Eplasty

Publisher: Open Science

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Other titles Eplasty, Open access journal of plastic surgery
ISSN 1937-5719
OCLC 166143070
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Open Science

  • Pre-print
    • Archiving status unclear
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    • Author can archive a post-print version
  • Conditions
    • Creative Commons Attribution License
    • All titles are open access journals
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The monophasic pulsed microcurrent is used to promote wound healing, and galvanotaxis regulation has been reported as one of the active mechanisms in the promotion of tissue repair with monophasic pulsed microcurrent. However, the optimum monophasic pulsed microcurrent parameters and intracellular changes caused by the monophasic pulsed microcurrent have not been elucidated in human dermal fibroblasts. The purpose of this study was to investigate the optimum intensity for promoting galvanotaxis and the effects of electrical stimulation on integrin α2β1 and actin filaments in human dermal fibroblasts. Methods: Human dermal fibroblasts were treated with the monophasic pulsed microcurrent of 0, 100, 200, or 300 μA for 8 hours, and cell migration and cell viability were measured 24 hours after starting monophasic pulsed microcurrent stimulation. Polarization of integrin α2β1 and lamellipodia formation were detected by immunofluorescent staining 10 minutes after starting monophasic pulsed microcurrent stimulation. Results: The migration toward the cathode was significantly higher in the cells treated with the 200-μA monophasic pulsed microcurrent than in the controls (P < .01) without any change in cell viability; treatment with 300-μA monophasic pulsed microcurrent did not alter the migration ratio. The electrostimulus of 200 μA also promoted integrin α2β1 polarization and lamellipodia formation at the cathode edge (P < .05). Conclusion: The results show that 200 μA is an effective monophasic pulsed microcurrent intensity to promote migration toward the cathode, and this intensity could regulate polarization of migration-related intracellular factors in human dermal fibroblasts.
    No preview · Article · Jan 2016 · Eplasty
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    ABSTRACT: Objective: A total of 62,611 patients with breast hypertrophy underwent breast reduction surgery in 2013 in the United States to improve their symptoms and health-related quality of life. While multiple studies utilizing various outcome instruments demonstrate the efficacy of reductive surgery, it is presently unknown how the postoperative course affects patient satisfaction and health-related quality of life as measured by the BREAST-Q. Our objective was to determine the temporal relationship of patient satisfaction and health-related quality of life after reduction mammoplasty. Methods: Patients prospectively completed the BREAST-Q reduction mammoplasty module at 3 time points during their treatment: preoperatively, at less than 3 months postoperatively, and at more than 3 months (<12 months) postoperatively. A single surgeon (N.P.P.) performed all of the breast reduction procedures. Results: Each time point contained 20 questionnaires. Mean preoperative BREAST-Q scores were significantly lower than scores at the less than 3-month postoperative time point for the scales Satisfaction With Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being (P < .001). There was no significant difference in BREAST-Q scores between the postoperative time points in these measures. Conclusion: Breast reduction surgery offers a vast improvement in patients' satisfaction and health-related quality of life that is maintained throughout the postoperative period. These findings can assist surgeons in managing patient expectations after reduction mammoplasty and help improve the probability of obtaining prior authorization for insurance coverage.
    No preview · Article · Jan 2016 · Eplasty
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    ABSTRACT: Objective: Lumpectomy may result in contour deformities or breast asymmetry in women with breast cancer and macromastia. This study investigates the use of bilateral reduction mammaplasty, with the tumor and margins included within the reduction specimen. Methods: Twenty-four patients who underwent lumpectomy with immediate bilateral reduction mammaplasty for unilateral breast cancer were included. Patient medical records were reviewed for demographic, oncological, and surgical characteristics. Results: Mean patient age was 57 years, and mean body mass index was 32.2 kg/m(2). Mean tumor size was 1.7 cm. All tumor margins were free of neoplastic involvement. No difference was noted between the ipsilateral and contralateral resection weights (P = .81). Adjuvant radiation therapy was delivered to 21 patients (88%). There were no significant differences in postoperative total (P = .36), major (P = .44), or minor (P = .71) complications between the tumor and nontumor sides. Only 1 patient required additional revision surgery following the initial lumpectomy with bilateral reduction mammaplasty. Conclusion: Lumpectomy with bilateral reduction mammaplasty did not compromise surgical margins. Lumpectomy with bilateral reduction mammaplasty may allow for adequate surgical treatment of breast cancer while avoiding significant breast asymmetry in women with macromastia.
    No preview · Article · Jan 2016 · Eplasty
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    ABSTRACT: Objective: We propose an algorithm on how to create a prospectively maintained database, which can then be used to analyze prospective data in a retrospective fashion. Our algorithm provides future researchers a road map on how to set up, maintain, and use an electronic database to improve evidence-based care and future clinical outcomes. Methods: The database was created using Microsoft Access and included demographic information, socioeconomic information, and intraoperative and postoperative details via standardized drop-down menus. A printed out form from the Microsoft Access template was given to each surgeon to be completed after each case and a member of the health care team then entered the case information into the database. Results: By utilizing straightforward, HIPAA-compliant data input fields, we permitted data collection and transcription to be easy and efficient. Collecting a wide variety of data allowed us the freedom to evolve our clinical interests, while the platform also permitted new categories to be added at will. Conclusion: We have proposed a reproducible method for institutions to create a database, which will then allow senior and junior surgeons to analyze their outcomes and compare them with others in an effort to improve patient care and outcomes. This is a cost-efficient way to create and maintain a database without additional software.
    No preview · Article · Jan 2016 · Eplasty
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    ABSTRACT: This is the first instance where the technique of supercharging a flap with a second pedicle, combined with a third pedicle using the flow-through technique, is described in literature. We present the case of a 66-year-old man with multiple recurrent squamous and basal cell carcinomas of the face. He underwent a wide local excision resulting in a 20 × 26-cm defect. This was reconstructed with near-total thigh free flap. Three separate pedicles providing independent perforators to the medial, posterior-lateral, and anterolateral thigh from the superficial femoral artery, directly from the profunda femoris artery, and from the descending branch of the lateral circumflex artery were harvested. We expand upon the technique of supercharging a flap by not only anastomosing 3 separate pedicles but also using the flow-through technique to provide inflow and outflow to the third pedicle.
    No preview · Article · Jan 2016 · Eplasty

