Current therapies that allow patients with bladder acontractility to void are limited. The standard therapy is clean intermittent catheterization. Latissimus dorsi detrusor myoplasty (LDDM) has been shown to provide functional contraction and allow patients with bladder acontractility to void voluntarily. Our goal was to summarize experimental studies of LDDM. We hypothesized that experimental studies would show that latissimus dorsi muscle (LDM) flaps for detrusor myoplasty have superior outcomes when compared with other types of flaps. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, and EMBASE databases, without time frame limitations, to identify articles on the use of LDDM. We excluded studies that investigated other treatments. Of 54 articles identified by the search, three fulfilled the eligibility criteria. A total of 24 dogs underwent procedures and were evaluated with a maximum follow-up of 9 months. Three types of procedures were performed: LDM in situ reconfiguration, LDM myoplasty, and augmentation cystoplasty after supratrigonal cystectomy. Electrical stimulation, cystography, urodynamic and hydrodynamic measurements, and microscopic examinations were performed. Innervated LDM flaps transferred to the bladder were able to contract and promote voiding in response to electrical stimulation. Experimental studies have shown the feasibility of LDDM in canine models. Although no comparison groups were included, innervated LDM flap transferred to the bladder showed promising results regarding contraction capable of voiding.
Hinojosa, Renee J. MSN, APRN, ACNS-BC, CPSN, CANS; President PSNCB; Benefield, Deana CANS; Dunn, Amanda CANS; Harper, Ashley CANS; Lieb, Jennifer CANS; Paver, Donna CANS; Reay, Karen CANS; Smith, Kelly CANS; Hewlett, Jade CPSN Author Information
Free flap reconstruction is a common procedure with success rates greater than 99%. However, vascular complications may occur, resulting in flap failure. For this reason, early detection of vascular compromise is crucial for flap salvage. Vascular complications may be detected early by monitoring tissue oximetry parameter changes using near-infrared spectroscopy (NIRS). This method of noninvasive monitoring can evaluate changes in flap oxygenation levels caused by arterial and venous thrombosis before surgical reexploration. The goal of this study was to assess the validity of using NIRS oximetry for monitoring free flaps. We conducted a prospective cohort observational study of 10 patients undergoing breast reconstruction. We used the INVOS 7100 cerebral oximetry monitoring system (Medtronic, Dublin, Ireland) to provide 24-hr continuous postoperative monitoring of flap perfusion and compared the data with clinical assessment findings. The median patient age was 57 years (range = 41–61 years). Patients underwent immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap surgery (n = 4), delayed reconstruction with DIEP flap surgery (n = 4), transverse upper gracilis flap surgery (n = 1), and latissimus dorsi flap with lipofilling (n = 1). We successfully monitored all 10 flaps for 24 hr postoperatively. The overall flap survival rate was 100%. Findings of clinical examination, Doppler studies, and surgical outcome were consistent with NIRS monitoring. In conclusion, NIRS tissue oximetry could potentially provide a noninvasive method for effective postoperative monitoring of free flaps.
Some may believe that being an injector is a dream job and that the job is easy. These individuals may believe there is a lot of money to be made and that injectors can choose their own hours making people beautiful and enjoying their passion. In this article, I will talk about my experience breaking into aesthetics, describe what it is like to be a new nurse injector in 2021, explain what you should expect as a new nurse breaking into this field, delineate some tips I have learned along the way, and provide some advice from my experience thus far.
Renee J. Hinojosa, MSN, APRN, ACNS-BC, CPSN, CANS, is the Director of Medical Aesthetics at the Age Management Institute in Reno, NV. She has been active in the field of plastic surgical nursing for more than 27 years. She also provides medical aesthetic treatments for the practice of Dr. Phillip Dahan at Advanced Aesthetic Plastic Surgery. In addition, she is a national trainer for AAI (Aesthetic Advancements Incorporated). Address correspondence to Renee Hinojosa, MSN, APRN, ACNS-BC, CPSN, CANS, Age Management Institute, 9393 Gateway Dr, Reno, NV 89521 ([email protected]). The author reports no conflicts of interest.
