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Plastic and Reconstructive Surgery. Global Open

Craig A Blum, Frank J DellaCroce, Scott K Sullivan, Chris Trahan, M Whitten Wise
Background: When a single perforator flap does not provide adequate volume or projection for satisfactory breast reconstruction, the addition of an implant may be considered at the time of second-stage revisions. Dissection of an implant pocket beneath the flap may lead to the inadvertent injury of the flap pedicle as the tissue planes have been obscured by tissue ingrowth. The authors present a technique in which the boundaries of the implant pocket are predetermined at the time of flap reconstruction allowing an implant to be inserted at the second stage in ideal position with greater ease of dissection and minimal risk to the flap pedicle...
March 2018: Plastic and Reconstructive Surgery. Global Open
Giovanni Nicoletti, Marco Saler, Marco Mario Tresoldi, Silvia Scevola, Angela Faga
Supplemental Digital Content is available in the text.
March 2018: Plastic and Reconstructive Surgery. Global Open
Takashi Fujiwara, Kenji Yano, Yoshio Tanji, Masaya Nomura
Breast-conserving therapy, where radiotherapy is performed after partial mastectomy, is a widely used surgical method that can preserve most of the breast tissue without increasing the recurrence rate of breast cancer. However, without reconstruction, asymmetry of the breast occurs due to the tissue defect and radiation fibrosis, producing in poor cosmetic results. In this case study, we performed staged prosthetic breast reconstruction combined with fat grafting for severe depressive deformation of the breast after breast-conserving therapy...
March 2018: Plastic and Reconstructive Surgery. Global Open
Carroll Ann Trotman, Julian Faraway, Tessa Hadlock, Caroline Banks, Nathan Jowett, Daniel Regan
Background: The objective of this study was to demonstrate simple three-dimensional analyses of facial soft tissue shape and asymmetry. Methods: There were 2 study samples: one retrospective comprised patients with repaired cleft lip and palate (CL/P) and control subjects; and the other prospective comprised patients with unilateral facial paralysis (FP) and control subjects. The data collected were digitized three-dimensional facial landmarks. Scores for shape and asymmetry of subjects' faces and for different facial regions were generated using Procrustes methods...
March 2018: Plastic and Reconstructive Surgery. Global Open
Lotte Ewalds, Anouk J M Cornelissen, René R W J van der Hulst, Shan S Qiu
At our institution, we performed a lymphaticovenous anastomosis in patients with primary or secondary abdominal lymphedema. Patients report good outcomes and feel relieved of their complaints. To obtain good results, it is important to have decent knowledge on the anatomical state of the lymphatic system. In general, the lymphatic system of the lower abdomen can be compared with the system of the upper legs. According to our current case results, the abdominal area might be susceptible to lymphaticovenous anastomosis procedure...
March 2018: Plastic and Reconstructive Surgery. Global Open
Xianghong Lou, Hang Xue, Gongchi Li, Kun Wang, Pan Zhou, Binghui Li, Jianghai Chen
Dermal regeneration template, such as Integra and Pelnac, was originally designed for treating large area burn injury by inducing regeneration of dermis. To date, it has been widely applied in various acute and chronic wound sites. The present study demonstrated that application of artificial dermis alone induced 1-stage wound healing for wounds with bone or tendon exposure that should usually be repaired by flap surgery. Eight patients who presented with skin defects with bone and/or tendon exposure were treated by 1-stage Pelnac approach...
March 2018: Plastic and Reconstructive Surgery. Global Open
Max J Greenfield, Joshua Luck, Michael L Billingsley, Richard Heyes, Oliver J Smith, Afshin Mosahebi, Abu Khoussa, Ghassan Abu-Sittah, Nadine Hachach-Haram
Augmented reality (AR) is defined as "a technology that superimposes a computer-generated image on a user's view of the real world, thus providing a composite view."1 This case report describes how emerging AR telesurgery technologies may be used to facilitate international surgeon-surgeon collaboration and training. Here, we illustrate how a remote surgeon in Beirut, Lebanon, was able to offer assistance to a surgeon in Gaza, Palestine, during a complex hand reconstruction case following a bomb-blast injury in an 18-year-old male...
