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Dissertations / Theses on the topic 'Plastic, Reconstructive and Maxillofacial Surgery'
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1
Kairinos, Nicolas. "The biomechanics of negative-pressure wound therapy." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10809.
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Includes references.Despite the success of negative-pressure wound therapy, its mechanism of action remains unclear. The common perception that it reduces tissue pressure and increases perfusion has recently been challenged following the observation that tissue necrosis can be caused as a result of its application. A programme of research has been conducted to clarify how tissue pressure changes during negative-pressure wound therapy and the resultant effect thereof on perfusion. The cause for conflicting evidence from other studies was also investigated.
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Hendricks, Mogamat Rushdi. "Evaluation of the clinical outcome of curvilinear transport distraction osteogenesis and revascularised fibula free flaps in the reconstruction of large post-maxillectomy defects." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25290.
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Background: Maxillary defects caused by trauma or tumour resection in the head and neck region can be devastating to the patient from a cosmetic and functional perspective. Patients who undergo maxillectomy procedures experience a substantial deterioration in their primary oral functions such as breathing, mastication, salivation, deglutition and phonation, which has a collective adverse influence on their quality of life (QOL). The revascularised free fibula flap (RFFF) has been demonstrated to be most reliable for the reconstruction of maxillary defects, and has been regarded as the 'gold standard.' A novel method of regenerating bone and soft tissue through the process of curvilinear transport distraction oseteogenesis (CTDO) has been developed and compared with the RFFF technique. Method: A prospective cohort study of 6 post-maxillectomy patients was compared regarding the clinical outcome of function and aesthetics with a group of 6 patients who had undergone RFFF reconstruction. The new bone (regenerate) was compared with the parent bone from which it had been generated. Objective measuring tools were employed to assess pre and post quality of life (QOL) aspects. The RFFF patients were not subjected to any invasive procedures save to undergo a clinical evaluation and undergo a CT scan of their maxillae. A cohort of 6 participants was treated prospectively using CTDO and the results were analysed within that cohort. These results were compared with a retrospective group of 6 participants of similar age and gender distribution who had undergone RFFF reconstruction as an external control. The patented Hendricks-Vicatos (H-V) maxillary transport distractor was applied to all selected participants by the primary investigator under general anaesthesia at Groote Schuur Hospital or a private clinic. The H-V maxillary transport distractor (5 prototypes) was pre-shaped and pre-fitted onto a 3-D model of the participant's maxilla, in a laboratory. This method reduced clinical installation time. If teeth were present in the area to be distracted, then at least 2 teeth were removed from the maxilla, preferably three months before the date of distraction. In the first few cases, this was the protocol for developing bone stock. This protocol was revised in the last 2 patients of the study, where no teeth were extracted at all. A linear fracture (bi-cortical) was created in the maxilla in a vertical direction (segmentally) to develop a mobile, well-vascularised transport disc. This carrier disc was attached to the metal plate of the 'crawler' via small titanium screws. The crawler was then moved on the reconstruction plate (BiometTM Zimmer Biomet,
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Rickard, Rory Frederick. "Arterial microanastomosis with size mismatch : a trial of two techniques." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12777.
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Includes bibliographical references.Use of perforators as recipient vessels in microvascular reconstruction has led to arterial diameter discrepancy becoming an increasingly common finding. Experimental and clinical evidence confirms that patency rates decrease with increasing diameter mismatch, but no good evidence is available to direct the choice of end-to-end microanastomotic technique where a small-to-large discrepancy exists. A programme of research has been conducted comparing two techniques of endto-end arterial microanastomoses, where a small-to-large diameter discrepancy exists of between 1:1.5 and 1:2.5. These techniques are; 45º oblique section of the smaller vessel, and; invaginating the smaller vessel inside the larger.
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Raith, Stefan [Verfasser]. "Applications of computational biomechanics in reconstructive cranio-maxillofacial and plastic surgery / Stefan Raith." Aachen : Hochschulbibliothek der Rheinisch-Westfälischen Technischen Hochschule Aachen, 2015. http://d-nb.info/1073185680/34.
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Pitak-Arnnop, Poramate. "Ethics in maxillofacial and facial plastic surgery." Paris 5, 2010. http://www.theses.fr/2010PA05T047.
