Reconstructive Plastic Surgery Research Articles

Lesiones por animal ponzoñoso, raya de agua dulce: serie de casos

IntroductionThe toxin produced by the freshwater stingray has a histolytic, anaphylactic and highly painful effect. ObjectiveTo present a series of clinical cases of accident with a poisonous animal, the stingray, and its clinical and epidemiological characterization. Results32 study series, 87,50% male and 12,50% female, age range 7-74 years, mean was 40,59 years, 59,38% were from rural areas and 40,62% urban, 34,37% consulted in the first 24 hours after the event, from one day to seven days 6,25%, from seven to 15 days 15,62%, and more than 15 days 43,75%, lesion in foot 53,13%, in neck of foot 21,87%, in leg 25%, symptoms presented: pain 100%, 71,87% signs of local infection, 59,37% purulent discharge, 56,25% lesion with necrosis. Complications: 9,37% compartment syndrome, 43,75% abscess, 12,50% osteomyelitis, 59,37% coverage defect. The range of surgical procedures performed per patient was 1-7. Isolation 83,33% gram negative, 93,75% in-hospital management and 6,25% were referred due to the severity of the lesions, mortality in this study was 3,12%. ConclusionFluvial stingray causes serious lesions in lower limbs that cause prolonged hospital stays, multiple surgical procedures, large coverage defects that merit the investment of high-tech materials and reconstructive plastic surgery.

Discussion: Modeling the Lifetime Impact of Reconstructive Plastic Surgery Training: Implications for Building Capacity in Global Surgery

Discussion: Modeling the Lifetime Impact of Reconstructive Plastic Surgery Training: Implications for Building Capacity in Global Surgery

Digital Twins Use in Plastic Surgery: A Systematic Review.

Background/Objectives: Digital twin technology, initially developed for engineering and manufacturing, has entered healthcare. In plastic surgery, digital twins (DTs) have the potential to enhance surgical precision, personalise treatment plans, and improve patient outcomes. This systematic review aims to explore the current use of DTs in plastic surgery and evaluate their effectiveness, challenges, and future potential. Methods: A systematic review was conducted by searching PubMed, Scopus, Web of Science, and Embase databases from their infinity to October 2024. The search included terms related to digital twins and plastic surgery. Studies were included if they focused on applying DTs in reconstructive or cosmetic plastic surgery. Data extraction focused on study characteristics, technological aspects, outcomes, and limitations. Results: After 110 studies were selected for screening, 9 studies met the inclusion criteria, covering various areas of plastic surgery, such as breast reconstruction, craniofacial surgery, and microsurgery. DTs were primarily used in preoperative planning and intraoperative guidance, with reported improvements in surgical precision, complication rates, and patient satisfaction. However, challenges such as high costs, technical complexity, and the need for advanced imaging and computational tools were frequently noted. Limited research exists on using DTs in postoperative care and real-time monitoring. Conclusions: This systematic review highlights the potential of digital twins to revolutionise plastic surgery by providing personalised and precise surgical approaches. However, barriers such as cost, complexity, and ethical concerns must be addressed. Future research should focus on validating clinical outcomes through large-scale studies and developing soft tissue modelling and real-time monitoring capabilities.

Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons.

Large-scale defects of body in the reconstructive surgical practice, and the helplessness of their repair with autologous tissues, have been an important factor in the development of artificial biological products for the temporary, definitive, or staged repair of these defects. A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices (ADMs). In recent years, not only the type of tissue from which ADMs are produced, product range, diversity and areas of use have increased, but their use in reconstructive fields, especially in post oncologic breast surgery, has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future. It is essential that reconstructive surgeons become familiar with some of the ADM's as well as the advantages and limitations to their use. This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the armamentarium of reconstructive surgeons. Brief considerations of possible future directions for ADMs are also conducted in the end.

