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Dysphagia     Hybrid Journal   (Followers: 161, SJR: 0.684, h-index: 46)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 7, SJR: 0.146, h-index: 8)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 12, SJR: 0.367, h-index: 12)
Earth Science Informatics     Hybrid Journal   (Followers: 3, SJR: 0.245, h-index: 5)
Earth, Moon, and Planets     Hybrid Journal   (Followers: 5, SJR: 0.436, h-index: 28)
Earthquake Engineering and Engineering Vibration     Hybrid Journal   (Followers: 7, SJR: 0.433, h-index: 17)
Earthquake Science     Hybrid Journal   (Followers: 9, SJR: 0.486, h-index: 7)
East Asia     Hybrid Journal   (Followers: 7, SJR: 0.165, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 6, SJR: 0.289, h-index: 23)
EcoHealth     Hybrid Journal   (Followers: 1, SJR: 0.651, h-index: 22)
Ecological Research     Hybrid Journal   (Followers: 7, SJR: 0.698, h-index: 38)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.666, h-index: 40)
Economic Bulletin     Hybrid Journal   (Followers: 3)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.263, h-index: 6)
Economic Theory     Hybrid Journal   (Followers: 5, SJR: 1.857, h-index: 31)
Economic Theory Bulletin     Hybrid Journal  
Economics of Governance     Hybrid Journal   (Followers: 2, SJR: 0.367, h-index: 12)
Ecosystems     Hybrid Journal   (Followers: 18, SJR: 1.793, h-index: 83)
Ecotoxicology     Hybrid Journal   (Followers: 10, SJR: 1.041, h-index: 53)
Education and Information Technologies     Hybrid Journal   (Followers: 143, SJR: 0.207, h-index: 15)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 11, SJR: 0.519, h-index: 14)
Educational Psychology Review     Hybrid Journal   (Followers: 13, SJR: 1.781, h-index: 52)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 8)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 8, SJR: 0.946, h-index: 27)
Educational Technology Research and Development     Partially Free   (Followers: 148, SJR: 1.124, h-index: 45)
Electrical Engineering     Hybrid Journal   (Followers: 9, SJR: 0.352, h-index: 17)
Electrocatalysis     Hybrid Journal   (SJR: 0.542, h-index: 7)
Electronic Commerce Research     Hybrid Journal   (Followers: 3, SJR: 0.636, h-index: 14)
Electronic Markets     Hybrid Journal   (Followers: 5, SJR: 0.326, h-index: 5)
Electronic Materials Letters     Hybrid Journal   (Followers: 2, SJR: 0.566, h-index: 11)
Elemente der Mathematik     Hybrid Journal  
Emergency Radiology     Hybrid Journal   (Followers: 4, SJR: 0.446, h-index: 22)
Empirica     Hybrid Journal   (Followers: 3, SJR: 0.185, h-index: 12)
Empirical Economics     Hybrid Journal   (Followers: 7, SJR: 0.5, h-index: 29)
Empirical Software Engineering     Hybrid Journal   (Followers: 4, SJR: 2.319, h-index: 33)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 2, SJR: 0.21, h-index: 13)
Endocrine     Hybrid Journal   (Followers: 4, SJR: 0.659, h-index: 55)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.555, h-index: 27)
Energy Efficiency     Hybrid Journal   (Followers: 10, SJR: 1.056, h-index: 10)
Energy Systems     Hybrid Journal   (Followers: 8, SJR: 0.589, h-index: 5)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.497, h-index: 26)
Entomological Review     Hybrid Journal   (Followers: 3, SJR: 0.128, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 28, SJR: 0.319, h-index: 26)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 5, SJR: 0.389, h-index: 29)
Environmental and Resource Economics     Hybrid Journal   (Followers: 17, SJR: 1.651, h-index: 46)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 3, SJR: 0.486, h-index: 53)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 3, SJR: 0.664, h-index: 22)
Environmental Earth Sciences     Hybrid Journal   (Followers: 10, SJR: 0.601, h-index: 55)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 5, SJR: 0.35, h-index: 3)
Environmental Evidence     Open Access  
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 2, SJR: 0.732, h-index: 23)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 2, SJR: 0.909, h-index: 32)
Environmental Geology     Hybrid Journal   (Followers: 11)
Environmental Health and Preventive Medicine     Hybrid Journal   (Followers: 2, SJR: 0.388, h-index: 14)
Environmental Management     Hybrid Journal   (Followers: 30, SJR: 0.773, h-index: 60)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 11, SJR: 0.413, h-index: 27)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 9, SJR: 0.671, h-index: 46)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 11, SJR: 0.878, h-index: 42)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 1, SJR: 1.002, h-index: 14)
