Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2008
A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects.
The reconstruction of large soft-tissue defects at the elbow is hard to achieve by conventional techniques and is complicated by the difficulty of transferring sufficient tissue with adequate elasticity and sensate skin. Surgical treatment should permit early mobilisation to avoid permanent functional impairment. Clinical experience with the distal pedicled reversed upper arm flap in 10 patients suffering from large elbow defects is presented (seven male, three female; age 40-70 years). ⋯ Stable defect coverage led to long-term wound stability without any restriction of elbow movement. The lateral and medial upper arm flaps represent a safe and reliable surgical treatment option for large elbow defects. The surgical technique is comparatively simple and quick.
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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
Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.
The ability of near infrared spectroscopy (NIRS) to predict vascular compromise in vascular free flaps postoperatively has been assessed, and the extent of regional tissue oxygen saturation (rSO(2)) after fibular flap transplantation was investigated quantitatively. To validate the sensibility and precision of the technique, the following methods were used. (1) Forearm vessel obstructive tests were conducted in four healthy volunteers. (2) Measurement and analysis of bilateral rSO(2) at the mandibular body and ramus were performed in 40 healthy volunteers by NIRS in the morning and afternoon. (3) Measurement and analysis of rSO(2) in transplanted fibular flaps for 41 cases with mandibular reconstruction were performed by NIRS at postoperative days 1-6. The results were: NIRS had high sensibility and precision in monitoring rSO(2) of living tissues. ⋯ However, rSO(2) in the transplanted fibular flaps was reduced compared to the value on the control side. rSO(2) decreased gradually 4-12 hours postoperatively. After that period, rSO(2) increased gradually and approached the value of the control side at 20 h after the operation. It can be concluded that NIRS is a reliable noninvasive method for monitoring blood circulation in transplanted tissues, particularly for buried flaps.
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J Plast Reconstr Aesthet Surg · Jan 2008
Ear reconstruction following severe complications of otoplasty.
Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. ⋯ While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.
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J Plast Reconstr Aesthet Surg · Jan 2008
Biography Historical ArticleOnce upon a time ... how west discovered east.
One of the most critical advances in modern burns care stemmed from the realisation that morbidity and mortality were significantly reduced if the burn tissue was surgically removed and the resulting surgical wound was closed with autologous skin grafts. This observation derived from the pioneering work of Zora Janzekovic who introduced the burns world to the practice of tangential excision. ⋯ This paper is a personal account of this revolutionary era of burns care. It was presented by Zora Janzekovic herself at the 10th Workshop of the European Club for Paediatric Burns held in Graz, Austria, in the autumn of 2007.