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Differential Equations     Hybrid Journal   (Followers: 2, SJR: 0.364, h-index: 15)
Differential Equations and Dynamical Systems     Hybrid Journal   (Followers: 1, SJR: 0.63, h-index: 7)
Digestive Diseases and Sciences     Hybrid Journal   (Followers: 4, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 2, SJR: 1.269, h-index: 40)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 3, 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: 98, SJR: 0.822, h-index: 52)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 9, SJR: 0.279, h-index: 9)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 14, SJR: 0.466, h-index: 16)
Earth Science Informatics     Hybrid Journal   (Followers: 3, SJR: 0.282, h-index: 7)
Earth, Moon, and Planets     Hybrid Journal   (Followers: 7, SJR: 0.303, h-index: 29)
Earthquake Engineering and Engineering Vibration     Hybrid Journal   (Followers: 7, SJR: 0.482, h-index: 21)
Earthquake Science     Hybrid Journal   (Followers: 8, SJR: 0.418, h-index: 9)
East Asia     Hybrid Journal   (Followers: 7, SJR: 0.18, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 9, SJR: 0.362, h-index: 27)
EcoHealth     Hybrid Journal   (Followers: 3, SJR: 0.88, h-index: 26)
Ecological Research     Hybrid Journal   (Followers: 8, SJR: 0.847, h-index: 43)
Economia e Politica Industriale     Hybrid Journal  
Economia Politica     Hybrid Journal   (SJR: 0.375, h-index: 6)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.527, h-index: 44)
Economic Bulletin     Hybrid Journal   (Followers: 4)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.264, h-index: 9)
Economic Theory     Hybrid Journal   (Followers: 9, SJR: 2.557, h-index: 34)
Economic Theory Bulletin     Hybrid Journal   (Followers: 2)
Economics of Governance     Hybrid Journal   (Followers: 2, SJR: 0.408, h-index: 14)
Ecosystems     Hybrid Journal   (Followers: 19, SJR: 1.909, h-index: 93)
Ecotoxicology     Hybrid Journal   (Followers: 9, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 97, 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: 18, 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: 14, SJR: 0.825, h-index: 32)
Educational Technology Research and Development     Partially Free   (Followers: 86, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 16, 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: 30, 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: 13, 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: 3, 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: 33, 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: 10, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 15, SJR: 0.885, h-index: 46)
Epileptic Disorders     Hybrid Journal   (SJR: 0.608, h-index: 38)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.287, h-index: 63)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 2, SJR: 0.731, h-index: 89)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.641, h-index: 62)
EPMA J.     Open Access   (SJR: 0.284, h-index: 6)
ERA-Forum     Hybrid Journal   (Followers: 3, SJR: 0.128, h-index: 3)
Erkenntnis     Hybrid Journal   (Followers: 14, SJR: 0.621, h-index: 16)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.206, h-index: 9)
Esophagus     Hybrid Journal   (SJR: 0.311, h-index: 10)
Estuaries and Coasts     Hybrid Journal   (Followers: 7, SJR: 1.332, h-index: 67)
Ethical Theory and Moral Practice     Hybrid Journal   (Followers: 11, SJR: 0.297, h-index: 10)
Ethics and Information Technology     Hybrid Journal   (Followers: 88, SJR: 0.484, h-index: 23)
Ethik in der Medizin     Hybrid Journal   (SJR: 0.163, h-index: 6)

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Journal Cover   European Journal of Plastic Surgery
  [SJR: 0.171]   [H-I: 14]   [2 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1435-0130 - ISSN (Online) 0930-343X
   Published by Springer-Verlag Homepage  [2280 journals]
  • Dual-incision approach for excision of postauricular sinus
    • PubDate: 2015-10-05
  • Evaluation of the use of vacuum-assisted closure (VAC) and platelet-rich
           plasma gel (PRP) in management of complex wounds
    • Abstract: Background “Complex wounds” is a term used to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. To compare the healing of complex wounds using vacuum-assisted closure (VAC) and platelet-rich plasma (PRP). Methods Forty adult patients, suffering from complex wounds, were equally allocated to either group I (VAC) or group II (PRP) using stratified sequential allocation method. Patients’ opinion of both groups was assessed through a questionnaire. Evaluation of the wound was through main and associate assessment parameters using clinical observation and check list. Results There was no significant demographic or wound size and grade difference between patients of both groups. Wounds of both groups became significantly smaller compared to their initial size at the end of the study period. PRP was associated with significantly less pain in the wound. Significantly higher healing percentage was observed in VAC group but with no significant difference in the hospital stay from PRP group. Conclusions Both modalities attained sound healing as well as a significant decrease in the wound size at the end of follow-up period. VAC was significantly superior in highly exudative and deep wounds. Level of Evidence: Level III, therapeutic study.
