Plastic and reconstructive surgery
-
Proponents of evidence-based medicine would acknowledge that several sources of evidence inform clinical decision making. Hierarchies of evidence have, however, been developed to help describe the quality of evidence that may be found to answer our clinical questions. According to this classification, the randomized clinical trial is the most effective way to determine whether a cause-and-effect relationship exists between an intervention and a predefined outcome. The basic principles of clinical trial design are reviewed, and the unique challenges of trial design in surgery are discussed.
-
Plast. Reconstr. Surg. · Apr 2011
The use of acellular dermal matrix in release of burn contracture scars in the hand.
Contracture deformities of the upper extremity are encountered frequently in burn victims. Surgical repair of this problem is challenged by a paucity of soft tissue, poor functional outcome, and a high rate of recurrence. Acellular dermal matrix has become increasingly popular in reconstructive surgery--at times--as an alternative to local and free tissue transfer in different parts of the body. However, its applicability in contracture release, particularly in hand surgery, has not been widely explored. ⋯ Acellular dermal matrix can be an effective tool in surgical treatment of difficult burn contracture deformity in the hand, with lasting results.
-
Plast. Reconstr. Surg. · Apr 2011
Antimicrobial activity of clinically used antiseptics and wound irrigating agents in combination with wound dressings.
A primary strategy for preventing and treating wound infection in chronic wounds is the use of topical antiseptics and wound irrigating agents. However, their interaction with commonly used wound dressings has not yet been investigated. In this study, the authors analyzed the antimicrobial activity of antiseptics and wound irrigating agents used with commercially available wound dressings. ⋯ This study revealed that commonly used wound dressings dramatically reduce antibacterial activity of clinically used antiseptics and wound irrigating agents in vitro.
-
Plast. Reconstr. Surg. · Apr 2011
Exchange cranioplasty using autologous calvarial particulate bone graft effectively repairs large cranial defects.
Autogenous particulate cranial bone graft has been proven to be effective for inlay cranioplasty but does not provide structural contour. This limitation can be overcome using an exchange cranioplasty technique. This study probes the effectiveness of this method for large (>5 cm(2)) or complicated cranial defects. ⋯ Autologous exchange cranioplasty using particulate bone graft is safe and highly effective for reconstructing even large cranial defects.
-
Plast. Reconstr. Surg. · Mar 2011
Comparative StudyWarfare-related craniectomy defect reconstruction: early success using custom alloplast implants.
Cranial bone defects secondary to decompression craniectomy associated with the Global War on Terror pose a unique reconstructive challenge. The objective of this study was to evaluate the outcome of alloplastic reconstruction using custom-designed implants for large craniectomy defects from warfare-related cranial trauma. ⋯ Despite war wound contamination, massive cranial defects can be successfully reconstructed using custom alloplastic implants. However, reconstruction of frontal cranial defects in proximity to the airways and orbits was associated with infection and implant removal.