The Internet Journal of Plastic Surgery最新文献

{"title":"Vacuum assisted Closure in wound management – Poor man’s VAC©","authors":"Manbeer Singh, Rahul Singh, S. Singh, V. Pandey, D. R. Singh","doi":"10.5580/1a71","DOIUrl":"https://doi.org/10.5580/1a71","url":null,"abstract":"Vacuum assisted closure has reformed the plastic surgery practice and wound management in the last decade and has become an established method of wound management. The equipment though not inexpensive has become an essential part of all major plastic surgery departments in the western world. In ideal world VAC Dressing equipment should be available at hand at all times and to every patient in need , but the shortage of equipment in developed countries , or even unavailability in developing world is a common phenomenon . most plastic surgeons would agree that they have at times delayed or postponed surgeries at some point in their career because of delay in procurement of VAC equipment . We describe a new method of wound VAC dressing application without using the standard VAC equipment from material readily available to any surgeon and present our experience of 7 cases where negative suction dressing was applied without use of standard equipment . INTRODUCTION The vac dressing and the equipment sandardised by the KCI has provided a great tool in the complex field of wound management The technique has been well advertised by the company’s’ marketing team and owing to the significant benefits and good clinical outcomes it has been well supported by various experts its versatility and efficacy is well documented in the medical literature . Vacuum assisted closure has reformed the plastic surgery practice and wound management in the last decade and has become an established method of wound management. The equipment though expensive has become an essential part of all major plastic surgery departments in the western world . In ideal world VAC Dressing equipment should be available at hand at all times and to every patient in need , but the shortage of equipment in developed countries , or even unavailability in developing world is a common phenomenon . Most plastic surgeons would agree that they have at times delayed or postponed surgeries at some point in their career because of delay in procurement of VAC equipment . We describe a new method of wound VAC dressing application without using the standard VAC equipment, from material readily available to any surgeon OBJECTIVE To evaluate alternate method of negative suction dressing application and its effectiveness. METHODS We applied negative suction sponge dressing to selected wounds which would have been difficult to manage by conventional dressings and where standard VAC equipment use was indicated. MATERIALS NEEDED Sponge foam ( needs to be sterilised ) 1. Romovac or similar 18 fr drain 2. Opsite or similar material 3. Gelonet / Bactigras / mepitel or similar dressing 4.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132820269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Stretch-Load is a Principle Step in the Surgical Treatment of Burned Knee Contracture","authors":"Al-shaham Al-shaham","doi":"10.5580/24c7","DOIUrl":"https://doi.org/10.5580/24c7","url":null,"abstract":"A prospective study which includes 36 patients who presented with 43 post burn knee contractures was conducted over the period of three years from Oct.2003-Oct.2006. Their mean age incidence was 17 years. Patients with right sided contractures were 16, left sided 13 and bilateral contractures were present in 7. The F/M ratio was 1:2.2. The mean time elapse from the burn injury to the development of contracture was 2.3 years. The mean healing time was 72 days .The degree of the flexion contractures were classified according to range of joint motion limitations into mild (less than 60° ) moderate (60-90°) and sever (more then 90°). The surgical release procedures involved two stages; (1) Incising of the contracted scar with subsequent application of progressive stretch load (PSL) to the limb through incremental weight traction over extended period of time, until the knee joint is fully extended. (2) To cover the created defect by Split Skin Graft (SSG). The weight traction range was 2.25-8.50 kilograms. The mean duration of PSL application was 7 days. The mean hospital stays was11.5 days .The mean follow-up period was 14 months. The complication rate was five (13.88 %), three patients (8.33%) showed partial (10-15°) recurrence in the contracture angle. Two patients (5.55 %) developed popliteal ulcerating graft which required excision and skin graft in six months period. By using the PSL method 31 patients (86.11 %) had full range of movements in the knee joint, and resumed their work in 3 -4 months during post operative periods.