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Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation. 重新审视埃利奥特对莫伯格襟翼的修改和我们的即兴创作。
IF 0.8 Q4 SURGERY Pub Date : 2024-02-19 eCollection Date: 2024-04-01 DOI: 10.1055/s-0044-1779658
Anand Prasath Jayachandiran, Suresh Rajendran, Surya Rao Rao Venkata Mahipathy, Alagar Raja Durairaj, Narayanamurthy Sundaramurthy, Manoj Ananthappan

Thumb tip injuries constitute one of the most common hand injuries. There are various reconstructive options for thumb tip injuries. We present our series of thumb tip injuries reconstructed using Elliot's modification of the Moberg flap, which provides like-for-like tissue. We also present our flap improvisation, which can be useful in the armamentarium of plastic surgeons. Background  Moberg described the advancement flap for thumb defects in 1964, which was modified by O'Brien in which the proximal part of the flap is incised and advanced. Although it is a popular flap, it has the disadvantage of interphalangeal (IP) joint flexion deformity. Among the various modifications of the Moberg flap, Elliot's flap provided more tissue with minimal donor site morbidity and no usage of skin grafts or first web skin. Methods  We retrospectively analyzed the patients who underwent reconstruction of thumb defects by Elliot's modified Moberg's flap. The size of the defect, etiology, and IP joint movement were analyzed. Two patients underwent our improvised flap where a daughter flap was elevated within Elliot's flap. Results  Between January 2021 and September 2023, 12 patients underwent reconstruction by Elliot's flap. All flaps settled well. There was no IP joint deformity. Two patients had scar hypertrophy that was managed conservatively. Conclusion  Elliot's modification of the Moberg flap is a very useful but underutilized flap for thumb tip injuries that provides like tissue with sensation and with little donor site morbidity. It can be used for thumb tip defects of up to 3 cm . It is possible to incorporate a second V-Y flap in patients for whom additional movement is required for tension-free closure.

拇指尖损伤是最常见的手部损伤之一。拇指尖损伤有多种重建方案。我们介绍了使用艾略特对莫伯格皮瓣进行改良后重建的一系列拇指尖损伤,这种皮瓣可提供相似的组织。我们还介绍了我们的即兴皮瓣,它可以作为整形外科医生的工具。背景 莫伯格在 1964 年描述了用于拇指缺损的推进皮瓣,奥布莱恩对其进行了修改,将皮瓣的近端部分切开并推进。虽然这是一种常用的骨瓣,但其缺点是会造成指间关节外翻畸形。在对Moberg翻转术进行的各种改良中,Elliot翻转术提供了更多的组织,且供皮部位的发病率极低,无需使用植皮或第一蹼皮肤。方法 我们回顾性地分析了使用 Elliot 改良 Moberg 手瓣重建拇指缺损的患者。分析了缺损的大小、病因和拇指关节活动情况。两名患者接受了我们的即兴腓骨重建术,即在艾略特腓骨内升高一个子腓骨。结果 2021年1月至2023年9月,12名患者接受了Elliot's flap 重建手术。所有手术均顺利完成。没有出现 IP 关节畸形。有两名患者出现疤痕肥大,但采取了保守治疗。结论 埃利奥特对莫伯格式瓣法的改良是一种非常有用但未被充分利用的拇指尖损伤瓣法,可提供有感觉的类似组织,且供区发病率低。它可用于最大 3 厘米的拇指尖缺损。对于需要额外活动以实现无张力闭合的患者,可以使用第二个 V-Y瓣。
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引用次数: 0
Single Incision Dual Cover with Temporoparietal Fascial Flap for Exposed Cochlear Implant: A Novel Take on a Workhorse Flap. 单切口双盖颞筋膜瓣用于外露人工耳蜗:工作瓣的新尝试。
IF 0.8 Q4 SURGERY Pub Date : 2024-01-30 eCollection Date: 2024-02-01 DOI: 10.1055/s-0044-1778704
U Rasheedha Begum, Mahadevan Kandasamy, Prethee Martina Christabel

Cochlear implant surgeries have become increasingly common in India, leading to a rise in complications such as cochlear implant exposure. To address this issue, we present a novel technique involving a single incision dual cover using the temporoparietal fascial flap (TPFF) and skin flap to give durable cover for exposed cochlear implants. Materials and Methods  A retrospective study was conducted between December 2019 and December 2022 on patients who underwent the dual flap procedure for exposed cochlear implants. Results  The average defect size was 2 × 2 cm, and the average length of hospital stay was 10 days. Fourteen skin flaps were closed primarily, while two required skin grafting for donor site closure. At the time of discharge, all wounds showed successful healing with intact skin coverage over the cochlear implant device site. The average follow-up period was 12 months, during which two patients had donor site scar alopecia, while others had adequate hair growth masking the scar. All patients consistently used their cochlear implants. Conclusion  Our single-incision, dual cover TPFF + skin flap technique offers a reliable and innovative solution for managing exposed cochlear implants. With successful implant salvage and favorable postoperative outcomes, this approach demonstrates the versatility and reliability of the TPFF as an excellent option for reconstructive surgeons dealing with cochlear implant complications.