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L’éthique en chirurgie maxillo-faciale (CMF) reste peu étudiée. Ce travail de thèse a pour but (1) d’identifier les problèmes éthiques concernant la protection des personnes (PP) et les conflits d’intérêts (CI) dans la recherche en CMF, (2) de proposer les guides pratiques pour maintenir l’intégrité scientifique et les normes éthiques en CMF, et (3) d’analyser les données cliniques concernant les lésions des mâchoires, pour discuter l’éthique de la décision médicale. Méthodes: Cette dissertation cumulative comporte 2 grandes parties : l’éthique de la recherche d’une part, et l’éthique clinique d’autre part. Partie 1 : l’éthique de la recherche, comprend une revue de la littérature, 4 études rétrospectives et 2 études transversales sur: (1) la non-conformité scientifique, (2) la PP et les CI dans les journaux en CMF, (3) la PP et les CI dans les recherches sur les 2 innovations en CMF (chirurgie piézoélectrique; sous-mandibulectomies assistées par endoscopie), (4) le biais de publication en CMF, (5) l’éthique dans les recommandations aux auteurs des journaux en CMF, et (6) une enquête internationale transversale dans un échantillon représentatif de 326 chirurgiens maxillo-faciaux. Partie 2 : l’éthique clinique, inclut une revue systématique et 3 études rétrospectives sur: (1) l’ostéoradionécrose, (2) le kératokyste odontogène, (3) l’améloblastome, et (4) les complications des lambeaux libres de péroné. Les méthodes classiques de statistiques descriptives et d’analyse univariée ont été utilisées. Les différences ont été considérées comme significatives lorsque p était < 0,05. Résultats: la PP et la déclaration des CI dans la recherche en CMF sont encore insuffisantes. Les causes peuvent provenir (1) des journaux eux-mêmes par l’absence de règles éthiques dans les recommandations aux auteurs et/ou le manque de rigueur du contrôle de l’éditeur et du comité de lecture du journal, et/ou (2) des auteurs par le manque de formation et d’expérience de l’éthique, par le biais lié à l’intérêt de la profession ou aux intérêts financiers, par ignorance, ou par une combinaison de ces facteurs. Les données cliniques sur les lésions maxillo-faciales et leur gestion peuvent être bien incorporées dans l’approche éthique de la décision médicale. Cependant, les études sur ce sujet souffrent en général d’une insuffisance de validité interne. Conclusions: la PP et la déclaration des CI reçoivent peu d’attention de la part de la communauté scientifique en CMF. Il est donc temps d’instaurer une surveillance appropriée sur l’éthique de la recherche et d’en appliquer les mécanismes comme standards scientifiques. Les auteurs et les chercheurs doivent se conformer strictement aux normes d’éthique de la recherche. La formation continue pour les chirurgiens maxillo-faciaux permettrait de réduire les mauvaises pratiques, intentionnelles ou non. La connaissance de l’éthique et de son application à la décision médicale en CMF gagnera à de plus amples investigationsIntroduction: Ethics in oral-maxillofacial surgery (OMS) remain understudied. The purposes of this dissertation were (1) to identify the ethical problems of human subject protection (HSP) and conflicts of interest (CoI) in OMS researches, (2) to propose the guidelines as to maintain scientific integrity and ethical standards in this surgical speciality, and (3) to analyse clinical data concerning jaw lesions to discuss the ethical considerations on clinical decision-making. Methods: This cumulative thesis consisted of 2 parts: research ethics and clinical ethics. Part 1: research ethics, included 1 narrative review, 4 retrospective and 2 cross-sectional studies on: (1) research misconduct, (2) HSP and CoI in OMS journals, (3) HSP and CoI in researches on 2 OMS innovations (piezoelectric surgery; endoscope-assisted submandibular sialadenectomy), (4) publication bias in the OMS literature, (5) ethical issues in the guideline to authors of OMS journals, and (6) a questionnaire survey enrolling 326 maxillofacial surgeons worldwide. Part 2: clinical ethics, comprised 1 systematic review and 3 retrospective studies on: (1) osteoradionecrosis, (2) odontogenic keratocysts, (3) ameloblastoma, and (4) complications of fibular free flaps. Descriptive and univariate statistics were computed when appropriate, and a P-value of < 0. 