scholarly journals Free flaps in scar treatment

2017 ◽  
Vol 2 (4) ◽  
pp. 203-209
Author(s):  
Peter M. Vogt ◽  
Seyed Arash Alawi ◽  
Ramin Ipaktchi
Keyword(s):  
Treatment Algorithm ◽  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Individual Case ◽  
Surgical Approaches ◽  
Radical Excision ◽  
Surgical Measures ◽  
Scar Management ◽  
The Individual

AbstractIntroduction:Scar management needs defined concepts and an algorithm to restore functional and aesthetic units. After an unsuccessful conservative treatment, surgical measures provide a vast spectrum of possibilities for remediation. The spectrum of possibilities consists of excision and Z-plasty, regional flaps, vascularized pedicled flaps, tissue expansion, and finally free tissue transfer. Severe scarring and highly destructed tissues with inferior functional and aesthetic units can be effectively treated with radical excision and free flap reconstruction. The complexity of flap architecture and tissue qualities allows for an individualized approach. Specific attention should be paid to the long-term consequences of severe scarring with progressive loss of functionality.Materials and methods:We worked out the most common surgical approaches and treatment algorithm for a stepwise and effective approach. Part of this algorithm is a seven-step surgical approach.Results:This article provides modern plastic and reconstructive surgery concepts with an algorithm for scar management.Discussion:The treatment of scars follows an algorithm with the level of complexity of techniques adjusted to the individual case and the conditions. Disabilities induced by scarring can lead to further functional loss. In these cases, surgical strategies have to be considered.

Resurfacing in Facial Burn Sequelae Using Parascapular Free Flap: A Long-Term Experience

2021 ◽  
Author(s):  
Gurdyal Singh Kalra ◽  
Sushrut Kalra ◽  
Samarth Gupta
Keyword(s):  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Surrounding Tissue ◽  
Parascapular Flap ◽  
Surgical Options ◽  
High Level ◽  
Flap Cover ◽  
Facial Burn

Abstract Background It is difficult to treat large post burn sequelae (scars and defects) over face. Available methods include skin grafts, local flaps, tissue expansion, and free flaps. These surgical options should be chosen wisely, depending upon individual patient requirements and area involved. In patients with large post burn scars and defects in which the surrounding tissue is also involved, use of free tissue transfer is extremely useful. Patients and Methods A retrospective analysis was done between 2011 and 2019 of fifty-two cases with extensive facial burn deformities in whom secondary reconstruction was done with free parascapular flap cover in or department. Outcome was assessed by direct questionnaire. Results There was no complete flap loss in the series. Two cases were re-explored for venous insufficiency and suffered partial marginal necrosis. Twenty patients had to undergo further debulking procedure. Forty-seven patients were satisfied by the final outcome. Conclusion Post burn facial deformities are difficult to treat, in many cases there are no local options and tissue from different regions is to be used for reconstruction. Free parascapular flaps can be used as an effective method in such cases with a high level of patient satisfaction.

Shoulder Pain at Work: Causation Analysis

2017 ◽  
Vol 22 (1) ◽  
pp. 11-16
Author(s):  
Joel Weddington ◽  
Charles N. Brooks ◽  
Mark Melhorn ◽  
Christopher R. Brigham
Keyword(s):  
Epidemiological Data ◽  
Case Law ◽  
Individual Case ◽  
Shoulder Injury ◽  
Work Related ◽  
Clear Cut ◽  
The Individual ◽  
Causation Analysis ◽  
Injury Causation ◽  
Relevant Factors

