Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jun 2019
Meta AnalysisFibrin tissue sealant and minor skin grafts in burn surgery: A systematic review and meta-analysis.
The indications for use of fibrin glue in skin grafting burn patients remains understudied. The purpose of this study is to review the efficacy of fibrin tissue sealant in skin graft adherence, establish guidelines for use of fibrin tissue sealant, and review the cost effectiveness of fibrin glue. ⋯ Fibrin glue is as effective as staples for adhering skin grafts, and trends towards lower rates of hematoma/seroma. In topographically complex regions, fibrin glue may be a better choice for adherence of skin grafts.
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J Plast Reconstr Aesthet Surg · Jun 2019
Multicenter StudyTenosynovial giant cell tumours of the hand: A multicentre case-control study.
Many factors have been proposed to contribute to the risk of recurrent tenosynovial giant cell tumours (TSGCT); however, we remain unable to predict those at risk, which formed the rationale for this multicentre retrospective case-control study of 28 patients with recurrence. We included cases of recurrence in a 1:1 ratio matched for age and sex with controls over 10 years. Using Cox regression, we present hazard ratios (HRs) for recurrence with 95% confidence intervals (CIs). ⋯ Recurrent TSGCT had a higher mitotic count/mm2 in the primary tumour (median increase of 3 [IQR 1, 7]). Mitotic count in the primary tumour was associated with the risk of recurrence (adjusted HR 1.1 [95% CI 1.1, 1.2]) meaning that for every additional mitosis, the risk of recurrence increased by 10% per annum. We recommend a prospective cohort study to validate our findings.
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J Plast Reconstr Aesthet Surg · Jun 2019
Comparative StudyPostmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study.
Lymphedema resulting from breast cancer treatment is a chronic condition that can significantly compromise quality of life. Several works have documented the efficacy of vascularized lymph node flap transfer (VLNT) for the treatment of advanced-stage lymphedema. Given that the axillary scar may contribute to the patient's existing lymphedema, the authors assumed that combining VLNT and scar release with fat graft could be an effective strategy of treatment. The purpose of this study is to compare the efficacy in the reduction of limb circumference and health-related quality of life between a combined strategy, namely, VLN transfer (VLNT) and axillary scar release with fat grafting, and only VLNT for patients affected by postmastectomy upper limb lymphedema. The idea. ⋯ Patients with postmastectomy upper limb lymphedema can benefit from combined lymph node transfer and axillary scar release with fat graft, as this approach seems to fasten the onset of improvement and to have a positive impact on patients' quality of life.
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J Plast Reconstr Aesthet Surg · Jun 2019
Four-corner fusion: Comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations.
Several operative approaches and various implants for osseous fixation have been described to achieve four-corner fusion of the wrist. Given the discordance and to aid in further standardizing the technique, this study directly compares the outcomes of K-wire, fusion plate, and headless retrograde compressive screw fixations to achieve four-corner arthrodesis. ⋯ The results show that all examined techniques of four-corner fusion can improve wrist function when compared to preoperative baseline (NRS at rest and activity, postoperative DASH-scores). However, headless retrograde compressive screw fixation had significant better results regarding pain relief (NRS) at activity and postoperative DASH-scores.
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J Plast Reconstr Aesthet Surg · Mar 2019
Physical activity, functional ability, and quality of life after breast cancer surgery.
This cross-sectional study aimed to assess the influence of different surgical treatment modalities on the level of physical activity, functional capacity, and quality of life of breast cancer survivors. One hundred eighty women aged 30-60 years old were selected and allocated to control group (CG, women without breast cancer, n = 45), breast-conserving surgery group (BCG, n = 45), mastectomy group (MG, n = 45), and breast reconstruction group (BRG, n = 45). Physical activity, functional capacity, and quality of life were assessed, respectively, using the following self-report questionnaires validated for use in Brazil: International Physical Activity Questionnaire (IPAQ), Stanford Health Assessment Questionnaire (HAQ-20), and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). ⋯ Differences were found for the SF-36 domains "physical functioning" (p < 0.01), "physical role functioning" (p < 0.001), "emotional role functioning" (p = 0.0174), and "general health" (p = 0.0307). CG and BRG differed significantly relative to the domains "physical role functioning" and "emotional role functioning" only. We concluded that patients who underwent breast reconstruction exhibited higher levels of physical activity and quality of life than patients subjected to mastectomy alone or breast-conserving surgery.