Annals of plastic surgery
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Annals of plastic surgery · Nov 2011
Bushfire disaster burn casualty management: the Australian "Black Saturday" bushfire experience.
Mass burn disasters are among the most difficult disasters to manage, with major burns requiring complex management in a multidisciplinary setting and specialist burns services having limited capacity to deal with large numbers of complex patients. There is a paucity of literature addressing health system responses to mass burn disasters resulting from wildfires, with the events of the "Black Saturday" disaster in the state of Victoria, Australia, able to provide a unique opportunity to draw lessons and increase awareness of key management issues arising in mass burn casualty disasters. The event comprised the worst natural disaster in the state's history and one of the worst wildfire disasters in world history, claiming 173 lives and costing more than AUD 4 billion. This article draws on the national burns disaster plan instituted, Australian Mass Casualty Burn Disaster Plan (AUSBURNPLAN), and details the management of mass burn cases through a systems-based perspective.
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Annals of plastic surgery · Oct 2011
Review Case ReportsHypothenar hammer syndrome: an update with algorithms for diagnosis and treatment.
Hypothenar hammer syndrome is an uncommon cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery as a result of repetitive trauma to the hypothenar region. The injury to the palmar ulnar artery occurs in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space. ⋯ The aim of this article is to describe a case report using current-day imaging and to present a review of literature. Algorithms for the diagnosis and treatment of hypothenar hammer syndrome will be proposed.
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Annals of plastic surgery · Oct 2011
Comparative StudyEnd-to-end versus end-to-side motor and sensory neurorrhaphy in the repair of the acute muscle denervation.
The aim of this study was to experimentally compare end-to-end and end-to-side neurorrhaphy in perineural window model after motor nerve lesion, evaluating which one was the most effective to preserve nerves. Also, differences in motor and sensorial nerve regeneration were tested to verify differences in nerve regeneration. ⋯ The use of sensory nerves to preserve skeletal muscle trophism is not justified, since, according to our model, it affects 50% to 80% of the muscle mass in a period of 16 weeks. End-to-side neurorrhaphy was demonstrated to be an option for re-enervation of a nerve-deprived motor muscle in selected cases.
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Annals of plastic surgery · Oct 2011
Case ReportsTransmanubrial transclavicular approach in tumors of the brachial plexus.
The standard transclavicular approach allows only limited and narrow exposure if the cervical thoracic region for the resection of tumors of the brachial plexus is involved. We report 2 cases of retroclavicular tumors of the brachial plexus. ⋯ This approach consists of retracting an osteomuscular flap that involves the medial portion of the clavicle, part of the sternal manubrium, the sternoclavicular joint, and the sternocleidomastoid muscle. We describe and discuss this approach, which provides access to the entire brachial plexus and the major vessels, thereby affording excellent control of the vessels; it is the approach of choice for tumors in this location.
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Annals of plastic surgery · Sep 2011
ReviewConcomitant face and hand transplantation: perfect solution or perfect storm?
Face and hand composite tissue allotransplantations have evolved into a promising subset of reconstructive transplant surgery due to recent advances in immunotherapy. Concomitant composite tissue allotransplantation, which involves a variable combination of facial (myocutaneous versus osteomyocutaneous) and upper extremity (ie, various levels) composite subtypes, has been performed infrequently at this time. In this review, we will describe many reasons as to why this field remains unexplored. Undoubtedly, future investigation is warranted to investigate the potential advantages and disadvantages of using this approach versus a staged manner for alloreconstruction and to identify the complexities of cortical reorganization and rehabilitation in this setting.