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| 3. |
- Andreasson, My, et al.
(author)
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Patient-Reported Outcome Measures Used in Gender Confirmation Surgery: A Systematic Review
- 2018
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In: Plastic and Reconstructive Surgery. - 0032-1052. ; 141:4, s. 1026-1039
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Research review (peer-reviewed)abstract
- Background: The usefulness of patient-reported outcome measures is emphasized along with the development of patient-centered care. When implementing patient-reported outcome measures, evidence of the instrument's validity, reliability, and responsiveness in the target population is necessary to secure accurate reporting of the patient's experience. The aim of this study was to identify the literature in which structured patient-reported outcome measures have been used to evaluate the results of gender confirmation surgery, and to systematically evaluate the validity of these instruments. Methods: A systematic review of the current literature was performed to identify structured patient-reported outcome measures used to evaluate the outcome of gender confirmation surgery. The identified instruments' validity in the transgender population was assessed for adherence to international guidelines for development and validation of health outcomes instruments. Results: A total of 110 instruments were identified: 64 ad hoc; six generic; 24 evaluating psychiatric, social, or psychosocial aspects; nine evaluating function but only valid in other patient groups; five ad hoc with some formal development/validation; and two specific for gender dysphoria. Conclusions: There is a lack of patient-reported outcome measures that are valid for the transgender population and concurrently sensitive enough to evaluate gender confirmation surgery without the influence of other gender confirming interventions. Basing research on instruments without confirmed validity decreases the validity of the study itself; thus, previous research using patient-reported outcome measures to evaluate gender confirmation surgery can be considered to have a low level of evidence. To obtain valid patient-reported outcome measures, specific for evaluating the results of gender confirmation surgery, development of new instruments or adaptation of existing instruments is needed.
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| 4. |
- Audolfsson, Thorir, et al.
(author)
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Nerve Transfers for Facial Transplantation : a cadaveric study for motor and sensory restoration
- 2013
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 131:6, s. 1231-1240
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Journal article (peer-reviewed)abstract
- BACKGROUNDRestoration of facial animation and sensation are highly important for the outcome after facial allotransplantation. The identification of healthy nerves for neurotization, through recipient to donor nerve coaptation, is of particular importance for successful nerve regeneration within the allograft. However, due to the severity of the initial injury and resultant scar formation, a lack of healthy nerve stumps in the recipient is a commonly encountered problem. In this study, we evaluate the technical feasibility of performing nerve transfers in facial transplantation for both sensory and motor neurotization.METHODSFifteen fresh cadaver heads were used in this study. The study was divided in two parts. First, the technical feasibility of nerve transfer from the cervical plexus (CP) to the mental nerve (MN) and the masseter nerve (MaN) to the buccal branches of the facial nerve (BBFN) was assessed. Next, we performed nerve transfers in simulated face transplants to describe the surgical technique focusing on sensory restoration of the midface and upper lip by neurotization of the infraorbital nerve (ION), sensory restoration of the lower lip by neurotization of the MN, and smile reanimation by neurotization of the BBFN.RESULTSIn all specimens coaptation of at least one of branches of the CP to the mental nerve was possible as well as between the masseter nerve to the buccal branch of the facial nerve. In simulated face transplant procedures nerve transfers of the supraorbital nerve (SON) to the infraorbital nerve (ION), cervical plexus branches to the mental nerve, and masseter nerve to facial nerve are all technically possible.CONCLUSIONNerve transfers are a technically feasible option that could theoretically be used in face transplantation either as a primary nerve reconstruction when there are no available healthy nerves, or as a secondary procedure for enhancement of functional outcomes. The supraorbital nerve, branches of the cervical plexus and the masseter nerve are nerves usually located out of the zone of injury and can be selected as neurotizers for the infraorbital nerve, mental nerve and buccal branch of the facial nerve respectively.
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| 11. |
- Borgquist, Ola, et al.
(author)
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The influence of low and high pressure levels during negative pressure wound therapy on wound contraction and fluid evacuation.
