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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: 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: 4, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 3, 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   (Followers: 1)
Drugs : Real World Outcomes     Hybrid Journal   (Followers: 2)
Dynamic Games and Applications     Hybrid Journal   (Followers: 2, SJR: 0.481, h-index: 5)
Dysphagia     Hybrid Journal   (Followers: 85, 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: 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: 8, SJR: 0.18, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 13, 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   (SJR: 0.264, h-index: 9)
Economic Theory     Hybrid Journal   (Followers: 16, 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: 23, SJR: 1.909, h-index: 93)
Ecotoxicology     Hybrid Journal   (Followers: 9, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 72, 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: 20, 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: 62, 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: 5, 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: 14, SJR: 0.732, h-index: 14)
Energy Systems     Hybrid Journal   (Followers: 14, SJR: 1.176, h-index: 7)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.433, h-index: 30)
Entomological Review     Hybrid Journal   (Followers: 7, SJR: 0.144, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 32, SJR: 0.419, h-index: 29)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 6, 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: 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: 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: 38, 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: 23, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 14, 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: 15, 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  [2279 journals]
  • Nasal endoscopy in total nasal reconstruction
    • Abstract: Abstract Total nasal reconstruction is a challenging task involving multiple surgical stages. It requires transfer of local and distant tissues to replace three structural layers of the nose: the lining, skeleton, and skin. Besides the paucity of local tissues, creation of the nose is demanding due to functional and aesthetic considerations, limited operative field, and poor visualization inside the created construct. The ability to inspect the newly created nasal cavity is vital in determining the condition of the airways. We present a case of complex total nasal reconstruction, where nasal endoscopy improved control of the reconstructive process and management of exposed hardware. Level of Evidence: Level V, diagnostic study.
      PubDate: 2016-02-01
  • Chronic expanding hematoma with feeding artery in the gluteus maximus
    • Abstract: Abstract A case of chronic expanding hematoma which had a clear feeding artery from the inferior gluteal artery was presented. Chronic expanding hematoma with feeding artery demonstrated by preoperative MRI imaging is very rare. Hypervascular mass and feeding arteries in image findings raised the suspicion of a malignant soft tissue tumor or a vascular malformation with repeated bleeding as differential diagnosis. A massive bleeding over 500 mL was observed during the partial resection for biopsy, indicating that the mass and its outer envelope had an abundant blood flow. Before operation, embolization of the feeding artery was performed. The patient underwent a complete surgical resection, and the mass was resected with minimal bleeding less than 20 mL. Preoperative embolization was very effective for controlling bleeding in this case. Level of Evidence: Level V, therapeutic study.
      PubDate: 2016-02-01
  • Leaking seroma following breast augmentation: technical fault or new
    • PubDate: 2016-02-01
  • Infrared technology to improve efficacy of venous access in burns
    • Abstract: Background Obtaining venous access in the burn population is challenging both in the acute and elective surgical settings. In paediatric burns, this is further compounded by smaller veins, thicker subcutaneous fat and poor cooperation. The introduction of infrared technology (Accuvein®) to identify veins up to 10 mm deep has been shown to increase efficacy. It has been promoted in challenging cases. We aim to ascertain whether Accuvein® is a useful clinical tool in the context of burns population. Methods A formal service evaluation of the device was carried out prospectively during a 6-week period. User feedback questionnaires were circulated. We reviewed patient demographics, indication of use, number of attempts and skin quality. We rated user satisfaction using visual analogue scales and a free text comment section. Results Twenty-eight questionnaires were returned. We noted inclination for use of device in paediatric patients compared to adults. Ethnicity included Caucasian, Asians, Afro-Caribbean and Hispanic. Skin quality in majority was described as normal; only four patients had poor quality skin (burn scars, friable thin skin). Fifteen patients had successful first attempts. Ninety-six percent of practitioners felt that the device was useful, although 59 % required assistance initially. We noted that it was not useful in detecting veins through grafted burn sites. Conclusions Accuvein® is a useful adjunct for venous access particularly in the paediatric population. By reducing the number of attempts to obtain venous access, this saves time and improve efficacy of care. However, we noted that it is not helpful over grafted burn sites. This could be attributable to the nature of the initial burn surgery (tangential excision) rather than the thickness of overlying skin. Level of Evidence: Level IV, risk/prognostic study.
