Journal of plastic, reconstructive & aesthetic surgery : JPRAS
-
J Plast Reconstr Aesthet Surg · Jan 2011
ReviewBeneficence, non-maleficence, distributive justice and respect for patient autonomy--reconcilable ends in aesthetic surgery?
Respect for patient autonomy, as a fundamental principle in contemporary bioethics, guides the process of informed consent through which, it is hoped, patients' wishes are determined and executed. However, when procedures are exclusively cosmetic, questions as to the ethical legitimacy of such requests and enhancements arise. ⋯ The final conclusion is that the complexity of the moral issues involved requires conceptualization of an expanded notion of responsibility, which recognises that we need to progress beyond a 'legal' to a 'moral' conception. The implications of this expanded notion of responsibility are discussed.
-
J Plast Reconstr Aesthet Surg · Dec 2010
Case ReportsThe use of Dermal Regeneration Template (Integra®) for reconstruction of a large full-thickness scalp and calvarial defect with exposed dura.
The reconstruction of large full-thickness scalp defects remains a challenge, particularly when dura is exposed. Various reconstructive methods have been described in the past. ⋯ We describe a case where Integra® was successfully used together with a Vacuum-Assisted Closure (VAC) dressing to reconstruct a full-thickness scalp defect with exposed dura. Surgical technique is discussed as well as problems encountered during the case and possible solutions.
-
J Plast Reconstr Aesthet Surg · Oct 2010
Resource implications of bilateral autologous breast reconstruction--a single centre's seven year experience.
Since the recent introduction of ''Payment by Results'' as part of NHS financial reforms, it has been noted that there is an imbalance between allocated Healthcare Resource Group tariffs and actual resource use for certain procedures. This study was undertaken to assess the impression that bilateral breast reconstruction using autologous flaps is under-funded. ⋯ The allocated tariff of £4 053 is insufficient, even before the inclusion of hidden costs. Bilateral free flap breast reconstructions are grossly under-funded at present. With increasing financial pressures on NHS Trusts there may be a drive towards simpler operations, which receive proportionally greater remuneration.
-
J Plast Reconstr Aesthet Surg · Oct 2010
Case ReportsDouble L-shaped free-style perforator flap for perineal and vaginal reconstruction after cylindrical abdominoperineal resection.
The improvement of patient carcinological status by an abdominoperineal resection by extended posterior perineal approach in a prone position requires the plastic surgeon to consider other reconstructive options. We present an original double L-shaped free-style propeller flap used to reconstruct the vagina and the perineum of a 57-year-old patient after the resection of a T4 tumour of the lower rectum.