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Diabetologia Notes de lecture     Hybrid Journal  
Diabetology Intl.     Hybrid Journal   (Followers: 1, SJR: 0.273, h-index: 5)
Dialectical Anthropology     Hybrid Journal   (Followers: 8, 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: 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: 236, 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: 13, 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: 6, 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: 9, 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: 10, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 232, SJR: 0.366, h-index: 16)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 17, SJR: 0.374, h-index: 15)
Educational Psychology Review     Hybrid Journal   (Followers: 15, SJR: 2.776, h-index: 61)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 7, 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: 218, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 13, SJR: 0.336, h-index: 18)
Electrocatalysis     Hybrid Journal   (SJR: 0.883, h-index: 10)
Electronic Commerce Research     Hybrid Journal   (Followers: 4, 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  
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: 5, SJR: 1.285, h-index: 39)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 2, SJR: 0.361, h-index: 15)
Endocrine     Hybrid Journal   (Followers: 5, SJR: 0.878, h-index: 57)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.638, h-index: 31)
Energy Efficiency     Hybrid Journal   (Followers: 11, SJR: 0.732, h-index: 14)
Energy Systems     Hybrid Journal   (Followers: 10, 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: 18, SJR: 1.632, h-index: 54)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 4, 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: 11, SJR: 0.724, h-index: 63)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 6, SJR: 0.524, h-index: 4)
Environmental Evidence     Open Access  
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 2, SJR: 0.437, h-index: 24)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 2, 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: 11, SJR: 0.533, h-index: 31)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 8, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 14, SJR: 0.885, h-index: 46)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 3, SJR: 1.4, h-index: 17)
Epileptic Disorders     Hybrid Journal   (Followers: 1, 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: 3, 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)

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Journal Cover   European Journal of Plastic Surgery
  [SJR: 0.171]   [H-I: 14]   [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  [2302 journals]
  • 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: 2015-03-14
  • 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: 2015-03-13
  • Transient purpura after axillary dissection due to malignant melanoma
    • PubDate: 2015-03-13
  • Chemical burns from topical use of traditional Chinese medicine
    • PubDate: 2015-03-13
  • Hot oil burns in Scotland: seasonal and ethnic patterns of presentation
    • PubDate: 2015-03-12
  • Modification of the anterolateral thigh free flap design for
           reconstruction after laryngo-pharyngoesophagectomy
    • Abstract: Abstract The anterolateral thigh free flap (ALTFF) has become the favourable fasciocutaneous flap for reconstruction of laryngo-pharyngoesophagectomy (LPO) defects. Reconstruction of these defects can be challenging. We report our experience with a new flap design based on the traditional ALTFF template for single-stage reconstruction of circumferential LPO defects with anterior neck skin deficits in previously irradiated patients. The design uses the traditional tubed skin island to create the neopharynx and also utilises the natural dog-ears from the thigh as a second vascularised skin island that can be used to fill dead space or externalised to resurface the neck. This addresses the issues of monitoring the internal skin paddle and also of replacing anterior neck skin deficits with a single flap. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-03-11
  • 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: 2015-03-07
  • The reconstructive challenges of electrical burns to the scalp: A case
    • Abstract: Abstract Soft tissue or bony loss to the scalp and forehead present a reconstructive challenge, especially in the young patient. Much literature is available on scalp and forehead reconstruction for primary malignant pathologies, however reconstruction for contact electrical burns is reported infrequently in the literature. This case series looks at two patients with full thickness burns to the scalp and forehead requiring free flap reconstruction over 11 years at the Burns Unit at Royal Perth Hospital in Perth, Western Australia. We describe the flap reconstruction and outcomes of these patients and review the relevant literature. Three free flap reconstructions were performed on the two patients. The first patient had a free gracilis flap which failed five days post-operatively. 25 days post initial injury a free rectus flap was used to cover the predominantly forehead defect. The second patient had a free latissimus dorsi flap completed one week after initial injury. Free flap reconstruction of scalp and forehead following contact electrical burns is complicated and challenging. The outcomes of both of the patients in this case series was positive and both have had satisfactory flap survival at the time of writing. Due to rare nature of this type of burn there is little published evidence outlining the definitive management of this type of injury. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-03-06
  • Reconstruction of calvarial and scalp defects using anterolateral thigh
           free flaps: A case series
    • Abstract: Background Regardless of underlying cause, calvarial and scalp reconstruction can be a challenging task. With increasing defect size, the local options also decrease, and in moderate to large sized defects, a free flap reconstruction is usually required. Since 2007, we have used the anterolateral thigh (ALT) flap as our flap of choice, and we present our results with this flap. Methods The study was a retrospective case series in a university hospital setting. All patients who had this procedure performed were included until October 2014, and their data was retrieved from electronic patient records. Results In total, eight patients were reconstructed with an ALT flap for calvarial (six) or scalp (two) reconstruction. The flaps used were fasciocutaneous (four), myocutaneous (three), and adipofascial (one). All patients were male with a mean age of 59 years. The median flap length was 22.5 cm and median flap width was 8 cm. All flaps survived. One patient was offered a revision procedure because of color mismatch, but this was cancelled as the patient requested hair transplantation in a private setting. No donor site morbidity was noted in any of the patients. Conclusions The ALT flap is very versatile and can be harvested in a number of different ways according to defect requirements. It has minimal donor site morbidity and is the optimal flap option for calvarial and scalp reconstruction, although still insufficient regarding to color mismatch and lack of hair. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-03-06