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128664492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Pilo-Nidal Sinus: Secret Of Recurrence","authors":"Ahmed Hussein Aer","doi":"10.5580/1f62","DOIUrl":"https://doi.org/10.5580/1f62","url":null,"abstract":"INTRODUCTION Pilonidal sinus is a disease of easy handling and difficult healing. It is a common problem in primary care due to recurrence following surgery and the need for frequent and timeconsuming wound care. This article covers the pathology, clinical presentations and appropriate management of pilonidal sinus disease.1 The patient was treated here had been operated three times before coming to the author. He was operated in his country twice and in Kuala Lumpur once. His sinus was in the natal cleft. REVIEW OF LITERATURE How does it develop? Theory 1: A minor congenital or hereditary abnormality in the skin of the natal cleft as it tends to run in some families. Part of the abnormality in this part of the skin may be that the hairs grow into the skin rather than outwards. Theory 2: abnormal hair growth direction. Hair is forced to grow in abnormal direction.2,3 Author theory 3: Lack of cleaning of this moist area with development of a small boil or furuncle which will open with long hairs around will come in and keep growing inside making a long track of granulation tissue. (A similar condition occurs between the fingers of hairdressers caused by customers' hair entering moist, damaged skin.) RECURRENT DISEASE Recurrence can be divided into two groups: early and late. Early recurrence is usually due to failure to identify one or more sinuses at incision and drainage, which was not followed by a second-look procedure. Late recurrence is usually due to secondary infection caused by residual hair or debris that was not removed at operation, inadequate wound care or insufficient attention to depilation.4 CASE DATA 29 years old male was presented to the author with the recurrent pilonidal sinus after three previous operations. All operations failed to achieve proper healing. METHODS Patient was operated by a closed method where the track was excised with an elliptical incision and excision of bad part of skin. The track had two openings one above and one below in the natal cleft. After excision of the track the two edges were approximated and closed. Simple closure of the two edges of the wound with vicreyl 1, and skin was closed by Nylon 3/0. The wound was left partially open in its upper part to heal spontaneously. Post operatively: patient was instructed to sleep prone position for few days. Hyperbaric oxygen was used in 5 sessions to accelerate healing. Bovidone iodine was used frequently for cleaning during dressing. Suture removal was done one week after surgery. RESULTS It was very promising where the sinus was healed after one month from surgery. At the beginning the surrounding hairs tended to cause recurrence by being imbedded into the lower part of the incision of the natal cleft. Fig 3 The author immediately shaved the hairs around the natal cleft and one week after the wound was completely healed. Fig 4 Recurrent Pilo-Nidal Sinus: Secret Of Recurrence 2 of 4 Figure 1 Figure 1 upper end of the track is shown by the arrow Figure 2 Fig","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122091277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Venous Ulcers An End Of Long Term Suffering","authors":"R. Hussein","doi":"10.5580/172b","DOIUrl":"https://doi.org/10.5580/172b","url":null,"abstract":"Chronic venous leg ulcers still represent a problem for an increasingly number of population1, 2. Many of patients usually undergo several operations without remarkable improvement over a long time. Post phlebitis ulcers accompany the post phlebitic Syndrome represent one of the problematic cases. In this study the authors tried to know the real reasons of development of these ulcers, then they could find out an easy solution for treating them. Patients: This study included 65 cases of chronic resistant venous ulcers. Place: These cases were treated over the period from September 2001 until September 2007 in three places, University Malaya Medical Center, UniMAS (Sarawak General Hospital), and University Technology Mara (Selayang Hospital), Malaysia. The technique which we used was based upon venous hypo-vascularization of the skin of the leg before any attempt to deal with the ulcer. Results: Results showed very good and successful healing of these ulcers in a short time evaluated by 2 to 3 weeks after surgery. Most of the cases had very long history of having these ulcers ranging from 3 to 9 years and of average 4 years. Surgery for Chronic venous leg ulcers now facilitated the perfect and effective closure which is sound and complete without recurrence if compared with other techniques as compression bandage and other methods3.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"79 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121203179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proboscis lateralis: Review of literature and a case report","authors":"Y. Bhatt, N. Panse, Kinnari A. Vyas, Girish S. Ambat, Hitesh Laad, H. Bakshi","doi":"10.5580/20f3","DOIUrl":"https://doi.org/10.5580/20f3","url":null,"abstract":"Proboscis Lateralis is a rare congenital anomaly, which is embryologically related to the median facial cleft, and may be associated with other anomalies of the eye and its adnexa and cleft lip and palate. A child with Group three proboscis lateralis was treated by using the flaps of the proboscis lateralis, one for the correction of maxillary hypoplasia and the other for correction of the grooving in the nasolabial region. This technique helped in achieving a good cosmetic outcome. Various methods have been suggested for the treatment of proboscis lateralis, ranging from the extirpation of the proboscis, to the tunneling method. We have suggested the use of the flaps from the proboscis, which gave us the advantage of a one-stage correction of the proboscis along with the maxillary hypoplasia, and to minimize the grooving in the nasolabial region.