Category: National Laser Institute

Full-Thickness Chemical Burn From Trifluoroacetic Acid: A Case Report and Review of the Literature

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imageTrifluoroacetic acid (TFA) burns are an ill-defined entity due to a lack of reported sizable burns from this chemical. In this case report of the largest reported burn from TFA, we demonstrate that TFA causes extensive, progressive full-thickness tissue injury that may initially appear superficial. Trifluoroacetic acid does not seem to involve the systemic toxicities that result from hydrofluoric acid burns, and there is no role for calcium gluconate in acute management based on this case. Operative intervention should be staged because wound beds may initially seem healthy yet demonstrate continued necrosis.

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Letter to the Editor Following “A Combination Flap for Nasal Defect Reconstruction” by Rajshree Jayarajan, Annals of Plastic Surgery, 2018

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The Regenerative Capability of the Urodele Amphibians and Its Potential for Plastic Surgery

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imageNewts and salamanders, both urodele amphibians, are the only vertebrates with tremendous regenerative potency throughout their lifetime. In contrast to the limited regenerative potential of most mammals, including humans, they can regenerate an entire limb after amputation and many other structures of their bodies, whereas humans mainly respond to injury by the formation of a scar. The intention of plastic surgery is to restore function of injured body parts, with the highest principle to replace “like with like.” Despite tremendous improvements in surgical techniques over the last century, the remaining drawbacks include the availability of autologous tissue for transfer to restore extensive tissue loss. Here, some regenerative features of the urodeles are reviewed, in particular wound healing, nerve and limb regeneration, and their potential impact for reconstructive surgery are discussed. With a detailed molecular and cellular understanding of the urodele regeneration processes in combination with recent advances in tissue engineering, new perspectives for plastic surgery and especially improvements in regards to tissue regeneration are opened.

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Acceptance of Vascularized Composite Allotransplantation (Face and Hand Transplant) in Singapore

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Skin Care news and information found at www.SpaTreatmentTraining.com brought to you by National Laser Institute. Are you interested in a career that can train you to be a Med Spa technician? Want to become a certified Laser Hair Removal Specialist, Laser Tattoo Removal Specialist, Botox Injections or many more exciting Medical Spa courses? Enroll in the National Laser Institute and find yourself on the fast track to success.

imageRecent advancements and innovations in the burgeoning field of vascularized composite allotransplantation has enabled face and hand transplant to become a reality in the Western world. Plastic surgeons from the United States, France, and Spain have since performed vascularized composite allotransplantation as a novel therapeutic option in patients suffering from severe facial disfigurement and limb loss. Results have demonstrated remarkable functional and esthetic outcomes with improvements in the immense psychological, social, and emotional burdens that can arise in these patients. Despite the success of existing national solid organ transplant programs, face and hand transplant has yet to be established in this region. The specific aims of this study were to assess the attitudes and amount of risk Singaporeans are willing to accept towards receiving or donating face and hand transplants; and hence ultimately evaluate the feasibility of establishing such a program in Singapore.

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Diversity, Transgender, Vulnerable, Fetus, Entitlement, Evidence-Based, and Science-Based

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Skin Care news and information found at www.SpaTreatmentTraining.com brought to you by National Laser Institute. Are you interested in a career that can train you to be a Med Spa technician? Want to become a certified Laser Hair Removal Specialist, Laser Tattoo Removal Specialist, Botox Injections or many more exciting Medical Spa courses? Enroll in the National Laser Institute and find yourself on the fast track to success.

imageNo abstract available

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Quality of Life of Patients After Immediate or Delayed Autologous Breast Reconstruction: A Multicenter Study

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imageIntroduction
It is known that breast reconstruction improves quality of life (QoL) in women who underwent mastectomy. Previous studies showed that autologous immediate breast reconstruction is as safe as delayed breast reconstruction. However, there is not much known about the influence of the timing of the breast reconstruction on QoL. Therefore, this study aims to assess the effect of timing of the breast reconstruction on QoL, using the BREAST-Q questionnaire.
Methods
A total of 543 patients aged 18 years or older who underwent deep inferior epigastric perforator flap reconstruction after mastectomy (for prophylactic or oncological reasons) at least 12 months ago were selected in 3 hospitals in the Netherlands and invited to complete the BREAST-Q. Mean QoL outcomes were compared between patients who underwent immediate or delayed breast reconstruction. Furthermore, QoL outcomes were compared with recently published normative data of the BREAST-Q.
Results
Patients who underwent immediate reconstruction reported higher scores on satisfaction with psychosocial well-being, sexual well-being, physical well-being of the chest, and physical well-being of the abdomen. Patients who underwent delayed reconstruction reported higher scores on satisfaction with breasts, outcome, and nipples. However, after adjusting for potentially influencing factors, none of the differences were significant. Compared with the normative BREAST-Q data, both of our patient groups reported higher scores on satisfaction with breasts, psychological well-being, and sexual well-being, whereas they reported lower scores on satisfaction with physical well-being of the chest and the abdomen.
Conclusions
This study suggests that patients who underwent immediate or delayed deep inferior epigastric perforator flap breast reconstruction have comparable QoL more than 1 year after surgery, irrespective of the timing of the breast reconstruction.