Epileptic Disorders     Hybrid Journal   (Followers: 1, SJR: 0.669, h-index: 34)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.435, h-index: 58)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 3, SJR: 0.749, h-index: 85)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.661, h-index: 57)
EPMA J.     Open Access   (SJR: 0.161, h-index: 4)
ERA-Forum     Hybrid Journal   (Followers: 2, SJR: 0.13, h-index: 2)
Erkenntnis     Hybrid Journal   (Followers: 11, SJR: 0.62, h-index: 14)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.173, h-index: 8)
Esophagus     Hybrid Journal   (SJR: 0.268, h-index: 9)
Estuaries and Coasts     Hybrid Journal   (Followers: 3, SJR: 1.111, h-index: 61)
Ethical Theory and Moral Practice     Hybrid Journal   (Followers: 7, SJR: 0.278, h-index: 8)
Ethics and Information Technology     Hybrid Journal   (Followers: 159, SJR: 0.363, h-index: 20)
Ethik in der Medizin     Hybrid Journal   (SJR: 0.204, h-index: 6)
Euphytica     Hybrid Journal   (Followers: 7, SJR: 0.709, h-index: 57)
Eurasian Soil Science     Hybrid Journal   (Followers: 2, SJR: 0.271, h-index: 10)
EURO J. of Transportation and Logistics     Hybrid Journal   (Followers: 4)
EURO J. on Computational Optimization     Hybrid Journal  
EURO J. on Decision Processes     Hybrid Journal  
Europaisches J. fur Minderheitenfragen     Hybrid Journal  
European Actuarial J.     Hybrid Journal   (Followers: 3)
European Archives of Oto-Rhino-Laryngology     Hybrid Journal   (Followers: 4, SJR: 0.737, h-index: 37)
European Archives of Paediatric Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.446, h-index: 12)
European Archives of Psychiatry and Clinical Neuroscience     Hybrid Journal   (Followers: 2, SJR: 1.334, h-index: 62)
European Biophysics J.     Hybrid Journal   (Followers: 4, SJR: 0.979, h-index: 53)
European Child & Adolescent Psychiatry     Hybrid Journal   (Followers: 4, SJR: 1.269, h-index: 51)
European Clinics in Obstetrics and Gynaecology     Hybrid Journal   (Followers: 4)
European Food Research and Technology     Hybrid Journal   (Followers: 8, SJR: 0.773, h-index: 49)
European J. for Education Law and Policy     Hybrid Journal   (Followers: 5)
European J. for Philosophy of Science     Partially Free   (Followers: 4, SJR: 0.165, h-index: 2)
European J. of Ageing     Hybrid Journal   (Followers: 8, SJR: 0.49, h-index: 17)
European J. of Applied Physiology     Hybrid Journal   (Followers: 7, SJR: 1.044, h-index: 74)
European J. of Clinical Microbiology & Infectious Diseases     Hybrid Journal   (Followers: 10, SJR: 0.958, h-index: 74)
European J. of Clinical Pharmacology     Hybrid Journal   (Followers: 9, SJR: 0.916, h-index: 69)
European J. of Dermatology     Hybrid Journal   (Followers: 8)
European J. of Drug Metabolism and Pharmacokinetics     Hybrid Journal   (Followers: 6, SJR: 0.24, h-index: 25)
European J. of Epidemiology     Hybrid Journal   (Followers: 17, SJR: 1.946, h-index: 60)
European J. of Forest Research     Hybrid Journal   (Followers: 3, SJR: 0.864, h-index: 25)
European J. of Health Economics     Hybrid Journal   (Followers: 9, SJR: 0.67, h-index: 25)

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Journal Cover European Journal of Plastic Surgery
   Journal TOC RSS feeds Export to Zotero [4 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1435-0130 - ISSN (Online) 0930-343X
     Published by Springer-Verlag Homepage  [2210 journals]   [SJR: 0.227]   [H-I: 13]
  • A new device for nerve approximation in traumatic injuries of extremities
    • Abstract: Background Precise approximation of two nerve endings is a major determinant of outcomes following nerve repairs. Despite technical and instrumental advances, approximation of nerve endings remains a challenge in reconstructive surgeries. We designed a new nerve approximator device for precise approximation of nerve endings and evaluated its utility in surgeries of peripheral nerves. Methods We conducted a longitudinal study comparing postoperative functional outcomes between patients with peripheral nerve injury undergoing surgical repair by the new approximator device and conventional technique. Results A total of 204 nerve trunks were repaired by the new approximator device and 91 nerves by conventional technique. Patients were followed for a median of 30 months. Time required for nerve approximation was significantly reduced with the approximator device (4.5 min vs. 7 min, p < 0.0001). Nerve conduction velocity and tinel sign revealed similar results in both groups. However, grip, pinch and intrinsic muscle strength tests did not differ between the two groups. Conclusions Our new nerve approximator device is feasible to use and reduces time of neurorrhaphy in microsurgical nerve repairs with sustained outcomes comparable to the conventional techniques. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-09-01
