Plastic Surgical Management Research Articles

Review of Plastic and Reconstructive Surgery in a General Hospital Setting: Experience from a Developing Country

Background: Plastic and reconstructive surgery in developing countries and underserved areas are significantly limited and face changes to start a proper service. This study presents a review of plastic surgery services and experiences in a district hospital located in an underserved area.Methods: This descriptive, retrospective, hospital-based study was conducted to review patients who presented to the plastic and reconstruction departments from January 2014 to January 2015. All patients seen in the outpatient clinic or emergency departments for plastic surgical consultation or management were included in the study.Results: The total of 403 cases fulfilled the inclusion criteria. The emergency surgical operation performed in our unit were distributed in the following descending order; fingertip injury (32%), cut wrist (12.7%), cut extensor tendon (9.9%), gunshot injuries (9.4%), fracture of a small bone of the hand (8.3%), and lower limb trauma. Surgery for congenital deformities constituted the most elective operation done in our unit (31.6 %), followed by tumor surgery (18.7%), burn surgery (17.3%), aesthetic surgery procedure (12.2%), and other miscellaneous cases (12.2%).Conclusion: This report demonstrates the efficacy of secondary hospital setting to accommodate a large volume of patients during the first year of establishment, and further predicting development needs, staff training, and governmental support.

Surgical Management of Hidradenitis Suppurativa: A Two-Center Retrospective Study.

Hidradenitis suppurativa is a chronic inflammatory condition that presents a challenging reconstructive problem for plastic surgeons. The authors performed a retrospective chart review of hidradenitis suppurativa patients managed with surgical excision between 2005 and 2020 at Brigham and Women's Hospital and Tulane University Medical Center. Operative cases associated with the same hospitalization were organized into treatment episodes and assessed for patient demographics, operative techniques, and outcomes. A total of 181 patients, 435 cases and 316 treatment episodes (Brigham and Women's Hospital, n = 269; Tulane University Medical Center, n = 47), were identified across two diverse institutions. Their respective series showed comparable patient demographics, and 94 percent of the combined episodes achieved wound closure and healing during the study period. Several techniques of closure were identified, including immediate closure and site-specific methods, such as an expedited staged closure using internal negative-pressure wound therapy as a temporary bridge, "recycled" skin grafting, and repurposing iodoform wicks as an adjunct wound healing therapy to immediate closure. This large multi-institutional retrospective chart review on the plastic surgical management of hidradenitis suppurativa demonstrates that surgery is an effective therapy for hidradenitis suppurativa and captures a diversity of site-specific techniques that may serve as a foundation for future prospective studies and evidence-based guidelines for the use of various techniques to optimize patients' surgical outcomes. Therapeutic, IV.

Plastic Surgical Management of Hidradenitis Suppurativa.

After studying this article, the participant should be able to: 1. Describe the pathogenesis of hidradenitis suppurativa. 2. Discuss perioperative multimodal therapy of hidradenitis suppurativa, including medical optimization. 3. Determine an appropriate surgical plan with excision and reconstruction based on hidradenitis suppurativa severity, size, and anatomical location. Successful treatment of hidradenitis suppurativa requires a multidisciplinary team approach and multimodal therapy.

Plastic and Orthopaedic Interventions and Long-Term Sequelae in Children with Meningococcal Septicemia-40 Years of Experience at the University Children's Hospital Zurich.

Meningococcal septicemia is not merely an acute disease with a high lethality, but patients surviving the fulminant phase can suffer from serious long-term sequelae. The records of 165 patients admitted to the hospital from 1968 to 2008 with the diagnosis of meningococcal septicemia were retrospectively reviewed for early signs at presentation, intensive care management, acute symptoms, the necessity of plastic and orthopaedic surgical management, and long-term orthopaedic sequelae. Possible predictors of these conditions were determined. Overall lethality was 17.5%, and mean time of hospitalization time was 28 days. Integument involvement occurred in 45%, often resulting in the necessity of plastic surgical procedures. Young age is a significant indicator or skin involvement. Amputations were necessary in 9% of all cases, affecting the lower extremities more often than the upper extremities. Six percent of all children suffered from long-term orthopaedic sequelae, such as growth retardation and angular deformities, appearing up to 11 years (mean 4.9 years) after onset of the acute disease. The incidence of amputations and long-term orthopaedic sequelae correlated significantly with severity of the disease. Meningococcal septicemia can entail devastating long-term consequences in children surviving the acute phase of the disease. Sequelae may become apparent only years later and cause further damage. To prevent this, a systematic follow-up till adulthood is necessary.

