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Plastic Surgery - Science topic

Discuss the advances and new perspectives of Plastic and Reconstructive Surgery.
Questions related to Plastic Surgery
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Dear all,
Kindly provide your valuable comments based on your experience with surgical loupes
- Magnification (2.5 x to 5x)
- Working distance
- field of vision
- Galilean (sph/cyl) vs Kepler (prism)
- TTL vs non TTL/flip
- Illumination
- Post use issues (eye strain/ headache/ neck strain etc)
- Recommended brand
- Post sales services
Thank you
#Surgery #Loupes # HeadandNeck #Surgicaloncology #Otolaryngology
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I am working on my MSc dissertation, investigating breast protection bras for female boxers. I am looking at their protection but also the fit and shaping of them and how this relates to their comfort during wear. Is there any sort of classification of the shape of women's breasts? How would I describe the natural breast shape?
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Thank you
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In UK we use the term WAG to describe wives and girlfriends of footballers, and sometimes minor celebrities. Celebrities are those who have gone on big brother, love island...they don't have talent as such but are chosen as got hot bodies, or for big brother have personality disorders, or just crazy. WAGS get attention as living luxury lifestyle but identity formed in relation to partner, not her own skills and capabilities. Women are perceived as eye candy on arm of footballer. The housewives world franchise has popularized vacuous lives of rich women who do loads of plastic surgery and charity events. Do other countries have a term like WAG? What do you think of WAG? I greatly concerned as happening as we discuss issues of feminism and harassment.
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It is an interesting topic. In Turkey, we generally call futballers wife as "yenge" which means aunt-in-law
Then they are introduced through sexy yenge or fashion yenge
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Regarding patients considering plastic surgery body contouring after massive weight loss?
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Thanks for the information
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Plastic surgery,  Breast surgery, Breast implants 
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Do you mean temporising saline implants?
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Hi. I am currently working with new materials that should be tested on a scarified skin.
I am employing the widely-accepted wound model using the ventral surface of a rabbit ear, which was originally suggested by professor Mustoe. In brief, this model involves full thickness excision of rabbit ear skin and perichondrium, leaving the bare cartilage to heal itself and form a scar wound.
However, i am having some drawbacks. From some samples, the hypertrophy of the rabbit ear cartilage, rather than the dermal portion, is too prominent. This makes the analysis of the dermal portion very difficult.
My guess is that there had been some random microdamage to the cartilage portion during the removal of the perichondrium, but that leaves me no choice but to leave the perichondrium, which will accelerate the healing and make the wound UN-hypertrophic.
Is there a way to maximally prevent cartilage hypertrophy, but only achieve dermal hypertrophy using this model? Thank You.
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kindly apply keloid (scar) preventing medicament. It is my guess only. Thanks
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Relation between methotrexate and wound healing
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Wait until she is no remission with psoriasi. There is no need to performe abdominoplasty under MTX. Better wait and push the surgery for a while. Otherwise pause mtx two weeks before and after.
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I am a student from the University of Toledo working on a project. Would anyone from the field of orthopedics, sports medicine, plastic surgery, etc. be able to tell me how many of each type of joint injection you perform annually? These joint injections may include knee, shoulder, hip, wrist/hand, elbow or any other that I may not have mentioned. Also, I was wondering if you could share with me if you use any type of topical anesthetic before the procedure: ethyl chloride, other vapocoolant, numbing cream etc.  Thank you so much for your time!
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A guess is that i perform over 500 a year.  It is joint injections, plantar fascia injections, tendon injections and digital blocks. 
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This is a link to the instrument in question:
J Trauma. 2001 Oct;51(4):740-6.
Development of a brief version of the Burn Specific Health Scale (BSHS-B).
Kildal M1, Andersson G, Fugl-Meyer AR, Lannerstam K, Gerdin B.
Author information
1
Burn Unit, Department of Plastic Surgery, University Hospital, Uppsala, Sweden
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Carole,
The Burn Specific Health Scale (BSHS) is an outcome scale designed specifically for burn patients.
The original scale is composed of 114 items across six domains of health.  Since the original scale it has been revised (BSHS-R) and shorter versions have been proposed, one of which you referenced, which used a factor analytic approach to further improve the scale for clinical use.