在印度,人工耳蜗植入手术越来越普遍,导致人工耳蜗外露等并发症增加。为了解决这个问题,我们提出了一种新技术,使用颞顶筋膜瓣(TPFF)和皮瓣进行单切口双覆盖,为暴露的人工耳蜗提供持久的覆盖。材料与方法 在 2019 年 12 月至 2022 年 12 月期间,对接受双皮瓣手术治疗外露人工耳蜗的患者进行了一项回顾性研究。结果 平均缺损大小为 2 × 2 厘米,平均住院时间为 10 天。有 14 个皮瓣主要是闭合的,有 2 个需要植皮来闭合供体部位。出院时,所有伤口都已成功愈合,皮肤完整覆盖人工耳蜗装置部位。平均随访时间为 12 个月,期间有两名患者出现了供体部位疤痕脱发,而其他患者的毛发生长良好,掩盖了疤痕。所有患者都坚持使用人工耳蜗。结论 我们的单切口、双覆盖 TPFF + 皮瓣技术为管理暴露的人工耳蜗提供了一种可靠、创新的解决方案。这种方法成功挽救了植入体,术后效果良好,证明了 TPFF 的多功能性和可靠性,是整形外科医生处理人工耳蜗并发症的绝佳选择。
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引用次数: 0
Utilizing Laparoscopic Camera with Indocyanine Green Fluorescence Filters in Lymphovenous Bypass Surgery. 在淋巴管搭桥手术中使用带吲哚菁绿荧光过滤器的腹腔镜照相机
IF 0.8 Q4 SURGERY Pub Date : 2024-01-30 eCollection Date: 2024-02-01 DOI: 10.1055/s-0044-1779470
Ramesh B A, Preetam A, Singaravelu V, Sathish Kumar J
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引用次数: 0
Schwannoma of the Nose at the Keystone Area in Relation to the Dorsal Nasal Nerve 与鼻背神经有关的基石区鼻部斯旺瘤
IF 0.8 Q4 SURGERY Pub Date : 2024-01-09 DOI: 10.1055/s-0043-1778097
T. M. Balakrishnan, Abinaya Karthikeyan, M. Sridharan, Indian J Plast
Schwannomas are well-circumscribed, solitary benign encapsulated tumors arising from Schwann cells, which originate from neural crest cells. 1 They constitute only 4% of the head and neck tumors and involve the paranasal sinuses and nasal cavities. 2 About 80% of cases involve the vestibulocochlear nerve, followed by the trigeminal nerve in this region. 3 A 27-year-old woman presented to us with complaints of swelling over the nose for the past 8 months. She was medically managed for associated tension headaches. She gave no history of nasal obstruction, trauma, epistaxis, localized facial numbness, anosmia, or other swellings. Clinical examination showed a hemispherical, fi rm swelling of size 1.5 (cid:1) 1.0 (cid:1) 0.75cm over the rhinion and left keystone area in the subcutaneous plane, with side-to-side mobility and pinchable overlying skin. Deep palpation caused dyses-thesia at thetip of the nose.Anterior rhinoscopyexamination revealed no intranasal extension. High-de fi nition ultrasonography (HD-USG) imaging showed no cystic degeneration. Computed tomography (CT) scan revealed a hyperintense lesion over the rhinion and left keystone area of the nose, with no bony or cartilaginous erosions. Contrast magnetic resonance imaging (MRI) showed the same with delayed centripetal fi lling
许旺瘤是由许旺细胞(起源于神经嵴细胞)引起的圆形、单发的良性包裹性肿瘤。1 它们仅占头颈部肿瘤的 4%,累及副鼻窦和鼻腔。2 约 80% 的病例累及前庭大神经,其次是该区域的三叉神经。3 一位 27 岁的女性因主诉过去 8 个月鼻子肿胀而前来就诊。她曾因相关的紧张性头痛接受过药物治疗。她没有鼻塞、外伤、鼻衄、局部面部麻木、嗅觉障碍或其他肿胀病史。临床检查显示,鼻翼和左侧鼻骨区皮下平面有一个半球形、大小为 1.5 (cid:1) 1.0 (cid:1) 0.75 厘米的肿物,可左右移动,上覆皮肤可捏起。前鼻镜检查未发现鼻内扩展。高分辨超声波成像(HD-USG)显示没有囊性变性。计算机断层扫描(CT)显示,鼻翼和左鼻骨区有高密度病变,没有骨质或软骨侵蚀。对比核磁共振成像(MRI)显示同样的病变,并伴有延迟向心钙化。
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引用次数: 0
An Outcome Analysis of Fibrin Sealant versus Staples for Fixation of Split-Thickness Skin Grafts 纤维蛋白密封剂与缝合线固定裂开皮肤移植的效果分析
IF 0.8 Q4 SURGERY Pub Date : 2024-01-05 DOI: 10.1055/s-0043-1777867
Akshara Shuchi, Deepti Gupta, Sujata Sarabahi
