Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Dec 2008
Treatment with vacuum-assisted closure and cryo-preserved homologous de-epidermalised dermis of complex traumas to the lower limbs with loss of substance, and bones and tendons exposure.
Lower-limb injuries with loss of tissue and exposure of bones and tendons are an increasing problem. The condition of the wound locally and the patient in general does not always allow immediate and adequate coverage of the structures exposed by the trauma. Therefore, new therapeutic solutions are needed. ⋯ Granulation tissue was obtained in all wounds, with complete coverage of exposed structures. No infections were detected in the cohort, and all patients were prepared for further necessary reconstructive treatments. In our experience, the combination of VAC therapy and DED could, in selected cases, constitute an effective treatment for complex lower limb traumatic injuries with bone and tendon exposure.
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J Plast Reconstr Aesthet Surg · Nov 2008
Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery.
The use of antimicrobial prophylaxis against surgical site infection (SSI) is widespread in plastic surgery, while results from prospective randomised controlled trials in guiding antibiotic use are lacking. The purpose of this study was to identify the incidence and risk factors for SSI in plastic surgery, and to evaluate the appropriateness of prophylactic antibiotic prescribing habits in a tertiary university centre. ⋯ This is the first study evaluating appropriateness of antimicrobial prophylaxis use by plastic surgeons. Despite widespread use of prophylactic antibiotics, significant SSI rates were still present and frequently responsible for re-hospitalisations and re-interventions. The appropriateness of administration and indications for perioperative prophylactic antibiotic use must be evaluated.
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J Plast Reconstr Aesthet Surg · Nov 2008
Long-term results after vascularised joint transfer for finger joint reconstruction.
Vascularised complete joint transfer from the finger or the second toe offers the unique possibility of reconstructing a joint defect on the thumb or fingers using autologous tissue, which fully preserves its growth potential. Indications for vascularised joint transfer on the finger in children are set because of lack of therapy options offering normal growth potential. In adults vascularised joint transfer is indicated in case of contraindication for prosthetic joint replacement or arthrodesis. ⋯ Whenever possible the 'tissue bank concept' according to CHASE should be applied in finger joint reconstruction using a vascularised joint graft from either an amputated or a redundant digit. Results of vascularised joint transfer have to be compared to those of persisting joint defect, prosthetic joint replacement, arthrodesis, or ultimately amputation of the finger involved. Patients in whom a vascularised joint transfer is anticipated should be informed about the following points: (1) The risk of failure (vascular failure, tendon adhesion, joint stiffness, etc.) is about 10%. (2) The expected active range of motion depends on aetiology, age, donor site and recipient site. Traumatic joint defects show a greater active range of motion than congenital defects. Children have more active joint motion than adults. (3) Because of minor donor site impairment and rapid recovery of normal gait the whole second ray should be amputated after harvesting of a joint graft on the second toe. (4) Hospitalisation takes 1-2 weeks. Immobilisation of the hand (palmar forearm splint) and the foot (lower leg cast) should be applied for 4 to 6 weeks. Intensive physiotherapy is necessary for at least 3 months. Additional splinting is advised for about 6 months. (5) Extensor tendolysis is necessary in a large number of cases but should not be done earlier than 6 months after transplantation.
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J Plast Reconstr Aesthet Surg · Oct 2008
Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction.
Prophylactic mastectomy is an effective risk-reducing option in women with hereditary increased risk of breast cancer. It may be combined with immediate reconstruction, with the intention of improving aesthetic outcome and health-related quality of life. Sixty-one women underwent prophylactic mastectomy and immediate breast reconstruction in Malmö, Sweden, between 1995 and 2003. ⋯ The study population scores were high, suggesting that prophylactic mastectomy and immediate reconstruction on both physical and psychological issues in this retrospective study had no negative effect. Also, the Hospital Anxiety and Depression Scale (HAD) questionnaire did not suggest any increased anxiety or depression among the patients. Prophylactic mastectomy and immediate breast reconstruction in women at risk of hereditary breast cancer may be carried out with a satisfactory aesthetic outcome and an acceptable rate of complications comparable to those in other studies, and does not in itself seem to be associated with a decreased quality of life.