Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Jan 2010
Biography Historical ArticleEvidence-based medicine and hospital reform: tracing origins back to Florence Nightingale.
The use of reliable evidence to evaluate health care interventions has gained strong support within the medical community and in the field of plastic surgery in particular. Evidence-based medicine aims to improve health care and reduce costs through the use of sound clinical evidence in evaluating treatments, procedures, and outcomes. The field is hardly new, however, and most trace its origins back to the work of Cochrane in the 1970s and Sackett in the 1990s. ⋯ She used medical statistics to reveal the nature of infection in hospitals and on the battlefield. Moreover, Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today.
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Plast. Reconstr. Surg. · Jan 2010
Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers.
Segmental bone defects of the tibia after high-energy trauma are limb-threatening conditions. Multiple treatment options have been proposed, including nonvascularized bone grafts, vascularized bone transfers, and callus distraction. A series of 41 patients with major segmental defects of the tibia treated with vascularized bone reconstruction is presented. ⋯ The use of vascularized bone transfer in the treatment of major segmental tibial defects was successful in the present series. The management of bone fixation and infection in these cases is discussed.
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Plast. Reconstr. Surg. · Jan 2010
Facial transplantation: an anatomic and surgical analysis of the periorbital functional unit.
Complete loss of eyelid pair is associated with chronic discomfort, corneal ulceration, and visual impairment. Contemporary reconstructive techniques rarely provide functionally acceptable results. Composite tissue allotransplantation may provide a viable alternative. This study reports on neurovascular anatomy and technical details of harvesting an isolated periorbital unit and discusses its functional potential. ⋯ Surgical harvest of a functional periorbital allotransplant is technically feasible. Revascularization of the isolated periorbital unit is influenced by variations in regional anatomy and cannot be guaranteed by a single vascular pedicle. The orbicularis oculi muscle and its innervation can be preserved, and recovery, albeit without the certainty of reflexive blinking, is expected.
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Plast. Reconstr. Surg. · Dec 2009
Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: a population-based study.
The present study investigated psychosocial factors expected to predict an interest in cosmetic surgery. It was hypothesized that body dysmorphic disorder-like symptoms, personality, interpersonal attachment insecurity, low self-esteem, poor body image, dissatisfaction with sexual life, distorted eating behavior, emotional distress, low education, poor relationship with parents and friends, teasing history, social acceptance of cosmetic surgery, and low level of physical activity would relate to an interest in cosmetic surgery. ⋯ The study gives new insights into psychosocial factors predicting an interest in cosmetic surgery. In addition to previously known predictors, having been teased for appearance and having children were positive predictors, whereas education and quality of relationship with parents were negative predictors of an interest in cosmetic surgery. The results may contribute to a better understanding of the various factors that may motivate an individual to undergo cosmetic surgery.
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Plast. Reconstr. Surg. · Dec 2009
Comparative StudyA cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures.
Lower extremity trauma is common. Despite an abundance of literature on severe injuries that can be treated with salvage or amputation, the appropriate management of these injuries remains uncertain. In this situation, a cost-utility analysis is an important tool in providing an evidence-based practice approach to guide treatment decisions. ⋯ Unless the injury is so severe that salvage is not a possibility, based on this economic model, surgeons should consider limb salvage, which will yield lower costs and higher utility when compared with amputation.