Abstract Background  Skin grafting plays a vital role in post-burn and post-traumatic wound management. Split-thickness skin grafts (STSG) are traditionally fixed using staples or sutures, which have tedious application and their removal necessitates painkillers, medical equipment, and human intervention. As an alternative, fibrin sealant is a biological tissue adhesive, composed of thrombin, calcium, and fibrinogen. Fibrin sealant promotes hemostasis and acts as a biological adherent. Objective  The aim of this study was to evaluate the outcomes (graft take, wound healing and complications) of fibrin sealant and staples for STSG fixation. Methods  It is a randomized controlled trial on 40 patients with wounds of minimum 400 cm 2 . Wound area was divided into equal halves and randomly allocated to the study group or control group. In the study group, 4 mL per 200 cm 2 of fibrin sealant was sprayed followed by STSG application. In the control group, STSG was fixed with only skin staples. Evaluation was done on postoperative days 3, 5, 15, and 30 for graft take, hematoma/seroma, infection, and complete wound healing. Results  The mean graft take was significantly higher ( p -value < 0.05) in the study group than in the control group (91 vs. 89%). No seroma or hematoma formation was seen in either group. Complete wound healing was seen in more patients in the study group, but the difference was statistically insignificant. Conclusion  Fibrin sealant is an excellent alternative to staples for skin grafting, with the advantage of better graft take and being free of pain that is incurred during staple removal.
摘要 背景 植皮在烧伤和创伤后伤口处理中起着至关重要的作用。裂开的厚皮移植(STSG)传统上使用订书针或缝合线固定,这种方法操作繁琐,而且拆除时必须使用止痛药、医疗设备和人工干预。纤维蛋白密封剂是一种生物组织粘合剂,由凝血酶、钙和纤维蛋白原组成。纤维蛋白密封剂可促进止血并起到生物粘附剂的作用。目的 本研究旨在评估纤维蛋白密封剂和缝合线用于 STSG 固定的效果(移植物取材、伤口愈合和并发症)。方法 这是一项随机对照试验,40 名患者的伤口最小面积为 400 平方厘米。伤口面积被平均分成两半,随机分配到研究组和对照组。在研究组中,每 200 平方厘米喷洒 4 毫升纤维蛋白密封剂,然后涂抹 STSG。在对照组中,只用皮肤钉固定 STSG。术后第 3 天、第 5 天、第 15 天和第 30 天对移植物取材、血肿/浆液肿、感染和伤口完全愈合进行评估。结果 研究组的平均移植物取材率(91% 对 89%)明显高于对照组(P 值小于 0.05)。两组均未发现血清肿或血肿形成。研究组有更多患者的伤口完全愈合,但差异在统计学上不显著。结论 纤维蛋白密封剂是植皮手术中替代缝合线的极佳选择,其优点是植皮效果更好,而且在拆除缝合线时不会产生疼痛。
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引用次数: 0
Flap Advancement Technique for Scalp Hair Preservation in Massive Cutis Verticis Gyrata 皮瓣推进技术用于大面积秃顶的头皮毛发保存
IF 0.8 Q4 SURGERY Pub Date : 2024-01-05 DOI: 10.1055/s-0043-1777075
Bilal Javed, Amina Rao, Waleed Abdullah, Akasha Amber, Mughese Amin
Abstract Cutis verticis gyrata (CVG) is a rare skin condition characterized by ridges and furrows resembling the brain. CVG falls under three categories: primary essential, primary nonessential, and secondary. This case report focuses on primary essential CVG, where approximately a fourth of the scalp and a significant portion of the forehead and eyelid were involved. Flap advancement after skin expansion was performed to rectify the disorder. This technique adequately covers the residual defect postexcision and preserves hair growth in affected regions. It is a successful skin expansion technique to cover the exposed scalp, preserve hair growth, and achieve excellent cosmetic results. Our approach demonstrates a promising solution for severe cosmetic disfigurement in primary essential CVG, positively impacting both the physical appearance and psychosocial well-being of the patient.
