No abstract available
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Background Dickkopf 2 (DKK2) has important roles in vertebrate development; it inhibits Wnt signaling-related processes, such as axial patterning, limb development, somitogenesis, and eye formation. However, DKK2 also acts as a Wnt signaling agonist. Dickkopf 2, induced during endothelial cell morphogenesis, promotes angiogenesis in cultured human endothelial cells. In this study, we explored the effect of DKK2-expressing adenovirus on random-pattern flaps using a rodent model. Methods A...
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No abstract available
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Background The long-term results of soft tissue rebalancing procedures of the shoulder in obstetric brachial plexus palsy have been scarcely reported. The effect of this procedure on the evolution of secondary bone changes has been a subject of controversy. Methods Twenty-six children are included in this study. All initially had postganglionic C5-6 or C5-7 (Narakas types I and II) obstetric brachial plexus palsy, which spontaneously recovered. Children included are those who had persistent...
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Purpose Today, medical education emphasizes clinical applications of anatomic knowledge. In 2014, we instituted Clinically Applied Anatomy (CAA) within first-year Human Gross Anatomy at our university. The course was designed and overseen by academic plastic surgery. We hypothesized CAA would positively impact students' understanding, performance, and interest in human anatomy. Methods From 2014 to 2018, 13 CAA case-based didactics were integrated into the anatomy curriculum without changing...
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Background Postmastectomy pain syndrome (PMPS) is characterized by neuropathic pain from direct nerve injury during oncologic breast surgery causing chronic pain, often leading to chronic opioid dependence and long-term disability. To our knowledge, this study represents the first meta-analysis that defines the incidence of PMPS in patients undergoing mastectomy, with and without breast reconstruction. Methods The Cochrane, Embase, MEDLINE, and PubMed databases were queried. A total of 166...
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Background There are multiple techniques used to inject hyaluronic acid to minimize the appearance of nasolabial folds. These techniques vary in accordance with the etiology of the nasolabial folds. Based on our understanding of nasolabial anatomy and our experience with the injection of hyaluronic acid fillers, we herein summarize a systemic treatment plan based on a practical nasolabial fold assessment method. Methods From November 2015 to December 2017, 180 patients received hyaluronic...
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Bright illumination sources using xenon lamps have improved microsurgical visualization under an operating microscope; however, surgeons must recognize the potential for accidental thermal damage to soft tissues. In this article, we present 2 reports of microscopic thermal burn in lymphaticovenular anastomosis (LVA). A 23-year-old woman and a 57-year-old woman with bilateral lymphedema of the legs had LVAs on both legs under local anesthesia. The burn wound in a 23-year-old woman was full thickness,...
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The internal nasal valve provides most of the upper airway resistance; therefore, many surgical techniques have been developed to reconstruct and widen this sensitive area of the nasal airway. Twenty patients participated in this study to compare the effects of 2 techniques (spreader grafts and modified spreader flap) on the true valve area and the average valve area after rhinoplasty according to standard axial computed tomography on admission and 6 months following the surgery. The mean follow-up...
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Background Reconstruction of the skin defect after myelomeningocele repair is a crucial step that influences the quality of the surgical outcome. Keystone perforator flap is an islanded fasciocutaneous flap based on random regional perforators, which is advanced to adjacent defects. It has become a reliable method of locoregional reconstruction in various body parts with minimum morbidity. The aim of this study was to evaluate our clinical experiences in using keystone perforator flaps as an alternative...
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Background The most important purpose of reconstruction is to increase or restore the patient's quality of life (QOL). The purpose of our study was to evaluate the QOL and aesthetic outcomes of patients after autologous versus implant-based breast reconstruction. Methods Patients who underwent breast reconstruction between 2009 and 2011 were included. The Breast-Q, a validated breast reconstruction QOL questionnaire, was used along with postoperative photographs panel analyses using a multiparameter...
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Background Preventing scar formation during wound healing has important clinical implications. Numerous studies have indicated that adipose-derived stem cell culture mediums, which are rich in cytokines and extracellular vesicles (EVs), regulate matrix remodeling and prevent scar formation after wound healing. Therefore, using a rabbit scar model, we tried to demonstrate which factor in adipose-derived stem cell culture mediums plays a major role in preventing scar formation (EVs or cytokines),...
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Purpose External beam radiation in the mantle field has been a mainstay of therapy for Hodgkin's lymphoma for decades. The incidence of breast cancer in patients treated with mantle radiation is known to be elevated. Few studies have examined outcomes of breast reconstruction in this high-risk group. The current study presents the largest series of immediate breast reconstruction in this population and aims to evaluate reconstructive outcomes and examine differences between implant-based and autologous...