- 2011
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In: Plastic and Reconstructive Surgery. - 0032-1052. ; 127:2, s. 551-559
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Journal article (peer-reviewed)abstract
- BACKGROUND: Negative pressure wound therapy (NPWT) promotes healing by drainage of excessive fluid and debris and also by mechanical deformation of the wound edge tissue. The most commonly used negative pressure is -125 mmHg. However, this pressure may cause pain and ischemia, and the pressure often needs to be reduced. The aim of the present study was to examine wound contraction and fluid removal during low and increasing levels of negative pressures. METHODS: A peripheral wound was created in 70 kg pigs. The immediate effects of NPWT (-10 to -175 mmHg) on wound contraction and fluid removal was studied in eight pigs. The long-term effects on wound contraction were studied in eight additional pigs during 72 hours of NPWT at -75 mmHg. RESULTS: The wound contraction and fluid removal increased gradually with increasing levels of negative pressure until reaching a steady state. Maximum wound contraction was observed at -75 mmHg. When NPWT was discontinued, after 72 hours of therapy, the wound surface area was smaller than before therapy. Maximum wound fluid removal was observed at -125 mmHg. Higher pressures did not further reduce wound surface area or fluid volume. The time required for evacuation of 50% of the maximal fluid drained for a specific pressure level was longer for low negative pressures (∼45 s for pressures below -50 mmHg) than for high negative pressures (∼15-20 s for pressures above -50 mmHg). CONCLUSIONS: NPWT facilitates drainage of wound fluid and exudates and results in mechanical deformation of the wound edge tissue which is known to stimulate granulation tissue formation. Maximum wound contraction is achieved already at -75 mmHg, and this may be a suitable pressure for most wounds. In wounds with large volumes of exudate, higher pressure levels may be needed for the initial treatment period.
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| 12. |
- Borgquist, Ola, et al.
(author)
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Wound edge microvascular blood flow during negative-pressure wound therapy: examining the effects of pressures from -10 to -175 mmHg.
- 2010
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In: Plastic and Reconstructive Surgery. - 0032-1052. ; 125:2, s. 502-509
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Journal article (peer-reviewed)abstract
- BACKGROUND: Negative-pressure wound therapy is believed to accelerate wound healing by altered wound edge microvascular blood flow. The current standard negative pressure is -125 mmHg. However, this pressure may cause pain and ischemia and often has to be reduced. The aim of the present study was to examine the blood flow effects of different levels of negative pressures (-10 to -175 mmHg). METHODS: Wound edge microvascular blood flow was studied in a peripheral wound model in eight 70-kg pigs on application of negative-pressure wound therapy. Blood flow was examined, using laser Doppler velocimetry, in subcutaneous and muscle tissue at 0.5, 2.5, and 5 cm from the wound edge. RESULTS: Blood flow changed gradually with increasing negative pressure until reaching a steady state. Blood flow decreased close to the wound edge (0.5 cm) and increased farther from the wound edge (2.5 cm). At 0.5 cm, blood flow decreased 15 percent at -10 mmHg, 64 percent at -45 mmHg, and 97 percent at -80 mmHg. At 2.5 cm, blood flow increased 6 percent at -10 mmHg, 32 percent at -45 mmHg, and 90 percent at -80 mmHg. Higher levels of negative pressure did not have additional blood flow effects (p > 0.30). No blood flow effects were seen 5 cm from the wound edge. CONCLUSIONS: Blood flow changes gradually when the negative pressure is increased. The levels of pressure for negative-pressure wound therapy may be tailored depending on the wound type and tissue composition, and this study implies that -80 mmHg has similar blood flow effects as the clinical standard, -125 mmHg.
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| 15. |
- Chubb, Daniel, et al.
