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Background: The most aggressive preventive strategies may fail to prevent pulmonary embolism (PE) after liposuction. PE can cause serious life-threatening consequences and death. If hemodynamic detoriation occurs, treatment is systemic or catheter-directed fibrinolytic therapy and, if failed, surgical embolectomy. A latent risk exists for catastrophic hemorrhage when thrombolytic is administered after surgery. Thus, the use of tissue plasminogen activator (tPA) has never been studied in postoperative patients, and the safety of this medicine is unknown. In this case study, a 31-year-old obese woman was evaluated for complaints of shortness of breath, palpitations, and hypotension in the first postoperative day after liposuction. Conclusions: Successful management of massive PE with a half-dose regimen of tPA (alteplase 50 mg over 2 hours) is reported.

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BACKGROUND: The most common cause of skin graft failure is the collection of blood or serous fluid underneath the graft. In our study, we describe the use of silicone tube for tie-over dressing to secure the skin graft margins with the aim of decreasing loss of the skin graft, particularly in grafting of deep wounds. METHODS: Between March 2008 and July 2011, we used this technique in 17 patients with skin defects with depths ranging from 3.5 to 8 mm (mean, 5.5 mm). First, the skin graft was sutured with 3/0 silk suture material from its corners. Then, a silicone round drain tube was sutured with 3/0 absorbable polyglactin 910 over the margins of the graft. Finally, long silk threads were tied over the bolus dressing, and the tie-over dressing was completed in the usual fashion. RESULTS: The mean follow-up was 7 months (range, 2-10 months) in the outpatient clinic. Graft loss on the graft margins due to hematoma or seroma was not developed. The results of adhesion between the graft and wound bed peripherally was excellent. CONCLUSIONS: In our study, we suggest that use of a silicone tube for additional pressure on the edges of skin grafts in case of reconstruction of deep skin defects.

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BACKGROUND: In a random pattern skin flap, distal flap necrosis occurs as a result of inadequate blood flow. Microneedling with a handheld roller device is a new treatment modality, especially for facial rejuvenation. In this study, the authors used microneedling to increase flap viability. METHODS: Forty adult male Sprague-Dawley rats were divided into two groups of 20. The study group was exposed to McFarlane flap elevation and repositioning. The microneedling procedure was performed four times: 3 days before, on the day of, and on the third and sixth days after surgery. The control group was only exposed to surgery. The skin flap necrosis area was measured on the seventh postoperative day topographically by digital imaging and scintigraphy. After determination of necrosis area, the amount of neovascularization and number of vascular structures within the papillary dermal layer were counted histopathologically. RESULTS: The mean percentages of necrosis in the flap area as determined by the Digimizer analysis program were 37.51 ± 5.08 in the control group and 29.42 ± 7.37 in the study group. The mean percentages of flap necrosis of the control group and the study group as determined by radionuclide scintigraphy were 31.4 ± 4.1 and 22.8 ± 5.0, respectively. The comparison of flap necrosis percentages showed that the study group had significantly lower values (p < 0.001). Vessel counts in the study group also showed significant increase (p < 0.05). CONCLUSIONS: The authors' study showed that the microneedling method applied directly on the flap could be a faster, safer, and more effective therapy modality to increase flap viability.

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Achromobacter xylosoxidans (A. xylosoxidans) has been described as an opportunistic pathogen causing infection. The case we describe is that of an elderly man who had osteomyelitis of calcaneal bone caused by A. xylosoxidans. As far as we are aware there are only 5 cases of osteomyelitis with A. xylosoxidans in the literature. Impaired defensive mechanism of the foot in direct contact with this waterborne bacterium can cause this disease. Because of the high level of antibiotic resistance of this bacterium, clinically more attention should be paid to patients who have impaired defensive mechanisms in their extremities, for example free flaps.

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