摘要 大脑脊状皱襞症(CVG)是一种罕见的皮肤病,其特征是皮肤上出现类似大脑的脊状皱襞。CVG 可分为三类:原发性本质型、原发性非本质型和继发性。本病例报告的重点是原发性本质型 CVG,约有四分之一的头皮和很大一部分前额和眼睑受累。在皮肤扩张后,进行了皮瓣推进术,以纠正这种失调。这种技术能充分覆盖切除术后的残余缺损,并保留受影响区域的毛发生长。这是一种成功的皮肤扩张技术,可覆盖暴露的头皮,保留毛发生长,并达到极佳的美容效果。我们的方法展示了一种很有前景的解决方案,可以解决原发性先天性 CVG 严重毁容的问题,对患者的外貌和心理健康都有积极的影响。
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引用次数: 0
Trends in Gender-Affirming Surgeries in the United States from 2010 to 2021 2010 至 2021 年美国性别确认手术的趋势
IF 0.8 Q4 SURGERY Pub Date : 2024-01-04 DOI: 10.1055/s-0043-1778096
Ally Ha, Kassra Garoosi, Elijah W. Hale, Ty Higuchi, J. Winocour, David W. Mathes, C. Kaoutzanis
Abstract Introduction:  In 2017, an estimated 1.6 million adults and 150,000 teenagers identified as transgender in the United States. With ever-changing legislative developments regarding health care benefits for this population and the increasing number of patients presenting for gender-affirming surgery (GAS), there is a scarcity of literature on the temporal trends within the past decade. The objective of this study was to examine the temporal trends of the utilization of GAS. Methods:  We conducted a cross-sectional study using TriNetX, a federated research network containing deidentified aggregate patient data. Using International Code of Disease (ICD) and Current Procedural Terminology (CPT) codes, we identified patients with a diagnosis of gender dysphoria who underwent GAS from 2010 to 2021. Basic demographic information and complications were analyzed. Complications of interest included site failure, infection, and systemic complications. Results:  We identified a total of 8,403 patients who underwent GAS between January 2010 and December 2021. The number of procedures per year increased nearly 500% between 2016 and 2021 from 421 procedures to 2,224 procedures. Our demographic results were consistent with previous survey-based studies. The average age of patients who underwent masculinizing surgeries was consistently younger than those who underwent feminizing surgeries. Most patients undergoing GAS were of white race. The overall complication rate was 4.7%. Conclusion:  In conclusion, our study reveals a significant and rapid rise in the utilization of GAS in the United States, with a fivefold increase in procedures between 2016 and 2021. The demographic characteristics and low complication rates observed highlight the evolving landscape of health care for transgender individuals and the need for ongoing assessment and support in this field.