  • 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: 2015-03-05
  • 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: 2015-03-03
  • Subjective psychic perception versus objective nasofacial measures in
           assessment of rhinoplasty results: A clinical report
    • Abstract: Background Rhinoplasty has become one of the main performed cosmetic surgeries. One of the main success factors for this type of surgeries is patients’ satisfaction; some of the patients are hardly satisfied with the postoperative results. Therefore, finding reliable, valid, agreeable, and effective evaluation tools for subjective and objective assessment of the rhinoplasty results is of great importance for both patients and surgeons. Methods Forty rhinoplasty patients were included in this work. The patients were evaluated by three methods objectively and subjectively; as patients’ and doctors’ satisfaction (subjective) and comparing that with the parameters of the ideal aesthetic nose that measured on the postoperative computer nasofacial images (objective). Results There was a highly significant difference between patients’ and surgeons’ satisfaction scores both pre- and postoperatively. Patients, more than 20 years old were more satisfied than the younger ones. The measured nasal parameters showed a significant difference in both the angles and ratios pre- and postoperatively. Conclusions Rhinoplasty is the aesthetic surgery that has the lowest satisfaction rate. Identifying good candidates to the procedure is fundamental to obtain good results. This study emphasizes the importance of using evaluative tools to subjectively and objectively assess rhinoplasty patients. The used evaluating tools appear to be internally consistent and valid brief instrument for assessing rhinoplasty patients, their aesthetic status and their surgical results. Level of Evidence: Level IV, risk/prognostic study.
      PubDate: 2015-02-27
  • Experience of 592 free tissue transfers: the case for clinical assessment
           alone to monitor free flaps
    • Abstract: Background Monitoring the microcirculation postoperatively has been the subject of numerous original articles and reviews since the early 1980s. Effective monitoring returns compromised flaps to the operating room early, increases the flap success and reduces secondary complications. We would like to present the case based on our experiences that clinical monitoring alone is sufficient for the majority of patients. Methods Using a retrospective case note review, we present the experiences of the senior surgeon (DG) in his first 592 consecutive free tissue transfers in practice. Results The overall success rate was 98.9 % (585/592) with an overall salvage rate of 93 % (13/14). Conclusions Clinical monitoring provides sufficient reassurance in the majority of patients undergoing free tissue transfers. We believe that buried flaps and flaps to the lower limb may warrant adjunctive monitoring techniques on a case-by-case basis. Level of Evidence: Level IV, diagnostic study.
      PubDate: 2015-02-26
  • The use of triamcinolone combined with surgery in major ear keloid
           treatment: a personal two stages approach
    • Abstract: Background Keloid is a fibroproliferative disorder characterized by an abnormal deposition of collagen within a wound. Despite an increased understanding of wound healing and collagen metabolism, the exact cause, the clinical behavior, and gold standard of treatment for keloids remain an enigma. There is no one right way of treatment, the results are variable, and the management of ear keloids can be difficult and frustrating both for patients and physicians. Traditional techniques include intralesional steroids, topical applications of silicone, vitamins, and segmental excision by lasers or surgery. The purposes of this article are to review the literature concerning the current therapies as well as to present the authors’ experience in the treatment of major ear keloids. Methods Twenty-seven consecutive black race patients (18 cases and 9 controls) underwent surgery for major keloids of the external ear at the Plastic and Reconstructive Surgery Unit of University of Palermo. The authors performed the radical excision and intralesional triamcinolone acetonide injection intraoperative and 1 month after surgical treatment. Results No complications were noticed in the early postoperative period, and no recurrence was noticed in all the patients. Conclusions The radical excision and the intralesional triamcinolone acetonide injection appear to be a successful option of treatment for major ear keloids. Compared to other methods, it does not necessitate several stages of treatment, moreover, it has the advantages to lower the risk of recurrence, the healing process is rapid, and improvement of quality of life is significant. Level of evidence: Level IV, therapeutic study
      PubDate: 2015-02-25
  • Free and pedicle flaps in lower extremity trauma
    • Abstract: Abstract Improvements in microsurgical techniques and perioperative management have led to more attempts at limb salvage surgery after severe extremity trauma. Although some microsurgery-trained orthopedic surgeons will perform extremity soft tissue reconstruction, many rely on plastic surgeons or hand surgeons. However, the orthopedic trauma surgeon often remains the principle decision maker in the follow-up of these patients. Therefore, orthopedic surgeons should have a clear understanding of the planning and execution of flap reconstruction of the traumatized extremities. Collaboration with the microsurgery team will also improve planning of orthopedic procedures and facilitate a better understanding of the expected outcomes after tissue transfer. This becomes especially important when considering, debridement, early amputation versus extensive soft tissue reconstruction and when discussing these alternatives with patients and family as well as postoperative course. The goals of this article are to provide orthopedic trauma surgeons with an understanding of the selection, planning, and execution of tissue transfers for posttraumatic extremity reconstruction and to review their successes and outcomes in the literature. Communication between teams involved in reconstruction of the traumatized extremity and an understanding of limitations are paramount to successful outcomes after reconstruction. Level of Evidence: Not ratable.
