Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Mar 2019
The impact of non-thermal injuries in combined burn trauma: A retrospective analysis over the past 35 years.
Combined burn trauma is rather uncommon and frequently difficult to manage. Historically combined burn trauma contributed to high mortality rates in severely injured patients. The purpose of this study was to determine the incidence, mechanisms and impact of non-thermal injuries in patients with severe burns. ⋯ Concomitant trauma did not reveal a significant impact on in-hospital mortality in our burn center recently. Retrospectively, trauma mechanisms shifted from motor vehicle crashes to electrical injuries in our population. Safety measures for motor vehicles and adequate emergency room algorithms seem to have contributed to a reduction of severity of injury and mortality.
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J Plast Reconstr Aesthet Surg · Mar 2019
Observational StudyWound healing after cultured epithelial autografting in patients with massive burn injury: A cohort study.
Last century, our laboratory produced Cultured Epithelial Autograft (CEA) for clinical use by the affiliated adult burn service and other burn units across the country. Production of CEA for clinical use was discontinued after several years because of a low success rate and subsequent low demand. Recently, at our burns unit, a cell culture program was reintroduced as a direct response to the need for improvement in ongoing deficiencies and clinical requirements in burn wound closure. The aim of this study was to validate the laboratory processes and clinical algorithms established and share our recent clinical experiences involving CEA. ⋯ It is important to address the problem of wound bed contamination, either through increased resistance on the part of the construct or wound bed sterilization. Improved understanding of the relative importance of vascularization, control of cell behavior, the extracellular matrix, immune function, and intrinsic antimicrobial capacity for graft take would then inform a more targeted approach to skin tissue engineering for wound closure in severe burns.
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J Plast Reconstr Aesthet Surg · Jan 2019
Observational StudyThe dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: Creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography.
Lymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements. ⋯ Dynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
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J Plast Reconstr Aesthet Surg · Jan 2019
Outcomes of shoulder abduction after nerve surgery in patients over 50 years following traumatic brachial plexus injury.
There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients, as outcomes are thought to be poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 years and factors related to success. ⋯ Brachial plexus nerve reconstruction for shoulder abduction in patients over the age of 50 years can yield useful BMRC scores and ROM, and age should not be used to exclude nerve reconstruction in these patients.
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J Plast Reconstr Aesthet Surg · Jan 2019
Randomized Controlled Trial Comparative StudyTreatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial.
Keloids have high recurrence rates. Current first-line therapy is triamcinolone (TAC) injection, but it has been suggested that approximately 50% of keloids are steroid resistant. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinalone injections in a double-blind randomized controlled trial. ⋯ Fibroblast proliferation evaluated by Ki-67 staining significantly decreased in the TAC group (p < 0.05) but increased in the 5-FU group (p < 0.05). TAC and 5-FU injections did not differ in their clinical effectivity in this randomized study, but 5-FU injections lead to increased proliferation rate and did not affect vascular density in histological assessment. Due to the greater number of adverse effects observed after TAC treatment, 5-FU injections may be preferable for cosmetically sensitive skin areas.