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Fantastic Plastic Surgery Opportunity With Group of Three Surgeons :: Pennsylvania :: CompHealth Inc
Job 658071 Busy Plastic Surgery group is recruiting an experienced Plastic Surgeon to join them Top Salary and benefits for the right candidate Call 1:4 No competition in local region Located in a wonderful
Facial Plastic Surgeon Needed for Excellent Practice Opportunity :: Pennsylvania :: CompHealth Inc
Job 6512599 Require Board Certified / Board Eligible Plastic Surgeon with Fellowship training in craniofacial surgery Employed position Join a surgical team at a 400 bed modern facility Enjoy an established
Metro Area Plastic Surgery With Hand (30%) Opportunity :: Iowa :: CompHealth Inc
Job 6512314 Hospital based surgery group seeks a Plastic Surgeon Unbeatable location - the best that Iowa offers Must be Board Eligible or Board Certified Plastic Surgeon with Hand training or experience

Archives of Facial Plastic Surgery current issue

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Highlights of Archives of Facial Plastic Surgery [Highlights of Archives of Facial Plastic Surgery]

The Evolution of the Archives of Facial Plastic Surgery [Editorial]
Larrabee, W. F.
The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla Transplant [Original Article]
Alam, D. S., Papay, F., Djohan, R., Bernard, S., Lohman, R., Gordon, C. R., Hendrickson, M., Siemionow, M. Objective  To discuss the technical and anatomical analysis and design of an osteocutaneous allograft transplant incorporating the donor maxilla and the execution of the operative protocol during the transplant. Methods  The Cleveland Clinic reported the world's first successful combined face and maxilla transplant in December 2008. Unlike the 3 prior face transplants, this surgical procedure was done as a salvage operation in a patient who had undergone 23 major reconstructive procedures. The additional complexity due to significant postoperative scarring and recipient vessel depletion presented a unique challenge in this case. The extensive 3-dimensional losses of facial structures in multiple tissue planes required a Le Fort III osteomyocutaneous allotransplant incorporating the donor maxilla. Results  We report the first successful transfer of a complete bony framework and soft-tissue envelope. The allograft has shown excellent integration and no long-term rejection. The traditional conception based on anatomical studies suggested that this transfer would require independent dissection of the internal maxillary vascular system. This was not required in our patient whose allograft was based solely on the facial arterial system and its arcades. Conclusions  Successful near-total face and maxilla allograft transplant can be accomplished based on the facial arterial system and its arcades. This presents a novel method for reconstructing massive facial injuries with significant involvement of the facial skeleton.
Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose [Original Article]
Kridel, R. W. H., Ashoori, F., Liu, E. S., Hart, C. G. Objective  In 1993, Kridel and Konior published a preliminary report (in the Archives of Otolaryngology–Head and Neck Surgery) on the use of irradiated homologous costal cartilage (IHCC) or homograft cartilage in the nose. This is a follow-up study to share our experience in answering fundamental questions: (1) What are the major long-term complications of IHCC, and are they any greater than with the use of the patient's own cartilage? (2) Is IHCC a reliable and safe implant? (3) Does IHCC resorb over time? (4) What measures are implemented in our practice to minimize the sequelae? Design  We performed a retrospective review of patient medical charts in a university-affiliated private practice setting. A total of 357 patients underwent primary or revision rhinoplasty using IHCC grafts with postoperative follow-up duration ranging from 4 days to 24 years (mean [SD], 13.45 [2.83] years). A total of 1025 IHCC grafts and 373 other grafts (including 218 autogenous cartilage [AC] grafts) were used. A total of 201 grafts were dorsal onlay grafts, and 74 of them have been further followed up since the previous report. The grafts were evaluated for warping, infection, infective resorption, noninfective resorption, mobility, and extrusion. Patient satisfaction evaluation was performed in 42 patients. Results  The total complication rate related to IHCC grafts was 3.25%, which included 10 warped grafts of 941 palpable or superficial IHCC grafts (1.06%), 9 infections of 1025 IHCC grafts (0.87%), 5 cases of infective resorption of 1025 IHCC grafts (0.48%), 5 noninfective resorptions of 943 palpable IHCC grafts (0.53%), and 3 cases of graft