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Dynamic Games and Applications     Hybrid Journal   (Followers: 2)
Dysphagia     Hybrid Journal   (Followers: 143, 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: 11, 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: 3, 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: 6, 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: 129, 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: 7, SJR: 0.946, h-index: 27)
Educational Technology Research and Development     Partially Free   (Followers: 132, SJR: 1.124, h-index: 45)
Electrical Engineering     Hybrid Journal   (Followers: 8, 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: 9, 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: 25, 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: 16, 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: 29, 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: 1, 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: 150, 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: 2)
European Archives of Oto-Rhino-Laryngology     Hybrid Journal   (Followers: 3, 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: 9, 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: 7)
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)

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Journal Cover European Journal of Plastic Surgery
   [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  [2209 journals]   [SJR: 0.227]   [H-I: 13]
  • 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: 2014-06-01
  • Sequencing of the interferon regulatory factor 6 (IRF6) gene and
           correlation to its phenotypes in familial non-syndromic cleft lip and
           palate in North Indian population
    • Abstract: Background The incidence of orofacial clefting varies depending upon geographical location, ethnicity, sex and even socioeconomic status. The study aimed to test the contribution of interferon regulatory factor 6 (IRF6) gene allelic variation to the incidence of non-syndromic cleft lip and/or cleft palate (CL/P) from the population of North India. Methods Patients from 12 North Indian families with non-syndromic cleft lip with or without cleft palate (NSCL/P) with at least two members affected were clinically evaluated and tested. DNA was extracted from the blood, and three exonic part of the IRF6 gene (exons 2, 5 and 7) were amplified by PCR. Direct sequencing was performed by PCR product, and sequencing results were compared with the reference DNA sequence of the IRF6 gene. Results Three SNPs (rs861019, rs2013162 and rs2235372) in 4 out of 12 families were observed. SNP rs861019 was detected in family no. 4 (F4) around exon 2, SNP 2013162 was detected in family no. 10 (F10) and SNP 2235372 was detected in family nos. 5 and 9 (F5 and F9). Conclusions This study demonstrates that the three SNPs within the IRF6 gene are associated with NSCL/P, suggesting IRF6 gene sequence variability and variation in this gene, providing first genetic clue to the NSCL/P phenotype in North Indian families. This is our initial step to demonstrate the involvement of the IRF6 gene in NSCL/P patients in North India. Further extensive study and statistical analysis are needed to validate our result. Level of Evidence: Level IV, diagnostic study.
      PubDate: 2014-06-01
  • Management of large dorsal diffuse plexiform neurofibroma
    • Abstract: Abstract Neurofibromas are considered one of the hallmark signs of neurofibromatosis type 1(NF1). Diffuse plexiform neurofibroma is a congenital NF1-associated tumor, characterized by overgrowth and interference with function of the affected area. The rich vascular plexus associated with neurofibromas, together with their infiltrative pattern, makes them difficult to eradicate. Complications of neurofibromas are rare but include malignant transformation and potentially life-threatening hemorrhages. The use of the term “giant” to define a neurofibroma is controversial because there is no clear consensus and descriptions are limited to few case reports. We report a case of a large dorsal diffuse plexiform neurofibroma responsible for significant worsening of a patient’s quality of life. These features make us believe that the mass can be defined as “giant.” Comprehensive perioperative management, including arterial embolization of the feeding vessels and stabilization of the patient’s conditions, is required to perform a safe surgical procedure in such a complicated case. Level of Evidence: Level V, therapeutic study
      PubDate: 2014-06-01
  • ‘The Crown flap’: a modification to the keystone flap types I
           and IIA
    • Abstract: Abstract The Crown flap is a modification of the keystone flap first described by Felix Behan in 2003. A third V-Y advancement limb is incorporated into the design in the central region of the flap where the line of maximum tension exists. This added V-Y closure utilizes surrounding tissue laxity and has been found to aid in closure of the defect centrally whilst not compromising the flap. The Crown flap is a useful modification to the keystone flap. Level of Evidence: Level V, therapeutic study.
