Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Mar 2011
Comparative StudyThe keystone island flap: use in large defects of the trunk and extremities in soft-tissue reconstruction.
Microsurgical perforator flaps are useful in an array of reconstructive scenarios, but their technical complexity, steep learning curves, and prolonged operative times may limit their widespread adoption. Alternatively, the keystone island flap combines perforator-based vascularity with relative simplicity of nonmicrosurgical tissue rearrangement. This article reviews the authors' reconstructive experience using the keystone flap to reconstruct large trunk and extremity defects. ⋯ The keystone flap can be applied to large defects of the trunk and extremities, obviating the need for either microsurgical techniques or extensive operative time while achieving primary wound healing. Despite minor complications, the 97 percent reconstructive success rate compares well to published rates of microsurgical tissue transfers but has several advantages: short operative times, high reproducibility, ease of use, and favorable aesthetic outcome. The authors conclude that the keystone flap is a reliable and effective reconstructive surgical technique for reconstruction of soft-tissue defects.
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Plast. Reconstr. Surg. · Mar 2011
Comparative StudyWarfare-related craniectomy defect reconstruction: early success using custom alloplast implants.
Cranial bone defects secondary to decompression craniectomy associated with the Global War on Terror pose a unique reconstructive challenge. The objective of this study was to evaluate the outcome of alloplastic reconstruction using custom-designed implants for large craniectomy defects from warfare-related cranial trauma. ⋯ Despite war wound contamination, massive cranial defects can be successfully reconstructed using custom alloplastic implants. However, reconstruction of frontal cranial defects in proximity to the airways and orbits was associated with infection and implant removal.
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Systematic reviews and meta-analyses are important research tools in modern medicine. They serve to condense and clarify large amounts of data into resources that can educate clinicians, enhance patient care, help formulate clinical guidelines, and guide future research endeavors. ⋯ Using clinical examples and published guidelines, a framework is presented to help the reader properly conduct a systematic review. These guidelines also help the reader conduct a critical appraisal of systematic reviews published in the scientific literature. Even more importantly, principles regarding application of systematic review results to individual patients are addressed.