      PubDate: 2015-10-01
  • Medial sural artery perforator flap: a challenging free flap
    • Abstract: Background Oral and extremity defect reconstruction can often require a flap that is thin, and traditionally, the radial forearm free flap has been used, however, this has significant donor site morbidity. Over the last decade, the medial sural artery perforator (MSAP) flap has emerged as a possible alternative with lower donor site morbidity. We present our experiences and review the literature regarding this promising but challenging flap. Methods The study was a retrospective case series in a university hospital setting. All patients who had a MSAP flap performed at our institution were included until March 2015, and their data was retrieved from electronic patient records. Results In total, ten patients were reconstructed with a MSAP flap for floor of mouth (eight) and lower extremity (two) defect reconstruction. The median flap dimensions were as follows: 10 cm (range 7–14 cm), width 5 cm (range 3.5–8 cm), thickness 5 mm (range 4–8 mm), and pedicle length 10 cm (range 8–12 cm). In one case, the procedure was abandoned because of very small perforators and another flap was used. In two cases, late onset of venous congestion occurred which could not be salvaged. There were no donor site complaints. Conclusions The MSAP flap is an ideal flap when a thin free flap is needed with lower donor site morbidity than alternative solutions. There seems to be a higher rate of late onset of venous thrombosis compared with more established flaps. Therefore, this flap should be monitored more closely for venous problems and we recommend performing two venous anastomoses when using this flap. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2015-10-01
  • Novel use of the superficial inferior epigastric vein lifeboat in DIEP
           flap harvest
    • Abstract: Abstract Deep inferior epigastric artery perforator (DIEP) flap reconstruction has become a well-established procedure for breast reconstruction. While vascular compromise is not common, venous congestion is the most commonly reported cause of such compromise, and of those that may require re-exploration, insufficient venous drainage is the most common cause. In such cases, flap salvage may require establishment of a secondary venous outflow source. In a standard unilateral breast reconstruction with a DIEP flap, zone IV is discarded, with the intra-flap segment of the superficial inferior epigastric vein (SIEV) unused. We describe the novel approach of harvesting the SIEV within zone IV and banking within the breast pocket near the contralateral superficial vein should it be required for further salvage surgery. Our approach involves harvest of the SIEV on a side table (which allows simultaneous operating), flushing the graft with heparinized saline, and tagging the proximal end with an 8/0 nylon suture. This vein graft is then transferred and banked at the breast recipient site, near the flap vein where it is likely to be required. This simple step prevents further morbidity of a secondary donor site and reduces operative time should re-exploration be required. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-10-01
  • A blinking periorbital prosthesis using surface electromyographic signals
           of the orbicularis oculi muscle
    • Abstract: Background Recent advances in human–machine interface technology have enabled the development of multifunctional, primarily orthopedic myoelectric prostheses. We developed a noninvasive blinking periorbital prosthesis that can synchronize with blinking of the intact eyelid by using surface electromyographic signals of the orbicularis oculi muscle. Methods Myoelectric potentials of the orbicularis oculi muscle while blinking were measured with surface electrodes on the eyelid in four healthy adults. Possible cross talk introduced via the electrodes was also measured and assessed to determine whether cross talk would affect surface electromyographic measurements while blinking. Results The amplitude of the surface myoelectric potential of the orbicularis oculi muscle was sufficiently high for the practical use of blinking prostheses. Our blinking model was successfully synchronized with blinks of the subjects’ eyelids under experimental conditions without cross talk between the orbicularis oculi muscle and other muscles. Conclusions Although our study revealed several problems, the use of surface electromyographic signals could be a promising and useful technique for synchronizing blinking of the prosthetic eyelid with blinking of the intact eyelid. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-10-01
