Annals of plastic surgery
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Annals of plastic surgery · Sep 1998
Prefabrication of a high-density porous polyethylene implant using a vascular induction technique.
Three-dimensional defects have been reconstructed with carved and remodeled frameworks wrapped within vascular carriers and have wide use in ear and nose reconstruction. The main problem with thick coverings is masking of the fine details in the frameworks. Other problems are insufficient blood supply, infection, and exposure of the implant. ⋯ Twenty implants were prefabricated in this procedure, and they were evaluated via histological examination and perfusion scintigraphy. Results revealed that the implants were invaded by fibroneovascular tissue. Blood supply coming from the vascular pedicle was sufficient to maintain the implant as a prefabricated composite flap, which could be transferred as a pedicled flap or a free flap.
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Annals of plastic surgery · Jul 1998
Case ReportsVersatility of tissue expansion in head and neck burn reconstruction.
Tissue expansion has enjoyed a wide range of applications since the technique was popularized by Radovan in 1978. A useful application of tissue expansion is in the reconstruction of the head and neck following burn injury. From July 1986 to March 1990, 25 patients underwent head and neck reconstruction for burn injury using tissue expanders. ⋯ Minor complications were frequent, although when managed conservatively they did not compromise the overall outcome. Despite a major complication rate of 12%, final reconstruction was achieved in all patients. This retrospective review demonstrates that tissue expansion is a versatile adjunct in the treatment of burn injuries to the head and neck, and reconstruction in this area can be accomplished with excellent cosmetic results.
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Coverage of midline posterior wounds presents a challenge to the reconstructive surgeon, especially when spinal stabilization hardware has been present and exposed in the wound. Most commonly those wounds that involve the mid to upper thoracic spine have been covered by latissimus dorsi muscle or musculocutaneous flaps. Lower midline wounds, especially in the thoracolumbar region, have needed more complex means of coverage. ⋯ We had only one failure in all patients, which involved a recurrent cerebrospinal fluid leak in which there was no decompression of the cerebrospinal fluid pressure utilized in the immediate postoperative period to protect the dural repair. In that instance, a leak recurred. This paper presents the method of flap elevation and the results of our series.
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Annals of plastic surgery · Apr 1998
Comparative StudyIschemic preconditioning of musculocutaneous flaps: effects of ischemia cycle length and number of cycles.
Previous work in our laboratory has indicated that ischemic preconditioning improves musculocutaneous flap survival 2.5 times that of the control flap area when the flaps are subsequently subjected to 4 hours of global ischemia. The preconditioning protocol used in this study was arbitrarily designed to be 10 minutes of pedicle clamping followed by 10 minutes of reperfusion. This sequence was repeated for three cycles with a total preconditioning time of 1 hour. ⋯ Ischemic preconditioning with 10-minute cycles is superior to 5-minute cycles. Three cycles of 10-minute preconditioning is statistically superior to one or two cycles. Future studies are planned to study four or more cycles and longer cycle times.
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Annals of plastic surgery · Mar 1998
Cold intolerance is not more common or disabling after digital replantation than after other treatment of compound digital injuries.
Cold intolerance is a common reason for disability after hand injury. In this study of posttraumatic cold intolerance, 20 patients with a history of digital replantation were matched with 20 control subjects who had not undergone replantation. ⋯ The analysis of data indicates that although the pattern of symptoms may vary, the condition is neither more common nor more disabling among those who have undergone digital replantation. Cold intolerance after digital replantation seems, therefore, to be defined by the initial trauma and not by the subsequent reconstructive surgery.