Plastic and reconstructive surgery
-
Plast. Reconstr. Surg. · Mar 2006
Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies.
Restoration of elbow flexion is the main objective in the treatment of brachial plexus palsies affecting the upper roots. Transfer of the ulnar nerve to the nerve of the biceps has given satisfactory results, but the restored biceps is often weak in cases with avulsions of the C5-C6-C7 roots, in elderly patients, and after long preoperative delays. The authors decided to investigate a double nerve transfer: one or more fascicles of the ulnar nerve to the nerve to the biceps and a fascicle of the median nerve to the motor branch to the brachialis muscle. ⋯ The results of this technique compare favorably with those of other methods. The percentage of success and the strength of elbow flexion restored were increased without any morbidity. This technique will probably reduce the need for secondary procedures to augment elbow flexion. The authors propose double nerve transfer as a standard procedure in C5-C6 and C5-C6-C7 injuries.
-
Plast. Reconstr. Surg. · Mar 2006
A cadaver study in preparation for facial allograft transplantation in humans: part I. What are alternative sources for total facial defect coverage?
Reconstruction of facial defects in burn, trauma, and head-neck cancer patients is challenging. The lack of autogenous tissue availability and the need to match facial texture and color are major concerns. ⋯ The authors' cadaver dissection confirmed that none of the conventional cutaneous autogenous flaps are able to cover total facial defects. Currently, the best option for reconstruction of the full facial defect is the autogenous bipedicled scapular-parascapular flap because of its large size and texture. However, perfect match of facial skin texture, pliability, and color can only be achieved by transplantation of the facial skin allograft from the human donor.
-
Plast. Reconstr. Surg. · Mar 2006
Exceptions to the Stark law: practical considerations for surgeons.
The purpose of this study was to provide an understanding of the applicable legislative exceptions to prohibitions under the Stark law, which governs common legitimate business relationships in surgical practice. ⋯ Although expert legal advice is required for navigation through the maze of Stark laws, it is incumbent on surgeons in private practice and at academic centers to have basic knowledge of exceptions under this burdensome statute. Antikickback "safe harbors" provide some protection against possible Stark violations. Penalties for violating Stark laws are severe, including fines of up to $15,000 per service and the economic threat of exclusion from participation in federal health care programs.
-
Plast. Reconstr. Surg. · Mar 2006
Dielectric measurement in experimental burns: a new tool for burn depth determination?
There has been a lack of methods to provide quantitative information of local tissue edema after burn injury. Noninvasive dielectric measurements provide this information. The measured value, the dielectric constant, is directly related to the amount of water in tissue. Using probes of different sizes, the measurements give information from different tissue depths. The aim of this study was to characterize edema formation at different tissue depths and to examine whether the dielectric measurements could be used to distinguish partial- and full-thickness burns in pigs. ⋯ The dielectric measurements provide a sensitive and noninvasive method for examining tissue edema and differentiate partial- and full-thickness burns in experimental burns. Thus, they are of clinical interest for early burn depth determination.
-
Plast. Reconstr. Surg. · Feb 2006
Case ReportsSuprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus.
Shoulder stabilization is of utmost importance in upper extremity reanimation following paralysis from devastating brachial plexus injuries. The purpose of this report is to present the authors' experience with suprascapular nerve reconstruction in 118 cases of adult brachial plexus lesions. Outcomes were analyzed in relation to various factors, including patient age, denervation time, donor nerve used, and functional restoration achieved in the supraspinatus versus the infraspinatus muscles. ⋯ Suprascapular nerve neurotization is a high priority in upper limb reanimation for restoration of glenohumeral joint stability, shoulder abduction, and external rotation. Concomitant neurotization of the axillary nerve yields improved outcomes in shoulder abduction function. The best results are seen when direct neurotization of the suprascapular nerve is performed within 6 months from the injury.