  • Loupe magnification for head and neck free flap reconstruction in a
           developing country
    • Abstract: Background Free tissue transfer has become the standard of care for the reconstruction of head and neck oncological defects. The Groote Schuur Hospital provides a microsurgical reconstructive service in a resource-limited setting, without access to venous couplers, invasive monitoring devices, modern microscopes or sophisticated pre-operative imaging. The reconstructive surgeons perform all anastomoses under ×4.5 loupe magnification. Methods A retrospective chart review was undertaken of cases performed by the service over a 3-year period. Demographic factors, indications for flap cover, operative details (flap used, duration and lowest recorded temperature), intensive care and hospital length of stay, and other outcomes were recorded and evaluated (including flap and systemic complications, donor site morbidity, haematomas as well as returns to theatre). Results Over a 36-month period, 109 flaps for head and neck reconstruction were performed. The main indication for surgery was squamous cell carcinoma of the oral cavity. The mean operating time for resection and reconstruction was 6.02 h (range of 4 to 12 h). Virtually, all reconstructions were performed using one of either radial forearm, free fibula or anterolateral thigh flaps. We report a complete flap loss rate of 6 %. All four successful salvages were undertaken in the early (less than 24 h) post-operative period. Hypothermia intra-operatively appears to correlate very closely with pejorative outcomes. Conclusions By restricting reconstructive options to three main ‘workhorse’ flaps and by utilising a simultaneous two-team approach for tumour ablation and flap elevation, success rates comparable to international standards have been achieved. Limited resources should not be regarded as an impassable barrier to providing a successful microvascular head and neck reconstructive service. Level of Evidence: Level III, risk/prognostic study.
      PubDate: 2015-10-01
  • Multidisciplinary management of risk-reducing mastectomy and immediate
           reconstruction: treatment algorithm and patient satisfaction
    • Abstract: Background Mutations in breast cancer type 1 and type 2 (BRCA 1/2) genes have been identified in populations expressing a strong family history of breast and ovarian cancers and account for 5–10 % of cases of breast cancer. The options for reconstruction in this cohort can be challenging because of the young age at which many patients present the sizeable defect and the psychosocial effect it has on their lives. A multidisciplinary one-stop clinic (MDOSC) is fundamental to their management Methods Our study included 91 patients, from July 2007 to July 2012, who underwent RRM with immediate autologous or implant-based reconstruction within our department. Women were invited to participate in the study post surgery and completed a validated Breast-Q questionnaire detailing their experience in a number of domains including body image and perception, sexuality, and cosmetic outcome. Patients were also invited to attend an individual interview for further analysis of patient experience and expectations. Results Using the questionnaire responses and private interview content, a detailed analysis of BRCA patient experience was achieved. The main concerns identified included expectations regarding the outcome and the dissatisfaction rates, less than 20 %, correlated with postoperative complication rates. Patients emphasized the importance of careful preoperative consultation with a multidisciplinary team, and >90 % cited a desire to recommend RRM with immediate reconstruction to other patients that met similar criteria. Conclusions RRM with immediate reconstruction is a good option for this unique group of patients; BRCA positive and overall patient satisfaction is high. Our study also highlights the significance of a multidisciplinary team working toward improving patient experience and outcome as well as managing patient expectations prior to surgery. Level of Evidence: Level III, risk/prognostic study.
