The Art of Local Tissue Rearrangements in Burn Reconstruction
In recent decades, advances in surgical anatomy, burn pathophysiology, surgical techniques, and laser therapy have led to a paradigm shift in how we approach burn scars and contractures. Scar excision and replacement with uninjured tissue, which predominated burn scar treatment for much of the 20th century, is no longer appropriate in many patients. A scar ’s intrinsic ability to remodel can be induced by reducing tension on the scar using various techniques for local tissue rearrangement. Often in combination with laser therapy, local flaps can optimally camouflage a burn scar with adjacent normal tissue and restore a p...
Source: Clinics in Plastic Surgery - April 6, 2024 Category: Cosmetic Surgery Authors: Matthias B. Donelan, Martin R. Buta Source Type: research
Nerve Versus Tendon Transfers in the Management of Isolated Upper Extremity Peripheral Nerve Injuries
Upper extremity peripheral nerve injuries present functional deficits that are amenable to management by tendon or nerve transfers. The principles of tendon and nerve transfers are discussed, with technical descriptions of preferred tendon and nerve transfers for radial, median, and ulnar nerve injuries. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - April 6, 2024 Category: Cosmetic Surgery Authors: Dexter W. Weeks, Ronald D. Brown Source Type: research
Free Functional Muscle Transfer —Technical Considerations
Free functional muscle transfers restore voluntary motion in extremities following the loss of local muscle-tendon units. Surgeons, at various levels of expertise, need to consider several technical aspects when performing this procedure. Successful and consistent outcomes can be attained by applying a combination of basic principles, drawing from techniques developed for successful tendon transfers and microsurgical free tissue transfers. Patient preparation through counseling and intensive rehabilitation is essential to achieve the optimal conditions before the transfer. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - April 4, 2024 Category: Cosmetic Surgery Authors: Utkan Aydin, Kevin C. Chung Source Type: research
Optimizing Outcomes in Revision Peripheral Nerve Surgery of the Upper Extremity
Peripheral nerve surgeries for compressive neuropathy in the upper extremity are generally successful. However, cases that either fail or have complications requiring revision surgery are challenging. During revision consideration, surgeons should perform a comprehensive preoperative workup to understand the etiology of the patient ’s symptoms and categorize symptoms as persistent, recurrent, or new in relation to the index procedure. Revision surgery often requires an open, extensile approach with additional procedures to optimize outcomes. Even with proper workup and treatment, clinical outcomes of revision surgeries a...
Source: Clinics in Plastic Surgery - April 3, 2024 Category: Cosmetic Surgery Authors: Michele Christy, Christopher J. Dy Source Type: research
Proximal and Distal Nerve Transfers in the Management of Brachial Plexus Injuries
This study explores nerve transfer strategies and their integration with other procedures, emphasizing their importance in enhancing outcomes in brachial plexus injury management. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - April 3, 2024 Category: Cosmetic Surgery Authors: Soo Jin Woo, Johnny Chuieng-Yi Lu Source Type: research
The Mangled Upper Extremity –Algorithm for Salvage
Mangling injuries of the upper extremity are severe, high-energy traumas that damage multiple functional systems including skin, nerves, vascular, tendon, and bone. Management requires familiarity with various techniques in orthopedic, vascular, and plastic surgery. A specific technique cannot be described due to the various combinations of injuries that can occur with mangled upper extremities, but we present principles and recommendations for treatment and judgment. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - April 3, 2024 Category: Cosmetic Surgery Authors: Tsz Kit Kevin Chan, Kevin Chi Chung Source Type: research
Health Policy Implications of Digital Replantation
This article aims to delve into the factors contributing to the decreasing numbers of replantations and proposes strategies to overcome this issue. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - April 3, 2024 Category: Cosmetic Surgery Authors: Zhixue Lim, Sandeep Jacob Sebastin, Kevin C. Chung Source Type: research
The Role of Microsurgery in Burn Surgery
Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site morbidity. Despite being rarely used, flap reconstruction becomes necessary when critical structures are exposed, offering robust coverage and reducing complications. However, free flaps in acute burns face challenges, including a higher failure rate attributed to hyperinflammatory states and hypercoagulability. Surgical optimization strategies involve careful timing, patient preparation, and meticulous postoperative care. In delayed burn reconstruction, free...
