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Plastic and Reconstructive Surgery

Jonas Gustafsson, Sung-Yu Chu, Wen-Hui Chan, Ming-Huei Cheng
BACKGROUND: Vascularized lymph node transfer (VLNT) has shown promising results in the treatment of lower limb lymphedema, but little is known about the number of lymph nodes needed for the transfer to achieve optimal results. This study investigated the correlation between number of transferred lymph nodes in submental VLNT and outcomes regarding limb circumference reduction and cellulitis incidence. METHODS: Thirty-five patients who had received submental VLNT to an ankle for lower limb lymphedema, post-gynecological cancer treatment, were included in the study...
July 10, 2018: Plastic and Reconstructive Surgery
Matthew T Houdek, Peter S Rose, Todd A Milbrandt, Anthony A Stans, Steven L Moran, Franklin H Sim
INTRODUCTION: Lower extremity intercalary allograft reconstruction has traditionally been used to facilitate limb salvage. Combing the allograft with a vascularized fibula graft (FVFG) has been described; however there is a paucity of data comparing the outcome of these reconstructions. MATERIAL AND METHODS: 29 pediatric patients (15 males, 14 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12 years...
July 10, 2018: Plastic and Reconstructive Surgery
Anna C Howell, Daniel J Gould, Cory Mayfield, Kamran Samakar, Cameron Hassani, Ketan M Patel
PURPOSE: The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer (VLNT). The anatomy of the gastroepiploic vessels, omentum, and lymph nodes (LN) has not been investigated. The purpose of this study is to describe the right gastroepiploic artery (GEA) and related structures by using computed tomography angiography (CTA). MATERIALS AND METHODS: A retrospective analysis was conducted on 34 patients who received CTA...
July 10, 2018: Plastic and Reconstructive Surgery
Megan E Fracol, Lindsay E Janes, Jason H Ko, Gregory A Dumanian
INTRODUCTION: Targeted muscle reinnervation (TMR) re-routes the ends of cut nerves to re-innervate small motor nerves of nearby muscles, with the goal of reducing neuroma pain and/or improving prosthesis function. Anatomical roadmaps for TMR have been established in the upper extremity and thigh, but not for the lower leg. METHODS: The major branch points (MBPs) of motor nerves and the motor entry points (MEPs) to muscles of the leg were dissected in five cadaver specimens...
July 10, 2018: Plastic and Reconstructive Surgery
Sanjay Naran, Jordan W Swanson, Cassandra A Ligh, Val Shubinets, Michael J Fisher, Jesse A Taylor, Scott P Bartlett
INTRODUCTION: Sphenoid wing dysplasia in patients with neurofibromatosis type 1 (NF-1) may result in challenging and significant changes, including ultimately vision loss. We describe the radiographic patterns of sphenoid dysmorphology with time and age, and the impact of surgical intervention on preservation of vision. METHODS: A retrospective study was performed at a single pediatric hospital, identifying subjects with NF-1. Records were reviewed in their entirety for each subject, with attention to opthamalogic evaluation...
July 5, 2018: Plastic and Reconstructive Surgery
Hamidreza Natghian, Marie Song, Jayaratnam Jayamohan, David Johnson, Shailendra Magdum, Peter Richards, Steven Wall
BACKGROUND: Metopic synostosis causing trigonocephaly is treated by fronto-orbital-advancement and remodelling to correct the deformity, cerebral distortion and to treat intracranial hypertension in a small number of cases. This study's aim was to evaluate complications, revisions and long-term outcomes. METHODS: A retrospective chart review was performed on consecutive metopic craniosynostosis patients treated between February 1995 and February 2017 at the Oxford Craniofacial Unit...
July 5, 2018: Plastic and Reconstructive Surgery
Marco Maricevich, Lawrence O Lin, Jun Liu, Edward I Chang, Matthew M Hanasono
BACKGROUND: Many surgeons are hesitant to use interposition vein grafting in head and neck microvascular free flap surgery due to concerns for elevated risk of flap loss. METHODS: We conducted a review of patients who underwent head and neck free flap reconstruction between 2005 and 2015. The effect of vein grafts on flap compromise and flap loss were analyzed using univariate and multivariate models. RESULTS: A total of 3240 free flaps were performed...
