Annals of plastic surgery
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Annals of plastic surgery · Jan 2014
Description and implementation of an ex vivo simulator kit for developing microsurgery skills.
Microsurgical training is an essential part of the plastic surgery training curriculum. Given the emphasis on safety and standardization in surgical training, use of simulators is key. We used a novel microsurgical skills training set to inexpensively, safely, and reproducibly teach and perfect microsurgical skills. ⋯ On the basis of our experience, this system is a cost-effective way to introduce trainees to microsurgical skills. Furthermore, performance on the skills trainer positively correlates with actual microsurgical experience. Use of this system is a valuable alternative, compared to animal-based skills laboratories. Its use as a metric to establish competence in microsurgical skills acquisition is described.
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Annals of plastic surgery · Jan 2014
ReviewHypertrophic burn scar management: what does the evidence show? A systematic review of randomized controlled trials.
Hypertrophic scars (HTS) are a source of morbidity for burn survivors and can present with a range of lifestyle-limiting problems. These include pruritus, pain, burning, stiffness, and contractures. Many solutions have been developed, but few have been studied in the form of a prospective, randomized control trial (RCT). Given the importance these RCTs carry in shaping the treatment of burn patients, we sought to systematically and critically review this portion of the burn literature. ⋯ Despite hypertrophic scars being a common occurrence in burn survivors, both the number of studies and consensus for treatment are limited. Efforts to perform larger, adequately powered RCTs are needed, specifically in the areas of silicone, compression garments, and combination therapy.
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Annals of plastic surgery · Jan 2014
Learning curves in abdominal wall reconstruction with components separation: one step closer toward improving outcomes and reducing complications.
Learning curves are characterized by incremental improvement of a process, through repetition and reduction in variability, but can be disrupted with the emergence of new techniques and technologies. Abdominal wall reconstruction continues to evolve, with the introduction of components separation in the 1990s and biologic mesh in the 2000s. As such, attempts at innovation may impact the success of reconstructive outcomes and yield a changing set of complications. The purpose of this project was to describe the paradigm shift that has occurred in abdominal wall reconstruction during the past 10 years, focusing on the incorporation of new materials and methods. ⋯ The overall learning curve for a specific procedure, such as abdominal wall reconstruction, can be quite volatile, especially as innovative techniques and new technologies are introduced and incorporated into the surgeon's practice. Our current practice includes primary repair myofascial flap of the components separation and the use of biologic mesh as an overlay graft, anchored to the external oblique. This process of outcome improvement is not gradual but is often punctuated by periods of failure and redemption.
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Annals of plastic surgery · Jan 2014
Transcriptional profiling of rapamycin-treated fibroblasts from hypertrophic and keloid scars.
Excess scar formation after cutaneous injury can result in hypertrophic scar (HTS) or keloid formation. Modern strategies to treat pathologic scarring represent nontargeted approaches that produce suboptimal results. Mammalian target of rapamycin (mTOR), a central mediator of inflammation, has been proposed as a novel target to block fibroproliferation. ⋯ Hypertrophic scar and keloid fibroblasts demonstrated overexpression of collagen I and III that was effectively abrogated with rapamycin. Blockade of mTOR specifically impaired fibroblast expression of the collagen biosynthesis genes PLOD, PCOLCE, and P4HA, targets significantly overexpressed in HTS and keloid scars. These data suggest that pathologic scarring can be abrogated via modulation of mTOR pathways in procollagen and collagen processing.
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Annals of plastic surgery · Jan 2014
Predictive risk factors of venous thromboembolism in autologous breast reconstruction surgery.
Venous thromboembolism (VTE) can be a significant cause of morbidity and mortality in autologous breast reconstruction surgery. The aim of this study was to evaluate the effect of patient characteristics, comorbidities, payer type, reconstruction type, reconstruction timing, radiation, chemotherapy, and teaching status of hospital on VTE (deep venous thrombosis and/or pulmonary embolism) in autologous breast reconstructive surgery. ⋯ In patients undergoing autologous breast reconstruction surgery, immediate reconstruction, older than 65 years, obesity, history of chemotherapy, and chronic lung disease are all independent predictors of higher VTE. Surgeons should consider these factors and use appropriate prophylaxis to minimize the risk of VTE development.