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Differential Equations     Hybrid Journal   (Followers: 2, SJR: 0.364, h-index: 15)
Differential Equations and Dynamical Systems     Hybrid Journal   (Followers: 1, SJR: 0.63, h-index: 7)
Digestive Diseases and Sciences     Hybrid Journal   (Followers: 4, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 2, SJR: 1.269, h-index: 40)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 2, SJR: 0.42, h-index: 32)
Distributed and Parallel Databases     Hybrid Journal   (Followers: 4, SJR: 0.766, h-index: 30)
Distributed Computing     Hybrid Journal   (Followers: 2, SJR: 1.41, h-index: 31)
DNP - Der Neurologe und Psychiater     Full-text available via subscription  
Documenta Ophthalmologica     Hybrid Journal   (Followers: 2, SJR: 0.946, h-index: 40)
Doklady Biochemistry and Biophysics     Hybrid Journal   (Followers: 2, SJR: 0.2, h-index: 10)
Doklady Biological Sciences     Hybrid Journal   (SJR: 0.248, h-index: 10)
Doklady Botanical Sciences     Hybrid Journal  
Doklady Chemistry     Hybrid Journal   (SJR: 0.272, h-index: 12)
Doklady Earth Sciences     Hybrid Journal   (SJR: 0.48, h-index: 17)
Doklady Mathematics     Hybrid Journal   (SJR: 0.345, h-index: 13)
Doklady Physical Chemistry     Hybrid Journal   (SJR: 0.299, h-index: 12)
Doklady Physics     Hybrid Journal   (Followers: 1, SJR: 0.293, h-index: 17)
Douleur et Analg├ęsie     Hybrid Journal   (SJR: 0.113, h-index: 6)
Drug Delivery and Translational Research     Hybrid Journal   (Followers: 2, SJR: 0.607, h-index: 8)
Drug Safety - Case Reports     Open Access  
Drugs : Real World Outcomes     Hybrid Journal   (Followers: 1)
Dynamic Games and Applications     Hybrid Journal   (Followers: 2, SJR: 0.481, h-index: 5)
Dysphagia     Hybrid Journal   (Followers: 90, SJR: 0.822, h-index: 52)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 9, SJR: 0.279, h-index: 9)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 14, SJR: 0.466, h-index: 16)
Earth Science Informatics     Hybrid Journal   (Followers: 3, SJR: 0.282, h-index: 7)
Earth, Moon, and Planets     Hybrid Journal   (Followers: 7, SJR: 0.303, h-index: 29)
Earthquake Engineering and Engineering Vibration     Hybrid Journal   (Followers: 7, SJR: 0.482, h-index: 21)
Earthquake Science     Hybrid Journal   (Followers: 8, SJR: 0.418, h-index: 9)
East Asia     Hybrid Journal   (Followers: 7, SJR: 0.18, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 9, SJR: 0.362, h-index: 27)
EcoHealth     Hybrid Journal   (Followers: 3, SJR: 0.88, h-index: 26)
Ecological Research     Hybrid Journal   (Followers: 8, SJR: 0.847, h-index: 43)
Economia e Politica Industriale     Hybrid Journal  
Economia Politica     Hybrid Journal   (SJR: 0.375, h-index: 6)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.527, h-index: 44)
Economic Bulletin     Hybrid Journal   (Followers: 4)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.264, h-index: 9)
Economic Theory     Hybrid Journal   (Followers: 9, SJR: 2.557, h-index: 34)
Economic Theory Bulletin     Hybrid Journal   (Followers: 2)
Economics of Governance     Hybrid Journal   (Followers: 2, SJR: 0.408, h-index: 14)
Ecosystems     Hybrid Journal   (Followers: 19, SJR: 1.909, h-index: 93)
Ecotoxicology     Hybrid Journal   (Followers: 9, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 94, SJR: 0.366, h-index: 16)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 19, SJR: 0.374, h-index: 15)
Educational Psychology Review     Hybrid Journal   (Followers: 17, SJR: 2.776, h-index: 61)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 8, SJR: 0.273, h-index: 9)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 11, SJR: 0.825, h-index: 32)
Educational Technology Research and Development     Partially Free   (Followers: 82, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 15, SJR: 0.336, h-index: 18)
Electrocatalysis     Hybrid Journal   (SJR: 0.883, h-index: 10)
Electronic Commerce Research     Hybrid Journal   (Followers: 3, SJR: 0.582, h-index: 16)
Electronic Markets     Hybrid Journal   (Followers: 5, SJR: 0.411, h-index: 8)
Electronic Materials Letters     Hybrid Journal   (Followers: 3, SJR: 1.407, h-index: 15)
Elemente der Mathematik     Hybrid Journal   (Followers: 1)