Abstract In most cases of shoulder injury at work, causation analysis is not clear-cut and requires detailed, thoughtful, and time-consuming causation analysis; traditionally, physicians have approached this in a cursory manner, often presenting their findings as an opinion. An established method of causation analysis using six steps is outlined in the American College of Occupational and Environmental Medicine Guidelines and in the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, as follows: 1) collect evidence of disease; 2) collect epidemiological data; 3) collect evidence of exposure; 4) collect other relevant factors; 5) evaluate the validity of the evidence; and 6) write a report with evaluation and conclusions. Evaluators also should recognize that thresholds for causation vary by state and are based on specific statutes or case law. Three cases illustrate evidence-based causation analysis using the six steps and illustrate how examiners can form well-founded opinions about whether a given condition is work related, nonoccupational, or some combination of these. An evaluator's causal conclusions should be rational, should be consistent with the facts of the individual case and medical literature, and should cite pertinent references. The opinion should be stated “to a reasonable degree of medical probability,” on a “more-probable-than-not” basis, or using a suitable phrase that meets the legal threshold in the applicable jurisdiction.

scholarly journals Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

2021 ◽  
Vol 06 (01) ◽  
pp. e35-e39
Author(s):  
Chelsi Robertson ◽  
Charles Patterson ◽  
Hugo St. Hilaire ◽  
Frank H. Lau
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Final Analysis ◽  
The United States ◽  
Local Flap ◽  
Recurrence Rates ◽  
Tissue Transfer ◽  
Cochrane Database

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

2020 ◽  
Author(s):  
Ravi Sankar Manogaran ◽  
Raj Kumar ◽  
Arulalan Mathialagan ◽  
Anant Mehrotra ◽  
Amit Keshri ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Tertiary Care ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Complete Excision ◽  
Lateral Skull Base ◽  
The Individual ◽  
Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

scholarly journals Italy on gaining official parliamentary recognition that obesity is a chronic disease

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Serra ◽  
A Lenzi ◽  
R Pella ◽  
C Spinato ◽  
G Fatati ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Obesity Prevention ◽  
Diagnostic Procedures ◽  
Healthcare Systems ◽  
Surgical Approaches ◽  
Life Years ◽  
Significant Burden ◽  
The Government ◽  
The Individual ◽  
Multi Stakeholder

Abstract Obesity places a significant burden on people affected, increasing their risk of unintended health consequences and reducing their life expectancy. Rising obesity levels have also had an adverse effect on society and economic prosperity, causing a decrease in economic activity through loss of productive life years, and by placing increasing demands on healthcare systems. Despite the scientific community recognising obesity as a multifactorial chronic disease which requires long-term management, it is often considered to be the responsibility of the individual by governments, healthcare systems and even people with obesity. Obesity is not recognition as disease in Italy, but it has a relevant impact on heath policy, clinical, social and economic. On November 13th 2019, the Chamber of Deputies of the Italian Parliament voted unanimously to approve a motion that recognises obesity as a chronic disease and asks the Government to implement specific actions to promote and improve obesity prevention and management. Among the various commitments there is also a national plan that harmonises the activities in the field of prevention and the fight against obesity; full access to the diagnostic procedures for comorbidities, to dietary-food treatments in the most serious cases, access to second-level centres to evaluate psychological, pharmacological and surgical approaches; guidelines concerning the “first 1,000 days of life” of the child and programs for the prevention of childhood obesity. Obesity now recognised as a chronic disease in Italy. The collaborative, multi-stakeholder effort was long in the making and includes a Charter of Human Rights for People Living with Obesity. The document enumerates actions necessary for the protection of health for obesity prevention and treatment of people living with obesity. The process implemented as a typical policy domino game. Key messages Obesity now recognised as a chronic disease. Policy domino game.

Judicial Lawmaking, Discourse Theory, and the ICTY on Belligerent Reprisals

2011 ◽  
Vol 12 (5) ◽  
pp. 1261-1278 ◽  
Author(s):  
Milan Kuhli ◽  
Klaus Günther
Keyword(s):  
International Criminal Court ◽  
International Criminal ◽  
International Criminal Tribunal ◽  
Individual Case ◽  
Criminal Court ◽  
Discourse Theory ◽  
Criminal Courts ◽  
Normative Expectations ◽  
Judicial Lawmaking ◽  
The Individual

Without presenting a full definition, it can be said that the notion of judicial lawmaking implies the idea that courts create normative expectations beyond the individual case. That is, our question is whether courts' normative declarations have an effect which is abstract and general. Our purpose here is to ask about judicial lawmaking in this sense with respect to international criminal courts and tribunals. In particular, we will focus on the International Criminal Tribunal for the Former Yugoslavia (ICTY). No other international criminal court or tribunal has issued so many judgments as the ICTY, so it seems a particularly useful focus for examining the creation of normative expectations.