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Evaluation of the Integrated Plastic and Reconstructive Surgery Prerequisite Core Surgical Training Experience: A Residents' Perspective

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imageBackground
A key educational component of the integrated plastic and reconstructive surgery (PRS) training model is the prerequisite, or core, experiences. The aim of this study is to assess the integrated PRS residents’ experience with this early part of training.
Methods
A 20-question survey was developed and piloted before deployment to integrated PRS training programs from 4 United States Census regions. Respondents were asked to characterize their prerequisite clinical and operative experiences. Results were analyzed using pairwise correlation statistics and logistic regression modeling following Bonferroni correction for multiple hypothesis testing.
Results
One hundred ninety six residents (22 programs) participated in the study (response rate, 65.3%). The majority of residents were satisfied with their prerequisite experiences. Most did not take the American Board of Surgery In-Training Examination, which was perceived as noncontributory to PRS training. The majority of residents preferred to have fewer prerequisite experiences. Operative hours per week were predictive of resident satisfaction with the clinical and operative prerequisite experiences (both P < 0.001). Perception of general surgery program director investment in PRS education was also predictive of resident satisfaction with clinical and operative experiences (P = 0.05 and P < 0.001, respectively).
Conclusions
The present study demonstrates that PRS residents are satisfied with the quality of prerequisite training but prefer less overall. Reevaluation of the benefits of the American Board of Surgery In-Training Examination and individual essential rotations for resident education would be welcomed. Furthermore, this study identifies the residents' clinical and operative experience and perceived general surgery program director involvement as important determinants of integrated resident satisfaction with prerequisite training.

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Commentary Regarding “Abdominal Wall Reconstruction and Patient Comorbidities”

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No abstract available

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Medial Plantar Venous Flap: Classic Donor Site Modification for Hand Defects

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imageBackground
Destruction of digits from trauma results in a much more significant influence on patients’ mental state and quality of life than do injuries to other parts. The purpose of this study was to describe a novel modification of medial plantar venous flap for soft tissue defects in the hands and digits.
Methods
Nine patients received medial plantar venous flap to resurface soft tissue defects in the hands or digits between January 2015 and February 2017. This flap can be used either in a free-island pattern or in a flow-through pattern through the medial branch of the great saphenous vein. All patient data including preoperative statues and follow-up examinations (flap survival rates, complication rates, total active motion, static 2-point discrimination, and Semme-Weinstein test score) were analyzed.
Results
We included 6 men and 3 women, with a mean age of 34.2 years. The medial plantar venous flaps were used for vascularization in 5 patients because of segmental defects of bilateral digit arteries. Eight flaps survived uneventfully in this study. One flap partially failed (20% of the flap area) because of venous congestion. The functional outcomes and sensory restoration were satisfied for all 9 flaps.
Conclusions
Compared with the traditional medial plantar flap, the medial plantar venous flap involves a simpler surgical procedure and allows for revascularization of distal areas using the flow-through technique. Furthermore, the medial plantar area presents a sensitive, glabrous skin with proper bulkiness and allows for movement of the underlying structure.

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Low-Temperature Burn on Replanted Fingers and Free Flaps in Hand

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imageBackground
Patients who have undergone microsurgery for reconstruction with a free flap or finger replantation are vulnerable to heat injury. Moreover, some of these injuries can occur at low temperatures. Although the temperature does not reach the threshold to cause burns in the adjacent normal tissues, burns can occur in the areas that underwent microsurgery. On the other hand, this type of burn is not completely understood and there are few reports of the clinical prognosis.
Methods
The medical records of patients who received warm therapy using an infrared heat lamp with the appropriate temperature after hand surgery from January 2009 to December 2016 were reviewed. The patients were classified into 2 groups. Group A comprised patients who underwent free flap or replantation surgery of the hand. Group B comprised patients who underwent other hand surgeries without microsurgery, such as tenorrhaphy, tenolysis, or joint surgery. Through the medical records, all patients with second- or third-degree thermal burns were selected. The relationship between the 2 types of surgery and thermal injury and the timing of the burn after microsurgery were analyzed.
Results
Groups A and B were composed of 370 (mean age, 48.2 years) and 7010 patients (mean age, 44.5 years), respectively. Burns requiring treatment occurred in 4 patients in group A and in 1 patient in group B. The proportion of low-temperature burns was 4 of 370 in group A and 1 of 7010 in group B. The occurrence of low-temperature burns was more associated with patients who had undergone microsurgery for a hand reconstruction with free flap or finger replantation (P < 0.05). In the patients who underwent microsurgery, all 4 patients had thermal burns within 1 year after surgery.
Conclusions
Low-temperature thermal burns can occur in patients who have undergone microsurgery for a hand reconstruction. This is believed to be related to a disruption of the thermoregulatory function of the skin and poor nerve regeneration, as well as more heat accumulation in the surgical area after microsurgery.

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