Emergency Radiology     Hybrid Journal   (Followers: 4, SJR: 0.678, h-index: 25)
Emission Control Science and Technology     Hybrid Journal   (Followers: 1)
Empirica     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 16)
Empirical Economics     Hybrid Journal   (Followers: 8, SJR: 0.489, h-index: 31)
Empirical Software Engineering     Hybrid Journal   (Followers: 7, SJR: 1.285, h-index: 39)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 3, SJR: 0.361, h-index: 15)
Endocrine     Hybrid Journal   (Followers: 7, SJR: 0.878, h-index: 57)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.638, h-index: 31)
Energy Efficiency     Hybrid Journal   (Followers: 12, SJR: 0.732, h-index: 14)
Energy Systems     Hybrid Journal   (Followers: 11, SJR: 1.176, h-index: 7)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.433, h-index: 30)
Entomological Review     Hybrid Journal   (Followers: 3, SJR: 0.144, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 29, SJR: 0.419, h-index: 29)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 5, SJR: 0.458, h-index: 32)
Environmental and Resource Economics     Hybrid Journal   (Followers: 17, SJR: 1.632, h-index: 54)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 5, SJR: 0.725, h-index: 58)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 2, SJR: 0.741, h-index: 28)
Environmental Earth Sciences     Hybrid Journal   (Followers: 12, SJR: 0.724, h-index: 63)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 4)
Environmental Evidence     Open Access   (Followers: 1)
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 2, SJR: 0.437, h-index: 24)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 3, SJR: 1.013, h-index: 36)
Environmental Geology     Hybrid Journal   (Followers: 11)
Environmental Health and Preventive Medicine     Hybrid Journal   (Followers: 3, SJR: 0.522, h-index: 19)
Environmental Management     Hybrid Journal   (Followers: 32, SJR: 0.942, h-index: 66)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 10, SJR: 0.533, h-index: 31)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 9, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 15, SJR: 0.885, h-index: 46)
Epileptic Disorders     Hybrid Journal   (SJR: 0.608, h-index: 38)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.287, h-index: 63)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 2, SJR: 0.731, h-index: 89)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.641, h-index: 62)
EPMA J.     Open Access   (SJR: 0.284, h-index: 6)
ERA-Forum     Hybrid Journal   (Followers: 3, SJR: 0.128, h-index: 3)
Erkenntnis     Hybrid Journal   (Followers: 13, SJR: 0.621, h-index: 16)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.206, h-index: 9)
Esophagus     Hybrid Journal   (SJR: 0.311, h-index: 10)
Estuaries and Coasts     Hybrid Journal   (Followers: 7, SJR: 1.332, h-index: 67)
Ethical Theory and Moral Practice     Hybrid Journal   (Followers: 10, SJR: 0.297, h-index: 10)
Ethics and Information Technology     Hybrid Journal   (Followers: 81, SJR: 0.484, h-index: 23)
Ethik in der Medizin     Hybrid Journal   (SJR: 0.163, h-index: 6)

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Journal Cover   European Journal of Plastic Surgery
  [SJR: 0.171]   [H-I: 14]   [2 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  [2281 journals]
  • Dislocation fracture of the pisiform in a 14-year-old—a rare injury
           to the hand
    • Abstract: Abstract Isolated dislocation or dislocation fracture of the pisiform are rare injuries with only few cases reported in the literature. Injuries to the pisiform occur more often in combination with other carpal injuries as the sturdiness and stability of its ligamentous attachments protect it from dislocating following a minor trauma. The most cases of dislocation or fracture occur following a direct trauma to the palmar and ulnar aspects of the wrist. Predominantly young male patients present with this problem. We present a case of a 14-year-old female who suffered from a dislocation fracture after falling from her bicycle on her outstretched hand. After confirming the diagnosis of pisiform dislocation fracture and reviewing the literature, we performed pisectomy with rerouting of the flexor carpi ulnaris tendon by suturing it to the ligamentous attachments. These rare injuries to the wrist are demanding in diagnostics and treatment and could be neglected in acute period. However, with a correct diagnosis and appropriate treatment, an excellent clinical outcome can be achieved. Level of Evidence: Level V, diagnostic study
