Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2006
ReviewRadiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: an argument about timing.
To conduct a systematic review to gather the available evidence on the optimum timing of the radiotherapy in relation to autologous breast reconstruction. ⋯ Despite the paucity of the published data, the current evidence suggests that the radiation has a deleterious effect on autologous flap reconstruction. Until better methods of radiation delivery can be devised to minimise the long term radiation sequelae in the irradiated tissue, delayed reconstruction seems to be a safe option in most of the cases. However, the findings from these studies should be interpreted with great caution before generalising from their results.
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J Plast Reconstr Aesthet Surg · Jan 2006
ReviewThe influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants.
Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. ⋯ The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.
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J Plast Reconstr Aesthet Surg · Jan 2006
Case Reports Multicenter StudyThe management of life-threatening haemorrhage following blunt facial trauma.
Life-threatening bleeding is uncommon following blunt facial trauma. There have been few reports in the literature describing its optimal management and a clear approach to treatment is yet to be defined. Reported strategies for control of facial haemorrhage include oro-nasal packing, external carotid artery ligation, transantral ligation of the internal maxillary artery, maxillary reduction and angiographic embolisation. ⋯ Its use in the management of bleeding following blunt facial trauma is unclear. The combined experience of the facial trauma teams at Harborview Hospital, Seattle, USA and Liverpool Hospital, Sydney, Australia yielded four cases of severe life-threatening haemorrhage following blunt trauma that underwent angiography. The roles of various management strategies were evaluated to generate a preferred management pathway in treating severe bleeding following blunt facial trauma.
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J Plast Reconstr Aesthet Surg · Jan 2006
Case ReportsGuillain-Barré syndrome following facial bone fracture.
Guillain-Barré syndrome (GBS) is an inflammatory disorder of the peripheral nerves and nerve roots characterised by lymphocytes and macrophage infiltration and myelin destruction. Two-thirds of cases of GBS emerge from viral or bacterial infection. ⋯ The association of GBS with head injury per se is not well recognised. This case highlights the possibility of GBS following facial bone fracture and indicates that medical staff should be alerted to the association.
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J Plast Reconstr Aesthet Surg · Jan 2006
Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.
Free flaps are the first choice procedure to manage soft-tissue defect of the lower limb for many authors, but loco-regional pedicled flaps are an alternative since they were described in the 1980s. We analysed the changes in our practice to reconstruct soft-tissue defects of the distal third of the leg. A retrospective chart review identified 215 cases of distal leg soft-tissue defect treated in the department during 15 years. ⋯ Moreover, complications of local and regional flaps are less severe. Our practice has changed to make pedicled flaps our first choice to cover soft-tissue defects of the lower limb. However, we still use free flaps as a first choice for wide or composite defects, when pedicled flaps are not feasible or for cosmetic considerations to avoid additional scarring of the leg.