March 2018: Plastic and Reconstructive Surgery. Global Open
Michal Brichacek, Julian Diaz-Abele, Sarah Shiga, Christian Petropolis
Closed reduction and percutaneous pinning (CRPP) of hand fractures can be a deceptively challenging procedure that requires significant hands-on time to teach and learn. We created a realistic three-dimensional simulator that can be used for teaching junior residents the CRPP. Computer-aided design and computer-aided manufacturing (CAD/CAM) software was used to create a three-dimensional hand model incorporating several common hand fractures: Bennett's fracture, transverse fifth metacarpal neck, and transverse second proximal phalanx...
March 2018: Plastic and Reconstructive Surgery. Global Open
Achilleas Thoma, Carolyn Levis, Pinkal Patel, Jessica Murphy, Eric Duku
Background: There are numerous surgical techniques for the treatment of first carpometacarpal joint osteoarthritis, however, controversy exists as to whether outcomes differ between techniques. This feasibility study aimed to determine if a large-scale, health-related quality of life and functional outcomes study comparing 2 surgical techniques, complete trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) versus partial trapeziectomy and tendon interposition (PT + TI) arthroplasty, is possible...
March 2018: Plastic and Reconstructive Surgery. Global Open
Yew L Loo, Pragash Kamalathevan, Peng S Ooi, Afshin Mosahebi
Background: Acellular dermal matrices (ADMs) have been used extensively in implant-based breast reconstruction. It was reported that due to the different sources and processing methods, the outcomes of ADMs in implant-based breast reconstructions are expected to differ. We designed this study to statistically analyze and discuss the outcome of 3 commonly used ADMs, Alloderm, Strattice, and Surgimend in implant-based breast reconstruction. Methods: Comprehensive review of the literatures searched on electronic databases was done to identify studies published between 2006 and 2017 comparing the outcome of ADMs...
March 2018: Plastic and Reconstructive Surgery. Global Open
Tim Brown
Background: Increased surface area of mammary implants is suggested as a causative agent for the development of biofilms, which may lead to capsular contraction. The aim of this study was to quantify the surface areas of round implants of different textures and examine how these data can be interpreted with regard to clinical observation. Methods: Surface areas of textured round breast implants were calculated from previously reported confocal scanning microscopic assessment, and dimensions sourced from 3 breast implant manufacturers (McGhan, Mentor, and Silimed)...
March 2018: Plastic and Reconstructive Surgery. Global Open
Jouseph O Barkho, Yu Kit Li, Eric Duku, Achilleas Thoma
Background: Ketorolac is a potent nonsteroidal anti-inflammatory drug that has valuable analgesic properties but also a hypothetical risk of increased bleeding due to inhibition of platelet activation. The clinical significance of this risk, however, is unclear when it is used after reduction mammaplasty. Our study objective was to therefore examine the association between ketorolac exposure and hematoma occurrence after breast reduction surgery. We hypothesized that there was no association between ketorolac exposure and hematoma occurrence in breast reduction surgery...
March 2018: Plastic and Reconstructive Surgery. Global Open
M Asher Schusterman, Rishi Jindal, Jignesh V Unadkat, Alexander M Spiess
In cases of significant upper extremity trauma, the thoracodorsal nerve is a reliable secondary option for the restoration of elbow flexion. In all previous descriptions, however, the entire nerve is transferred. We describe a case utilizing the lateral thoracodorsal nerve (LaT) branch for biceps reinnervation with an associated cadaver study. Transfer of the LaT branch to the biceps branch was performed on a patient who had sustained a traumatic brachial plexus injury that left him without elbow flexion. Also, 4 cadavers (8 upper extremities) were dissected to identify the bifurcation of the thoracodorsal nerve and confirm the feasibility of transferring the LaT branch to the biceps motor branch...