      PubDate: 2015-08-29
  • Outcomes following manipulation of nasal fractures—the Durham
    • Abstract: Background Early manipulation of nasal fractures can negate the need for formal rhinoplasty. However, residual nasal deformity is reported in up to 50 % of cases. The aim of this study was to evaluate the outcome following manipulation of nasal fractures in a regional plastic surgery department and quantify the subsequent rhinoplasty conversion rate. Methods A retrospective review of all patients presenting with nasal fractures who had undergone manipulation under anaesthetic (MUA) in a single plastic surgery unit over a 7-year period was performed. Results Three hundred fifty-three MUA procedures were performed, the majority of which were in young males (76 %). Common causes included assault (54 %), sporting injuries (24 %) and falls (12 %). MUA was performed for nasal bone fracture (69 %) or bony and septal fracture (31 %). Only 37 % (130 patients) attended outpatient follow-up. Functional problems were identified in 17 % (22 patients), whilst 24 % (31 patients) noted residual deformity. Of these, 10 patients (3 %) accepted and underwent formal rhinoplasty surgery. This accounted for 17 % of all rhinoplasties carried out within the time period. Conclusions In our department, the outcome following manipulation of these injuries compares favourably with the literature, with the majority of patients having no major long-term sequelae. Our data suggest that many patients are happy to accept a degree of residual deformity and decline further surgery. Level of Evidence: Level IV, risk / prognostic study
      PubDate: 2015-08-19
  • The false tune of Burow’s triangle
    • PubDate: 2015-08-18
  • Encysted haematoma formation following a latissimus dorsi flap-based
           breast reconstruction
    • PubDate: 2015-08-13
  • The use of dermal regeneration template (Pelnac®) in acute
           full-thickness wound closure: A case series
    • Abstract: Background Dermal regeneration template (DRT) has been well implicated in the reconstruction of full-thickness burn injury. This case series specifically presents our experience and our clinical application of Pelnac® to achieve wound closure with complex acute full-thickness defect. Methods A retrospective review of patients treated with Pelnac for complex wound defects from 2008 to 2014 at Concord Burns Unit was carried out. Variables such as wound aetiology, wound size and complications were considered. Results Five patients (four females and one male with a mean age 54 ± 20) all had full-thickness defects (mean defect size 4.3 ± 2.0 % TBSA), some with exposed tendon and bone. The wounds were treated with Pelnac®; the silicone layer was removed at postoperative day 14 and a split-thickness skin graft (0.2 to 0.3 mm) was applied. Clinically, the reconstructed areas demonstrated good granulation tissue at 14 days with good take of the skin graft. There were no major acute graft loss, rejection or associated infection. However, there were small areas of graft loss which did not require re-grafting. Conclusions DRT provides a safe and efficacious alternative when dealing with acute contaminated full-thickness wounds. Pelnac® seems versatile in obtaining wound coverage in difficult complex wounds, especially in critically ill patients where free or pedicle flap reconstruction would be problematic. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-08-08
  • Determination of the optimal frequency of injection of triamcinolone:
           monitoring change in volume of keloid lesions following injection of
           40 mg of triamcinolone