05 was considered statistically significant. Results: HSP and disclosure of CoI in OMS researches are still lacking. The possible reasons are (1) the OMS journals themselves (lack of ethical issues in the instructions to authors and/or failure of editors and/or reviewers to be strict with their own regulations/policies and international ethical standards) and/or (2) the OMS authors (lack of ethical education, inadequate research experience, bias from career self-interest or financial gains, ignorance about research ethics, or a combination of these). Clinical data on jaw lesions and their management can be incorporated into the ethical approach to clinical decisionmaking. However, the studies on this matter usually contain inadequate internal validity. Conclusions: The results of these studies suggest that HSP and disclosure of CoI receive little attention from the OMS speciality. It is, therefore, high time to have appropriate oversight of ethical breaches and implement the measures as a standard in peer-review publishing. An author/investigator has to adhere strictly to the research ethics standards. Adequate research training for oral-maxillofacial surgeons would help reduce both intentional and unintentional scientific malpractice. Ethics and clinical decisionmaking require further investigations
Hintergrund: Ethische Aspekte in der Mund-Kiefer-Gesichtschirurgie (MKG-Chirurgie) wurden bislang kaum beleuchtet. Anliegen der Dissertation war [1] die Identifikation von Problemen beim Schutz des Menschen und Interessenkonflikte der MKG-chirurgischen Forschung, [2] die Formulierung von Leitlinien zur Sicherstellung der wissenschaftlichen Integrität und der ethischen Standards in dieser chirurgischen Disziplin, und [3] die Analyse klinischer Daten zu Erkrankungen des Kiefers zur Erörterung ethischer Erwägungen auf die klinische Entscheidungsfindung. Methode: Diese kumulative Dissertation gliedert sich in 2 Hauptteile: [1] Ethikforschung und [2] Klinische Ethik. Der Teil 1: Ethikforschung, beinhaltet 1 traditionellen Übersichtsartikel, 4 retrospektive Studien und 2 Querschnittstudien zu [1] Fehlleistungen in der Forschung (wissenschaftliches Fehlverhalten), [2] Schutz des menschlichen Individuums in der MKG-chirurgischen Literatur, [3] Schutz des menschlichen Individuums bei zwei neuartigen MKG-chirurgischer Verfahren (piezoelektrische Chirurgie; endoskopisch gestützte Exstirpation der Glandula submandibularis), [4] Ergebnisverzerrung (Publikationsbias) in der MKG-chirurgischen Literatur, [5] Ethik-Aspekte in den Richtlinien für Autoren von MKG-chirurgischen Zeitschriften und [6] eine auf Fragebögen basierende Querschnittstudie, welche ein Kollektiv von 326 MKG-Chirurgen weltweit erfasst. Der zweite Teil: Klinische Ethik, enthält 1 systematischen Übersichtsartikel und 3 retrospektive Studien zu den Themen [1] Osteoradionekrose, [2] odontogenen Keratozyste, [3] Ameloblastom und [4] Komplikationen des freien Fibulatransfers. Deskriptive und univariate statistische Daten wurden, sofern möglich, berechnet; für das Signifikanzniveau konnte ein p-Wert von < 0,05 festgelegt werden. Ergebnis: Innerhalb der MKG-chirurgischen Forschung gibt es noch immer Defizite hinsichtlich des Schutzes des menschlichen Individuums und der Offenlegung von Interessenkonflikten. Mögliche Ursachen hierfür reichen von [1] redaktionellen Problemen bei den MKG-chirurgischen Zeitschriften (fehlende Ethik-Standards in den Instruktionen für Autoren, Unschärfen seitens der Herausgeber bzw. Gutachter bezüglich der strikten Umsetzung von journaleigenen oder globalen Regeln) bis hin zu [2] autorenbezogenen Problemen (Wissenslücken, Verwerfungen durch Karrieredenken, finanzielle Interessen); auch Kombinationen multipler Gründe sind denkbar. In die klinische Daten über kieferchirurgische Erkrankungen und deren Management sollten ethische Ansätze bei der therapeutischen Entscheidungsfindung einfließen. Bisherigen Studien zu diesem Thema fehlt es in der Regel an interner Validität. Schlussfolgerung: Die Ergebnisse der Untersuchung sprechen dafür, dass dem Schutz des menschlichen Individuums und der Offenlegung von Interessenkonflikten innerhalb der MKG-chirurgischen Forschung bisher zu wenig Aufmerksamkeit geschenkt wird. Es ist somit höchste Zeit, geeignete Überwachungsverfahren zum Schutz vor ethischen Rechtsverletzungen zu etablieren und diese Maßnahmen als Standard in den Begutachtungsprozess für internationale Publikationen (‚peer-review publishing‘) einzuführen. Jeder Autor bzw. Forscher sollte sich strikt an ethische Standards halten. Geeignete diesbezügliche Fortbildungen für MKG-Chirurgen könnten bewusste und unbewusste wissenschaftliche Fehltritte vermeiden helfen. Die klinische Entscheidungsfindung unter ethischen Aspekten bedarf in Zukunft weiterer Untersuchungen
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Huss, Fredrik R. M. "In vitro and in vivo studies of tissue engineering in reconstructive plastic surgery." Doctoral thesis, Linköpings universitet, Brännskadevård, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-8504.
