RESUMEN
Reconstruction of the nasal ala presents surgical challenges, including loss of the nasofacial junction and vasculature compromise, in addition to achieving a cosmetically satisfactory result. The reconstructive surgeon has a variety of closure techniques to employ, but few allow for acceptable cosmesis in a single-stage procedure. The objective of this study is to discuss a novel approach to alar reconstruction using a melolabial-based transposition island pedicle flap, an alternative to traditional interpolated melolabial flaps and inferiorly based interpolated paranasal flap methods. Our reconstruction method utilizes an island pedicle flap harvested from the nasolabial fold and rotated 165Ë medially and superiorly into a surgical defect on the adjacent ala. The pedicle is placed within the alar facial sulcus for a slight trap-dooring effect, recreating the sulcus. The harvest site is closed linearly, resulting in a fusiform scar line to take advantage of the nasolabial fold. Although delicate care is required while dissecting and positioning the flap, it is an otherwise straightforward procedure. The ideal candidate for this technique presents with loss of the alar subunit with an intact alar rim. The only limitation to this style of flap is that the patient has undergone prior procedures involving the ipsilateral nasolabial fold. The transposition island pedicle flap is a well-tolerated alternative to patient cases that require grafting or more involved multi-step reconstructions to efficiently repair nasal alar defects. This technique provides the patient with a presentable cosmetic result using local tissue with minimal post-surgical complications and alar compromise.
RESUMEN
IMPORTANCE: Congenital malalignment of the great toenail (CMGT) is an idiopathic deviation of the nail apparatus. CMGT predisposes patients to recurrent stress forces, microtrauma, and secondary complications. The purpose of this study was to review the current published photographs to determine the relationship between variants of CMGT and the disappearing nail bed (DNB). OBSERVATIONS: A search in PubMed and Google using the terms congenital malalignment of the great toenail, disappearing nail bed, and lateral nail deviation was performed. Of the 53 photographs found in a total of 35 articles, 23 were disqualified due to low picture resolution or poor angle. The remaining 30 photographs were evaluated. Pure nail malalignment with associated dystrophy and DNB was found in 22 of 30 photographs. Four of 30 cases demonstrated pure deviation of the distal phalanx, with nail dystrophy but minimal DNB. The remaining 4 cases demonstrated a combination of toe deviation and nail unit deviation with varying degrees of DNB. CONCLUSIONS AND RELEVANCE: DNB was associated with all forms of pure CMGT. Moreover, a variant of malalignment of the distal phalanx was noted in 8 photographs. This has potential implications for further studies and treatment to correct secondary complications.
RESUMEN
Background: The early stages of the SARS-COV-2 pandemic left many hospital systems devoid of personal protective equipment. Community-driven groups manufactured Personal Protective Equipment (PPE) as a form of temporary replacement until supply could increase to frontline healthcare workers. The purpose of this study was to survey hospital systems in Alabama and Mississippi who requested and received PPE to determine recipient opinions concerning community involvement. Methods: A 15-question Qualtrics survey was distributed to hospital systems who requested and received community-generated PPE (CGPPE) from the group known as Alabama Fighting COVID. 275 responses were gathered over a period of 6 months. Results: Survey data showed that most respondents from healthcare and healthcare-associated professions responded that wearing community generated personal protective equipment provided them with the perception of added protection (55.31% of participants selected either "Agree" or "Strongly Agree"), and that it improved their outlook and desire to work during the pandemic (51.77% of participants selected either "Agree" or "Strongly Agree"). Conclusions: Most respondents reported that wearing community generated personal protective equipment not only provided them with the perception of added protection, but that it improved their outlook and desire to work during the pandemic. With these responses in mind, our study raises questions concerning whether local CGPPE distribution could improve well-ness outcomes of healthcare workers (HCWs) not only in relation to decreased viral transmission, but also in favorable psychosocial health assessments. Further implications for research concerning community involvement during future medical crises are indicated, especially with the current rise of the delta variant strain.