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Paralytic Hip Dislocation – Cerebral Palsy
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Reconstructive surgery Softtissue release (adductors, gracilis, iliopsoas)Proximal femoral osteotomy (varus derotation and shortening)Acetabuloplasty (volume-reducing procedure such as Dega or San Diego)
Pediatric Hematocolpos
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Omar M. Abuzeid, Mostafa I. Abuzeid
The goal of treatment of this condition is to alleviate symptoms, to establish communication between the proximal part of the vagina and the introitus, to ensure future sexual satisfaction and reproductive function, and to avoid short-term and long-term complications of the operative procedure. The treatment plan should take into consideration the presenting symptoms and signs and the age of the patient at the time of presentation. Definitive treatment should only be performed by an experienced reproductive surgeon at the proper referral center. A successful first surgery offers the patient the best outcome and the least complication. If the first surgery was not successful, subsequent surgery may be difficult to perform as a result of scar tissue formation, which makes it very difficult to find a surgical plane for eventual reconstructive surgery.
Nipple-areola complex reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The goal of nipple-areola reconstruction is to replicate the size, shape, texture, projection, and position of the contralateral breast or the preoperative conditions.4 Timing of reconstruction of the nipple-areola complex is crucial to the final aesthetic result. The ideal timing is approximately 3–5 months after the last revisional reconstructive surgery. This allows for swelling and inflammation to subside, while allowing for settling of the reconstructed breast mound into its final position.5 Generally, nipple-areola complex reconstruction can be safely performed on an outpatient basis under local anesthesia.
Treatment of women with BRCA mutation
Published in Climacteric, 2023
All options of prophylactic breast removal eventually followed by breast reconstruction should be discussed in length. With the enormous progress in reconstructive surgery, many reconstructive options are now available. The skin and the areola, which is also skin tissue, can be saved. The option not to remove the nipple during breast ablation should be offered [15]. The removed breast tissue can be replaced by a breast implant. The advantage of this surgical option is that this operation is easy to perform, in virtually every clinical setting. A disadvantage is that this implant may need to be replaced when contractions of the capsule occur within the following years after the surgery. Newer techniques using injection of fat and fat stem cells may offer a solution. In this situation, the prosthesis is gradually deflated and replaced by autologous fat through fat injections. After several consecutive procedures the prosthesis may be completely replaced by this injected fat which has started to form viable fat tissue. Pictures of operations may help women to make the decision.
A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Xianyu Zhou, Di Sun, Fei Liu, Wen Jun Li, Chuan Gu, Ling Ling Zhang
A 29-year-old female had a palmar oblique amputation with injury type of PNB 455 [18,19] (Figure 2(A)) in the right index finger (Figure 2(B–D)). Replantation was impossible as the distal amputation was unfound. Radiography, tetanus antitoxin, analgesic, antibiotics, biological dressing and laboratory tests were routinely administrated. Sub-emergent reconstructive surgery was performed. A size of 2.5 × 2.0 cm osteo-onychocutaneous free flap was designed preoperatively in the left hallux (Figure 2(E,F)). Composite flap was dissected and checked for blood perfusion by releasing of tourniquet intraoperatively (Figure 2(G)). The donor site was primarily closed with the medial flap strip after flap harvest (Figure 2(H)). After proper flap fixation, the vessels and nerve were repaired. The injured index finger was well reconstructed and reperfusion was robust immediately (Figure 2(I–K)). At follow-up of 16 months, satisfactory shape in the pulp and nail was achieved (Figure 2(L–N)). No obvious morbidity was found in the donor hallux (Figure 2(O,P)). Static 2-PD was approximately 9 mm. Key-pinch strength was 82% of that of the intact left index finger. The highest score, nine points, was recorded for both the donor and recipient sites.
Ultrathin free flaps for foot reconstruction: impact on ambulation, functional recovery, and patient satisfaction
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Beatriz Hatsue Kushida-Contreras, Miguel Angel Gaxiola-García
In our study, based on non-sensate free microvascular flaps, almost all the flaps showed some amount of deep sensation; the exception being a diabetic patient. Protective sensation was regained in 75% of patients, similar to that reported by other authors [34]. The selection of a sensate free flap is still a matter of debate in foot reconstruction. We performed only non-sensate flaps based on the data that demonstrate good protective sensation at one year of follow-up when compared to sensate flaps [35]. Of note, some authors advocate equivalence between sensate and non-sensate flaps in terms of potential sensory reinnervation manifested in lower rates of ulceration, hyperkeratosis, wound breakdown, and lacerations [36]. Such reinnervation, when present, usually can be detected from the sixth postoperative month [34]. The main advantage of neurorraphy in sensate flaps is a faster sensory recovery, allowing early rehabilitation and return to work [34,35]. The reconstructive surgeon must be able to recognize these aspects for an appropriate and suitable reconstruction, especially in young and productive patients.