  • Contralateral axillary silicone lymphadenopathy after modified radical
           mastectomy and reconstruction
    • Abstract: Abstract We describe a 49-year-old female patient who was diagnosed with breast cancer in her left breast. The patient underwent a modified radical mastectomy and immediate reconstruction with the placement of an expander implant. Two years later, the patient suffered a minor trauma and began to feel the softening of her reconstructed breast, and a growing palpable mass appeared in the contralateral (right) axilla. Examinations revealed the intracapsular rupture of the expander implant. Aspiration cytology from the palpable axillary mass suggested silicone lymphadenopathy. We replaced the ruptured implant, and the lymph node from the contralateral axilla was removed. Silicone lymphadenomegaly in the right axilla was verified by a postoperative histopathological review. This case represents a rare manifestation of silicone lymphadenopathy caused by altered lymphatic drainage due to previous axillary lymphadenectomy. Level of Evidence: Level V, diagnostic study.
      PubDate: 2014-09-01
  • Commentary on &quot;A new device for nerve approximation in traumatic
           injuries of extremities&quot; by K.S. Forootan et al.
    • PubDate: 2014-09-01
  • The surgical management of angiosarcoma of the breast—a single
           institution experience
    • Abstract: Background Angiosarcoma of the breast is a rare and aggressive tumour of the vascular endothelium. It may arise spontaneously or secondary to radiation. We present our experience of managing breast angiosarcoma, the largest single institution case series from the UK to date along with a summary of the relevant literature. Methods Data on all patients with breast angiosarcoma treated in our unit were prospectively recorded (2002–2014). Demographics, surgical details and outcomes were analysed. Results Eighteen female patients presented with breast angiosarcoma. Sixteen patients previously underwent adjuvant radiotherapy following surgery for breast carcinoma; the mean duration between radiotherapy and angiosarcoma development was 8.4 years (range 3–21). Resections were as follows: radical mastectomy (n = 14), simple mastectomy (n = 1) and wide local excision (n = 3). Reconstruction was undertaken as follows: pedicled lattisimus dorsi (LD) musculocutaneous flap (n = 5), pedicled LD muscle flap and split skin graft (n = 7), free deep inferior epigastric perforator (DIEP) flap (n = 1), pedicled vertical rectus abdominus muscle (VRAM) flap and split skin graft (n = 1), pedicled LD muscle and pedicled VRAM muscle flaps and split skin graft (n = 1), pedicled LD muscle and pedicled (contralateral) pectoralis major muscle flaps and split skin graft (n = 1) and direct closure (n = 2). Three patients developed local recurrence; mean duration from resection to recurrence was 12 months (range 9–19). Three patients developed metastasis. Seven patients (38.8 %) died; median survival from presentation was 19 months (range 2–55 months). The remaining eleven patients remain well with no disease recurrence; mean follow-up was 38 months (range 4–125). The estimated 5-year survival (Kaplan-Meier equation) in our cohort was 49 %. Conclusions Breast angiosarcomas are rare and challenging to manage. Successful outcomes can be achieved by early, aggressive resection and appropriate reconstruction. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-09-01
  • Quality of life, personality changes, self esteem, and emotional stability
           after breast augmentation
    • Abstract: Background Although breast augmentation is a common intervention in esthetic surgery, there aren’t enough reports evaluating accurately patients’ satisfaction retrospectively. In a previous study, we evaluated the quality of life in patients undergoing esthetic surgery. In the present study, we split up the operative indication and examined the quality of life, self-esteem, and emotional stability after breast augmentation only. Methods Seventy-three patients underwent esthetic breast augmentation (1995–2009) were included in the study. The testing instruments consisted of a self-developed indication specific questionnaire especially for breast augmentation and three widely used standardized questionnaires (FLZM, FPI-R, and the RSES), which can be compared to norm data. Results