Clinics in plastic surgery
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The appearance and symmetry of the auricle is crucial for the maintenance of facial cosmetic harmony. The earlobe is considered to be an important attribute of beauty in most cultures, and earlobe decoration with color or earring is a common practice in many societies. A reconstructive technique for congenital or acquired deformity of the earlobe is described. In addition, the postauricular chondrocutaneous flap is very convenient for reconstruction of various auricular parts.
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The external ear enjoys a special place in society all over the world. It is meant to be flaunted and adorned. Ear piercing is routine, with a range of jewelry pieces concentrating in enhancing its natural beauty. ⋯ There is a definite need to reconstruct the deformed ear of both sexes. To achieve desirable results in ear reconstruction is a difficult task. Although cartilage fabrication is an important step in ear reconstruction in postburn deformity of the ear, the final outcome is mainly decided by the quality and quantity of skin available in the auricular region for draping of framework.
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It has been estimated that 2 million people per year have burns requiring medical attention in the United States. The available and expert clinicians in dedicated burn centers around the country have cared successfully for these patients and given them a second chance at a functional life. It still behooves current-day plastic surgeons to be knowledgeable and adept in their care, not only because they may be called upon at times to manage some of the smaller acute burns, but also because many of the general principles of burn reconstruction and wound management are relevant to other areas of general plastic surgery. ⋯ Physicians should keep in mind the advantages (and disadvantages) of using the scalp and back. As far as research and technological advances in the area of plastic surgery, burn surgery may be the most progressive, with the evolution of biologic tissue-engineered skin substitutes and the research of growth factors in healing. Further improvements in tissue engineering and technology should result in even more effective skin substitutes and hence better functional and aesthetic outcomes with economic efficiency in large burns.
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Despite ample evidence that silicone gel-filled implants do not cause systemic illness, they are still not available in the United States for widespread use. At this point, saline-filled implants are widely available for use, and assuming favorable outcomes of the relevant silicone studies, some forms of silicone gel-filled implants could be approved by the FDA and be available as soon as 2003. ⋯ Assuming favorable study results, one or more could be approved by the FDA by the year 2004. Any products not yet submitted to the FDA for review of study designs by this time are not likely to be available in the United States in the next 4 or 5 years.
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Because patients assume a position of comfort during acute burn management, affected joints or regions must be splinted in positions of function to avoid contractures. Particularly with the increasing trend towards ambulatory burn care, close monitoring by the burn team and patient education is required to achieve the best functional result. ⋯ Although the physiologic mechanism is incompletely defined, pressure therapy to prevent and treat hypertrophic burn scars is an integral component of burn care. Multiple materials and methods are available with treatment, starting soon after burn wound closure, and modified as needed until scar maturation has occurred.