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The Management of Salivary Fistulas. 唾液瘘管的治疗。
IF 2.3 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-12-03 eCollection Date: 2023-02-01 DOI: 10.1055/s-0042-1759561
Alexandra Belcastro, William Reed, Liana Puscas
{"title":"The Management of Salivary Fistulas.","authors":"Alexandra Belcastro, William Reed, Liana Puscas","doi":"10.1055/s-0042-1759561","DOIUrl":"10.1055/s-0042-1759561","url":null,"abstract":"<p><p>Postoperative salivary fistula is an especially undesirable complication because it can be difficult to address, may delay postoperative radiation, and always delays enteral nutrition. Patients who are malnourished, have already undergone radiotherapy, or are hypothyroid are at higher risk of developing this problem. Conservative measures work in most patients, but a significant percentage of patients require intervention beyond pressure dressings and tincture of time. Medications, hyperbaric oxygen therapy, and surgical intervention may be required when fistulas do not heal in a timely manner. Decisions about the approach and timing of more aggressive interventions are part of the art of medicine since definitive scientific protocols are lacking.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10712621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of the Failing Flap. 失效皮瓣的管理。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-12-03 eCollection Date: 2023-02-01 DOI: 10.1055/s-0042-1759563
Allison A Slijepcevic, Sara Yang, Daniel Petrisor, Srinivasa R Chandra, Mark K Wax
{"title":"Management of the Failing Flap.","authors":"Allison A Slijepcevic, Sara Yang, Daniel Petrisor, Srinivasa R Chandra, Mark K Wax","doi":"10.1055/s-0042-1759563","DOIUrl":"10.1055/s-0042-1759563","url":null,"abstract":"<p><p>Free tissue transfer has become the reconstructive modality of choice for replacing composite tissue defects. While the success rate in high-volume centers is reported to be greater than 95%, up to 10% of patients will require revision of their vascular anastomosis secondary to thrombosis or compromise to flow. In the intraoperative setting, immediate revision is successful in the majority of cases. Rarely, the flap cannot be revascularized and a secondary option must be used. In the perioperative setting revision is successful if the patient can be brought back to the operating room in a timely fashion. Revision rates up to 70% are reported. A small number of these patients may then suffer a second episode of compromise where revision is less successful at 30%. In these cases, consideration should be given to secondary reconstruction rather than attempting salvage. Finally, there are a small number of patients whose flaps will fail following discharge from the hospital. These patients can rarely be salvaged and secondary reconstructive options should be explored.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Great Toe Transplantation. 大脚趾移植。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-11-21 eCollection Date: 2022-11-01 DOI: 10.1055/s-0042-1758689
Antonio J Forte, Karla C Maita, Ricardo A Torres-Guzman, Francisco R Avila, Bauback Safa, Gregory Buncke, Rudolph Buntic, Andrew Watt
{"title":"Great Toe Transplantation.","authors":"Antonio J Forte, Karla C Maita, Ricardo A Torres-Guzman, Francisco R Avila, Bauback Safa, Gregory Buncke, Rudolph Buntic, Andrew Watt","doi":"10.1055/s-0042-1758689","DOIUrl":"10.1055/s-0042-1758689","url":null,"abstract":"<p><p>Despite being relatively uncommon in the general population, thumb amputations cause severe disability. More than 3,300 thumb amputations occurred in the United States. The thumb makes up around 40% of the function of the hand. Therefore, losing it would result in significant medical, hospital, and societal costs. Thumb reconstruction surgery's primary goal is to restore grip strength, including the range of motion, fine and tripod pinch, power grasp, strength, and sensibility, while secondary goals include restoring hand aesthetics. In cases of thumb replantation, like-for-like replacement is possible; however, when thumb replantation is not possible, great toe-to-hand transplantation is the best available reconstruction. When compared with other reconstructive options such as osteoplastic thumb reconstruction, pollicization, second toe transplantation, and the use of a thumb prosthesis, great toe transplantation provides superior function and aesthetics. For restoring pinch, sensitivity, strength, and aesthetics of the hand with well-tolerated donor site morbidity, toe to thumb transplantation is regarded as the gold standard.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Approach to Lymphedema Management. 淋巴水肿的治疗方法。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-11-16 eCollection Date: 2022-11-01 DOI: 10.1055/s-0042-1758691