    • Abstract: Background Different dosage protocols may be advocated by different clinicians for the same keloid lesion. The aim of this study was to determine the optimal frequency of injection of triamcinolone for the purpose of reducing the size of keloid, by monitoring volume change in lesions. Methods Volume of all lesions was measured, and 40 mg of triamcinolone was injected once. Lesion volume was thereafter monitored weekly for 6 weeks. Results Mean pretreatment volume was 6.4 ml. Following triamcinolone injection, mean lesion volume became 5.1, 3.7, 3.6, and 3.6 ml at 1, 2, 3, and 4 weeks postinjection, respectively. The mean lesion volume was 3.7 and 3.9 ml at 5 and 6 weeks postinjection. Mean lesion volume was 1.29 ml lower at 1 week than at pretreatment stage (SD ± 0.8797), 1.35 ml lower in volume at 2 weeks than 1 week (SD ± 1.0386), and 0.138 ml lower in volume at 3 weeks than 2 weeks (SD ± 0.159). Mean lesion volume was 0.0250 ml lower at 4 weeks than at 3 weeks (SD ± 0.3215), 0.1000 ml greater in volume at 5 weeks than 4 weeks (SD ± 0.1713), and 0.2000 ml greater in volume at 3 weeks than 2 weeks (SD ± 0.0418). There is a statistically significant difference between the mean volume at 1 week postinjection and that at pretreatment stage, between 2 and 1 week, and between 3 and 2 weeks (p ≤ 0.05). Reduction in volume was found to be most profound and statistically significant within the first 2 weeks postinjection. Conclusions This study finds that the optimal frequency of intralesional injection of triamcinolone involves a 2-week injection interval. Level of Evidence: Level IV, therapeutic study
      PubDate: 2015-08-06
  • Nasal reconstruction with a prefabricated free flap
    • Abstract: Abstract We report a case of a 61-year-old patient who presented to us for nose and cheek reconstruction post multiple excisions of an extensive recurrent basal cell carcinoma (BCC) of the right cheek and most of the nose. Nasal reconstruction was achieved with a free helical rim flap for the right ala and a staged prefabricated radial artery forearm free fascial flap. We were successful in producing a very favorable esthetic result and restoring nasal function. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-08-02
  • Porcine acellular dermis-based breast reconstruction: complications and
           outcomes following adjuvant radiotherapy
    • Abstract: Background Acellular dermal matrices (ADM) such as StratticeTM are increasingly used in UK during implant-based reconstruction. However, there are mixed opinions regarding the compatibility of radiotherapy treatment in pre- and post-reconstructed breasts. The aims of this study are to audit the rates of radiation induced complications in patients who underwent breast reconstruction using StratticeTM and establish whether there is an association between timing of radiotherapy and complication rates. Methods Retrospective data collection was performed for all patients who underwent skin-sparing mastectomy and immediate or delayed StratticeTM-based reconstruction, and received pre- or post-reconstruction radiotherapy from July 2010 to November 2014. Results The age ranged from 33 to 78 years (mean age 51 ± 10.6) with a mean follow-up time of 21 months. There were 25 StratticeTM-based reconstructions performed. Sixteen had delayed reconstruction, and 9 had skin-sparing mastectomy and immediate reconstruction. There were 4 (16 %) abandoned procedures due to inability to stretch the mastectomy flap secondary to poor skin compliance. Two women (8 %) presented 4 and 9 months later with wound breakdown. One case (4 %) developed severe capsular contracture following radiotherapy post-reconstruction and 1 case (4 %) of implant rupture. There were no episodes of extrusion or implant infection. Overall complication rates were 32 %. The majority (75 %) of complications occurred in breasts reconstructed post-radiotherapy; however, this is not significant when analysed using chi-square (p = 0.43). Conclusions Our evidence suggests that there is no difference in complication rates in pre- and post-radiation individuals; this would suggest that implant-based reconstruction using StratticeTM should not be an absolute contraindication in pre- or post-radiotherapy patients. However, when planning these procedures, it is paramount that the increased risks are emphasised to patients in order to better manage patient expectation in cases where complications arise. Level of Evidence: Level III, risk / prognostic study.