      PubDate: 2015-10-01
  • Implant exposure repaired combining the use of acellular dermal matrix and
           lateral thoracodorsal flap
    • PubDate: 2015-10-01
  • Apocrine carcinoma of the nasal alar rim
    • Abstract: Abstract Apocrine carcinoma is a rare and potentially highly aggressive cutaneous adenocarcinoma, normally seen in areas rich in apocrine glands. An apocrine carcinoma was diagnosed following excisional biopsy of a nasal rim lesion and expert review of the histology. It represents the first reported case in this area. Following exclusion of further lesions by PET CT, a wide local excision was performed curatively, followed by a three-stage reconstruction with a nasolabial flap to correct the defect. Management of such rare lesions is difficult and is best directed, as in this case, by specialist pathological input and through a specialist MDT. Level of Evidence: Level V, diagnostic study.
      PubDate: 2015-10-01
  • Surgical treatment of isolated trapezoid bone pseudarthrosis: A case
    • Abstract: Abstract Isolated trapezoid fractures are rarely observed. Clinical suspicion is necessary for a diagnosis that is usually delayed or missed. There is no consensus on whether treatment modalities should be conservative or surgical. A 20-year-old female patient complained of pain, and an MRI examination showed a non-union fracture of the trapezoid bone. Surgical treatment using a headless cannulated screw and grafting was performed for trapezoid pseudarthrosis. Clinical and radiological results were satisfactory. Level of Evidence: Level V, diagnostic study.
      PubDate: 2015-10-01
  • Abdominal wall neuropraxia: a previously unreported complication of
           latissimus dorsi flap breast reconstruction
    • Abstract: Abstract The latissimus dorsi flap is one of the most commonly used in breast reconstruction. We report the case of a 61-year-old female, who developed abdominal wall neuropraxia as a complication of latissimus dorsi free flap harvest. The cause of injury was compression of the T8–T12 spinal root outlets due to lateral spinal flexion during the procedure, which caused demyelination of the nerve roots. This complication is previously unreported in the literature. Level of Evidence: Level V, risk/prognostic study.
      PubDate: 2015-10-01
  • Use of Spongostan™ for pedicle stabilisation in head and neck
           microvascular reconstruction
    • PubDate: 2015-10-01
  • Use of an acellular dermal template for defect coverage on the penile
    • Abstract: Abstract Skin defects of the penile shaft, caused by trauma, infection, or iatrogenically after surgery are commonly treated with skin grafts. A suboptimal postoperative outcome after the use of skin grafts is affected by the trend towards wound bed and skin graft contraction in this often-expanding region. We report on our experience using a new technique for defect coverage of the penile shaft with respect to its elasticity demands during erection and its mechanical demands during sexual intercourse. Furthermore we would like to illustrate the advantages of the application of a dermal substitute together with split-thickness skin grafts compared to the use of split-thickness skin grafts alone. At the follow-up, the patient did not report any impairment during erection or after sexual intercourse. The aesthetic outcome was natural and pleasing. The use of acellular dermal templates together with unmeshed split-thickness skin grafts has proven its superior functional and aesthetic outcome in several demanding regions. With the aid of negative-pressure wound therapy, a single procedure for penile defect coverage is possible. Our reported procedure revealed a natural and pleasing outcome, with no sexual impairment and high patient satisfaction. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-10-01
  • Hot oil burns in Scotland: seasonal and ethnic patterns of presentation
    • PubDate: 2015-10-01
  • Metacognitive strategies for enhancing language development in children
           with cleft palate
