Annals of plastic surgery
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Annals of plastic surgery · Jan 2014
Description and implementation of an ex vivo simulator kit for developing microsurgery skills.
Microsurgical training is an essential part of the plastic surgery training curriculum. Given the emphasis on safety and standardization in surgical training, use of simulators is key. We used a novel microsurgical skills training set to inexpensively, safely, and reproducibly teach and perfect microsurgical skills. ⋯ On the basis of our experience, this system is a cost-effective way to introduce trainees to microsurgical skills. Furthermore, performance on the skills trainer positively correlates with actual microsurgical experience. Use of this system is a valuable alternative, compared to animal-based skills laboratories. Its use as a metric to establish competence in microsurgical skills acquisition is described.
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Annals of plastic surgery · Jan 2014
Review Meta AnalysisEfficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials.
There is no consensus with regard to antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery. This meta-analysis sought to assess the efficacy and safety of antibiotic prophylaxis and to determine appropriate duration of prophylaxis. ⋯ This meta-analysis of RCTs provides evidence supporting that antibiotic prophylaxis reduced postoperative SSI in clean plastic surgeries with high-risk factors and clean-contaminated plastic surgeries. Besides, a short-course administration regimen seemed to be of adequate efficacy and safety. High-quality prospective trials on larger scale are needed to further confirm these findings.
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Annals of plastic surgery · Jan 2014
ReviewHypertrophic burn scar management: what does the evidence show? A systematic review of randomized controlled trials.
Hypertrophic scars (HTS) are a source of morbidity for burn survivors and can present with a range of lifestyle-limiting problems. These include pruritus, pain, burning, stiffness, and contractures. Many solutions have been developed, but few have been studied in the form of a prospective, randomized control trial (RCT). Given the importance these RCTs carry in shaping the treatment of burn patients, we sought to systematically and critically review this portion of the burn literature. ⋯ Despite hypertrophic scars being a common occurrence in burn survivors, both the number of studies and consensus for treatment are limited. Efforts to perform larger, adequately powered RCTs are needed, specifically in the areas of silicone, compression garments, and combination therapy.
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Annals of plastic surgery · Jan 2014
Comparative StudyThe biophysical characteristics of human composite flexor tendon allograft for upper extremity reconstruction.
Devastating volar hand injuries with significant damage to the skin and soft tissues, pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. In this article, we expand the technique of human composite flexor tendon allografts (CFTAs), pioneered by Dr E.E. Peacock, Jr, which consist of both the intrasynovial and extrasynovial flexor digitorum superficialis and flexor digitorum profundus tendons and their respective fibro-osseous sheath consisting of the digital pulley structures, periosteum, and volar plates procured from cadaveric donors with the use of modern tissue processing techniques. ⋯ The use of CFTAs addresses the issues of adhesion formation and lack of suitable donor material by providing a source of intrasynovial tendon in its unaltered fibro-osseous sheath without donor morbidity. This approach represents an important step toward designing an ideal material for complex flexor tendon reconstruction, which takes advantage of an intrasynovial flexor tendon in its native fibro-osseous sheath without the need for additional donor morbidity using a construct which can be engineered to have minimal tissue reactivity, negligible potential for disease transmission, and improved tendon healing properties versus standard tendon allograft.
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Annals of plastic surgery · Jan 2014
Predictors of contralateral prophylactic mastectomy and the impact on breast reconstruction.
Contralateral prophylactic mastectomy (CPM) is being performed with increased frequency. Predictors of CPM and their impact on breast reconstruction are examined. ⋯ The incidence of CPM is increasing and is associated with younger age, white race, family history, and the use of breast reconstruction. Implant-based reconstructions predominate in this cohort. The added morbidity of a contralateral procedure is significant.