      PubDate: 2015-08-02
  • Transient purpura after axillary dissection due to malignant melanoma
    • PubDate: 2015-08-01
  • Spinal accessory nerve iatrogenic trauma following cervical lymph node
           biopsy. Treatment by anterior medial antebrachial cutaneous nerve graft: A
           case report
    • Abstract: Abstract Spinal accessory nerve (SAN) injury often occurs as an iatrogenic nerve injury following posterior cervical lymph node biopsy. Failure to recognize the injury or delayed intervention by hoping that it will resolve with conservative treatment is a usual pitfall. Pain, shoulder drop, scapula instability, asymmetric neckline, and inability to abduct the arm may variably be the symptoms. Direct repair, nerve grafts, nerve conduits, and muscle transfers have been described as treatment options. We report on a case of using a 4.5-cm nerve autograft from the medial antebrachial cutaneous (MABC) nerve branch in order to repair an iatrogenic accessory nerve complete transection following a cervical node biopsy. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2015-08-01
  • Review of the analgesia options for patients undergoing TRAM and DIEP flap
           breast reconstruction
    • Abstract: Background The mainstay of autologous breast reconstruction involves abdominal wall-based tissue transfer in the form of free or pedicled TRAMs or more recently free DIEP flaps. Although excellent choices for breast reconstruction, all of these techniques do have significant morbidity when considering donor-site pain. This can lead to other complications such as reduced mobility, deep vein thrombosis, pulmonary emboli, respiratory infections, heavy opiate use, constipation and prolonged in hospital stay. Minimising postoperative donor-site pain is therefore of paramount importance. This article provides a review of the forms of analgesia available in the literature and in use in clinical practise. It is a summary of the published studies and exciting future options in this field. Methods A literature search was performed through Medline, EMBASE, Cochrane database and Google Scholar for any previous research publications pertaining to postoperative analgesia in patients undergoing autologous breast reconstruction using abdominal tissue. We reviewed all articles with the aim to evaluate the current knowledge and evidence of analgesic techniques in autologous breast reconstruction including benefits, limitations, indications and patient outcomes. Results The literature search yielded a total of 31 articles identifying 6 analgesic techniques: patient-controlled analgesia (PCA), epidural analgesia, continuous wound infusion with local anaesthetic, intermittent boluses of local anaesthetic, transverse abdominis plane (TAP) blocks and slow release bupivicaine. Conclusions Various anaesthetic techniques are used to reduce postoperative mortality in autologous breast reconstruction. Knowledge of these techniques is paramount as it reduces complications and expedites discharge in this group of patients. Level of Evidence: Not ratable.
