Annals of plastic surgery
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Annals of plastic surgery · Sep 2013
Thigh laxity after massive weight loss: a utilities outcomes assessment.
The presence of excess skin after massive weight loss, particularly in the thighs, not only contributes to a negative body image but can also lead to functional deficits in mobility. In the present study, we quantified the health state utility of living with excess skin in the thighs in an attempt to objectively establish the burden on the quality of life in patients living with excess thigh skin laxity. ⋯ We have objectified the utility of living with thigh deformity after massive weight loss. Our sample population if faced with the condition was willing to sacrifice a potential 3.6 years of life and potentially undergo a procedure with 11% chance of mortality to address excess thigh laxity.
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Annals of plastic surgery · Aug 2013
Case ReportsImmediate and early tissue expander placement for acute closure of scalp wounds.
Scalp tissue expansion is a reliable technique for reconstruction of scalp alopecia and other deformities. However, the conventional practice involves establishing temporary wound coverage before expander placement, expansion, and definitive reconstruction. We propose that immediate (at the time of injury and initial wound debridement, leaving an open wound during expansion) tissue expander placement may be a reasonable approach to the management of full-thickness scalp wounds not amenable to primary closure. ⋯ Immediate placement of tissue expanders is a reasonable approach that greatly expedites scalp reconstruction. In this series, the complication rate was consistent with or slightly higher than published rates of complications in conventional techniques. Immediate expansion may be especially useful when other reconstructive options (such as free tissue transfer) are unavailable or not feasible.
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Annals of plastic surgery · Aug 2013
Comparative StudyAn assessment of the risks and benefits of immediate autologous breast reconstruction in patients undergoing postmastectomy radiation therapy.
The utility of immediate autologous breast reconstruction in patients likely to undergo radiation therapy remains controversial. The purpose of this study was to perform a quantitative outcomes assessment of patients undergoing immediate free-flap breast reconstruction and postmastectomy radiation therapy (PMRT). ⋯ Postmastectomy radiation therapy can result in volume loss and fat necrosis, yet there are no increases in other complications or revision procedures. The deleterious effects of PMRT do not preclude the decision for immediate autologous reconstruction.
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Annals of plastic surgery · Aug 2013
Clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in scapholunate advanced collapse at 5 and 10 years.
This retrospective study examined clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in patients with a scapholunate advanced collapse (SLAC) at 5 and 10 years. ⋯ This retrospective cohort study of patients followed up for more than 10 years showed that the midterm and long-term results of 4-corner fusion for stage III SLAC were satisfactory, and arthritic changes in the radiolunate joint were minimal.
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Annals of plastic surgery · Jul 2013
Single-Institution Financial Analysis of Biologic Versus Synthetic Mesh Hernia Repair: A Retrospective Analysis of Patients Readmitted for Hernia Repair.
The advent and proliferation of commercially available biologic mesh material has expanded the repertoire of hernia repair materials available to the surgeon. Given the higher initial cost of these mesh materials relative to synthetic materials such as polypropylene, there has been debate regarding the purported benefit of the use of biologic mesh. This study is a single-institution review of complex hernia repairs using both biologic and synthetic mesh materials. ⋯ The objective of this study was to evaluate the financial implications of mesh choice. Specific parameters reviewed included type of mesh used, total costs of hospitalization, direct cost associated with the hernia repair, total collections, and percentage of collections relative to total charges. Through such analysis, our aim was to determine whether there were any variances in revenue and costs associated with the application of either mesh material or the associated clinical scenarios.