Annals of plastic surgery
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Annals of plastic surgery · May 2013
Case ReportsLower extremity nerve decompression in burn patients.
Generalized neuropathy after burn injury is quite common, but the diagnosis and management of peripheral nerve compression, late after injury, can be difficult. Although the release of upper extremity nerves has been reported, the indications, timing, and outcomes of lower extremity nerve decompression, after burn injury, are not known. ⋯ Lower extremity nerve decompression is effective in improving sensory and motor dysfunction, even late after burn injury, and should be considered in patients with persistent foot drop, paresthesias, and dysesthesias, given the low morbidity of this procedure and high potential for improved function.
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Annals of plastic surgery · May 2013
Logistics of building a laser practice for the treatment of hypertrophic burn scars.
Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars. ⋯ Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.
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Annals of plastic surgery · May 2013
Factors affecting complications in radiated breast reconstruction.
Breast irradiation in combination with breast reconstruction is associated with increased complications. Because of the diminishing threshold for radiotherapy, breast reconstruction irradiation is rising. Our aim was to evaluate factors affecting outcomes in irradiated breast reconstructions. ⋯ Radiation after prosthetic reconstruction may produce an increase in failure rates. The use of ADMs in the face of breast irradiation increases the likelihood of a complication requiring reoperation.
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Annals of plastic surgery · May 2013
Case ReportsUse of osteogenesis distractors in cloverleaf skull reconstruction.
Cloverleaf skull deformity (Kleeblattschädel-Syndromen, trilobular skulls) results from synostosis of multiple cranial sutures. The number of sutures involved, the pathogenesis of the synostosis, and the associated anomalies and syndromes are variable. All forms of cloverleaf skull are associated with a high morbidity and mortality. ⋯ Maximal advancement of the forehead/brow at the initial surgery is usually not enough to correct the associated proptosis and a second brow advancement must be done. We present a patient with Apert syndrome and cloverleaf skull deformity that required early (1 month old) cranial vault decompression due to severe proptosis and papilledema. Our management included the placement of osteogenesis distracters on the forehead/brow to gain additional advancement and expand the soft tissue.
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Annals of plastic surgery · Apr 2013
Teaching core competencies of reconstructive microsurgery with the use of standardized patients.
The Accreditation Council of Graduate Medical Education has defined 6 core competencies that residents must master before completing their training. Objective structured clinical examinations (OSCEs) using standardized patients are effective educational tools to assess and teach core competencies. We developed an OSCE specific for microsurgical head and neck reconstruction. ⋯ Junior residents were also more likely to omit critical elements of the physical examination compared to senior residents. We have modified our educational curriculum to specifically address these deficiencies. Our study demonstrates that the OSCE is an effective assessment tool for teaching and assessing all core competencies in microsurgery.