Journal of plastic, reconstructive & aesthetic surgery : JPRAS
-
J Plast Reconstr Aesthet Surg · Jun 2017
Case ReportsRestoration of basic hand function following devastating hand injuries using a microsurgically fabricated chimeric iliac osteocutaneous flap.
Reconstruction following devastating hand injuries, with amputations of the thumb plus multiple digits, is challenging. Double flap or combined flap transfers may be options in such cases. Between 2012 and 2014, 6 patients underwent hand reconstruction following devastating injuries with amputations of the thumb and multiple digits. ⋯ All patients were able to perform basic hand functions after a median follow-up of 1.8 years. Microsurgically fabricated chimeric iliac osteocutaneous flaps may restore basic hand function to some extent. This procedure is an option worth considering for hand reconstruction following devastating injuries in carefully selected patients.
-
J Plast Reconstr Aesthet Surg · May 2017
Review Case ReportsIs it time for a change in the approach to chemical burns? The role of Diphoterine® in the management of cutaneous and ocular chemical injuries.
A multitude of household and occupational compounds have the potential to induce chemical burns to the eye and skin. Without prompt intervention, irreversible visual loss and disfigurement may prevail. ⋯ However, although Diphoterine® and Hexafluorine® uptake is slowly increasing in industrial workplaces, there is a paucity of education and use in both emergency departments and plastic surgery units worldwide. Herein, we present a case report of combined ocular and cutaneous acid burn treated with Diphoterine®, together with a review of the current supporting literature.
-
J Plast Reconstr Aesthet Surg · Mar 2017
Prevention of thrombosis in hypercoagulable patients undergoing microsurgery: A novel anticoagulation protocol.
Hypercoagulable conditions are often considered relative contraindications to free flap reconstruction. This paper presents and critically examines a novel anticoagulation regimen developed to address this disease state. ⋯ The key approach to hypercoagulable patients is likely prevention over treatment. Patients who received prophylactic heparin infusions had clinically lower rates of thrombotic events and flap loss. However, this encouraging finding must be balanced with the increased risk for postoperative bleeding complications.
-
J Plast Reconstr Aesthet Surg · Feb 2017
ReviewDelay techniques for nipple-sparing mastectomy: A systematic review.
Rare but serious complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) and mastectomy skin flaps. NAC and mastectomy flap delay procedures are novel techniques designed to avoid these complications and may be combined with retroareolar biopsy as a first-stage procedure. We performed a systematic review of the literature to evaluate various techniques for NAC and mastectomy flap delay. ⋯ Delay procedures for NSM have a good safety profile and may be considered in patients at risk for NAC or mastectomy flap necrosis, such as patients with pre-existing breast scars, active smoking, prior radiation, or ptosis. These procedures have the added benefit of allowing a retroareolar biopsy to be sent for permanent sections prior to mastectomy, allowing the surgical team to plan for the removal of the NAC at the time of mastectomy if indicated and eliminating the risk of a false-negative result on frozen section analysis.
-
J Plast Reconstr Aesthet Surg · Feb 2017
Facilitating shared decision-making with breast augmentation patients: Acceptability of the PEGASUS intervention.
PEGASUS is an intervention to facilitate shared decision-making by helping prospective patients consider their expectations of surgery, so that surgeons have a clear understanding of their individual goals. To date, shared decision-making interventions within aesthetic surgery are lacking. The present mixed methods study therefore explored the acceptability of implementing PEGASUS into routine private practice with breast augmentation patients and aesthetic providers. ⋯ This study provides preliminary support for the acceptability of PEGASUS to breast augmentation patients and to aesthetic providers working in the private sector.