July 5, 2018: Plastic and Reconstructive Surgery
Xuan Wang, Shi Feng, Xiaojun Tang, Lei Shi, Lin Yin, Wei Liu, Yongyu Yin, Yinan Yang, Zhiyong Zhang
BACKGROUND: This article mainly focused on the safety and unexpected incidents of mandibular distraction osteogenesis in treating patients with hemifacial microsomia. METHODS: Records of 71 patients with hemifacial microsomia treated by mandibular distraction osteogenesis from February 2010 to March 2015 were examined in this retrospective study. The modified mandibular osteotomy was conducted under the assistance of three-dimensional (3D) reconstruction, computer-aided design and rapid prototyping technique...
July 5, 2018: Plastic and Reconstructive Surgery
Lawrence O Lin, Rosaline S Zhang, Daniel Mazzaferro, Ian C Hoppe, Rebecca L Pearl, Jordan W Swanson, Scott P Bartlett, Jesse A Taylor
BACKGROUND: Facial scarring and disharmony due to clefting is associated with psychosocial stress which may be improved by orthognathic surgery. The authors examine how a history of clefting influences change in layperson perception of a patient following orthognathic surgery. METHODS: 1000 laypeople were recruited through Mechanical Turk to evaluate patient photographs pre- and post-orthognathic surgery. Nineteen patients - 5 with unilateral and 4 with bilateral clefting - were included...
July 5, 2018: Plastic and Reconstructive Surgery
Sabrina Nicole Pavri, Cyril Gary, Rajendra Sawh Martinez, Samuel Kim, Dale Han, Stephan Ariyan, Deepak Narayan
PURPOSE: Lymphoscintigraphy (LS) is often obtained prior to sentinel lymph node biopsy (SLNB), especially in areas likely to have multiple or aberrant drainage patterns. This study aims to determine the incidence and characteristics of melanoma patients with a negative LS and to review the management options and surgical recommendations. METHODS: This is a retrospective study of patients with primary cutaneous melanoma who underwent SLNB between 2005 and 2016. Patients with nonvisualized lymph nodes on preoperative LS were compared in a 1:4 ratio with a randomly selected unmatched cohort drawn from all melanoma patients who underwent preoperative LS within the time period of the study...
July 5, 2018: Plastic and Reconstructive Surgery
Marc Najjar, Marcos M Lopez, Alberto Ballestin, Naikhoba Munabi, Alexandra I Naides, Roberto Daniel Noland, Collin Blackburn, Yelena Akelina, Jeffrey A Ascherman
BACKGROUND: Vascularized lymph node transfer (VLNT) has recently received attention as a potential surgical treatment for lymphedema. Despite good results in some series, the mechanism and benefits of VLNT have yet to be fully understood. This study aimed to investigate the re-establishment of drainage into transferred lymph nodes following VLNT in a rat model. METHODS: Seven rats underwent VLNT. The operation performed on each rat consisted of two parts. First, the left groin lymph node basin with superficial epigastric vessels was harvested as a free flap...
July 3, 2018: Plastic and Reconstructive Surgery
Frank Yuan, Lin Zhong, Kevin C Chung
BACKGROUND: Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. Our study compares the long-term aesthetic outcomes of these two flap techniques. METHODS: Forty-five patients were included in our study. The methods of reconstruction used were a dorsally-based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting...
July 3, 2018: Plastic and Reconstructive Surgery
Cassio Eduardo Raposo-Amaral, Rafael Denadai, Pedro Furlan, Cesar Augusto Raposo-Amaral
BACKGROUND: Apert hand reconstruction requires complex surgical planning. The purpose of this study is to describe our 8 year surgical experience with Apert syndrome hand reconstruction, and provide specific surgical strategies for achieving a 5-digit hand in Upton type I and II hands. METHODS: A retrospective analysis of consecutive Apert patients who underwent web space releases between 2007 and 2015 was performed. Demographic, surgical, and outcome data were verified through medical records, clinical photographs, radiographic images, and patient interviews...
July 3, 2018: Plastic and Reconstructive Surgery
Kevin Shultz, Janae Kittinger, Wendy L Czerwinski, Robert A Weber
BACKGROUND: While steroid injection remains a common first-line treatment of trigger fingers, clinical experience suggests that not all trigger fingers respond the same. The purpose of this study was to utilize a classification system for trigger finger that is simple, reproducible, and produces clearly definable, clinically relevant cutoff points to determine if responsiveness to steroid injection correlates to clinical staging. METHODS: This was a prospectively-collected longitudinal study of trigger finger patients separated into four stages of severity...
