Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Dec 2011
Risk factors of tissue-expansion failure in burn-scar reconstruction.
Tissue expansion has become invaluable for burn-scar reconstruction. However, its use is hindered by the complications that often result in expansion failure. This study attempts to identify the risk factors of expansion failure in burn patients, as such factors have not been clearly defined. ⋯ We conclude that tissue expansion should be avoided in older patients and in lower limbs. The largest possible expander size and inflation at time of implantation should be used to lower the risk of expansion failure.
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J Plast Reconstr Aesthet Surg · Dec 2011
A multidisciplinary protocol for face transplantation at Brigham and Women's Hospital.
Face transplantation introduces an unprecedented potential to restore form and function in patients with severe facial disfigurement. A successful face transplantation programme requires a sound research protocol, a solid infrastructure, expert personnel and adequate funding. There are only a few active face transplant programmes in the world and interest in the development of new such programmes continues to grow. ⋯ The roles of each team member during the various stages of the face transplant process are presented here. Additional insight into the interaction between the face transplant team, the Institutional Review Board and the regional Organ Procurement Organization is given. The BWH team's experience has shown that true collaboration, creativity and a unique approach to each candidate translate into the optimal care of the face transplant patient both before and after surgery.
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J Plast Reconstr Aesthet Surg · Dec 2011
Case ReportsLymph node compression of the lesser occipital nerve: a cause of migraine.
Recent investigation has focussed on the concept of peripherally triggered migraine headaches caused by compression, irritation or entrapment of the sensory nerves in the head and neck. We report a case of a 52-year-old male suffering from an occipitoparietal migraine that presented with a mass in the right occipital area. The mass was found in the deep layer of subcutaneous tissue just over the semispinalis muscle, sitting on top of the lesser occipital nerve, which was preserved through delicate dissection using loupe magnification. ⋯ After removal of the mass, the patient reported complete resolution of headaches. Sensation of the scalp was not altered. This is the first report of a case of hyperplastic lymph node causing migraine through physical compression of a peripheral nerve.
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J Plast Reconstr Aesthet Surg · Dec 2011
The effects of topically applied silicone gel and its silver derivative on the prevention of hypertrophic scarring in two rabbit ear-scarring models.
Topically applied silicone gel is an effective treatment in the management of hypertrophic scars. This early study of silicone gel predates other well-controlled scientific studies that demonstrate these findings. Our well-established rabbit ear scarring model creates 7 mm punch wounds down to the bare cartilage, including the removal of the perichondrium. ⋯ Silicone gel silver significantly reduced scar elevation index (p=0.004). The new 10 mm scar model resulted in more hypertrophic scarring than the typical, 7 mm wound scar model (p=0.0001). In conclusion, silicone gel and its silver derivative are effective in preventing hypertrophic scarring and scar models that leave the perichondrium intact causes scars with more hypertrophy.