Plastic and Reconstructive Surgery

The research evaluated the association between plastics and endocrine disruptors, as well as the viable and active ways to mitigate the challenges posed by plastic pollution. Consumption of seafood represents one major pathway for the exposure of human to microplastic. Microplastics may pass up to higher levels in food chain. Three likely toxic effects of plastic particles have been put forward: the release of persistent organic pollutants (POPs) adsorbed to the plastics, leaching of plastic additives, and plastic particles themselves. Chemical additives such as bisphenol A (BPA), phthalates, polybrominated diphenyl ethers (PBDE), tetrabromobisphenol A (TBBPA), bisphenol S (BPS), etc., used in plastic production pose several health risks to both humans and animals. Due to the use of some chemical additives during production of plastics, plastics have potentially risk and harmful effects that could be carcinogenic or encourage endocrine disruption. Some of the chemical additives are used as phthalate plasticizers (phthalates) and brominated flame retardants. By biomonitoring, chemicals in plastics, such as phthalates and BPA, have been identified in human population. Humans are exposed to the chemicals through the skin, nose, or mouth. Bisphenol A (BPA) can disrupt normal, regular physiological levels of sex hormones. Recent studies suggest that BPS also has endocrine disrupting properties, just like BPA. The presence of a hydroxy group on the benzene ring makes bisphenol S and bisphenol A endocrine disruptors. A widespread concern about phthalate exposure is the possibility that it is the cause of a drop in male fertility. Some recent studies suggest that tetrabromobisphenol A may be an endocrine disruptor and immunotoxicant. As an endocrine disruptor, tetrabromobisphenol A may interfere with both estrogens and androgens. There is also growing concern that PBDEs share the environmental long life and bioaccumulation properties of polychlorinated dibenzodioxins. It is not known if PBDEs can cause cancer in people, although liver tumors developed in rats and mice that ate extremely large amounts of decaBDE throughout their lifetime. The use of biodegradable plastics, policymaking, institutional arrangements, plastic waste collection, promotion of non-usage and lessening usage, incineration, use of the enzyme PETase, and creating awareness, in addition to banning have been the active ways for the management of plastic pollution.

The operations were performed with the patient under general anesthesia. For reconstruction, three different flaps adjacent to the defect were raised in a slopey tripod manner, with a base on one of the main arteries of the scalp (Fig 1). The flaps were ...

Reconstruction after pan-plexus root avulsions often includes gracilis free functioning muscle transfer. For elbow flexion reconstruction, the free functioning muscle transfer distal tendon is inserted into the biceps tendon or more distally (i.e., flexor digitorum profundus/flexor pollicis longus tendons) for combined elbow and finger flexion; the theoretical drawback of the latter approach is weaker elbow flexion. The authors compared elbow flexion strength with a biceps tendon versus a flexor digitorum profundus/flexor pollicis longus tendon attachment to determine which insertion point resulted in better elbow flexion. Thirty-nine patients underwent free functioning muscle transfer with either a biceps tendon or a distal attachment. Groups were compared on postoperative elbow flexion strength, preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores, range of motion, and other surgical and demographic characteristics. A biomechanical analys...

In the treatment of photoaged skin, glycolic acid works by removing superficial portions of the epidermis and stimulating dermis regeneration. Vitamins A, C, and E should stimulate collagen production and antioxidants should prevent free radical damage and skin aging. However, the effectiveness of different therapies has often relied on subjective methods of assessment. Histologic analysis has seldom been used because of the drawback of permanent scarring. In the literature, the use of a quantitative method for the assessment of facial rejuvenation has been described: the silicone replica technique. The authors' aim was to promote and recommend the use of this technique and, in particular, to test the effect of glycolic acid and multivitamin- and antioxidant-based products on skin texture. The authors performed a prospective, randomized, double-blind, controlled study on 30 women treated topically in the outer canthal region (crow's-feet area). Patients were divided into thr...

After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major ro...

The deep inferior epigastric artery perforator (DIEP) flap aims to reduce donor-site morbidity by minimizing rectus muscle damage; however, damage to motor nerves during perforator dissection may denervate rectus muscle. Although cadaveric research has demonstrated that individual nerves do not arise from single spinal cord segments and are not distributed segmentally, the functional distribution of individual nerves remains unknown. Using intraoperative nerve stimulation, the current study describes the motor distribution of individual nerves supplying the rectus abdominis, providing a guide to nerve dissection during DIEP flap harvest. Twenty rectus abdominis muscles in 17 patients undergoing reconstructive surgery involving rectus abdominis (DIEP, transverse rectus abdominis musculocutaneous, or vertical rectus abdominis musculocutaneous flaps) underwent intraoperative stimulation of nerves innervating the infraumbilical segment of the rectus. Nerve course and extent of rectus muscle contraction were recorded. In each case, three to seven nerves entered the infraumbilical segment of the rectus abdominis. Small nerves (type 1) innervated small longitudinal strips of rectus muscle, rather than transverse strips as previously described. There was significant overlap between adjacent type 1 nerves. In 18 of 20 cases, a single large nerve (type 2) at the level of the arcuate line supplied the entire width and length of rectus muscle. Nerves innervating the rectus abdominis are at risk during DIEP flap harvest. Small, type 1 nerves have overlapping innervation from adjacent nerves and may be sacrificed without functional detriment. However, large type 2 nerves at the level of the arcuate line innervate the entire width of rectus muscle without adjacent overlap and may contribute to donor-site morbidity if sacrificed.

