Annals of plastic surgery
-
Annals of plastic surgery · May 2011
Comparative StudyThe independent plastic surgery match: an in-depth analysis of the applicants and process.
The independent plastic surgery match is an extremely competitive process that remains the most common training model for residents. The purpose of this study was to analyze the candidates and the overall process, both quantitative and qualitatively. ⋯ Candidates applying to the independent plastic surgery match need to be aware of the competitiveness and financial commitment the process requires.
-
Annals of plastic surgery · May 2011
Comparative StudyAnterolateral thigh free flap for "head-to-toe" reconstruction.
Since its conception the anterolateral thigh (ALT) free flap has become a cornerstone in the reconstruction of complex head and neck defects. It has quickly gained further uses because of its variability in size, malleability, 2-team approach to the operation, and low-morbidity donor site. The ALT lends itself well to reconstructing complex defects throughout the body, from the lower extremities up to the head and neck, and a variety of indications, from oncologic defects to burns and traumatic injuries. ⋯ The objective of this article is to review our institutional review board-approved case series at the University of Florida and further elucidate the widespread adaptability of the ALT flap. We share our experience in indications for use, recipient-site variables, donor-site management, complications, and outcomes. We also review other applications of this useful flap described in the literature.
-
Annals of plastic surgery · May 2011
Comparative StudyPostmastectomy breast reconstruction after previous lumpectomy and radiation therapy: analysis of complications and satisfaction.
Lumpectomy and radiation therapy (breast conservation therapy [BCT]) are common treatments for early-stage breast cancer. However, many of these patients will require a subsequent salvage mastectomy and reconstruction after a locoregional recurrence. This study examines whether prior BCT leads to higher rates of complications and dissatisfaction with subsequent mastectomy and breast reconstruction. ⋯ Radiation in the setting of BCT did not increase overall rates of complications or dissatisfaction with subsequent breast reconstruction in our patient population. These patients, however, had a higher incidence of mastectomy skin flap loss. These findings are important for preoperative counseling and intraoperative planning in patients with prior lumpectomy and radiation.
-
Annals of plastic surgery · May 2011
Comparative StudyPreoperative computed tomography angiogram to predict patients with favorable anatomy for superficial inferior epigastric artery flap breast reconstruction.
Superficial inferior epigastric artery (SIEA) flap breast reconstruction has advantages over deep inferior epigastric perforator flap (DIEP) and muscle sparing transverse rectus abdominus myocutaneous flap (TRAM) reconstructions with less donor site morbidity and less complicated flap dissection. Not all patients have an adequate SIEA and superficial inferior epigastric vein (SIEV) to support free tissue breast reconstruction, and dissection of the SIEA in all patients can be time consuming. Preoperative computed tomography (CT) angiograms can be used to identify the SIEA and SIEV in patients planning to undergo free abdominal tissue breast reconstruction and direct more efficient dissection in patients with a large SIEA. ⋯ If the SIEA was not visualized on CT angiogram, no usable SIEA was found during surgery. Preoperative CT angiogram of the abdominal wall perforating arteries can help predict which patients may have adequate anatomy for an SIEA-based free flap. This information may help direct more efficient dissection of the abdominal flaps by selecting out patients who do not have an adequate SIEA.
-
Annals of plastic surgery · May 2011
Comparative StudyDoes use of bupivacaine-soaked pledgets aid in the care of postoperative cleft palate patients?
Bupivacaine-soaked pledgets have been shown to decrease postoperative pain in patients requiring iliac crest harvesting, even with the use of field blocks. This finding was applied to cleft palate repair. ⋯ There was no significant decrease in postoperative analgesic use, time to first significant oral intake feeding or discharge. There was no post operative bleeding or infection. Bupivicaine soaked pledgets do not significantly decrease postoperative analgesic use or shorten time to first or sustained feeding. However the use of hemostatic pledgets may decrease postoperative infection and bleeding rates.