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    <title><![CDATA[Plastic and Reconstructive Surgery - Featured Articles - PRS Editor's Picks]]></title>
    <link>http://journals.lww.com/plasreconsurg/</link>
    <description><![CDATA[For more than 50 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The journal brings readers up-to-the-minute reports on the latest techniques and follow-up for maxillofacial reconstruction, burn repair, cosmetic reshaping, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques. ]]></description>
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    <lastBuildDate>Sun, 22 Nov 2009 15:29:43 -0600</lastBuildDate>
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      <title><![CDATA[Plastic and Reconstructive Surgery - Featured Articles - PRS Editor's Picks]]></title>
      <link>http://journals.lww.com/plasreconsurg/</link>
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      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/Carcinoma_and_Atypical_Hyperplasia_in_Reduction.2.aspx</link>
      <author>Ambaye, Abiy B.; MacLennan, Susan E.; Goodwin, Andrew J.; Suppan, Thomas; Naud, Shelly; Weaver, Donald L.</author>
      <category>Breast: Original Articles</category>
      <title><![CDATA[Carcinoma and Atypical Hyperplasia in Reduction Mammaplasty: Increased Sampling Leads to Increased Detection. A Prospective Study]]></title>
      <description><![CDATA[Background: Reduction mammaplasty for symptomatic macromastia or correction of asymmetry is performed more than 100,000 times per year in the United States. The reported incidence of occult breast cancer in reduction mammaplasty ranges from 0.06 to 4.6 percent. No standard pathology assessment for reduction mammaplasty exists. The authors evaluated the incidence of occult carcinoma and atypical hyperplasia in reduction mammaplasty specimens and identified clinical risk factors. Systematic sampling of additional tissue sections was instituted to evaluate the hypothesis that increased sampling would identify more significant pathologic findings.
Methods: All reduction mammaplasty specimens over a 20-month period at a single institution were prospectively examined. All specimens had baseline gross and microscopic evaluations, and then each was subjected to systematic additional sampling. The incidence of significant pathologic findings (carcinoma and atypical hyperplasia) was tabulated. Variables such as age and preoperative mammogram were examined.
Results: A total of 202 cases were evaluated. Significant pathologic findings (carcinoma and atypical hyperplasia) were present in 12.4 percent. The rate of carcinoma was 4 percent in all patients (6.2 percent in patients >=40 years and 7.9 percent in patients >=50 years).
Conclusions: A significantly higher rate (12.4 percent) of significant pathologic findings was identified in this prospective study compared with published literature. None of the lesions was identified on preoperative mammogram. Age was significantly associated with significant pathologic findings. Increased sampling was associated with significant pathologic findings only in patients 40 years or older, indicating the need for thorough sampling of reduction mammaplasty specimens in patients older than 40.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00002</guid>
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      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/Improvement_of_the_Survival_of_Human_Autologous.9.aspx</link>
      <author>Lu, Feng; Li, Jie; Gao, JianHua; Ogawa, Rei; Ou, Chunquan; Yang, Bo; Fu, Bingchuan</author>
      <category>Experimental: Original Articles</category>
      <title><![CDATA[Improvement of the Survival of Human Autologous Fat Transplantation by Using VEGF-Transfected Adipose-Derived Stem Cells]]></title>
      <description><![CDATA[Background: The efficacy of autologous fat transplantation is reduced by fat absorption and fibrosis due to fat necrosis. Enhanced transplant neovascularization early after transplantation may reduce these outcomes. The authors asked whether cell and concomitant gene therapy using adipose-derived stem cells transduced with vascular endothelial growth factor (VEGF) improves fat transplant neovascularization and survival.
Methods: Human adipose-derived stem cells were expanded ex vivo for three passages, labeled with 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine (DiI), and transduced with VEGF or left untransduced. Human fat tissues were then mixed with the DiI-labeled VEGF-transduced adipose-derived stem cells, the DiI-labeled adipose-derived stem cells, the known vascularization-promoting agent insulin, or medium alone, and 18 nude mice were injected subcutaneously with all four preparations, with each of the four designated spots receiving one of these four mixtures in a random fashion. Six months later, transplanted tissue volume and histology were evaluated and neovascularization was quantified by counting the capillaries.
Results: Control transplant survival was 27.1 +/- 8.2 percent, but mixture with the VEGF-transduced and VEGF-untransduced stem cells significantly increased transplant survival (74.1 +/- 12.6 percent and 60.1 +/- 17.6 percent, respectively). Insulin was less effective (37.7 +/- 6.9 percent). Histological analysis revealed both types of transplants consisted predominantly of adipose tissue, unlike the control transplants, and had significantly less fat necrosis and fibrosis. The VEGF-transduced, adipose-derived stem cell-treated transplants had significantly higher capillary density than the other transplants and bore DiI-double-positive and CD31-double-positive cells (i.e., adipose-derived stem cell-derived endothelial cells).