Walter C Lin, Bauback Safa, Rudolf F Buntic
{"title":"Approach to Lymphedema Management.","authors":"Walter C Lin, Bauback Safa, Rudolf F Buntic","doi":"10.1055/s-0042-1758691","DOIUrl":"10.1055/s-0042-1758691","url":null,"abstract":"<p><p>Millions of people worldwide suffer from lymphedema. In developed nations, lymphedema most commonly stems secondarily from oncologic treatment, but may also result from trauma. More recently, lymphedema has been identified in patients after gender-affirmation phalloplasty reconstruction. Regardless of the etiology, the underlying pathophysiology involves blockage of lymphatic flow, resulting in lymph stasis, thus triggering a cascade of inflammation culminating in fibrosis and adipose deposition. Recent technical advances led to the refinement of physiologic and reductive surgeries-including lymphovenous anastomosis and free functional lymphatic transfer, which collectively encompass a variety of flap procedures including lymph node transfer, lymph channel transfer, and lymphatic system transfer. This article provides a summary of our approach in the assessment and management of the lymphedema patient, including detailed intraoperative photography and imaging, in addition to advanced technical considerations in physiologic reconstruction.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Approach to Complex Lower Extremity Reconstruction. 复杂下肢重建的方法。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-11-16 eCollection Date: 2022-11-01 DOI: 10.1055/s-0042-1758205
David Cholok, Ean Saberski, David W Lowenberg
{"title":"Approach to Complex Lower Extremity Reconstruction.","authors":"David Cholok, Ean Saberski, David W Lowenberg","doi":"10.1055/s-0042-1758205","DOIUrl":"10.1055/s-0042-1758205","url":null,"abstract":"<p><p>Composite injuries to the lower extremity from etiologies including trauma and infection present a complex dilemma for the reconstructive surgeon, and require multidisciplinary collaboration amongst plastic, vascular, and orthopaedic surgical specialties. Here we present our algorithm for lower-extremity reconstructive management, refined over the last decades to provide an optimized outcome for our patients. Reconstruction is predicated on the establishment of a clean and living wound, where quality of the wound-bed is prioritized over timing to soft-tissue coverage. Once established, soft-tissues and fractures are provisionally stabilized; our preference for definitive coverage is for microvascular free-tissue, due to the paucity of healthy soft-tissue available at the injury, and ability to avoid the zone of injury for microvascular anastomosis. Finally, definitive bony reconstruction is dictated by the length and location of long-bone defect, with a preference to utilize bone transport for defects longer than 5 cm.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microsurgical Gender Affirmation Surgery. 显微外科性别确认手术。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-11-11 eCollection Date: 2022-11-01 DOI: 10.1055/s-0042-1758226
Andrew J Watt, Bauback Safa, Mang L Chen
{"title":"Microsurgical Gender Affirmation Surgery.","authors":"Andrew J Watt, Bauback Safa, Mang L Chen","doi":"10.1055/s-0042-1758226","DOIUrl":"10.1055/s-0042-1758226","url":null,"abstract":"<p><p>Phalloplasty in the female to male transgender patient is a complex operation aimed at creating a functional and aesthetic phallus, external genitalia, and perineum. Functional goals include standing micturition and sexual function with erogenous and tactile sensation as well as the ability to participate in penetrative intercourse. Functional genital reconstruction relies on creating of a fully lengthened urethra from local tissues as well as the provision for additional length via tissue transplantation. This manuscript will review techniques for the creation of perineal urethral segment as well as primary flaps available for the creation of neophallus. Particular emphasis is given to our preferred method of reconstruction: single-stage urethral lengthening with radial forearm flap phalloplasty including a review of surgical techniques and complications.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10427773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Approach to Complex Upper Extremity Reconstruction. 复杂上肢重建的方法。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-11-04 eCollection Date: 2022-11-01 DOI: 10.1055/s-0042-1758131
Alexander Y Li, Andrew J Watt