      PubDate: 2016-02-01
  • Outcomes following manipulation of nasal fractures—the Durham
    • Abstract: Background Early manipulation of nasal fractures can negate the need for formal rhinoplasty. However, residual nasal deformity is reported in up to 50 % of cases. The aim of this study was to evaluate the outcome following manipulation of nasal fractures in a regional plastic surgery department and quantify the subsequent rhinoplasty conversion rate. Methods A retrospective review of all patients presenting with nasal fractures who had undergone manipulation under anaesthetic (MUA) in a single plastic surgery unit over a 7-year period was performed. Results Three hundred fifty-three MUA procedures were performed, the majority of which were in young males (76 %). Common causes included assault (54 %), sporting injuries (24 %) and falls (12 %). MUA was performed for nasal bone fracture (69 %) or bony and septal fracture (31 %). Only 37 % (130 patients) attended outpatient follow-up. Functional problems were identified in 17 % (22 patients), whilst 24 % (31 patients) noted residual deformity. Of these, 10 patients (3 %) accepted and underwent formal rhinoplasty surgery. This accounted for 17 % of all rhinoplasties carried out within the time period. Conclusions In our department, the outcome following manipulation of these injuries compares favourably with the literature, with the majority of patients having no major long-term sequelae. Our data suggest that many patients are happy to accept a degree of residual deformity and decline further surgery. Level of Evidence: Level IV, risk / prognostic study
      PubDate: 2016-02-01
  • ISAPS plastic surgery statistics—a closer look
    • PubDate: 2016-02-01
  • Extended distally based DMCA flap in combination with autologous amputate
           skin transplantation as a salvage procedure for ring avulsion injury
    • Abstract: Abstract A 23-year-old male student presented to our clinic with a traumatic complex ring avulsion of his right dominant index finger. Clinical evaluation revealed a complete distal amputation of the DIP joint with a laceration of the soft tissue at the middle phalanx and a rupture of the FDP-2-tendon far proximally. We hereby present the patient’s clinical outcome after reconstruction with a distally based extended DMCA-II flap. To our own knowledge, this is the first report of an extended distally based DMCA flap for coverage of a class IVd ring avulsion injury in combination with autologous amputate skin transplantation. Level of Evidence: Level V, therapeutic study.
      PubDate: 2016-02-01
  • Clinical presentation of head and neck skin malignancies among albinos and
           value of basic surgical intervention
    • Abstract: Background Radiation from sunlight may play a role in the clinical presentation of head and neck skin cancers in albinos. This study assesses the clinical presentation of such cancers and outcome of basic surgical treatment without primary repair of resulting defects. Methods An analysis of sites from head and neck affected by cancers using traditional anatomical landmarks was carried out. The frequency of involvement of each division in malignant skin changes was also documented and compared. Results The eyes were not involved with any malignancy. With the head and neck region partitioned by a transverse line using the lateral canthus of the eye as landmark, the superior portion was found to be involved in 209 lesions, all (100 %) of which were successfully treated. The inferior portion had 119 but enjoyed 92.4 % success rate. With the head and neck region partitioned in the coronal plane using the lateral canthus of the eye as landmark, the posterior portion was involved in 282 lesions, of which 273 (96.8 %) were successfully treated. The anterior portion was involved in 46 lesions, all (100 %) of which were successfully treated. Conclusions Hair appears to protect the skin beneath it from actinic damage and cancers among albinos. Failed treatment was recorded only among lesions on the cheek and neck. Level of evidence: Level IV, risk / prognostic study.