Epidemiology and Characteristics of Plastic Surgery Cases in Simpang Lima Gumul General Hospital, Kediri Regency During Covid-19 Pandemic

Backgrounds: Chinese Government found the first case of coronavirus disease 2019 (COVID-19) in Wuhan, China, in December 2019. The pandemic impacts the number of visits to plastic surgery clinics in many countries such as Italy and the United States following surgical limitations. This study was aimed to determine the impact of the pandemic on the field of Reconstructive and Aesthetic Plastic Surgery in Indonesia, particularly in Kediri Regency, East Java.Methods: The study design was an analytical cross-sectional study, using data obtained from the medical records of plastic surgery patients at SLG General Hospital in Kediri Regency. The data analysis included descriptive analysis and dummy regression analysis.Results: This study included a total of 29 observations, 14 before the pandemic era and 15 during the pandemic, with a total of 460 individuals from various diagnostic categories. Based on the findings, the number of patients diagnosed with Congenital Disorders, Skin, and Soft Tissue, and Aesthetic Surgery dropped by 7%, 2%, and 6%, respectively. Meanwhile, there was an increased number of patients with Maxillofacial, Burn and Wound Care, and Hand and Microsurgery by 5%, 4%, and 1%, respectively. Conclusions: The average number of patient visits for the Skin and Soft Tissue, Burn and Wound Care, and Hand and Microsurgery categories did not vary much during this pandemic.

Vascular Endothelial Growth Factor Expression of Adipose-Derived Stromal Cells and Adipocytes Initiated from Fat Aspirations.

Fat grafting is frequently employed in aesthetic and reconstructive plastic surgery with a low complication rate. However, fat necrosis may occur in dependence of the mode of fat aspiration, processing of the tissue and graft size. Graft survival is critically dependent on the contained adipose-derived stromal cells (ADSCs), adipocyte precursors and their potential for vascular supply. This work investigated the potential role of the expression of vascular endothelial growth factor A (VEGF) and various cytokines by ADSCs and differentiated adipocytes as key factors of fat grafting. Adipokine expression of ADSCs and differentiated adipocytes were assessed using Proteome Profiler Arrays that detect 58 relevant proteins. Collected fat grafts could be categorized according to their adipokine expression into VEGFhigh and VEGFlow ADSCs groups, the former exhibiting higher content of VEGF-related angiopoietin-like 2, nidogen-1/entactin, CCL2/MCP-1 and elevated expression of IGFBPs in association with a fourfold higher VEGF expression. Differentiation of ADSCs into adipocytes increased VEGF concentrations in VEGFlow ADSCs but not in ADSCs exhibiting initial high VEGF concentrations. The adipocytes revealed high expression of HGF, leptin, CCL2/MCP-1, nidogen-1/entactin, M-CSF but lower induction of angiopoietin-like 2. Half of the ADSCs from fat grafts express high concentrations of VEGF and other adipokines that support angiogenesis and survival of this tissues following transfer. Differentiation of ADSClow cells to adipocytes may make up for the initially low VEGF expression, but this activation is 7-10 days delayed compared to the VEGFhigh ADSC cells and may fail to support angiogenesis from the beginning. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Capsular contracture after performing reconstructive plastic surgery in patients with breast cancer

