Annals of plastic surgery
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Annals of plastic surgery · Feb 2012
Innovative treatment of peripheral nerve injuries: combined reconstructive concepts.
Although autografts are the gold standard for failed primary nerve repairs, they result in donor-site morbidity. Nerve conduits and decellularized allografts are a novel solution for improved functional outcomes and decreased donor-site morbidity. Unfortunately, previous reconstructive algorithms have not included the use of decellularized allograft nerve segments, either for repair of the primary injury or reconstruction of the autograft donor site. To identify the optimal sequence of techniques and resources, we reviewed our cases of upper extremity peripheral nerve reconstruction. ⋯ To restore maximal target-organ function with minimal donor-site morbidity, we have created an algorithm based on evidence for nerve reconstruction using allograft, conduit, and autologous donor nerve. Based on our clinical outcomes, despite small sample study, the adoption of the proposed algorithm may help provide uniform outcomes for a given technique, with minimal patient morbidity. Individualized reconstructive technique, based not only on nerve gap size but also on functional importance and the anatomical level of the nerve injury are important variables to consider for optimal outcome.
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Owing to the diverse application of the pectoralis major muscle (Pmaj) in reconstructive surgery, with special reference to its safe and functional transfer, a precise knowledge of its nerve supply becomes mandatory. The aim of the present study was to investigate its innervations. ⋯ The muscle is mainly innervated by the lateral pectoral nerve supplemented by the branches of the MPN. The proximal segment, having a separate nerve, allows its functional transfer. Care should be practiced whenever the distal segment is to be harvested, because of having multiple nerves.
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Annals of plastic surgery · Feb 2012
Case ReportsFungal colonization within a tissue expander: a case report.
Fungal contamination derived from prosthetic substances is not common, although because of the following reasons the number of cases has increased in the recent years: increased life expectancy, and therefore a greater number of surgical candidates; higher rates of underlying diseases, which are accompanied by immunosuppressive disorders that can cause a higher susceptibility for such infections. Most reports of infection in breast prosthesis and tissue expanders are bacterial infections, and fungi cases are still rare. ⋯ This fungal growth inside saline-filled tissue expander was asymptomatic and not troublesome. It also caused no changes in the patient's treatment course.