ISRN Plastic Surgery http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Flexor Tendon Injuries in the Hand: A UK Survey of Repair Techniques and Suture Materials—Are We Following the Evidence? Tue, 18 Mar 2014 09:14:55 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2014/687128/ Introduction. Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in the hand are dependent on a sound surgical repair allowing early active mobilisation. Materials and Methods. We reviewed the literature regarding the choice of suture material and repair technique. We then carried out a nationwide postal survey of plastic surgery hand units to assess the level of compliance with the evidence. Results. Fifty-four units were surveyed. The response rate was 72%, with the most popular core suture being Prolene (64%) and the most popular technique being the Kessler repair (36%). Discussion. Current evidence advocates a multistrand repair using Ethibond. We found that the majority of units are not following the evidence. We suggest the use of evidence-based departmental guidelines to improve the practice and outcomes following these common injuries. W. B. J. Rudge and M. James Copyright © 2014 W. B. J. Rudge and M. James. All rights reserved. Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects Tue, 04 Mar 2014 08:56:59 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2014/969420/ Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Defects at this site will often require flap cover. Free flap is ideal for these defects and gives good results but with its own limitations. The reverse sural artery flap (RSAF) and distal peroneus brevis flap (DPBF) have gained popularity for lower third leg defects among surgeons. We did a retrospective study on 64 patients admitted between 2011 and 2013 with posttraumatic moderate size defects of lower one-third leg who underwent RSAFs and DPBFs. These patients were followed up in the immediate and late postoperative period for complications and outcome assessment. The average surface area covered by DPBF was 27 cm2 and by RSAF was 38 cm2. Both flaps gave a good functional outcome. DPBF has better aesthetic appearance at donor site and recipient site, with the advantages of ease of surgery, speedy recovery, less hospital stay, and no donor site morbidity; DPBFs appear to be a preferred choice for moderate size lower third leg defects. RSAFs should be chosen over DPBFs for defects in medial malleolus and larger size defects. Ramesha Kunchekoppal Thammannagowda, Ghuge Ashish, Shankarappa Mudukappa, Dehpande Pushkar, and Abhishek Vijayakumar Copyright © 2014 Ramesha Kunchekoppal Thammannagowda et al. All rights reserved. An Audit of Surgical Management of Pressure Sores in a Resource Constrained Hospital in Kenya Thu, 20 Jun 2013 12:50:15 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/756439/ Objective. To determine the surgical management of pressure sores at the National Spinal Injury Hospital and the outcome. Design. This was a four-year prospective study from June 2008 to June 2012. Setting. The study was carried out at the National Spinal Injury Hospital, Nairobi, Kenya. Subjects. Patients with pressure sores operated on during the defined period of study. Results. A total of 46 patients with 58 pressure sores were operated on during the defined period of study. The male : female ratio was 10.5 : 1. The mean age was 36.5 years. Trochanteric sores accounted for 60 percent of the pressure sores operated on with the V-Y tensor fascia lata, the commonest surgical procedure, accounting for 37 percent of the procedures performed. At one year of followup 90 percent of the surgeries done were successful with no ulcer recurrence noted. Conclusion. Surgical management of pressure sores even in resource constrained environment would result in faster rehabilitation and early patient discharge. The recurrence of the pressure sores could be greatly reduced by involving patients relatives in the rehabilitation and home-based care. W. F. Nangole, S. O. Khainga, Soren Otieno, and Audi Tanga Copyright © 2013 W. F. Nangole et al. All rights reserved. Managing Acute Wounds with Negative Pressure System in a Developing Country Wed, 12 Jun 2013 16:29:32 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/796254/ Introduction. The negative pressure system has been found to be a valuable addition to the various procedures of wound management and has been widely accepted to be safe and effective in promoting wound healing. Aim. The study seeks to find out the outcome of the use of the VAC device in the treatment of patients with acute wounds. Materials and Methods. Between January 2009 and December 2011, a consecutive nonrandomized study was conducted among 48 patients who presented with acute wounds at the Komfo Anokye Teaching Hospital. Patients were made to undergo negative pressure wound therapy using the VAC device. Results. Forty-eight patients with various degrees of acute wounds were treated, of which 