Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2008
Microtia: ear reconstruction using tissue expander and autogenous costal cartilage.
Ear reconstruction is one of the most challenging surgeries faced by the reconstructive surgeon. Currently, the use of autogenous costal cartilage is still best practice for microtia reconstruction. However, the relative deficiency of thin skin for coverage of the cartilage framework remains a limiting factor. ⋯ All these innovations may solve the deficiency of the skin and improve cartilaginous framework definition. In conclusion, tissue expander offers a non-hairbearing, thin, well-vascularised skin to envelope an erect, contour-accentuated framework. Most patients with microtia are satisfied with their ear reconstruction.
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J Plast Reconstr Aesthet Surg · Jan 2008
Burned ear: the use of a staged Nagata technique for ear reconstruction.
Four features, manifested in various combinations, characterise deformity in the burned ear: (i) the presence of scarred skin at the site of and surrounding the ear, with dramatic loss of skin elasticity; (ii) the presence of longitudinal scars of the pinna due to previous drainage of the perichondritis as an initial trial for saving the ear; (iii) absence of different components of the framework of the ear, mostly the helix/antihelix complex (the cartilage-containing part) with or without the ear lobule; (iv) scarred chest wall due to associated burns of the skin of the chest. In the face of these deformities, the surgical goals for auricular reconstruction include the following: (i) removal of the remaining cartilage of the burned ear, part or the whole of it in severe cases, because it may be a source of infection; (ii) wide exposure of the cartilage of the ribs through sufficient chest wall incision to overcome the severe fibrosis of the burned chest wall skin; (iii) creation of delicate smooth cartilage framework, free of sharp edges; (iv) creation of a skin pocket of sufficient size. ⋯ There was a good colour match between the reconstructed auricle and the surrounding skin. Patient satisfaction was high and the results were well accepted.
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J Plast Reconstr Aesthet Surg · Jan 2008
ReviewComposite tissue allotransplantation: a review of relevant immunological issues for plastic surgeons.
Composite tissue allotransplantation of hand, facial and other tissues is now a clinical reality. The terminology, treatment principles, drug combinations, dosage schedules and mechanisms of the immunosuppression medications on which contemporary transplant surgery is based are unfamiliar to plastic surgeons and most healthcare providers outside the field of transplantation medicine. With this in mind, the purpose of this manuscript is to provide plastic surgeons with a comprehensive and understandable review of key immunological principles relevant to composite tissue allotransplantation. ⋯ Today, as transplant and reconstructive surgeons join forces to move hand and facial tissue allotransplantation into the clinical arena, it is important that plastic surgeons have an understanding of the major immunological principles upon which this new treatment is based.
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J Plast Reconstr Aesthet Surg · Jan 2008
Case ReportsTotal upper and lower eyelid replacement following thermal burn using an ALT flap--a case report.
Upper and lower eyelid unilateral full thickness reconstruction in a patient with no available adjacent tissues because of burns or trauma sequelae is a surgical challenge. A case of severe thermal burn with unilateral complete defect of both upper and lower eyelids is reported, together with the surgical technique of reconstruction. The patient was a 65-year-old man who sustained deep burns of the head and neck with upper airway burns after falling into a fireplace. ⋯ Flap vessels were anastomosed to the superficial temporal artery and vein. The conjunctiva and the fascia replaced the new inner upper and lower lamella. To our knowledge, this is the first report of the use of a perforator flap, the ALT flap, in full thickness reconstruction of both upper and lower eyelids and may be a reliable option in such selected and challenging situations.
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Children with burns inflicted by other children represent a small proportion of referrals to our paediatric burns unit. The aim of this paper is to investigate any differences between them. ⋯ Older male children sustained significant burns outside their homes. They reported them as being deliberate assaults, although on closer inspection of the circumstances it was difficult to support their account of the events.