Journal of plastic surgery and hand surgery
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J Plast Surg Hand Surg · Dec 2017
ReviewAssessment of burn size in obese adults; a literature review.
Obesity causes changes in the total body surface area as well as the distribution of skin surfaces. In burn management, three methods are commonly used to determine the surface area burned: the patient's palm, the rule of nines, and the Lund-Browder chart. These methods rely on the distribution of skin surface, although none of these methods consider differences in body mass. This study investigates the relationship between body surfaces and body mass in the assessment of burn size to determine the validity of the conventional methods when applied to obese individuals. ⋯ The commonly used methods for assessment of burns should be used with caution when applied to obese burn patients, and the clinical parameters observed even more systematically.
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J Plast Surg Hand Surg · Dec 2017
Reoperations and postoperative complications after osteosynthesis of phalangeal fractures: a retrospective cohort study.
The aim of the study was to describe the reoperation rates and postoperative complications associated with different methods of osteosynthesis in all extra-articular, closed fractures of the proximal and middle phalanges operated on in the Department of Hand Surgery at Södersjukhuset beween 2010-2014, and to describe the associated patient demographics. ⋯ Open reduction with plate fixation was associated with a higher reoperation rate, but this method was also used for the more complex fractures. Plate fixation for phalangeal fractures often entails a need for later tenolysis and plate removal. More aggressive mobilisation regimes might be indicated to prevent adhesion problems.
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Although free flap is gaining popularity for the reconstruction of diabetic foot ulcers, it is unclear whether free flap reconstruction increases the chances of postoperative independent ambulation. The aim of this study is to evaluate the relationship between free flap success and postoperative ambulation. ⋯ The present study indicates that free flap reconstruction may increase the possibility of independent ambulation for patients with extensive tissue defects due to diabetic ulcers. Intermediate limb salvage rates and independent ambulation rates were favourable in patients with successful reconstruction. The use of foot orthoses and a team approach with pedorthists were effective to prevent recurrence.
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J Plast Surg Hand Surg · Dec 2017
Effect of chymase activity on skin thickness in the Clawn miniature pig hypertrophic scarring model.
The female red Duroc pig, a heavy and cumbersome animal, is routinely used as an animal model for hypertrophic scarring. Chymase, a chymotrypsin-like serine protease, plays an important role in skin fibrosis. This study aimed to create a lightweight pig hypertrophic scarring model using Clawn miniature pigs, and to investigate the role of chymase in hypertrophic scarring. ⋯ Both tissue thickness and chymase activity were increased in scar tissue, peaked on day 90 after injury, and then gradually decreased. Peripheral scar tissue showed higher chymase activity than central scar tissue. Neither chymase activity nor transforming growth factor-beta 1 was detected in the surrounding normal skin, whereas central scar tissue showed a high transforming growth factor-beta 1 concentration, peaking on day 15, and decreasing to normal by day 120. We found the Clawn miniature pig to be a useful model for hypertrophic scarring. Chymase activity and skin thickness were well-correlated, suggesting that scars thicken when chymase activity is high.