Part Of Reconstructive Surgery Research Articles

Factors Associated with Free Flap Viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: A free flap is part of reconstructive surgery. This technique takes tissue or bone flaps along with their original vascular supply and performs microvascular anastomosis of the pedicle arteries and veins at the recipient site. Several risk factors that influence the occurrence of flap failure are still a major concern, such as age, gender, defect size, duration of surgery, length of tissue ischemic time, nutritional status, etc. This is further associated with higher morbidity, the potential for flap failure, higher costs, and increased length of stay in the hospital. This study aimed to determine the factors associated with free flap viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
 Methods: Cross-sectional analytic observational study. A total of 33 research subjects participated in this study. Observation of risk factors was carried out using SPSS univariate and bivariate.
 Results: Gender and ischemic time factors are related to free flap viability. Male gender and ischemic time < 60 minutes increase the success of free flap viability.
 Conclusion: Gender and length of ischemic time are associated with free flap viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

The evolution of head and neck reconstruction

Like most areas of plastic surgery, head and neck reconstruction has evolved considerably over the past half century, incorporating new techniques and innovations. Inmany parts of the world it has become part of the specialty of head and neck surgery, which itself evolved from general surgery, plastic surgery and otolaryngology, such that it is no longer thought of as part of plastic surgery alone. This discipline now includes new techniques, new flaps and new approaches. In addition, we have seen the blending of hitherto unrelated subspecialties, so that microsurgery and craniofacial surgery are now often practiced by a new breed of practitioners who are trained in both techniques. We have also seen a blending of resection and reconstruction, often by the same surgeon, which though it may seem like a new approach, is how it was done originally. The sheer scope of the subject prevents this paper from being exhaustive, so we attempt to give a broad overview of the changes and to give some background on how and why these advances happened. Such an overview is considered timely and useful for an early issue of this journal. Key references are cited to provide further reading.

Course Review: AOTrauma-Hand Fixation for Surgeons.

Hand trauma forms an important part of plastic surgery and orthopedic training curricula. Although numerous practical hand trauma courses exist, there is always difficulty in achieving the right balance between educational content and practical workshops. AOTrauma-Hand Fixation for Surgeons is a 2.5-day course for plastic surgery and orthopedic trainees that aims to instill the principles of hand fracture fixation and soft tissue coverage through self-directed learning, lectures, small group discussion, and dry bone practical workshops. This course with international faculty and delegates is held in Leeds, United Kingdom, at a cost of 860 Swiss francs (880 US dollars). In this review, we provide an evaluation of the course.

Correlation of compound muscle action potential generated by donor nerves with the recovery of elbow flexion in Oberlin transfer in brachial plexus injury.

Objective:To study the correlation of compound muscle action potential of donor nerves with the recovery of elbow flexion in Oberlin transfer in brachial plexus injury.Introduction:Distal nerve transfer using motor fascicle of ulnar or median nerve to restore elbow flexion is a part of reconstructive surgery after upper brachial plexus injury, first described by Oberlin et al. However, one of the most critical influences on functional outcome is number of functioning motor axons in donor fascicle which is reflected by its compound muscle action potential. We studied whether nerve transfers with donor nerves showing higher amplitudes will yield better reinnervation of muscle and therefore better function as estimated by clinical examination.Methods:We prospectively studied 30 cases of upper brachial plexus injury, of which were treated with Oberlin transfer using ulnar or median or both nerves. The prerequisites were no elbow flexion and hand and wrist flexors showing the power of more than Medical research Council MRC Grade 4. Donor nerves selected either ulnar or median having CMAP >4 mv in our electrophysiology laboratory during nerve conduction study. Patients were followed up for 1 year and assessed clinically for restoration of elbow flexion, weight tolerance.Results:A total of 30 patients of Oberlin transfer were evaluated for improvement power of biceps and elbow flexion. (MRC) grading was done at 1 year. Twenty-seven patients had a good result (MRC grade ≥3), i.e., 90% of patients. Based on the MRC grades, we categorised the patients into two groups as follows: Group A and Group B. Group A included patients with MRC Grade 4–5 and Group B included Grades 3–3.5. We tried to establish a correlation between CMAP and MRC scores by comparison of MRC grade patients for their pre CMAPs which revealed a statistically significant higher CMAPs between the groups. (Mann–Whitney U-test, P = 0.028). This indicates the association of higher pre-CMAPs with higher MRC grades.Conclusion:We conclude that higher the compound muscle action potential of donor nerves, better the recovery of elbow flexion in Oberlin transfer in brachial plexus injury.