Cranial Nerve and Hearing Function after Combined-Approach Surgery for Glomus Jugulare Tumors

1996 ◽  
Vol 105 (12) ◽  
pp. 949-954 ◽  
Author(s):  
Mislav Gjuric ◽  
Stephan Rüdiger Wolf ◽  
Malte Erik Wigand ◽  
Manfred Weidenbecher
Keyword(s):  
Tumor Growth ◽  
Cranial Nerve ◽  
Functional Results ◽  
Surgical Approaches ◽  
Tumor Removal ◽  
Transcervical Approach ◽  
Glomus Jugulare ◽  
Cranial Nerve Palsies ◽  
Ablative Surgery ◽  
The Individual

In this retrospective study, oncologic and functional results of 46 patients treated for glomus jugulare tumor are reported. The standard surgical approach was the combined transmastoid-transcervical approach, modified according to the individual tumor growth, and eventually combined with a transtemporal or a suboccipital approach. Complete tumor removal resulted in a cure rate of 90%. New-onset cranial nerve palsies developed in less than 22% of patients. In 54% of cases it was possible to retain middle ear function. From a total of 12 patients with incomplete tumor removal and postoperative irradiation, progressive tumor growth was noted in 4 patients, and was controlled by salvage irradiation or surgery. Radical tumor removal by ablative surgery can be modified by efforts to reduce mutilating resections. In their place, individually tailored and combined multidirectional surgical approaches may allow total tumor removal with lower morbidity.

Assessing the validity of NART-estimated premorbid IQs in the individual case

1990 ◽  
Vol 29 (4) ◽  
pp. 435-436 ◽  
Author(s):  
J. R. Crawford ◽  
K. M. Allan ◽  
R. H. B. Cochrane ◽  
D. M. Parker
Keyword(s):  
Individual Case ◽  
The Individual

Menopause

2018 ◽  
Author(s):  
Susan D. Reed ◽  
Eliza L. Sutton
Keyword(s):  
Treatment Algorithm ◽  
Menopausal Symptoms ◽  
Menopausal Transition ◽  
Pharmacologic Therapy ◽  
Reproductive Aging ◽  
Hormonal Changes ◽  
Hormone Production ◽  
Natural Menopause ◽  
Estrogen Receptor Modulators ◽  
The Individual

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 highly rendered figures, 7 tables, and 119 references.

Principles of Wound Management and Soft Tissue Repair II

2018 ◽  
Author(s):  
Jonathan S. Friedstat ◽  
Michelle R Coriddi ◽  
Eric G Halvorson ◽  
Joseph J Disa
Keyword(s):  
Soft Tissue ◽  
Tissue Repair ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Wound Management ◽  
Soft Tissue Coverage ◽  
Soft Tissue Repair ◽  
Healing Wound ◽  
Contour Defects ◽  
Tissue Flaps

Wound management and soft-tissue repair can vary depending on the location. The head and neck, chest and back, arm and forearm, hand, abdomen, gluteal area and perineum, thigh, knee, lower leg, and foot all have different local options and preferred free flaps to use for reconstruction. Secondary reconstruction requires a detailed analysis of all aspects of the wound including any scars, soft tissue and/or skin deficits, functional defects, contour defects, complex or composite defects, and/or unstable previous wound coverage. Careful monitoring of both the patient and reconstruction is necessary in the postoperative period to ensure long-term success.   This review contains 2 figures and 17 references. Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps

Sign in / Sign up

Export Citation Format

Share Document