Reconstructive breast surgery, including the use of silicone endoprostheses after radical mastectomy, is an integral part of the comprehensive treatment of breast cancer patients. One of the serious long‑term complications of reconstructive surgery is capsular contracture (CC). Purpose of the study. To analyze the literature data on the etiopathogenesis of periprosthetic capsule (PC) defects and the possibilities of reducing the risk of CC after breast reconstructive surgery. Materials and methods. The literature was searched using PubMed, eLibrary, Cyberleninka databases. The following keywords were used: "breast reconstruction", "capsular contracture", "radiation therapy", "polyurethane", "breast implant", "mesh implant". Original studies, meta‑analyses, randomized controlled trials and systematic reviews were used. Results. The exact etiology of the development of CC has not yet been established. The main pathogenetic mechanism of CC development is chronic inflammation followed by the formation of capsular fibrosis. Radiation therapy significantly increases the risk of developing CC due to the development of fibrotic changes not only in the PC, but also the occurrence of fibrosis of the pectoralis major muscle. The frequency of CC is higher when using adjuvant radiation therapy, compared with neoadjuvant or no radiation therapy, as well as with dual‑plane reconstruction compared with pre‑pectoral placement of the endoprosthesis. The use of a polyurethane endoprosthesis in simultaneous pre‑pectoral breast reconstruction significantly reduces the risk of developing CC in the case of adjuvant radiation therapy, in comparison with textured endoprostheses. One of the ways to reduce the risk of developing CC in breast cancer can be considered the installation of mesh implants, which contributes to the augmentation of the integumentary tissues and improves the stability of the breast endoprosthesis in conditions of tissue deficiency. Conclusion. Simultaneous pre‑pectoral breast reconstruction based on polyurethane endoprosthesis and mesh implants can be considered as a promising technique for reducing the risk of developing CC. There is a positive trend towards reducing the risk of developing CC against the background of adjuvant radiation therapy. Further research is needed related to the reduction of the risk of developing CC.

Perioperative Use of Systemic Steroids Within Otolaryngology-Head and Neck Surgery: Evidence-Based Guidance for Clinicians.

To review and synthesize the available evidence for use of perioperative systemic steroids for otolaryngologic surgical procedures. A comprehensive literature review with evidence-informed recommendations. Databases were queried for medical subject heading terms and keywords related to perioperative systemic corticosteroids use for comprehensive otolaryngology and subspecialty procedures including otologic, sinonasal, sleep, laryngeal, head and neck, facial plastics, and pediatric surgery. Perioperative period included preoperative (up to 7 days prior to surgery), intraoperative (on the day of surgery), and postoperative (initiated within 24 hours after surgery) timeframes. Evidence from clinical practice guidelines, systematic reviews, and original research studies supports perioperative systemic corticosteroid use for specific otolaryngologic indications. Numerous studies support perioperative steroid use for nausea, vomiting, or edema in tonsillectomy, rhinoplasty, and thyroidectomy, although formal guideline recommendations are limited. Strong evidence supports perioperative steroid use before and after endoscopic sinus surgery for chronic rhinosinusitis with polyposis and fungal sinusitis. Evidence of benefit is sparse or absent on systemic perioperative steroid use for the middle and inner ear, laryngeal, salivary gland surgery, and reconstructive facial plastic surgery. Although perioperative administration of systemic steroids is routinely performed for many otolaryngologic surgeries, high-level evidence is limited to specific contexts. Evidence supports the benefit for reducing nausea, vomiting, or edema for several otolaryngologic procedures, as well as for either chronic rhinosinusitis with polyposis or fungal sinusitis. However, these benefits need to be weighed against risks, and further investigations are needed to define the role for perioperative steroids in otolaryngology.

Analytical review of the literature on plastic surgery with a research depth of 5 years according to PubMed data