      PubDate: 2014-06-01
  • Umbilical port site keloid extending through rectus sheath
    • PubDate: 2014-06-01
  • Is dermatome shaving a potential treatment for actinic keratosis in organ
           transplant recipients' A cross-sectional study
    • Abstract: Background Non-melanoma skin cancer (NMSC) is correlated with high morbidity and mortality in solid-organ transplant recipients (OTR) and it appears after a mean interval of 8 to 10 years. Prophylactic treatments are still required to prevent the development of NMSC. This study aims to investigate whether dermatome shaving reduced the occurrence of keratotic skin lesions in OTRs. Methods A retrospective study was conducted. One thousand and twenty-four patients who had a split-thickness skin graft due to NMSC excision were identified in the Central Denmark Region and the Region of Southern Denmark between 1996 and 2011. Eleven of these patients were OTRs at the time of split-thickness skin grafting and were included in the study. The patients were examined for keratotic skin lesions, representing suspected premalignant lesions, on the donor area of the split-thickness skin graft, recipient area and two corresponding control areas. Epidemiological and medical parameters for each patient were registered via medical records and through patient interviews. Results The average time between split-thickness skin grafting and clinical examination was 6.2 years (1.1–16.8). The occurrence of keratotic skin lesions were lower in the donor area compared to both of the control areas (Wilcoxon matched-pairs signed-rank test, p = 0.024, respectively, p = 0.019). Conclusions Dermatome shaving reduced the occurrence of keratotic skin lesions in OTRs and might prevent the development of field cancerization and NMSC. Level of Evidence: Level III, therapeutic study.
      PubDate: 2014-06-01
  • Breast reconstruction by tissue expander after radiotherapy: When the skin
           does not expand, the rib cage is at risk
    • Abstract: Background Expander-based breast reconstructions in irradiated chest walls have been documented to result in an increased risk of complications including skin necrosis, extrusion, displacement, and capsule contracture. In this article, thoracic cage deformity and rib fractures were investigated following breast reconstruction by tissue expansion. Methods A prospective series of 89 immediate postmastectomy tissue expander breast mound reconstructions in 81 patients, the patients were divided into two groups, reconstruction with radiotherapy (n = 37) and without radiotherapy (n = 52). The patients were observed for any sudden severe pain and development of capsule contracture; intraoperative assessment was done first during expander insertion then after exchange of expander with implant to detect any deformity of the chest wall. CT scans were done as an objective way to support the clinical findings in patients who developed flat or concave chest wall deformities. Results Patients who had reconstructions with radiotherapy developed severe capsular contractures causing severe pain and limitation in breast expansion in 35 % of reconstructions compared with 5.7 % in the control group. Twenty-six reconstructions (70.2 %) in the study group developed chest wall deformities; in four of them, the deformity was concave, and two patients (5.4 %) developed multiple rib fractures at the expander site. The overall rate of ribcage deformities in the control group was 32.6 %; all of them were simple flattening with no concave deformities. No fractures were noted in the control group. Conclusions Expander-based breast reconstruction in combination with radiotherapy and tight unyielding overlying skin and capsule can redirect the expansion force toward the thoracic ribcage rather than the skin causing rib deformities and possible fractures. Level of Evidence: Level IV, risk/prognostic study
      PubDate: 2014-06-01
  • Freestyle facial perforator flaps—a safe reconstructive option for
           moderate-sized facial defects