Although expected by just 11 % preoperatively, an improved sexuality was stated by 71 % of the patients postoperatively. A very high percentage (74 %) of the participants declared a better quality of life overall. Both of these findings were parallel confirmed by the FLZM. Significantly increased values were found for the following FLZM items: “housing/living conditions” (p = 0.008), “partner/sexuality” (p = 0.042), “mobility” (p = 0.019), and “independence from help/care” (p = 0.026). In the module “Satisfaction with Appearance/Body Image”, satisfaction with breasts (p < 0.001) and 10 further body parts increased significantly. The data revealed by the FPI questionnaire and the RSES questionnaire showed that participants’ emotional stability was very well balanced and their self-esteem very high. Conclusions Breast augmentation is a common surgical intervention widely accepted and very well tolerated among female patients, achieving a better quality of life, due to significant changes to their sexuality, satisfaction with their body image, and personal well-being. Level of Evidence: Level III, risk/prognostic study.
      PubDate: 2014-09-01
  • A quantitative analysis of the effects of different harvesting,
           preparation, and injection methods on the integrity of fat cells
    • Abstract: Background The percentage of intact fat cells membrane obtained by even a well-known technique remains poorly studied. The purposes of this study were to evaluate and compare the structural effects of various harvesting, preparation, and injection methods on human fat cell integrity. Methods We enrolled 20 healthy females in this study, ages ranged from 20 to 41 years with an average age of 31 ± 0.5 years. We harvested fat tissues from the abdomen and thigh of donors using two different methods: conventional and syringe liposuction; we treated the aspirated fat specimens within 30 min of harvesting by fine-mesh gauze or using centrifugation. We injected the prepared fat through small or large needle, and then obtained a specimen from each different method. We analyzed all fat graft samples by routine histological examination. Results There was a significant difference in the percentage of intact fat cells wall was observed in syringe aspiration (75.95 ± 0.31 %) versus vacuum liposuction (56.43 % ± 0.67). There was a significant difference in the percentage of intact fat cells when using centrifugation versus fine-mesh gauze preparation. Also there was a significant difference in the percentage of intact fat cells observed when using large versus small needle for injection. Conclusions The highest intact adipocyte counts were in syringe suction, no centrifuge, and using large cannula, while the fewest intact adipocyte counts were in conventional liposuction, using centrifuge, and using small cannula. Level of Evidence: Level IV, prognostic study
      PubDate: 2014-09-01
  • Application of porous hydroxyapatite blocks for maxillofacial deformities
    • Abstract: Background In maxillofacial fields, concave deformity often requires hard tissue augmentation. Various types of materials are used for facial augmentation: Hydroxyapatite is the most ideal material because of its remarkable biocompatibility and ability to maintain the desired form for a long period. This article describes a simple surgical procedure to augment facial concavity with porous hydroxyapatite block (pHA-B) and its clinical applications and potential complications. Method In this retrospective study, we reviewed 24 patients with facial concave deformity and who underwent surgery using the pHA-B for facial augmentation, from July 1992 to January 2014. These patients underwent 30 pHA-B procedures for facial augmentation and were evaluated for complications and malposition. The study group consisted of 12 male and 12 female patients (age ranged, 15–52 years; mean, 26.7 years). The follow-up periods ranged from 6 to 80 months, with a mean period of 27.3 months. Results The primary diagnoses of facial concave deformity consisted of 13 congenital craniofacial deformity cases; eight, esthetic contouring; and three, posttraumatic facial deformity. The augmented sites included the malar and parapiriformis areas and the mandible. There was no malpositioning and nor any obvious infection for which removal of the pHA-B was needed. Conclusions Our surgical treatment for facial concave deformity using pHA-B is simple, minimally invasive, provides the desired result in form, and is safe for the long term. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-09-01
  • Algorithms in plastic surgery—expansive or restrictive?
