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Background and Objectives: Breast cancer-related lymphedema (BCRL) is a complication of axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may help to decrease lymphedema after ALND by creating lymphatic bypasses. This retrospective single-institution study aimed to compare lymphedema in patients undergoing ALND with and without ILR. Materials and Methods: Bioimpedance and limb measurements determined the presence of BCRL. The categorical data that were collected and analyzed included BMI, comorbidities, BCRL onset, and number of lymphatic bypasses. Pearson’s chi-square test and multivariable logistic regression were performed to identify factors associated with the onset of lymphedema. An odds ratio compared the incidence of BCRL with and without ILR. Results: In total, 186 patients underwent ALND, 44 (24%) with ILR and 142 (76%) without. The mean number of bypasses during ILRs created was 3.54. The odds of developing lymphedema with ILR were 64% lower than for ALND alone. ILR patients who developed BCRL had a mean onset of 543 days post-operatively versus 389 days in the control group. Age, ethnicity, BMI, and bypass amount had no significant influence on lymphedema development. Conclusions: ILR was associated with lower rates of BCRL after ALND. Patients who developed lymphedema despite undergoing ILR did so 8 months later than the controls.

Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients.

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care.

Additionally, he had an extensive medical and surgical history, which included coronary artery disease treated with coronary artery bypass grafting, atrial fibrillation, end-stage renal disease requiring hemodialysis, and an uncomplicated elective aortic aneurysm repair 25 years prior. CT scan is of benefit because it can reveal inflammation, loss of perigraft fat planes, air bubbles, or abscesses surrounding the aortic prosthesis, which suggest graft infection and possible fistula formation with a sensitivity rate of 83.3 per cent, specificity of 99.7 per cent, and accuracy rate of 93.7 per cent.1 The management of AEF is surgical with three goals in mind: 1 treatment of the compromised graft to prevent exsanguination and sepsis; 2 restoration of distal blood flow; and 3 repair of the gastrointestinal defect.

Typically EXOS affect the older patient, usually presenting in the sixth decade of life, in contrast to their skeletal counterparts that normally present in the first three decades of life. 1_3 Males are predominantly affected with a male to female ratio of 1.9: 1.1 The lower extremity is the most common location (50 to 68%) followed by the upper extremity (1 1.5%) and the retroperitoneum (1 1.5 to 17%). Preoperative evaluation in patients with retroperitoneal sarcomas should include a thorough history and physical examination with special focus on symptoms and signs of lymphoma, germ cell tumors, and adrenal tumors.

Type II hernias involve acute appendicitis localized to the sac, in which case appendectomy via the inguinal incision is performed and a tissue repair of the hernia is done. Type III hernias involve acute appendicitis with peritonitis and are treated with appendectomy via laparotomy, and endogenous repair.

Despite significant advances, wound management remains a medical challenge and a major health-expense problem. Currently, a wide range of therapeutic interventions are available for wound care. This is only partially explained by the variability in the presenting clinical situation and shows that there is no panacea for this complex medical problem. Over time, a multitude of interventions have been proposed as solutions for faster and more effective healing; however, only a few are still part of the wound care armamentarium today. Based on the fact that platelets contain a high concentration of growth factors, the application of platelet-enriched plasma over wound sites was recently introduced as a novel therapeutic modality. As increasing evidence started to validate its benefit, several devices for platelet-rich plasma preparation became available. Here, we present the most recently introduced platelet concentration system and provide insights on the current and possible future applications of this treatment modality.