    • Abstract: Background Perforators are a constant anatomical finding in the facial area and any known flap can in theory be based on the first perforator located at the flap rotation axis. Methods A case series of single stage reconstruction of moderate sized facial defects using 21 perforator based local flaps in 19 patients from 2008–2013. Results A sufficient perforator was located in every case and the flap rotated along its axis (76 %) or advanced (24 %). Reconstruction was successfully achieved with a high self reported patient satisfaction. Two minor complications occurred early on in the series and corrective procedures were performed in four patients. Conclusions The random facial perforator flap seems to be a good and reliable option for the reconstruction of facial subunits, especially the periorbital, nasal and periocular area with a minimal morbidity and a pleasing result in a one stage outpatient setting. Level of Evidence: Level IV, therapeutic study
      PubDate: 2014-06-01
  • An untreated benign lesion: digital dermatofibroma with lysis on phalanx
    • PubDate: 2014-06-01
  • Titanium-coated polypropylene mesh (TiLoop Bra®)—an effective
           prevention for capsular contracture'
    • Abstract: Background Silicone implants have been used in breast augmentation for more than 45 years. Complications, in particular, capsular contracture, still occur with a high incidence. Titanium-coated polypropylene mesh (TCPM; TiLoop Bra®, pfm medical, Cologne, Germany) provides new opportunities for implant-based breast reconstruction. We investigated the influence of the surface of silicone implants on the formation of capsular contracture by comparing textured silicone with TCPM-covered smooth silicone implants. Methods Twenty textured silicone gel-filled (group A) and twenty TCPM-covered smooth silicone gel implants (group B) (Silimed®, Rio de Janeiro, Brazil) were implanted in female Wistar rats. After 60 days, the implants and capsules were extracted, and histological and immunohistochemical staining was performed. The double-blind evaluation of the capsules was performed by two examiners. Results We were able to detect a thinner, but stiffer, capsule and a less development of an inner synovia metaplasia layer as well as a lower vascularity in capsules around TCPM-covered silicone implants. We found a higher percentage of myofibroblasts within the capsule structure and more inflammatory cell infiltration. Conclusions The quality of capsule structure around both tested implants differs significantly. Although capsules around TCPM-covered implants presented were thinner, they integrated with the mesh in a rigid cage structure capsule with higher infiltration of inflammatory cells caused by a significant foreign body reaction. TCPM-covered silicone implants showed no apparent advantage in the reduction of capsular contracture. On the other hand, the indication for using this material as a supportive soft tissue structure can be confirmed. Level of Evidence: not ratable, experimental study.
      PubDate: 2014-06-01
  • Pseudoangiomatous stromal hyperplasia: case report in a young patient and
           review of the literature
    • Abstract: Abstract Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast pathology, ranging from focal microscopic findings to clinical and mammographically evident masses, characterized by abnormal proliferation of the mammary stroma. Hormonal factors contribute probably to this pathology, since the average age of patients has been reported to be 40 years and can occur in postmenopausal patients who are on hormone replacement therapy. Notwithstanding, the etiology remains unclear and controversial. Usually, it is characterized by solitary, mobile, and slow-growing nodules. Notwithstanding, it may also occur as nodules or diffuse masses with rapid growth, simulating a malignant tumor. The recommended treatment is a wide excision of the lesion, with adequate free margins of resection, avoiding local recurrences. Herein, authors present a rare case of PASH in a 14-year-old patient, that produced severe breast deformity and assymetry. After complete excision, the breast was reconstructed by applying concepts of vertical scar breast reduction to restore breast symmetry. Level of Evidence: Level V, therapeutic study.
