Eric L. Wan

Injured Anterior Superior Alveolar Nerve Endoscopically Resected within Maxillary Sinus

Posttraumatic facial pain is due to an injured nerve, most often a branch of the trigeminal nerve. While surgical approaches to injuries of the supraorbital, supratrochlear, infraorbital, and inferior alveolar nerves have been reported, an injury to the anterior superior alveolar nerve (ASAN) has not been reported. An algorithm is proposed for the diagnosis of injury to the ASAN versus the infraorbital nerve itself. A case is reported in which pain relief was achieved by dividing the ASAN within the maxillary sinus, leaving the proximal end exposed within the sinus at the level of the orbital floor.

Treatment of Peripheral Neuropathy in Leprosy: The Case for Nerve Decompression.

Summary: Plastic surgery has a tradition of caring for patients with facial deformity and hand deformity related to leprosy. The approach, however, to the progressive deformity and disability related to chronic nerve compression is underappreciated in the world today. A cohort of patients with leprous neuropathy from an indigenous area of leprosy in Ecuador was evaluated for the presence of chronic peripheral nerve compression, and 12 patients were chosen for simultaneous upper and lower extremity, unilateral, nerve decompression at multiple levels along the course of each nerve. The results at 1 year of follow-up show that 6 patients improved into the excellent category and 4 patients improved into the good category for improved function. Based on the early results in this small cohort of patients with leprous neuropathy, an approach to peripheral nerve decompression, encompassing the concept of multiple crush at multiple levels of each nerve, seems to offer optimism to improve upper and lower extremity limb function. Long-term studies with quality-of-life outcomes would be welcome.

Abstract 52: Health-Related Quality of Life Throughout the Breast Reconstruction Process

PURPOSE: Patients’ adherence to their immunosuppressive regimen is vital for favorable immunologic and functional outcomes. Poor medication adherence MA remains a major cause of preventable graft rejection. Selfand physician report are the common methods used to assess adherence in clinical settings, they are often inaccurate and may underestimate nonadherence. Data related to MA and accurate method to assess MA in upper extremity transplants (UETs) have not been adequately evaluated and are thus not available. We present our experience of MA monitoring utilizing an objective and subjective battery of measures including patient, protocol (drugs/endogenous materials level measurement), graft, and physician related metrics.

Injury to the perineal branch of the pudendal nerve in men: Outcomes from surgical resection of the perineal branches

The objective is to report the outcome of an anterior surgical approach to treat neuroma of the perineal branch of the pudendal nerve (PBPN).

Abstract 9. Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy: a Cohort Study of 211 Breast Reconstruction Patients Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy

RESULTS: Hundred and sixteen pre-and post-operative 3D photo data sets were included. The sample included 29 subjects. The facial volume was analyzed both overall and comparing each subgroup (orthognathic versus orthognathic + fat grafting group). Post-operative facial volume increase averaged 23.7% for the entire cohort (FG and nFG). By week twelve, the swelling decreased about 62% from baseline. In all patients, there was a statistically significant decrease in facial volume with time. In the fat-grafted group, despite adding volume, was equal to the non-fat grafted group at week 1, yet the rate of decrease was faster with fat grafting at week 12.

Abstract 4: Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy: a Cohort Study of 211 Breast Reconstruction Patients

CONCLUSIONS: For the first time, our results reveal a decrease of the stemness marker CD34 in murine skin cells in hypertrophic scars over time compared to unwounded skin. We are currently conducting single cell transcriptional analyses and functional studies on these fibroblasts to understand the heterogeneity of fibroblasts during hypertrophic scarring and the specific role of CD34+ fibroblasts in skin fibrosis. Our findings have promising therapeutic implications for the treatment of skin fibrosis.

Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches

Background This study describes outcomes from a new surgical approach to treat “anterior” pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN). Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS). Results Fourteen patients reported their condition pre‐ and postoperatively. Mean postoperative follow‐up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms. Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.