Conclusion: Adipose-derived stem cells together with VEGF transduction can enhance the survival and quality of transplanted fat tissues.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00009</guid>
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      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/A_New_Method_for_the_Second_Stage_Auricular.15.aspx</link>
      <author>Chen, Zung-Chung; Goh, Raymond C. W.; Chen, Philip Kuo-Ting; Lo, Lun-Jou; Wang, Sun-Ya; Nagata, Satoru</author>
      <category>Reconstructive: Head and Neck: Original Articles</category>
      <title><![CDATA[A New Method for the Second-Stage Auricular Projection of the Nagata Method: Ultra-Delicate Split-Thickness Skin Graft in Continuity with Full-Thickness Skin]]></title>
      <description><![CDATA[Background: Staged auricular reconstruction remains mainstream among the various techniques of microtia reconstruction using autogenous costal cartilage. The initial stage involves fabrication and implantation of the cartilage framework, followed by projection of the reconstructed auricle in the second stage. During the projection stage, the line of incision is usually made close to the helical rim, from the superoanterior margin of the helical rim to the region of the lobule. Generally, a fascial flap is raised and covered over a cartilage block to project the auricle, and a skin graft is inset over the raw surface of the newly created postauricular sulcus.
Methods: The authors developed a new refinement for the second-stage auricular projection, whereby the skin cover for the raw surface over the posterior aspect of the auricle and the postauricular sulcus is an ultra-delicate split-thickness skin graft raised in continuity with the full-thickness skin over the anterior aspect of the auricle.
Results: Incorporation of this new technique has minimized the visibility of suture lines and improved the appearance of the superior otobasion. In addition, the dimension of the skin cover required can be designed with greater precision. Postoperative outcomes using this new technique for auricular projection have been more than satisfactory.
Conclusion: More favorable results that carry less surgical stigma can now be achieved in auricular reconstruction using this new modification of Nagata's two-stage method.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00015</guid>
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      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/Barbed_Suture_Tenorrhaphy__An_Ex_Vivo.22.aspx</link>
      <author>Parikh, Pranay M.; Davison, Steven P.; Higgins, James P.</author>
      <category>Hand/Peripheral Nerve: Original Articles</category>
      <title><![CDATA[Barbed Suture Tenorrhaphy: An Ex Vivo Biomechanical Analysis]]></title>
      <description><![CDATA[Background: Using barbed suture for flexor tenorrhaphy could permit knotless repair with tendon-barb adherence along the suture's entire length. The purpose of this study was to evaluate the tensile strength and repair-site profile of a technique of barbed suture tenorrhaphy.
Methods: Thirty-eight cadaveric flexor digitorum profundus tendons were randomized to polypropylene barbed suture repair in a knotless three-strand or six-strand configuration, or to unbarbed four-strand cruciate repair. For each repair, the authors recorded the repair site cross-sectional area before and after tenorrhaphy. Tendons were distracted to failure, and data regarding load at failure and mode of failure were recorded.
Results: The mean cross-sectional area ratio of control repairs was 1.5 +/- 0.3, whereas that of three-strand and six-strand barbed repairs was 1.2 +/- 0.2 (p = 0.009) and 1.2 +/- 0.1 (p = 0.005), respectively. Mean load to failure of control repairs was 29 +/- 7 N, whereas that of three-strand and six-strand barbed repairs was 36 +/- 7 N (p = 0.32) and 88 +/- 4 N (p < 0.001), respectively. All cruciate repairs failed by knot rupture or suture pullout, whereas barbed repairs failed by suture breakage in 13 of 14 repairs (p < 0.001).
Conclusions: In an ex vivo model of flexor tenorrhaphy, a three-strand barbed suture technique achieved tensile strength comparable to that of four-strand cruciate repairs and demonstrated significantly less repair-site bunching. A six-strand barbed suture technique demonstrated increased tensile strength compared with four-strand cruciate controls and significantly less repair-site bunching. Barbed suture repair may offer several advantages in flexor tenorrhaphy, and further in vivo testing is warranted.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00022</guid>
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    <item>
      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/Refinements_of_Tissue_Expansion_for_Pediatric.23.aspx</link>
      <author>Gosain, Arun K.; Zochowski, Christopher G.; Cortes, Wilberto</author>
      <category>Pediatric/Craniofacial: Original Articles</category>
      <title><![CDATA[Refinements of Tissue Expansion for Pediatric Forehead Reconstruction: A 13-Year Experience]]></title>
      <description><![CDATA[Background: Reconstruction of the forehead in children when 25 percent or more of the forehead is involved presents a complex reconstructive challenge because of the confluence of highly visible aesthetic units. The present study was performed to develop an algorithm for lesions involving 25 percent or more of the forehead.