Plastic surgical management in lower extremity sarcoma reconstruction

Tumors in the lower extremity with a critical size of over 5 cm diameter should principally be tested for being malignant soft-tissue sarcomas. If a soft-tissue sarcoma is present, radical oncological resection with sufficiently wide surgical margins is the most important cornerstone of curative therapy. No neoadjuvant or adjuvant treatment (radiotherapy or chemotherapy) can replace this treatment approach. Modern techniques of tumor resection as well as plastic-reconstructive surgery permit one to perform radical tumor excision in more than 95% of cases and to close large defects and to largely preserve function of the extremity by transplantation of muscles, tendons and bones as well as transplantations of nerves and blood vessels. The plastic reconstructions after radical tumor resection are often demanding and complex and require intensive interdisciplinary cooperation. This consists of the full spectrum of plastic surgical options, which should be performed in specialized centers and be specifically adapted to the patient and case profile. In this review different options for functional reconstruction after radical oncological removal of soft-tissue sarcomas are presented.

Periodontal plastic surgical management of traumatic mucogingival deformities – A case report

The mucogingival deformities are most commonly encountered periodontal problems in day to day periodontal examination. Such deformities may disturb the healthy relationship between gingiva and alveolar mucosa, and may also interfere in the lip movement and proper brushing due to shallow vestibule. These deformities may be congenital or due to periodontal diseases. Sometimes the malpositioned tooth/teeth may also be responsible for the traumatic mucogingival deformities, if not timely corrected may lead to further complications, especially in children as they are more prone to have traumatic injuries. Such type of teeth may injure the lip in routine accidents which may lead to mucogingival deformities. Though, such types of reported cases are very few in number.Presenting an interesting case report, where traumatic mucogingival deformities are corrected with two stage periodontal plastic surgical management.

Severe open tibial fractures in combat trauma

The aim of this study was to report the pattern of severe open diaphyseal tibial fractures sustained by military personnel, and their orthopaedic-plastic surgical management.The United Kingdom Military Trauma Registry was searched for all such fractures sustained between 2006 and 2010. Data were gathered on demographics, injury, management and preliminary outcome, with 49 patients with 57 severe open tibial fractures identified for in-depth study. The median total number of orthopaedic and plastic surgical procedures per limb was three (2 to 8). Follow-up for 12 months was complete in 52 tibiae (91%), and half the fractures (n = 26) either had united or in the opinion of the treating surgeon were progressing towards union. The relationship between healing without further intervention was examined for multiple variables. Neither the New Injury Severity Score, the method of internal fixation, the requirement for vascularised soft-tissue cover nor the degree of bone loss was associated with poor bony healing. Infection occurred in 12 of 52 tibiae (23%) and was associated with poor bony healing (p = 0.008). This series characterises the complex orthopaedic-plastic surgical management of severe open tibial fractures sustained in combat and defines the importance of aggressive prevention of infection.

Contemporary postnatal plastic surgical management of meningomyelocele

The goals of this study were to review the outcome of the surgical procedure and hospitalization associated with meningomyelocele repair, and to examine the results of different closure strategies. Eighty-three consecutive patients having surgery for meningomyelocele over a ten year period form the basis of this study. Thirty-two closures with a mean defect size preoperatively of 11.5 cm(2) were performed by the neurosurgeon (ADP), and fifty-one closures with a mean defect size of 28.4 cm(2) by the plastic surgeon (MFA). Defects up to 12 cm(2) were closed with local advancement fasciocutaneous flaps. As defect size increased, latissimus muscle flaps were added in 30 (36%) and gluteus muscle in 16 (19%). In recent years, 18 patients (21.6%) with a mean defect of 29 cm(2) were treated with overlapping of deepithelialized fasciocutaneous flaps to add an additional layer of coverage to the dural closure. There were 9 major complications, 6 requiring reoperation. There were 10 minor wound failures managed conservatively. Mean hospital stay was 24.2 days. Re-operation increased length of stay to 45 days (p < 0.0001). Minor wound problems added 6 days to mean hospital stay. Wound failure did not correlate with either defect size or closure technique. Thoracic location was associated with increased wound failure (p < 0.05). Use of a shunt did not increase morbidity. All closures remained durable after discharge. Location in the thoracic area predicts major wound failure and need for reoperation. Wound complications significantly increase hospital stay. The use of a variety of techniques to achieve multi-layered closures leads to durable coverage for defects of all sizes.