(author)
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The Efficacy of Clinical Assessment in the Postoperative Monitoring of Free Flaps : A Review of 1140 Consecutive Cases
- 2010
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 125:4, s. 1157-1166
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Journal article (peer-reviewed)abstract
- Background: Effective postoperative monitoring of the vascular pedicle to a free flap can potentiate rapid return to the operating room in the setting of compromise, allowing for the potential to salvage the flap. The only ubiquitous method for postoperative monitoring of free flaps is clinical bedside monitoring, but although the use of clinical monitoring may be inferred in large reported series of free flaps, there has been little discussed in the literature of specific clinical outcome measures. Methods: The authors present their experience with 1140 consecutive cases of free tissue transfer and the use of clinical monitoring as a sole method of monitoring, and subgroup analysis of different recipient sites. Results: There were 94 take-backs, four of which had no pedicle compromise (false-positives) and there were four false-negatives. The overall flap salvage rate was 62.8 percent and the false-positive rate was 0.4 percent. Subgroup analyses demonstrated statistically significant differences between recipient sites for the false-positive rates: fewer false-positives with breast reconstruction cases (p < 0.05) and significantly more false-positives in the extremity group (p < 0.05). There was an improved flap salvage rate in cases of venous compromise compared with arterial compromise (69 percent versus 51 percent, p = 0.015). Conclusions: This largest reported series to date provides an outcome-based analysis of postoperative monitoring for free flaps, providing a benchmark standard against which adjunctive monitoring techniques can be compared. Future studies need to be assessed in the context of individual recipient sites, with significant differences in monitoring outcomes between sites.
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| 16. |
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| 17. |
- de Lecea, Cristina Gomez-Martinez, et al.
(author)
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Five-Step Scapula Tip Flap Harvesting for Oromaxillofacial Defects Reconstruction
- 2022
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In: Plastic and reconstructive surgery (1963). - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052 .- 1529-4242. ; 150:2, s. 416e-418e
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Journal article (peer-reviewed)abstract
- In the last 10 years, there has been an increased focus on the scapula tip free flap for head and neck reconstructions. Its several advantages make it a versatile and reliable reconstructive option for patients with orofacial compound defects. The aim of this article is to present a systematic surgical approach for the harvesting of the scapula tip free flap. Herein, a step-by-step surgical approach and some technical tips are described to make the scapula tip flap dissection simpler, safer, and more straightforward.
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| 18. |
- Docherty-Skogh, Ann-Charlott, et al.
(author)
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Bone morphogenetic protein-2 delivered by hyaluronan-based hydrogel induces massive bone formation and healing of cranial defects in minipigs
- 2010
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 125:5, s. 1383-1392
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Journal article (peer-reviewed)abstract
- Background: Reconstruction of large craniofacial bone defects is a challenge using bone transplants or alloplastic materials. The use of bone morphogenetic protein (BMP)-2 together with a suitable carrier is an attractive option that may facilitate new bone formation. The authors have developed a hydrogel that is formed in situ by the cross-linking of multifunctional hyaluronic acid and polyvinyl alcohol derivatives mixed with hydroxyapatite nanoparticles, in the presence of BMP-2. The aim of this study was to evaluate the suitability of the hydrogel as a carrier for BMP-2 in repairing critical size cranial defects in a minipig model. Methods: Cranial defects (2 × 4 cm) were created in 14 minipigs. The experimental groups were as follows: group 1, craniotomy and application of 5 ml of hydrogel with 1.25 mg of BMP-2 (n = 6); group 2, craniotomy and application of 5 ml of hydrogel without BMP-2 (n = 6); and group 3, craniotomy with no further treatment (n = 2). Results: After 3 months, computed tomographic and histologic examinations were performed. There was spontaneous ossification in the untreated group, but the healing was incomplete. The hydrogel alone demonstrated no further effects. The addition of 1.25 mg of BMP-2 to the hydrogel induced a greater than 100 percent increase in bone volume (p = 0.003) and complete healing of the defects. Histologic examination revealed compact lamellar bone in the BMP group without intertrabecular fibrous tissue, as was seen in the other groups. The hydrogel was resorbed completely within 3 months and, importantly, caused no inflammatory reaction. Conclusion: The injectable hydrogel may be favorable as a BMP-2 carrier for bone reconstruction.
