| 1. |
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| 2. |
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| 3. |
- 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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| 4. |
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| 5. |
- 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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| 6. |
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| 7. |
- 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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| 8. |
- 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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| 9. |
- 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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| 10. |
- 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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| 11. |
- 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.
- 2024
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In: Plastic and Reconstructive Surgery. - 0032-1052 .- 1529-4242. ; 154:2
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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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| 12. |
- 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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| 13. |
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| 14. |
- 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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| 15. |
- 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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| 16. |
- 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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| 17. |
- 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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| 18. |
- 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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| 19. |
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| 20. |
- 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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| 21. |
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| 22. |
- 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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| 23. |
- Maltese, Giovanni, 1974, et al.
(author)
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Spring-assisted correction of hypotelorism in metopic synostosis.
- 2007
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In: Plastic and reconstructive surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1529-4242 .- 0032-1052. ; 119:3, s. 977-84
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Journal article (peer-reviewed)abstract
- BACKGROUND: Metopic synostosis, apart from the pointed forehead, typically is characterized by hypotelorism with egg-shaped orbits on cephalography and the frontoorbital axis parallel or even converging superiorly. The frontoorbital axis angle is a novel parameter for analyzing and describing the orientation of the orbits. Current methods of surgery often result in undercorrection of the almost ever-present hypotelorism. The present study was performed to analyze a new technique, capable in this respect, using steel wire springs in conjunction with a cranioplasty. METHODS: A retrospective study of 23 metopic synostosis patients operated on between 1999 and 2004 was conducted. A strip midline craniectomy and frontal reshaping were combined with the insertion of a steel wire spring across the midline craniectomy, forcing lateral displacement of the orbits. Preoperative and postoperative follow-up cephalograms were obtained, and the bony medial interorbital distance was measured and compared with the bony medial interorbital distance of a control group. Perioperative data and complications were noted. RESULTS: Preoperative mean bony interorbital distance was 10.6 mm (range, 7.7 to 13.2 mm). It increased to 15.7 mm (range, 10.4 to 22 mm) at 1.5 months postoperatively and to 16.2 mm (range, 10.9 to 24.5 mm) 5 months postoperatively. Results as judged clinically ranged from little effect to a definitive overcorrection. The frontoorbital axis was improved in every case. Average frontoorbital axis was -4 degrees (range, -33 to 23 degrees) preoperatively and 28 degrees (range, 11 to 46 degrees) postoperatively. CONCLUSION: It was concluded that a spring used together with a cranioplasty is a powerful tool for the correction of both hypotelorism and orbital shape in trigonocephaly.
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| 24. |
- Moeller, Ellie, et al.
(author)
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Female Leadership in Academic Plastic Surgery: A Comprehensive Analysis
- 2021
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In: Plastic and reconstructive surgery (1963). - : LIPPINCOTT WILLIAMS & WILKINS. - 0032-1052 .- 1529-4242. ; 148:6, s. 1408-1413
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Journal article (peer-reviewed)abstract
- Background: Gender equity remains to be realized in academic plastic and reconstructive surgery. The purpose of this study was to measure the proportion of women in leadership roles in academic plastic and reconstructive surgery to verify where gender gaps may persist. Methods: Six markers of leadership were analyzed: academic faculty rank, manuscript authorship, program directorship, journal editor-in-chief positions, society board of directors membership, and professional society membership. Descriptive statistics were performed, and chi-square tests were used to compare categorical variables. Results: About 16 percent to 19 percent of practicing plastic surgeons are female, as measured by the percentage of female faculty and American Society of Plastic Surgeons members. Female plastic surgeons comprised 18.9 percent (n = 178) of the faculty from 88 academic plastic surgery institutions, and represented 9.9 percent of full professors and 10.8 percent of chiefs. Nineteen institutions had no female faculty. Women were first authors in 23.4 percent of publications and senior author in 14.7 percent of publications. No journal studied had a female editor-in-chief. Of the examined plastic and reconstructive societies, the proportion of women on the board of directors ranged from 16.7 percent to 23.5 percent. Conclusions: The proportion of female program directors, first manuscript authors, and board members of certain societies is commensurate with the number of women in the field, suggesting an evolving landscape within the specialty. However, women remain underrepresented in many other leadership roles, heralding the work that remains to ensure gender parity exists for those pursuing leadership roles in the field of plastic and reconstructive surgery.
