Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 7 Articles
We defined the glandular flap including fat in the subclavicular area as an extended glandular flap, which has been used for breastconserving\r\nreconstruction in the upper portion of the breast. Indication. The excision volume was 20% to 40% of the breast\r\nvolume, and the breast density was dense. Surgical Technique. The upper edge of the breast at the subclavicular area was drawn in\r\nthe standing position before surgery. After partial mastectomy, an extended glandular flap was made by freeing the breast from both\r\nthe skin and the pectoralis fascia up to the preoperative marking in the subclavicular area. It is important to keep the perforators\r\nof the internal mammary artery and/or the branches of the lateral thoracic artery intact while making the flap. Results. Seventeen\r\npatients underwent remodeling using an extended glandular flap. The cosmetic results at 1 year after the operation: excellent in 11,\r\ngood in 1, fair in 3, and poor in 2. All cases of unacceptable outcome except one were cases with complications, and more than 30%\r\nresection of moderate or large size breasts did not obtain an excellent result for long-term followup. Conclusion. This technique is\r\nuseful for performing the breast-conserving reconstruction of small dense breasts....
Background: Emerging attempts have been made to reduce operative trauma and improve cosmetic results of\r\nlaparoscopic cholecystectomy. There is a trend towards minimizing the number of incisions such as natural\r\ntransluminal endoscopic surgery (NOTES) and single-port laparoscopic cholecystectomy (SPLC). Many retrospective\r\ncase series propose excellent cosmesis and reduced pain in SPLC. As the latter has been confirmed in a\r\nrandomized controlled trial, patient�s satisfaction on cosmesis is still controversially debated.\r\nMethods/Design: The SPOCC trial is a prospective, multi-center, double blinded, randomized controlled study\r\ncomparing SPLC with 4-port conventional laparoscopic cholecystectomy (4PLC) in elective surgery. The hypothesis\r\nand primary objective is that patients undergoing SPLC will have a better outcome in cosmesis and body image\r\n12 weeks after surgery. This primary endpoint is assessed using a validated 8-item multiple choice type\r\nquestionnaire on cosmesis and body image. The secondary endpoint has three entities: the quality of life 12 weeks\r\nafter surgery assessed by the validated Short-Form-36 Health Survey questionnaire, postoperative pain assessed by\r\na visual analogue scale and the use of analgesics. Operative time, surgeon�s experience with SPLC and 4PLC, use of\r\nadditional ports, conversion to 4PLC or open cholecystectomy, length of stay, costs, time of work as well as intraand\r\npostoperative complications are further aspects of the secondary endpoint. Patients are randomly assigned\r\neither to SPLC or to 4PLC. Patients as well as treating physicians, nurses and assessors are blinded until the 7th\r\npostoperative day. Sample size calculation performed by estimating a difference of cosmesis of 20% (alpha = 0.05\r\nand beta = 0.90, drop out rate of 10%) resulted in a number of 55 randomized patients per arm.\r\nDiscussion: The SPOCC-trial is a prospective, multi-center, double-blind, randomized controlled study to assess\r\ncosmesis and body image after SPLC....
Pretibial lacerations are problematic and best managed by surgical debridement, then skin grafting. Traditional postoperative care\r\ninvolves bed rest to optimise graft survival. This meta-analysis assesses early mobilisation versus bed rest for skin graft healing\r\nof these wounds. Medline, Embase, Cochrane, Cinahl, and Google Scholar databases were searched. Analyses were performed on\r\nappropriate clinical trials. Four trials met with the inclusion criteria. No difference was demonstrated in split skin graft healing\r\nbetween patients mobilised early compared to patients admitted to hospital for postoperative bed rest at either 7 (OR 0.86 CI\r\n0.29ââ?¬â??2.56) or 14 days (OR 0.74 CI 0.31ââ?¬â??1.79). There was a statistically significant delay in healing in patients treated with systemic\r\ncorticosteroids (OR 8.20 CI 0.99ââ?¬â??15.41). There was no difference in postoperative haematoma, bleeding, graft infection, or donor\r\nsite healing between the comparison groups. In the available literature, there is no difference between early mobilisation and\r\nbed rest for the healing of skin grafts to pretibial wounds. Corticosteroids exert a negative effect on skin graft healing unlike\r\nearly mobilisation, which does not cause increased haematoma, bleeding, infection, or delayed donor site healing. Modality of\r\nanaesthesia does not affect skin graft healing....