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To correct, improve, and maintain tissues, and their functions, are common denominators in tissue engineering and reconstructive plastic surgery. This can be achieved by using autolo-gous tissues as in flaps or transplants. However, often autologous tissue is not useable. This is one of the reasons for the increasing interest among plastic surgeons for tissue engineering, and it has led to fruitful cross-fertilizations between the fields. Tissue engineering is defined as an interdisciplinary field that applies the principles of engineering and life sciences for development of biologic substitutes designed to maintain, restore, or improve tissue functions. These methods have already dramatically improved the possibilities to treat a number of medical conditions, and can arbitrarily be divided into two main principles: > Methods where autologous cells are cultured in vitro and transplanted by means of a cell suspension, a graft, or in a 3-D biodegradable matrix as carrier. > Methods where the tissue of interest is stimulated and given the right prerequisites to regenerate the tissue in vivo/situ with the assistance of implantation of specially designed materials, or application of substances that regulate cell functions - guided tissue regeneration. We have shown that human mammary epithelial cells and adipocytes could be isolated from tissue biopsies and that the cells kept their proliferative ability. When co-cultured in a 3-D matrix, patterns of ductal structures of epithelial cells embedded in clusters of adipocytes, mimicking the in vivo architecture of human breast tissue, were seen. This indicated that human autologous breast tissue can be regenerated in vitro. The adipose tissue is also generally used to correct soft tissue defects e.g. by autologous fat transplantation. Alas 30-70% of the transplanted fat is commonly resorbed. Preadipocytes are believed to be hardier and also able to replicate, and hence, are probably more useful for fat transplantation. We showed that by using cell culture techniques, significantly more pre-adipocytes could survive and proliferate in vitro compared to two clinically used techniques of fat graft handling. Theoretically, a biopsy of fat could generate enough preadipocytes to seed a biodegradable matrix that is implanted to correct a defect. The cells in the matrix will replicate at a rate that parallels the vascular development, the matrix subsequently degrades and the cell-matrix complex is replaced by regenerated, vascularized adipose tissue. We further evaluated different biodegradable scaffolds usable for tissue engineering of soft tissues. A macroporous gelatin sphere showed several appealing characteristics. A number of primary human ecto- and mesodermal cells were proven to thrive on the gelatin spheres when cultured in spinner flasks. As the spheres are biodegradable, it follows that the cells can be cultured and expanded on the same substrate that functions as a transplantation vehicle and scaffold for tissue engineering of soft tissues. To evaluate the in vivo behavior of cells and gelatin spheres, an animal study was performed where human fibroblasts and preadipocytes were cultured on the spheres and injected intra-dermally. Cell-seeded spheres were compared with injections of empty spheres and cell suspensions. The pre-seeded spheres showed a near complete regeneration of the soft tissues with neoangiogenesis. Some tissue regeneration was seen also in the ‘naked’ spheres but no effect was shown by cell injections. In a human pilot-study, intradermally injected spheres were compared with hyaluronan. Volume-stability was inferior to hyaluronan but a near complete regeneration of the dermis was proven, indicating that the volume-effect is permanent in contrast to hyaluronan which eventually will be resorbed. Further studies are needed to fully evaluate the effect of the macroporous gelatin spheres, with or without cellular pre-seeding, as a matrix for guided tissue regeneration. However, we believe that the prospect to use these spheres as an injectable, 3D, biodegradable matrix will greatly enhance our possibilities to regenerate tissues through guided tissue regeneration.On the day of the defence date the status of article V was In Press.