    • Abstract: Background Children born with cleft palate frequently show compensatory articulation errors (CA), and they are also at risk for language delays. There is a need of studies on speech–language intervention in this patient group. The purpose of this paper is to study metacognitive strategies for enhancing language development in children with cleft palate. Methods Twenty-six children with unilateral cleft lip and palate (UCLP) were studied and divided in two groups. The age of the patients ranged from 5 to 8 years. Language and articulation measurements for evaluating language development were made at the beginning and the end of the study. Both groups were treated with previously reported strategies routinely used for enhancing language. In addition, children from one group (active group) were exposed to metacognitive strategies which have been described as useful for enhancing expert thinking processes, such as think-aloud. For evaluating language development, all children were analyzed using the Situational-Discourse-Semantic Model. Results The results indicate that children with UCLP and CA benefit from an intervention which also addresses specific aspects of language development. The patients included in the active group in which the metacognitive strategies were used showed a greater improvement as compared with the patients from the control group. Conclusions Intervention in children with cleft palate and CA should address not only the articulation processes, but also specific aspects of language development. Metacognitive strategies could be an adequate option for enhancing language performance in this patient group. Level of Evidence: Level III, therapeutic study
      PubDate: 2015-10-01
  • Immediate microsurgical breast reconstruction in pregnant breast cancer
    • Abstract: Abstract Pregnancy-associated breast cancer (PABC) is defined as breast cancer occurring anytime during gestation, lactation or within 1 year after delivery. Breast reconstruction is considered an essential component in managing breast cancer patients, and immediate reconstruction provides superior esthetic outcome and better patient satisfaction. There are no sufficient reports on the feasibility of immediate breast reconstruction in patients during the course of gestation and no studies have been published using microsurgery breast reconstruction in PABC. We report three cases of immediate microsurgery breast reconstruction in pregnant cancer patient. We consider two distinct subsets in breast reconstruction in PABC: “pregnancy” and “after delivery.” Pregnant breast cancer patients can be considered for immediate microsurgical breast reconstruction with optimal treatment through multidisciplinary management. Level of Evidence: Level V, therapeutic study
      PubDate: 2015-10-01
  • Effect of botulinum toxin type A in the contraction of lesions treated
           with full-thickness grafts
    • Abstract: Background The treatment of traumatic injuries and burns presenting tissue loss—which are called full-thickness wounds—is primarily accomplished with skin grafts. This, however, remains an ongoing challenge because grafts have a number of limitations, perhaps being the secondary contraction determining movement restriction due to graft contracture, the main one. In this context, the currently available treatments are—in many cases—insufficient, and thus, the search for new alternatives is necessary. The objective was to evaluate the effect of botulinum toxin type A (in different doses) in the contraction of full-thickness wounds treated with full-thickness grafts. Methods Eighteen male Wistar rats were used, with an average weight of 350 g, divided into three groups. In group 1, two full-thickness wounds were produced on their back. The first wound was subjected to graft + 1 Ui/cm2 and the second one was subjected only to skin graft. The same routine was done in group 2, except with a dose of 2 Ui/cm2. In group 3, aiming at a 14-day histological analysis, three full-thickness wounds were produced. On the first wound, a graft + toxin 1 Ui/cm2 was used, on the second one, a graft + toxin 2 Ui/cm2, and on the third, only the graft was done. The areas of injury were analyzed by both digital photography—at 7, 14, and 28 days—and histology—at 14 and 28 days. Results Decreased contractions of the graft (at 28 days) in the lesions treated with toxin 1 Ui/cm2 (p < 0.05) and 2 Ui/cm2 (p < 0.01) were observed. The epithelialization and neovascularization were not altered by the toxin, either at 14 or 28 days (p > 0.05). The degree of inflammation was reduced after 14 days in toxin-treated groups (p < 0.05), equaling up to controls after 28 days. The density of fibroblasts (p < 0.05) and collagen (p < 0.05) was reduced after 28 days in both treated groups. Conclusions According to the data obtained, botulinum toxin seems to reduce secondary contraction of the graft, thus reducing local inflammation, as well as the density of fibroblasts and collagen deposition. Level of Evidence: Not ratable.
