Annals of plastic surgery
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Annals of plastic surgery · May 2014
Outcomes of breast reconstruction in breast cancer patients with a history of mantle radiation for Hodgkin lymphoma.
Although mantle radiation (ie, extended field radiation) represented the standard of care in the past for Hodgkin disease, contemporary treatment of lymphoma consists of a multimodal approach with chemotherapy. Patients who were exposed to mantle radiation have a higher risk of breast cancer and are more susceptible to postoperative complications after breast reconstruction due to radiation. In this study, we present postoperative outcomes in patients with a history of mantle radiation who underwent mastectomy and breast reconstruction. ⋯ Although the risk of complications associated with preoperative radiation is well documented, physicians and patients should be cognizant of the increased risk of complications after mantle radiation as it represents a unique modality of radiation exposure.
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Annals of plastic surgery · May 2014
Case ReportsSingle-specialty management and reconstruction of necrotizing fasciitis of the upper extremities: clinical and economic benefits from a case series.
Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. ⋯ Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams.
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Annals of plastic surgery · May 2014
Rigid fixation for the prevention and treatment of sternal complications.
Most surgical specialties working with bone have transitioned from wire fixation to more stable plate and screw fixation. Rigid plate fixation results in more rapid bony healing with decreased rates of nonunion, malunion, and infection. Despite sternotomies being the most frequently performed osteotomy, cerclage wire fixation remains the standard technique of closure. This study reviews our 5-year experience with rigid fixation at the University of California Davis Medical Center. ⋯ Rigid sternal fixation is a natural extension of principles learned from bone stabilization in other parts of the body. It can be used for rigid bony fixation of osteotomies performed after median sternotomy as well as in sternal reconstructions for traumatic fractures, nonunions, and pectus deformities. Rigid sternal fixation can be used safely and effectively in the prophylaxis against the development of mediastinitis in addition to the treatment of sternal nonunion or malunion in high-risk patients.
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Annals of plastic surgery · May 2014
The value of color duplex imaging for planning and performing a free anterolateral thigh perforator flap.
The free anterolateral thigh (ALT) flap has been used successfully for various soft tissue reconstructions. However, the drawback of this flap has been the difficulty associated with finding consistent perforators due to the variable anatomy. In this study, the value of color duplex imaging for reliably identifying the perforators of the flap was investigated. ⋯ The color duplex scan is a useful imaging modality for planning and performing free ALT flap. It enables surgeons to improve efficiency in the operating room and overall outcomes, as well as shortens the learning curve when first performing these highly variable flaps. The close working relationship between the vascular technologist and the surgeon may be the key to its success.
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Annals of plastic surgery · May 2014
Case Reports Clinical TrialUse of the dorsal digital sensate free flap for reconstruction of volar soft tissue defect of digits.
Sensate cross-finger flaps and homodigital and heterodigital island flaps can usually be used for sensory reconstruction in the volar aspect of the digit. However, when the donor areas are damaged by concomitant injuries, these flaps are not available. The free dorsal digital flap, including both dorsal branches of the proper digital nerves, can be used as an alternative to resolve this problem. ⋯ At final follow-up, the static 2PD of 2-branch flap is superior to 1-branch flap. The dorsal digital sensate free flap can be used as an alternative for the reconstruction of volar soft tissue defect of the digits. Sufficient sensory recovery can be achieved using this technique.