March 2018: Plastic and Reconstructive Surgery. Global Open
Parthena I Deskoulidi, Pantelis K Diamantopoulos, Nikolaos A Maltzaris, Maria D Kotrotsiou, Konstantinos M Benetatos, Spiros D Stavrianos
Reconstruction of perineal defects is a challenging procedure. Various surgical techniques have been proposed. Compared with traditional myocutaneous flaps, pedicled perforator flaps are believed to be a less invasive option for perineal reconstruction, with better functional and cosmetic results. We present the case of a 47-year-old woman with a perianal Paget's disease who underwent surgical excision of the lesion. The reconstructive technique was a pedicled flap based on an internal pudendal skin perforator artery...
March 2018: Plastic and Reconstructive Surgery. Global Open
Vasileios Vasilakis, Malack Hamade, Steven A Stavrides, Thomas A Davenport
As gluteal augmentation continues to gain in popularity among patients seeking aesthetic enhancements, a thorough knowledge of the postoperative complications associated with this procedure is crucial. This case report concerns a 31-year-old woman who suffered bilateral foot drop secondary to sciatic neuropathy and as a result was wheelchair-bound for several months, following gluteal autologous fat grafting in the Dominical Republic. One year later, the patient had persistent left foot drop and sensory deficits...
March 2018: Plastic and Reconstructive Surgery. Global Open
Inge A Hoevenaren, Rinaldo D Vreeken, Arico C Verhulst, Dietmar J O Ulrich, Thomas J J Maal, Till Wagner
Syndactyly is a congenital condition characterized by fusion of the fingers. If not treated correctly during infancy, syndactyly may hinder the normal development of hand function. Many surgical techniques have been developed, with the main goal to create a functional hand with the smallest number of operative corrections. Therefore, exact preoperative planning of the reconstructive procedure is essential. An imaging method commonly used for preoperative planning is 3-dimensional (3D) surface imaging. The goal of this study was to implement the use of this technique in hand surgery, by designing a virtual planning tool for a desyndactylization procedure based on 3D hand images...
March 2018: Plastic and Reconstructive Surgery. Global Open
Elbert E Vaca, Justin L Bellamy, Sammy Sinno, Eduardo D Rodriguez
Background: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author's early and definitive staged reconstructive approach to these challenging patients. Methods: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes...
March 2018: Plastic and Reconstructive Surgery. Global Open
Ruizhao Cai, Zeming Xie, Lihuan Zhou, Jin Wang, Xing Li, Junhao Huang, Yan Wang, Mingtian Yang, Edward I Chang, Jun Tang
Volume loss is 1 of the major factors influencing cosmetic outcomes of breast after partial mastectomy (PM), especially for smaller breasts, and therefore, volume replacement is critical for optimizing the final aesthetic outcome. We present a novel technique of raising a pedicled descending branch latissimus dorsi (LD) mini-flap for reconstruction of PM defects via an axillary incision. After PM, the LD mini-flap is harvested through the existing axillary incision of the axillary dissection or the sentinel lymph node biopsy...
March 2018: Plastic and Reconstructive Surgery. Global Open
Mora-Ortiz Asuncion, Sung-Yu Chu, Yen-Ling Huang, Chia-Yu Lin, Ming-Huei Cheng
Background: Submental lymph node transfer has proved to be an effective approach for the treatment of lymphedema. This study was to investigate the anatomy and distribution of vascularized submental lymph node (VSLN) flap using magnetic resonance imaging (MRI) and their clinical outcome. Methods: Fifteen patients who underwent 19 VSLN flap transfers for upper or lower limb lymphedema were retrospectively analyzed. The number of submental lymph nodes was compared among preoperative MRI, preoperative sonography, intraoperative finding, postoperative sonography, and postoperative computed tomography angiography...
March 2018: Plastic and Reconstructive Surgery. Global Open
Narendra Kumar, Arthur Swift, Eqram Rahman
Background: A detailed understanding of facial anatomy, specifically the vascular framework, is crucial for delivering safe nonsurgical aesthetic procedures. To date, there is no core document based on consensus for the teaching of facial anatomy to aesthetic physicians exists. The aim of this study was to ascertain the most critical anatomical structures for avoiding disastrous complications during nonsurgical aesthetic procedures. Methods: After a detailed literature review, Delphi questionnaire was developed listing 154 anatomical structures of the face and neck for consensus review...
March 2018: Plastic and Reconstructive Surgery. Global Open
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