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| 25. |
- Fagrell, D, et al.
(author)
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Capsular contracture around saline-filled fine textured and smooth mammary implants : A prospective 7.5-year follow-up
- 2001
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In: Plastic and reconstructive surgery (1963). - : Wolters Kluwer. - 0032-1052 .- 1529-4242. ; 108:7, s. 2108-2112
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Journal article (other academic/artistic)abstract
- In a previous prospective randomized clinical study comparing in the same patient textured and smooth saline-filled mammary implants (Biocell) with large pore size (300 to 600 mum), we saw no difference in capsular contracture. This study was undertaken in a similar way to compare capsular contracture around smooth and textured saline-filled prostheses with pores of small size. During a period of 7.5 years, the breast hardness was followed tip, and at the end of the study patient satisfaction was evaluated. Twenty healthy women with a mean age of 30 years were operated on for breast augmentation. Two surgeons performed all operations in a standardized way. Each patient received subglandularly a Siltex textured saline-filled prosthesis with a pore size of 30 to 70 mum in one breast, and a smooth saline-filled prosthesis in the other. The hardness of the breasts was evaluated after 0.5, 1, and 7.5 years using Baker grading and applanation tonometry. Eighteen patients completed 1-year and 7.5-year follow-up. Two breasts With smooth prostheses were contracted after 6 months (Baker III or IV). After I year, four patients with smooth prostheses and one with a textured prosthesis had capsular contracture (p = 0.34). Seven and one-half years after surgery, six patents with smooth and four with textured implants had contracture (p = 0.66). On two patients with smooth prostheses and one patient with a textured prosthesis, the capsule around the implant hardened between 6 and 12 months. Between 1 year and 7.5 years, three breasts with smooth and textured implants contracted and one with a textured implant softened. The patients reported on a Visual Analogue Scale (I to 10) the impact of the augmentation oil their (quality of life to be 9 +/- 1. Four patients preferred the breast with file smooth prosthesis, three preferred the breast with the textured prosthesis, and the others found both breasts equal. This study showed no significant difference of contracture with smooth versus fine textured implants. The majority of the patients preferred the smooth implants. The patients reported that the breast augmentation had had an extremely high impact on their quality of life.
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| 26. |
- Falk Delgado, Alberto, et al.
(author)
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The Skoog Lip Repair for Unilateral Cleft Lip Deformity : The Uppsala Experience
- 2018
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 141:5, s. 1226-1233
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Journal article (peer-reviewed)abstract
- Background: The Uppsala Craniofacial Center has been treating patients with unilateral cleft lip deformity using the lip repair technique described by Tord Skoog. The aim of this study was to determine complications after lip surgery and the incidence and indications for lip revisions in all patients born with unilateral cleft lip from 1960 to 2004.Methods: All patients who were born from 1960 to 2004 with unilateral cleft lip, cleft lip and alveolus, or cleft lip and palate and underwent lip repair were studied retrospectively. The timing, indication, complications of the primary procedure, and type of secondary surgery were recorded. Kruskal-Wallis and Fisher’s exact tests were used, with Bonferroni correction.Results: The study included 443 patients. The total rate of early surgical complications was 6 percent (n = 26). Secondary surgery for short upper lip was performed in 3.8 percent (n = 17), 8.4 percent (n = 37) underwent reduction of excess vermillion, 8.6 percent (n = 38) underwent scar revision, 11 percent (n = 51) underwent revision for incongruent vermillion-cutaneous border, and 10 percent (n = 45) underwent revision for other indications. Altogether, 45 percent had no secondary revisions.Conclusion: In conclusion, the Skoog lip repair is associated with a low total revision rate, and a short-lip deformity is rare.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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| 27. |
- Fischer, Sara, et al.