mobility of 941 palpable grafts (0.31%). Nine cases of local infection were treated and could have arisen from any of the 1025 IHCC grafts as well as from the 373 other grafts. Among the 9 cases of infection, in 2 patients IHCC grafts were used alone, and in 7 patients IHCC grafts were used in combination with other types of graft materials; therefore, the actual infection rate related to the pure use of IHCC was 2 of 1025 or 0.2%. Of the 218 AC grafts used at the same operative intervention along with IHCC grafts, 3 grafts (1.37%) underwent minimal resorption. The overall comparative resorption rates were 1.01% (IHCC) vs 1.37% (AC). The complication rate in conjunction with the use of 162 IHCC s in 53 cases of septal perforation repair was 2.46% (4 cases), including only 1 case of infection, 1 case of mobility of the graft, 1 case of warping, and 1 case of infective resorption (0.61% for all). Of the 25 AC grafts used in septal perforation cases, there were 2 cases of noninfective resorption (8%). The overall comparative complication rates in septal perforation cases were 2.46% for IHCC vs 8% for AC, which indicated a 3.25-times higher complication with the AC than with IHCC. No allergic reaction or systemic disease was reported by patients as a result of use of the IHCC. Irradiated homograft cartilage also proved to be a reliable graft in 2 patients with progressive autoimmune diseases over 2.08 years and 10 years of follow-up. The average rates of patient satisfaction increased during a mean follow-up of 7.87 years, from 91.31% to 94.18%, in 4 categories, including nasal appearance, nasal breathing, nasal symptoms, and quality of life. Conclusions  Based on careful and extensive review of the data, we have concluded that IHCC is well tolerated as a grafting material in rhinoplasty and yields superb functional, structural, and cosmetic results in the most complex and challenging operative cases necessitated by previous unsuccessful nasal surgery, septal perforations, and even in autoimmune diseases that led to nasal deformity. Not only did very few complications occur following the use of 1025 IHCC grafts in 357 patients after 386 rhinoplasties over 24 years (rate, 3.25%), but the rate of complications was no greater than rhinoplasty complication rates when AC grafts are used. The results indicate safety and reliability and justify the convenient use of IHCC grafts for primary and revision rhinoplasty without creating donor site morbidity. Irradiated homograft cartilage grafts are quite stable in the nose and maintain structural contour and support in most cases. Irradiated homograft cartilage grafts should be considered as an alternative or even a primary grafting material when the patient does not have adequate quantities of septal or auricular cartilage remaining to provide the correction or when the shape or quality of such an AC does not adequately provide the structure required. Autogenous rib cartilage is also an alternative material but also increases operative and anesthesia time and adds potential morbidity. The use of IHCC is both cost- and time-effective.
Measurements of Orbital Volume Change Using Computed Tomography in Isolated Orbital Blowout Fractures [Original Article]
Kwon, J., Barrera, J. E., Jung, T.-Y., Most, S. P. Objectives  To measure the orbital volume of unilateral pure blowout fractures with computed tomography before and after surgery and to compare 3-dimensional (3-D) imaging systems. Methods  Twenty-four patients were evaluated with facial computed tomographic scans before and after surgery. Both the orbital volume and the displaced soft tissue volume were measured by 2 operators using 2 different 3-D software programs (Vitrea; Vital Images Inc, Minnetonka, Minnesota; and Dextroscope; Bracco AMT Inc, Princeton, NJ). Results  The mean (SD) normal orbital volumes calculated by Vitrea and Dextroscope were 25.5 (2.4) mL and 24.8 (3.0) mL, respectively. The average preoperative orbital volumes were 28.3 (2.3) mL and 27.6 (3.1) mL, while the postoperative volumes were 25.8 (2.5) mL and 24.9 (3.0) mL. Vitrea showed that the average volume of displaced orbital soft tissue was 2.8 (1.9) mL before surgery and that it was reduced to 0.3 (1.3) mL after surgery, while Dextroscope showed that the average displaced orbital soft tissue was 2.9 (1.4) mL before surgery and that it was reduced to 0.1 (1.2) mL after surgery. There was no statistical difference between the 3-D analysis programs. Conclusions  Consistent volume measurements can be obtained using different 3-D image analysis programs. Measuring preoperative and postoperative volume changes and postoperative reduction can ensure a good surgical result and thereby decrease the incidence of enophthalmos.