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I'd like to know specific informations about breast skin repairing surgery after breast cancer, only skin repairing?
Surgeons
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Thank u all. Truly appreciate ur response. 
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We are involved in an animal experiment to compare results of diferent abdominoplasty techniques, finding exact position and preservation of the umbilicus stalk has been quite difficult in pilot studies. Sugestions? 
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I suppose it's anatomically determined by any median scar or depressed point in the middle of the abdomen less than 10cm distal to xiphoid apêndix region below clavicle.   
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I need texts about this two kinds of compensatory articulations. And texts about judgment/evaluation of compensatory articulations
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Thank you very much!
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What is the best conservative approach for management of xanthelasma palpebrum?
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 thanks my dear 
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early Rhinophyma in a young girl of 23 years.. How best ccan it be managed without much recurrence, and improving QOLI. quality of life Index.
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Dear Venkata, Rhinophyma and other phymas are localized swellings of facial soft tissues due to variable combinations of fibrosis, sebaceous hyperplasia and lymphoedema. They develop almost entirely in males. The commonest is rhinophyma, a swelling of the nose which may become grossly distorted in contour. Other areas which may be affected include the forehead (metophyma), chin (gnathophyma), eyelids (blepharophyma) and ears (otophyma). In many cases rhinophyma develops in patients with a long
history of other features of rosacea, and it is often regarded as a complication or ‘end stage’ of the disease. However, rhinophyma is sometimes also seen in patients who do not have any history of other manifestations of rosacea. Occasionally rhinophyma is complicated by the development of a malignancy and this can be difficult to recognize. It is likely, but not proved, that active treatment of
rosacea may inhibit the development of rhinophyma. Unfortunately neither systemic nor topical treatments for rosacea have any useful impact on established rhinophyma. One exception is systemic isotretinoin, which can significantly reduce the bulk of rhinophyma although it does not restore normal skin contours. Treatment of rhinophyma and other phymas therefore usually involves surgical removal of excess tissue or other means of physical ablation. Remodelling can often be successfully achieved simply by paring off the excess tissue with a
scalpel. Electrosurgery is an inexpensive alternative method. Excision and vaporization with argon, carbon dioxide or Nd : Yag lasers is effective. Other treatments have included cryotherapy and ionizing radiation. The latter approach is probably most useful in cases with coexisting malignancy.
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Why do teenagers want to change there appearance at such a young age?
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If you say:"Plastic surgery", my answer  is "yes".For exemple i operate on approximatly 2000 children for cleft lip and palate and about the last 450 ones i operate during the 15 days after birth with better results than with late surgery :  local résult and more safety anesthesia : buccal and naso-pharynx more clean than after several monts...
But if you say :"Esthetic surgery, never perform it for teen aggers!
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Is there a good controlled trial with large number of patients?
The number of aspiration needed and timing to achieve complete resolution
Is it working for small as well as for large abscess?
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Meddling provides a number of studies that establish the efficacy of needle aspiration of breast abscesses. However, this technique is used in specific patient and abscess-related conditions. E.g., the patient should not be toxic from the abscess and should in general be well. The abscess should be unilocular, without any overlying necrotic skin changes. It is recommended the procedure is performed ultra-sound guided, and the patient is followed up to ensure there is no re-formation of the abscess. The procedure can be repeated, but if there is any doubt or if the patient becomes septic, then incision and drainage must be performed, Most of us will use a small incision in a dependent area, though for cosmetic reasons some prefer to use a periareolar curved incision. Like in other including ischiorectal abscesses, the modern practice is to avoid large cruciate incisions. A Foley's catheter may be left or a corrugated drain, but only with a couple of corrugations. 
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I identified anatomical variation of zygomatic nerve branches around Zygomaticus major muscle in sub-SMAS plane when I was operating on face lift. So, I am preparing paper. I would like to ask colleagues some advices.
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I am assuming that we are talking about a branch of the facial nerve. No, in 50 years of practice  and extensive knowledge of anatomy, I have never seen this nor have I seen a paper reporting this. 
