Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Nov 2014
Microtia reconstruction using tissue expanders without skin grafts from groin region.
Microtia reconstruction is a multistage procedure for which a variety of surgical strategies have been devised. Most surgeons continue to employ the long-established two-stage procedures described by Nagata and Firmin, which use autogenous rib cartilage for auricular reconstruction. The groin area is the most common donor site for full-thickness skin grafts in auricular elevation, the second stage. In this article, we present a new method that uses tissue expanders before auricular elevation, which provides the necessary skin and creates satisfactory results without groin scarring. ⋯ Various procedures using tissue expanders have been introduced in microtia reconstruction. However, they utilized complicated strategies for tissue expanders or obtained suboptimal aesthetic results. With our simple and reproducible methods, we can obtain satisfactory aesthetic results using expanded skin without the additional morbidity of a donor site. Despite the addition of an operation procedure, patient satisfaction with regard to the lack of groin scarring was much higher than expected.
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Previous neurophysiological studies of discrete hand regions have suggested the dorsum to be more sensitive to temperature changes than the palmar surface, but no multiple-region investigation of the corresponding dorsal and palmar regions has been performed. This study aimed to investigate whether the dorsum of the hand is more sensitive to temperature changes than the palm across multiple regions. In 15 healthy human volunteers, cold and warmth detection thresholds were measured in 10 defined areas of the hand using a thermode of 2.56 cm(2). ⋯ All dorsal regions were significantly more sensitive to cold than equivalent palmar areas. Differences in warmth thresholds were not uniform but, overall, dorsal sensitivity was significantly higher. This study finds that the dorsal aspect of the hand was more sensitive to temperature changes than the palm, with higher sensitivity to painful thermal stimuli.
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J Plast Reconstr Aesthet Surg · Nov 2014
Case ReportsPropeller flap for treatment of a poststernotomy sternal fistula: a case report.
The treatment of post-operative deep sternal wound infections is a real challenge for surgeons. Conservative treatment with debridement and vacuum-assisted closure (VAC) therapy is not always successful. In the most severe and chronic cases, a surgical debridement and reconstruction of the defect is mandatory. In this report, the authors present a case of a 61-year-old female patient with a chronic cutaneous fistula in the sternal region following a median sternotomy after coronary artery bypass. The patient had already undergone treatment with antibiotics, drainage of an abscess and local debridement, but the infection continued to relapse periodically. The authors decided to treat the fistula with debridement and reconstruction with a local freestyle propeller flap mobilised from the right parasternal region. ⋯ Sternal fistulas after medial sternotomy are difficult to treat. The treatment method of debridement followed, in certain cases, by VAC therapy is quite controversial. A surgical procedure is sometimes necessary to speed healing. Mobilisation of a freestyle propeller flap represents a less invasive surgical approach to the treatment of sternal fistulas in cases of conservative treatment failure.
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J Plast Reconstr Aesthet Surg · Nov 2014
Mastectomy with or without immediate implant reconstruction has similar 30-day perioperative outcomes.
Immediate breast reconstruction (IBR) using implants remains a favorable reconstructive option in breast cancer. Understanding the added risk associated with IBR continues to enhance the risk counseling process and management of these patients. ⋯ Prognostic/risk category, level II.