(author)
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Springs Produce Favorable Morphological Outcomes Relative to H-craniectomy According to a Two-center Comparison of Matched Cases.
- 2023
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In: Plastic and reconstructive surgery. - 1529-4242 .- 0032-1052.
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Journal article (peer-reviewed)abstract
- Sagittal synostosis is the most common type of premature suture closure, and many surgical techniques are used to correct scaphocephalic skull shape. Given the rarity of direct comparisons of different surgical techniques for correcting craniosynostosis, this study compared outcomes of craniotomy combined with springs and H-craniectomy for non-syndromic sagittal synostosis.Comparisons were performed using available pre- and postoperative imaging and follow-up data from the two craniofacial national referral centers in Sweden, which perform two different surgical techniques: craniotomy combined with springs (Gothenburg) and H-craniectomy (Renier's technique; Uppsala). The study included 23 pairs of patients matched for sex, preoperative cephalic index (CI), and age. CI, total intracranial volume (ICV), and partial ICV were measured before surgery and at 3 years of age, with volume measurements compared against those of pre- and postoperative controls. Perioperative data included operation time, blood loss, volume of transfused blood, and length of hospital stay.Craniotomy combined with springs resulted in less bleeding and lower transfusion rates than H-craniectomy. Although the spring technique requires two operations, the mean total operation time was similar for both methods. Of the three complications that occurred in the group treated with springs, two were spring-related. Importantly, the compiled analysis of changes in CI and partial volume distribution revealed that craniotomy combined with springs resulted in superior morphological correction.The findings showed that craniotomy combined with springs normalized cranial morphology to a greater extent than H-craniectomy based on changes in CI and total and partial ICVs over time.
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| 28. |
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| 29. |
- Fryzek, Jon P., et al.
(author)
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Self-reported symptoms among women after cosmetic breast implant and breast reduction surgery
- 2001
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In: Plastic and Reconstructive Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052. ; 107:1, s. 206-213
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Journal article (peer-reviewed)abstract
- A retrospective cohort study was performed in Sweden to evaluate the possibility that an individual symptom or constellation of illness symptoms related to silicone occurs in women after breast implant surgery. A random sample (n = 2500) of all women in the Swedish national implant registry who underwent breast augmentation surgery with alloplastic breast implants during the years 1965 through 1993 was compared with a sample (n = 3500) of women who underwent breast reduction surgery during the same period, frequency matched to the implant patients for age and calendar year at the time of surgery. In total, 65 percent of the breast implant patients (n = 1546) and 72 percent of the breast reduction patients (n = 2496) completed a self-administered questionnaire covering 28 rheumatologic and other symptoms and lifestyle and demographic factors. Practically all of the 28 symptoms inquired about were reported more often by women in the breast implant cohort, with 16 (57 percent) significantly more common in breast implant recipients. In contrast, few significant differences or consistent patterns were observed in the length of time since the implant and in the type (silicone or saline) or volume of the implant. Although women with breast implants report a multitude of symptoms more often than women who have breast reduction surgery, the lack of specificity and absence of dose-response relationships suggest that the excess of reported symptoms is not causally related to cosmetic implants.
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| 30. |
- Fryzek, JP, et al.
(author)
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Silicone breast implants and fibromyalgia - Reply
- 2001
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In: PLASTIC AND RECONSTRUCTIVE SURGERY. - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052. ; 108:7, s. 2166-2167
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Journal article (other academic/artistic)
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| 38. |
- Hagert, Elisabet, et al.
(author)
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Upper extremity nerve entrapments: the axillary and radial nerves - clinical diagnosis and surgical treatment.