      PubDate: 2015-10-01
  • Free spreader grafts in rhinoplasty
    • Abstract: Background Spreader grafts (SPG) are widely used for different purposes in rhinoplasty procedures. However, selection of the size of the grafts, trimming and fixation often proved time consuming and difficult. We used an original method of placement of “free” SPG to improve both ease of placement and fine trimming of the grafts. To assess pertinence of this approach, we evaluated retrospectively our rate of correction of the middle third of the nose. Methods We used a personal method for securing SPG after suturing upper lateral cartilages (ULC). Grafts were inserted between the ULC and nasal septum, adding fibrin glue for fixation. We reviewed the aesthetic results of a series of 420 consecutive rhinoplasties in whom free SPG were used in 218 patients and conventional fixed SPG were used in 33 patients. Retrospective analysis of the photographic data of all patients was performed. Adequacy of brow tip lines, symmetry and relative width of the middle third was assessed by an independent observer and the surgeon. Results No evidence of postoperative displacement was noted. Symmetry of the middle third of the nose and adequacy of aesthetic brow tip lines were obtained in the vast majority of the patients. Comparable rates of middle vault correction and harmony were obtained in patients with free SPG or conventional SPG. On occasion during revision surgeries, we found the grafts resting in adequate position. Conclusions Free SPG placement appeared a straightforward and timesaving method in rhinoplasty procedures and proved especially meaningful when limited to moderate amount of support was needed in the middle vault reconstruction. Repositioning, resizing of the graft or placement of additional pieces of cartilage were feasible instantly if needed. This technique might help to obtain better correction of the middle third due to easiness and possibility of fine adjustments in rhinoplasty procedures. Level of Evidence: Level III, therapeutic study.
      PubDate: 2015-10-01
  • Injection complications and change in keloid height following
           intralesional injection of lesions: a novel injection system compared with
           the traditional method
    • Abstract: Background Injection complications can compromise the accuracy of the dosage of a medication, which is critical to keloid treatment success. This study aims to compare the incidence of injection complications of a metal dental syringe injection system with that of the traditional plastic hypodermic syringe, and the change in keloid height associated with their use in intralesional keloid injection of triamcinolone. Methods Complications of the injection systems such as inability to inject due to toughness of the tissue, spillage of the drug following separation of a friction-gripped needle from the syringe, backflow of the drug through the space between the plunger and barrel, bending of the plunger and outright breakage of the injected skin were documented. A visual analogue scale (VAS) was administered to measure pain experienced by patients. Change in height of lesions was documented. Results Eighty-eight lesions were injected: 44 were injected using the metal dental syringe system while another 44 were injected using a plastic hypodermic syringe. The metal dental syringe system was involved in fewer incidents of skin breakage and backflow of liquid medication than the traditional. The traditional system was involved in three other complications. The mean (VAS) pain score of 78 mm was derived for patients injected using the metal dental syringe system, while 71 mm was the corresponding value for the traditional. The keloid flattening rate was greater in the group injected using the metal dental syringe system. Conclusions The metal dental syringe delivery system recorded fewer complications during intralesional injection of triamcinolone than the traditional plastic syringe system. Level of Evidence: Level III, risk/prognostic study.
      PubDate: 2015-10-01
  • Banking a fillet flap to aid in reconstruction following a hindquarter
    • Abstract: Abstract A hindquarter amputation and hemipelvectomy for recurrent malignancy presents a reconstructive challenge to the plastic surgeon. Tumour resection leaves a considerable defect, with exposure of bone, neurovascular structures, pelvic and abdominal organs. A free lower leg fillet flap is a recognised method of providing soft tissue coverage, but ischaemic time is often lengthy as described in the literature. We present a unique method of providing soft tissue coverage using a free lower leg fillet flap, and minimising ischaemic time by banking the flap on the ulnar artery during the hindquarter amputation and tumour resection. Level of Evidence: Level V, therapeutic study.
      PubDate: 2015-09-25
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