Annals of plastic surgery
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Annals of plastic surgery · Mar 2010
Is it possible to prefabricate a vascularized peripheral nerve graft?
The ideal technique to repair a damaged peripheral nerve is primary repair. Unfortunately, most damaged peripheral nerves have gaps making primary repair impossible. Autologous nerve grafts that are used to repair damaged nerves can either be conventional nonvascularized nerve grafts or vascularized nerve grafts. ⋯ In this study, to prefabricate a vascularized nerve, segments harvested from left sciatic nerves of 10 Wistar albino rats were implanted on right femoral vessels, and intact right sciatic nerves were used as controls to evaluate the function, electrophysiologic studies, and histopathologic examination, were performed on these grafts 4 weeks after implantation. Prefabricated sciatic nerve grafts showed vascularization, but they did not show compound action potential activity to electrical stimulation and demonstrated diffuse and severe vacuolar degeneration and myelin loss. We were unable to prefabricate a functional vascularized nerve graft by this method.
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Annals of plastic surgery · Feb 2010
Orthogonal polarization spectral imaging: a tool for assessing burn depths?
The estimation of burn depths is still a challenge, and even experienced surgeons often fail. In search of an objective method for differentiation between deep- and partial-thickness burns, we investigated the use of orthogonal polarization spectral (OPS) imaging to visualize the microcirculation in burn wounds. Twenty-seven burned patients were included in the study, 81 burn areas were investigated at day 1 and 4 post burn. ⋯ It has proved a useful tool in particular for the prognosis as to whether the burn will heal spontaneously within 14 days or not. The presented OPS-Imaging device provides additional qualitative and quantitative information about the perfusion of the skin and therefore facilitates decisions about the follow on therapy. It is not an alternative to an experienced burn surgeon but provides important additional information.
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Annals of plastic surgery · Jan 2010
Management of chronic leg and knee pain following surgery or trauma related to saphenous nerve and knee neuromata.
Patients who present with lower extremity pain following surgery or trauma can occasionally have the saphenous nerve as the offending anatomic cause of their pain. Consistent with its anatomic course, the saphenous nerve can be the source of pain that manifests anywhere along its sensory distribution. Patients who presented to the Georgetown Peripheral Nerve Institute with lower extremity pain were evaluated, and those patients whose pain was suspected to be of saphenous nerve origin were offered surgical treatment. ⋯ The saphenous nerve can be a source of lower extremity and knee pain following trauma or surgery. Accurate clinical diagnosis followed by surgical intervention can result in clinical resolution in the majority of patients, with improvement in ambulation and quality of life. This study reports the largest series of surgically-corrected saphenous neuropathy in the literature.
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Annals of plastic surgery · Jan 2010
A new composite hemiface/mandible/tongue transplantation model in rats.
Extensive head and neck deformities, including bone and soft tissue defects, are always challenging for reconstructive surgeons. The purpose of this study was to extend the application of the face/scalp transplantation model in rats by the incorporation of vascularized mandible, masseter and tongue (based on the same vascular pedicle), and to use this as a model to test new reconstructive options for extensive head and neck deformities with involving large soft and bone tissue defects. A total of 10 composite hemiface/mandible/tongue transplantations were performed in Lewis rats (RT1). ⋯ We have introduced a new composite hemiface/mandible/tongue transplant model. The main advantage of this model is the presence of vascularized bone marrow within the mandibular component, which may facilitate future studies on chimerism and tolerance induction. Although this mandible composite allograft is placed heterotopically to the recipient inguinal region, we believe that it may serve as a new reconstructive option for the coverage of combined bone and soft tissue defects within the head and neck region.
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Annals of plastic surgery · Dec 2009
Case ReportsReconstruction of cicatricial microstomia and lower facial deformity by windowed, bipedicled deep inferior epigastric perforator flap.
We performed simultaneous facial scar repair and oral aperture open with a windowed, bilateral, bipedicled deep inferior epigastric perforator flap (DIEP flap) in a 20-year-old male patient who had suffered from severe postburn scar of the face and neck in association with serious cicatricial microstomia. DIEP flap is a typical perforator flap that has less donor site morbidity because of a minimal sacrifice of muscles. ⋯ From our challenging case, we learned that bilateral, bipedicled DIEP flap is an excellent option for the repair of large faciocervical defects. Bilateral, bipedicled DIEP flap, which can produce an excellent esthetic and functional outcome, has reliable blood perfusion, provides soft and pliable tissue, and causes the minimal donor-site morbidity.