43 (89.6%) were females and 5 (10.4%) were males. Ages of patients ranged from 19 to 78 years. Satisfaction with rate of wound healing revealed that 86.7% and 8.9% had excellent and good healing, respectively, while 4.4% said theirs was satisfactory. Therapy was discontinued in three (6.3%) patients who developed some complications. Conclusion. There was reduction in the hospitalization by patients thereby reducing costs. Also, quality of life of persons who had undergone the therapy with the VAC device had improved. Even though a few device-related complications were observed, patient satisfaction was high. J. Akpaloo, J. Yorke, P. Agbenorku, and E. M. T. Yenli Copyright © 2013 J. Akpaloo et al. All rights reserved. Orofacial Clefts: A Worldwide Review of the Problem Mon, 20 May 2013 11:16:05 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/348465/ Orofacial cleft is one of the commonest congenital abnormalities which impacts negatively on the life of the individual and to a large extent affects the family. Caused by the interaction of environmental and genetic factors, this abnormality brings about decreased quality of life. Management of this abnormality entails a team involving a cleft surgeon, speech therapist, dentist, orthodontists, and so forth. This study involves the review of the various literatures on orofacial clefts, discussing the problems on the genetic basis, associated syndromes, and their management. Counseling of prospective mothers should be promoted to ensure that the abnormality is prevented at the early stages. Education on orofacial clefts should be promoted to create awareness on its preventive measures. Much attention must be geared towards cleft genetics studies to identify potential risk factors which might be predisposing individuals to the anomaly. P. Agbenorku Copyright © 2013 P. Agbenorku. All rights reserved. Incidence of Orofacial Clefts in Kumasi, Ghana Wed, 15 May 2013 09:30:27 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/280903/ Background. Cleft lip and cleft palate are among the most common orofacial congenital anomalies. This study is to establish Orofacial Clefts Database for Kumasi, Ghana, with a view to extend it to other cities in future to obtain a national orofacial anomaly database. Methods. A descriptive prospective survey was carried out at eleven selected health facilities in Kumasi. Results. The total number of live births recorded was 27,449. Orofacial anomalies recorded were 36, giving an incidence of 1.31/1000 live births or 1 in 763 live births. The mean maternal age of cleft lip/palate babies was 29.85 years (range 18–40 years). The male : female ratio for the orofacial anomalies babies was 1.3 : 1; the male : female ratio was 0.5 : 1 in the cleft lip group, 1.3 : 1 in the cleft lip and palate group, and 4 : 1 in the cleft palate group. The majority of clefts were unilateral (69.4%, ), with females () outnumbering males (). A family history of cleft was recorded with five babies (13.9%). Associated congenital anomalies were recorded in seven (19.4%) cleft lips and/or palates. Conclusion. The incidence of 1 in 763 live births found in this study indicates that cleft lip/palate is a common congenital anomaly in Kumasi. P. Agbenorku, M. Yore, K. A. Danso, and C. Turpin Copyright © 2013 P. Agbenorku et al. All rights reserved. Retrospective Review of Patients Operated on with Bilateral Cleft Lip through Surgical Outreaches in Kenya Mon, 15 Apr 2013 15:29:02 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/268094/ This was a study to evaluate the characteristics and outcome of patients operated on with bilateral cleft lip through surgical outreach programs in Kenya between January 2006 and December 2011. Files for fifty-nine patients operated on during the study period were evaluated. The mean age for surgery was ten months with about forty-five percent of the patients more than one year of age. No presurgical orthopaedic devices were utilized on any of the patients. Mulliken surgical technique and the Manchester technique were the commonest surgical techniques in equal proportions. An overall complication rate of about 7.5 percent was noted. In conclusion we noted a delay in the surgical management of the majority of our patients. This resulted in a backlog of cases. There is thus a need to intensify more surgical outreach camps as well as training more surgeons to assist in the management of clefts. Cleft surgery is a relatively safe surgery that could be carried out in relatively remote centers through surgical outreach programs. This was evidenced by the low complication rates in our series. F. W. Nangole and S. O. Khainga Copyright © 2013 F. W. Nangole and S. O. Khainga. All rights reserved. Short-Term Effects of Radiotherapy Postquadrantectomy on Internal Mammary Artery and Vein Mon, 04 Mar 2013 09:27:34 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/606073/ When a tumor local recurrence occurs a possible approach can be a mastectomy