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Diabetology Intl.     Hybrid Journal   (Followers: 1, SJR: 0.273, h-index: 5)
Dialectical Anthropology     Hybrid Journal   (Followers: 9, SJR: 0.314, h-index: 9)
Die Weltwirtschaft     Hybrid Journal   (Followers: 2)
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: 5, 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: 100, 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: 2, 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: 92, 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: 16, 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: 84, 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)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4, SJR: 1.4, h-index: 17)
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: 2, 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)

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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  [2291 journals]
  • Non-infective bilateral upper limb subcutaneous emphysema following elbow
    • PubDate: 2015-08-01
  • Multilayer tutoplast-processed fascia lata use in revision rhinoplasty for
           overresected dorsum
    • Abstract: Background Several grafting materials have been used in revision rhinoplasty to correct overresected dorsum. Autologous materials are generally preferred, but have the drawbacks of additional surgical time and donor site morbidity. Tutoplast-processed fascia lata (TPFL) offers a commercially available alternative to autologous fascia grafts. We reviewed the results of 42 revision rhinoplasty procedures that used TPFL with or without autologous cartilage to correct overresected dorsum. Methods Forty-two patients with overresected dorsum underwent revision rhinoplasty with multilayered TPFL at our institution between 2005 and 2012. Saddle nose deformities were classified into one of three types, according to severity. Surgical results were evaluated as excellent, good, or fair by an otolaryngologist who compared preoperative photographs with pictures taken at final follow-up. Surgical complications were analyzed. Results Of the 42 patients who underwent rhinoplasty with multilayered TPFL, 36 were treated with TPFL alone, while autologous cartilage was used concurrently in six. Twenty-six (62 %) of the patients showed excellent aesthetic improvement, 11 (26 %) showed good improvement, and five (12 %) showed fair improvement. There were no major complications. Minor complications included edema in six patients, major resorption in three, and minimal resorption in nine. Patients with mild or moderate saddle nose deformity had better surgical results than those with more severe deformity. Conclusions There are many possible methods to correct overresected dorsum. Multilayer TPFL is safe alternative to autologous rib cartilage grafts. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2015-08-01
  • Simplified skin excision pattern for skin-sparing/reducing mastectomy and
           direct-to-implant single-stage immediate (DISSI) breast reconstruction
    • Abstract: Background One-stage implant-based breast reconstruction with minimal scarring is a highly appealing option to most patients. In fact, expander/implant reconstruction accounts for nearly 70 % of all breast reconstructions. We present our experience with a simplified skin-preserving/reducing excision pattern in association with immediate breast reconstruction using permanent expander or prosthesis. Methods Thirty-two patients with 45 reconstructed breasts (unilateral or bilateral) between February 2010 and March 2014 are included in this study. All implants, except for two reconstructed breasts, were placed in a dual plane. Implants used were either a permanent expander or permanent silicone prosthesis. Results Two patients developed postoperative infections requiring removal of the implants. Minor wound dehiscence without implant extrusion occurred in one breast. One breast had a late deflation of the permanent expander secondary to trauma. Another patient required postoperative revision with fat grafting to improve breast contour. Conclusions One-stage prosthetic-based immediate breast reconstruction is a safe option with gratifying outcomes provided adequate patients’ selection and enough surgeons’ expertise to perform it. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2015-08-01
  • Transient purpura after axillary dissection due to malignant melanoma
    • PubDate: 2015-08-01
  • The vertical pedicled DIEP flap: an alternative for large perineal
           reconstructions after tumour excision
    • Abstract: Abstract Traditionally, the vertical rectus abdominis muscle (VRAM) flap has been used as a robust and effective loco-regional reconstruction for perineal defects. We present a unique approach using a vertical skin paddle pedicled deep inferior epigastric artery perforator (DIEP) flap for the management of large perineal defects following colorectal tumour excision. As a colorectal and plastic surgery tertiary referral centre, over the last 5 years, we have developed a vast experience in reconstructing these defects in collaboration with our general surgical colleagues in the multidisciplinary setting. Our main reconstructions consisted of pedicled VRAM flaps, although we have used other local and free flap options when and as required. We have since moved towards this improved technique of the pedicled DIEP flap reconstruction and present our initial experience, highlighting its main advantages, particularly over the VRAM flap. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-08-01
  • Giant plexiform neurofibroma of the upper limb and anterior chest wall:
           case report and review of the literature
    • Abstract: Abstract Plexiform neurofibroma is generally accepted as a component of neurofibromatosis type 1. It is frequently seen on the head and neck regions, and extremity involvement is rare. In this report, a case of giant plexiform neurofibroma located on the upper extremity and anterior chest wall is presented. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-08-01
  • Mirror ear—surgical correction of this rare external ear anomaly: A
           case series
    • Abstract: Background Mirror ear, also known as polyotia, is an infrequently reported form of external ear malformation characterized by morphologic and dimensional similarity to a normal pinna. The condition has been described in association with various syndromes, and in isolation. However, as the data with specific relevance to polyotia is sparse, not only are the precise causative processes of mirror ear unknown, but the paucity of documented cases also lends the operative approach to be daunting. Methods Six patients with eight mirror ears underwent surgical reconstruction at Great Ormond Street Hospital for Children. All children were followed from infancy and reviewed in a multidisciplinary setting to coordinate aspects of their care—including plastic surgery, maxillofacial surgery, dentistry, audiology, speech and language pathology, and psychiatry where relevant. Concurrent surgical procedures in addition to mirror ear correction occurred in four patients. Results Pleasing results were achieved in all cases, as reconstruction employed a bespoke approach. Nonetheless, there were unifying principles adhered to, which began in the planning stages by assessing the morphology of the anomalous ear and evaluating the accessory cartilage available for utilization. Deliberate positioning of the incisions, exploiting cartilage remnants to fill the depression of the mirrored ear, and manipulation of excess tissue to reconstruct an anatomically sound tragus were crucial to achieving agreeable aesthetic results. Conclusions Given that it is rarely encountered, the successful reconstruction of a mirrored ear requires a thoughtful surgical approach. With this report, we provide a comprehensive review of this unique type of ear deformity, significantly add to the documented cases of polyotia, and describe our operative technique to recreate a tragus that throws a natural shadow in the conchal bowl and shields the external auditory meatus. Level of evidence: level V, therapeutic study.
      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
  • Does the arrow flap associated with dermal platform really improve
           long-term nipple projection'
    • PubDate: 2015-07-25
  • Vancomycin-related partial necrosis of congenital hemangioma
    • Abstract: Abstract The term hemangioma refers to the common tumor of infancy that exhibits rapid postnatal growth and slow regression during childhood. Infantile hemangiomas are benign vascular neoplasms that develop from the dermal capillary network. Vancomycin is a bactericidal antibiotic agent commonly used in the treatment of infections caused by Gram-positive organisms. The most common adverse effect of intravenously administered vancomycin is “red man syndrome” (RMS), which is associated with the rapid infusion of large doses of vancomycin. This reaction is secondary to mast cell degranulation and is characterized by erythema, pruritus, flushing of the upper torso, and, in severe cases, angioedema and (rarely) cardiovascular complications. We present the case of a 3.5-month-old girl who developed partial hemangioma necrosis secondarily to RMS following intravenous administration of vancomycin for the treatment of Gram-positive bacteremia. Level of Evidence: Level V, prognostic / risk study.
      PubDate: 2015-07-22
  • 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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