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130136878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound can be routinely used in the diagnosis of the carpal tunnel syndrome?: Electrophysiological and ultrasonographic study of the of carpal tunnel","authors":"Banu Biçerol, Merter Keçeli, E. Copçu, N. Kıylıoğlu, O. Bolukbasi, A. Akyol","doi":"10.5580/1306","DOIUrl":"https://doi.org/10.5580/1306","url":null,"abstract":"Purpose: To determine electrophysiological and ultrasonographic features of the carpal tunnel during flexion and extension of the wrist. Methods: This study included 35 right-handed healthy volunteers, of whom 24 were females and 11 males. The mean age of females and males were 37,5 ± 2.4 and 42 ± 1,9 years respectively. All subjects gave oral informed consent. Anterio-posterior and medio-laterally diameters of the carpal tunnel were measured on ultrasonography during flexion and extension of the wrist. Electrophysiological features of the median nerve sensorimotor conduction in the first digit of the right hand were determined during flexion and extension of the hand. Data from ultrasonographic and electrophysiological measurements were analyzed with SPSS 10.0 package program and the data were compared with ANOVA and Tukey tests. Results: There was a decrease in median n. motor amplitude on flexion and extension of the wrist (p<0.0001), while median n. motor conduction speed decreased only on extension of the wrist (p<0.005). Median n. sensory conduction decreased (p<0.0001) and distal latency lengthened (p<0.0001) on flexion of the wrist. On ultrasonography, the medio-laterally diameter of the carpal tunnel increased on flexion and extension of the wrist (p<0.0001), wile there was a considerable decrease in anterioposterior diameter of the tunnel on flexion of the wrist (p<0.0001). Conclusions: The diagnosis of carpal tunnel syndrome (CTS) is usually based on clinical and electrophysiological findings and then an appropriate treatment alternative is determined accordingly. Incorporation of ultrasonography (US), computed tomography (CT) and/or magnetic resonance imaging (MRI) into diagnostic efforts will help determine both etiopathogenesis and the most apropriate treatment alternative.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129873899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropraxia In tissue expansion - should not delay reconstructive process","authors":"O. Fenton, Rahul Singh","doi":"10.5580/2161","DOIUrl":"https://doi.org/10.5580/2161","url":null,"abstract":"INTRODUCTION Tissue expansion has come a long way Since Neumann1 first used the principles of controlled tissue expansion in 1957 and Radovan's2, 3 description of a tissue expander in breast reconstruction in 1982. Tissue expansion has numerous advantages. it provides skin with a near-perfect match in color and texture, minimal donor site morbidity and scarring occur (Austad, 1982; Pasyk, 1982)4. It has superior sensation e.g. in breast reconstruction. 2, 3 Expanded flaps are more resistant to bacterial invasion than random cutaneous flaps (Barker, 1987).5 Retains adnexal characteristics the hair-bearing flaps designed in the treatment of male pattern baldness.6, 7, 8 Though safe and effective tissue expansion has its own complications we highlight a case of neuropraxia of ant cutaneous nerve of thigh as a complication of tissue expansion and propose a management plan which should not delay the reconstructive process. CASE REPORT In August 2000 18 yr old girl was involved in a RTA. She sustained multiple injuries including bilateral femoral fractures and large soft tissue defects to right and left thigh and buttocks particularly on the left hand side She had initially had internal fixation of fractures defunctioning colostomy and debridement and skin graft. In October 2001 cable graft was done using sural nerve bilaterally (20 cm) and closure of colostomy in Jan 2002. Since 2005 she has had serial scar revisions and tissue expansion for reconstruction. In June 2006 she had tissue expanders sited in left upper thigh anteriorly inamed 1000 cm3 and lower thigh posteriorly inamed 800cm3 in late September 2006 she had 775 mls in ant thigh and 428 mls in post thigh . She developed numbness of ant cutaneous nerve of thigh since expansion, skin was viable and 30 ml. saline was removed from ant expander. In October she had removal of expanders and flap rotation and re-sitting of tissue expander for further surgery. The nerve recovered fully in Feb 2007 and further expansion and flap advancement has been planned.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130222507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cheapest headlamp for Plastic Surgery","authors":"E. Copçu","doi":"10.5580/575","DOIUrl":"https://doi.org/10.5580/575","url":null,"abstract":"Although many visual apparatus were designed and invented, classical headlamps are still widely used by many plastic surgeons in rhinoplasty, breast and abdominal aesthetic surgery. Until today, ideal features of the headlamps were described in the literature but there was no data about the prices. We believe that cheap headlamps which produced for general puposes can be used instead of expensive headlamps. INTRODUCTION Visualization of the surgical site is one of the most important factors for the best results in all kind of operations. Good visualization requires