      PubDate: 2015-08-01
  • Acellular dermal matrix fenestrations and their effect on breast shape
    • Abstract: Background Acellular dermal matrices (ADMs) are increasingly being utilized in primary and secondary breast reconstruction as they confer several advantages, including soft tissue enhancement at the inferolateral pole of the breast. The senior authors have added fenestrations to ADMs to allow for more rapid expansion and improved breast aesthetics. The purpose of this study is to describe the benefits of ADM fenestration using a mathematical formula as a proof of concept for the effects of these modifications on breast shape. Methods The aggregate effect of symmetrically arranged fenestrations on the ADM’s mechanical properties is explained by a uniform reduction in the effective Young’s modulus of the graft in a direction perpendicular to the chest wall in the area of graft fenestration. Asymmetric reduction of the Young’s modulus is achieved by concentration of the fenestrations at either the cephalic or caudal ends of the ADM. Results The relaxed Young’s modulus facilitates an increased deflection of the ADM from its resting, unaltered state under the weight of the implant or tissue expander and is modeled using a one-dimensional boundary equation. The reduced inferior pole tension allows for enhanced expansion under the weight of the implant or tissue expander. The effects of asymmetrically arranged fenestrations are similarly modeled and appear to afford the surgeon greater precision in controlling inferior pole characteristics. Conclusions Acellular dermal matrix fenestration improves aesthetic outcome by facilitating greater inferior pole expansion. Mathematical models are provided to describe the modifications and elucidate the mechanism behind their effect on breast shape. Level of Evidence: Not ratable
      PubDate: 2015-08-01
  • Clinical and histopathological analysis of 152 pigmented skin lesion
           excisions apart from melanocytic nevus due to cosmetic reasons
    • Abstract: Background Melanocytic naevus (MN) is a normal, benign proliferation of melanocytes, which may be acquired or congenital, and it is the most common pigmented lesion posing an aesthetic problem for many patients and can be found anywhere on the skin. There are several other types of pigmented skin lesions apart from MN such as seborrhoeic keratosis (SK) which mimics both MN and basal cell carcinoma (BCC). Methods A retrospective study was designed in order to investigate the characteristics of 152 non-MN pigmented skin lesion excisions performed between June 2009 and October 2014. All patients desired their lesions to be removed for only cosmetic reasons. None of our patients described their lesions as ‘suspicious’. All patients were evaluated for age and gender in addition to the clinical characteristics of the lesion such as location, size and morphology. Twenty-two different types of pigmented lesion were identified. Results A total of 152 patients underwent surgery. Of the 152 patients, 83 were female (54.6 %) and 69 were male (45.4 %). The average age of our patient group was 51.4 (12–87) years. The average size of the lesions was 1.27 cm2 (0.01–6 cm2). Conclusions Seborrhoeic keratosis was the most common lesion type (49.6 %), followed by dermatofibroma, haemangioma, fibroepithelial polyp and BCC. These five lesions in total constituted 79.4 % of all lesions. It was also observed that approximately 19 % of all excised lesions were malignant, pre-malignant or a feature of a systemic disease. The main complaint for all of our patients was cosmetic disturbance. None of the lesions were symptomatic, and none of the patients considered their lesions as ‘suspicious’. Level of Evidence: Level III, risk/prognostic study.
      PubDate: 2015-08-01
  • PIP breast implant rupture—A retrospective study from Portugal
    • Abstract: Background Silicone breast implants have been used for cosmetic and reconstructive breast surgery for several decades. Rupture and silicone leakage are well-known complications for silicone mammary implants. However, in the last years, an unexpected high prevalence of rupture and silicone leakage have been reported for the Poly Implant Prothèse (PIP) manufacturer, which culminated in the withdrawal of these implants from the European market in 2010. Methods In order to analyze rupture in PIP breast implants and compare it with other manufacturers, we carried out a retrospective study which included all women undergoing revision or replacement of breast implants between January 2005 and June 2012, at the Hospital Center of Gaia, Portugal. Results The most frequent reason for undergoing implant revision was suspection of rupture. Intraoperatively, the majority of the implants replaced were not ruptured (56 %). However, within ruptured implants, 88.2 % were PIP and 11.8 % were not, and this difference was statistically significant. Parameters such as subglandular vs. retromuscular plane, shape or volume were not significantly correlated with rupture. About the concordance between imaging diagnosis and intraoperative finding of implant rupture, we found that magnetic resonance imaging was superior to the ultrasound. Conclusions We have detected a higher prevalence of rupture for PIP breast implants comparing to that of the other manufacturers, which is in consonance with recent papers. Our results led us to suggest the poor quality shell, rather than the silicone gel, as the main cause for the higher rupture rates in this brand. Level of Evidence: Level IV, risk/prognotic study.