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Hayes, Philip Michael. "Ethnic-specific associations between abdominal and gluteal fat distribution and the metabolic complications of obesity : implications for the use of liposuction." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12235.
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Includes bibliographical references.More than three-quarters (77%) of the 40.5 million people living in South Africa are black African, of which more than 40% are urbanised. Black African women living in urban areas have a significantly higher prevalence (62%) of overweight than urban black males (28%) or white females (53%). It was previously thought that obesity in black South African women was not associated with deleterious metabolic sequelae and was termed "healthy" obesity...
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Potgieter, Dawid Jacobus. "Experience with the Meek micrografting technique in major burns." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20522.
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Background. Early excision of burn eschar and urgent skin cover is mandatory for survival in all major burns. The tremendous cost and time delay in cultured skin and the shortage of donor allograft can make early skin cover a life threatening problem for paediatric patients in this country. The Meek micrografting technique was introduced in 2003 as a rescue method to achieve epithelialisation in major burns. Objective. To evaluate its role in the management of major burns with reference to its efficacy, technical detail and role in major burn surgery.
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Dos, Passos Gary. "Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22754.
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Background: Free tissue transfer has become the standard of care for the reconstruction of head and neck oncological defects. The Groote Schuur Hospital provides a microsurgical reconstructive service in a resource-limited setting, without access to venous couplers, invasive monitoring devices, modern microscopes or sophisticated pre-operative imaging. The reconstructive surgeons perform all anastomoses under x4.5 loupe magnification. Methods: A retrospective chart review was undertaken of cases performed by the service over a 3-year period. Demographic factors, indications for flap cover, operative details (flap used, duration and lowest recorded temperature), intensive care and hospital length of stay, and other outcomes were recorded and evaluated (including flap and systemic complications, donor site morbidity, haematomas as well as returns to theatre). Results: Over a 36-month period, 109 flaps for head and neck reconstruction were performed. The main indication for surgery was squamous cell carcinoma of the oral cavity. The mean operating time for resection and reconstruction was 6.02 h (range of 4 to 12 h). Virtually, all reconstructions were performed using one of either radial forearm, free fibula or anterolateral thigh flaps. We report a complete flap loss rate of 6 %. All four successful salvages were undertaken in the early (less than 24 h) post-operative period. Hypothermia intra-operatively appears to correlate very closely with pejorative outcomes. Conclusions: By restricting reconstructive options to three main 'workhorse' flaps and by utilising a simultaneous two-team approach for tumour ablation and flap elevation, success rates comparable to international standards have been achieved. Limited resources should not be regarded as an impassable barrier to providing a successful microvascular head and neck reconstructive service.
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van, Niekerk Gertruida. "Scalp as a donor site in children: Is it really the best option?" Master's thesis, Faculty of Health Sciences, 2017. http://hdl.handle.net/11427/30983.
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Introduction
Humans have several different types of hair, classified into eight different groups, of which types VII and VIII predominate in South Africa. The scalp with its abundance of hair is often used as a preferential donor site for small burns. Major reasons cited are that the donor site is hidden from view (covered by hair), rapidly epithelializes with minimal scarring and provides a relatively large surface area. The author postulates that the type of hair will have an influence on the healing of scalp donor sites, complications and aesthetic outcome. Contrary to international consensus, the Red Cross War Memorial Children’s Hospital (RCWMCH) experience indicated that the use of the scalp as donor area is not ideal due to the frequent complications seen amongst paediatric patients e.g. visible scars, recurrent folliculitis, patchy alopecia, hypertrophic scarring and areas of de- and hyperpigmentation.
Objective
This study reviewed the complications encountered with the use of the scalp as primary donor area in children of mostly black African origin (type VI-VIII hair).