    • PubDate: 2014-09-01
  • Osteoarthritis after cold injuries
    • Abstract: Abstract Frostbite is a thermal injury resulting in localised tissue damage due to inadequate circulation when the ambient temperature is below freezing. Osteoarthritis (OA) can develop after cold injuries. A 30-year old rock-climber presented with clinical and radiological signs of OA in his right middle and ring finger distal interphalangeal joints (DIPJ). He denied any hand trauma but had suffered frostbite to his fingers at the age of 19 during a trip in the Himalayas. Arthrodesis was performed in a functional position for his activities. The exact pathophysiology is unknown, but it is believed that both freezing and rapid rewarming are contributing factors. We postulate that osteoarthritis after frostbite in young adults is more likely to occur as the growth plate is nearing maturity. Initially, the ischaemic insult is partially remedied during reperfusion, but further cartilage damage may continue during the remodelling phase as the young adult continues to be active and the joints are subjected to constant load transmission. This may explain the variability in the timing of clinical presentation with osteoarthritis. Arthrodesis is indicated for symptomatic cases and facilitates continued interest in active sports. Hobbies should be considered in the history, including exposure to extreme weather conditions when young active patients present with OA. Level of Evidence: Level V, diagnostic study.
      PubDate: 2014-09-01
  • Surgical site fire caused by alcohol and diathermy
    • PubDate: 2014-09-01
  • Basal cell carcinoma on rhinophyma: a case series analysis
    • Abstract: Background Several authors described the presence of malignant tumors that rarely can grow hidden over rhinophymatous skin. Basal cell carcinoma (BCC) is the most commonly reported tumor and it should always be sought and diagnosed in presence of a rhinophyma. Methods Between 1998 and 2012, 56 cases of rhinophyma were treated at our department. There were 54 males and 2 females with an age range between 34 to 87 years. In all cases of major or moderate degree, scalpel decortications was executed, while in cases of suspicious lesions, a biopsy and histological examination was also indicated. Results In this series, six cases of BCC were diagnosed and treated showing an incidence rate higher than 10 %. Conclusions Our results support the need of histological examination of the surgically removed tissue in patients with rhinophyma. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-08-19
  • A rare case of primary apocrine carcinoma of the axilla
    • PubDate: 2014-08-16
  • Improvement of efficacy in surgical management of facial basal cell
           carcinoma: an interdisciplinary pilot study in The Netherlands
    • Abstract: Background The increasing incidence of basal cell carcinoma demands for an improvement of current health care management to gain more efficacies in the interdisciplinary treatment of facial basal cell carcinoma. We prospectively evaluated the level of agreement between referring dermatologists and plastic surgeons to assess in which cases routine pre-operative consultation of patients with facial basal cell carcinoma was not required for surgical treatment by plastic surgeons. Methods The outcome of a self-designed standardized referral form was prospectively evaluated in 100 patients with clinically suspected facial basal cell carcinoma that were referred from the dermatology outpatient clinic to the surgical outpatient clinic of Plastic Surgery for tumor removal under local anesthetics between 2009 and 2011. Results The level of agreement between the dermatologists and plastic surgeons on whether patients could be booked on the surgical outpatient clinic without routine pre-operative consultation was categorized as “moderate agreement” (Kappa = 0.589). We found that in 12.7 % of the patients with high-risk facial basal cell carcinoma (BCCs), both specialists agreed that pre-operative consultation was not required. In another 12.7 % of the patients, consensus was not achieved. In 74.6 % of the patients, both specialists agreed that pre-operative consultation was recommended. Conclusions We found that in selected patients with high-risk facial BCCs, both specialists agreed that pre-operative consultation was not required. Once a standardized referral system has been implemented, its use may improve efficacy in the surgical treatment of high-risk facial BCC. Future research should be directed towards clinical controlled trials. Level of Evidence: Level III, risk/prognostic study.
