Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Jan 2009
Surgical outcomes of VRAM versus thigh flaps for immediate reconstruction of pelvic and perineal cancer resection defects.
Reconstruction following abdominoperineal resection or pelvic exenteration is commonly performed with regional flaps from the thigh or abdomen. This study compared the surgical outcomes and complications in cancer patients who underwent immediate reconstruction of these defects with vertical rectus abdominis myocutaneous (VRAM) versus thigh flaps. ⋯ Immediate VRAM flaps result in fewer major complications than thigh flaps without increased early abdominal wall morbidity when used to repair abdominoperineal resection and pelvic exenteration defects.
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Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Although many individual case reports exist, no thorough evaluation of Marjolin's ulcer patients has been conducted to date. ⋯ The authors' review suggests that there is much variability in the anatomical location of Marjolin's ulcers, with the majority occurring in wounds of the upper and lower extremities. Marjolin's ulcer appears to be preventable if early wound coverage is undertaken. Countries with limited access to medical treatment report a high number of Marjolin's ulcers compared with more developed regions.
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Partial joint denervation is the concept of preservation of joint function and relief of joint pain by interrupting neural pathways that transmit the pain message from the joint to the brain. Partial denervation of painful wrist, elbow, and shoulder joints was described in part I. Application of these principles to the knee and ankle is described in part II. ⋯ For patients with a structurally intact joint but with chronic knee or ankle pain after trauma or arthroplasty, this approach provides an outpatient, ambulatory operative approach that is joint sparing and can be rehabilitation-free. Partial joint denervation in the lower extremity offers plastic surgeons the opportunity to help our colleagues in orthopedic surgery, podiatric medicine, and pain management with some of their most difficult pain-related lower extremity patient problems.
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Plast. Reconstr. Surg. · Jan 2009
The error of omission: a simple checklist approach for improving operating room safety.
The primary goal of patient safety must go hand in hand with the goal of producing reliably good aesthetic and functional results. The implementation of a proactive checklist improves operating room communication and takes the necessary step toward reducing the often neglected errors of omission. These steps are necessary if we are to ultimately achieve our goal of improving safety comprehensively in the operating room.