  • No preview · Article · Jan 2016 · Eplasty
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    ABSTRACT: Introduction: Desmoplastic melanoma is a rare variant of melanoma that has been reported to demonstrate unique clinical behavior when compared with other histological subtypes. In this study, we present the clinical course of patients with this unusual diagnosis. We hypothesized that desmoplastic melanoma would differ from nondesmoplastic melanoma with regard to its presentation, rate of regional metastasis, and recurrence pattern. Methods: After institutional review board approval, a retrospective chart review was performed on all patients with a diagnosis of desmoplastic melanoma since 1998. The following data were collected: patient demographics, histopathological details of the lesion, initial treatment, and clinical course. In addition, the available slides were reviewed by a dermatopathologist. Results: Twenty-eight patient charts were reviewed. Mean age at diagnosis was 65 years. Fifty-seven percent of patients were men, and 67% of the lesions originated from the head and neck. Of the 28 patients, 11 had pathology slides that were adequate for evaluation. Pure desmoplastic melanoma, defined by more than 90% of the specimen demonstrating desmoplastic features, was found in only 3 patients. Taking into account all cases, the mean Breslow thickness was 5.09 mm and ulceration was present in 12.5% of lesions. Regional disease was discovered in 18% of patients. The mean follow-up time was 43 months, and the overall recurrence rate was 32%. 66.7% of first recurrences were local. Two of 3 patients with pure desmoplastic melanoma developed regional metastasis. Conclusions: Our data largely support previous studies that suggest desmoplastic melanoma behaves differently compared with other histological subtypes. However, the incidence of regional disease among patients with pure desmoplastic melanoma appears to be higher in our study than in previous reports. Although this rare variant typically presents with advanced local disease, the rate of regional metastasis is less than what would be expected for similar thickness, nondesmoplastic cutaneous melanoma. The recurrence pattern is different compared with nondesmoplastic melanoma, and the most common site of recurrence is local. Discrepancy in the literature regarding the clinical behavior of this disease may be related to inconsistent pathological criteria for diagnosis. Further research will help clarify the optimal management of desmoplastic melanoma.
    No preview · Article · Jan 2016 · Eplasty