Aesthetic Plastic Surgery

Trauma: A New Pseudogynecomastia Cause
Sat, 14 Nov 2009 06:58:59 -0000
Trauma: A New Pseudogynecomastia Cause Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9435-8Authors SongĂĽl Erol, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 TurkeyErkan Orhan, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 TurkeyAsuman Sevin, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 TurkeyBĂĽlent ErdoÄźan, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Lipomodeling of Poland’s Syndrome: A New Treatment of the Thoracic Deformity
Tue, 10 Nov 2009 08:04:23 -0000
Abstract Background  The severe forms of Poland’s syndrome, with thoracic deformity, were until now very difficult to treat, with treatment involving complex surgery and implant insertion. Results were, in general, inadequate and the appearance unnatural. Our experience with fat transfer for breast reconstruction led us to propose reconstruction of the breast and thorax by serial fat transfer. Methods  Our patient had a very severe form of Poland’s syndrome with agenesis of the pectoralis major and latissimus dorsi muscles and lack of fusion of the fourth costal arch. She was treated by fat transfer, or lipomodeling. Lipomodeling was developed in our team in 1998 to augment breast volume after autologous latissimus dorsi flap reconstruction. Because this technique and use of an implant were not possible, we attempted reconstruction by repeated lipomodeling. The patient underwent five sessions at intervals of a few months, the first in August 2001. Results  With 6 years of follow-up, the aesthetic, functional, and psychological results exceeded our expectations. In five sessions we were able to reconstruct a breast of natural shape, sensitivity, and consistency, and which was totally accepted by the patient. Mammography, echography, and MRI 1 year later showed a normal breast of fatty type. Conclusion  Lipomodeling in Poland’s syndrome is technically feasible. This original description of treatment of the severest form of Poland’s syndrome, with impressive results and at the cost of limited constraints and scar sequelae, opens new perspectives and suggests extensive potential applications of lipomodeling in all disciplines related to the breast. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9428-7Authors Emmanuel Delay, University of Lyon, Centre LĂ©on BĂ©rard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceRaphael Sinna, University of Lyon, Centre LĂ©on BĂ©rard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceKaled Chekaroua, University of Lyon, Centre LĂ©on BĂ©rard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceThomas Delaporte, University of Lyon, Centre LĂ©on BĂ©rard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceSebastien Garson, University of Lyon, Centre LĂ©on BĂ©rard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceGilles Toussoun, University of Lyon, Centre LĂ©on BĂ©rard Plastic Surgery Department 28 rue Laennec 69008 Lyon France Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Announcements
Tue, 03 Nov 2009 14:01:31 -0000
Announcements Content Type Journal ArticleCategory AnnouncementsDOI 10.1007/s00266-009-9430-0 Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 33 Journal Issue Volume 33, Number 6 / November, 2009
Percutaneous Electrothrombosis: A Minimally Invasive Technique for the Treatment of Deep Hemangiomas
Sat, 24 Oct 2009 06:04:37 -0000
Abstract Background  A percutaneous electrocauterization technique for the treatment of deep hemangiomas is introduced as an alternative and minimally invasive treatment mode. Methods  Percutaneous electrothrombosis was applied through a needle-catheter that is a small silicone catheter with a needle guide in it. Thus, it is possible to do needle-point monopolar electrocauterization only at the needle tip because of the insulation of the other parts of the needle by the silicone catheter. By retracting the needle with catheter on it during electrocauterization, electrothrombosis was achieved through and around the channel of the needle, leaving vascularized tissue areas between the channels to perfuse the skin or mucosa covering the hemangioma. Results  This technique was applied as a single treatment or before surgery for the treatment of cavernous hemangiomas to more than 40 patients. However, adequate documentation was found for only 10 patients. After percutaneous electrocauterization of deep hemangiomas, discrete areas of skin necrosis appeared in some patients during the healing period, but the subsequent debridement and surgical excisions were easier because of the thrombosis effect of the technique due to the diffuse denaturation and fibrosis through and around the electrocauterization channels. The follow-up period was 1–13 years. Conclusion  The proposed percutaneous electrocauterization technique for the treatment of deep hemangiomas achieved four effects: (1) volume reduction, (2) bleeding reduction, (3) anesthesia time reduction, and (4) cost reduction. The technique can be defined as a minimally invasive and effective alternative treatment for deep hemangiomas. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9425-xAuthors O. Onur Erol, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul TurkeyO. Ata Uysal, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul TurkeyGalip Agaoglu, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Experience of 1000 Cases on Subfascial Breast Augmentation
