Annals of plastic surgery
-
Annals of plastic surgery · Jan 2015
ReviewCombined Achilles tendon and soft tissue defects: functional outcomes of free tissue transfers and tendon vascularization.
Rupture of the Achilles tendon can be a debilitating event, affecting ankle stability and gait efficiency. When this rupture is combined with a large soft tissue defect, reconstruction of the tendon and free tissue transfer for wound resurfacing should be considered. ⋯ For combined free tissue transfer and Achilles tendon reconstruction, there seems to be no functional superiority in ankle range of motion or strength when vascularized tendon repairs were compared to avascular autograft and allograft methods.
-
Annals of plastic surgery · Jan 2015
Accessibility of academic plastic surgeons as mentors to medical students.
Determining a field of specialty can be a difficult decision for medical students. Career plans are often fostered through exposure to the field and mentorship, but it is often hard to identify accessible mentors. The purposes of this study were to determine the prevalence of accessible mentors among academic plastic surgery faculty and to characterize predictors of accessibility. ⋯ Most academic plastic surgeons are accessible as mentors (78%). Medical students enrolled at a highly ranked medical school seeking younger faculty mentors may have the greatest access to research opportunities and career advice. Encouraging faculty to participate in mentorship is important in developing the next generation of plastic surgeons.
-
Annals of plastic surgery · Jan 2015
Predictive and protective factors for partial necrosis in DIEP flap breast reconstruction: does nulliparity bias flap viability?
Although success rate of deep inferior epigastric perforator (DIEP) flap breast reconstruction has greatly improved, complications still occasionally occur. Perfusion-related complications (PRCs) (ie, fat necrosis and partial flap necrosis) are the most frequent concern, affecting aesthetic final result of the reconstructed breast. The aim of our study was to retrospectively investigate 287 consecutive DIEP flap breast reconstructions to investigate predictive and protective factors for PRCs. ⋯ Learning curve did not show significant decrease of PRC risk over time. Our study first proved nulliparity as a statistically significant predictor for PRCs in DIEP flap breast reconstruction, possibly due to different superficial abdominal perfusion between pluriparous and nulliparous women, with potential weaker pattern of perforators and smaller angiosomes in the latter. The choice of medial row perforators and combined crystalloid/colloid fluid infusion might reduce PRC risk.
-
Annals of plastic surgery · Jan 2015
Clinical TrialSafe extensive tumescent liposuction with segmental infiltration of lower concentration lidocaine under monitored anesthesia care.
Tumescent anesthesia makes it feasible to perform liposuction in an office setting. There are often patients who desire extensive liposuction on approximately 30% of total body surface area, which means the lidocaine total dose might be over the dosing recommendation. So the segmental infiltration is applied, although the concentration of lidocaine in tumescent fluid is gradually reduced to 0.0252%. ⋯ Our previous study on the fluid management has demonstrated the risk of hypovolemia or fluid overload is very low with this technique, although the patients who received only maintenance fluid (500 mL) in the operating room and could discharge and resume oral intake after 6 hours of recovery room stay. The adequate anesthesia support is available in our office-based setting with adequate recovery facilities in place. It has a high margin of safety, without increasing of lidocaine toxicity or adverse cardiopulmonary sequelae while using a segmental tumescent infiltration with lower concentration of lidocaine.