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| 25. |
- Möller, Thomas, 1986, et al.
(author)
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In Vivo Chondrogenesis in 3D Bioprinted Human Cell-laden Hydrogel Constructs
- 2017
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In: Plastic and Reconstructive Surgery - Global Open. - 2169-7574 .- 0032-1052 .- 1529-4242. ; 5:2, s. Article no e1227 -
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Journal article (peer-reviewed)abstract
- Background: The three-dimensional (3D) bioprinting technology allows creation of 3D constructs in a layer-by-layer fashion utilizing biologically relevant materials such as biopolymers and cells. The aim of this study is to investigate the use of 3D bioprinting in a clinically relevant setting to evaluate the potential of this technique for in vivo chondrogenesis. Methods: Thirty-six nude mice (Balb-C, female) received a 5-x 5-x 1-mm piece of bioprinted cell-laden nanofibrillated cellulose/alginate construct in a subcutaneous pocket. Four groups of printed constructs were used: (1) human (male) nasal chondrocytes (hNCs), (2) human (female) bone marrow-derived mesenchymal stem cells (hBMSCs), (3) coculture of hNCs and hBMSCs in a 20/80 ratio, and (4) Cell-free scaffolds (blank). After 14, 30, and 60 days, the scaffolds were harvested for histological, immunohistochemical, and mechanical analysis. Results: The constructs had good mechanical properties and keep their structural integrity after 60 days of implantation. For both the hNC constructs and the cocultured constructs, a gradual increase of glycosaminoglycan production and hNC proliferation was observed. However, the cocultured group showed a more pronounced cell proliferation and enhanced deposition of human collagen II demonstrated by immunohistochemical analysis. Conclusions: In vivo chondrogenesis in a 3D bioprinted human cell-laden hydrogel construct has been demonstrated. The trophic role of the hBMSCs in stimulating hNC proliferation and matrix deposition in the coculture group suggests the potential of 3D bioprinting of human cartilage for future application in reconstructive surgery.
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| 26. |
- Natghian, Hamidreza, et al.
(author)
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Qualitative and Quantitative Analysis of Smile Excursion in Facial Reanimation : A Systematic Review and Meta-analysis of 1- versus 2-stage Procedures
- 2017
-
In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 5:12
-
Research review (peer-reviewed)abstract
- Background: Free functional muscle transfer has become a common treatment modality for smile restoration in long-lasting facial paralysis, but the selection of surgical strategy between a 1-stage and a 2-stage procedure has remained a matter of debate. The aim of this study was to compare the quantitative and qualitative outcomes of smile excursion between 1-stage and 2-stage free muscle transfers in the literature.Methods: A comprehensive review of the published literature between 1975 and end of January 2017 was conducted.Results: The abstracts or titles of 2,743 articles were screened. A total of 24 articles met our inclusion criteria of performing a quantitative or qualitative evaluation of a free-functioning muscle transfer for smile restoration. For the purpose of meta-analysis, 7 articles providing quantitative data on a total of 254 patients were included. When comparing muscle excursion between 1-stage and 2-stage procedures, the average range of smile excursion was 11.5 mm versus 6.6 mm, respectively. For the purpose of systematic review, 17 articles were included. The result of the systematic review suggested a tendency toward superior functional results for the 1-stage procedure when comparing the quality of smile.Conclusions: The results of this review must be interpreted with great caution. Quantitative analysis suggests that 1-stage procedures produce better excursion than 2-stage procedures. Qualitative analysis suggests that 1-stage procedures might also produce superior results when based on excursion and symmetry alone, but these comparisons do not include one important variable dictating the quality of a smile—the spontaneity of the smile. The difficulty in comparing published results calls for a consensus classification system for facial palsy.
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| 27. |
- Nordenskjöld, Jesper, et al.