Thu, 22 Oct 2009 05:59:23 -0000
Abstract Background  Throughout the years the female breast has been manipulated through aesthetic and reconstructive surgery. Since the 18th century there have been reports of techniques that have tried to increase the volume of the mammary gland. This article demonstrates a technique for increasing the volume of the mammary gland by dissection of the fascia of the pectoralis major muscle. This technique provides long-term results due to the optimized dynamics between the soft tissue and the implant. The subfascial technique is paramount to the subglandular method because primarily it offers better palpable firmness in the periareolar area, a significant decrease in the step effect produced by an excessive projection of the breast, a favorable gravitational pull of the breast, and a considerable reduction in the incidence of capsular contractures. The movement of the implant, postsurgical pain, and bleeding caused by the incision of the pectoralis muscle diminish with this technique. Because of the fascia’s tendency to be preserved, this procedure has the advantage of being able to be applied where previous surgery has been performed; this concedes the subfascial technique a more versatile angle. Methods  In the last 10 years 1000 patients were subjected to subfascial breast augmentation with soft-gel cohesive textured implants. An inframammary incision was used in 95% of the patients and the periareolar incision in 5%. Results  The patient does not suffer from immediate postsurgical pain. Recovery time and the ability to start daily activities is briefer than after the submuscular procedure. A better projection is obtained without the need to use a bigger implant to get the same result because there is no pressure on top of the implant as in the submuscular technique. Conclusion  The subfascial procedure offers a high-grade result for the short and long term and has fewer disadvantages than the submuscular or subglandular technique. Likewise, there are fewer immediate postoperative symptoms and patients have a much better and less painful recovery. The morbidity in these patients is less than with the subglandular and submuscular methods. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9402-4Authors Victor Noe Elizondo Tijerina, Monterrey Nuevo Leon MexicoRodolfo A. Elizondo Saenz, Monterrey Nuevo Leon MexicoJair Garcia-Guerrero, Monterrey Nuevo Leon Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Silicone Nipple Shields: An Innovative Postoperative Dressing Technique After Nipple Reconstruction
Tue, 20 Oct 2009 15:19:38 -0000
Abstract Background  The newly reconstructed nipple is extremely sensitive to mechanical pressure and shearing forces, which can cause flap necrosis and sloughing of the skin, eventually promoting infection. Current available dressing solutions are cumbersome, inefficient, displeasing, or otherwise not readily obtainable. Methods  In this study, 10 patients with newly reconstructed nipples were instructed to use breastfeeding nipple shields as the sole means of nipple dressing after the reconstruction procedure. Results  No complications were observed overall. Patients reported full adherence to the postoperative dressing regimen as well as ease of use, availability, low costs, and pleasing aesthetic appearance under garments. Discussion  Silicone breastfeeding nipple shields offer an efficient, affable, cheap, widely available, and aesthetically pleasing form of postoperative dressing for reconstructed nipples. Their use may enhance patient compliance with the dressing regimen and lower the postoperative complication rate. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9426-9Authors Oren Weissman, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelAriel Tessone, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelAlon Liran, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelDemetris Stavrou, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelNimrod Farber, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelArie Orenstein, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelJosef Haik, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelEyal Winkler, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan Israel Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

pubmed: 1529-4242

Anesthesia for Cosmetic Surgery.