Methodology
A retrospective folder review of patients admitted to RCWMCH between 2003 and 2015 with major burns (>30% total body surface area) was conducted. A total of 179 patient folders were reviewed. Only children (n=25) with unburned scalp donor areas were included in this study. Both short- long-term complications were identified. The patient age range was six months - 12 years, while the mean patient follow-up period was 580 days and mean burn TBSA was 44.92% (range 4 – 85%).
Results
Patient demographics: black African 60% descent (hair types VI-VIII), 32% mixed race (hair types III-V) and 4% Caucasian (hair types II-III). In the group of black African children 60% had short-term and 46.7% long-term complications, whereas in the mixed race children 37.5% had short-term and 25% long-term complications. No complications were encountered in the Caucasian group. Eleven (48%) of patients in total had short-term complications (88.9% folliculitis, 22.2% delayed healing) and seven (28%) had long-term complications (57,1% non-healing wounds, 42.8% recurrent folliculitis, 57.1% alopecia, 42.9% depigmented scars, 28.6% visible scars, 28.6% hypertrophic scars). The first procurement in 11 children resulted in a 91% complication rate (54.5% short-term and 36.4% long-term). Ten children had two procurements resulting in an 80% complication rate (40% short-term and 40% long-term complications). In four children with three scalp procurements an acute 25% complication rate, with no subsequent long-term complications, was encountered.
Discussion
Hair type has an influence on outcome and donor sites should be carefully selected. Hair types VI-VIII has a higher propensity for complications and these usually follow the first procurement procedure. Complications did not increase with multiple procurements. Significant complications with long-term sequelae are not uncommon when the scalp is used as donor site and these complications are difficult to treat. Although the sample size is small, it does reflect a significant complication rate.
Conclusion
Contrary to international consensus, the use of the scalp as donor site in South African children with hair types VI-VIII with large burns should not be the preferential site and should only be used as a last resort.
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Xoagus, Elizabeth Alexia. "Autologus fat grafting for mild to moderate velopharyngeal insufficiency: Our experience." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29724.
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The standard surgical treatment of velopharyngeal insufficiency (VPI) includes revision palatoplasty, posterior pharyngeal flap and sphincter pharyngoplasty. These procedures are not without complication and can also be challenging to the occasional cleft surgeon. The greatest complication is iatrogenic obstructive sleep apnoea particularly in high risk patients. With the introduction of posterior pharyngeal wall augmentation, a lesser and simpler surgical procedure, various materials have been used for this purpose with limited success and significant complication rates. Augmentation of the velo-pharynx with autologous fat has been practiced for decades. Autologous fat has multiple advantages compared to other biological and synthetic materials used for augmentation of the velopharynx. Autologous fat is readily available, has low donor site morbidity, does not migrate, injects easily and is non-allergenic. The outcome of fat grafting for VPI is good and stable long term, albeit unpredictable due to the resorption of fat. The procedure may therefore need to be repeated in order to achieve the desired results. The aim of this study is to evaluate and document the outcome of autologous fat grating for the treatment of mild to moderate VPI in children at the Red Cross War Memorial Children's Hospital (RCWMCH). A retrospective folder review was conducted on 9 consecutive patients who underwent velopharygeal fat grating for the treatment of mild to moderate VPI at the RCWMCH from 2010 to 2014. All the patients had had primary palatoplasty performed previously and subsequently developed VPI. Patients were assessed pre- and postoperatively by two cleft surgeons, and an experienced speech and language therapist with the aid of laterl view videofluoroscopy (VF). Pre-operative and post-operative perceptual speech assessments were performed by a dedicated speech and language therapist. Two senior cleft surgeons performed pre-and post-operative videofluoroscopy interpretations. Eleven fat grafting procedures were performed on 9 patients and an average of 5.64 ml (range 1 ml to 7 ml) of autologous fat was transferred to the velopharynx. The average age at the time of operation was 6.5 years (range 3 years to 14 years) with a follow-up period of 18 months (range 7 months to 34 months). Most of the patients (7 out of 9) showed improved speech following fat grafting. There were no complications related to the fat grafting procedure. This small study suggests that fat grafting is an effective, minimally invasive surgical alternative for the treatment of mild to moderate VPI and to our knowledge, is the first reported study from Africa.
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Moodley, Sean Thirumalay. "The role of propranolol in the treatment of infantile haemangioma." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/13923.