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1. CLAP- Cleft Lip And Palate
2. Any specific age in days/months/years
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 Infants born with a cleft of the palate (with or without cleft lip) are unable to breastfeed effectively and require special feeding equipment (such as squeezable bottles and teats) and many mothers need specialist feeding advice and support. While some maternity service providers and Maternal Child Health Nurses are able to provide general feeding support to new mothers, there remains significant confusion amongst both the lay and professional community about the effective feeding interventions for infants born with CL/P. As a result many families receive conflicting advice and experience significant and unnecessary emotional distress and fatigue during the first year of life if they are not able to access specialist cleft feeding support services. From the RCH cleft unit website 
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I want to know if they are effective osmotic expansore?
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Irfan, this is not my experience: the company Osmed.de produced varies osmotic expanders with an exact expansion rate of 1:2, 1:4, 1:10 etc. and the final result was absolutely predictable ! Causing skin necrosis needs quite some internal pressure : the 1:10 expanders broke and flattened under the skin before they could stop the blood supply. - 
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Plastic surgery, Plastic and Reconstructive Surgery,  Breast surgery 
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Capsule formation Baker III and IV has nothing to do with the surface of the implants- it is merely due to slow infection with Biofilm producing bacteria, mostly St. epidermidis of the patient ! Read the recent literature on Breast Implants and  Biofilm (abstracts at www.pubmed.gov)  and use the more natural feeling of silicone gel filled implants with natural feeling - and a vial of antibiotics (any cephalotin) into the implant pocket at the end of the operation . 
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We usually retake graft after a delay of 3 weeks. 
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Thanks for your comments Tahir!
I agree with the  risk of 7% (2/28) of hypertrophic scar in areas re-harvested different from scalp. On the other hand, when the scalp is available, we do not have seen hyperthrofic or keloid scars on it, if a thin split-thickness skin graft is harvested or re-harvested from this area. So, mainly in patients with a trend for pathological scars, the scalp is very safe as a donor site minimizing more chance of sequelae.
I`d like to share this article: 
Absence of pathological scarring in the donor site of the scalp in burns: an analysis of 295 cases. Burns. 2010 Sep;36(6):883-90.
Regards,
Jayme
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I am currently working on my thesis and I am looking for more detailed articles about the surgical procedures used in hands and fingers re-plantations.
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Unfortunately the couplers are for veins only, ment to be used for reducing surgical time in larger vessels anastomoses and require an excess length of vessel which is not really available in most replants. There have been several research projects in the 80's trying to address the question you asked such as using lasers instead of sutures, doing continuous as opposed to interrupted sutures, sleeve anastomosis etc. I suggest you look up these studies
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Mirror software is a patient's data and pictures management, which has been on the market for more than 10 years, available for PC environment. It has been mainly used in the plastic surgery field.
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I use VMWare on my MacMini with lots of RAM.
On the windows side I use Mirror for my photos.
Database is stored on the server I think.
IT had to configure it, but it works quite well.
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presently skin excision is the answer for simon 's grade 3 gynecomastia for good cosmetic results 
can anyone suggest if any other treatment guidelines available
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When skin excision is necessary I usually prefer to do inferior pedicle. As a result the final scar is located in the IMF and there is no horizontal scar on the left and right of the areola.
The technique is well described in a plastic surgery book by Peter Neligan.
However, especially in young patients two stages should be considered. After liposuction many patients are happy with the result and they don’t want to proceed to further operation.
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The specific area of fate regeneration I am referring to is the nasolabial folds. Imagine that you have a patient with a bodyfat percentage of 3% and not the typical nasolabial fold patient who has them due to being overweight. The area is very thin and has almost no fat in or around it. The "fold" to be treated is a fine line that is not in the skin but the fat, and the patient is young(as in 21-24). Could injecting prp in the creased area induct fat regeneration?  I am talking about permanant results, as in repair or regenerating the fat, not temporarily hiding the lines while your time dwendles until the next injection date. I do not want to plump up the area or use prp as a filler. Do not suggest using fillers as they are an absolute disgrace to science and medicine.
