Annals of plastic surgery
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Annals of plastic surgery · Apr 2014
ReviewA systematic review of peripheral nerve interventional treatments for chronic headaches.
This study aimed to systematically compare the outcomes of different types of interventional procedures offered for the treatment of headaches and targeted toward peripheral nerves based on available published literature. ⋯ Of the 3 most commonly encountered interventional procedures for chronic headaches, peripheral nerve surgery via decompression of involved peripheral nerves has been the best-studied modality in terms of total number of studies, level of evidence of published studies, and length of follow-up. Reported success rates for nerve decompression or excision tend to be higher than those for peripheral nerve stimulation or for RF, although poor study quantity and quality prohibit an accurate comparative analysis. Of the 3 procedures, peripheral nerve stimulator implantation was associated with the greatest number of complications. Although peripheral nerve surgery seems to be the interventional treatment modality that is currently best supported by the literature, better controlled and normalized high-quality studies will help to better define the specific roles for each type of intervention.
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Annals of plastic surgery · Apr 2014
ReviewExperimental and clinical methods used for fat volume maintenance after autologous fat grafting.
Management of soft tissue deficits resulting from congenital abnormalities, trauma, systemic disease, and tumors is a particularly challenging field of plastic and reconstructive surgery. Fat grafting, a technique traditionally used in the correction of facial asymmetry, is commonly seen in aesthetic procedures which use the grafted fat for soft tissue augmentation and recontouring. Despite its widespread use in reconstruction and aesthetic surgery, therapeutic modalities applied in fat grafting are crude and the results of this intervention are unpredictable. The aim of this review was to present the most recent evidence regarding experimental studies and designs which confirmed or disproved fat volume expansion or fat maintenance after autologous fat grafting.
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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.