Clinics in plastic surgery
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This article discusses scar contracture of the hand. It contains a brief outline of the anatomy of the hand and upper extremities and the types of injuries involved. Hand reconstruction, including examination, nonoperative treatment, surgery, excision and skin grafting, flaps, postoperative management, and complications, are covered.
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In the management of traumatic peripheral nerve injuries, the severity or degree of injury dictates the decision making between surgical management versus conservative management and serial examination. This review explores some of the recent literature, specifically addressing recent basic science advances in end-to-side and reverse end-to-side recovery, Schwann cell migration, and neuropathic pain. The management of nerve gaps, including the use of nerve conduits and acellularized nerve allografts, is examined. Current commonly performed nerve transfers are detailed with focus on both motor and sensory nerve transfers, their indications, and a basic overview of selected surgical techniques.
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Medical imaging has become critically important in the diagnosis and treatment planning of vascular anomalies. The classification of lesions into fast-flow and slow-flow categories, the identification of a soft tissue mass, and the determination of the extent of the lesions are all facilitated by the use of magnetic resonance imaging, ultrasonography, catheter angiography, and other imaging studies. The use of these imaging techniques in the diagnosis and assessment of vascular tumors, malformations, and combined malformation syndromes is discussed in this article.
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This article provides a review of the current medical management of patients with high-risk and metastatic cutaneous melanoma, including a review of the use of adjuvant interferon therapy and a discussion of adjuvant treatments under evaluation. The use of standard chemotherapeutic agents for metastatic disease is discussed, with an emphasis on developmental therapeutics using targeted agents. This discussion includes a review of the immune therapy for metastatic melanoma, including newer immunomodulatory agents and cellular therapeutics that are expected to significantly impact the care of these patients.
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Many patients continue to experience problems long after burn wounds have closed. Contracture and deformity are frequent sequelae of the scar tissue that is formed secondary to thermal trauma. A variety of techniques are available to the burn reconstructive surgeon, ranging from simpler grafting methods to complex free-tissue transfers. In this article, the clinical applications of these procedures are discussed, with examples of management techniques for selected problems commonly encountered by the reconstructive surgeon.