Current Issue : January - March Volume : 2015 Issue Number : 1 Articles : 6 Articles
Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of\nindeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At\nthe same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging\n(LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed,Medline, EMBASE, and Google\nScholar.Key search terms included the following: ââ?¬Å?LaserDoppler imaging,ââ?¬Â ââ?¬Å?laserDoppler flow,ââ?¬Â and ââ?¬Å?burn depth.ââ?¬Â Results. A totalof\n53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions.\nThe numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one.\nDespite the presence of alternative burn depth assessment techniques, LDI remains the most favoured.Various newer LDI machines\nwith increasingly sophisticated methods of assessing burn depth have been introduced throughout the years.However, factors such\nas cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral\nvascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research....
Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and\nindependent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is\nparticularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed\nto assess residents� perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three distinct\nsections: demographic information, current state of aesthetic surgery training, and residents� perception regarding the quality of\naesthetic surgery training. Results. A total of 86 senior plastic surgery residents completed the survey. Twenty-three, 24, and 39\nresidents were in integrated, combined, and independent residency programs, respectively. No statistically significant differences\nwere seen with respect to number of aesthetic surgery procedures performed, additional training received in minimal-invasive\ncosmetic procedures, median level of confidence with index cosmetic surgery procedures, or perceived quality of aesthetic surgery\ntraining. Facial aesthetic procedures were felt to be the most challenging procedures. Exposure to minimally invasive aesthetic\nprocedures was limited. Conclusion. While the educational experience in aesthetic surgery appears to be similar, weaknesses still\nexist with respect to training in minimally invasive/nonsurgical aesthetic procedures....
The correction of cleft lip nasal deformity is challenging and there have been numerous methods described in the literature with\nlittle demonstrated technical superiority of one over another.The common clinical issues associated with cleft lip nasal deformity\nare its lack of symmetry, alar collapse on the affected side, obtuse nasal labial angle, short nasal length, loss of tip definition, and\naltered columella show among others. We carried out augmentation of cleft lip rhinoplasties with rib graft in 16 patients over the\none-year study period. Each of these patients was reviewed and given questionnaire before and after surgery to evaluate their\nresponse on the outcome to the approach. Preoperatively, nasal asymmetry is the main complaint (14/16, 87.5%) among our series\nof patients. Postoperatively, 12 (75%) patients out of the 16 reported significant improvement in their nasal symmetry with the other\nfour marginal. All patients reported excellent nasal projection postoperatively with good nasal tip definition. Our series of patients\nreported overall good satisfaction outcome and will recommend this procedure to other patients with cleft lip nasal deformity. In\nconclusion, augmentation of cleft lip rhinoplasty can be employed to achieve perceivable and satisfactory outcome in patients with\ncleft lip nasal deformity....
Purpose. Congenital anomalies and injuries of the hand are often undertreated in low-middle income countries (LMICs).\nHumanitarian missions to LMICs are commonplace, but few exclusively hand surgery missions have been reported and none have\nattempted to demonstrate their cost-effectiveness. We present the first study evaluating the cost-effectiveness of a humanitarian\nhand surgery mission to Honduras as a method of reducing the global burden of surgically treatable disease. Methods. Data were\ncollected froma hand surgery mission to San Pedro Sula,Honduras. Costs were estimated for local and volunteer services.Thetotal\nburden of disease averted from patients receiving surgical reconstruction was derived using the previously described disabilityadjusted\nlife years (DALYs) system. Results. After adjusting for likelihood of disability associated with the diagnosis and likelihood\nof the surgery�s success, DALYs averted totaled 104.6. The total cost for the mission was $45,779 (USD). The cost per DALY averted\nwas calculated to be $437.80 (USD), which is significantly below the accepted threshold of two times the per capita gross national\nincome of Honduras. Conclusions.This hand surgery humanitarian mission trip to Honduras was found to be cost-effective. This\nmodel and analysis should help in guiding healthcare professionals to organize future plastic surgery humanitarian missions....
Background. Postresective mandibular reconstruction is common in cases of oral andmandibular tumors. However, complications\nsuch as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after\nreconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications.\nMethods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between\nJanuary 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using\nHashikawa�s CAT and Eichner�s classification methods. Then, we determined whether these classifications and different treatment\nor surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred\nin 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation\ntherapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of\nsecuring reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The\nsuccess of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence\nof occlusions, and the amount of vascularization of the flap....
Objective. To assess the outcomes of functional rhinoplasty for nasal valve incompetence and to evaluate an in-office test used to\nselect appropriate surgical techniques. Methods. Patients with nasal obstruction due to nasal valve incompetence were enrolled.The\nmodified Cottle maneuver was used to assess the internal and external nasal valves to help select the appropriate surgical method.\nThe rhinoplasty outcomes evaluation (ROE) formand a 10-point visual analog scale (VAS) of nasal breathing were used to compare\npreoperative and postoperative symptoms. Results. Forty-nine patients underwent functional rhinoplasty evaluation. Of those, 35\nisolated batten or spreader grafts were inserted without additional procedures. Overall mean ROE score increased significantly\n(P < 0.0001) from 41.9 Ã?± 2.4 to 81.7 Ã?± 2.5 after surgery. Subjective improvement in nasal breathing was also observed with the VAS\n(mean improvement of 4.5 (95% CI 3.8ââ?¬â??5.2) from baseline (P = 0.000)). Spearman rank correlation between predicted outcomes\nusing the modified Cottle maneuver and postoperative outcomes was strong for the internal nasal valve (Rho = 0.80; P = 0.0029)\nand moderate for the external nasal valve (Rho = 0.50; P = 0.013). Conclusion. Functional rhinoplasty improved subjective nasal\nairflow in our population. The modified Cottle maneuver was effective in predicting positive surgical outcomes....
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