      PubDate: 2016-02-01
  • Bacterial adhesion to braided surgical sutures: an in vitro study
    • Abstract: Background Surgical suture materials are accepted to be associated with a substantial proportion of surgical site infections. These infections are related with biofilm formation similar to that of other synthetic and implantable medical devices. Methods We conducted an in vitro study to investigate the bacterial adherence to different types of braided surgical sutures. The included sutures were polyglactin (Vicryl®) group (VG), rapidly absorbable polyglactin (Rapide-Vicryl®) group (RVG), nitrofurazone-coated polyglactin (Vicryl®) group (FVG), polyethylene terephthalate (Etibond®) group (EG), and natural silk (Silk®) group (SG). All sutures were cut in 1 cm length, embedded into tryptic soy broth, and then 106-CFU/ml Escherichia coli and Staphylococcus aureus were added. After the 24th and 96th hour of incubation, bacterial colonies were counted, and results were expressed as CFU/cm. Results E.coli adhesion was significantly lower in VG and significantly higher in SG compared to FVG, RVG, and EG at the 24th and 96th hour of cultivation (p < 0.05). The S.aureus adhesion results at 24th hour showed that VG had the least bacterial adhesion, and FVG had the most bacterial adhesion compared to other sutures (p < 0.05). The S.aureus adhesion results at the 96th hour of cultivation showed that bacterial adhesion on sutures was not significantly different between groups (p > 0.05). Conclusion Of all braided surgical sutures, bacterial adhesion is significantly lower in polyglactin and significantly higher in silk sutures. Nitrofurazone coverage of suture worsens S.aureus contamination of the suture. Level of Evidence: Not ratable
      PubDate: 2016-02-01
  • The recognition of plastic surgery as a medical speciality in the European
           economic community: a 40th anniversary
    • Abstract: Abstract With the signing of the Treaty of Rome in 1957, the European Economic Community (EEC) was established. Its principal aim was to allow free mutual movement of goods, capital, services and persons. Medical doctors from the EEC countries were to obtain the right of establishment and practice in all six countries, as of January 1, 1968. In 1959, the national professional associations of doctors formed an interest group (Standing Committee) to act as discussion partner for the legislative bodies of the EEC on medical issues. The professional organisations of the medical specialists in the EEC countries formed the Union Européenne des Médecins Spécialistes (UEMS) to give advice to the Standing Committee in matters concerning specialised medicine. The UEMS established various monospecialistic sections, one for each recognised speciality, thus expressing the fact that the speciality is practised by specialists who occupy themselves solely with this one particular speciality. Because no monospecialistic section for plastic surgery was initially established, the Dutch plastic surgeons initiated efforts to have their speciality recognised, in 1964. This initiative resulted in recognition and the establishment of a ‘Section Monospécialisée de Chirurgie Plastique’ by the UEMS, in 1969. The impact of the formation of this separate section on the national status of plastic surgery in various countries has been considerable. Still, it took another 6 years before the European Council of Ministers formally recognised this speciality on June 16, 1975. The years of step-by-step efforts to obtain this recognition are memorised to commemorate its 40th anniversary. Level of Evidence: Not ratable.
      PubDate: 2016-02-01
  • Does the arrow flap associated with dermal platform really improve
           long-term nipple projection?
    • PubDate: 2016-02-01
  • Critical choices in cleft surgery: 18-year single-surgeon retrospective
           review of 900 cases
    • Abstract: Background Multidisciplinary management of orofacial clefts may lead to a successful treatment outcome. However, it is quite usual that lack of long-term treatment planning and collaboration among various specialists and lack of standardized surgical protocols result in poor esthetic and functional treatment outcomes. This article aims to hypothesize some critical determinants of outcome in cleft surgery. Methods Throughout a period of 18 years, 900 patients with different clinical types of congenital cleft anomaly were subject to primary repair of cleft lip, nose, and palate by single surgeon using various procedures, including preoperative nasoalveolar molding, two-stage and one-stage repair of complete cleft lip and palate, two-flap and one-flap palatoplasty, open tip rhinoplasty, and postoperative nasal molding. Results Clinical results of preoperative nasoalveolar molding and surgical repair of lip, nose, and palate were satisfactory for most patients, parents, and surgeon panel. Conclusions Treatment based on the individual patient’s facial assets and deficits must be the controlling factor in designing therapy. The essential key to successful management of clefts is to figure out the three-dimensional dynamics that govern the deformity and to recognize a fourth dimension for time along these dynamics in order to envision how a small difference in the position of a single suture during the first surgery can bring about a giant deformity upon completion of facial growth, hence the crucial role of the first surgery and its related concepts, techniques, and tactics in dictating the final outcome of the case. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2016-02-01
  • Porcine acellular dermal matrix for reconstruction of the dura in
           recurrent malignant schwannoma of the scalp
    • Abstract: Abstract We used acellular dermal matrix (ADM) to reconstruct the dura in a patient with recurrent malignant schwannoma of the scalp. The patient had previously undergone ablative surgery with reconstruction and radiation therapy. The present recurrence involved the dura. Full-thickness resection was performed. Reconstruction was carried out using ADM, a free muscle-flap covered with at split skin graft, and healed primarily. The patient recovered completely. Dural reconstruction may be performed using foreign materials. Biologic materials may prove superior as they favour ingrowth of the patients’ own supporting tissues. We found that ADM provided the patient with at fluid-tight dural reconstruction. ADM may be a feasible alternative to other dural substitutes. Level of Evidence: Level V, therapeutic study.