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There has been a change in the management of infantile haemangioma with the introduction of propranolol. The aim of this study is to retrospectively evaluate a simple treatment for infantile haemangioma at the Red Cross War Memorial Children’s Hospital (RCWMCH) and document the results. While it is known that all haemangiomas undergo involution at some stage, some haemangiomas pose certain problems. These relate mainly to visual axis obstruction and aesthetics. Subjects are children in the first two years of life presenting with haemangiomas. All patients were treated with oral propranolol in conjunction with haemangioma size documentation, using a simple radiological modality, i.e. ultrasound imaging. Patients are followed up and clinical and radiological evaluations are undertaken to observe changes in size and appearance. Propranolol is non-selective β-adrenergic antagonist that is used extensively for the treatment of a multitude of disorders, mainly cardiovascular indications. The main adverse effects include bradycardia, hypotension and bronchospasms. For the purposes of this study, all subjects were routinely examined, especially with regard to the cardiopulmonary systems. Any perceived anomaly was referred to the cardiorespiratory physicians at RCWMCH for further evaluation, which includes all the necessary investigations such as electrocardiograms(ECG) and echocardiograms. Therefore, only fit healthy patients were selected for this study. Patients are educated and fully informed regarding the adverse effect profile of propranolol, and advised of the appropriate route of management.
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Möller, Ernst Lodewicus. "Patient reported outcome measures (PROMs) in breast cancer patients after immediate breast reconstruction using the Breast-Q." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32865.
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Background Mastectomy is the mainstay of surgical treatment for women with breast cancer in South Africa. The increase in breast reconstruction after a mastectomy has prompted the need to evaluate patient reported outcome measures (PROMs) for this set of operative intervention. This study aimed to assess clinical and patient reported outcome measures in immediate breast reconstruction patients using the BREAST-Q and compare these with international cohorts. Methods A cross-sectional study was performed on all patients who underwent immediate breast reconstruction between January 2011 and December 2016. This consisted of a retrospective clinical record review of perioperative outcomes, and a quality of life analysis using the BREAST-Q Post-Reconstruction questionnaire. Outcome predictors were identified using Chi-square, Fisher exact, One-way ANOVA, Student t-tests and Kruskal Wallis analysis of variance. A random-effect single arm meta-analysis was performed to compare the BREASTQ scores with international cohorts. Results A total of 52 patients were included with a mean age of 43.2 (+/-9.5) years. Eighteen patients (34.6%) developed early complications; of these 8 (44.4%) were major. Thirty-one patients (59.6%) developed late complications; of these 18 (58.1%) were major. Fifteen patients (28.8%) had failed reconstruction. There was a significantly higher risk of failure following a total mastectomy (TM) (p=0.02), tissue expander reconstruction (TE) (p< 0.01) and stage 2 breast cancer (p=0.01). Patients who underwent nipple reconstruction and immediate-delayed reconstruction before 12 months, reported higher well-being and satisfaction scores. Compared to international cohorts our BREAST-Q scores were lower but fall within the 95% confidence interval for Sexual Well-Being and Satisfaction with Nipples and Care. Conclusion Immediate breast reconstruction poses a high risk of complications and reconstructive failure especially, with TM and TE. Our BREAST-Q scores are comparable to international studies and may be useful in guiding patient consent.
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Lelala, Ngoato Bruce. "Anthropometric Changes in a Prospective Study of 100 Patents Requesting Breast Reduction." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32773.
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Background The anthropomometry of the “ideal” breast is well described, but changes that occur with enlarged breasts are not. The aim of this study was to assess the prevalence of nipple asymmetry in the horizontal plane and changes in the inframammary fold (IMF) in patients presenting with macromastia (defined as excessive development of the mammary gland by Merriam-Webster dictionary). Methods One hundred patients (200 breasts) presenting to the Plastic Surgery Clinic for bilateral breast reduction were enrolled in this study. Patient's characteristics captured for this study included age, body mass index (BMI), and breast anthropometric measurements, such as suprasternal notch to nipple, nipple to IMF, IMF projected to cubital fossa, midhumeral point, and nipple measurement from meridian. Basic univariate statistical analysis were performed to evaluate the impact of nipple asymmetry. Results The average age was 37 years (SD 12 years), and the median BMI was 33 (IQR 28-37). More patients presented with nipple asymmetry, of whom 45% were classified as lateral to meridian, 19% were classified as medial to the meridian, and 36% were classified as central to the meridian. Patients with lateral asymmetry and medial asymmetry has a significantly higher BMI (median BMI 35) compared with patients with central positioning (median 30). Increasing breast size was positively associated with nipple asymmetry, whereas BMI (R = - 0.30, P =0.003) and macromastia correlated negatively with IMF position (R= - 0.38), P= 0.0001). Conclusion In macromastia, nipple displacement from breast meridian, especially lateral displacement, is common and is aggravated by an increase in BMI. The IMF also descends, and this is also common in patients with a raised BMI. These changes have clinical implications.
