Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Sep 2013
Comparative StudyNipple reconstruction after implant-based breast reconstruction: a "matched-pair" outcome analysis focusing on the effects of radiotherapy.
The major focus of research when addressing nipple reconstruction has been on developing new techniques to provide for long-lasting nipple projection. Rarely, has the outcome of nipple reconstruction as it relates to postoperative morbidity, particularly after implant-based breast reconstruction, been analyzed. ⋯ While nipple reconstruction is a safe procedure after implant-based breast reconstruction in patients without a history of radiotherapy the presence of an irradiated field converts it to a procedure with a significant increase in postoperative complication rate.
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J Plast Reconstr Aesthet Surg · Sep 2013
Review Case ReportsReversal of hand peripheral ischaemia due to extravasation of adrenaline during cardiopulmonary resuscitation.
A 63 year old woman sustained an extravasation of vasopressor during a successful in hospital cardiopulmonary resuscitation resulting in an acutely ischaemic hand. This was treated with multiple washouts of the hand due to incipient recurrence of the ischaemia. ⋯ This case highlights the specific problems associated with extravasation of vasopressor. We present an algorithm for treatment of these and identify the potential need to use specific antidotes for the vasoconstriction caused by adrenaline extravasation.
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J Plast Reconstr Aesthet Surg · Sep 2013
Comparative StudyPIP silicone breast implants: rupture rates based on the explantation of 676 implants in a single surgeon series.
To determine the true rupture rates of PIP implants from a large single surgeon cohort and to assess whether rupture rates varied depending on time of implant insertion. In addition, the efficacy of ultra sound scanning (USS) in determining rupture is examined. ⋯ Our paper has confirmed high rates of PIP implant failure in the largest published series to date. The significant difference in rupture rates between implants inserted prior to 2003 and those after this time supports the view that industrial silicone was used in the devices after 2003. Implants are more likely to rupture if inserted in the sub muscular plane compared to the sub glandular plane. USS is highly effective at detecting rupture in PIP implants and loco-regional spread is high compared to other devices. We believe this paper provides hard data enabling more informed decision making for patients, clinicians and providers in what remains an active issue affecting thousands of women.
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J Plast Reconstr Aesthet Surg · Sep 2013
Comparative StudyModified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application.
The classic deep iliac circumflex osteocutaneous flap with iliac crest has been one of the most commonly used flaps for mandibular reconstruction since its advent. However, the unnecessary bulk of the 'obligatory muscle cuff' limited its widespread use. The authors describe in this article the use of a modified deep iliac circumflex osteocutaneous flap with reduced bulk and great mobility between the skin and the bone components. ⋯ The modified deep iliac circumflex osteocutaneous flap enjoys a great degree of mobility between the skin and the bone components; it has greater manoeuvrability compared to the conventional one for the reconstruction of complex three-dimensional defects. The donor site of the skin flap is confined to the lower abdominal region, facilitating direct closure.
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in the year since Poly Implant Prothèse (PIP) found itself the epicentre of intense, global media attention initial studies have started to evaluate the abnormally high premature device failure rate suspected for their mammary prostheses. A cohort free from most of the usual confounding variables affords opportunities to improve upon previous estimates of rupture prevalence, assess the media effect and evaluate contemporary ultrasound scan (USS) accuracy. ⋯ this study not only reaffirms PIP's rupture prevalence to be higher than comparative breast prostheses, but also records the media's beneficial effect in improving recall. Importantly, there is a relatively high proportion of patients with ruptured devices of which they are otherwise unaware. Ultrasonography, at least in PIP-augmented women, seems to be a more accurate tool than previously measured, especially in the presence of rupture. Finally, 35.2% resisted all attempts at review despite repeated efforts and widespread media coverage.