      PubDate: 2016-02-01
  • Management of scalp defects due to high-voltage electrical burns: a case
           series and proposed algorithm to treat calvarium injury
    • Abstract: Background Multiple modalities to manage scalp and underlying skull defect due to high-voltage electrical burns have been discussed. We aimed to describe our experience and to propose an algorithm for the management of skull injury which could be helpful in decision-making. Methods A retrospective study of patients who sustained electrical burns to the head from May 2007 to April 2012 was carried out. Sex, age, size of scalp defect, and method of reconstruction and management were analyzed. Results Thirteen patients were identified. Out of 13, 11 patients had scalp defects which were covered using local scalp flap. Free latissimus dorsi (LD) muscle flap and pedicle trapezius flap were used in two patients. The largest defect covered with local scalp flap was the size of 80 cm2. Free LD flap was used to cover a defect of 144 cm2. Of the nine patients who presented early (immediately after injury), seven required debridement of the outer table and the other two patients required full-thickness excision of the skull. The remaining four patients who presented late (after 3 months) were found to have osteomyelitic segments which required full thickness excision of the skull. Conclusions Most of the soft tissue defects of the scalp due to high-voltage electrical burns can be managed with local scalp flaps. However, if the local tissue is injured or not sufficient to close the defect, then free flap should be considered. In management of calvarium injury, the emphasis should be debridement of necrotic bone to provide infection-free site followed by soft tissue cover. Level of Evidence: Level IV, therapeutic study.
      PubDate: 2016-02-01
  • Aesthetic rhinoplasty as the final step of nasal reconstruction with a
           forehead flap
    • Abstract: Background The reconstruction of nasal defects represents a difficult challenge for a plastic surgeon as it can be actually difficult to obtain good aesthetic and functional results. Reconstruction needs the use of several complex flaps, including the forehead flap. However, the use of the forehead flap does not give always the optimal aesthetic result. In our opinion, rhinoplasty can optimize the aesthetic outcome and can be used as the last step in nasal reconstruction. Methods From the patients admitted to our department, resulting in full thickness nasal defects and reconstructed using the forehead flap, ten were selected to perform rhinoplasty after passing the inclusion criteria. Results In the patients where rhinoplasty was performed we obtained aesthetic and functional improvement. The patients referred better acceptance of the residual surgical stigmata and improvement of social acceptance. Conclusions Optimizing the aesthetic appearance of the nose, making it look better than before surgery, is fundamental to improve patient’s life quality and better acceptance of the demolition or trauma. Level of Evidence: Level V, therapeutic study.
