Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Oct 2008
Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II.
Traumatic instability of the proximal carpal row is based either on a scaphoid fracture or a scapholunate dissociation. Long-standing scaphoid nonunion or scapholunate ligament insufficiency may lead to a carpal collapse and subsequent arthrosis. Controversy exists regarding the appropriate salvage procedure for patients with scapholunate advanced collapse (SLAC)- or scaphoid nonunion advanced collapse (SNAC)-wrist in stage II. Proximal row carpectomy (PRC) and midcarpal arthrodesis (MCA) are two commonly used options. The purpose of this retrospective study was to evaluate the functional outcome and pain relief in SNAC-SLAC-wrist stage II after MCA, compared to PRC in a long term follow up. ⋯ Our data demonstrate that PRC is more favourable for patients who require less grip strength at work. For patients carrying out heavy manual work we recommend MCA due to the significantly better grip strength postoperatively.
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J Plast Reconstr Aesthet Surg · Oct 2008
T-anastomosis in microsurgical free flap reconstruction: an overview of clinical applications.
In free flap transfer, the recipient vessel is often sacrificed to provide the pedicle anastomosis. As the recipient vessel is likely necessary for distal circulation, preserving its patency is also important, especially in the extremities of aged or chronic vasculopathy patients, such as those with diabetes. If a reliable proximal branch is included in the T-shaped pedicle preparation, the pedicle can be interposed between two ends of the recipient vessel, thus allowing for T-anastomosis. ⋯ In addition, the anastomosis is quite useful in difficult recipient sites and for many purposes, such as chronic diabetes or traumatic vascular injury. With this technique, a single recipient vessel can be reused in a staged reconstruction. In perforator flaps, the concentrated flow through a narrow perforator pedicle with a small diameter can be dispersed until the autoregulation of new flow distribution in the flap is stabilised.
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J Plast Reconstr Aesthet Surg · Oct 2008
The role of the epidermis in the control of scarring: evidence for mechanism of action for silicone gel.
Hypertrophic scars can be reduced by the application of silicone dressing; however, the detailed mechanism of silicone action is still unknown. It is known that silicone gel sheets cause a hydration of the epidermal layer of the skin. An in vitro co-culture experiment has shown that hydration of keratinocytes has a suppressive effect on the metabolism of the underlying fibroblasts resulting in reduced collagen deposition. ⋯ Our findings demonstrate that 2 weeks of silicone gel application at a very early onset of scarring reduces dermal and epidermal thickness which appears to be due to a reduction in keratinocyte stimulation. Oxygen can be ruled out as a mechanism of action of silicone occlusive treatment. Hydration of the keratinocytes seems to be the key stimulus.
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J Plast Reconstr Aesthet Surg · Sep 2008
Case ReportsA circumferential incision technique to release wide scar contracture.
Wide scar contracture in patients with large burns is generally treated with a skin graft or flap after release of the contracture. In children, however, the creation of a new scar at the donor site should be avoided because additional operations are sometimes required later in life. Patients with large scars often lack adequate donor sites. ⋯ It makes it possible to release multiple contracture bundles or a largely contracted area at one time. This technique is simple, safe, minimally invasive for patients, and requires no other donor sites. It should be tried before resorting to the use of skin grafts or flaps in patients with large scar contractures.