      PubDate: 2014-08-16
  • Consecutive formation of extensive late seromas with sudden onset: a
           breast augmentation patient with a puzzling clinical presentation
    • Abstract: Abstract Silicone gel-filled breast implants are the backbone of augmentation mammoplasty. Although a safe and straightforward procedure, augmentation mammoplasty is not exempted from complications. Seroma formation—as a well-known complication—generally occurs at early postoperative period. Although it generally undergoes spontaneous resorption within four to six postoperative weeks, its persistence can cause increased pain, wound dehiscence and infection, which might necessitate subsequent removal of the implant. The term “late seroma” describes seroma after 4 months postoperatively. Late seromas are rare and tend to occur unilaterally. Although late seromas generally have an insidious onset, clinical presentation may vary regarding each individual patient. We present a case report of extensive late seroma formations, with sudden onset, on both sides in a consecutive manner. Our review of the literature suggests that this is the only report of consecutive late seroma formation on both sides of a silicone gel breast augmentation patient. Level of Evidence: Level V, diagnostic study.
      PubDate: 2014-08-15
  • Genta-Foil resorb, a novel advance in the treatment of paediatric nail bed
    • PubDate: 2014-08-14
  • Distally based posterior tibial artery perforator flap for coverage of
           defects around the ankle, heel and lower third of leg
    • Abstract: Introduction Reconstruction of distal leg region remained a difficult task. Free flaps had long been considered as a gold standard for these regions. However, due to various limitations of the free flap, a local fasciocutaneous flap could be considered as a good alternative. In this study, the use of a distally based posterior tibial artery perforator flap had been evaluated in the coverage of defects around the ankle, heel, and lower third of a leg. The study also outlined the donor-site morbidity and the technical details of the surgical procedure. Methods In this prospective study, a total of 42 patients with distal lower leg defects were included. The defects were located on the lower third of the leg (n = 23), ankle (n = 11), and heel (n = 8). Reconstruction was performed using distally pedicled posterior tibial artery perforator flaps. Patients were evaluated in terms of viability of the flap, functional gain, and donor-site morbidity. The technical details of the operative procedure have also been outlined. Results All the flaps survived well, with the exception of one patient, who experienced complete flap loss. Minor complications were, however, noted in four other patients: One patient developed superficial epidermolysis; one developed postoperative venous congestion, which subsided within 3 days by conservative means, and in two patients, partial loss of the skin graft occurred at the donor site but healed completely with dressing and antibiotics. The patients were followed up for an average period of 6 months, ranging from 1 to 13 months. Donor-site morbidity was minimal. Conclusions It was concluded that the distally based pedicled posterior tibial artery perforator flap was a reliable, easy, less time-consuming, and versatile procedure for covering the defects around the ankle, heel, and lower third a leg. Level of Evidence: Level IV, therapeutic study
      PubDate: 2014-08-14
  • Fat grafting used for the prevention of cardiac implantable electronic
           devices (CIED) exposure. Preliminary report of a clinical study
    • Abstract: Background Subcutaneous cardiac devices can sometimes undergo exposure, and often, the removal and contralateral repositioning of a new device is necessary. Pressure sores of the device cause a gradual thinning of the cutaneous and subcutaneous layers resulting in implant exposure. Our department has developed a closed collaboration with the Department of Cardiology in order to prevent the exposure of subcutaneous devices and to avoid the more risky and invasive surgery necessary for implant removal and reposition. Methods Thirty selected cardiopathic patients presenting pressure sores of the device, without exposure, were selected for lipofilling. The selection of patients is a key moment to ensure the success of the procedure. The surgery was performed under local anaesthetic without epinephrine. Results There was an improvement of local conditions, and none of the patients, after a year, were subjected to a removal operation of the implant. No cases of infection were observed. Conclusions Adipose tissue graft improved cutaneous trophism and increased the thickness of the subcutaneous tissue, reducing the risk of implant exposure. Level of Evidence: Level IV, risk/prognostic study.