PURPOSE:
To evaluate the effect of a collagen-fibrin sealant patch (TachoSil®) in preventing postoperative complications after inguinofemoral lymphadenectomy for vulvar cancer.

METHODS:
Double-blind randomized-controlled trial on consecutive patients undergoing bilateral inguinofemoral lymphadenectomy for vulvar cancer. Intraoperatively, inguinofemoral areas were randomized: one was treated with TachoSil®, while the contralateral had standard closure without collagen-fibrin sealant patch. Surgical outcomes, amount of drainage volume, duration of drain placement, and any postoperative complication (vulvar wound dehiscence, inguinal wound dehiscence, cellulitis, lymphangitis, lymphoceles, and hematoma) were recorded. Leg measurements were taken preoperatively and during postoperative follow-up until 6 months to evaluate lymphedema.

RESULTS:
A total of 19 patients were enrolled and 38 inguinofemoral dissections were performed. There was no significant difference between the investigational and control arm in the amount of drainage volume (p = 0.976), and duration of drain placement (p = 0.793). The postoperative complications, excluding lymphedema, were 10/19 (53%) in investigational arm and 9/19 (47%) in control arm (p = 0.74). At the end of follow-up, the prevalence of grade 1 lymphedema was 44.4% and 50% in investigational and control arm, respectively (p = 0.744); grade 2 and 3 lymphedema had a prevalence of 33.3% in both arms (p = 1).

CONCLUSION:
Application of TachoSil® does not seem to improve postoperative lymphorrhagia nor to reduce the incidence of postoperative complications in patients undergoing inguinofemoral lymphadenectomy for vulvar cancer. Considering this point, it would be useful to identify additional strategies in inguinofemoral dissection for the prevention of these complications.

Placement of a totally implantable venous access device in children with cancer often leads to hypertrophic scars after its removal. This study investigates whether the use of silicone gel sheets has a beneficial effect on scar outcome in children with cancer. In a three-arm randomized controlled trial, the effects of use of silicone gel sheets for 2 and 6 months were assessed and compared with no intervention in children with cancer after removal of the totally implantable venous access device. Silicone gel sheets were first administered 14 days after surgery. The 1-year follow-up included measurements at seven time points. Next to scar size assessment, the modified Vancouver Scar Scale was used to assess scar outcome. Thirty-six children participated. For hypertrophy, no significant differences were found between the two intervention groups and the control group. However, at 1-year follow-up, the 2-month application group showed significantly smaller scars compared with the group ...

A stark contrast exists between the physiologic importance of the umbilicus during development and after birth. During development, the umbilical cord functions as a channel allowing blood flow between the placenta and fetus, it also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present, except the umbilical scar, as landmark of the previously exist cord. Nevertheless, umbilical disorders are frequently encountered in pediatric surgery. It has been estimated that 30% of births have some type of umbilical cord finding. These disorders range from the very common umbilical hernia to infections such as omphalitis, which can be life threatening, and from simple straightforward anatomy like granuloma, to a complicated and sophisticated malformations; like vitellointestinal and urachal anomalies. Most patients with umbilical problems present with a mass or drainage from the umbilicus. An understanding of the anatomy and embryology of the abdominal wall and umbilicus is important to identify and properly treat common as well rare complicated conditions.

This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA

This article describes the theory and principles behind the authors' success in megavolume (250-ml range) autologous fat transfer to the breasts. When large volumes are grafted into a tight space, the interstitial fluid pressure increases to impair capillary blood flow and the crowded graft droplets coalesce into lakes, with poor graft-to-recipient interface. These factors have historically restricted the volume of fat that can be grafted into small recipient breasts. The decreased interface increases the distance oxygen must diffuse to reach the grafted adipocytes, causing central necrosis to occur before neovascularization. The increased interstitial fluid pressure reduces capillary radius, reducing oxygen delivery to grafted adipose tissue. The Brava external expansion device harnesses the regenerative capabilities of mechanical forces to preoperatively increase the volume and vascularity of the recipient site, allowing megavolumes of fat to be grafted diffusely without significantly decreasing graft-to-recipient interface or increasing interstitial fluid pressure. The application of these principles has allowed the authors to successfully graft megavolumes of fat into the breasts of over 1000 patients with substantial long-term retention.

Tout prête à croire à une inflammation  : une main ou un pied rouge, enflé, réellement plus chaud, des sensations de brûlures cuisantes à l’intérieur de l’articulation. Autant de symptômes d’un syndrome effroyable, laissant, au petit matin, la personne épuisée après une nuit sans repos. A Budapest, après trois jours de délibérations, une réunion consensuelle de 38 experts valide les critères diagnostiques précis de ce syndrome : le syndrome douloureux régional complexe (SDRC de … Budapest). PAS incurable.