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Auricle reconstruction is a challenging problem in plastic surgery due to the ear's prominent location, complex anatomy, and limited local tissue availability. The Dieffenbach flap, a folded postauricular flap, offers a viable flap for reconstruction of larger ear defects. Although the technique has been well defined in previous literature, there are few studies evaluating its outcomes and complications. The authors conducted a retrospective review of patients who underwent auricle reconstruction with the Dieffenbach flap by a single surgeon between 2016 and 2022. Data collection included demographics, medical history, cancer type, defect characteristics, postoperative care, outcomes, and complications. Univariable analyses using the Fischer exact test assessed the association between risk factors (smoking, anticoagulation use, and age) and complication rates, with P ≤ 0.05 considered statistically significant. A total of 40 patients were included in this study, with a mean age of 67.6 and a male prevalence of 77.5%. The mean defect size was 6.5 cm2, with most defects located on the superior helix. The most common complication was postoperative cellulitis (3 patients, 7.5%), followed by contour abnormality that required revision surgery (2 patients, 5.0%). History of smoking had a statistically significant association with complications (P = 0.013). Use of anticoagulants, or older age (defined as >70 years), had no significant association with complication risk. The Dieffenbach flap remains a reliable method for reconstruction of various auricle defects. It is low maintenance, well tolerated by patients, and involves minimal donor site morbidity without the need for cartilage.

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PURPOSE: Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area's complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects. METHODS: This retrospective review examines a single surgeon's experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations. RESULTS: In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11 cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds. CONCLUSIONS: While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.

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The Dieffenbach flap is often used for post-Mohs reconstruction of auricle defects, effectively restoring the auricle rim. However, its impact on auricle projection and length after division and inset is not well-documented. This study evaluates auricle projection and length following defect repair with the Dieffenbach flap, comparing results to the nonoperative ear. We conducted a retrospective review of patients who underwent a Dieffenbach flap repair surgery at a single institution from 2016 to 2023. Auricle projection and length of the reconstructed ear were measured within the first month following division and inset of the flap and compared with the contralateral ear. A subset of patients had additional measurements > 1 month following division and inset, and these measurements were compared with the contralateral ear. Our study included 23 patients with an average age 67.4 years and 78.3% male. Within 1 month following division and inset, the Dieffenbach flap resulted in a significant decrease in auricle projection (16.5 vs. 18.6 mm, p < 0.05) and length (67.0 vs. 69.7 mm, p < 0.05) compared with the contralateral ear. Subsequent follow-up showed no significant differences in projection (18.5 vs. 18.5 mm, p = 0.98) or length (68.0 vs. 68.7 mm, p = 0.54). Following division and inset of the Dieffenbach flap, auricle projection and length experience initial reduction but subsequently self-correct to match the contralateral ear.

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Debris strikes on operational spacecraft are becoming more common due to increasing numbers of space objects. Sample return missions indicate hundreds of minor strikes, but rigorous analysis is often only performed when a strike causes an anomaly in spacecraft performance. Developing techniques to identify and assess minor strikes that do not immediately cause anomalous behavior can help to validate models for debris populations, perform risk assessments, and aid in the attribution of future anomalies. This study introduces debris strikes to a spacecraft dynamics simulation and assesses the effect on spacecraft telemetry. Various signal processing and change detection techniques are used to identify strikes in noisy telemetry and estimate strike parameters. Matched filter wavelets are developed to identify the effects on state telemetry, where errors are autonomously corrected by the spacecraft attitude control system. A bank of matched filters is used to estimate the parameters of the strike based on a priori knowledge of the spacecraft's response characteristics. A sequential probability ratio test is used to highlight abrupt changes in the spacecraft's angular momentum. Monte-Carlo analyses are conducted to characterize the performance of these algorithms. The results of the various techniques are compared in terms of correctly identifying the debris strikes and accurately estimating the strike parameters. Developing the capability to catalog and characterize minor debris strikes allows any spacecraft to be used as an in situ debris sensor.

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Purpose Constipation in hospitalised older adults leads to adverse events and prolonged stay. The purpose of this paper, therefore, is to effectively prevent and manage constipation in older adults undergoing inpatient rehabilitation using a multidisciplinary war on constipation (WOC) algorithm. Design/methodology/approach A quality improvement project in older adults undergoing rehabilitation for prevention and constipation management was conducted. Quality improvement "plan-do-study-act" cycles included an initial constipation audit in the wards and meetings with the multidisciplinary team (MDT) to develop an algorithm for the preventing, detecting and effectively treating constipation. Findings The project resulted in a 14 per cent reduction in constipation incidence after the newly developed WOC algorithm was introduced. The project also improved communication between patients and the MDT around patients' bowel habits. Practical implications The project shows that using quality improvement methods in rehabilitation settings, earlier detection, earlier intervention and overall reduction in constipation in older adults can be achieved. Originality/value The WOC algorithm has been developed and institutionalised in the current setting. This algorithm may also be applicable in other inpatient settings.