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I'm afraid that I disagree with AND do not understand (not referring to your various errors in spelling and grammar) a number of your points. My comments are as follows:
1) Nasolabial folds are not due to being overweight, rather, midface structural volume-loss (along with loss of skin-elasticity and some effects of gravity) causes the folds to increase in 'severity';
2) What do you mean by a 'fine line' in the fat?;
3) PRP does not 'regenerate' fat, but 'supercharges' lipografts to increase survival of the transferred fat (e.g. due to angiogenesis, and by enhancing the natural antibacterial properties);
4) PRP as a filler is a flawed concept (and clinicians should not be 'solely' using PRP for such a purpose). At the very least, in the face, with such high blood-perfusion, the 'goodies' in PRP are washed away;
5) Why have you referred to fillers as a disgrace?! Firstly, fat is a filler (autologous), so I cannot see what is disgraceful about that. Secondly, if your statement is supposed to refer to ‘non'-autologous fillers, such as hyaluronic acid fillers (e.g. Juvéderm and Restylane), then they have been shown to be incredibly safe with great outcome-satisfaction. Furthermore, histological analyses have demonstrated their integration into the skin over long-term-use, and should their placement be suboptimal, they can be dissolved with enzyme. 
I agree with Tausif Alam's thoughts as a good discussion point to have with the patient in question, to start off with. Also, tell us more about this patient, e.g. weight, body mass, occupation (body-builder?), systemic diseases, et.c.. 
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As compared with autologous fat transfer breast auto-augmentation. Could these two techniques be combined ?
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To answer your question,it must be simplified at first:a-how much is the breast volume of the patient? b-the degree of mastoptosisi(if  it is present)
Benelli mastopexy is a gold standart in ptotic breasts,especially there was no volume problem..If there is hypoplasia, one of the following methods may be selected: 1-implant,2-adipofacial flap transfer 3-Free Dermal fat transfer 4-Autologous Fat transfer(injection) with or withouth BRAVA vacum aplicator ..To my opinion,selection should be made by individual characteristics of each patient.
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If you have any recommendations, I'd be grateful!
Especially actual case studies from Brazil, Korea, European countries, etc! 
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Thank you all for your recommendations! Really really helpful! 
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What is the rate of success?
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Drs. Plock and O'Boyle have answered all the aspects of this unpleasant situation. Fortunately however, we do not come across with total amputations frequently and in cases of clean cut injuries success rate is very high.
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For those of you who don't know, there is a procedure called "SNIF", or sharp-needle-intradermal-fat graft. Here is a video for it, and a link to a pdf that details it in excellent easy detail.
video
pdf
From what I can understand and correct me if I am wrong, the ""SNIF" procedure is basically a dermal filler, not a fat graft. Is this correct? If so, then I have a few other questions.
First, when I see surgeons performing fat grafts into the nasolabial fold area, I see then go in through the upper lip with a cannula. I have given many manual liposuctions with different types of cannulas on the abdomen, and I know that technically, you could access the fat to be lipoaspirated from any point of entry. Of course there are places that are best, but if you had to, you could go in from (almost) anywhere.
IN the pdf, they say that a 23 gauge needle is used for injection. They also directly mention the nasolabial folds. They say that first, they fill it with "traditional lipofilling". What I want to know is, why can't this SNIF replace the "traditional lipofilling" that surgeons usually perform on the nasolabial fold area? Maybe not "replace", but you could graft fat into the nasolabial folds with a 23 gauge needle correct? Not as a filler, but as an actual fat graft that will take as a part of the patients face.
In other words:
Instead of using this snif type needle and point of entry for dermal filling, couldn't you technically graft fat into the nasolabial area (not just a dermal filler) and have that graft take as part of your facial fat?
If you had a patient that was just beginning to get the folds (as in early 20's, just barely visible), couldn't you solve this without going in through the lips? I think the answer is yes. You can access the subcutaneous fat via a 23 gauge needle, there is no need for anything else. I think by using the snif technique, you could do real lipofiling rather than just dermal filling.
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In Brazil I personally saw 3 cases of alar necrosis following treatments like this. For me is mandatory the use of microcannula to avoid facial vessels injury.
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Correction of gynecomastia.
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Periodontal plastic surgery is the most challenging task a periodontal surgeon faces in his or her practice. Sometimes we are in a dilemma as to which technique to employ. It would be interesting to know the view points of others.