Purpose of the work: to study current areas of research in plastic surgery for 2018–2023. based on determining the frequency and structure of publication topics in the PubMed electronic database (MEDLINE).Material and methods. The literature review was carried out in accordance with the international requirements of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search for literature sources was carried out in the electronic database PubMed (MEDLINE) using combinations of operators OR, AND and keywords: plastic surgery OR aesthetic surgery OR reconstructive surgery OR microsurgery AND plastic surgery OR flap in reconstr surgery. The study period was 5 years, the search was carried out from February 8, 2018 to February 8, 2023.Results. For analysis, we selected 521 articles that fully met the inclusion criteria. Articles on reconstructive surgery predominated – 78%, compared to aesthetic problems – 22%. When evaluating articles according to the anatomical section, it was revealed that 122 articles (23.42%) were devoted to the head and neck section, 109 (20.92%) – to the mammary gland, 104 (19.96%) – to the skin, 40 (7.68%) – to limbs, 33 (6.33%) – to flaps, 26 (4.99%) – to peripheral nerves, 23 (4.41%) – to urogenital pathology, 15 (2.88%) – to lymphatic system, 14 (2.69%) – to body, 10 (1.92%) – to other questions, 8 (1.54%) – to anatomy, 6 (1.15%) – to genetics, 6 (1.15%) – to hair cover, 3 (0.58%) – to microsurgical technique, 2 articles (0.38%) – to stomach. It was noted that urogenital reconstruction remains less popular among plastic surgery articles. The topic of limb replantation is also insufficiently studied.Conclusion. An analysis of publication activity corresponding to the research topic, as well as the inclusion criteria, demonstrated that there is a stable trend towards an increase in the number of publications in the time period 2019–2023, which is due to the relevance and demand for this area of surgical practice.

Успешное лечение и реабилитация профессионального местного лучевого поражения кисти методом пересадки пальца стопы на кисть

Purpose: To introduce a wide range of specialists with the technique of reconstructive plastic surgery, which was first used in local radiation injury (LRI). Material and methods: clinical analysis of the case histories of the severe LRI of the hand. The report describes the results of the first autotransplantation of the II toe in the position of the right hand III finger for the restoration of grip function in LRI. Results: Patient L., 38 years old, was admitted to the A.I. Burnazyan Federal Medical Biophysical Center in 2010 for the treatment of late consequences of severe LRI of the right hand resulting from contact with a gamma radiation source (Ir 192) in 2008. In the period from 2010 to 2018, the patient underwent repeated surgical operations, including reconstructive plastic surgery, which made it possible to achieve healing of constantly recurring late radiation ulcers. However, multiple necrectomies, exarticulations, finger amputations and resections of the phalanges led to the formation of a functionally defective hand and persistent disability of the patient. In 2018, the patient was admitted to the clinic for reconstructive surgery to restore the function of hand grip - microsurgical transplantation of the II toe into the position of the III finger of the hand. As a result of the treatment, the function of grabbing objects with the right hand was restored, and the patient’s ability to work was largely restored. Conclusions: The obtained long-term functional and aesthetic results allow us to consider the applied method of fingerless hand reconstruction by autotransplantation of the toe with the imposition of microvascular anastomoses optimal. It is advisable to use this type of surgical treatment more widely for the rehabilitation of patients with severe and extremely severe hand LRI.

Management of Acute Compartment Syndrome During the Al Haouz Earthquake - Department of Reconstructive and Aesthetic Plastic Surgery, CHU Mohammed VI, Marrakech

On September 8, 2023, a devastating earthquake struck the Al Haouz region of Morocco, causing significant injuries, including cases of acute compartment syndrome (ACS), a surgical emergency. This report presents a case of a patient from the earthquake, treated for ACS at Mohammed VI University Hospital in Marrakech. The patient, who suffered limb trauma from debris crushing, presented with rhabdomyolysis and signs of ACS in the left upper and lower limbs. Clinical findings included functional impairment, "Coca-Cola" urine, and high creatine kinase levels (60,000), accompanied by renal failure. Decompression surgery (aponevrotomies) was performed to relieve intracompartmental pressure, followed by a directed healing protocol using the "shoe-lace" technique for wound closure. Post-operative management included antibiotics, hemodialysis for acute renal failure, nutritional support, and motor rehabilitation. Complications, such as surgical site infection and hematoma, were addressed with revision surgery and adjusted antibiotic therapy. Despite these challenges, the patient showed significant clinical improvement and resumed normal activity within three months post-operatively. This case highlights the critical importance of timely surgical intervention in ACS, particularly in disaster settings. Early diagnosis, prompt fasciotomy, effective wound management, and multidisciplinary care are essential to prevent severe complications, such as septic wounds or amputation, and ensure successful recovery.