{"title":"Approach to Complex Upper Extremity Reconstruction.","authors":"Alexander Y Li,&nbsp;Andrew J Watt","doi":"10.1055/s-0042-1758131","DOIUrl":"10.1055/s-0042-1758131","url":null,"abstract":"<p><p>The management of complex upper extremity trauma can be overwhelming in its urgency and complexity. Having a systematic approach that maintains a clear set of priorities focused on hand and upper extremity function, operative efficiency, and long-term planning for future operations allows the reconstructive extremity surgeon to effectively treat these complex injuries. This article addressed these overall clinical considerations and details the approach taken at the Buncke Clinic including replantation and revascularization as well as osseous and soft tissue reconstruction.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10482253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Virtual Surgical Planning in Free Tissue Transfer for Orbito-Maxillary Reconstruction. 眶-上颌重建游离组织移植的虚拟手术计划。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-08-01 DOI: 10.1055/s-0042-1754386
Min-Jeong Cho, Matthew M Hanasono
{"title":"Virtual Surgical Planning in Free Tissue Transfer for Orbito-Maxillary Reconstruction.","authors":"Min-Jeong Cho,&nbsp;Matthew M Hanasono","doi":"10.1055/s-0042-1754386","DOIUrl":"https://doi.org/10.1055/s-0042-1754386","url":null,"abstract":"<p><p>Since its introduction, virtual surgical planning (VSP) has been rapidly adopted as a part of reconstructive surgeon's armamentarium. VSP allows reconstructive surgeons to simulate resection, plan osteotomies, and design custom plates. These unique advantages have been especially beneficial for head and neck reconstructive surgeons as there is small room for error and high technical demand in head and neck reconstruction. Despite its popularity, most surgeons have limited experience in using VSP for orbito-maxillary reconstruction as tumors that involve the midface are relatively rare compared with other head and neck oncologic defects. In our institution, we routinely use VSP for orbito-maxillary reconstruction using free fibula flap to provide support for orbit, to restore normal dental occlusion, and to restore midface projection. In this chapter, we will discuss the role of virtual surgical planning and our algorithmic approach of performing orbito-maxillary reconstruction using free tissue transfer.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9729062/pdf/10-1055-s-0042-1754386.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10123735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The Impact of the Syrian Civil War on One Department in an Israeli Hospital. 叙利亚内战对以色列医院一个部门的影响。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-05-01 DOI: 10.1055/s-0042-1749105
Omer I Sagi, Nissan Ohana, Richard Appel, Leonid Kogan
{"title":"The Impact of the Syrian Civil War on One Department in an Israeli Hospital.","authors":"Omer I Sagi,&nbsp;Nissan Ohana,&nbsp;Richard Appel,&nbsp;Leonid Kogan","doi":"10.1055/s-0042-1749105","DOIUrl":"https://doi.org/10.1055/s-0042-1749105","url":null,"abstract":"<p><p>During the Syrian civil war, Syrian refugees crossed the Israeli border to receive medical treatment. During this time, Galilee Medical Center (GMC) became the main center for multidisciplinary treatment of these war-wounded patients. This retrospective study compares the demographics of local Israeli and refugee Syrian patients, as well as the volume and types of procedures each group received over a 5-year period. From January 2013 to December 2017, 963 unique patients underwent 1,751 procedures in the GMC Plastic Surgery Department. Of these patients, 176 were Syrian-including 42 children-and 787 were Israeli. These groups underwent 393 and 1,358 procedures, respectively, for a procedure-per-patient ratio of 2.23 versus 1.72, respectively. On average, Syrian patients tended to be younger than Israeli patients (23.6 vs. 49.25 years), had longer median hospitalization time (50 vs. 8 days), longer median operative times (102 vs. 85 minutes), and higher incidence of infection with multidrug-resistant bacteria (52.2 vs. 5.8%). Further, Syrian patients had more trauma-related procedures, such as skin grafts, wound debridement, and microsurgery, than Israeli patients. Through this process, GMC's plastic surgery department gained unprecedented exposure to a variety of complex procedures.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9352387/pdf/10-1055-s-0042-1749105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Asaf Olshinka, MD. asao Olshinka，医学博士。
IF 2 3区 医学
Seminars in Plastic Surgery Pub Date : 2022-05-01 DOI: 10.1055/s-0042-1749381
Edward P Buchanan
{"title":"Asaf Olshinka, MD.","authors":"Edward P Buchanan","doi":"10.1055/s-0042-1749381","DOIUrl":"https://doi.org/10.1055/s-0042-1749381","url":null,"abstract":"","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9352381/pdf/10-1055-s-0042-1749381.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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