  • No preview · Article · Dec 2015 · Eplasty
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    ABSTRACT: Objective: We provide a design for an effective suture practice board for surgical instruction that is both easily assembled and repaired. Methods: This model's design is achieved through inexpensive materials that do not compromise adequate simulation through repetitive use. We used a wooden board, synthetic microfiber cloth, and metal plates and screws to create the suture board. Two pieces of synthetic microfiber cloth, folded along the long axis, were attached to the outer edges of the wooden board using an electric screwdriver, with the metal plates and screws to secure the attachment. Results: Upon completion of construction, we have a board sufficient for instructing various suturing techniques. Conclusions: Our suture board design provides an effective practice material that is an improvement in cost, as well as reusability compared with other models. Our board has the advantage over animal tissues, such as chicken's or pigs' feet, because it is not perishable and maintains its durability over extended periods of time. This model is advantageous compared with other commercially available synthetic models because the materials are cheaper and more easily replaced. Our suture board model provides sufficient simulation to enhance the user's skills across various suturing techniques in a manner that is cost-effective in production and maintenance.
    No preview · Article · Dec 2015 · Eplasty
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    ABSTRACT: Unlabelled: Large defects of the nasal tip with exposure of the underlying cartilage pose a significant reconstructive challenge to the plastic surgeon. Objective: This article presents a case of a large nasal tip defect following basal cell excision that was successfully treated with Integra bilayer wound matrix and skin grafting. Methods: Following tumor excision, meshed Integra bilayer wound matrix was placed over the exposed nasal tip cartilage. After 4 weeks, the silicone layer was removed and a full-thickness graft placed on the nasal tip. Results: This reconstruction resulted in the restoration of patient's nasal tip with good contour and color match without the need for a forehead flap. Conclusion: This demonstrates the reconstructive potential of this modality in patients who are not candidates for reconstruction with a forehead flap.
    No preview · Article · Dec 2015 · Eplasty
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    ABSTRACT: Purpose: The impact of subspecialty fellowship training on research productivity among academic plastic surgeons is unknown. The authors' aim of this study was to (1) describe the current fellowship representation in academic plastic surgery and (2) evaluate the relationship between h-index and subspecialty fellowship training by experience and type. Methods: Academic plastic surgery faculty (N = 590) were identified through an Internet-based search of all ACGME-accredited integrated and combined residency programs. Research output was measured by h-index from the Scopus database as well as a number of peer-reviewed publications. The Kruskal-Wallis test, with a subsequent Mann-Whitney U test, was used for statistical analysis to determine correlations. Results: In the United States, 72% (n = 426) of academic plastic surgeons had trained in 1 or more subspecialty fellowship program. Within this cohort, the largest group had completed multiple fellowships (28%), followed by hand (23%), craniofacial (22%), microsurgery (15%), research (8%), cosmetic (3%), burn (2%), and wound healing (0.5%). Higher h-indices correlated with a research fellowship (12.5; P < .01) and multiple fellowships (10.4; P < .01). Craniofacial-trained plastic surgeons demonstrated the next highest h-index (9.8), followed by no fellowship (8.4), microsurgery (8.3), hand (7.7), cosmetic (5.2), and burn (5.1). Conclusion: Plastic surgeons with a research fellowship or at least 2 subspecialty fellowships had increased academic productivity compared with their colleagues. Craniofacial-trained physicians also demonstrated a higher marker for academic productivity than multiple other specialties. In this study, we show that the type and number of fellowships influence the h-index and further identification of such variables may help improve academic mentorship and productivity within academic plastic surgery.
    No preview · Article · Dec 2015 · Eplasty
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    ABSTRACT: Breast reconstruction with implantable devices is now the most common type of technique utilized following mastectomy. Because infections are one of the most common complications for the procedure and currently no one method has been proven to stand above the rest, we designed and implemented a novel technique that employed 24 hours continuous triple-antibiotic irrigation via a catheter-based system. From August 2009 to March 2012, 79 patients underwent tissue expander-based reconstruction from a single plastic surgeon. Forty-five consecutive patients underwent breast reconstructive surgery with implant-based reconstruction alone; the remaining 34 patients underwent breast reconstructive surgery with tissue expansion and closed continuous postoperative antibiotic irrigation. Incidences of infection, seroma, hematoma, and premature explantation were recorded. Both the rate of premature explant (20% vs 2.9%; P = 0.037) and surgical site infections (22.2% vs 5.8%, P = 0.060) decreased. Twenty-four hour continuous antibiotic irrigation is a useful adjunct to tissue expander breast reconstruction.
    No preview · Article · Dec 2015 · Eplasty
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    ABSTRACT: Microvascular free flaps are key components of reconstructive surgery, but despite their common use and usual reliability, flap failures still occur. Many pharmacological agents have been utilized to minimize risk of flap failure caused by thrombosis. However, the challenge of most antithrombotic therapy lies in providing patients with optimal antithrombotic prophylaxis without adverse bleeding effects. There is a limited but growing body of evidence suggesting that the vasoprotective and anti-inflammatory actions of statins can be beneficial for free flap survival. By inhibiting mevalonic acid, the downstream effects of statins include reduction of inflammation, reduced thrombogenicity, and improved vasodilation. This review provides a summary of the pathophysiology of thrombus formation and the current evidence of anticoagulation practices with aspirin, heparin, and dextran. In addition, the potential benefits of statins in the perioperative management of free flaps are highlighted.
    Full-text · Article · Nov 2015 · Eplasty
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    Full-text · Article · Nov 2015 · Eplasty
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    Full-text · Article · Nov 2015 · Eplasty