(author)
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Benefit of Local Anesthesia in Reducing Pain during Collagenase Injection for Dupuytrens Contracture
- 2017
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In: Plastic and reconstructive surgery (1963). - : Lippincott Williams & Wilkins. - 0032-1052 .- 1529-4242. ; 140:3, s. 565-569
-
Journal article (peer-reviewed)abstract
- Collagenase injection for Dupuytrens contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received collagenase using the standard method (0.58 mg injected in one spot) without local anesthesia. Immediately after the first injection (collagenase or local anesthesia), the patients rated the severity of injection-related pain on a visual analogue scale from 0 (no pain) to 10 (worst pain). Before finger manipulation 1 or 2 days after injection, the patients rated the pain experienced since injection. Mean score +/- SD for pain experienced during modified collagenase injection was 4.3 +/- 2.5 without local anesthesia and 2.3 +/- 1.7 during injection of local anesthesia (before collagenase) (age-and sex-adjusted mean difference, 2.1; 95 percent CI, 1.5 to 2.7; p amp;lt; 0.001). Mean pain score +/- SD during standard collagenase injection without local anesthesia was 4.8 +/- 1.8. Mean pain score +/- SD during the injection-manipulation interval was 2.9 +/- 1.9 in the group without local anesthesia and 2.9 +/- 2.3 in the local anesthesia group (p = 0.79). This study shows that local anesthesia significantly reduces the patients overall pain experience during collagenase treatment for Dupuytrens contracture.
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| 28. |
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| 29. |
- Pejler, Gunnar
(author)
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The Role of Mouse Mast Cell Proteases in the Proliferative Phase of Wound Healing in Microdeformational Wound Therapy
- 2014
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In: Plastic and Reconstructive Surgery. - 0032-1052 .- 1529-4242. ; 134, s. 459-467
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Journal article (peer-reviewed)abstract
- Background: Stored in the secretory granules of cutaneous mouse mast cells are mouse mast cell proteases (mMCP-4, -5, and -6). Using transgenic mouse lines that lacked these enzymes, it was shown that mMCP-4 and mMCP-5 modulate the outcome of burn-induced skin injury. Whether or not these proteases also play a role in the repair of surgically damaged skin, with or without microdeformational wound therapy, remains to be determined.Methods: Wild-type C57BL/6 mice and transgenic C57BL/6 mouse lines lacking mMCP-4, -5, or -6 were subjected to surgical wounding of their skin. Wounds were splinted with a stabilizing patch, and the mice received either microdeformational wound therapy (n = 5) or occlusive dressing (n = 5) for 7 days. Wound healing parameters were assessed in the proliferative phase.Results: Cell proliferation in the wounded wild-type mice receiving microdeformational wound therapy was 60 +/- 3 percent. Cell proliferation was only 35 +/- 5 percent, 25 +/- 5 percent, and 45 +/- 4 percent for the treated mMCP-4, mMCP-5, and mMCP-6 null mice, respectively (p = 0.005). Blood vessel sprouting was higher in the control mice with microdeformational wound therapy (170 +/- 40 vessels/high-power field) compared with mouse mast cell protease 6 null mice with microdeformational wound therapy (70 +/- 20 vessels/high-power field; p = 0.005), and higher in the control mice with occlusive dressing (110 +/- 30 vessels/high-power field) compared with mMCP-4 null mice with occlusive dressing (50 +/- 20 vessels/high-power field; p = 0.01). Qualitatively, the granulation tissue of all the protease-deficient groups receiving microdefoimational wound therapy was disrupted.Conclusion: Results suggest that mouse mast cell proteases 4, 5, and 6 are mediators of the critical role mast cells play in microdefoi national wound therapy in the proliferative phase of healing.
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| 30. |
- Rodriguez Lorenzo, Andres, et al.