- 2014
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In: Plastic and Reconstructive Surgery. - 0032-1052 .- 1529-4242. ; 134:1, s. 71-80
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Journal article (peer-reviewed)abstract
- Non-traumatic pain in the shoulder, arm and hand (brachialgia) is a common complaint in the field of musculoskeletal disorders, where nerve entrapment constitutes a possible cause. The effect of nerve compression is dose-dependent; hence a low-level compression will only result in decreased endoneurial circulation, neural edema and a Seddon's grade-IV weakness, but won't be revealed in nerve conduction or magnetic resonance imaging studies. Due to technical limitations, several clinical options to diagnose compression neuropathies in the upper extremity have been proposed. These include blinded-controlled studies on manual muscle testing to delineate level of nerve compression, and scratch-collapse test (SCT) to verify the level of compression. In this manuscript, we describe the clinical examination and surgical techniques to diagnose and treat entrapments of the axillary and radial nerves.
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| 39. |
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| 40. |
- Hoffner, Mattias, et al.
(author)
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Liposuction Gives Complete Reduction of Arm Lymphedema following Breast Cancer Treatment : A 5-year Prospective Study in 105 Patients without Recurrence
- 2018
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In: Plastic and reconstructive surgery (1963). - : LIPPINCOTT WILLIAMS & WILKINS. - 0032-1052 .- 1529-4242. ; 6:8
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Journal article (peer-reviewed)abstract
- Background: Arm lymphedema is a well-recognized complication after breast cancer surgery that negatively impacts patients' quality of life, both physiologically and psychologically. Lymph stasis and inflammation result in excess formation of adipose tissue, which makes removal of the deposited subcutaneous fat necessary to eliminate the excess volume. Liposuction, combined with postoperative controlled compression therapy (CCT), is the only treatment that gives complete reduction of the excess volume. The aim of this study was to evaluate the 5-year results after liposuction in combination with CCT. Methods: Patients consecutively operated on between 1993 and 2012 were identified from the lymphedema registry, comprising all patients with nonpitting lymphedema treated with liposuction and CCT in our department. Standardized forms were used to collect pre-, peri-, and postoperative data. Results: One hundred five women with nonpitting edema were treated. The mean interval between the breast cancer operation and lymphedema start was 2.95.0 years, the mean duration of lymphedema was 10 +/- 7.4 years, and the preoperative mean excess volume was 1,573 +/- 645ml. The mean volume aspirated was 1,831 +/- 599ml. Postoperative mean reduction 5 years postoperatively was 117% +/- 26% as compared with the healthy arm. Conclusion: Liposuction is an effective method for the treatment of chronic, nonpitting, arm lymphedema resistant to conservative treatment. The volume reduction remains complete after 5 years.
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| 41. |
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| 42. |
- Huisstede, Bionka M A, et al.
(author)
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Dupuytren disease : european hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline: results from the HANDGUIDE Study
- 2013
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In: Plastic and reconstructive surgery (1963). - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052 .- 1529-4242. ; 132:6, s. 964e-976e
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Journal article (peer-reviewed)abstract
- BACKGROUND:Multidisciplinary treatment guidelines for Dupuytren disease can aid in optimizing the quality of care for patients with this disorder. Therefore, this study aimed to achieve consensus on a multidisciplinary treatment guideline for Dupuytren disease.METHODS:A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of interventions was conducted and used as an evidence-based starting point for this study. In total, 39 experts (hand surgeons, hand therapists, and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report.RESULTS:After four Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of Dupuytren disease. No nonsurgical interventions were included in the guideline. Needle and open fasciotomy, and a limited fasciectomy and dermofasciectomy, were seen as suitable surgical techniques for Dupuytren disease. Factors relevant for choosing one of these surgical techniques were identified and divided into patient-related (age, comorbidity), disease-related (palpable cord, previous surgery in the same area, skin involvement, time of recovery, recurrences), and surgeon-related (years of experience) factors. Associations of these factors with the choice of a specific surgical technique were reported in the guideline. Postsurgical rehabilitation should always include instructions and exercise therapy; postsurgical splinting should be performed on indication. Relevant details for the use of surgical and postsurgical interventions were described.CONCLUSION:This treatment guideline is likely to promote further discussion on related clinical and scientific issues and may therefore contribute to better treatment of patients with Dupuytren disease.