good lightening. Headlamps are indispensable devices for the most surgeons. The first paper about headlamp was presented in 1959 by Cutler1 in the literature and one of the most detailed one was presented in same year by Morey2. According to this study headlamp should have following standarts : the light must be of high intensity; 1. the beam must be either coincident with, or parallel 2. to and in line with, the visual axes; the light must be focused into a clear homogeneous 3. circle; the whole apparatus must be light in weight and 4. not be too bulky; it must not get too hot. 5. After 1949, technology was changed so much. Although many visual apparatus were designed and invented, classical headlamps are still widely used by many plastic surgeons in rhinoplasty, breast and abdominal aesthetic surgery. Until today, ideal features of the headlamps were described in the literature but there was no data about the prices. Undoubtedly, prices are related with the technology and crude material of the devices. Prices varied between from 100 to 2500 USD on the searching of the internet by Google.3 METHODS We use 12 Led headlamp which produced for the camp and general purposes (figure 1and 2). Figure 1 Figure 1: The headlamp for general purposes The cheapest headlamp for Plastic Surgery 2 of 3 Figure 2 Figure 2: Illumination of the lamp Price of lamp was less than 5 USD. It consists of high intensity 12 LED with adjustable headstrap. Inclination of the lamp can be adjustable, also. It works with three 1.5 volt AAA batteries ad batter life is maximum 120 hours. RESULTS There were no problems related with using of this headlamp. Different surgeons were used and no complaints were reported. Good visualization were achieved. Figure 3 Figure 3: Headlamp in the operation There was no need extra illumination. Application of the headlight and focusing were quite easy. DISCUSSION There are three important study about using of the headlamp in Plastic Surgery. One of them was presented by Furnas4 . He described ideal headlamp for overseas surgery. Other one is presented by editor of our journal, Rohrich5 . He strongly emphasized that potentially, the most detrimental combination for a surgeon's cervical spine is the use of the headlight with loupes. While attempting to adjust the head and neck to match the focal length of the loupes and the light together, we set ourselves up for a cervical spine sprain ","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"12 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130506600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porous Polyethylene Implants In Secondary Revision Of Rhinoplasty: A Safer Procedure?","authors":"E. Copçu, C. Baytekin, Nazan Sivrioğlu, B. Koç, Ş. Er","doi":"10.5580/164","DOIUrl":"https://doi.org/10.5580/164","url":null,"abstract":"Revision rhinoplasty is one of the most challenging operations in facial surgery. Not only is a surgical procedure being performed on a scarred facial structure, which limits overall success, but also the patient undergoing revision rhinoplasty often has unrealistic expectations of the final results. Revision rhinoplasty has stimulated a variety of reconstructive techniques by surgeons dedicated to restoration of both nasal form and nasal function. Supportive materials are widely used in this operation. These materials may be categorized as autogenous tissue, homograft materials, and alloplastic materials. In this study we present our experience with high density porous polyethylene (HDPP) in thirteen patients who had operated for aesthetical revision rhinoplasty with autogenous tissue before. HDPP implants were used in nasal dorsum in aesthetical revisions. We detected only one complication as implant malposition. We speculate that prior augmentation of the nasal dorsum forms a preexpanded nasal skin and increases the vascularity of the region. Rasping of the nasal dorsum increases the bare contact surface adding to tissue ingrowth to the implant and stabilization of it. Scar tissue due to prior surgery and subperiosteal placement of the implant increases the barrier effect of the nasal skin. Although autogenic materials should be preferred in nasal dorsal augmentation, in secondary cases in which donor area limitations are encountered, HDPP implants can easily and effectively be used for nasal dorsum augmentation.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125553933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syngnathia Without Any Other Associated Anomaly: A Very Rare Case Report","authors":"M. Mir, S. Iqbal, A. Hafeez, H. Zargar, A. Rasool, M. Mohsin, A. Darzi","doi":"10.5580/2872","DOIUrl":"https://doi.org/10.5580/2872","url":null,"abstract":"Congenital bony fusion of the mandible and maxilla (syngnathia) without any other oral anomalies is a very rare condition. Numerous cases with other anomalies like cleft lip, cleft palate, aglossia have been described. Syngnathia can also occur with Vander Woude syndrome and popliteal pterygium syndrome. This report presents a very rare case of syngnathia with true bony fusion between mandible and maxilla, unusually with no other intra-oral or systemic anomalies, of which only a few cases exist in the world literature.","PeriodicalId":284795,"journal":{"name":"The Internet Journal of Plastic Surgery","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117134473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}