Annals of plastic surgery
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Annals of plastic surgery · Feb 2015
Comparative StudyCost-benefit analysis of outcomes from the use of fibrin sealant for fixation of skin grafts in small-size burns compared to staples as historical controls: a retrospective review.
Historically, split-thickness skin grafts have been fixed onto the recipient site by suture and/or staples. Fibrin sealants have become available for the fixation in the past 10 years. Fibrin sealants have been shown to be at least as effective as staples, and recent reports show them to cause less pain. However, the product is much more expensive than traditional suture and/or staple fixation. The cost-benefit ratio of sealant has not yet been proven. ⋯ The use of fibrin sealants allows for fewer graft loss complications and earlier discharge in patients who have burns that are less than 10% TBSA. This decrease in hospital days results in savings, although this difference is not statistically significant.
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Annals of plastic surgery · Feb 2015
Comparative StudyThe use of patient registries in breast surgery: a comparison of the tracking operations and outcomes for plastic surgeons and national surgical quality improvement program data sets.
The National Surgical Quality Improvement Program (NSQIP) and the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) registries gather outcomes for plastic surgery procedures. The NSQIP collects hospital data using trained nurses, and the TOPS relies on self-reported data. We endeavored to compare the TOPS and NSQIP data sets with respect to cohort characteristics and outcomes to better understand the strengths and weakness of each registry as afforded by their distinct data collection methods. ⋯ The TOPS and NSQIP capture significantly different patient populations, with TOPS' self-reported data allowing for the inclusion of private practices. This self-reporting limits TOPS' ability to identify medical complications; surgical complications and readmissions, however, were not underreported. Many surgical complications are captured by TOPS at a higher rate due to its broader definitions, and others are not captured by NSQIP at all. The TOPS and NSQIP provide complementary information with different strengths and weakness that together can guide evidence-based decision making in plastic surgery.
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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.
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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.
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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.