Taub PJ, Bashey S, Hausman L Related Articles Anesthesia for Cosmetic Surgery. Plast Reconstr Surg. 2009 Nov 11; Authors: Taub PJ, Bashey S, Hausman L PMID: 19910860 [PubMed - as supplied by publisher]
Transcutaneous Lower Eyelid Blepharoplasty with Orbitomalar Suspension: Retrospective Review of 212 Consecutive Cases.
Korn BS, Kikkawa DO, Cohen SR Related Articles Transcutaneous Lower Eyelid Blepharoplasty with Orbitomalar Suspension: Retrospective Review of 212 Consecutive Cases. Plast Reconstr Surg. 2009 Nov 11; Authors: Korn BS, Kikkawa DO, Cohen SR BACKGROUND:: Midfacial aging is associated with increased demarcation of the nasolabial, malar and nasojugal folds, deflation of facial soft tissues and bones, and descent of the midface. The latter is primarily due to attenuation of the orbitomalar ligament. Traditional surgery of the lower eyelid and midface often requires removal of excess skin, orbicularis oculi muscle and orbital fat which can be complicated by postoperative lower eyelid malposition. We describe a novel adjunct to transcutaneous lower eyelid blepharoplasty that rejuvenates the lower eyelid and midface by reconstituting the orbitomalar ligament while minimizing the development of postoperative eyelid malposition. METHODS:: This study was a retrospective, consecutive, non-randomized interventional case series. We reviewed the medical records of 212 consecutive patients who underwent transcutaneous lower eyelid blepharoplasty with orbitomalar suspension. The aesthetic outcome, patient satisfaction, and development of eyelid malposition were evaluated. RESULTS:: Transcutaneous lower eyelid blepharoplasty with orbitomalar suspension resulted in improved lower eyelid dermatochalasis, contour, midfacial ptosis and improved appearance of the nasojugal and malar folds. All patients report satisfaction with the aesthetic outcome. One patient (0.5 percent) developed lower eyelid retraction requiring subsequent lower eyelid tightening. Three patients (1.4 percent) developed transient lagophthalmos from lower eyelid orbicularis paresis that spontaneously resolved. CONCLUSIONS:: Transcutaneous lower eyelid blepharoplasty combined with orbitomalar suspension is a powerful technique that can be performed concomitantly with facial rejuvenative procedures. Orbitomalar suspension addresses midfacial ptosis by restoring the natural function of the orbitomalar ligament and minimizes the development of postoperative lower eyelid malposition. PMID: 19910859 [PubMed - as supplied by publisher]
Management of Infantile Parotid Gland Hemangiomas: a Forty Year Experience.