Stressing the need for rapid referral of complex open fractures to a specialist centre

Guidelines from the British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons recommend the immediate referral of complex open fractures of the lower limb to a specialist centre for combined orthopaedic and plastic surgical management.1 However, Townley et al reported that across a large area of South-West England the mean delay in referral of open tibial fractures was 5.4 ±1.7 days.2

Paediatric ride-on mower related injuries and plastic surgical management

Lawnmower related injuries cause significant morbidity in children and young teenagers. The 'ride-on' mowers which are more powerful than the 'walk behind' mowers are becoming increasingly popular. The incidence and severity of injuries from either type of lawnmower appears to be steadily rising as is the burden placed on local plastic surgical and emergency services in managing the care of these patients. The aims of the study were to demonstrate changing trends in lawnmower-related injuries to children presenting to a single unit over a ten-year period and to identify any association between injury severity and machine subtype ('ride-on' versus 'walk-behind'). Hospital databases, theatre records and medical case notes were reviewed retrospectively of all patients under the age of 16 treated for lawnmower related injuries over a 10 year period from July 1998 to June 2008. Data gathered included patient demographics, injury site and severity, management (type and number of surgical procedures), length of hospital stay and outcome. Injury severity score was also calculated for each case. Controlling for estimated regional population changes, there was a significant increase in the number of ride-on mower related accidents in the time period 2003-2008, compared to the time period 1998-2003. Ride-on injuries had significantly higher injury severity scores, longer hospital stays and were more likely to involve amputations as compared with walk-behind injuries. Children can sustain significant injuries with unsafe lawnmower use. The current study demonstrates the increasing incidence of ride-on mower related injuries in children and identifies a greater morbidity associated with such injuries. Such presentations place intense demands on local plastic surgical services.

Plastic surgical management of large cicatricial scalp alopecia

To investigate the proper ways to manage a large cicatricial scalp alopecia. Based on the location, size and condition of the scarring lesions, 218 patients with 20 - 75% scarring alopecia were selected and treated with either dense-packing hair grafting technique (136 cases) or tissue expansion (82 cases). There were 209 in burn, 5 in avulsed injury and 4 in tumor excision. The lesions with thick, stable scars in the frontal or/and temporal areas undergoing either hair grafting or tissue expansion process as desired by the patients. In addition, the alopecia in an unstable scar on the skull, with skull defect under the lesion and the lesion involved in the back of the head was only treated with tissue expansion. The hair-grafting technique was carried out by harvesting a scalp strip from the back of the head, then dividing it into a series of 1 - 3 hair grafts and finally implanting them into the prepared recipient holes of the lesion with a desired hair direction. Ten areas with 1 cm(2) size in 10 patients were randomly selected to examine the hair survival over 8 months post-operation. Tissue expansion was performed by firstly positioning a tissue expander in the subgaleal pocket of the scalp and serially inflating it with normal saline in 5 - 7 days intervals for about 3 months. Thereafter, an expanded scalp flap was designed, with the combination of advancement and rotation flap transplantation principles, to be transferred to the recipient site after lesion removal. In patients with hair-grafting technique, hair density reaching 60 - 80 hairs/cm(2) per session. Over 8-months following-up, the grafted hairs grew good with 98% hair survival. Forty-five patients with 20% - 30% scalp hair loss were reaching very satisfactory results with only one session while 91 patients with 31% - 50% hair loss were needed a second session to improve their appearance. In those with tissue expansion, 56 patients with 20% - 50% scalp loss were managed in one session and 26 patients with 51% - 75% scalp loss needed secondary tissue expansion. All of the expanded hair-bearing flaps survived well with only minimal complications (9.8%) of the infective dome explosion in 3, slight skull depression in 2, seroma in 5 and early infection in 1. Either hair grafting or tissue expansion is proven as a safe and effective technique for restoration of large cicatricial scalp alopecia. The former technique could be of benefits to simple, mini-surgical procedure, natural hair growth and good for lesion size under 30%. And the letter technique shows wider clinical indications, especially for the patients with unstable scar, skull defect under lesion and lesion over 50%. But the obvious drawbacks are multi-clinic visiting, disfigurement and long-term procedures.