(author)
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Comparative study of single-, double-, and triple-nerve transfer to a common target : experimental study of rat brachial plexus
- 2011
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 127:3, s. 1155-1162
-
Journal article (peer-reviewed)abstract
- BACKGROUND:The purpose of this study was to investigate the recovery of a common target motor function after different single and combined motor nerve transfers in rat brachial plexus model.METHODS:The musculocutaneous nerve and biceps muscle were chosen as the target for neurotization. The phrenic, pectoral, and suprascapular nerves were selected as the neurotizers. Forty-two Sprague-Dawley rats were randomly assigned to seven groups (six rats in each group): single-neurotizer transfer (three groups), double-neurotizer transfer (three groups), and triple-neurotizer transfer (one group). The contralateral intact forelimb was used as a control. Functional outcomes were measured by grooming test, electrophysiological study, muscle contraction strength, muscle weight, and axon counts.RESULTS:At 12 weeks, 40 operative rats were studied (two had died). In the single-neurotizer transfer, all three transfers showed no significant difference in motor recovery of the biceps. In the double-neurotizer transfer groups, the worst results were seen in group 6 (combined pectoral and suprascapular nerve transfer) despite increasing axon counts.CONCLUSIONS:This study may potentially suggest: (1) single-neurotizer transfer will not have synergistic or antagonistic effects; (2) two neurotizers with functional antagonism will significantly downgrade motor recovery of the neurotized muscle despite increasing axon counts; (3) multiple motor neurotizer transfers may not always provide a better outcome, although increasing axons may outweigh antagonistic effects; and (4) phrenic nerve transfer alone did not upgrade the functional outcome despite its automatic discharge. Any nerve transfer combined with phrenic nerve transfer, however, showed improved functional results.
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| 31. |
- Rodríguez Lorenzo, Andrés, et al.
(author)
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Vascular Perfusion of the Facial Skin : Implications in Allotransplantation of Facial Aesthetic Subunits
- 2016
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 138:5, s. 1073-1079
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Journal article (peer-reviewed)abstract
- BACKGROUND: As the field of face transplantation develops, it may be possible to transplant segments of facial skin to replace facial aesthetic subunits in selected cases. The aim of this study was to identify the more reliable vascular pedicles of each facial aesthetic subunit for its use in transplantation METHODS:: Six full facial soft-tissue flaps were harvested, and the external carotid artery was identified and cannulated proximal to the facial artery. Next, radiopaque contrast was injected through the facial artery into three of the facial flaps and through the superficial temporal artery in the other three facial flaps. After vascular injections, three-dimensional computed tomographic arteriographs of the faces were obtained, allowing analysis of the arterial anatomy and perfusion in different facial aesthetic subunits.RESULTS: The chin, lower lip, upper lip, medial cheek, nose, and periorbital units were perfused in all facial flaps where the facial artery was injected and in none of those where the superficial temporal artery was injected. The lateral cheek was perfused in 100 percent of the superficial temporal artery flaps and in 67 percent of the facial artery flaps. The lateral forehead contained contrast in 100 percent of the superficial temporal artery-injected flaps and in none of the facial artery-injected flaps, and the medial foreheads contained contrast in 67 percent of the facial artery-injected flaps and in 67 percent of the superficial temporal artery-injected flaps.CONCLUSION: The majority of the facial subunits can be harvested based on the facial artery pedicle, with the exception of the lateral forehead, which is based on the superficial temporal artery.
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| 32. |
- Rozen, Shai, et al.
(author)
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Obturator Nerve Anatomy and Relevance to One-Stage Facial Reanimation : Limitations of a Retroperitoneal Approach
- 2013
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 131:5, s. 1057-1064
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Journal article (peer-reviewed)abstract
- Background: Single-stage facial reanimation with a partial gracilis muscle coapted to the contralateral facial nerve seems an optimal surgical solution yet has not supplanted the two-stage approach. Insufficient obturator nerve length may limit reach to sizable contralateral facial nerve branches (possibly necessitating interposition nerve grafting), compromise optimal muscle positioning, or risk nerve coaptation under tension. This study evaluates whether retroperitoneal obturator nerve dissection would effectively lengthen the nerve, thus obviating the aforementioned limitations. Methods: Ten hemifaces and obturator nerves of five cadavers were dissected. Facial measurements included modiolus to contralateral facial nerve branches of sufficient size at the vertical line of the lateral orbital rim. Obturator nerve measurements included gracilis neurovascular hilum to (1) obturator canal entry point (ab), (2) intraobturator canal point where additional adductor branches are inseparable by internal neurolysis (ac), and (3) retroperitoneal point of separation between anterior and posterior obturator branches (ad). Obturator nerve reach for cross-facial nerve coaptation was assessed. Results: Successful coaptation was achieved with obturator nerve dissection to point b approximately 20 percent of the time, to point c 60 to 70 percent of the time, and to retroperitoneal point d 90 to 100 percent of the time Conclusions: Successful coaptation to large contralateral facial nerve branches is feasible in 90 to 100 percent of cases if the entire anterior obturator branch is harvested. However, the increased risk of retroperitoneal dissection and sacrifice of additional adductor branches decreases the viability of this approach. Obturator canal dissection (point c) provides reach in 60 to 70 percent of cases, but short interposition nerve grafting may prove necessary.