摘要 简介:2017 年,美国估计有 160 万成年人和 15 万青少年被认定为跨性别者。随着有关该人群医疗福利的立法发展不断变化,以及越来越多的患者前来接受性别确认手术(GAS),有关过去十年中的时间趋势的文献却非常稀少。本研究的目的是探讨使用 GAS 的时间趋势。研究方法我们使用 TriNetX 进行了一项横断面研究,TriNetX 是一个包含去身份化患者综合数据的联合研究网络。我们使用国际疾病代码 (ICD) 和现行医疗程序术语 (CPT) 代码,确定了 2010 年至 2021 年期间接受 GAS 治疗的诊断为性别焦虑症的患者。我们对基本人口统计学信息和并发症进行了分析。关注的并发症包括手术部位失败、感染和全身并发症。结果:2010年1月至2021年12月期间,共有8403名患者接受了GAS手术。在 2016 年至 2021 年期间,每年的手术数量增加了近 500%,从 421 例增加到 2,224 例。我们的人口统计结果与之前的调查研究结果一致。接受男性化手术的患者平均年龄一直比接受女性化手术的患者年轻。大多数接受 GAS 手术的患者为白人。总体并发症发生率为 4.7%。结论总之,我们的研究表明,在美国,GAS 的使用率显著快速上升,在 2016 年至 2021 年期间,手术量增加了五倍。观察到的人口特征和较低的并发症发生率凸显了变性人医疗保健不断发展的现状,以及在这一领域持续评估和支持的必要性。
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引用次数: 0
The Momentous 2023: Publication Frequency, Impact Factor, and IJPS Archival 重要的 2023 年:发表频率、影响因子和 IJPS 档案
IF 0.8 Q4 SURGERY Pub Date : 2023-12-06 DOI: 10.1055/s-0043-1777446
Dinesh Kadam
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引用次数: 0
Sir Benjamin Keith Rank (1911–2002): A Founding Father and Ambassador of Plastic Surgery 本杰明-基思-兰克爵士(1911-2002):整形外科的奠基人和大使
IF 0.8 Q4 SURGERY Pub Date : 2023-12-05 DOI: 10.1055/s-0043-1777364
Dinesh Kadam
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引用次数: 0
DIEP Flap for Head and Neck Reconstruction: An Underutilized Option! 用于头颈部重建的 DIEP 皮瓣:未被充分利用的选择!
IF 0.8 Q4 SURGERY Pub Date : 2023-11-28 DOI: 10.1055/s-0043-1777076
D. Jaiswal, Firoz Borle, S. Mathews, Mayur Mantri, Vineet Kumar, A. Bindu, P. Yadav, V. Shankhdhar
Abstract Background  The deep inferior epigastric artery perforator (DIEP) flap is a workhorse flap for breast reconstruction. Its use for head and neck (HN) reconstruction is rare. Abdomen provides a donor site abundant in skin and subcutaneous tissue, amenable to primary closure; sizeable, robust, and consistent perforators and a long, sizeable pedicle for comfortable microvascular anastomosis. Its offers all the donor variables needed for HN reconstruction in abundance. Methods  It is a quasiexperimental design study. DIEP flap use for HN reconstruction in our series was opportunistic, that is, when donor site matched the defect. Cases that had very thick thighs and lesser bulk in abdomen and cases that had very thin thighs but much more bulk in abdomen were considered for reconstruction using DIEP flap. Results  The DIEP flap was done in 11 cases for HN reconstruction. There were two re-explorations during postoperative period: one flap loss and another had partial necrosis. Conclusion  Abdomen is an excellent donor site option for HN reconstruction in selected cases, especially when harvested as a perforator flap.
摘要 背景 上腹部深动脉穿孔器(DIEP)皮瓣是乳房重建的主要皮瓣。但很少用于头颈部(HN)重建。腹部提供了一个皮肤和皮下组织丰富的供体部位,可进行初次闭合;穿孔器大小适中、坚固、一致,瓣蒂长而大,可进行舒适的微血管吻合。它提供了 HN 重建所需的所有供体变量。方法 这是一项准实验设计研究。在我们的系列研究中,DIEP皮瓣用于HN重建是机会性的,即当供体部位与缺损相匹配时。大腿很粗而腹部较小的病例和大腿很细而腹部较大的病例都考虑使用 DIEP 皮瓣进行重建。结果 11 例患者采用 DIEP 皮瓣进行 HN 重建。术后有两例再次手术:一例皮瓣脱落,另一例皮瓣部分坏死。结论 在选定的病例中,腹部是进行 HN 重建的绝佳供体部位选择,尤其是作为穿孔器皮瓣采集时。
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引用次数: 0
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Indian Journal of Plastic Surgery
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