      PubDate: 2014-08-13
  • Lymphatic drainage study after latissimus dorsi flap breast reconstruction
    • Abstract: Background Recurrence of breast cancer to latissimus dorsi (LD) flap donor site is a very rare condition, and as a result, few data are currently available on its possible causes. The aim of the study was to investigate the role of LD flap transfer in lymphangiogenesis and connection to the preexisting lymphatic network after mastectomy and axillary lymph node dissection and the lymphatic drainage involvement in local relapse to flap donor site. Methods Lymphoscintigraphy was performed on subgroup of ten patients who had previously undergone modified radical mastectomy, axillary lymph node dissection, and pedicled LD flap reconstruction. Lymphatic drainage was imaged by static gamma camera acquisitions after two intradermal injections of 37 MBq 99mTc-Nanocoll® on residual breast skin and LD skin paddle, respectively. Results In eight cases (80 %), the residual breast skin showed fast lymphatic drainage directed only toward the ipsilateral axilla, while in two cases (20 %), it was also seen to the internal mammary nodes. LD skin paddle showed slower drainage in all cases but 1, where no visible drainage was observed within 2 h after injection. Conclusions Although a small case series is the study limitation, our findings suggested that the LD flap harvest can promote a preferential route of lymphatic drainage in the axillary region and could be involved in a metastatic spread to the dorsum because of the new tissue plane opening. The direct communication created between recipient and donor sites could have lead to cell cancer transfer to the donor site either by lymphatic or a contiguity pathway. Level of Evidence: Level V, diagnostic study.
      PubDate: 2014-08-12
  • Single-stage reconstruction of alar defect of the nose by subcutaneous
           island nasolabial and remnant alar flap
    • Abstract: Abstract A single-stage technique for reconstruction of the medial nasal ala with a nasolabial flap and an inferiorly based remnant alar flap is presented in this article. The technique has been used in four cases. All the flaps healed uneventfully with aesthetically pleasing results using the one-stage technique. The subcutaneous nasolabial island flap and alar remnant flap have become the method of choice in the author’s clinic for partial medial nasal ala reconstruction. It allows one-stage reconstruction with very similar tissue and a concealed scar in the natural groove. The remnant ala as an inferiorly based flap has been used by the author to cover the subcutaneous pedicle of the nasolabial flap to provide better shape to the alar base without its lateral drift during healing. Level of Evidence: Level V, therapeutic study.
      PubDate: 2014-08-12
  • Railway graft for internal nasal valve reconstruction
    • Abstract: Background Although many methods have been proposed to restore the internal nasal valve (INV) such as suture techniques, various grafts, upper lateral cartilage folding techniques, and combined techniques, the most popular and effective one remains spreader grafts. The aim of the present study is to propose a new graft design for INV reconstruction and to test the reliability and feasibility of the technique. Methods Thirty-two primary septorhinoplasty patients divided in three groups underwent surgery with railway, spreader, and no graft techniques. The functional results were evaluated with the Nasal Obstruction Evaluation Scale (NOSE) scores subjectively. Results Significant improvements were observed comparing preoperative and postoperative NOSE scores in railway and spreader grafts groups. However, there was no significant difference in NOSE scores between those groups of patients. Conclusions Railway graft is an effective method that can be recommended if septal cartilage is limited for reconstruction of INV. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-08-12
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Heriot-Watt University
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