Annals of plastic surgery
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Annals of plastic surgery · May 2007
Prognostic factors in necrotizing fasciitis and myositis: analysis of 16 consecutive cases at a single institution in Switzerland.
Necrotizing fasciitis and myositis are life-threatening infections involving the superficial fascia and musculature, respectively. Outcome depends on early diagnosis and aggressive treatment. Here, we aimed to determine prognostic factors for necrotizing soft tissue infections. ⋯ As infectious agents, group A streptococci (GAS) were identified in 10 patients and multiple pathogens in 6 patients. Lethal outcome was always associated with GAS infection and streptococcal toxic shock syndrome (STSS). In our patients, myonecrosis, GAS infection, and STSS appeared to be negative prognostic factors for survival in necrotizing soft tissue infections.
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Annals of plastic surgery · May 2007
Comparative StudyComparison of various methods and materials for treatment of skin laceration by a 3-dimensional measuring technique in a pig experiment.
The ability to obtain an objective comparison of scar formations by reproducible and quantitatively measurable results have posed a longstanding problem. This was especially troublesome when conclusions were to be drawn about the materials and methods applied. Two-dimensional methods (photography) gave no plastic impression about the spatial coherences in an examined scar. However, a quantifiable and reproducible recording of volumes and a 3-dimesional visualization of scars should provide the basis of any evaluation of methods and materials. ⋯ For objective comparison of intention and scarring, a scanning technique was used that permits a quantifiable, contact-free, single-session recording of volume differences. For this purpose, various suture materials and methods were used. Altogether, it could be shown that, if possible, wound closure treated with common suturing techniques, and especially with skin adhesive, should be enhanced by an intracutaneous suture with an increase in wound length. At the same time and under certain circumstances, skin adhesive poses an adequate substitute for the common suturing materials and methods. In the end, however, the final decision about the choice of method and material should be made depending on the localization and expanse of the wound as well as on the comfort of the patient (eg, absorbable suture/nonabsorbable suture), the time of exposure (eg, skin adhesive vs suture), and the economic efficiency (eg, producer of suture material).
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Annals of plastic surgery · May 2007
Flap choices to treat complex severe postburn hand contracture.
Many regions of the hand are affected seriously in the patients with complex severe postburn hand contractures. Multiple flap choices should be in count to treat complex severe postburn hand contractures affectively. We preferred dorsal ulnar flap for palmar region, cross-finger flap, side finger flap, and combined use of both for flexion contracture of the fingers, and rhomboid flap for web contractures. ⋯ The maximum improvements of the joint extensions were 75 degrees for median of digits metacarpophalangeal joint and 105 degrees for proximal interphalangeal joint. Grasp function of the hand dramatically improved, and the bulk of the flap did not interfere grasping. Complex severe postburn hand contracture can be treated sufficiently with dorsal ulnar flap, combined use of cross-finger and side finger transposition flap, and rhomboid flap.
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Annals of plastic surgery · May 2007
Case ReportsThe use of reinforced adhesive tape in supporting pendulous upper eyelid lesions.
Prolonged interference in the conjugate vision of an infant by monocular occlusion of the visual axis produces a significant risk of the development of stimulus deprivation amblyopia. Any clinician dealing with a large number of children's vascular lesions in the periorbital region will encounter cases where vision is threatened in this way. We have used a simple technique to help avoid interference with the visual axis while awaiting responses to conventional treatments of vascular lesions including laser and more rarely systemic steroid therapy. This involves the use of a reinforced adhesive tape.
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Annals of plastic surgery · May 2007
Freestyle perforator-based V-Y advancement flap for reconstruction of soft tissue defects at various anatomic regions.
Perforator flap surgery has gained great popularity in the last decade because surgeons can prepare freestyle flaps in anywhere on the body if they find a perforator supplied to the flap. One of the basic principles of reconstructive surgery is that superior results can be obtained for color and texture match if immediately adjacent soft tissue is used to repair a defect. V-Y advancement flaps are used successfully based on this principle, but the degree of mobility of a V-Y advancement flap is dependent on the laxity of the underlying subcutaneous tissue. This is an important disadvantage of traditional V-Y advancement flap and limits its use. ⋯ Perforator-based V-Y advancement flaps are safe and very effective for coverage of defects in which closure is impossible with a standard V-Y advancement flap. Dissection of the perforator or perforators offers remarkable excursion to the V-Y flap with minimal donor site morbidity. These axial pattern flaps can be used successfully with good esthetic and functional results at various regions of the body if there is any detectable perforator.