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No abstract available
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Background Breast cancer, with an incidence of 33.2 per 100,000 in Iranian population, is considered as the most common cancer in Iranian women. Nowadays, with the increasing survival rates, breast reconstruction has been integrated into surgical techniques of breast cancer treatment. The aim of this study was to evaluate the current status of breast reconstruction in Iranian population. Patients and Methods This retrospective study was conducted in Imam Hospital between January 2008 and...
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Introduction Hypertrophic scars are fibroproliferative disorders, seen after burn, trauma, and/or surgery. We aimed to compare the clinical and histopathological results of 1064-nm Nd:YAG laser and combined intense pulsed light and radiofrequency in the treatment of hypertrophic scars. Methods Fifty patients with hypertrophic scars were included in this prospective, randomized study. Twenty-five patients were treated with Nd:YAG laser and 25 patients with combined intense pulsed light and...
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Management of sciatic nerve injuries can be difficult for surgeons without a special interest in nerve surgery as they would only treat a handful of such cases for many years. Sciatic nerve defects pose the greatest repair challenges, with nerve grafting producing mixed results because of the large size of the nerve in both diameter and length. This article first presents the peculiarities of sciatic nerve defects management, based on the authors experience and a literature review. Various issues...
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Background Reconstruction of distal foot defect remains a challenge in plastic surgery. The purpose of this report is to present a new procedure that repairs these defects in severe burn patients. Results of application and follow-up in 7 patients were presented. Methods From January 2016 to March 2018, a total of 7 patients (age ranging from 21 to 57 years) with distal foot defects were treated in our department. All the wounds were caused by severe burns and repaired by the free vascularized...
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Background Hidradenitis suppurativa (HS) is a chronic and physically debilitating condition. Achieving long-term remission is difficult and sometimes remains elusive despite use of multiple pharmacological agents. However, surgery remains underused in the pediatric population. Methods We conducted a retrospective review for a 10-year period of all patients younger than 18 years who had undergone surgery for HS at a tertiary university hospital. In addition, we performed a literature review...
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Introduction The aim of any reconstruction is to provide a robust and cosmetically pleasing result that does not significantly alter function. We describe our experience of using the V-Y principle in advancement flaps designed around a distinct perforator to reconstruct soft tissue defects of the upper limb. The shortcomings of fasciocutaneous and fascial flaps requiring skin grafting can be eliminated. Methods This was a 10-year retrospective review of patients who had V-Y flaps based on...
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Backgrounds Distally based perforator propeller flap from the lower leg region is a versatile local reconstructive technique for the foot and ankle defects. However, flap venous congestion remains a tough nut to crack. We hypothesize that raising an adipofascial flap with turnover mode of transposition can improve venous drainage and enhance flap safety. Methods Based on the 2 rows of septocutaneous perforators in the posterior distal third of the lower leg, distally based adipofascial flap...
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Background The lateral arm flap (LAF) represents an attractive option for elbow reconstruction, due to low donor site morbidity and a consistent surgical anatomy. It has been described as reverse-flow and as perforator propeller flap (radial collateral artery perforator [RCAP]). We compared the 2 techniques in terms of immediate- and long-term outcomes, together with functional and aesthetic evaluation. Methods We retrospectively reviewed 15 patients, 9 males and 6 females, according to the...
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Background The care of unilateral cleft lip (UCL) patients is extremely variable. Historical benchmarks for perioperative and intraoperative choices by cleft surgeons were produced by Sitzman et al (Plast Reconstr Surg. 2008;121:261e–270e) in 2005. However, emerging data and cleft lip repair methods around this period were not captured by this study. The aim of this study was to update the current practice patterns of cleft lip surgeons. Methods An electronic survey was distributed to surgeons...
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Background and Aim It is well known that palatoplasty can often cause disturbances in maxillary growth. The use of a single-layer vomer flap for the early closure of the hard palate is controversy among surgeons. The aim of this study is to compare the 10-year facial growth of 2 surgical protocols in the treatment of patients with unilateral cleft lip and palate performed by a single surgeon. Methods This retrospective analysis includes 43 nonsyndromic patients with complete unilateral cleft...
