Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Sep 2015
Soft tissue reconstruction after compound tibial fracture: 235 cases over 12 years.
Outcomes in management of compound tibial fractures are measured by the rate of infection and non-union. These are a function of many variables that interact in complex ways. Our aims are to describe changes in these injuries over the past decade, to determine which variables predict a poor outcome and to compare reconstructive options controlling for these variables. ⋯ Therapeutic III.
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J Plast Reconstr Aesthet Surg · Sep 2015
ReviewBilateral hand transplantation: Functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4-13 years).
Between January 2000 and July 2009, five adults who had suffered bilateral traumatic below-elbow amputations, received bilateral hand-forearm allografts performed by the Lyon team. We report the functional benefits achieved over a mean follow-up period of 7.6 years (range 4-13 years), up to December 31st, 2013. Clinical measurement is hampered by the lack of specific validated assessment tools, obliging us to use non-specific standardized evaluation means. ⋯ Improvement was seen to continue during the first three years, and then tend to become stable. Continued efforts should be directed at designing comprehensive, condition-specific, reliable outcome measurement tools. Continuous monitoring and evaluation of patients is required to assess the long-term risk-benefit balance.
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J Plast Reconstr Aesthet Surg · Sep 2015
Perfusion dynamics in lower limb reconstruction: Investigating postoperative recovery and training using combined white light photospectroscopy and laser Doppler (O2C(®)).
Postoperative regimes designed to acclimatise lower limb free flaps to the changing flow dynamics of standing (flap training exercises) are widely employed despite a paucity of evidence for their use. This study utilises non-invasive monitoring of perfusion parameters to investigate flap training at the microcirculatory level. ⋯ Prior to flap training, lower limb dependency causes reduced oxygenation, increased venous pooling and decreased flow consistent with venous congestion. Following a three day training regime, flap perfusion begins to accommodate for these changes. These findings provide a rationale for flap training, although further work is required to explain the mechanisms.
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J Plast Reconstr Aesthet Surg · Sep 2015
Management of perioperative microvascular thrombotic complications - The use of multiagent anticoagulation algorithm in 395 consecutive free flaps.
Thrombotic complications remain a major barrier to successful microsurgical reconstruction, but their effective management remains controversial. ⋯ Thrombophilia uncovered by microvascular procedures can be effectively treated with anticoagulation upon discovery and prevent postoperative free flap thrombotic events. High free flap salvage can be achieved with the early intervention combined with thrombolysis and multiagent anticoagulation and antiplatelet therapy.
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J Plast Reconstr Aesthet Surg · Sep 2015
Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI).
Sternal wound infections after sternotomy are associated with high morbidity, high mortality and escalating treatment costs. Repeated radical debridement - with the removal of any hardware - and wound conditioning are the prerequisites for reconstruction. Muscle and, less frequently, omentum flaps are usually used for reconstruction. ⋯ Our experience reveals that a fasciocutaneous flap based on the second intercostal perforator of the internal mammary artery can be an alternative, quick-to-prepare flap for covering sternal defects. In adipose patients, it has sufficient bulk, and it is large enough to cover common sternal wounds. It also has low complication and morbidity rates, and it achieves an aesthetically pleasing result.