scholarly journals Simplified management of a giant forehead congenital nevus allows for early reconstruction

2020 ◽  
Vol 13 (7) ◽  
pp. e234164
Author(s):  
Moris Topaz ◽  
Michael Gurevich ◽  
Itamar Ashkenazi
Keyword(s):  
Tissue Expander ◽  
Early Conclusion ◽  
Complete Excision ◽  
Delayed Primary Closure ◽  
Skin Stretching ◽  
Reconstructive Process ◽  
Simple Alternative ◽  
Early Reconstruction ◽  
A Minor ◽  
Relief System

We report simplified surgical management of giant congenital forehead nevus that customarily requires the use of tissue expander for complete excision. Commencing treatment at the age of 3 months, the TopClosure tension relief system (TRS) was applied as an external tissue expander allowing preoperative skin stretching by mechanical creep. This was followed by partial excision of the nevus. Intraoperative stress-relaxation allowed further expansion of the skin. Postoperative wound closure was secured with the aid of the TRS. Repeated, six simple staged excisions of the forehead lesion and a minor skin graft to the eyelid part, allowed for delayed primary closure of the entire lesion by the age of 2. This simple alternative approach, which allows the early start and early conclusion of the reconstructive process, should be considered as the primary option in the treatment of these patients.

scholarly journals Skin stretching by a balloon tissue expander: Interplay between contact mechanics and skin growth

2016 ◽  
Vol 9 ◽  
pp. 175-187 ◽  
Author(s):  
Abhishek Srivastava ◽  
Adrián Buganza Tepole ◽  
Chung-Yuen Hui
Keyword(s):  
Contact Mechanics ◽  
Tissue Expander ◽  
Skin Stretching

scholarly journals Use of New Technologies in Implant-Based Breast Reconstruction

2019 ◽  
Vol 33 (04) ◽  
pp. 258-263
Author(s):  
Glyn E. Jones ◽  
Victor A. King ◽  
Aran Yoo ◽  
Amjed Abu-Ghname ◽  
Charalambos K. Rammos
Keyword(s):  
Breast Reconstruction ◽  
New Technologies ◽  
Breast Implant ◽  
Tissue Expander ◽  
Improved Outcomes ◽  
Reconstructive Process ◽  
Perfusion Assessment ◽  
The 1960S ◽  
Instrumental Methods ◽  
Mastectomy Flap

AbstractOutcomes after mastectomy and prosthetic-based breast reconstruction have improved immensely since the development of the first tissue expander and breast implant in the 1960s. One major factor contributing to our improved outcomes over the past two decades is the increasing availability and improvement of perfusion assessment technology. Instrumental methods now exist which allow surgeons to assess tissue viability intraoperatively, and provide actionable, objective data that augments clinical assessment. In this article, the authors detail two commercially available, state-of-the-art technologies that surgeons may use to assist in mastectomy flap assessment and facilitate the reconstructive process.

1998 William J. Stickel Silver Award. Mechanically assisted, delayed primary closure of diabetic foot wounds

1998 ◽  
Vol 88 (10) ◽  
pp. 483-488 ◽  
Author(s):  
DG Armstrong ◽  
LA Lavery
Keyword(s):  
Diabetic Foot ◽  
Primary Closure ◽  
Wound Care ◽  
Wound Dehiscence ◽  
Healing Time ◽  
Control Group ◽  
Secondary Intention ◽  
Delayed Primary Closure ◽  
Skin Stretching ◽  
And Control

The authors evaluated the time to healing and prevalence of complications in patients undergoing mechanically assisted, delayed primary closure of diabetic foot wounds compared with a similar population who received standard wound care. A total of 55 patients were enrolled for study, with 25 in the experimental group and 30 in the control group. Patients in the experimental (stretch) group underwent mechanically assisted primary closure of their wounds using a skin-stretching device. There was no difference between the stretch and control groups with regard to any descriptive characteristics, including wound chronicity. Although the wounds were over three times as large on average in the stretch group (P < .001), the stretch group reached full epithelialization approximately 40% sooner than the control group (26.4 +/- 16.0 versus 42.5 +/- 19.9 days; P < .002). Eighty-eight percent of patients in the stretch group experienced wound dehiscence, at a mean time of 1.8 +/- 0.6 weeks following mechanically assisted closure. However, patients who experienced dehiscence in the stretch group healed significantly faster than patients in the control group (27.4 +/- 16.7 versus 42.5 +/- 19.9 days; P < .007). The results of this study suggest that mechanically assisted closure of diabetic foot wounds may result in reduced healing time compared with healing by secondary intention.

Management of Postfasciotomy Wounds and Skin Defects Following Complex Vascular Trauma to the Extremities Using the External Tissue Extender System

2018 ◽  
Vol 17 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Christos D. Karkos ◽  
Ioakeim Papoutsis ◽  
Ioakeim T. Giagtzidis ◽  
Ioannis Pliatsios ◽  
Maria-Aphroditi Mitka ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Primary Closure ◽  
Soft Tissue Defect ◽  
Vascular Trauma ◽  
Soft Tissue Defects ◽  
Delayed Primary Closure ◽  
Skin Stretching ◽  
The Mean ◽  
Wound Length ◽  
Tissue Defects

