Annals of plastic surgery
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Annals of plastic surgery · Mar 2014
Outcomes of immediate tissue expander breast reconstruction followed by reconstruction of choice in the setting of postmastectomy radiation therapy.
A common sequence for performing staged tissue expander breast reconstruction is to immediately insert a tissue expander, complete expansion before radiotherapy, and then perform the definitive reconstruction after radiotherapy is complete. This study evaluates the outcomes of this treatment regimen in 237 patients over a 10-year period at Northwestern Memorial Hospital. ⋯ Of the patients who underwent second-stage tissue expander to implant exchange, 87.5% successfully completed reconstruction without experiencing complications leading to explantation or conversion to autologous reconstruction. Thus, this study indicates that immediate tissue expander followed by reconstruction of choice breast reconstruction in the setting of postmastectomy radiation therapy can be successfully performed in most of the patients.
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Annals of plastic surgery · Mar 2014
ReviewA systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit.
Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? ⋯ Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.
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Annals of plastic surgery · Mar 2014
Case ReportsDistally based perforator propeller sural flap for foot and ankle reconstruction: a modified flap dissection technique.
Distally based perforator propeller sural flaps that pedicled on an isolated perforator from the peroneal artery or posterior tibial artery are a versatile local reconstructive option for defects of the foot and ankle region. However, flap venous congestion is yet a difficult problem after operation. We hypothesize that containing some adipofascial tissues around the axial perforator can preserve some tiny venous return routes, improve venous drainage, and ultimately enhance flap safety in distally based sural flaps. ⋯ Keeping a quadrant adipofascial tissue around the distal pivot perforator to form a perforator-adipofascial-pedicle can preserve more venous return routes and relieve flap swelling. This technique should be recommended in distally perforator-pedicled propeller flaps because it enhances flap safety yet does not increase the difficulty of 180-degree rotation.
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Annals of plastic surgery · Mar 2014
To heal and restore broken bodies: a retrospective, descriptive study of the role and impact of pastoral care in the treatment of patients with burn injury.
Despite advances in resuscitation, resurfacing, and reconstruction, recovery in burn patients often depends upon emotional, psychosocial, and spiritual healing. We characterized the spiritual needs of burn patients to help identify resources necessary to optimize recovery. ⋯ In burn patients, utilization of pastoral care appears to be linked to size of burn, financial charges, and length of stay, with religious affiliation serving as a possible marker for improved survival. Plastic surgeons and burn providers should consider and address the spiritual needs of burn patients, as a component of recovery.
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Annals of plastic surgery · Mar 2014
The course of the intercostobrachial nerve in the axillary region and as it is related to transaxillary breast augmentation.
The aim of this study was to precisely determine the course of the intercostobrachial nerve (ICBN) in the axillary region and as it is related to bony landmarks, and all of this might be of use for transaxillary breast augmentation. ⋯ When performing mammary augmentation, care should be taken not to dissect the undersurface of the P minor at the second intercostal space to avoid injury to the ICBN.