Background and Objective. There has been a heightened interest in laser-assisted fat reduction procedures.We aimed to determine\r\nif lipolysis with the 1,320nm Nd-YAG short-pulsed laser without subsequent suction results in satisfactory contouring of the\r\nupper extremity. Materials and Methods. Unilateral laser lipolysis of the upper arm was performed on 5 patients. Subcutaneous,\r\nsubdermal, and skin surface temperatures were monitored with flexible thermocouples throughout the procedure to aid in the\r\nestablishment of a treatment endpoint. Photographs and arm circumference measurements were evaluated before and 3 months\r\nafter laser lipolysis. Patients were given the choice of undergoing the procedure on the contralateral arm at 3 months. Results.\r\nAll patients achieved no improvement to minimal improvement in upper arm contour. One of five patients was elected to have\r\nlipolysis performed on the contralateral arm. Conclusion. Laser lipolysis may be safely performed with the parameters utilized in\r\nthis pilot study, although minimal improvement was seen in upper extremity contour....
The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by\r\ntwo-team work.Most importantly, the donor-site morbidity is minimal.However, the anatomic variations decreased its popularity.\r\nBy adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator\r\ndissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications:\r\nthe fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis\r\nmuscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle\r\nlength could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and\r\nconceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to\r\ntoe....
Tissue expansion, is a simple method of breast reconstruction. Method. A prospective study of 27 patients treated over a 43 month\r\nperiod is described. At the first stage the expander is inserted in the dual plane, and the medial pectoral nerve is divided. The tissue\r\nexpander is over-expanded. Second stage: a de-epithelialized vertical triangle is used to aid anterior projection, an inframammary\r\nfold is created and a silicone gel prosthesis inserted. Z-plasties are added to the transverse scar. The contralateral breast can be\r\ntreated or left alone. Complications were recorded and the results were assessed by 4 plastic surgeons using a visual analogue scale.\r\nResults. 19 patients had expanders inserted at mastectomy (2 bilateral) and 8 underwent delayed reconstruction, with a mean age\r\nof 47 years (range 30ââ?¬â??65 years). A single prosthesis was inserted in 15 patients (mean size 320 mL) and two prosthesis were stacked\r\nin 12 patients (mean volume of 400 mL). The mean delay from full expansion to the second stage was 10 weeks (range 3 weeksââ?¬â??11\r\nmonths). A contralateral augmentation was performed in 5 patients, pexy in 10, a reduction in 2 and in 8 patients no procedure\r\nwas performed. One patient required explantation. The mean visual analogue assessment was 7. Conclusion. This technique should\r\nbe considered enhance the cosmetic results in tissue expansion....
Background: Various agents and techniques have been introduced to limit intra-operative blood loss from skin\r\nlesions. No uniformity regarding the type of haemostasis exists and this is generally based on the surgeon�s\r\npreference. To study the effectiveness of haemostatic agents, standardized wounds like donor site wounds after\r\nsplit skin grafting (SSG) appear particularly suitable. Thus, we performed a systematic review to assess the\r\neffectiveness of haemostatic agents in donor site wounds.\r\nMethods: We searched all randomized clinical trials (RCTs) on haemostasis after SSG in Medline, Embase and the\r\nCochrane Library until January 2011. Two reviewers independently assessed trial relevance and quality and\r\nperformed data analysis. Primary endpoint was effectiveness regarding haemostasis. Secondary endpoints were\r\nwound healing, adverse effects, and costs.\r\nResults: Nine relevant RCTs with a fair methodological quality were found, comparing epinephrine, thrombin, fibrin\r\nsealant, alginate dressings, saline, and mineral oil. Epinephrine achieved haemostasis significantly faster than\r\nthrombin (difference up to 2.5 minutes), saline or mineral oil (up to 6.5 minutes). Fibrin sealant also resulted in an\r\nup to 1 minute quicker haemostasis than thrombin and up to 3 minutes quicker than placebo, but was not\r\ndirectly challenged against epinephrine. Adverse effects appeared negligible. Due to lack of clinical homogeneity,\r\nmeta-analysis was impossible.\r\nConclusion: According to best available evidence, epinephrine and fibrin sealant appear superior to achieve\r\nhaemostasis when substantial topical blood loss is anticipated, particularly in case of (larger) SSGs and burn\r\ndebridement....
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