Treatment of pan-brachial plexus injuries has evolved significantly over the past 2 decades, with refinement and introduction of new surgical techniques, particularly free functional muscle transfer. The extent to which contemporary brachial plexus surgeons utilize various techniques as part of their treatment algorithm for pan-plexus injuries and the rationale underlying these choices remain largely unknown.
  A case scenario was posed to 12 brachial plexus surgeons during semi-structured qualitative interviews. The case involved a young patient presenting 6 weeks after a pan-plexus injury from a motorcycle accident. Surgeons were asked to formulate a treatment plan. Inductive thematic analysis was used to identify commonalities and variation in approach to treatment.
 
  For shoulder function, the majority of surgeons would graft from a viable C5 nerve root, if possible, though the chosen target varied. Two-thirds of the surgeons would address elbow flexion with nerve transfers, though half would combine this with a free functional muscle transfer to increase elbow flexion strength. Free functional muscle transfer was the technique of choice to restore finger flexion. Finger extension, intrinsic function, and sensation were not prioritized.
 
  Our study sheds light on current trends in the approach to pan-plexus injuries in the U.S. and identifies areas of variability that would benefit from future study. The optimal shoulder target and the role for grafting to the MCN for elbow flexion merit further investigation. The role of FFMT plays an increasingly prominent role in treatment algorithms.
 Our study sheds light on current trends in the approach to pan-plexus injuries in the U.S. and identifies areas of variability that would benefit from future study. The optimal shoulder target and the role for grafting to the MCN for elbow flexion merit further investigation. The role of FFMT plays an increasingly prominent role in treatment algorithms.Prepectoral implant placement has many potential advantages in immediate breast reconstruction. Acellular dermal matrices (ADMs) are commonly used in these surgeries. ADM meshing may enhance integration, decrease seroma and infection rates, and reduce surgical costs.
  This was a retrospective, single-center study of 49 women (71 breasts) undergoing immediate, prepectoral, implant-based breast reconstruction with 21 meshed, bovine-derived ADM (SurgiMend). Outcomes were compared against those of 77 patients (105 breasts) undergoing a similar procedure but with partial subpectoral implant placement.
 
  In the prepectoral group, the mean age was 49.1 years and mean body mass index was 24.7 kg/m
  . There were no significant differences in baseline characteristics versus the partial subpectoral control group. Mean follow-up was 18.6 months (prepectoral) and 21.3 months (partial subpectoral). Mean time to drain removal was reduced in the prepectoral group (6.5 versus 8.5 days; 
  0.001). Rates of minor and major complications with prepectoral implant placement were 15.5% and 11.3%, respectively - similar to partial subpectoral placement (15.2% and 14.3%) (overall 
  = 0.690). Capsular contracture and explantation were associated with radiation therapy, and rates were similar between groups.
 
  Prepectoral implant placement with meshed ADM is a safe and reproducible alternative to partial muscle coverage with meshed ADM. Recovery may be easier and animation deformity avoided. It could therefore become the standard of care for implant-based breast reconstruction.
 Prepectoral implant placement with meshed ADM is a safe and reproducible alternative to partial muscle coverage with meshed ADM. Recovery may be easier and animation deformity avoided. It could therefore become the standard of care for implant-based breast reconstruction.Trigeminal Neuralgia (TN) is defined as a recurrent, unilateral, brief, electric shock-like pain and is associated with a significant deterioration in quality of life due to the debilitating nature of the pain. The first line treatment is medical therapy, and surgical treatment is reserved for patients with inadequate pain control or undesirable side effects. Surgical options for treatment may include microvascular decompression (MVD), stereotactic radiosurgery, percutaneous radiofrequency rhizotomy, and percutaneous balloon compression of trigeminal ganglion. MVD is considered the procedure of choice due to its high efficacy and safety profile; however, it carries a recurrence rate of 1%-5% annually and 15%-35% long term. Although re-operative MVD has been reported for recurrent cases, it carries a high risk of complications due to arachnoid adhesions and distorted anatomy. Peripheral neurectomy is a simple, expeditious, low-risk procedure that is well tolerated by patients and can be done even under local anesthesia. We report a case of a 69-year-old man who presented with a debilitating TN in the V1 and V2 territory refractory to MVD, stereotactic radiosurgery, and percutaneous balloon compression of the trigeminal ganglion, who had been treated with neurectomy of the left supraorbital, supratrochlear, and infraorbital nerves, with an excellent outcome at 6 months follow-up. Peripheral neurectomy is an effective alternative for patients with refractory TN who failed multiple surgical interventions.  https://www.selleckchem.com/products/brd-6929.html  Previous publications have reported an elevated long-term recurrence rate after this procedure, perhaps due to peripheral nerve regeneration or neuroma formation. It is not yet studied whether using nerve conduits may lead to a decrease in recurrence.The authors present a case of a 11-year-old girl with fibrous dysplasia involving the nasal cavity and sphenoid sinus that potentially required a tracheostomy for anesthesia. The tumor was to be approached through both supraorbital and Le Fort I osteotomies. The tumor prevented nasal intubation, and the necessity of maxillomandibular fixation to reduce the osteotomized maxilla with traditional fixation prevented oral intubation. Given the age of the patient and the desire to avoid a tracheostomy scar, a decision was made to utilize custom fixation plates. Virtual surgical planning was utilized to design custom cutting guides with splints for maxillomandibular fixation. These custom maxillary orthognathic plates ensured accurate reduction of the osteotomized maxillary segment and allowed for placement of an oral endotracheal tube. Despite the oral endotracheal tube preventing maxillomandibular fixation, use of custom plates established proper occlusion as determined immediately after extubation and at postoperative visits.