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| 33. |
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| 34. |
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| 35. |
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| 36. |
- Schaakxs, Dominique, 1979-, et al.
(author)
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Intramuscular Stem Cell Injection in Combination with Bioengineered Nerve Repair or Nerve Grafting Reduces Muscle Atrophy
- 2022
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In: Plastic and reconstructive surgery (1963). - : Lippincott Williams & Wilkins. - 0032-1052 .- 1529-4242. ; 149:5, s. 905E-913E
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Journal article (peer-reviewed)abstract
- Background: Peripheral nerve injuries represent a clinical challenge, especially when they are accompanied by loss of neural tissue. In this study, the authors attempted to attain a better outcome after a peripheral nerve injury by both repairing the nerve lesion and treating the denervated muscle at the same time.Methods: Rat sciatic nerves were transected to create 10-mm gaps. Repair was performed in five groups (n = 5 rats for each), as follows: group 1, nerve repair using poly-3-hydroxybutyrate strips to connect the proximal and distal stumps, in combination with control growth medium injection in the gastrocnemius muscle; group 2, nerve repair with poly-3-hydroxybutyrate strip seeded with Schwann cell-like differentiated adipose stem cells (differentiated adipose stem cell strip) in combination with growth medium intramuscular injection; group 3, differentiated adipose stem cell strip in combination with intramuscular injection of differentiated adipose stem cells; group 4, repair using autograft (reverse sciatic nerve graft) in combination with intramuscular injection of growth medium; and group 5, autograft in combination with intramuscular injection of differentiated adipose stem cells. Six weeks after nerve injury, the effects of the stem cells on muscle atrophy were assessed.Results: Poly-3-hydroxybutyrate strips seeded with differentiated adipose stem cells showed a high number of βIII-tubulin-positive axons entering the distal stump and abundant endothelial cells. Group 1 animals exhibited more muscle atrophy than all the other groups, and group 5 animals had the greatest muscle weights and muscle fibers size.Conclusion: Bioengineering nerve repair in combination with intramuscular stem cell injection is a promising technique to treat nerve lesions and associated muscle atrophy. Clinical Relevance Statement: Nerve injuries and resulting muscle atrophy are a clinical challenge. To optimize functional recovery after a nerve lesion, the authors treated the nerve and muscle at the same time by using regenerative medicine with adipose stem cells and obtained encouraging results for future clinical applications.
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| 37. |
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| 38. |
- Smit, Jeroen M., et al.
(author)
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Advancements in Free Flap Monitoring in the Last Decade : A Critical Review
- 2010
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 125:1, s. 177-185
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Research review (peer-reviewed)abstract
- Background: The authors conducted a review of the recent literature on the monitoring of free flaps to create an overview of the current monitoring devices and their potential as an ideal monitoring method. Methods: A literature-based study was conducted using the PubMed and Cochrane databases. The following search terms were used: "flap" and "monitoring." All monitoring methods found between January of 1999 and January of 2009 were evaluated. Monitoring methods that were described in five or more clinical reports were further investigated. Results: The advantages and disadvantages of conventional monitoring methods, the implantable Doppler system, color duplex sonography, near-infrared spectroscopy, microdialysis, and laser Doppler flowmetry are presented. Furthermore, an overview is given of their potential as ideal monitoring method. Conclusions: The implantable Doppler system, near-infrared spectroscopy, and laser Doppler flowmetry appear to be the best monitoring devices currently available. As most of the publications on monitoring have focused on the reliability of the systems, future research should also address their cost efficiency.