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Postmastectomy pain syndrome (PMPS) is defined as chronic pain after breast cancer surgery lasting greater than 3 months and has been shown to affect up to 60% of breast cancer patients. Substantial research has been performed to identify risk factors and potential treatment options, although the exact cause of PMPS remains elusive. As breast reconstruction becomes increasingly popular, plastic surgeons are likely to encounter more patients presenting with PMPS. This article summarizes current evidence...
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Background Large involuted upper lip infantile hemangioma is a challenge for plastic surgeon because of high visibility of disfigurement. To achieve an optimal reconstruction with matched color and texture, nasolabial flap based on the upper lateral lip subunit is used for the upper lip reconstruction. Methods Records of 8 patients who underwent upper lip reconstruction from 2014 to 2018 at Shanghai Ninth People's Hospital were reviewed. After flap design according to the contralateral upper...
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Breast cancer affects 1 in 8 women. As the treatment of breast cancer evolves, breast reconstruction does as well. Implant-based reconstructions are increasing, leading to increased use of acellular dermal matrix (ADM) for better implant positioning. Acellular dermal matrices are derived from cadaveric skin and are processed to be immunologically inert. However, ADM can be costly and can have complications such as seroma and infection. This has led to the development of dermal autografts. These were...
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Objectives Recently, anterolateral thigh flap has become one of the most commonly used free flaps in reconstructive surgery. Although its pedicle has relatively sufficient length, it falls short in some circumstances. Eccentric perforator location can be used to lengthen the pedicle, but flap tip viability can be a problem in this case. In addition, partial flap loss can be encountered in perforator flaps. The aim of this study was the use of multidetector computed tomographic angiography in preoperative...
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No abstract available
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Background Reconstruction of intrapelvic soft tissue defects traditionally relies on regional pedicled myocutaneous flaps. However, there remain situations in which local options are unavailable. We review our experience treating intrapelvic defects with the anterolateral thigh (ALT) microvascular free flap. Methods A retrospective, institutional review was conducted from 2014 to 2018 of patients undergoing microvascular ALT flap reconstruction of intrapelvic defects. Four patients were identified...
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No abstract available
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An 85-year-old man presented with a 6-month history of worsening left proptosis and painless ophthalmoplegia. Imaging revealed an extensive intraconal and extraconal tumor extending to the level of the optic foramen, as well as the scalp, cheek, and the nasal bridge. Incisional biopsy was consistent with lacrimal gland adenocarcinoma. The patient underwent a left orbital exenteration followed by immunotherapy with pembrolizumab. The treatment was stopped prematurely after 5 cycles due to development...
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Purpose: To report the presentation, investigation, management, and outcomes of primary nasocutaneous fistulae in granulomatosis with polyangiitis and review the literature of this complication. Methods: Retrospective series of 5 patients with granulomatosis with polyangiitis and nasocutaneous fistulae and the medical and surgical management strategies employed. Results: Two cases presented with fistulae as the primary symptom of their systemic disease. Systemic management of granulomatosis...
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Purpose: To compare the degree of ptosis and the risk of ptosis repair failure among patients with and without a history of topical corticosteroid use. Methods: Retrospective, case-controlled study examining topical corticosteroid use among adults with ptosis who underwent external levator advancement/resection (ELR) or Müller muscle conjunctival resection with at least 3 months postoperative follow-up. Comparative statistical analyses of surgical outcomes were performed amongst patients...
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Ophthalmoplegia following cosmetic facial filler injections is a rare but serious complication. The authors report 2 cases of ophthalmoplegia following filler injection. In the first case, a 54-year-old female presented with acute onset headache, vomiting, and diplopia during malar and temporal injection of hyaluronic acid. In the second case, a 37-year-old female presented with binocular diplopia that developed following injection of an unknown filler to the upper face. Neither of the 2 patients...
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Purpose: To evaluate the clinical features, management, and outcomes of orbital schwannomas. Methods: Retrospective study analyzing 20 orbital schwannomas in 18 patients managed in an orbital service over 26 years. Clinical, radiological, histological, and surgical procedural data were analyzed. Results: Mean age of the study population was 40.89 ± 20.84 years. The most common nerve of origin was frontal nerve (50%), and majority of patients (70%) had a superior and/or posteriorly located...
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Purpose: To prospectively explore the incidence and risk factors of moderate to severe pain after primary and secondary orbital implantation following evisceration or enucleation surgery. Methods: One hundred eighteen patients under general anesthesia for orbital implantation were enrolled in this study. In 91 patients, primary orbital implantation followed evisceration, and in 27 patients, the implantation was secondary after previous evisceration or enucleation surgery. Medical interventions...
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No abstract available
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