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| 43. |
- Jabbari, Fatemeh, et al.
(author)
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Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus : Long.term effects on alveolar Bone Formation and Maxillary Growth
- 2017
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 139:1, s. 137-148
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Journal article (peer-reviewed)abstract
- Background: Clefts involving the alveolus are treated using one of two strategies: primary periosteoplasty at the time of lip repair or secondary alveolar bone grafting at mixed dentition. Most teams favor secondary alveolar bone grafting because of its high success rate, and concerns have been raised that primary periosteoplasty may interfere with maxillary growth. However, primary periosteoplasty may obviate the need for future bone grafting and is still practiced in some centers. Few studies compare the long-term outcomes of these two strategies.Methods: Fifty-seven consecutive patients born with unilateral cleft lip and alveolus were studied retrospectively. All patients underwent primary lip repair using Skoog's method; 28 patients underwent primary periosteoplasty at the time of lip repair and the remaining 29 underwent secondary alveolar bone grafting at mixed dentition. Occlusal radiographs obtained at ages 10 and 16 years were analyzed for alveolar bone height. Cephalometric analysis assessed growth at ages 5, 10, and 18 years.Results: Seventeen of 28 patients treated using primary periosteoplasty required later secondary bone grafting, and the bone height at age 16 years was lower in the primary periosteoplasty group (p < 0.0001). There was a more pronounced decrease in maxillary protrusion from ages 5 to 10 years in the primary periosteoplasty group (p < 0.03). However, at age 18 there was no significant difference in maxillary growth between the two groups.Conclusion: Primary periosteoplasty did not seem to inhibit long-term maxillary growth but was ineffective as a method of reconstructing the alveolar cleft.
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| 44. |
- Jensson, David, et al.
(author)
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Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.
- 2018
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 141:4, s. 582e-585e
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Journal article (peer-reviewed)abstract
- In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.
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| 45. |
- Johansson Niemelä, Birgitta, et al.
(author)
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Prominent Ears : The Effect of Reconstructive Surgery on Self-Esteem and Social Interaction in Children with a Minor Defect Compared to Children with a Major Orthopedic Defect
- 2008
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 122:5, s. 1390-98
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Journal article (peer-reviewed)abstract
- Background: In a prospective study of patients with prominent ears, the effect of reconstructive surgery on self-esteem and social interaction was examined 1 year after surgery.Methods: Of 42 patients with prominent ears aged 7 to 15 years, 21 were matched with a comparison group of orthopedic patients (leg lengthening) and a control group of schoolchildren. Psychological measures evaluated self-esteem, depression, anxiety, cognition, parents' ratings of child behavior and symptoms, and parent anxiety. Semistructured interviews with the child and parents were also conducted.Results: The motivation to be operated on was pain, teasing, and feelings of being different. The satisfaction rate with the result of reconstructive surgery was high. The psychological measures of the prominent ears group had results close to those of the control group, although the leg lengthening group had lower self-esteem and higher depression and anxiety scores. With few exceptions, all patients had scores within the normal range on self-rating scales. Parents reported less activity at leisure time in both patient groups than in the control group. After surgery, parents reported improved behavior on the Child Behavior Checklist total problem score.Conclusions: Patients with minor defects had fewer self-reported psychological and behavior problems than the major defect group. Interestingly, prominent ears patients also had low activity levels. Reconstructive surgery had no adverse effect on the prominent ears patients in this interim study but rather resulted in improved well-being. It is important to investigate further the effect of reconstructive surgery on children's self-esteem and social interaction.
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| 46. |
- Karlsson, Tobias, et al.
(author)
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Liposuction for Advanced Lymphedema in a Multidisciplinary Team Setting in Australia - Five-Year Follow-Up
- 2023
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In: Plastic and Reconstructive Surgery. - 0032-1052.
