Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Mar 2016
Proximal and distal patterns: Different spreading patterns of indocyanine green lymphography in secondary lower extremity lymphedema.
As a clinical evaluation of secondary lymphedema of the leg, indocyanine green (ICG) lymphographic assessment has established its usefulness. In this study, we analyzed the ICG findings of patients with secondary lymphedema of the leg, focusing on the location and spreading pattern of dermal backflow (DBF). ⋯ In the proximal pattern, the ICG injected into the distal part of the leg propelled to the proximal part, but an obstruction after lymphadenectomy caused ICG pooling to appear first on the proximal side. In the distal pattern, the lymphatic system hypoplasia of the leg may have already been present, and lymph node dissection might be the only trigger for the development of lymphedema. This classification may reflect the pumping function and preexisting hypoplasty of the lymphatic vessels, and provides a novel approach for the pathological evaluation of lymphedema. Patients with proximal pattern on ICG lymphography may well indicate lymphaticovenous anastomosis.
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J Plast Reconstr Aesthet Surg · Mar 2016
The role of elective amputation in patients with traumatic brachial plexus injury.
Despite undergoing complex brachial plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after brachial plexus injury. ⋯ Elective amputation after brachial plexus injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation.
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J Plast Reconstr Aesthet Surg · Jan 2016
ReviewPediatric lower extremity sarcoma reconstruction: A review of limb salvage procedures and outcomes.
In recent years, dramatic advances in the multidisciplinary treatment of pediatric sarcoma have resulted in significant improvement in the long-term survival of the patient. Thus, following tumor resection, significant effort has gone into limb salvage and improving functional outcomes. Plastic surgeons, in conjunction with orthopedic surgeons, are using techniques in microvascular free-tissue transfer and rotational flap surgery to preserve limb length. This study presents a review of the current reconstructive strategies and the oncologic, surgical, and functional outcomes in this population. ⋯ Plastic surgery procedures play an increasingly important role in pediatric lower extremity sarcoma reconstruction and functional limb salvage. Published series are limited in number and case volume; to date, no systematic review has been published. The existing data emphasize the role of microvascular free-fibula transfer as well as local muscle flap coverage in preserving limb length and function, with minimal risk of local recurrence and need for amputation.