with simultaneous breast reconstruction with autologous tissue. The area involved by tangential radiation portals includes also the internal mammary artery and veins, considered by the most part of plastic surgeons to be the best recipient vessels for a free flap in breast reconstruction. Internal mammary vessels receives low but not necessary insignificant doses during whole breast irradiation; arteries and veins are traditionally considered quietly resistant to the irradiation but limited data on the flux in mammary vessels after radiotherapy are available. The goal of our study (37 patients from September 2011 to February 2012) was to evaluate modifications in vascular parameters of the flux at ultrasonography in the internal mammary chain after adjuvant radiotherapy that could influence the choice of the autologous surgical technique (free or pedicled flap) and the choice of the recipient vessels in breast reconstruction. Based on the results of our study, we would recommend avoiding an irradiated recipient site when no irradiated recipient vessels are available; a preoperative ultrasound evaluation is recommended in patients underwent whole breast irradiation. Mario Cherubino, Stefano Scamoni, Dominic Taibi, Francesca Maggiulli, Igor Pellegatta, Matteo Izzo, and Luigi Valdatta Copyright © 2013 Mario Cherubino et al. All rights reserved. The Use of Postoperative Restraints in Children after Cleft Lip or Cleft Palate Repair: A Preliminary Report Tue, 22 Jan 2013 14:58:36 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/540717/ Purpose. This study examines whether the use of elbow restraints after cleft lip/palate repair has a relationship to postoperative complications. Methods. A comparative descriptive design was used to study a convenience sample of children undergoing repair of cleft lip/palate at Akron Children’s Hospital with Institutional Review Board approval. The children were randomized into intervention or control groups with use of elbow restraints considered the intervention. The study consists of two arms; one examined children after cleft lip repair, the second examined children after cleft palate repair. Repairs were performed by a single surgeon. Data collected included age, comorbidities, patient discomfort measured by pain score, frequency and duration of pain medications, use of pacifier or finger/thumb sucking, and postoperative complications including disruption of the suture line. Results. With 47 post palate repair patients and 47 post cleft repair patients, there is no significant difference () in the occurrence of postoperative complications. Conclusions. Study results provide prospective evidence to support postoperative observation of children by surgery staff and family following cleft lip or cleft palate repair without the use of elbow restraints. Clinicians should reevaluate the use of elbow restraints after cleft lip/palate repair based on the belief restraints prevent postoperative complications. Jennifer Huth, J. Dayne Petersen, and James A. Lehman Copyright © 2013 Jennifer Huth et al. All rights reserved. A New Algorithm for The Surgical Management of Defects of the Scalp Mon, 21 Jan 2013 11:08:43 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/916071/ Scalp reconstruction is a daily challenge for plastic surgeons. The authors propose their algorithm for reconstructive surgery after ablative surgery. They considered not only the size defect but also the anatomical defect and the clinical condition of the patient to achieve the best choice for reconstruction. During the two-year period, a total of 86 procedures were performed on 78 patients. We used five different techniques for reconstruction, including primary closure, graft, local or free flap, and a dermal regeneration template. No statistical difference of complication was observed in the different groups. We consider our algorithm a useful improvement in the management of the defect at the vertex. Mario Cherubino, Dominic Taibi, Stefano Scamoni, Francesca Maggiulli, Danilo Di Giovanna, Rita Dibartolo, Matteo Izzo, Igor Pellegatta, and Luigi Valdatta Copyright © 2013 Mario Cherubino et al. All rights reserved. Cost Effectiveness of Vacuum-Assisted Closure and Its Modifications: A Review Mon, 21 Jan 2013 10:51:23 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/595789/ Negative topical pressure, the general category to which the trademarked VAC therapy belongs, is not a new concept in wound therapy. It is also called subatmospheric pressure therapy, vacuum sealing, vacuum-assisted closure therapy, vacuum pack therapy, and sealing aspirative therapy. The VAC therapy system is trademarked by Kinetic Concepts, Inc., or KCI. It was first reported in 1997. The aim of the procedure is to use negative pressure to create suction, which drains the wound of exudate (i.e., fluid, cells, and cellular waste that has escaped from blood vessels and seeped into tissue) and influences the shape and growth of the surface