction. Therefore, we propose the subcalcaneal fat pad as an alternative and reliable route for the passage of the flap pedicle to the posterior tibial vessels in free flap reconstruction of soft-tissue defects in the lateral calcaneal region. Consequently, the vascular pedicle can be safely anastomosed to the posterior tibial vessels. This approach provides a new option for recipient vessels in free flap reconstruction.

Summary: The reconstruction of complex dorsal hand injuries can be challenging. For coverage of dorsal hand defects, thin flap tissue is preferred. In addition, it is ideal to raise flaps with minimal donor-site morbidity and a discrete scar. In a 65-year-old obese man, we successfully reconstructed a soft-tissue defect measuring 7 × 5 cm at the dorsal hand with an omental free flap harvested through single-port laparoscopy. Our patient regained hand function and is satisfied with the aesthetic results. We propose the single-port laparoscopic omental free flap to be a suitable option for free flap dorsal hand reconstruction, especially in obese patients with small defects. The technique provides a thin free tissue with a concomitant negligible donor-site scar.

Migraine affects more than 1 billion people globally, with distinct genetic variations influencing susceptibility. Thereby, genetic variations play a key role in the probability of developing migraine. However, personalized genetic analysis-based treatment options in migraine treatments are limited. Notably, surgical deactivation of extracranial trigger has shown efficacy in the treatment of migraine patients with identifiable trigger points in specific anatomical locations in the head and neck region.