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Journal article (peer-reviewed)abstract
- Background: Liposuction for International Society of Lymphology (ISL) late stage II or III limb lymphedema is an established surgical option to remove excessive adipose tissue deposition and has been performed in Australia since 2012 at the Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Macquarie University.Patients and methods: Between May 2012 and May 2017, 72 patients with unilateral primary or secondary lymphedema of the arm or leg underwent suction-assisted lipectomy using the Brorson protocol. This prospective study presents 59 of these patients who had consented to research with a five-year follow-up.Results: Of the 59 patients, 54 (92%) were women, 30 (51%) had leg lymphedema and 29 (49%) had arm lymphedema. For arm patients, the median preoperative volume difference between the lymphedematous and the contralateral arm was 1061 mL, which reduced to 79 mL one year after surgery and to 22 mL five years after surgery. For leg patients, the median preoperative volume difference was 3447 mL, which reduced to 263 mL one year after surgery but increased to 669 mL five years after surgery.Conclusions: Suction-assisted lipectomy is a long-term option for the management of selected patients with ISL late stage II or III limb lymphedema when conservative management can offer no further improvement.a
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| 48. |
- Lauritzen, Claes G, et al.
(author)
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The evolving role of springs in craniofacial surgery: the first 100 clinical cases.
- 2008
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In: Plastic and reconstructive surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1529-4242 .- 0032-1052. ; 121:2, s. 545-54
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Journal article (peer-reviewed)abstract
- BACKGROUND: The use of springs in craniofacial surgery originated at Sahlgrenska University Hospital in 1997 as a way of remodeling the cranial vault postoperatively. METHODS: The hospital records of the first 100 operations involving spring placement were analyzed retrospectively. Demographic, perioperative, and postoperative data were recorded. RESULTS: Two hundred forty-six springs were used in 96 patients. Results for sagittal, metopic, bicoronal, multiple synostoses, and midface surgery are presented. In total, five patients (5 percent) required further surgery because of undercorrection. There were no major complications. Spring dislodgement (5 percent) was the most common complication in early cases. Raised intracranial pressure resulted in a protocol change with the use of compressive springs. The data compare favorably with those of standard craniofacial procedures performed in the same unit. CONCLUSIONS: This therapeutic modality in craniofacial surgery has allowed minimization of the extent of surgery without compromising clinical outcomes. Springs have now become part of the authors' treatment protocol for craniosynostosis and midface surgery. The authors have shown the use of these techniques to be safe and, in selected situations, to offer significant advantages over other methods of treatment.
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| 50. |
- Lutz, Barbara S., et al.
(author)
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Interposition of a pedicle fat flap significantly improves specificity of reinnervation and motor recovery after repair of transected nerves in adjacency in rats
- 2001
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 107:1, s. 116-123
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Journal article (peer-reviewed)abstract
- Despite highest standards in nerve repair, functional recovery following nerve transection still remains unsatisfactory. Nonspecific reinnervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome. This study was conducted to establish a method for preventing aberrant reinnervation between transected and repaired nerves in adjacency.Rat sciatic nerve was transected and repaired as follows: epineural sutures of the sciatic nerve (group A, n = 6), fascicular repair of tibial and peroneal nerves respectively (group B, n = 8), and, as in group B, separating both nerves using a pedicle fat flap as barrier (group C, n = 8). As control only, the tibial nerve was transected and repaired (group D, n = 5).Muscle contraction force of the gastrocnemius muscle was significantly higher in group C as compared with groups A and B after 4 months. Muscle weight showed significantly lower values in group A as compared with groups B, C, and D. Histologic examination in group C revealed little growth of axons from the tibial to the peroneal nerve and vice versa. This axon crossing was observed only when gaps between the fat cells were available. These findings were confirmed by a significantly lower rate of misdirected axonal growth as compared with groups A and B using sequential retrograde double labeling technique of the soleus motoneuron pool.We conclude that a pedicle fat flap significantly prevents aberrant reinnervation between repaired adjacent nerves resulting in significantly improved motor recovery in rats. Clinically, this is of importance for brachial plexus, sciatic nerve, and facial nerve repair.
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