Plastic surgical management of maxillofacial trauma after earthquake

地震灾害中最为常见的损伤为脏器及软组织挤压伤、颅脑外伤、骨折,其中发生于颌面部的软组织外伤占一定比例.此类损伤除可能导致严重出血、感染、窒息等并发症外,常常在治疗后期遗留明显的功能障碍和形态畸形。

Application of breast ultrasound in classification and plastic surgical management of gynecomaslia

Objective To investigate the possibility of using the results of breast ultrasound and Cohen-classification to determine the gynecomastia patients' subtype, and to evaluate the effectiveness of different surgical methods based on the classification. Methods In the past 3 years, 40 with gy-necomastia were treated in this hospital. The patients age ranged from 18 to 50 years, with an average of 21.38. All the had the bilateral lesions, and their pathological diagnosis was gynecomastia. The mammary gland resected from each side weighted from 30 to 180 grams. The total fat volume liposucted ranged from 200 ml to 1 200 ml. As a routine, we performed breast ultrasound examination before the op-eration on each patient. According to the different echo, we marked the extent of breast gland on the chest walls and determine the Cohen classification of the patients. For breast tissue hyperplasia, we only resected the gland under the direction of the chest wall marks. For fat tissue hyperplasia, we just per-formed liposuction. For with mixed fat and gland hyperplasia, we combined these two methods rationally. If necessary, the procedures was repeated. Results With the help of breast ultrasound exami-nation, the operating procedure was more accurate and simple, as a result, our treatments had less injury and no severe complications. After a following-up of 6-36 months, satisfactory results were achieved, with normal male chest appearance and small obscure scar. Conclusions Male breast surgery is totally different from the females. The Cohen classification has been determined for each gynecomastia patient, based on the results of breast ultrasound examination, which helps choose the surgical methods and procedures and decrease surgical injuries and complications, with satisfactory results. Key words: Gynecomastia; Cohen-lassification; Breast ultrasound examination

The Rectus Abdominis Free Flap as an Emergency Procedure in Extensive Upper Extremity Soft-Tissue Defects

Stable wound coverage after extensive soft-tissue loss of the upper extremity remains a difficult problem in the management of large defects of the upper limb. To prevent further tissue loss owing to infection or inadequate cover when important structures such as vessels, tendons, nerves, joints, and bones are exposed, various free flaps have been introduced into the therapeutic armamentarium of acute plastic surgical management options. Emergency or delayed early reconstruction has been proposed to prevent chronic infection and further tissue loss. We report a series of 12 emergency and delayed early reconstructions of the forearm, wrist, carpus, metacarpus, and hand using the free rectus abdominis muscle flap with split-skin coverage, demonstrating the versatility of this flap within this special context. Emergency free rectus muscle flap transfer is safe, technically easy, and expandable. (Plast. Reconstr. Surg. 103: 1421, 1999.)

The rectus abdominis free flap as an emergency procedure in extensive upper extremity soft-tissue defects.

Stable wound coverage after extensive soft-tissue loss of the upper extremity remains a difficult problem in the management of large defects of the upper limb. To prevent further tissue loss owing to infection or inadequate cover when important structures such as vessels, tendons, nerves, joints, and bones are exposed, various free flaps have been introduced into the therapeutic armamentarium of acute plastic surgical management options. Emergency or delayed early reconstruction has been proposed to prevent chronic infection and further tissue loss. We report a series of 12 emergency and delayed early reconstructions of the forearm, wrist, carpus, metacarpus, and hand using the free rectus abdominis muscle flap with split-skin coverage, demonstrating the versatility of this flap within this special context. Emergency free rectus muscle flap transfer is safe, technically easy, and expandable.

Type III tibial fractures in the elderly: results of 23 fractures in 20 patients

A series of 23 type III fractures of the tibia in 20 elderly patients (over 60 years of age) presenting for combined plastic and orthopaedic surgical management over a period of 15 years are reviewed. Overall limb salvage was 53 per cent, with an average inpatient duration not significantly different from that for amputation, suggesting that an age of over 60 years is not necessarily a contraindication to attempts at limb salvage in type III injuries.

Lower Extremity Salvage and Reconstruction. Orthopedic and Plastic Surgical Management.

Lower Extremity Salvage and Reconstruction. Orthopedic and Plastic Surgical Management.

Plastic surgical management of children with Down's syndrome: indications and results

The face of a child with Down's syndrome is stigmatised by the large tongue, open mouth, saddle nose and epicanthal folds. Operative reduction of macroglossia facilitates nose-breathing, comprehensible speech and eating. Raising the nasal bridge with Cialit-preserved homograft cartilage obliterates the epicanthal folds and conceals the oblique slant of the eyelids. The child should be operated on from the third year onwards.

Plastic surgical management of common lesions of the face and oral cavity

Plastic and Reconstructive Surgery and the Transplantation Bulletin: January 1959 - Volume 23 - Issue 1 - p 80