Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jun 2010
Skin scar preconceptions must be challenged: importance of self-perception in skin scarring.
Greater objective scar severity and visibility should intuitively cause greater psychosocial distress for patients. Previous research is contradictory and has employed non-validated scar severity measures whilst neglecting patient-rated severity. The aim of this study was to assess the effects of objective and patient-rated scar severity, scar type and location on psychosocial distress. ⋯ Scar type was unrelated to psychosocial distress. Patient-rated scar severity and scar visibility are correlated with psychosocial distress rather than clinician's objective severity rating or scar type. Although counter-intuitive, results are consistent with research into other disfiguring conditions and patient self-assessment should therefore form an integral part of clinical assessment.
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J Plast Reconstr Aesthet Surg · Jun 2010
Matrix metalloproteinases and tissue inhibitors of metalloproteinases in patients with different types of scars and keloids.
Hypertrophic scars and keloids are fibroproliferative skin disorders characterised by progressive deposition of collagen. Our study is designed to investigate the expression and concentration of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in different types of scars and keloids. ⋯ The concentration of TIMP-1 in sera of patients varies depending on the size of the involved fibrotic scar tissue. A decrease in MMP-to-TIMP expression in scar tissue may contribute to increased synthesis and deposition of collagen, leading to a severe fibrotic reaction with pathologic scar formation. The results implicate non-operative therapy options in these patients that not only down-regulate TIMPs but also increase the activity of MMPs.
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J Plast Reconstr Aesthet Surg · Jun 2010
Postoperative fluid management in major elective plastic surgery.
To document the current practice of postoperative fluid management and evaluate its effectiveness in major elective plastic surgery. ⋯ Patients undergoing major elective plastic surgery are in massive positive fluid balance. Majority of these patients develop a brisk diuresis in the early postoperative period. Current practice centres on preventing oliguria, often with excessive and unnecessary fluid being administered resulting in cardiac failure in some patients. Postoperative fluid management should be guided by a protocol with minimal fluid administration that maintains adequate tissue perfusion, guided by lower and upper limits of desirable urine output. The rates of fluid administration should be adjusted dynamically by the surgical or the nursing staff using such a protocol.
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J Plast Reconstr Aesthet Surg · Jun 2010
Historical ArticleEURAPS at 20 years. A brief history of European Plastic Surgery from the Société Européenne de Chirurgie Structive to the European Association of Plastic Surgeons (EURAPS).
By the end of WWI, plastic surgery had reached unexpected heights. The high quality of the work done for soldiers with facial injuries and burns, either as an emergency or as a delayed procedure, demonstrated that this new discipline was honourable, worthwhile and socially crucial, thus deserving official recognition and independence. The establishment of new plastic surgery centres, scientific societies and specialised journals were the key to success for the achievement of this goal. ⋯ The first scientific meeting took place in Strasbourg, France, city of the Council of Europe, on 7-9 June 1990. Based on the high scientific level of the clinical and aesthetic presentations, EURAPS soon ranked among the leading associations in Europe for plastic surgery and this leadership is now recognised all over the world. The EURAPS successfully celebrated its 20th anniversary in 2009.
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Today, microsurgery plays a fundamental role in plastic surgery, expanding surgical possibilities for cancer, trauma and aesthetic-related surgery. However, throughout the years, teaching and training systems for microsurgery have not evolved in the same manner as its operative techniques. ⋯ However, stringent laws for animals used in experiments, combined with the rising costs of this model, have instigated the need to find alternative methods. To overcome this dilemma, we have developed a three-step approach to optimise microsurgery training, particularly when there is no access to animal laboratories.