      PubDate: 2014-05-25
  • 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: 2014-05-25
  • Bilateral pectoralis muscle advancement flap in the management of deep
           sternal wound infection: a single clinic study of clinical outcome and
           postoperative quality of life
    • Abstract: Background Poststernotomy mediastinitis is a serious complication after open heart surgery. There are currently no specific guidelines with regards to standard treatment. Methods This is a prospective cohort study using a source population of 7842 patients who underwent open heart surgery. Between 1999 and 2010, 83 patients were diagnosed with mediastinitis, of which 24 patients underwent reconstruction with bilateral pectoralis major advancement flap. All surviving patients were seen at follow-up, and postoperative functional level was examined. The closing date was October 1, 2011. Results Median follow-up time from primary operation was 6.0 (1.6–15.5) years. Median follow-up from postsurgical mediastinitis was26 5.4 (0.4–12.4)years. There was no early mortality, and 22 patients were discharged with complete wound closure and infection control. Quality of life questionnaires revealed significant morbidity with chronic pain and reduced mobility, but despite this, patients were satisfied with their overall health outcome. Conclusions Mediastinitis remains a serious postoperative complication after open heart surgery accounting for significant morbidity and mortality. Treatment of deep sternal wound infection by pectoralis major flap reconstruction gives excellent wound closure. Follow-up showed that these patients were multimorbid with reduced quality of life as measured. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-05-23
  • Using pedicled TRAM flap in conjunction with the bony anchoring
           reinforcement system (BARS) for abdominal wall reconstruction
    • Abstract: Background Pedicled transverse rectus abdominis myocutaneous (TRAM) breast reconstruction is associated with increased abdominal wall morbidity. We present a method of abdominal wall reconstruction using an adjunct technique to validated procedures of hernia repair. Methods This study is a retrospective, single-surgeon analysis of 21 patients between 2005 and 2012. Patients had bony suture anchoring of synthetic polypropylene mesh to the anterior superior iliac spine bilaterally and the pubic symphysis after the abdominal fascia was reconstructed. Results Patient mean follow-up was 62 months. Of the series, five patients underwent bilateral pedicled TRAM breast reconstruction. None of the 21 patients developed abdominal wall hernias. One patient developed postoperative bulging, which was retreated successfully. Two patients developed mesh infections; none required radical removal of mesh. There were no flap failures or loss in the series. Conclusions The BARS technique for abdominal wall reconstruction provides excellent reinforcement of abdominal reconstruction in conjunction with pedicled TRAM breast reconstruction. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-05-23
  • 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: 2014-05-22
  • Complex incisional hernias repaired in conjunction with the Bony Anchoring
           Reinforcement System (BARS) prevents hernia recurrence
    • Abstract: Background Complex abdominal wall reconstruction and incisional hernia repair have been plagued by high recurrence rates, especially after multiple repair attempts and in those patients with high body mass index. We present an adjunct technique to validated procedures of hernia repair. Methods This study is a retrospective analysis of 63 patients between January 2006 and August 2012. Patients had bony suture anchoring of synthetic polypropylene mesh to the anterior superior iliac spine bilaterally, and the pubic symphysis after the abdominal fascia was reconstructed. Results Patient mean follow-up was 3.1 years (range 6 months to 6 years). None of the 63 patients had recurrent abdominal wall hernias. One patient, from early in the series, had post-operative bulging, which was retreated successfully using the current revised bone anchoring protocol. Five patients developed mesh infections; none of whom required radical debridement or removal of mesh. Conclusions The BARS technique for abdominal wall reconstruction provides an excellent reinforcement of fascial reconstruction with decreased hernia recurrence rates. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-05-18
  • Negative pressure wound therapy using gauze and foam: histological,
           immunohistochemical, and ultrasonography morphological analysis of
           granulation and scar tissues