Bone Anchors—A Preliminary Finite Element Study of Some Factors Affecting Pullout

Bone anchors (or suture anchors) are used to provide attachment points for sutures to connect tissue such as tendons or ligaments to bone, and work by engaging a threaded portion—sometimes tapered—to the cancellous and/or cortical bone. Such repair is often needed after trauma, or as part of reconstructive surgery. This paper uses the finite element method to compare the pullout characteristics of one common type of bone anchor in different cancellous bone structures. Finite element models are created by using computed tomography (CT) scans of cancellous bone and building computer-aided design (CAD) models to define the cancellous bone geometry. Orthopedic surgeons will sometimes remove parts of the cortical shell and this paper also examines the mechanical effects of decortication. Furthermore, the importance of the connection between anchor and cortical layer is examined. One of the key outcomes from the model is that the coefficient of friction between bone and anchor determines potential mechanisms of pullout. The stiffness of anchors and the effect of the cortical layer are presented for different pullout angles to obtain the theoretical response. The results show the detailed modeling that includes the micro-architecture of the cancellous bone is necessary to capture the large variations that can exist.

Core skills in hand surgery

This course attracts trainees mainly from plastic surgery but also from trauma and orthopaedics and accident and emergency—anyone with an interest in hand surgery and trauma. The college advises a level of experience from core training year 1 to specialty training year 4. I did this course in January 2012, as a core trainee year 2 with eight months’ experience in plastic surgery. I did the course for two reasons. Firstly, because hand trauma is a large part of plastic surgery, I wanted to be taught (and then practise) techniques by hand surgeons from all over the United Kingdom. Secondly, I thought that having a …

Oral Arginine Supplementation and the Effect on Skin Graft Donor Sites: A Randomized Clinical Pilot Study

Although arginine has been shown to improve healing in rodents and in small induced wounds in healthy volunteers, little is known about the effects of arginine supplementation on healing of clinically relevant surgical wounds. We studied 18 patients in a double-blind randomized pilot study (12 men, 6 women), who underwent skin transplantation as part of reconstructive surgery. Patients were randomly assigned to receive arginine (n = 8) or placebo (n = 10) supplementation as an enteral dose of 36.2 g of l-arginine-HCl or an isocaloric amount of placebo (51.2 g alanine), respectively. Wound healing was evaluated at the donor sites of skin grafts by measuring angiogenesis, reepithelialization, and neutrophil count. Arginine metabolism was studied by measuring plasma and wound fluid amino acid concentrations. Our results show that none of these parameters were significantly different between the oral arginine supplementation group and the placebo group. In conclusion, enteral arginine supplementation does not improve wound healing of skin donor sites.

Möglichkeiten und Grenzen der Plastischen Chirurgie

Demographic changes of the industrialised modern society can be recognised throughout every medical specialisation. In the past plastic surgery had a main focus in the reconstruction of posttraumatic disorders but nowadays the typical disorders of the elderly and "civilization diseases" became a major part of reconstructive surgery. In this context the preservation of the lower extremity is a major concern of the plastic surgeon. Especially in patients with diabetes and its typical peripheral atherosclerosis we have to treat peripheral ulcers in an interdisciplinary setting including diabetologist, vascular and plastic surgeon to preserve the endangered extremity.

Quality assurance in plastic surgery: reduction mammaplasty.

Continuous quality assessment is essential to keep the quality of health care high as well as being a powerful educational tool. Good surgical and aesthetic results and high levels of patient satisfaction are clinical indicators of good quality plastic surgery. Breast surgery, particularly reduction mammaplasty, makes up a considerable part of plastic surgery. We have developed quality indicators of this procedure for objective evaluation of the surgical results in general, the different techniques, and the different surgeons. Consideration was taken of the patient's subjective assessment. Data were collected on the "Reduction mammaplasty quality assurance sheet." We find this form sufficient and easy to handle and we can recommend it for use by other plastic surgeons.

Kineplastik nach der Amputation der oberen Extremitäten

In our country the preprosthetic surgical reconstruction of the upper-limb stumps based on the idea of kinematization has become a separate part of reconstructive surgery. Kineplastics- the formation of the skin-muscular canals-aimed at controlling the prosthetic-orthotic devices has acquired a new trend closely connected with the achievements of prosthetics, particularly with the development of the upper-limb externally powered prostheses. At the Leningrad Research Institute of Prosthetics 80 patients underwent kineplastic operations and 102 skin-muscular canals were formed in the period of 1975-1980. Most of the patients were severely disabled; among 65 cases there were upperlimb amputations, congenital deficiencies of the proximal shoulder girdle and disarticulations of shoulder joints. The authors improved the technique of the kineplastic operations, developed the original operations for fastening the prostheses and controlling the functional externally powered prostheses. The physiological investigations showed that the skin-muscular canals possessed a required number of commands and may be a reliable source of control. The skin-muscular canals are used for controlling prostheses, holding different devices for self-help, work and sports. This complex treatment enables the amputees not only to control the prostheses and aid devices, but also to become highly skilled workers.