July 3, 2018: Plastic and Reconstructive Surgery
Gwendolyn M Hoben, Xueping Ee, Lauren Schellhardt, Ying Yan, Daniel A Hunter, Amy M Moore, Alison K Snyder-Warwick, Sheila Stewart, Susan E Mackinnon, Matthew D Wood
BACKGROUND: Nerve grafting with an autograft is considered the gold standard. However, the functional outcomes of long (>3cm) nerve autografting are often poor. We hypothesized that a factor contributing to these outcomes is the graft microenvironment, where long compared to short autografts support axon regeneration to different extents. METHODS: A rat sciatic nerve defect model was used to compare regeneration within short (2cm) and long (6cm) isografts. Axon regeneration and cell populations within grafts were assessed using histology, retrograde labeling of neurons regenerating axons, immunohistochemistry, qRT-PCR, and electron microscopy at 4 and/or 8 weeks...
July 3, 2018: Plastic and Reconstructive Surgery
Yoel Rojas, Catherine Sinnott, Cesar Colasante, John Samas, Richard Reish
BACKGROUND: Polyethylene (Medpor) and Silicone are two of the most popular materials used today for facial skeleton implantation. Previous studies have identified common complications with the use of these implants, but patient follow up has been short. This review of literature examines complications and patient follow up in cases using Medpor and Silicone implants for reconstructive and aesthetic surgeries of the mid and lower face over the last 20 years. METHOD: A literature search was conducted through the PUBMED database...
July 3, 2018: Plastic and Reconstructive Surgery
Rami S Kantar, William J Rifkin, Stelios C Wilson, Joshua A David, J Rodrigo Diaz-Siso, Jamie P Levine, Alyssa R Golas, Daniel J Ceradini
BACKGROUND: The prevalence of Obesity along with bariatric surgery and massive weight loss requiring panniculectomy is increasing in the United States. The effect of Diabetes Mellitus (DM) on outcomes following panniculectomy remains poorly defined despite its prevalence. Our study aims to evaluate the impact of DM on complications following panniculectomy and determine risk factors for adverse events. METHODS: The American College of Surgeons National Surgical Quality Improvement (ACS NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015...
July 2, 2018: Plastic and Reconstructive Surgery
Dominic Henn, Masood Abu-Halima, Florian Falkner, Dominik Wermke, Lilian G Meme, Clemens K├╝hner, Andreas Keller, Ulrich Kneser, Eckart Meese, Volker J Schmidt
BACKGROUND: The placement of arteriovenous (AV) loops can enable microvascular anastomoses of free flaps when recipient vessels are scarce. In animal models, elevated fluid shear stress in AV loops promotes neoangiogenesis. Anecdotal reports in patients indicate that vein grafts used in free flap reconstructions of ischemic lower extremities are able to induce capillary formation. However, flow-stimulated angiogenesis has never been systematically investigated in humans and it is unclear whether shear stress alters proangiogenic signaling pathways within the vascular wall of human AV loops...
July 2, 2018: Plastic and Reconstructive Surgery
Howard H Tang, Xiao-Lian Han, Heidi Debels, Beryl Tan, Jason Palmer, Christopher Poon, Keren Abberton, Wayne Morrison
BACKGROUND: Free fat grafting is popular but it is still unclear how it works. Although focusing on graft survival seems an obvious direction for improving clinical results, our research suggests that long term volume retention is in part due to new fat regeneration. Measures to facilitate adipogenesis may therefore be equally important. METHODS: To investigate the relative roles of survival and regeneration of fat grafts, we measured the fate of human lipoaspirate implanted into the scalps of immunodeficient mice, with and without stromal vascular fraction (SVF) and a porcine extracellular matrix (Adipogel)...
July 2, 2018: Plastic and Reconstructive Surgery
Rodrigo G Rosique, Marina J F Rosique
According to recent data, augmentation gluteoplasty continues to gain popularity in the US and globally, especially in procedures involving fat grafts. However, serious concerns about its safety have been raised over the last two years. Will this trend continue or has it already reached its peak? The answer depends on how the technique is going to be performed hereafter. In this paper, the following seven learning objectives are covered to perform gluteal augmentation safely and effectively: 1. the concept of what is a beautiful buttock and how to select the patients who will have better outcomes; 2...
July 2, 2018: Plastic and Reconstructive Surgery
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