    • Abstract: Background Negative pressure wound therapy (NPWT) is becoming routine for the preparation of wounds prior to grafting for wound closure. With this purpose, we have been using both foam and gauze-based NPWT obtaining similar proportions of closed wounds and observing less pliable scar tissue on the foam-treated patients. The aim of this study was to compare this two different fillers and to identify if there are different indications for their use according to anatomical areas in relation to the type of granulation and scar tissue obtained. Methods Both foam and gauze patients were compared in terms of depth and wound location, patients' age, and comorbidities. All foam patients were treated at 125 mmHg for an average of 25 days before skin grafting, while gauze patients were treated at 80 mmHg for an average of 21 days before skin grafting. Biopsies of granulation and scar tissues were taken and stained with hematoxylin-eosin and Masson's trichrome stainings, investigating vascular endothelial growth factor (VEGF) and metalloproteinase (MMP). An ultrasound analysis of the closed wounds was also conducted. Results Histological, immunohistochemical, and ultrasonographical results after gauze-based NPWT showed a minor tissue thickness and disorganization and less sclerotic components. Conclusions These results support the hypothesis that different fillers generate different scar tissues. The choice of the filler to apply negative pressure should be dictated by the anatomical areas affected by the lesion. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2014-05-16
  • Merkel cell carcinoma: a single-centre experience
    • Abstract: Background For patients with merkel cell carcinoma (MCC), the status of regional lymph nodes at presentation is the single most important prognosticating tool, and the procedure is used for managing MCC patients with early stage disease identifying regional nodal micrometastasis. Methods A retrospective study was conducted of MCC patients treated at the University Hospital of Aarhus, Denmark, between 1998 and 2013. Outcomes of interest included the time and type of first recurrence after first treatment. In 2010, our institution began using sentinel lymph node biopsy (SLNB) for MCC patients with clinically early stage disease. Results Thirty four patients were identified, 61.8 % of the patients presented with stage I disease, 21.5 % with stage II, 11.8 % with stage III and 5.9 % with stage IV. Thirteen patients (38.2 %) had disease recurrence, with local recurrence in three patients, regional recurrence in seven patients and distant recurrence in three patients. Median length of follow-up for all patients was 14.5 months (range 0–86). Since 2010, SLNB has been performed in seven patients; all with negative sentinel lymph nodes (SLN). Three patients had tumour located to the head and neck, three patients to the extremities and one patient to the truncus. Nodal recurrence developed in one of these patients after 5.9 months. Conclusions The majority of patients develop recurrence within the first 2 years after initial treatment, most representing with nodal metastasis. The introduction of SLNB may hopefully detect nodal involvement in an early stage, improving the outcome for patients with MCC. Level of Evidence: Level IV, risk/prognostic study.
      PubDate: 2014-05-09
  • Unusual midline mandibular fistula
    • Abstract: Abstract Congenital midline upper lip sinus is a rare lesion. However, congenital midline mandibular skin tag combined lower lip fistula is very rarely reported and described. Therefore, a case report of a congenital midline sinus of the mandibular area in a 6-year-old female is presented. A 6-year-old girl presented with a nipple-like swelling on the mandibular area. Physical examination revealed about 5 × 5 mm protruding round mass with just a small opening that was non-tender to palpation. The tract is excised using probe and dye as the guide. Postoperatively, simple radiologic finding shows retained bony spur on the mandibular symphysis. Microscopic examination of the resected mass revealed the fistulous tract itself, consisting of fibrous connective tissue covered with stratified squamous epithelium, was observed in the center of the sample and especially showed dental component in the peripheral specimen. In the 6-month follow-up, this patient had a good result which was obtained by the method of the excision of the mass and fistulectomy. Level of Evidence: Level V, diagnostic study.
      PubDate: 2014-05-09
  • Successive uneventful pregnancies immediately following bilateral TRAM
           flap harvest
    • Abstract: Abstract We here report a 37-year-old woman who had two successful pregnancies following a bilateral harvest of transverse rectus abdominis musculocutaneous (TRAM) flap. The abdominal wall was firmly repaired by component separation as well as external oblique fascial patch grafts. Although she had a scar from a cesarean section and the recovery interval between the harvest and the first postreconstructive pregnancy was less than 2 months, each pregnancy and delivery was uneventful. With the popularization and improvement in TRAM breast reconstruction, there may be an increase in the number of pregnancies without physician’s approval. Our case revealed that a large bilateral anterior sheath defect can be firmly repaired to endure immediate pregnancy without using any synthetic material. Level of Evidence: Level V, risk/prognostic study.
      PubDate: 2014-04-25
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