Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Dec 2019
The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache.
Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias. ⋯ Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.
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Plast. Reconstr. Surg. · Nov 2019
The Fragility of Statistically Significant Randomized Controlled Trials in Plastic Surgery.
The fragility index has been proposed as a metric to evaluate the robustness of statistically significant findings in randomized controlled trials. It measures the number of events that a trial result relies on to maintain statistical significance. This study examines the robustness of statistically significant results from randomized controlled trials in the plastic surgery literature. ⋯ The results of randomized controlled trials in plastic surgery demonstrate substantial fragility, as statistically significant results were found to hinge on a small number of events. The fragility index offers an intuitive and simple metric to complement the p value and determine the confidence in the results of randomized controlled trials.
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Plast. Reconstr. Surg. · Sep 2019
Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review.
Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. ⋯ A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.
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Plast. Reconstr. Surg. · Sep 2019
ReviewLocal Anesthetic Systemic Toxicity: A Narrative Literature Review and Clinical Update on Prevention, Diagnosis, and Management.
The objective of this narrative review of local anesthetic systemic toxicity is to provide an update on its prevention, diagnosis, and management. ⋯ All physicians who administer local anesthetics should be educated regarding the nature of systemic toxicity and contemporary management algorithms that include lipid emulsion therapy.
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Plast. Reconstr. Surg. · Jun 2019
Review Comparative StudyProsthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss.
Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation. ⋯ Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.