tissues in a way that helps healing. Negative-pressure therapy for the closure of wounds accelerates secondary wound healing. High cost is still a hindrance in its use in developing nations. Many modifications were tried, but their efficacy is yet to be proved. In reality, this method is quite cost effective. It is only the lack of understanding and adequate setup which makes this method hard to use. The main objective of this paper is to focus on the cost effectiveness of VAC and its modifications. We want to emphasize the importance of homemade NPT and the use of simple suction devices. Akhlak Hussain, Kuldip Singh, and Mohinder Singh Copyright © 2013 Akhlak Hussain et al. All rights reserved. Enumeration of Salivary Streptococci and Lactobacilli in Children with Differing Caries Experiences in a Rural Indian Population Mon, 14 Jan 2013 16:54:40 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/476783/ Objectives. Compare the total salivary Streptococci and Lactobacilli counts in cleft and noncleft children with differing caries experiences, correlate the bacterial counts with dmft/DMFT status and identify the different biotypes of Mutans Streptococci (MS). Patients. Group I included thirty subjects with dental caries (DC) and cleft lip and palate (CL/P); Group II had thirty subjects with DC but without CL/P. Group III comprised a control of thirty subjects with neither DC nor CL/P. Methodology. Enumeration of total salivary Streptococci and Lactobacilli was done by the plate count method and correlation of counts with dmft/ DMFT status examined. Differences in biochemical reactions were used to identify the biotypes. Results. Streptococci colonies in CL/P children with caries (64.30 ± 24.52) was significantly higher than in children with no CL/P or caries (45.57 ± 16.73). No significant differences in the Lactobacilli count were observed. dmft/DMFT status and Streptococci counts showed a strong positive correlation whereas Lactobacilli counts showed a moderate correlation. S. mutans was the predominant biotype. Conclusions. Higher total salivary Streptococci and Lactobacilli counts exist in cleft subjects with caries than in the non-cleft subjects. Positive correlation between dmft/DMFT scores and salivary Streptococci reinforces its role in DC. S. mutans and S. sobrinus are the biotypes more frequently associated with dental caries in children. Sreeja Ravindran, Minal Chaudhary, and Madhuri Gawande Copyright © 2013 Sreeja Ravindran et al. All rights reserved. Simultaneous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients Sun, 09 Dec 2012 09:30:41 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/954576/ The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation. Kazi Md. Noor-ul Ferdous, M. Saif Ullah, M. Shajahan, M. Ashrarur Rahman Mitul, M. Kabirul Islam, Kiorsh Kumar Das, M. A. Mannan, M. Junaed Rahman, Sanjoy Biswas, A. J. M. Salek, and Bijoy Krishna Das Copyright © 2013 Kazi Md. Noor-ul Ferdous et al. All rights reserved. Orofacial Clefts: A Clinical Community Study in a Developing Country Wed, 28 Nov 2012 13:08:20 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/945254/ Aim. The study aimed at finding the types of orofacial clefts, reasons for delay in the repair of the deformity and medium through which patients and/or their relatives heard about the outreach program. Methods. This study was from 2009 to 2011 at two different study sites. The team visited various media houses and health facilities at each study site to disseminate information concerning the cleft outreach program. Patients and/or their parents who visited the hospitals were interviewed using a questionnaire designed for the study to retrieve needed information for the study. Patients were then examined and booked for cleft repair by specialists in the team. Results. A total of 61 patients were recorded from both study sites, with ages ranging from 3/12 to 54 years old, with a mean age of (SD) years; while, male : female ratio was 1.05 : 0.5. Cleft lip only (52.5%, ) was the highest type of orofacial cleft recorded in the study. In terms of occurrence, complete cleft (63.9%, ) was majority; while, position-wise, unilateral cleft right (32.8%, ) was the highest. A significant () association between males and unilateral right cleft lips was identified. Lack of finance (47.5%, ) was the main reason for delaying in deformity repair. Also, information from physician (41.0%, ) was the major medium for information dissemination. Conclusion. Unilateral cleft lip constitutes most of the orofacial clefts in this study, with lack of finance being the commonest reason why patients delay in the repair of their deformity. Pius Agbenorku, Thomas Diby, Margaret Agbenorku, Fritz Abude, Randy Sefenu, Daniel Osei, Mary Kofitse, and Edem Maniwa Copyright © 2013 Pius Agbenorku et al. All rights reserved. The “Power” Brow Lift: Efficient Correction of the Paralyzed Brow Wed, 28 Nov 2012 10:38:56 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/735406/ Purpose. To describe a novel approach to brow ptosis correction and evaluate its long-term efficacy in patients with facial-paralysis-associated brow ptosis. Methods. Twenty-two patients aged from 50 to 90 years underwent “power” brow lifting, involving 3 intrabrow stab incisions and suture suspension of the brow to the frontal calvarium via titanium miniplate. Long-term results of the operation were assessed retrospectively. Pre- and postoperative photographs were measured with FACE-gram software to evaluate efficacy of the procedure. Results. Seventeen patients who underwent “power” brow lift were available for postoperative evaluation. Among them, follow-up length ranged from 12 to 448 days. The average post-operative change in brow height was 5.7 mm, which was statistically significant (). There were no complications. Conclusions. The “power” brow procedure can help to restore upper facial symmetry and visual fields and improve periocular hygiene. The operation is easily performed in an office setting, under local anesthesia, and appears to provide reliable long-term results. The time required to perform the procedure is far less than that required for a standard direct brow lift; there is no risk of postoperative forehead hypesthesia, and there is no superciliary scar. Marc H. Hohman, Amanda L. Silver, Douglas K. Henstrom, Mack L. Cheney, and Tessa A. Hadlock Copyright © 2013 Marc H. Hohman et al. All rights reserved. Evaluation of Facial Esthetics in Rehabilitated Adults with Complete Unilateral Cleft Lip and Palate: A Comparison between Professionals with and without Experience in Oral Cleft Rehabilitation Wed, 28 Nov 2012 09:10:13 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/357568/ Objectives. The aim of this study was to evaluate the facial esthetics of White-Brazilian adults with complete unilateral cleft lip and palate (UCLP) rehabilitated at a single center. Design. 30 patients (13 females; 17 males; mean age of 24.0 years), rehabilitated at a single center, were photographed and evaluated by 25 examiners, 5 orthodontists, and 5 plastic surgeons dealing with oral clefts, 5 orthodontists and 5 plastic surgeons with no experience in the cleft treatment, and 5 laymen. Their facial profiles were classified into esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Results. Orthodontists dealing with oral clefts classified the majority of the sample as esthetically pleasant. Plastic surgeons dealing with oral cleft, orthodontists, and plastic surgeons without experience with oral clefts classified most of the sample as esthetically acceptable. Laymen evaluation also considered the majority of the sample as esthetically acceptable. Conclusions. The facial profiles of rehabilitated adults with UCLP were classified mostly as esthetically acceptable, with variations among the categories of examiners. The examiners dealing with oral clefts gave higher scores to the facial esthetics when compared to professionals without experience in oral clefts and laypersons, probably due to their knowledge of the limitations involved in the rehabilitation process. Araci Malagodi Almeida, Leopoldino Capelozza Filho, Flavio Mauro Ferrari Junior, Rita de Cassia Moura Carvalho Lauris, and Daniela Gamba Garib Copyright © 2013 Araci Malagodi Almeida et al. All rights reserved. Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers Wed, 18 Jul 2012 11:21:45 +0000 http://www.hindawi.com/journals/isrn.plastic.surgery/2013/952971/ Background. With greater experience in microsurgical reconstruction, free tissue transfer has become common and reliable. However, total flap necrosis after microsurgical reconstruction is sometimes seen in patients who have undergone radical ablation of head and neck malignancies. We investigated factors predicting free flap loss in head and neck reconstruction. Methods. We reviewed the records of 111 free flap reconstructions carried out among 107 patients with head and neck cancer who required radical resection and microsurgical reconstruction in our unit from 2004 through 2010. Among these patients, 6 showed total flap necrosis postoperatively. We investigated the associations between primary or recurrent tumor, type of flaps, chemotherapy, and radiotherapy and flap loss. Results. Five of 20 (25.0%) patients who underwent radiotherapy developed flap necrosis: among the 91 patient who did not undergo radiotherapy, only one (1.1%) developed. Preoperative radiotherapy was statistically identified as the most important risk factor for postoperative flap failure. Conclusions. Patients receiving radiation treatment are more likely to develop total flap failure when they undergo reconstructive surgery with free flaps after tumor ablation, because the combination of endarteritis and chronic ischemia caused by radiation damaged endothelial membrane in the recipient vessels, consequently, thrombosis tends to develop. Masaki Fujioka Copyright © 2013 Masaki Fujioka. All rights reserved.