1,720,979 research outputs found
Microsurgical Training with the Three-Step Approach
No full textBackground Microsurgery is very challenging, requiring a high degree of dexterity and manual skills that should be fully trained outside of the operating room. Common microsurgery courses usually follow a stepwise training approach beginning practice on nonliving models and proceeding with live rats. However, training on live rats raises certain issues, including ethical concerns as well as the associated costs. As such, there is an increasing drive toward alternative models. The current article describes a three-step training approach (latex glove-endovascular prosthesis-human placenta), which aims to prepare trainees for the clinical direct application. Also, to validate it, this approach was compared with microsurgical training on rats. Methods Overall, 20 residents were randomly assigned to two different microsurgical training courses, each based on one of the aforementioned approaches. Residents were evaluated in terms of correct handling of the instruments, correct use of the microscope, adventectomy, triangulation technique, posterior wall technique, success of the end-to-end anastomosis, and ability in assisting the tutor during the arterial anastomosis. Results The three-step and the live rats groups evidenced similar scores in term of acquired basic skill levels. Conclusions The three-step model allows to progressively gain skills on microsurgical techniques and to perform a good vascular anastomosis without the need of further steps on rats. The availability of both endovascular prosthesis and human placenta makes this training model definitely accessible from a practical and logistical point of view
THOREK MODIFIED REDUCTION MAMMAPLASTY: LONG TERM EVALUATION OF AESTHETIC AND FUNCTIONAL RESULTS.
No full textText: INTRODUCTION AND AIMS
Gigantomastia is an excessive breast enlargement, disabling for the patient. The treatment of choice is reduction mammaplasty. Thorek technique was developed to treat gigantomastia avoiding the main risk associated with the pedicle based techniques: Nac necrosis. The technique presented many advantages and some inconvenient, mainly concerning the aesthetical result and Nac sensitivity, so several authors modified it, but it is still frequently criticized. The authors describe a modification developed to prevent the main disadvantages of the original procedure.
MATERIAL AND METHODS
15 patients were selected. The selection criteria were: age, preoperative jugular-nipple distance > 35 cm, comorbidities, no desire to breast-feeding. The modification of the technique is the creation of an inferiorly based dermal flap and its anchorage to pectoralis major muscle. The results were evaluated on three levels: aesthetic, functional, management of the patients.
RESULTS
The aesthetic results were satisfactory. The sensitivity of the NAC was preserved at least in 3 areolar quadrants in 90% of patients. The contractility of the nipple was preserved in more than 50% of cases. The mean operative time was 2,5 hours, the drains permanence and the recovery time were reduced. Postoperative complications were: a single case of partial necrosis of the nipple areola complex; a case of pathological scarring.
CONCLUSION(S)
Many surgical options can be used to treat gigantomastia. Thorek modified technique is still valid in selected patients and when the alternative techniques are relatively contraindicated: aged patients, jugular nipple distance greater than 35cm, comorbidities, no future breastfeeding desire
Medical and surgical treatment of hidradenitis suppurativa. A review
No full textHidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with painful nodules, abscesses, sinus tracts, and scarring primarily affecting apocrine gland-rich intertriginous areas. HS prevalence ranges from 0.05 to 1%. The central pathogenic event in HS is believed to be the occlusion of the upper part of the folliculopilosebaceous unit, leading to the rupture of the sebofollicular canal with the consequent development of perifollicular lymphohistiocytic inflammation. The HS treatment choices are influenced by disease severity and its individual subjective impact, involving both medical and surgical interventions. However, given the chronic nature of HS, its destructive impact on social, working, and daily life of patients, its management is often frustrating for both the patient and physician. Hence, prompt and effective management strategies are urgently needed and a multidisciplinary approach is advocated. Therefore, in this article, we highlighted the main features of HS (clinical aspects, epidemiology, pathogenesis, diagnostic criteria, classifications, comorbidities, and treatments), so that awareness of this disease might be heightened in primary care physicians and surgeons, who may be the first health care providers to see patients with this disease owing to its characteristic clinical presentation (inflammatory nodules, abscesses, sinus tract, etc.)