      PubDate: 2016-01-27
  • Local muscle flaps via video-assisted thoracoscopic surgery (VATS) without
           thoracotomy for dead space obliteration
    • Abstract: Abstract The obliteration of intra-thoracic dead space following tumor or empyema extirpation is imperative to successful long-term outcomes. We sought to describe the technique of using a pedicled latissmus dorsi muscle flap for obliteration of a large 14 × 6cm intrathoracic dead space following pleural decortication of chronic empyema, without thoracotomy or rib spreading via video-assisted thoracoscopic surgery (VATS). Specific attention is directed to the technical details of the flap harvest and inset in relation to the modifications required to inset the flap without a thoracotomy or rib spreading. The patient’s history, presenting symptoms, pre-operative imaging, intraoperative details, and post-operative course are delineated with a focus on the length of stay, post-operative pain, and morbidity. The length of stay was 2 days with minimal pain on post-operative day one managed with oral nacrotic; long term post-operative X-ray revealed obliterated dead space and the patient experienced no complications. Inset of pedicled latissmus muscle flaps via VATS technique without thoracotomy or rib spreading seems a safe and effective technique that can offer short hospitalization with minimal pain morbidity. Level of Evidence: Level V, therapeutic study
      PubDate: 2016-01-22
  • Acknowledgment to reviewers—2015
    • PubDate: 2016-01-19
  • DIEP flap salvage by cannula venesection of the superficial inferior
           epigastric vein
    • Abstract: Abstract The deep inferior epigastric perforator (DIEP) flap is a technique of autologous breast reconstruction that is gaining popularity. The main advantage of the DIEP flap over the traditional transverse rectus abdominis myocutaneous (TRAM) flap is that there is a lower incidence of abdominal wall donor-site morbidity with the DIEP flap. However, venous congestion is the most dreaded complication of DIEP flap surgery which requires prompt intervention. In this case report, we present a simple but effective procedure to salvage the congested DIEP flap. A 55-year-old female underwent left breast reconstruction with DIEP flap and developed venous congestion during surgery. Cannula venesection of the superficial inferior epigastric vein (SIEV) was performed intraoperatively followed by intermittent aspiration of blood for 3 days. A satisfactory aesthetic result was achieved with no evidence of fat necrosis. This procedure eliminated the need for performing an additional microvascular anastomosis, required less operative time, and allowed augmentation of the venous drainage of the congested flap. Level of Evidence: Level V, therapeutic study.
      PubDate: 2016-01-15
  • The Pfannenstiel scar and its implications in DIEP flap harvest: a
           clinical anatomic study
    • Abstract: Background Despite the utility of the deep inferior epigastric artery perforator (DIEP) flap, the presence of abdominal wall scars can limit flap perfusion. Pfannnstiel scars are among the most common abdominal scars, during which undermining at either a subfascial or suprafascial level can damage perforators. There is an anecdotal belief that raising a DIEP flap in the presence of a Pfannenstiel scar may be less reliable due to vascular disruption. Methods A clinical prospective analysis of retrospectively recorded imaging from 150 patients (300 hemi-abdominal walls) was undertaken. Preoperative imaging, with two computer software programmes used to reconstruct three dimensional (3-D) volume-rendered images and analyse vasculature, was used to accurately identify and measure perforators. Results A total of 959 perforators were identified, with 319 perforators identified in the ‘Pfannenstiel scar’ group and 640 perforators in the ‘no abdominal scar’ group. All patients, except for one patient with a Pfannenstiel scar, had one or more perforators that were larger than 1.0 mm in diameter. There were no differences in the number of DIEA perforators (6.81 vs 6.22, p = 0.2819); however, perforators of the ‘Pfannenstiel scar’ group were of larger mean diameter than the ‘no abdominal scar’ group (0.96 vs 0.85 mm (p = 0.0027). Conclusions The presence of a Pfannenstiel scar is associated with larger perforator size than controls and no diminution in overall perforator number. As such, a Pfannenstiel scar may in fact aid DIEP flap harvest, a finding consistent with anecdotal outcomes. Level of Evidence: Level III, risk / prognostic study.
      PubDate: 2016-01-05
  • Fat transfer for cicatricial ectropion in lamellar ichthyosis.
    • Abstract: Abstract The risk of ectropion recurrence due to skin graft contracture is high especially in patients with ichthyosis. In order to overcome this problem, fat transfer underneath the skin graft was carried out in three consecutive sessions during the early postoperative period of a 27-year-old male patient with lamellar ichthyosis and bilateral upper and lower eyelid ectropion. Transferred fat reduced graft contraction by improving the hydration and viability of the skin. In addition, the grafted fat acted like a spacer and provided tarsal support. To address the persisting epiphora, a medial spindle technique was used to invert the lower punctum lacrimalis. At 8 months follow-up, all the symptoms associated with the ectropion were completely resolved. Level of evidence: Level V, therapeutic study.
      PubDate: 2015-12-04
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