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| 39. |
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| 40. |
- Smit, Jeroen M., et al.
(author)
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Introduction of the Implantable Doppler System Did Not Lead to an Increased Salvage Rate of Compromised Flaps : A Multivariate Analysis
- 2010
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 125:6, s. 1710-1717
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Journal article (peer-reviewed)abstract
- Background: The Cook-Swartz implantable Doppler system was introduced at the Uppsala University Hospital to ease free flap monitoring and improve salvage rates by an earlier detection of vascular compromise. The aim of the current analysis was to investigate whether the system indeed improved the salvage rate of revisions. Methods: All cases that needed revision among a consecutive series of patients being monitored with the implantable Doppler system between June of 2006 and January of 2009 were compared with a similar set of patients operated on before the introduction of the implantable Doppler system over an equal time span monitored with conventional methods. Data were extracted from the medical files of the patients. Logistic regression was used to identify factors associated with the outcome of the revision. Values of p < 0.05 were considered statistically significant. Results: A total of 327 flaps were monitored with the implantable Doppler system, of which 35 needed revision. In the control group, 303 flaps were included, of which 40 needed revision. The revision was successful in 69 percent of the cases in the implantable Doppler system group; in the group monitored by only conventional methods, this rate was 60 percent. Univariate analysis showed no statistical difference between these success rates (p = 0.441; odds ratio, 1.455; 95 percent confidence interval, 0.560 to 3.775). Multivariate analysis did not show a statistical difference either (p = 0.799; odds ratio, 1.143; 95 percent confidence interval, 0.410 to 3.182). Conclusion: The introduction of the implantable Doppler system did not lead to a significant increase in the salvage rate of revised flaps.
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| 41. |
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| 42. |
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| 43. |
- Staalesen, Trude, 1974, et al.
(author)
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Development of excess skin and request for body-contouring surgery in postbariatric adolescents.
- 2014
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In: Plastic and reconstructive surgery. - 1529-4242 .- 0032-1052. ; 134:4, s. 627-36
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Journal article (peer-reviewed)abstract
- Background: Little is known about the development of excess skin and requests for body-contouring surgery after bariatric surgery in adolescents. Methods: Forty-seven of 86 adolescents that had undergone gastric bypass surgery answered two questionnaires regarding excess skin and requests for and performed body-contouring surgery. An objective assessment of the amount of excess skin was also performed. The results were compared to earlier results from postbariatric adults. Results: The most common overall problem in adolescents was the feeling of having an unattractive body (91 percent). The most common locations for developing excess skin were the upper arms and thighs according to the measurements. Five of 47 adolescents had undergone body-contouring surgery, and 88 percent of the others desired one or more body-contouring operations. Correlations were found between the objectively measured excess skin and the subjectively experienced amount of excess skin. Correlations were also found between the measured excess skin and the experienced discomfort of excess skin for the abdomen, breast/chest, upper arms, and chin. Conclusions: The authors’ results indicate that bariatric surgery in adolescents often leads to severe problems associated with excess skin in both sexes. Thus, the commonly held belief that young people do not develop excess skin to the same extent as adults is strongly questioned. Health care professionals must address the current imbalance between requests for and the performance of body-contouring surgery in adolescents.
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| 44. |
- Svee, Andreas, et al.