Source: Clinics in Plastic Surgery - April 1, 2024 Category: Cosmetic Surgery Authors: Mario Alessandri Bonetti, Francesco M. Egro Source Type: research
Fat Grafting and Regenerative Medicine in Burn Care
Regenerative therapies such as fat grafting and Platelet Rich Plasma (PRP) have emerged as new options to tackle burn-related injuries and their long-term sequelae. Fat grafting is able to promote wound healing by regulating the inflammatory response, stimulating angiogenesis, favoring the remodeling of the extracellular matrix, and enhancing scar appearance. PRP can enhance wound healing by accelerating stages including hemostasis and re-epithelization. It can improve scar quality and complement fat grafting procedures. Their cost-effectiveness, minimal invasiveness, and promising results observed in the literature have m...
Source: Clinics in Plastic Surgery - April 1, 2024 Category: Cosmetic Surgery Authors: Mario Alessandri Bonetti, Nelson S. Piccolo, J. Peter Rubin, Francesco M. Egro Source Type: research
Principles for Achieving Predictable Outcomes in Flexor Tendon Repair
Flexor tendon injuries require surgical repair. Early repair is optimal, but staged repair may be indicated for delayed presentations. Zone II flexor tendon injuries are the most difficult to achieve acceptable outcomes and require special attention for appropriate repair. Surgical techniques to repair flexor tendons have evolved over the past several decades and principles include core strand repair using at least a 4 strand technique, epitendinous suture to add strength and gliding properties, and pulley venting. Early postoperative active range of motion within the first 3 to 5 days of surgery is essential for optimiz...
Source: Clinics in Plastic Surgery - April 1, 2024 Category: Cosmetic Surgery Authors: Erin A. Miller, Lindsey Teal Source Type: research
Pediatric Burns
This article reviews the most important aspects of the management of a pediatric burned patient starting from the acute through reconstructive phases. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - March 28, 2024 Category: Cosmetic Surgery Authors: Mark D. Fisher, William Norbury Source Type: research
Update on Hypertrophic Scar Management in Burn Patients
Hypertrophic scars arise from burn injuries because of persistent inflammation in the reticular dermis. Several risk factors promote this chronic inflammation. One is tension on the burn wound/scar due to surrounding skin tightness and bodily movements. High estrogen levels and hypertension are also important systemic risk factors. Thus, to prevent burn wounds from developing into hypertrophic scars, it is important to focus on quickly resolving the reticular dermal inflammation. If conservative treatments are not effective and the hypertrophic scar transitions to scar contracture, surgical methods such as Z-plasty, full-t...
Source: Clinics in Plastic Surgery - March 21, 2024 Category: Cosmetic Surgery Authors: Rei Ogawa Source Type: research
Emerging Technologies
In this article, an array of new developments in burn care, from diagnosis to post-burn reconstruction and re-integration, will be discussed. Multidisciplinary advances have allowed the implementation of technologies that provide more accurate assessments of burn depth, improved outcomes when treating full-thickness burns, and enhanced scar tissue management. Incorporating these new treatment modalities into current practice is essential to improving the standard of burn care and developing the next generation of burn wound management methodologies. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - March 21, 2024 Category: Cosmetic Surgery Authors: Sigrid A. Blome-Eberwein Source Type: research
Head and Neck Reconstruction in Burn Patients
Reconstruction of burns in the head and neck region is challenging. This is because it must achieve both functional reconstruction and esthetic reconstruction. Local flaps are best for minor defects, particularly in the case of deep burns, because they bear the correct texture and color. However, for large deep burn wounds, simple grafting or small local flaps will not produce satisfactory results. It is also crucial to assess the extent and depth of reconstruction that is needed throughout the face-neck-anterior chest region, and to make the choice between techniques such as Z-plasty, skin grafting, super-thin flaps, and ...
Source: Clinics in Plastic Surgery - March 21, 2024 Category: Cosmetic Surgery Authors: Rei Ogawa Source Type: research
Acute and Reconstructive Burn Care of the Hand
The hand is commonly affected in thermal injuries. Hand burns account for 39% of all burns and they are involved in 34% of instances when the total body surface area of a burn exceeds 15%. Inadequate or inappropriate treatment could result in significant morbidity. The ultimate integration of a burn patient into the society largely depends on the functionality of the hands. Hence, it is important to reduce complications by providing good care during the acute stage. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - March 15, 2024 Category: Cosmetic Surgery Authors: Shanmuganathan Raja Sabapathy, R. Raja Shanmugakrishnan, Charles Scott Hultman Source Type: research