The use of the Alexis(®) device in breast augmentation to improve outcomes. A comparative randomized case-control survey.
No full textBackground: We present our experience in using a disposable wound retractor commonly used in abdominal surgery named Alexis® (Applied Medical Resources Corporation, Rancho Santa Margarita, CA, USA), during breast augmentation in order to improve outcomes, particularly final scar length. Methods: Between January 2010 and November 2012, 40 patients undergoing breast augmentation with an inframammary approach were enrolled in the present study. Patients were randomly assigned to two groups: group 1 underwent breast augmentation with the standard technique; group 2 underwent breast augmentation by using the Alexis® (Applied Medical Resources Corporation) device. Patients were followedup for a 12-month period. The time of surgery, the days of drain duration and the length of the incisions were recorded for both groups and statistical significance was evaluated with the Wilcoxon rank sum test. Also, final scar appearance was evaluated using a visual analogue scale (VAS). Results: Patients in group 2 reported a lower incidence of hematomas and had shorter drain duration. The difference in scar length between the two groups was statistically significant (P<0.05). Surgeons and patients were mostly satisfied with the final appearance of the scar. Conclusions: The use of the Alexis® (Applied Medical Resources Corporation) device has proven useful in reducing the length of the inframammary incision. Interestingly, the increased visibility obtained with the use of the Alexis device allowed a better hemostasis, as suggested by the shorter drain duration and lower incidence of hematomas. However, its use prolongs the operative time, for which we recommend surgeons to allow themselves some time to become familiar with the device. Level of evidence: level I, evidence obtained from at least one properly designed randomized controlled trial
Response to "the value of two-dimensional analysis of changes in breast shape"
No full textWe read the letter by Dr. Swanson,1 in which he refers to the two-dimensional system for the evaluation of augmented breasts we described,2 with considerable interest. This system is useful as a means of keeping a visual record of patients’ data and of evaluating changes in size over time, though it does require the ability to use computer programs and it is somewhat time-consuming. The pros and cons of one-dimensional systems have instead been extensively described in the literature, as Swanson remarked in his lette
Surgical strategies for cutaneous neoplasm of the scalp State of art
No full textScalp reconstruction has always been a challenging task, in particular after oncological demolition and this article gives an overview on the state of the art in scalp reconstruction strategies
Surgical treatment of nasal non-melanoma skin cancer in elderly patients using dermal substitute
No full textAbstract
CONCLUSIONS:
The nose is often involved by non-melanoma skin cancer (NMSC) and the increase in the incidence of such tumors, the morbidity and treatment-related costs represent a significant burden to healthcare systems. A bioresorbable dermal substitute (Hyalomatrix®) has been used for immediate dermal coverage and nose restoration after excision of infiltrating nasal NMSCs in elderly ASA III patients. Further studies on dermal substitutes are needed to improve benefit to patients.
OBJECTIVE:
Surgical treatment of nasal non-melanoma skin cancer (NMSC) in elderly patients.
MATERIALS AND METHODS:
Ten elderly ASA III patients with nasal defects after resection of infiltrating NMSC were reconstructed in a two-stage strategy. The surgical protocol targeted an initial wide tumor excision and apposition of a dermal induction template (Hyalomatrix®) and successive full thickness skin autograft. Results were documented by photography, visual analog scale for patient satisfaction, and Vancouver scar scale for evaluation of final graft characteristics.
RESULTS:
All patients were tumor-free during the 2 years follow-up. The procedure achieved acceptable nose reshaping and graft scarring evolution. Patient satisfaction was good-to-high
Reconstruction of anterior auricular conchal defect after malignancy excision: Revolving-door flap versus full-thickness skin graft
No full textSkin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone todelay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p < 0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours. (C) 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons
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