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I think , Pedicle graft is the most suitable for the treatment of Class II gingival recession if the condition is suitable. since pedicle graft has connected to blood vessel and gives predictable result, compared to free gingival graft and others ( It has plasmatic circulation, and it needs more technique sensitive, need graft stabilisation)
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Will sclerotherapy be helpful in this big lesion, if yes how much should be injected?
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The location of this lesion makes management difficult.Is this an AV malformation?
Intralesional Bleomycin injections to the lesion may be an option.There are reports of favourable results with this technique. However multiple sessions will be required.
Please investigate with Digital Subtraction Angiography (DSA) and MRA to assess the extent of the lesion.The lesion may be extending internally and what you see may be the tip of the iceberg.
High flow lesions resistant to conservative methods may require embolization followed by excision. Embolization makes the lesion avascular and safe to excise.Excision must be performed within 48 hours.Otherwise colaterals will form quickly and revascularize the lesion. If skin excision is required, depending of the defect, a help of a reconstructive surgeon may be necesary.
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The femoral nerve can be used and easily dissected, after stripping the perineurum you can sever parcially the nerve then take standardized macrophotographs of the injured nerve and have a range of percentage of its lesion ( Image pro plus program,p.ex.), or just count how many fascicles were injured in the surgical microscopic field, specifying the used zoom, I suppose its ok.
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What is the best method of coverage of a big myelomeningocele coverage in third world countries
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Pre-op
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any recommended MCQs for european board exam in plastic surgery
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thank you I've already passed the exam and got the fellowship
and one of the books I've read was the secrets
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it inlcudes : BSSO, LE FORT osteotomies, genioplasty
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Selection of case for orthognathic Surgery : From the spectrum of patients we receive in Central part of India It is mostly cases of late deformities of TM Joint Ankylosis ,Cleft Palate and some anthropometric deformity ,congenital deformities of Jaw or Binders Syndrome or few Pierre Robin sequence etc.I plan them in two visits
First visit
I listen to the patients need what they want
I Examine to assess what they have
then I investigate for the deformity
and plan what is ideal requirement for this patient in given context.
Second visit
I explain and discuss with them what ideally should be done to address their problem
then ask them to compare what they want and what I can offer and what is ideal.
Now I help them to reach the conclusion by drawing a line of satisfaction between the desire and availability of treatment in the given circumstances , finance and time frame. Many time it ends up in camouflage surgery othertime it both correction of occlusion and bony deformity both rarely a temporary correction of occlusion without jaw deformity correction
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Routine change of dressing is done 24-48 hours after abscess drainage.
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In my experience, after I & D, the abcess will resolve much faster with saline irrigation and regular dressing changes. In the patients who are hospitalized, we find that the abcess tends to extend if we don't irrigate and change the dressings. We tend to dress or pack the I & D site with 0.125% sodium hypochlorite solution.
In terms of cellulits, the real question is does the patient have weeping or drainage? If drainage is allowed to sit on the skin or form a crust, it is a perfect environment for bacterial proliferation. I see cellulitis patients frequently in my practice. I always have the nurse wash the area daily and apply a moisturizing ointment.
If there is drainage or weeping, we apply a non-adherent dressing that will control the moisture. If the patient has massive edema with large volume drainage, we usually wash twice a day, moisturize and wrap in a large underpad or adult brief to control drainage.
Obviously, this is in addition to appropriate antibiotic therapy. Cleaning the area and controlling drainage seems to help the cellulitis resolve a bit faster.
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We have a patient presented with post mastectomy lymphoedema with metastatic deposits of ductal CA in upper limb.
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Did this patient have any previous surgery/wound or skin graft in that lower limb?
I also work in a burn center, where we had a patient, who developed lesion within the burned skin area, we thought is was scar tissue. But after excision, it recurred. Finally, we sent it for pathology examination and it turned out to be a skin metastasis of an unknown pancreatic cancer. We hypothesized that this patient developed a skin metastasis (very uncommon) in this area, due to the inflammation and high VEGF levels, due to the recent burn wounds.
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I would like to figure out differences in fatty tissues harvested from different sites (ie - Abdomen, thight, flanks). There might be a different composition of cells, but preliminarily we also found differences in receptors (insulin). The problem was, that these receptors kept changing very rapidly, according to nutrition status etc.
Any experience or suggestion for a more stable difference that could be detected?
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What about looking at leptin and leptin receptors?