RESUMEN
OBJECTIVES: A systematic review to assess the evidence supporting surgical repair of digital nerve injury versus no repair in adults in terms of clinical outcomes. DESIGN: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review with methodology based on the Cochrane Handbook of Systematic Reviews of Interventions. DATA SOURCES: Databases included OvidMEDLINE, EMBASE, AMED, clinicaltrials.gov and the Cochrane Database of Systematic Reviews, searched from inception until 10 November 2018. ELIGIBILITY CRITERIA: Adult digital nerve injury in which either direct repair or no repair was undertaken and an outcome measure was recorded. DATA EXTRACTION AND SYNTHESIS: Study data extracted included demographics, injury type and extent, timing, treatment details, outcome data and time points, adverse outcomes, hand therapy and return to work. The National Institute of Health quality assessment tool for case series was used to assess risk of bias. RESULTS: Thirty studies were included. One compared surgical repair with non-repair. All studies were case series of between 15 and 110 nerve injuries, with heterogeneous patient, injury and treatment characteristics. Two studies detailed nerve repair without magnification. Static 2-point discrimination (s2PD) was the most commonly reported outcome measure. Return of protective sensation was achieved in most cases in the nerve repair and no nerve repair groups. Repair resulted in better s2PD than no repair, but <25% repaired nerves achieved normal levels. Adverse outcomes were similar between repair and no repair groups. CONCLUSIONS: Only level IV evidence is available to support surgical repair of digital nerves in adults. Return of normal sensibility is uncommon and almost all unrepaired nerves regained protective sensation by 6 months and all patients declined further surgery. There was no difference in adverse outcomes. There is currently a lack of high-quality evidence to support surgical repair of digital nerve injuries in adults and further research is needed. PROSPERO REGISTRATION NUMBER: CRD42017065092.
Asunto(s)
Traumatismos de los Dedos/cirugía , Regeneración Nerviosa/fisiología , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Tacto/fisiología , Adulto , Humanos , Evaluación de Resultado en la Atención de Salud , Pronóstico , Recuperación de la Función , Sensación/fisiologíaRESUMEN
Autologous breast reconstruction can give excellent cosmetic results and is preferred by some women. Donor tissue can be scarce however, especially for bilateral reconstructions and/or when a large breast is needed. In addition, the decision of which donor tissue to use in unilateral reconstruction may have an impact on a subsequent reconstruction if needed. We present a case of a patient who required a large volume unilateral reconstruction, performed using a free TRAM flap, who then re-presented 10 years later with disease in the contralateral breast. For her second reconstruction, a pedicled TRAM was used from the same side as the previous free TRAM. We believe that this sequence of reconstructions using the TRAM twice on the same side has not been previously reported.
Asunto(s)
Músculos Abdominales/cirugía , Arterias Epigástricas/trasplante , Colgajos Tisulares Libres/trasplante , Mamoplastia/métodos , Neoplasias Primarias Secundarias/cirugía , Colgajos Quirúrgicos/trasplante , Músculos Abdominales/irrigación sanguínea , Mama/anomalías , Mama/cirugía , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Colgajos Tisulares Libres/irrigación sanguínea , Humanos , Hipertrofia/cirugía , Mastectomía/métodos , Persona de Mediana Edad , Neoplasias Primarias Secundarias/patología , Reoperación , Colgajos Quirúrgicos/irrigación sanguínea , Trasplante Autólogo , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
Neonatal necrotising fasciitis is very rare in comparison to the adult presentation of the disease and a Plastic Surgeon may only encounter one such case during his or her career. Often this is initially misdiagnosed and managed as simple cellulitis. It generally affects previously healthy babies, the site is often the lower back area and a history of minor skin trauma may be elicited. The causative organism is usually Streptococcus or polymicrobial, as is the case in the adult population. We present the case of a previously healthy 11-day-old infant with idiopathic, rapidly progressive necrotising fasciitis of the back, cause by Methicillin sensitive Staphylococcus aureus (MSSA) infection. The strain was isolated and found to encode the Panton-Valentine Leukocidin genes, which have been associated with particularly severe necrotising infections in other sites, with high mortality. These strains are the subject of specific treatment and eradication guidance in the UK but awareness of this and the importance of obtaining detailed culture typing is likely to be low amongst Plastic Surgeons.
Asunto(s)
Infecciones Comunitarias Adquiridas/microbiología , Fascitis Necrotizante/microbiología , Infecciones Estafilocócicas/microbiología , Toxinas Bacterianas/genética , Técnicas de Tipificación Bacteriana , Nalgas , Terapia Combinada , Infecciones Comunitarias Adquiridas/terapia , Exotoxinas/genética , Fascitis Necrotizante/terapia , Transferencia de Gen Horizontal/genética , Humanos , Recién Nacido , Leucocidinas/genética , Masculino , Resistencia a la Meticilina/genética , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/terapia , Staphylococcus aureus/genéticaRESUMEN
Plastic surgeons specialize in working closely with other surgical colleagues to help solve clinical problems. In this case, we performed surgical stabilisation of a large flail chest fragment in conjunction with the cardiothoracic surgical team, using the mini-plating set more commonly used for hand fracture fixation. The use of this fixation system for flail chest has not previously been described, but offers advantages over other reported methods, primarily by dispensing with the need for an extensive thoracotomy incision and by providing robust stabilisation without the presence of prominent hardware.