Management of large postfasciotomy wounds and/or skin and soft tissue defects after major vascular trauma to the extremities can be challenging. The External Tissue Extender (Blomqvist; ETE), a skin-stretching device, which consists of silicone tapes and plastic stoppers, approximates wound margins and facilitates delayed primary closure. We describe our experience with the use of ETE in 5 patients (4 males) with a total of 8 wounds (7 postfasciotomy, 1 soft tissue defect) over the past 12 years. The mean patient age was 32 (range 17-61) years. The wounds involved the lower limb in 3 patients and the upper limb in 2, whereas the injured arteries were the popliteal in 3, the axillary in 1, and the brachial in 1. The mean wound length was 24 cm (range 9-37 cm), and the mean number of ETE silicone tapes used per wound was 13 (range 5-19). The median duration of ETE therapy was 7 days (range 4-7). ETE therapy resulted in sufficient wound approximation to allow complete closure with conventional suturing in 7 out of the 8 wounds. Of these, one developed infection that required drainage, debridement, and resuturing. All wounds achieved satisfactory healing status and all limbs had been salvaged. In conclusion, the ETE is a useful, easy-to-use, and simple adjunct that may facilitate delayed primary closure of large postfasciotomy wounds or extensive skin and soft tissue defects following complex vascular trauma to the extremities.

Rating Post-Operative Backs (Part I)

1997 ◽  
Vol 2 (4) ◽  
pp. 1-3
Author(s):  
James B. Talmage
Keyword(s):  
Spinal Stenosis ◽  
Foot Drop ◽  
Neurogenic Claudication ◽  
Root Damage ◽  
Fourth Edition ◽  
Minor Strain ◽  
Injury Model ◽  
Strain Type ◽  
A Minor ◽  
Anterior Tibialis

Abstract The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, uses the Injury Model to rate impairment in people who have experienced back injuries. Injured individuals who have not required surgery can be rated using differentiators. Challenges arise when assessing patients whose injuries have been treated surgically before the patient is rated for impairment. This article discusses five of the most common situations: 1) What is the impairment rating for an individual who has had an injury resulting in sciatica and who has been treated surgically, either with chemonucleolysis or with discectomy? 2) What is the impairment rating for an individual who has a back strain and is operated on without reasonable indications? 3) What is the impairment rating of an individual with sciatica and a foot drop (major anterior tibialis weakness) from L5 root damage? 4) What is the rating for an individual who is injured, has true radiculopathy, undergoes a discectomy, and is rated as Category III but later has another injury and, ultimately, a second disc operation? 5) What is the impairment rating for an older individual who was asymptomatic until a minor strain-type injury but subsequently has neurogenic claudication with severe surgical spinal stenosis on MRI/myelography? [Continued in the September/October 1997 The Guides Newsletter]

Pelvic Impairments

2018 ◽  
Vol 23 (4) ◽  
pp. 9-10
Author(s):  
James Talmage ◽  
Jay Blaisdell
Keyword(s):  
Pelvic Ring ◽  
Reproductive Organs ◽  
High Impact ◽  
Pelvic Fractures ◽  
Motor Dysfunction ◽  
Impact Event ◽  
Concomitant Injuries ◽  
Rating Process ◽  
Pass Through ◽  
A Minor

Abstract Pelvic fractures are relatively uncommon, and in workers’ compensation most pelvic fractures are the result of an acute, high-impact event such as a fall from a roof or an automobile collision. A person with osteoporosis may sustain a pelvic fracture from a lower-impact injury such as a minor fall. Further, major parts of the bladder, bowel, reproductive organs, nerves, and blood vessels pass through the pelvic ring, and traumatic pelvic fractures that result from a high-impact event often coincide with damaged organs, significant bleeding, and sensory and motor dysfunction. Following are the steps in the rating process: 1) assign the diagnosis and impairment class for the pelvis; 2) assign the functional history, physical examination, and clinical studies grade modifiers; and 3) apply the net adjustment formula. Because pelvic fractures are so uncommon, raters may be less familiar with the rating process for these types of injuries. The diagnosis-based methodology for rating pelvic fractures is consistent with the process used to rate other musculoskeletal impairments. Evaluators must base the rating on reliable data when the patient is at maximum medical impairment and must assess possible impairment from concomitant injuries.

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

The Effect of Path Length and Display Size on Memory for Spatial Information

2012 ◽  
Vol 59 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Katherine Guérard ◽  
Sébastien Tremblay
Keyword(s):  
Path Length ◽  
Potential Role ◽  
Spatial Information ◽  
Recall Performance ◽  
Minor Role ◽  
Length Effect ◽  
Serial Memory ◽  
Fixed Reference ◽  
A Minor

In serial memory for spatial information, some studies showed that recall performance suffers when the distance between successive locations increases relatively to the size of the display in which they are presented (the path length effect; e.g., Parmentier et al., 2005) but not when distance is increased by enlarging the size of the display (e.g., Smyth & Scholey, 1994). In the present study, we examined the effect of varying the absolute and relative distance between to-be-remembered items on memory for spatial information. We manipulated path length using small (15″) and large (64″) screens within the same design. In two experiments, we showed that distance was disruptive mainly when it is varied relatively to a fixed reference frame, though increasing the size of the display also had a small deleterious effect on recall. The insertion of a retention interval did not influence these effects, suggesting that rehearsal plays a minor role in mediating the effects of distance on serial spatial memory. We discuss the potential role of perceptual organization in light of the pattern of results.

Sign in / Sign up

Export Citation Format

Share Document