Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Apr 2010
Comparative StudyManagement of microstomia in adult burn patients revisited.
This study aims to review our experience in the surgical management of microstomia following facial burns. ⋯ Commissuroplasty is an early functional post-burn corrective procedure that often must be performed prior to completion of scar maturation. Mucosal advancement flaps are a viable procedure for the treatment of microstomia after facial burns, resulting in good aesthetic and functional outcome. Direct scar excision and skin grafting, although unavoidable in cases of extensive perioral scarring, frequently produces inferior results.
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Nitric acid burn traumata often occur in the chemical industry. A few publications addressing this topic can be found in the medical database, and there are no reports about these traumata in children. A total of 24 patients, average 16.6 years of age, suffering from nitric acid traumata were treated. ⋯ An immediate lavage should be followed by silver sulphadiazine treatment. Thereafter, fluid-absorbent foam bandages or occlusive, antiseptic moist bandages should be used according to the burn depth. Slow demarcation caused a delay in performing surgical treatments.
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J Plast Reconstr Aesthet Surg · Apr 2010
Comparative StudyThe pedicled descending branch muscle-sparing latissimus dorsi flap for trunk and upper extremity reconstruction.
The major blood supply of the latissimus dorsi muscle flap is based on the descending and tranverse branches of the thoracodorsal artery. This segmental blood supply allows the muscle to be split and harvested based solely on vascularization from the descending branch, thus sparing the latissimus dorsi muscle function. This article reports the use of the descending branch muscle-sparing latissimus dorsi myocutaneous flap in reconstructing defects on the trunk and upper extremities. ⋯ The pedicled descending branch muscle-sparing latissimus dorsi myocutaneous flap with a transversely orientated skin paddle results in minimal functional deficit of the donor site, absence of seroma, low rate of flap complications and an aesthetically acceptable scar.
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J Plast Reconstr Aesthet Surg · Apr 2010
Case ReportsRespiratory management of Pierre Robin sequence using nasopharyngeal airway with Kirschner wire.
The Pierre Robin sequence (PRS) is a relatively rare symptom complex characterised by glossoptosis, micrognathia and respiratory obstruction. The initial problem that children with PRS face is obstructive dyspnoea, which can result in death without appropriate respiratory management. We designed and used a modified airway with a Kirschner wire (K-airway) in children with PRS who suffered from dyspnoea that did not improve with conservative treatment. ⋯ This method is safe because it is less invasive, and its effects can be easily evaluated, suggesting that it is a good method to try prior to surgical treatment.
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J Plast Reconstr Aesthet Surg · Apr 2010
Comparative StudyIn vivo observations of cell trafficking in allotransplanted vascularized skin flaps and conventional skin grafts.
The problem of allogeneic skin rejection is a major limitation to more widespread application of clinical composite tissue allotransplantation (CTA). Previous research examining skin rejection has mainly studied rejection of conventional skin grafts (CSG) using standard histological techniques. The aim of this study was to objectively assess if there were differences in the immune response to CSG and primarily vascularized skin in composite tissue allotransplants (SCTT) using in vivo techniques in order to gain new insights in to the immune response to skin allotransplants. ⋯ The immune response in both SCTT and CSG was focused on targets in the dermis, with infiltrating cells clustering around hair follicles (CSG and SCTT; p<0.01) and blood vessels (SCTT; p<0.01) in allogeneic transplants. This study suggests that there are significant differences between rejection of SCTT and CSG that may limit the relevance of much of the historical data on skin graft rejection when applied to composite tissue allotransplantation. Furthermore, the use of novel in vivo techniques identified characteristics of the immune response to allograft skin not previously described, which may be useful in directing future approaches to overcoming allograft skin rejection.