Citations

Objectives/Hypothesis Evaluate feasibility and success of elongating only the venous pedicle of the submental flap to increase the superior arc of rotation for the “hybrid” flap allowing coverage of more distal defects. Study Design Retrospective evaluation of all submental flaps undergoing pedicle‐lengthening procedure at a single institution. Methods Medical records were reviewed for all patients undergoing reconstruction with submental flaps between 2002 and 2012. Information regarding demographics, etiology, location, size, and extent of defects, type of submental flap harvested, operative time, and outcomes were recorded. Special note was made of vascular pedicle length and any pedicle vessel manipulation to increase the superior arc of rotation. Results Nine patients (67% male) with a mean age of 61 years (range, 25–83 years) underwent hybrid submental flap procedures. Eight surgical defects resulted from cancer ablation and one from trauma. Five flaps were musculocutaneous, and four were osseomusculocutaneous. The divided pedicle vein was anastomosed to the external jugular vein (n = 6), retromandibular vein (n = 1), common facial vein (n = 1), and internal jugular vein (n = 1). Pedicle vessel elongation averaged 5 cm. Skin paddle size averaged 71 cm 2 (range, 48–99 cm 2 ). All donor sites were closed primarily with no further surgery required. One flap experienced venous thrombosis and was successfully salvaged. Overall flap survival was 100%. No local or regional cancer recurrence was detected in the cancer patients with a mean follow‐up of 20 months (range, 3–87 months). Conclusions The hybrid submental flap safely extends the arc of rotation 5 cm, allowing coverage of defects in the forehead, temporal‐parietal, and occipital regions. Level of Evidence 4. Laryngoscope , 124:637–641, 2014

ABSTRACTThis study investigated the internal fluid pressure of human cadaver meniscal root attachments. A pressure micro‐sensor was implanted inside each attachment site. Tibiofemoral joints were compressed to 2× body weight at various flexion angles and pressure recorded for 20 min. The anterior cruciate ligament (ACL) was then transected and joints retested. Lastly, a longitudinal incision of the lateral posterior (LP) horn was made and the joint retested. Ramp pressure was defined as the pressure when 2× body weight was reached, and equilibrium pressure was recorded at the end of the hold period. The medial posterior (MP) attachment was subjected to greater ramp pressure than the medial anterior (p = 0.002) and greater equilibrium pressure than all other root attachment sites (p < 0.001). Flexion angle had a significant effect on pressure as full extension was greatest at ramp (p = 0.040). Transection of the ACL decreased ramp pressure in the LP attachment (p = 0.025) and increased equilibrium pressure (p = 0.031) in the MP attachment. The results suggest that repair strategies should be developed which reconstruct the MP attachments to be sufficient to withstand large pressures. Furthermore, since meniscal pressure is highest at full extension, this fact should be considered when prescribing rehabilitation following repair of an attachment. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1507–1513, 2013

BACKGROUNDFluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) tests are commonly used to assess human epidermal growth factor 2 (HER2) status of tumors in patients with breast cancer. This analysis evaluates the likely cost‐effectiveness of expanded retesting to assess HER2 tumor status in women with early stage breast cancer.METHODSWe developed a decision‐analytic model to estimate the incremental cost‐effectiveness ratio (ICER) of expanded reflex testing from a US payer perspective. Expanded reflex testing is defined as retesting tumor specimens from patients whose tumors are IHC0, IHC1+, or FISH‐negative on their first test. In the base case, we assumed that 80% of patient tumors are initially IHC‐tested and 20% are FISH‐tested. Testing outcomes for IHC and FISH with and without retesting were based on published meta‐analyses. The cost of tests and treatment and the long‐term health outcomes were obtained from the literature.RESULTSIn the base case, we estimated that 2.27% of women who received expanded reflex testing would be HER2‐positive and receive trastuzumab treatment: the projected ICER was $36,721 per life year or $39,745 per quality‐adjusted life year (QALY). This varied between $47,100 per QALY and $35,500 per QALY if we assumed that 1%‐8% of patients retested were then HER2+, respectively. The results of deterministic and probabilistic sensitivity analysis were robust. This strategy would result in 4700 (2000‐17,000) patients being eligible to receive trastuzumab treatment annually.CONCLUSIONSRetesting patients who are IHC0, IHC1+, or FISH‐negative is projected to be a cost‐effective clinical strategy. Cancer 2013;119:3113–3122. © 2013 American Cancer Society.