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The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a "hot topic" in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her to the emergency department. The girl's statements and photographs, as reported by her parents, were used by an emergency physician to make a diagnosis of suicidal risk and to disposition of the patient to an inpatient psychiatric ward. We discuss the potential diagnostic utility of information posted on Facebook and briefly discuss the ethical questions surrounding this situation.

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Excess visceral adiposity is associated with increased gastrointestinal cancer risk. Evidence suggests that the systemic inflammation and dysmetabolism observed in visceral obesity underpins this association. Along with magnetic resonance imaging, computed tomography is a gold standard for abdominal fat quantification and is routinely available for gastrointestinal cancer research. However, no gender-specific cutoff values are currently available for classifying visceral obesity in white populations. Using the metabolic syndrome (MetSyn) as an indicator of obesity-associated dysmetabolism, this study aimed to establish pathologically relevant, gender-specific cut-off values for use in obesity-associated cancer research. Total, visceral and subcutaneous fat areas were calculated between the L3 and L4 invertebral space from computed tomography scans in a cohort of 170 males and 66 females undergoing gastrointestinal resection. Receiver operating characteristics analysis was used to determine cut-off values for total, visceral and subcutaneous fat areas associated with MetSyn. Linear regression was used to correlate these values with waist circumference. Visceral fat area (VFA) strongly correlated with the presence of MetSyn (P < .0001). The cut-off value for VFA associated with the presence of MetSyn was 163.8 cm(2) in males (83.6% sensitivity, 62.5% specificity) and 80.1 cm(2) for females (96% sensitivity, 73.2% specificity). The waist circumference corresponding to these VFA values was 96.1 cm in males and 83.2 cm in females. This study is the first to generate gender-specific and pathologically relevant cut-off values for VFA in patients with gastrointestinal cancer. In the field of obesity-associated research, this new anthropometric measure is of paramount importance for determining the accurate pathological obesity status of cancer patients.

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STUDY OBJECTIVE: At our 35,000 visit/year emergency department (ED), we studied whether patients presenting to the ED with psychiatric complaints were admitted to the hospital at a higher rate than non-psychiatric patients, and whether these patients had a higher rate of reevaluation in the ED within 30 days following the index visit. METHODS: We reviewed the electronic records of all ED patients receiving a psychiatric evaluation from January to February 2007 and compared these patients to 300 randomly selected patients presenting during the study period for non-psychiatric complaints. Patients were followed for 30 days, and admission rates and return visits were compared. RESULTS: Two hundred thirty-four patients presented to the ED and were evaluated for psychiatric complaints during the study period. Twenty-four point seven percent of psychiatric patients were admitted upon initial presentation versus 20.7% of non-psychiatric patients (p = 0.258). Twenty-one percent of discharged psychiatric patients returned to the ED within 30 days versus 13.4% of discharged non-psychiatric patients (p=0.041). Patients returning to the ED within 30 days had a 17.1% versus 21.6% admission rate for the psychiatric and non-psychiatric groups, respectively (p=0.485). CONCLUSION: Patients presenting to this ED with psychiatric complaints were not admitted at a significantly higher rate than non-psychiatric patients. These psychiatric patients did, however, have a significantly higher return rate to the ED when compared to non-psychiatric patients.

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OBJECTIVE: Low childhood immunization rates have been a challenge in Colorado, an issue that was exacerbated by a diphtheria-tetanus-acellular pertussis (DTaP) vaccine shortage that began in 2001. To combat this shortage, the locally based Tri-County Health Department conducted a study to assess immunization-related barriers among children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk for undervaccination. METHODS: This study assessed characteristics and perceptions of WIC mothers in conjunction with their children's immunization status in four clinics. RESULTS: Results indicated poor immunization rates, which improved with assessment and referral. The uninsured were at higher risk for undervaccination. DTaP was the most commonly missing vaccine, and discrepancies existed between the children's perceived and actual immunization status, particularly regarding DTaP. Targeted interventions were initiated as a result of this study. CONCLUSION: Local health departments should target immunization-related interventions by assessing their own WIC populations to identify unique vaccine-related deficiencies, misperceptions, and high-risk subpopulations.

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