Annals of plastic surgery
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Annals of plastic surgery · Apr 2014
ReviewExperimental and clinical methods used for fat volume maintenance after autologous fat grafting.
Management of soft tissue deficits resulting from congenital abnormalities, trauma, systemic disease, and tumors is a particularly challenging field of plastic and reconstructive surgery. Fat grafting, a technique traditionally used in the correction of facial asymmetry, is commonly seen in aesthetic procedures which use the grafted fat for soft tissue augmentation and recontouring. Despite its widespread use in reconstruction and aesthetic surgery, therapeutic modalities applied in fat grafting are crude and the results of this intervention are unpredictable. The aim of this review was to present the most recent evidence regarding experimental studies and designs which confirmed or disproved fat volume expansion or fat maintenance after autologous fat grafting.
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Annals of plastic surgery · Mar 2014
ReviewA systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit.
Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? ⋯ Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.
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Annals of plastic surgery · Jan 2014
Review Meta AnalysisEfficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials.
There is no consensus with regard to antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery. This meta-analysis sought to assess the efficacy and safety of antibiotic prophylaxis and to determine appropriate duration of prophylaxis. ⋯ This meta-analysis of RCTs provides evidence supporting that antibiotic prophylaxis reduced postoperative SSI in clean plastic surgeries with high-risk factors and clean-contaminated plastic surgeries. Besides, a short-course administration regimen seemed to be of adequate efficacy and safety. High-quality prospective trials on larger scale are needed to further confirm these findings.
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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 · May 2013
ReviewThe evils of nicotine: an evidence-based guide to smoking and plastic surgery.
As nearly 1 of 5 adult Americans are smokers, plastic surgeons should be familiar with the effect of smoking on perioperative risk, the importance of smoking cessation, and the tools to help patients quit. Cigarette smoke contains over 250 known toxins, including nicotine, carbon monoxide, hydrogen cyanide, and nitric oxide, which all are known to impair wound healing, through multiple mechanisms. ⋯ The ameliorating effects of cessation are supported by level 1 evidence, which suggests that the optimal duration of preoperative cessation is 4 weeks or longer. Nicotine replacement therapy and smoking cessation medications are effective aids for quitting and should be familiar to plastic surgeons.