Methods: A 13-year retrospective review was performed of all pediatric patients who completed reconstruction for lesions involving at least 25 percent of the forehead by a single surgeon (A.K.G.). All lesions were classified on the basis of percentage of forehead involved and involvement of adjacent subunits.
Results: Twenty patients completed reconstruction. The median number of surgical procedures required was six (range, two to 11), with a median of three (range, one to four) expansion procedures. Simultaneous expanders were placed in the scalp (16 patients) and cheek (eight patients). Five patients underwent correction of eyebrow ptosis at a final procedure. Reconstruction involved 25 to 70 percent of the forehead in 19 patients, 17 of whom were reconstructed with serial forehead expansion and advancement flaps. One patient with a pigmented nevus occupying more than 75 percent of the forehead received an expanded full-thickness skin graft from the lower abdomen. For all groups, the entire extent of the visible lesion was excised and complete skin coverage achieved.
Conclusions: Reconstruction of 25 to 70 percent or more of the forehead in children is best accomplished using tissue expansion and direct advancement of adjacent tissues. Simultaneous expansion should be performed in the cheek and scalp if indicated. Brow ptosis should be addressed with each advancement. Lesions greater than 70 percent of the forehead are best accomplished with distant tissues.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00023</guid>
    </item>
    <item>
      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/Middle_Eastern_Rhinoplasty_in_the_United_States_.32.aspx</link>
      <author>Daniel, Rollin K.</author>
      <category>Cosmetic: Original Articles</category>
      <title><![CDATA[Middle Eastern Rhinoplasty in the United States: Part I. Primary Rhinoplasty]]></title>
      <description><![CDATA[Background: Middle Eastern rhinoplasty is becoming more frequent in the United States. Mature patients request a more refined, feminine nose, whereas younger patients (aged 15 to 25 years) want a smaller, "cuter" nose.
Methods: The author completed a prospective study of 50 consecutive female primary Middle Eastern rhinoplasty patients. The presenting anatomy, including the alar anatomy, and selected surgical techniques and their variations for particular cases were recorded.
Results: The majority of patients requested and received a significant change in their nasal appearance. Of the 40 patients followed for 18 months, three (7.5 percent) had revisions, two minor and one moderate. There were no functional complaints.
Conclusions: The author emphasizes the need for structure throughout the nose, with use of both spreader grafts and columellar struts, to support the large and often heavy skin sleeve. Tip suture techniques, with or without tip grafts, are highly effective and there is no need for destructive tip techniques.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00032</guid>
    </item>
    <item>
      <link>http://journals.lww.com/plasreconsurg/Fulltext/2009/11000/Chest_Reconstruction__I__Anterior_and.42.aspx</link>
      <author>Netscher, David T.; Baumholtz, Michael A.</author>
      <category>CME</category>
      <title><![CDATA[Chest Reconstruction: I. Anterior and Anterolateral Chest Wall and Wounds Affecting Respiratory Function]]></title>
      <description><![CDATA[Learning Objectives: After studying this article, the participant should be able to: 1. Describe the indications for chest wall reconstruction. 2. Understand the function of the chest wall and implications for both reconstruction and the chest wall itself when components are missing or used for reconstruction. 3. List the reconstructive requirements of chest wall wounds. 4. Identify flaps for regional reconstruction of the chest wall. 5. Describe the role of microvascular surgery in chest wall reconstruction.
Background: Chest wall and mediastinum wounds may be life-threatening. They interfere with respiratory mechanics and may also be contaminated with exposed vital structures. Consideration is given to flap choice to restore function, resolve infection, and maintain suitable aesthetics.
Methods: Literature search as well as the authors' personal experience enabled preparation of this article.
Results: Where necessary, skeletal integrity must be restored, generally with prosthetic material, and then covered with well-vascularized soft tissue. "Living tissue" is required to help combat infection, buttress visceral repairs, and fill dead space. Soft-tissue deficiency must occasionally be augmented with large distant microvascular flaps.
Conclusion: Flap reconstruction has reduced morbidity and mortality of these complex problems without undue donor-site impairment of respiratory and upper extremity function.
(C)2009American Society of Plastic Surgeons]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00006534-200911000-00042</guid>
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