Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 6 Articles
Background. Decellularized human skin has been used in a variety of medical applications, primarily involving soft tissue\nreconstruction, wound healing, and tendon augmentation. Theoretically, decellularization removes potentially immunogenic\nmaterial and provides a clean scaffold for cellular and vascular in growth. The use of acellular dermal matrix in two-stage\npostmastectomy breast reconstruction is described. Methods. Ten consecutive breast cancer patientswere treated with mastectomies\nand immediate reconstruction from August to November 2011. There were 8 bilateral and 1 unilateral mastectomies for a total of 17\nbreasts, with one exclusion for chronic tobacco use. Reconstruction included the use of a new 6 Ã?â?? 16 cm sterile, room temperature\nacellular dermal matrix patch (DermACELL) soaked in a cefazolin bath. Results. Of the 17 breasts, 15 reconstructions were\ncompleted; 14 of them with expander to implant sequence and acellular dermal matrix. Histological analysis of biopsies obtained\nduring trimming of the matrix at the second stage appeared nonremarkable with evidence of normal healing, cellularity, and\nvascular infiltration. Conclusion. Postoperative observations showed that this cellular dermal matrix appears to be an appropriate\nadjunct to reconstruction with expanders. This acellular dermal matrix appeared to work well with all patients, even those receiving\npostoperative chemotherapy, postoperative radiation, prednisone, or warfarin sodium....
Background.With the increase in bariatric surgery in the UK, there has been a substantial increase in patients undergoing massive\nweight loss (MWL) seeking postbariatric body-contouring (bariplastic) surgery.However, there is a wide variation of availability on\ntheNationalHealth Service (NHS). Aims. To (1) reviewthe funding policies of PrimaryCare Trusts (PCTs) in England for bariplastic\nsurgery and (2) analyse the number of procedures funded in two consecutive financial years. Methods.We sent out questionnaires to\nall PCTs in England regarding their funding policies for bariplastic surgery and requested the number of procedures funded in 2008-\n09 and 2009-10. Findings. 121/147 (82%) PCTs replied to our questionnaires. 73 (60%) excluded all bariplastic procedures. 106/121\n(87.6%) PCTs had referral guidelines for plastic surgery. 46/121 (38%) PCTs provided the total number of funded abdominoplastyapronectomy\n(A-A) in the two financial years: total number of A-A applicants rose from 393 to 531, but approval for funding fell\nfrom 24.2% to 19.6%. Only 3 (2%) PCTs indicated increase in their future spending on bariplastic procedures in the next 5 years,\nwith 67% planning to decrease or unsure about future funding. Conclusion.There exists a postcode lottery for bariplastic surgery\nin England and we feel the need for guidelines on provision of bariplastic procedures following MWL....
Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications\nof hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material\nand Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were\nacquired fromthe hospitalâ��s database and analyzed with Statistical Package for Social Sciences (SPSS). Results.Atotal of 428 patients\nwith mean age of 8.12 �± 5.04 SD presented for hypospadias repair.Midpenile hypospadias were themost common. Chordee, meatal\nabnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage\n(Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively.The most\ncommon complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands\nof specialists than residents (??-value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than\nsingle-stage repair (?? value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of\ntemperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable\ndue to its lower postoperative complications....
Introduction. Literature on ideal management of accessory auricles is limited. Traditionally, accessory auricles are managed by\npaediatricians with suture ligation at the base of the accessory auricle to induce ischaemic necrosis (Mehmi et al, 2007). This\nmethod can be associated with complications and poor cosmesis thus leading to the vogue of surgical excision ( Frieden et al, 1995;\nSebben, 1989). We present our experience in managing these lesions in children with the application of a titanium clip in a onestop\noutpatient setting. Methods. Data was collected retrospectively through review of patient records and telephone questionnaire\nidentifying outcomes fromthe parents� perspective. Results.Of 42 patients, 24 (57.1%) responded. Eleven (26.2%) underwent surgical\nexcision, 6 (14.3%) had no intervention, and 1 (2.4%) was not contactable. All parents were happy with the outcome and would\nrecommend this management to other parents. Twenty-three (96%) had no complications apart froma tiny residual nubbin, which\nwas considered cosmetically acceptable. One child had a residual nubbin that grew in size requiring surgical excision at later stage.\nConclusion. Management of accessory auricles by the application of a titanium clip in one-stop outpatient setting is safe, simple,\nquick, and well tolerated with no need for admission, anaesthesia, or followup due to the low complication rate....
Background. Tissue expansion is a well-established surgical technique that produces an additional amount of normal skin to cover\na defect. This technique is appealing because the skin quality and color are from the patient�s own. The widely used injectable\nexpanders are of great reliability but carry the disadvantage of being painful during injection and most of the time require multiple\nclinic visits. So the idea of self-inflation became attractive and hydrogel expanders were developed and became widely known for\nbeing painless during clinic visit and decrease number of visits.Thefirst generation expandersweremodified by adding an enclosing\nplastic shell to decrease the unopposed expansion that occurred in the first generation expanders, which lead to pressure necrosis\nof the skin flaps. This made it an attractive option for tissue expansion in children and some adult patients. Patients,Materials, and\nMethods. Charts of 17 patients were retrospectively reviewed, all of them had second generation self-inflating expanders implanted\nover a 2-year period for one of two purposes, the treatment of giant nevi or burn scars. Results. Fifteen patients were females and\n2 were males. The indication was large burn scar in 14 cases (14/17), in which 47/55 expanders were implanted, and giant nevus in\n3/17 cases in which 8/55 expanders were implanted. Extrusion of the expander occurred in 8/55 expanders (14.5%), which occurred\nin 6/14 patients. The highest percentage of extrusion occurred in the neck in which two out of three expanders extruded; otherwise\nthis complication does not seem to be related to the indication, gender, nor age of the patients. It seems to be that it is technical in\nnature.The patients did not have to get any injections to fill the tissue expanders, which made the expansion process less painful\nand more convenient. Conclusion.This seems to be currently the largest published review in which second generation expanders\nwere used. Those expanders seem to offer a desirable advantage of being painless for children, also they do not require repeated\nvisits to the surgeon�s clinic, which is of great value for patients living in the periphery....
We performed vascular waveform analysis of flap-feeding vessels using color Doppler ultrasonography and evaluated the blood\nflow in the flaps prior to surgery. Vascular waveform analysis was performed in 19 patients. The analyzed parameters included the\nvascular diameter, flow volume, flow velocity, resistance index, pulsatility index, and acceleration time.The arterial waveform was\nclassified into 5 types based on the partiallymodified blood flow waveformclassification reported byHirai et al.; in particular, D-1a,\nD-1b, and D-2 were considered as normal waveforms. They were 4 patients which observed abnormal vascular waveform among\n19 patients (D-4 : 1, D-3 : 1, and Poor detect : 2). The case which presented D-4 waveform changed the surgical procedure, and a\nfavorable outcome was achieved. Muscle flap of the case which presented D-3 waveform was partially necrosed. The case which\ndetected blood flow poorly was judged to be the vascular obstruction of the internal thoracic artery. In the evaluation of blood\nflow in flaps using color Doppler ultrasonography, determination of not only basic blood flow information, such as the vascular\ndistribution and diameter and flow velocity, but also the flow volume, vascular resistance, and arterial waveform is essential to\nelucidate the hemodynamics of the flap....
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