Sinno H, Thibaudeau S, Coughlin R, Chitte S, Williams B Related Articles Management of Infantile Parotid Gland Hemangiomas: a Forty Year Experience. Plast Reconstr Surg. 2009 Nov 11; Authors: Sinno H, Thibaudeau S, Coughlin R, Chitte S, Williams B BACKGROUND:: Infantile hemangiomas represent one of the most common childhood tumors. We have previously demonstrated that the most appropriate management for such tumors is a nonoperative approach. Some authors have recently advocated surgical management as the primary treatment. Medical treatment such as steroids or interferon therapy has also been proposed. Definitive treatment for infantile parotid gland hemangioma remains controversial. METHODS:: 1) Retrospective Study: We reviewed the last 400 charts of children with hemangiomas managed at the Montreal Children's Hospital in the past forty years. Twenty patients with parotid hemangiomas were identified. 2) Literature review: The Ovid Medline Database and the PubMed database were used to retrieve all published original articles on the management of parotid hemangiomas from 1950 to Dec 2008. RESULTS:: All our patients underwent successful non-operative management with 100% resolution of their parotid hemangiomas within 2 years of diagnosis with an average follow-up time of 8.6+/-5.7 years. There were no complications of any of the treatments. The literature review retrieved a total of 413 patients in 12 original articles and 4 case reports. Management included observation, medical (steroid or interferon) and/or surgical. Complications included failure to thrive, scarring, facial nerve palsy, and death. CONCLUSION:: We have shown that non-operative therapy resulted in regression and involution of infantile parotid hemangiomas with no major complications. PMID: 19910858 [PubMed - as supplied by publisher]
Facial Transplantation; An anatomic and surgical analysis of the periorbital functional unit.
Vasilic D, Barker JH, Blagg R, Whitaker I, Kon M, Gossman MD Related Articles Facial Transplantation; An anatomic and surgical analysis of the periorbital functional unit. Plast Reconstr Surg. 2009 Nov 11; Authors: Vasilic D, Barker JH, Blagg R, Whitaker I, Kon M, Gossman MD BACKGROUND:: Complete loss of eyelid pair is associated with chronic discomfort, corneal ulceration and visual impairment. Contemporary reconstructive techniques rarely provide functionally acceptable results. Composite tissue allotransplantation may provide a viable alternative. This study reports on neurovascular anatomy and technical details of harvesting an isolated periorbital unit and discusses its functional potential. METHODS:: Twenty-four hemifaces (12 fresh cadavers) were dissected to study surgically relevant neurovascular structures and develop an efficient harvest method. Angiographic analysis was performed in 7 hemifaces following harvest. RESULTS:: The superficial temporal and facial vessels demonstrated consistent location and diameters. Anatomic variability was characterized by absence of the frontal branch of superficial temporal artery or facial-to-angular artery continuation, but never of both vessels in the same hemiface. Angiographic analysis demonstrated filling of the eyelid arcades, providing the anastomoses between the internal and external carotid branches were preserved. The facial nerve exhibited consistent planar arrangement and diameters in the intra and proximal extraparotid region, but less so in the distal nerve course. The inferior zygomatic and buccal branches frequently co-innervated the orbicularis oculi and lower facial muscles with unpredictable inter-muscular course. Based on foregoing an effective surgical harvest of the periorbital composite was developed. CONCLUSIONS:: A surgical harvest of a functional periorbital allotransplant is technically feasible. Revascularization of the isolated periorbital unit is influenced by variations in regional anatomy and cannot be guaranteed by a single vascular pedicle. The orbicularis oculi muscle and its innervation can be preserved and recovery, albeit without the certainty of reflexive blinking, is expected. PMID: 19910857 [PubMed - as supplied by publisher]
Outcomes and patient satisfaction following breast reconstruction with bilateral pedicled TRAM flaps in 105 consecutive patients.