Is Reconstructive Plastic Surgery Appropriately Valued? Comparison of Reimbursement per Unit Time for Reconstructive versus Aesthetic Procedures.

The work relative value units (wRVUs) system was established as a quantifier of physician labor, technical skill, medical decision-making, and training time required to complete a surgical procedure; hence, more challenging operations should theoretically result in higher reimbursement or compensation. Our purpose was to highlight the discrepancies between insurance-based reconstructive and fee-for-service aesthetic procedures based upon dollar/unit time. We analyzed national data from the American College of Surgeons National Surgical Quality Improvement Program, Aesthetic Surgery Databank, and Centers for Medicare and Medicaid Services to compare reimbursement for 8 reconstructive microsurgery and 3 aesthetic procedures and assessed operative times and reimbursement rates, then calculated "relative value unit per unit time" to measure compensation efficiency. This difference in remuneration translates to a 4.7× difference, with an overwhelming gap of $25.26 per minute between microsurgical reconstructive and aesthetic cases. These findings suggest that aesthetic cases are more profitable considering the compensation per unit time. Based on national rates of reimbursement, there is a large discrepancy between reimbursement in microsurgical reconstructive procedures and aesthetic procedures. We demonstrated that complexity and time are not directly related to compensation.

Accelerated Frostbite-Induced Acroosteolysis in Pediatric Insensate Hand: A Case Report and Literature Review.

In pediatric patients, frostbite is a well-documented cause of epiphyseal cartilage destruction and subsequent growth deformity of the affected phalanges. Cases of full acroosteolysis, also referred to as phalangeal osteolysis, of distal phalanges as soon as three months after cold exposure have yet to be reported. We describe a complicated case of frostbite-associated phalangeal osteolysis in the dominant hand of a nine-year-old patient, in the context of post-traumatic insensate hand after sustaining prior electrical burn injuries. This case demonstrates the unique sequela of pediatric frostbite injury involving early loss of the distal phalanx through resorption of the bone and parallel soft tissue retraction, rendering early plastic surgery reconstruction impractical. Reconstructive strategies for frostbite injury in pediatric patients will need to account for the individualized dynamic tissue changes that develop in the months after cold exposure.

Long-term functional results of reconstructive plastic surgery on the pelvic floor

Background. With all the variety of treatment methods for pelvic organ prolapse (POP), the criteria for cure are reduced to the absence of anatomical defects of the pelvic floor. At the same time, the complete restoration of the physical, psycho-emotional and social components of a woman’s life is practically not taken into account. Studying the quality of life, as well as the sexual function of patients with POP will help to clarify the effectiveness of the synergy of surgical treatment and hardware rehabilitation methods.The purpose of the study is to assess the quality of life and sexual function of women of reproductive age after reconstructive plastic surgery on the pelvic floor in combination with radiofrequency exposure.Material and methods. An open prospective longitudinal study was conducted on 60 patients of reproductive age with stage II-III genital prolapse according to the POP-Q classification. The women were divided into two groups: group 1 — patients who underwent vaginal plastic surgery with their own tissues (n=30); group 2 — patients who, after reconstructive plastic interventions, underwent postoperative rehabilitation using dynamic quadripolar radiofrequency (n=30). Before surgery, 1 month and 1 year after treatment, a survey was conducted to determine the quality of life using the Short Form-36 questionnaire and sexual function using the Female Sexual Function Index and Female Sexual Distress Scale.Research results. The combination of surgical correction of pelvic organ prolapse with subsequent radio wave therapy makes it possible to correct anatomical defects, and at the same time statistically significantly increases the index of quality of life and female sexual function, reducing a woman’s experiences associated with problems in her sexual life.Conclusion. The synergy of surgical methods of correction and postoperative rehabilitation with the use of DCRF contributes to the long-term preservation of the functional results of treatment of pelvic floor incompetence during reproductive age.

The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry.

Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools. This retrospective, double-blind study was conducted at Tekirdağ Namık Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques. Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality. The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of cellular versus acellular amnion in facial burns at burn center of Punjab: Our experience.

Objective: To compare the effectiveness of cellular versus acellular amnion in patients with superficial facial burns at tertiary care hospital burn center of Punjab. Study Design: Randomized Control Trial. Setting: Department of Burn and Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st September 2020 to 31st December 2021. Methods: A total of 60 patients who fulfilled the inclusion criteria were recruited after the informed consent and were randomly divided into two groups with 30 patients in Group A and 30 patients in Group B. Group A patients had acellular amnion application and Group B had cellular amnion application over the superficial facial burns. The data was noted on a predesigned proforma and analyzed by using IBM-SPSS.Version.25 and was compared in terms of outcome measures. Results: The mean age in Group A and B was 37.79.86 and 38.19.37(range20-70 years) respectively and mean pain score was 8.50.937 in group A and 8.70.897 in group B. Hypersensitivity reaction was seen in 13.33% in group A vs 26.67% patients in Group B, infection rate of 8.33% in Group A vs 25% in Group B, Healing in 31.67% vs 18.33% in Group A and B respectively while in Group A the need for skin graft was noted in 8.33% vs 20% in group B patients and the difference was significant statistically (p=0.045). Conclusion: Application of Acellular amnion is better choice than Cellular amnion over facial burns with less hypersensitivity reaction, infection rate, need of skin graft and with improved wound healing. Objective: To compare the effectiveness of cellular versus acellular amnion in patients with superficial facial burns at tertiary care hospital burn center of Punjab. Study Design: Randomized Control Trial. Setting: Department of Burn and Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st September 2020 to 31st December 2021. Methods: A total of 60 patients who fulfilled the inclusion criteria were recruited after the informed consent and were randomly divided into two groups with 30 patients in Group A and 30 patients in Group B. Group A patients had acellular amnion application and Group B had cellular amnion application over the superficial facial burns. The data was noted on a predesigned proforma and analyzed by using IBM-SPSS.Version.25 and was compared in terms of outcome measures. Results: The mean age in Group A and B was 37.79.86 and 38.19.37(range20-70 years) respectively and mean pain score was 8.50.937 in group A and 8.70.897 in group B. Hypersensitivity reaction was seen in 13.33% in group A vs 26.67% patients in Group B, infection rate of 8.33% in Group A vs 25% in Group B, Healing in 31.67% vs 18.33% in Group A and B respectively while in Group A the need for skin graft was noted in 8.33% vs 20% in group B patients and the difference was significant statistically (p=0.045). Conclusion: Application of Acellular amnion is better choice than Cellular amnion over facial burns with less hypersensitivity reaction, infection rate, need of skin graft and with improved wound healing.

Early Detection of Vascular Obstruction in Microvascular Flaps using Thermographic Camera.

To evaluate the early detection of vascular obstruction in microvascular flaps using a thermographic camera. A cross-sectional study. Place and Duration of the Study: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan, from July to December 2023. Microvascular flaps with cutaneous islands were monitored postoperatively with a thermographic camera in addition to conventional clinical methods. The decision to re-explore was based on conventional methods, and confirmation was achieved through intraoperative findings of vascular obstruction during re-exploration. Thirty-one patients who underwent microvascular surgery were monitored postoperatively with a thermographic camera. There were 20 (64.5%) anterolateral thigh flaps, 4 (12.9%) radial forearm flaps, 3 (9.7%) scapular-parascapular flaps, 1 (3.2%) medial plantar flap, 1 (3.2%) myocutaneous gracilis flap, 1 (3.2%) latissimus dorsi (LD) flap, and 1 (3.2%) chimeric adductor longus and gracilis flap. Three (9.7%) flaps developed postoperative vascular obstruction. The thermographic camera detected complications two to four hours earlier than conventional methods, with a statistically significant difference (p >0.109). A thermographic camera is a valuable, non-invasive, and simple tool for monitoring microvascular flaps. It can detect complications several hours earlier and has the potential to be a practice-changing modality. Microvascular flaps, Thermographic camera, Vascular obstruction.