      PubDate: 2015-02-18
  • 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: 2015-02-11
  • Concurrent Poland’s syndrome and gynaecomastia: achieving the
           balance using lipomodelling
    • Abstract: Abstract The occurrence of both Poland’s syndrome and gynaecomastia in the same patient is extremely rare. This is only the second report in the medical literature. These distinct deformities of the chest wall have very different aetiologies. Poland’s syndrome is a heterogeneous congenital condition thought to be a consequence of a developmental hypoxic insult between 6 and 8 weeks of gestation as the upper limb and chest musculature develops. It encompasses a spectrum of congenital anomalies, characterised by hypoplasia or agenesis of the pectoralis muscles, breast, nipple areolar complex, soft tissue and upper limb skeletal anomalies. It is usually unilateral. Gynaecomastia by contrast is the benign enlargement of breast tissue in males. Aetiology in adult patients includes systemic disease, hormone imbalances and drugs, and may be unilateral or bilateral. We report the case of a 46-year-old man who presented with chest wall asymmetry. The Poland’s syndrome affecting his right chest had only become apparent with the development of a contralateral gynaecomastia. Surgery was performed with liposuction and nipple-preserving skin reduction of the gynaecomastia. The harvested fat from the breast was used with additional abdominal wall fat and transferred to the right chest defect caused by Poland’s syndrome. This is the first time that lipomodelling has been reported in the reconstruction of Poland’s syndrome using fat transferred from the contralateral breast. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-02-04
  • Melanocytic tumours of uncertain malignant potential (MELTUMPs)—a
           diagnostic and management dilemma
    • Abstract: Background Melanocytic tumours of uncertain malignant potential (MELTUMPs) represent melanocytic proliferations within the dermis and are thereby associated with a potential risk of disease dissemination and metastases. However, there is a paucity of data regarding these lesions, their malignant potential and thus their management. Methods This is a retrospective evaluation of all MELTUMPs treated in a single tertiary plastic surgery unit to establish patient demographics, clinical management and outcomes including recurrence and regional and distant metastases. Results Forty-two patients were treated for MELTUMPs between 2005 and 2011 in our unit. The mean Breslow thickness was 0.85 mm (range in situ disease to 5 mm). A complete data set was available for 37 of these patients, of whom, 32 (86 %) underwent wider excision with a 1-cm margin and 5 (14 %) with 2-cm margin. The mean follow-up time was 23 months (range 2 to 48 months). One patient developed locally recurrent disease, one patient developed regional metastases and one patient died of metastatic disease. Conclusions MELTUMPs present a diagnostic and management dilemma with a paucity of agreed strategies for ongoing patient care. We propose that all MELTUMPs should be treated using a melanoma strategy under the care of a skin cancer multidisciplinary team. Level of Evidence: Level IV, risk / prognostic study.
      PubDate: 2015-02-01
  • Penile epidermal inclusion cyst: the importance of surgical care
    • PubDate: 2015-02-01
  • Orofacial cleft outreach in rural Ghana: any positive impact on the
    • Abstract: Background Orofacial clefts (OFC) are common congenital malformations in humans. They impact negatively on the life of the affected and often regarded as stigma in the society especially among the rural folks. The aim of this study was to analyze retrospectively the cases managed by a Ghanaian indigenous plastic surgery outreach team and prospectively outline the social impacts on the lives of those treated and their communities. Methods The study reviewed the medical records of patients treated during OFC outreaches in rural Ghana from January 2003 to December 2012 (10 years). This involved visiting and interviewing patients and their parents/relatives, as well as the community leaders comprising chiefs, assemblymen, church leaders, etc., using structured pretested questionnaires within 5 days (September 1–5, 2013) in communities in southeast of Ghana. Results A total of 32 outreach services were handled over the 10-year period, treating 303 OFC patients (among other pathologies), comprising 175 (57.8 %) males and 128 (42.2 %) females. Out of the 303, 159 (52.5 %) were located and interviewed; also, 65 community/opinion leaders/relatives were interviewed. Sixty-one percent (61 % = 35 patients) of the females and 48 % (n = 49) of the males got married after the surgery; 83 % (n = 45) of the school-going-age patients continued and completed basic schools. Conclusions OFC outreaches help to restore the lives and dignity of cleft patients and their families improving their quality of life. Stigmatization and psychological effects on them were removed; they were well accepted in their societies and family gatherings. Level of Evidence: Level III, risk-prognostic study.
      PubDate: 2015-02-01
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