Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2006
Psychiatric assessment of patients with self-inflicted lacerations to the wrist and forearm admitted to a nonpsychiatric ward: the experience of a regional plastic surgery unit.
In 1984, the Department of Health (DoH) recommended that all patients with deliberate self-harm (DSH) must have a mental assessment before discharge. DSH patients, especially those with lacerations to wrist and forearm, are a regular source of admission to plastic surgery units. In Northern Ireland, the regional plastic surgery service is provided at the Ulster Hospital, which does not have an on-site psychiatric department. ⋯ The average hospital stay was two days. Despite difficulties, our practice was found effective in ensuring psychiatry assessment and follow-up without risking the patient's physical health. The study also highlighted the need for collaboration between plastic surgeons and psychiatrists to improve services in regards to DSH patients.
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J Plast Reconstr Aesthet Surg · Jan 2006
Case ReportsGuillain-Barré syndrome following facial bone fracture.
Guillain-Barré syndrome (GBS) is an inflammatory disorder of the peripheral nerves and nerve roots characterised by lymphocytes and macrophage infiltration and myelin destruction. Two-thirds of cases of GBS emerge from viral or bacterial infection. ⋯ The association of GBS with head injury per se is not well recognised. This case highlights the possibility of GBS following facial bone fracture and indicates that medical staff should be alerted to the association.
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J Plast Reconstr Aesthet Surg · Jan 2006
The 'expansile' supraclavicular artery flap for release of post-burn neck contractures.
Soft tissue defects in the cervico-facial region can result from trauma, tumour excision or post-burn scarring. All rungs of the reconstructive ladder offer possible reconstructive options for these defects. The supraclavicular artery based flap is an extremely reliable local flap for this purpose. It offers thin and pliable skin with good colour match and minimal donor site morbidity. An additional advantage, in our experience, is that this skin can stretch postoperatively to allow further improved neck contour and mobility. ⋯ All the flaps survived completely. The average operating time for contracture release and flap coverage was 2 h. The hospital stay ranged from 5 to 8 days. Follow-up ranged from 1 to 4 years with an average of 22 months. Complications included epidermolysis (n=2) and delay in donor site healing (n=2). Almost all patients had some widening of the donor site scar. In our experience the width of the flap increased in the postoperative period. At the time of surgery, the width of the flap ranged between 9 and 12 cm. At the 3-month follow-up there was an average increase in width of 24.2%. At 6 months, the average increase in width was 42.8% of the original flap width. At 1 year the average flap expansion was 63% of the original. The length of the flap ranged from 18 to 24 cm and generally remained unaltered during follow-up.
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J Plast Reconstr Aesthet Surg · Jan 2006
Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.
Free flaps are the first choice procedure to manage soft-tissue defect of the lower limb for many authors, but loco-regional pedicled flaps are an alternative since they were described in the 1980s. We analysed the changes in our practice to reconstruct soft-tissue defects of the distal third of the leg. A retrospective chart review identified 215 cases of distal leg soft-tissue defect treated in the department during 15 years. ⋯ Moreover, complications of local and regional flaps are less severe. Our practice has changed to make pedicled flaps our first choice to cover soft-tissue defects of the lower limb. However, we still use free flaps as a first choice for wide or composite defects, when pedicled flaps are not feasible or for cosmetic considerations to avoid additional scarring of the leg.
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J Plast Reconstr Aesthet Surg · Jan 2006
Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: five years of monitoring of a prospective trial.
One hundred and seven breast cancer patients underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously-placed, round, saline-filled prosthesis with a textured surface. The primary aim of this prospective study was to determine the frequency of capsular contracture in both irradiated and non-irradiated breasts after this operation. Two different types of round implants with different pore sizes on their textured surfaces, Siltex and Microcell, were randomly chosen. ⋯ None of the 16 reoperated patients had a recurrence of capsular contracture within 5 years. The results indicate a high rate of capsular contracture after this operation, especially when followed by radiation. However, a fairly simple procedure to treat capsular contracture seems to give good long-term results.