Update burn surgery: overview of current multidisciplinary treatment concepts.

The treatment of severe burn injuries is an essential part of plastic-reconstructive surgery. Severe burned patients are treated in burn centers, which have highly specialized technical and personnel equipment. In addition to clear recommendations for prehospital management, intensive care therapy is usually required for extensive burn wounds. Shock therapy in burns primarily involves balanced fluid resuscitation according to hemodynamic monitoring, vasopressor support, pain management, temperature regulation, oxygen therapy, and comprehensive supportive care to stabilize the patient's condition. Surgical treatment is still based on wound debridement and the gold standard of autologous split-thickness skin grafting. Besides skin transplantation, surgical management of burns may also involve the application of various topical therapies to promote wound healing, reduce pain, and prevent infection. These therapies may include antimicrobial dressings, skin substitutes, growth factors, or specialized wound care products. Once the acute treatment has been completed, multidisciplinary rehabilitation treatment takes place, which begins in the acute hospital and continues in the outpatient and inpatient rehabilitation areas. Surgical treatment of the secondary complications of burns and scars is also an important component of burn care. Comprehensive knowledge of the various components and players involved in the care of severely burned patients is, therefore, required in order to achieve the best possible outcome for the patient.

Unusual Multiple and Bilateral Combinations of Arterial and Neural Variations in the Axillae of Single Cadaver

Nerve During the dissection of the axillae and upper limbs of an 80-year-old male donor, multiple vascular and neural variations were encountered. On the right side, the thoracoacromial artery and the lateral thoracic artery were absent. On the left side the subscapular artery was absent, and the posterior cord of the brachial plexus gave branch to two upper subscapular nerves and then divided into radial nerve and a common stem that branched into thoracodorsal nerve, lower subscapular nerve, nerves to teres major and minor muscles and the axillary nerve. Additionally, in the left arm there was a variant communication between the musculocutaneous nerve and the median nerve. Although the existence of these variations is well documented in the literature as individual entities or few combinations, the occurrence of such multiple variations in a single cadaver in a limited area of the body involving vessel and nerves is not common. A multitude of variations in a small area of the body such as this can be a source of diagnostic and imaging interpretation errors. Unpredictable iatrogenic injuries can also occur during various procedures in the area such as during preparation of muscle flap, mastectomy with axillary lymph node dissection, reconstructive and aesthetic plastic surgery of the breast and other clinical procedures including shoulder arthroplasty.

Occurrence of contralateral breast cancer in a BRCA-positive breast cancer patient who underwent free TRAM flap reconstruction: a case report

This report presents a case of contralateral breast cancer in a BRCA mutation-positive patient who had previously undergone delayed free transverse rectus abdominis myocutaneous flap reconstruction for unilateral breast cancer. Having used up the available abdominal autologous tissue in the first reconstruction, a direct-to-implant procedure was employed for the reconstruction of the second, contralateral breast. Therefore, one breast was reconstructed using autologous tissue from the abdomen, while the other was asymmetrically reconstructed with an implant. If the risk of contralateral breast cancer had been anticipated initially, we might have opted for implant-based reconstruction from the start to facilitate a more symmetrical outcome in the event of subsequent contralateral reconstruction. This case underscores the importance of reviewing the risk of contralateral breast cancer in patients with unilateral breast cancer who also carry mutations in BRCA and other breast cancer susceptibility genes. Furthermore, it encourages consideration of how mutations in breast cancer susceptibility genes, including BRCA, influence the choice of plastic surgery reconstruction techniques. The findings from genetic testing for breast cancer susceptibility are now crucial to achieving aesthetic completeness in breast reconstruction.