Chun YS, Sinha I, Turko A, Lipsitz S, Pribaz JJ Related Articles Outcomes and patient satisfaction following breast reconstruction with bilateral pedicled TRAM flaps in 105 consecutive patients. Plast Reconstr Surg. 2009 Nov 11; Authors: Chun YS, Sinha I, Turko A, Lipsitz S, Pribaz JJ INTRODUCTION:: Breast reconstruction using pedicled TRAM flaps has come under increasing scrutiny secondary to presumed abdominal wall morbidity. This study analyzes morbidity and patient satisfaction in a consecutive series of breast reconstruction performed using bilateral pedicled TRAM flaps. METHODS:: Between 1991 and 2007, 105 women underwent bilateral pedicled TRAM flap breast reconstruction by the senior author (J.J.P.). Charts were reviewed for post-operative complications and demographic data. Minimum 11-month follow-up survey data was obtained through the Michigan Breast Satisfaction, Qualitative Assessment of Back Pain, and Short Form (SF)-36 questionnaires. RESULTS:: The mean follow-up interval was six years. Abdominal wall complications included three abdominal hernias (2.9 %), three abdominal wall bulges (2.9 %), and four partial donor site skin dehiscences (3.8 %). Fat necrosis was the most common flap complication, present in 24 (11.4 %) flaps. The survey response rate was 61.9 %. SF-36 data demonstrated no significant difference from a mean age-matched female population in general well being, although patients with a BMI >/= 30 reported significantly lower emotional well-being (p = 0.01), social functioning (p = 0.03), and overall energy scores (p = 0.03) in comparison to patients with a BMI < 30. Thirteen (20 %) patients complained of post-operative back pain, although most of these patients reported their symptoms to be mild in nature. CONCLUSIONS:: Low complication rates were demonstrated and patients were generally satisfied in this series of 105 consecutive bilateral pedicled TRAM flaps. This suggests that bilateral pedicled TRAM flap remains a viable option for breast reconstruction. PMID: 19910856 [PubMed - as supplied by publisher]
Non-Cross-Linked Porcine Acellular Dermal Matrices for Abdominal Wall Reconstruction.
Burns NK, Jaffari MV, Rios CN, Mathur AB, Butler CE Related Articles Non-Cross-Linked Porcine Acellular Dermal Matrices for Abdominal Wall Reconstruction. Plast Reconstr Surg. 2009 Nov 11; Authors: Burns NK, Jaffari MV, Rios CN, Mathur AB, Butler CE BACKGROUND:: Non-cross-linked porcine acellular dermal matrices (PADMs) have been used clinically for abdominal wall repair; however, their biologic and mechanical properties and propensity to form visceral adhesions have not been studied. We hypothesized that PADM would result in fewer, weaker visceral adhesions than polypropylene mesh (PP) when used to repair ventral hernias and form a strong interface with the surrounding musculofascia. METHODS:: Thirty-four guinea pigs underwent inlay repair of surgically created ventral hernias using PP, PADM, or a composite of the 2 (PP/PADM). The animals were killed at 4 weeks, and the adhesion tenacity grade and surface area of the repair site involved by adhesions were measured. Sections of the repair sites, including the implant-musculofascia interface, underwent histologic analysis and uniaxial mechanical testing. RESULTS:: The incidence of bowel adhesions to the repair site was significantly lower with PADM (8%, p<0.01) and PP/PADM (0%, p<0.001) than with PP (70%). PADM and PP/PADM repairs, compared to PP repairs, had significantly lower mean adhesion surface areas [12.8% (p<0.001), 9.2% (p<0.001), and 79.9%] and grades [0.6 (p<0.001), 0.6 (p<0.001), and 2.9]. The PADM underwent robust cellular and vascular infiltration. The ultimate tensile strength at the implant-musculofascia interface was similar in all groups. CONCLUSIONS:: PADM becomes incorporated into the host tissue and causes fewer adhesions to repair sites than does PP, with similar implant-musculofascia interface strength. PADM also inhibits adhesions to adjacent PP in PP/PADM repairs. PADM has distinct advantages over PP for complex abdominal wall repairs, particularly when material placement directly over bowel is unavoidable. PMID: 19910855 [PubMed - as supplied by publisher]

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