(author)
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Use of the Cephalic Vein in DIEP Breast Reconstruction Does Not Increase Risk of Lymphedema of the Ipsilateral Arm
- 2023
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In: Plastic and reconstructive surgery (1963). - : Lippincott Williams & Wilkins. - 0032-1052 .- 1529-4242. ; 151:1, s. 195-201
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Journal article (peer-reviewed)abstract
- Flap failure is a rare but devastating complication in deep inferior epigastric perforator (DIEP) flap reconstructions. Common causes of partial or complete flap failure are related to venous congestion. Although the cephalic vein is usually a safe and reliable recipient vein for additional venous outflow, there is a hypothesized risk of donor-arm lymphedema secondary to lymphatic vessel damage in the vicinity of the cephalic vein or related to scarring and reduced venous backflow of the arm. The aim was to assess whether the cephalic vein as an additional recipient vessel, by means of the superficial inferior epigastric vein in DIEP flap breast reconstruction, was associated with long-term volume changes of the arm and/or symptoms of lymphedema. Arm volume was assessed preoperatively in patients scheduled to undergo unilateral delayed DIEP flap breast reconstruction at Uppsala University Hospital, Sweden, between 2001 and 2007. Long-term postoperative assessments were performed in 2015 to 2016. Water displacement and circumferential measurement were assessed preoperatively and postoperatively by the same lymphedema therapists. Patients were divided into two groups: DIEP reconstruction with the cephalic vein or without. Fifty-four patients fulfilled the inclusion criteria and completed the study, with a mean follow-up time of 136 months. There was no increased occurrence of lymphedema in the group undergoing DIEP flap reconstruction with the cephalic vein as extra venous drainage, based on an analysis of change from baseline in arm volume difference.This study shows that the cephalic vein can be used for secondary venous outflow in DIEP breast reconstruction without long-term risk of ipsilateral arm volume increase or symptoms of lymphedema.
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| 45. |
- Temple-Oberle, Claire, et al.
(author)
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Consensus Review of Optimal Perioperative Care in Breast Reconstruction : Enhanced Recovery after Surgery (ERAS) Society Recommendations
- 2017
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In: Plastic and reconstructive surgery (1963). - : Lippincott Williams & Wilkins. - 0032-1052 .- 1529-4242. ; 139:5, s. 1056E-1071E
-
Research review (peer-reviewed)abstract
- Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol.Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society.Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery.Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented.
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| 46. |
- Thorfinn, Johan, et al.
(author)
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Flexor Tendon Tissue Engineering: Temporal Distribution of Donor Tenocytes versus Recipient Cells
- 2009
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In: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 124:6, s. 2019-2026
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Journal article (peer-reviewed)abstract
- Background: Tissue-engineered tendon material may address tendon shortages in mutilating hand injuries. Tenocytes from rabbit flexor tendon can be successfully seeded onto acellularized tendons that are used as tendon constructs. These constructs in vivo exhibit a population of tenocyte-like cells; however, it is not known to what extent these cells are of donor or recipient origin. Furthermore, the temporal distribution is also not known. Methods: Tenocytes from New Zealand male rabbits were cultured and seeded onto acellularized rabbit forepaw flexor tendons (n = 48). These tendon constructs were transplanted into female recipients. Tendons were examined after 3, 6, 12, and 30 weeks using fluorescent in situ hybridization to detect the Y chromosome in the male donor cells. One unseeded, acellularized allograft in each animal was used as a control. Results: The donor male tenocytes populate the epitenon and endotenon of the grafts at greater numbers than the recipient female tenocytes at 3 and 6 weeks. The donor and recipient tenocytes are present jointly in the grafts until 12 weeks. At 30 weeks, nearly all cells are recipient tenocyte-like cells. Conclusions: Donor male cells survive in decreasing numbers over time until 30 weeks. The presence of cells in tissue-engineered tendon grafts has been shown in prior studies to add to the strength of the constructs in vitro. This study shows that recipient cells can migrate into and repopulate the tendon construct. Cell seeding onto tendon material may create stronger constructs that will allow the initiation of motion earlier. (Plast. Reconstr. Surg. 124: 2019, 2009.)
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| 47. |
- Tillman, Karin K., et al.
(author)
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Nonsyndromic craniosynostosis is associated with increased risk for psychiatric disorders
- 2020
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In: Plastic and reconstructive surgery (1963). - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052 .- 1529-4242. ; 146:2, s. 355-365
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Journal article (peer-reviewed)abstract
- BACKGROUND: Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis.METHODS: The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders.RESULTS: Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders.CONCLUSIONS: Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors).CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
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| 48. |
- Vejbrink Kildal, Villiam, M.D., et al.
