Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Oct 2014
Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England.
This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. ⋯ The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction.
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J Plast Reconstr Aesthet Surg · Oct 2014
A functional periorbital subunit allograft: vascular, anatomic, and technical considerations for future subunit facial transplantation.
Injury to the face can result in the loss of critical specialized structures (the eyelids, lips, ears and nose). Vascularized composite allotransplantation (VCA) allows the surgeon to replace exactly what has been lost. The success of the clinical face transplants suggests the possibility of transplanting specialized units of the face. In this study we explore the neurovascular anatomy and technical specifics for harvest of a functional composite eyelid subunit flap. ⋯ Based this study, a periorbital flap can be based on the STA. Motor innervation of the flap is via the zygomatic and buccal branches of the facial nerve with sensory innervation via the infraorbital, supraorbital and supratrochlear nerves. FA could be used, but its ability to perfuse the entire flap was inconsistent.
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J Plast Reconstr Aesthet Surg · Sep 2014
A retrospective study to classify surgical indications for infantile hemangiomas.
Infantile hemangiomas (IHs) spontaneously involute, but some leave contour deformities necessitating surgical correction. There is a paucity of data reviewing predictive risk factors associated with a need for surgery to guide clinicians when counseling parents. Patients undergoing IH resection by a single surgeon from August 2004 to August 2011 were reviewed to determine patient (age, gender, birth history) and IH characteristics (size, location) associated with surgical intervention. ⋯ Resected head and neck IHs were smaller than those below the neck (average, 8.85 cm(2) vs. 22.35 cm(2), p = 0.017). Preterm birth is associated with higher risk for requiring surgical intervention. IHs on the head and neck are more likely to be removed when compared to those below the neck, and at a smaller size threshold.
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J Plast Reconstr Aesthet Surg · Sep 2014
Reconstruction following partial and total sacrectomy defects: an analysis of outcomes and complications.
Reconstruction of sacrectomy defects following ablative surgery remains a challenge, with high complication rates in the reported literature. The size of the defect is the primary consideration for flap choice; however, the cause of intra-abdominal and flap complications remains unclear. The aim of the study was to evaluate our results for sacrectomy flap reconstruction in order to determine predictive or protecting factors for complications. ⋯ Gluteal advancement and vertical RAM or transverse RAM flaps are both reliable options for reconstruction of sacrectomy defects. The use of acellular dermal matrix (ADM) for reconstructing the posterior abdominal wall provides a barrier between the intra-abdominal contents and flap, preventing bowel adhesions/obstruction and fistulas as well as prevents sacroperineal hernia.
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J Plast Reconstr Aesthet Surg · Sep 2014
Closure of large defects after microcystic lymphatic malformations using lateral intercostal artery perforator flap.
The surgical treatment of microcystic lymphatic malformations (LMs) has historically been difficult and frustrating because of a high recurrence rate due to incomplete resection. However, complete removal of the multifocal and extensive lesions rely on accurate imaging diagnosis and effective repair methods for the resulting large defect. The purpose of this study was to repair large skin defects due to complete resection of microcystic LMs using lateral intercostal artery perforator (LICAP) flap. ⋯ Surgical resection is necessary for microcystic LMs. Imaging assists in the diagnosis and identification of the scope and level of lesions. The LICAP flap provides good coverage for the large defects and achieves acceptable morphology without functional deficits at flap donor sites. Ultrasound and MRI are safe and accurate diagnostic imaging methods for the pre- and postoperative evaluation of microcystic LMs in patients undergoing surgery.