Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jul 2011
Fasciocutaneous flaps based on a doppler detected perforator, an illustrative series as used for burn contracture reconstruction.
Perforator flaps are well established as a versatile option in reconstructive surgery that provide thin, pliable cutaneous or fasciocutaneous tissue. They are particularly useful in the reconstruction of large shallow defects, such as after the release of a burn contracture, however there are situations where the additional time spent islanding these flaps may be unnecessary, and the flap is then essentially a fasciocutaneous flap based, but not islanded, on a perforator artery. This paper documents a series of 22 severe burn contractures in 17 patients reconstructed with fasciocutaneous flaps in this way. ⋯ There were three cases of partial superficial flap necrosis treated with split skin grafting. The functional and aesthetic outcomes were far better then those expected with split skin grafting, and published series show that contractures treated with perforator flaps are unlikely to ever need further surgery. Without islanding the flap it becomes a feasible option for reconstructing these patients even in the extremely resource poor environment in which they often present, and is an option for all plastic surgeons to consider in the reconstruction of large superficial defects.
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J Plast Reconstr Aesthet Surg · Jul 2011
Case ReportsCyanoacrylate glue burn in a child--lessons to be learned.
Cyanoacrylate is the generic name for cyanoacrylate based 'fast-acting' adhesives such as methyl-2-cyanoacrylate and ethyl-2-cyanoacrylate(commonly sold under trade names like Super Glue and Krazy Glue). Other forms have been developed as medical grade glues to be non-toxic and less irritating to skin tissue. Cyanoacrylate has a multitude of uses, ranging from simple domestic applications, to those for industrial purposes. ⋯ This was likely due to the novel presentation of this patient, and lack of education of staff. Although there have been cases of burns resulting from this type of glue documented in the literature, there are none of this exact nature and depth. [See figure in text]. Polymerization of methyl-2-cyanoacrylate.
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J Plast Reconstr Aesthet Surg · Jun 2011
Case ReportsUse of latissimus dorsi perforator flap to facilitate simultaneous great toe-to-thumb transfer in hand salvage.
Severe crushing and degloving injury of the hand often involves multiple tissue structures requiring several stages of reconstructions. This is more challenging when tissue defect and loss of thumb co-exist, requiring vascularised tissue transfer and toe-to-thumb reconstruction in a hand that has severely compromised vascularity. The management variables to be considered include the use of pedicled or free flap, simultaneous or staged procedures, consideration for early rehabilitation and flap selection to facilitate simultaneous free tissue transfers without further jeopardy to the vascularity of the hand. We illustrate these considerations in a case we have managed with simultaneous application of a latissimus dorsi perforator flap and great toe-to-thumb transfer.
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J Plast Reconstr Aesthet Surg · May 2011
Comparative StudySelection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers.
Venous insufficiency is the most common cause of re-exploration in free-tissue transfers to the lower extremity. There is currently no consensus regarding the best approach to recipient vein selection. This study was designed to evaluate whether the type of venous system or the number of recipient veins would impact flap outcomes after microsurgical lower-extremity reconstruction. ⋯ One-vein-anastomosis flaps were associated with statistically significant fewer complete flap failure in comparison with two-vein-anastomosis flaps (p = 0.014). In conclusion, the assessment of recipient vein parameters by surgeon's experience is the best predictor of flap outcome in lower-extremity reconstruction. In our cohort of patients, the deep venous system was more reliable than the superficial venous system, but the use of more than one vein for anastomosis did not correlate with better flap outcomes.
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J Plast Reconstr Aesthet Surg · Mar 2011
Review Case ReportsPovidone-iodine-related burn under the tourniquet of a child--a case report and literature review.
Chemical burn under pneumatic tourniquet caused by povidone-iodine is an iatrogenic injury and is rarely reported in the literature. It is even rarer in paediatric cases. We report a case of 2-year-old female patient who underwent excision and reconstruction of bilateral radial polydactylies. ⋯ These wounds healed secondarily within 4 weeks. This morbidity is relatively under-recognised. Special attention should be paid to paediatric patients, whose skins are more delicate and vulnerable.