(author)
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Ultrasound-guided injections for treatment of facial paralysis sequelae : A randomized study on body donors
- 2024
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In: Plastic and reconstructive surgery (1963). - : Wolters Kluwer. - 0032-1052 .- 1529-4242. ; 153:3, s. 617e-625e
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Journal article (peer-reviewed)abstract
- Background: Botulinum toxin injection is the gold standard treatment of synkinesis and gustatory hyperlacrimation in facial paralysis patients. However, poor injection accuracy may lead to suboptimal treatment results and complications. Diplopia, ptosis, and lagophthalmos are common after lacrimal gland injections. Intra-ocular injections have been reported in the treatment of both synkinesis and excessive tearing. Ultrasound guidance should increase injection accuracy in the facial region, but this has not been proven.Methods: Twenty-six hemifaces of non-embalmed cadavers were studied in a randomized split-face manner. Ink was injected with ultrasound or landmark guidance into the lacrimal gland and three common synkinetic muscles: the orbicularis oculi, depressor anguli oris, and mentalis. Injection accuracy was evaluated through several measures.Results: Using ultrasound guidance, most ink (>50%) was found inside the correct target in 88% of cases, compared with 50% using landmark guidance (p<0.001). This was most pronounced in the lacrimal gland (62% vs. 8%), depressor anguli oris (100% vs. 46%), and mentalis (100% vs. 54%) (p<0.05). All ink was found inside the correct target (no ink outside) in 65% using ultrasound guidance vs. 29% without (p<0.001). Injection accuracy (any ink in target) was 100% when using ultrasound guidance vs. 83% without (p<0.01). Twenty-three percent of landmark-guided depressor anguli oris injections stained the facial artery (p=0.22).Conclusions: Ultrasound guidance significantly increased injection accuracy and reduced the amount of ink lost in surrounding tissue when compared with landmark guidance. Clinical trials are needed to explore the effects of ultrasound guidance on treatment outcome, duration, and complications in facial paralysis patients.
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| 49. |
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| 50. |
- Yafi, Amr, et al.
(author)
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Postoperative Quantitative Assessment of Reconstructive Tissue Status in a Cutaneous Flap Model Using Spatial Frequency Domain Imaging
- 2011
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In: Plastic and reconstructive surgery (1963). - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052 .- 1529-4242. ; 127:1, s. 117-130
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Journal article (peer-reviewed)abstract
- Background:The purpose of this study was to investigate the capabilities of a novel optical wide-field imaging technology known as spatial frequency domain imaging to quantitatively assess reconstructive tissue status.Methods:Twenty-two cutaneous pedicle flaps were created on 11 rats based on the inferior epigastric vessels. After baseline measurement, all flaps underwent vascular ischemia, induced by clamping the supporting vessels for 2 hours (either arteriovenous or selective venous occlusions); normal saline was injected into the control flap and hypertonic-hyperoncotic saline solution was injected into the experimental flap. Flaps were monitored for 2 hours after reperfusion. The spatial frequency domain imaging system was used for quantitative assessment of flap status over the duration of the experiment.Results:All flaps demonstrated a significant decline in oxyhemoglobin and tissue oxygen saturation in response to occlusion. Total hemoglobin and deoxyhemoglobin were increased markedly in the selective venous occlusion group. After reperfusion and the administration of solutions, oxyhemoglobin and tissue oxygen saturation in those flaps that survived gradually returned to baseline levels. However, flaps for which oxyhemoglobin and tissue oxygen saturation did not show any signs of recovery appeared to be compromised and eventually became necrotic within 24 to 48 hours in both occlusion groups.Conclusions:Spatial frequency domain imaging technology provides a quantitative, objective method of assessing tissue status. This study demonstrates the potential of this optical technology to assess tissue perfusion in a very precise and quantitative way, enabling wide-field visualization of physiologic parameters. The results of this study suggest that spatial frequency domain imaging may provide a means for prospectively identifying dysfunctional flaps well in advance of failure.
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