      PubDate: 2015-08-01
  • Nipple delay prior to completion mastectomy for oncoplastic surgery
    • Abstract: Abstract Oncoplastic breast surgery is becoming increasingly popular, aiming to provide adequate oncological clearance of a tumour, whilst devoting attention to breast aesthetics. There are instances, however, where completion mastectomy is necessary, and this poses a threat to nipple viability due to the previous oncoplastic procedure. Delay is a technique used to axialise the blood supply of an angiosome, providing more reliable supply to a distal segment of tissue. This report details two cases where the technique of nipple delay was used to ensure nipple-areolar viability prior to proceeding with completion mastectomy. Nipple delay assists in the decision-making process for completion mastectomy in this setting, anticipating the results of complete oncological clearance whilst ensuring the best aesthetic outcome. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-08-01
  • ‘Tension Tile System’ (TTS): a simple innovative wound closure
    • Abstract: Abstract Wounds closed under severe tension often result in breakdown due to skin necrosis and suture cheese wiring causing both physical and financial morbidity. Although a few commercial wound closure systems have been described in the literature, but they are all expensive and not readily available. We have designed a simple and inexpensive system called ‘Tension Tile System’ (TTS) which utilizes plastic casing found in most sterile surgical suture packs. The device is easy to construct, sterile, inexpensive, easily available, and based on already proven principles of mechanical creep and stress relaxation. Large wounds in five patients were closed with the help of TTS system with no complications. We believe that this system will find wide application in all surgical fields where the wound encounters tension during closure. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-08-01
  • Modified application of thumb tourniquet to enlarge the operative field
    • PubDate: 2015-08-01
  • Open hand fractures: 2 years of experience at a hand centre
    • Abstract: Background Despite open hand fractures being relatively common, little has been published regarding their prevalence, mechanism of injury and outcomes. Methods A retrospective case note review was performed of all patients presenting with open metacarpal, proximal and middle phalangeal fractures over a 25-month period at a regional hand centre. Results Eighty-five patients were included (median age 43 years). “Sharp” injury was the commonest mechanism (39 %). Forty-three percent were managed with open reduction and internal fixation; this group was significantly more likely to require revision surgery compared to other fixation methods. Four patients developed nonunion. Overall superficial infection rate was 9.4 %, one patient developed deep infection, and there were no cases of osteomyelitis. No infections developed in the group receiving oral antibiotics alone. Conclusions Further research is necessary, but we postulate that some open hand fractures are suitable for day case surgery with oral antibiotic prophylaxis. The follow-up after these injuries is often protracted, and patients should be counselled accordingly, particularly of the high risk of revision surgery in patients managed with open reduction internal fixation. Level of evidence: Level IV, therapeutic study.
      PubDate: 2015-08-01
  • How to treat a vaginal burn due to acetic acid'
    • Abstract: Abstract Up to the present, no recommendations have been made on vaginal and cervical burns. The aim of this article was to compare our treatment with other strategies found in the literature on the outcome of vaginal strictures and to propose a protocol for the treatment of vaginal burns. A patient underwent colposcopy with 100 % acetic acid, which caused deep vaginal burns. We treated her with daily vaginal packing with Vaseline gauze for 5 days and daily irrigation with saline solution for 2 weeks. Antibiotic capsules were used for 7 days. Subsequent physiotherapy was performed for 6 months. Topical hyaluronic acid was applied, and hyaluronic vaginal capsules were introduced from 1 month onwards and for 5 months. Healing took 1 month. No vaginal synechia or stricture was found at 6 months. In a review of literature, vaginal stents, topical estrogen, systemic antibiotics, and oral non-steroidal anti-inflammatory agents have been proposed. No cases of vaginal strictures or synechiae have been reported. The treatment has to be the simplest and the less traumatizing. Vaginal packing does not prevent vaginal strictures. Simple saline irrigation with a regular pelvic examination appears to be sufficient for the treatment of vaginal burns. Topical estrogens can be interesting if there is an atrophic mucosa. At distance, topical hyaluronic acid can be used to enhance healing. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-08-01
  • Erratum to: Simplified skin excision pattern for skin-sparing/reducing
           mastectomy and direct-to-implant single-stage immediate (DISSI) breast
    • PubDate: 2015-07-03
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