Patients in the OCTR group were also significantly more likely to obtain early refills and to have prolonged postoperative use. There was no difference in the rate of new persistent use. Compared with ECTR, patients who underwent OCTR filled higher quantities of opioids in the perioperative period, were more likely to obtain early refills, and were more likely to have prolonged postoperative use. These findings suggest either a lower opioid requirement after ECTR or a lower perceived requirement reflected in the difference in prescribing habits between techniques.Compared with ECTR, patients who underwent OCTR filled higher quantities of opioids in the perioperative period, were more likely to obtain early refills, and were more likely to have prolonged postoperative use. These findings suggest either a lower opioid requirement after ECTR or a lower perceived requirement reflected in the difference in prescribing habits between techniques.Resection of soft-tissue sarcomas near important tissues (major blood vessels, nerves, bones) is challenging. "In situ preparation" (ISP) technique enables the function of the affected limb to be maintained by preserving the tissue as much as possible. The technique is based on evaluation of the margin of resection of important tissues near the tumor during surgery. Postoperative fractures are known to frequently occur, however, in cases where bones were preserved and periosteum has been resected by the ISP. We present the case of a 51-year-old woman who required treatment for soft-tissue sarcoma close to the femur. During surgery, femoral periosteum was included in the tumor side and the femur was preserved by the ISP. We covered the femur using a vascularized latissimus dorsi free flap instead of periosteum. The flap survived completely, and 5 years after surgery, there has been no recurrence or postoperative complications and the lower limb is functional. This is the first reported case of successful combined use of the bone ISP and the vascularized latissimus dorsi free flap to preserve the function of the limb affected by femoral sarcoma suspected of bone infiltration.Several oncoplastic techniques have been proposed for subareolar breast cancer, some of which may require contralateral operation for symmetry, or more than one operation for delayed reconstruction of the nipple-areola complex (NAC). We herein developed a simple and effective oncoplastic approach following central quadrantectomy, aiming to achieve the following (1) preservation of breast shape and contour for patients who are not accepting of a notably smaller breast or bilateral operation; (2) single procedure with advantages of single anesthetic and the ability to reconstruct a breast that has not yet been affected by radiation; (3) no autologous grafts with disadvantage of an extra donor site; (4) creation of natural neo-NAC with only incision within the region of the areola complex; and (5) maintaining long-term nipple projection. In this technique, the medial and lateral peri-areolar flap was advanced and rotated to restore partial neo-NAC, and to fill the defect after central tumor and NAC resection. The whole neo-NAC margin was created using the "round block" technique. Additionally, the nipple reconstruction was performed at the mitten of the neo-areola area using the C-V nipple flaps with an internal strut of rolled dermal grafts harvested from excised skin during the round block procedures. Lastly, a purse-string suture is placed in the outer skin margin for control of areola diameter and project. Six patients with central tumors of the breast were treated in this easily achieved approach. Patient satisfaction was noted as high, and the cosmetic results were evaluated as good to excellent.Cognitive impairment is frequently reported by silicone breast implant (SBI) patients. The aim of our study is to investigate whether subjective cognitive failure indeed is more frequent in a cohort of SBI patients compared with healthy controls (HCs). Furthermore, the severity of this cognitive failure and a possible relation to other symptoms as well as the duration of SBI exposure was examined. In addition, we assessed the effect of ruptures and reinterventions on cognitive failure severity. A cohort study was performed, including 376 women and consisting of 3 different groups of patients; 143 SBI patients (group 1), 94 age- and sex-matched HC patients (group 2), and 139 women with SBI and health issues who registered themselves at a Dutch foundation for women with illness due to SBI (group 3). All patients filled in the Cognitive Failure Questionnaire (CFQ). The American College of Rheumatology Fibromyalgia Diagnostic Criteria (2010) were used to score other symptoms. Completed CFQ data from 222 patients were available for analysis n = 79 for group 1, n = 62 for group 2, and n = 81 for group 3. SBI patients from group 3 had a significantly higher prevalence of subjective cognitive dysfunction (CFQ score ≥ 43) compared with SBI patients from group 1 and HC (60.5% versus 13.9% and 12.9%; = 0.000). Linear regression showed a statistically significant relation between subjective cognitive functioning scores and other symptoms ( = 0.000). Implant duration as well as rupture rate and reinterventions were not found to significantly influence CFQ scores. An increased risk of cognitive failure in consecutive SBI patients when compared with HCs could not be found.An increased risk of cognitive failure in consecutive SBI patients when compared with HCs could not be found.Adenoid cystic carcinoma (ACC) is a relatively rare malignant tumor. It is more common in women than in men and typically develops in the lacrimal, salivary, and breast glands. ACC of the external auditory canal (EAC) is exceedingly rare, and its invasion into the ear lobe is even more unusual. In this report, we present a case of ACC that presented as a mass on the surface of the ear lobe in a 28-year-old woman and was initially diagnosed as infected atheroma. For wide resection of the tumor, half of the entire auricula was resected and superficial parotidectomy was performed. selleck inhibitor After confirming no tumor cells on the surface of the facial nerve, the defect was reconstructed by the combination of platysma muscle flap to prevent Frey syndrome and free forearm flap for the ear lobe form. There was no recurrence or metastasis of the tumor, and Frey syndrome did not occur at 2 years and 8 months after surgery. The patient was satisfied with the result, oncologically and cosmetically. Even in young patients, comprehensive treatments (including diagnosis, resection, and reconstruction) are important in painful ear lobe masses.