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Najjaar, Azzaam. "Percutaneous Puncture of Flexor Sheath Ganglions: An Assessment of Recurrence." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32930.
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Background Flexor tendon sheath ganglions (FTSG) comprise up to 15% of hand ganglions. The management is split between two schools of practice: percutaneous puncture or surgical excision. The literature is equivocal as to which holds true superiority in terms of recurrence rates. The cost of surgical excision is higher and the recovery is longer. In addition, surgery also brings with it the potential for surgical complications, both immediate and long term. Percutaneous puncture can be performed at the time of the initial consult and an immediate return to normal activity with no down-time for the patient. The aim of this study is to assess the recurrence rate after percutaneous puncture. We also describe our employed technique. Method The technique for percutaneous puncture involved the use of a 25-gauge needle for ganglion puncture, no sclerosant or corticosteroid was injected, and an immediate post-procedure mobilisation protocol was employed. Patients were identified from clinical records and were followed up at a minimum of six months to check for recurrence. Results Eighteen patients were included in the study, 12 females and 6 males. The majority of FTSG were found to occur in the middle finger. Two patients experienced a recurrence. Both were successfully treated with a repeat puncture. No patients experienced a complication. Conclusion In our study, we show a low recurrence rate obtained with percutaneous puncture of FTSG using a simple technique. No complications were noted in our cohort on follow-up. We, therefore, recommend employing it as a first line treatment in the management of FTSG.
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Pillay, Kamlen. "The use of Acellular Dermal Matrices in the Management of Complex Traumatic Wounds in a Paediatric Population." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32976.
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Introduction Complex soft tissue injuries are common in children. Paediatric wounds associated with large soft tissue defects pose a surgical challenge. This often necessitates extensive reconstructive surgery and frequently requires the use of microvascular free flaps. Local, regional and free flap surgery in children poses several challenges related to donor site morbidity, flap failure and the long-term sequelae of repeated surgeries for flap modification in a growing child. The introduction of acellular dermal matrices (ADM's) in recent decades has dramatically influenced the management of complex soft tissue wounds. The dermis in skin represents the functional aspect of skin. ADM's represent dermal structures artificially, hence their incorporation into the wound should restore skin characteristics specifically pliability. Some authors believe that ADM's have improved prognosis and reduced morbidity in the treatment of open wounds. Combining the use of ADM's together with split-thickness skin grafting (SSG) is rapidly becoming an important method used to manage such complex wounds. In this study, we explore whether the use of this technique has been a beneficial addition to the traditional management armamentarium for complex injuries in the extremities and report the rate of complications experienced by our patients at our paediatric hospital in Cape Town. Objective This study reviewed the number of complications experienced with the use of ADM's in treating complex wounds on the extremities of children. It includes 54 children treated between the years 2011 and 2016 at a national paediatric hospital. Methodology A retrospective folder review of children treated at our hospital between the years 2011 and 2016 with extremity injuries was conducted. A total of 189 patient folders were reviewed. Children (n= 54) with complex wounds in their extremities who had received an ADM were included in this study. Both short and long-term complications were identified. The patient age range was six months - 12 years, while the mean patient follow-up period was 390 days. Results All patients treated with ADMs for traumatic extremity injuries during this period were included in the study, irrespective of age or co-morbidities. In 45 patients the ADM and SSG healed without any complication that is, not requiring revision surgery at 1 year follow up. Seven patients who did not receive postoperative splinting and occupational / physiotherapy displayed wound contractures, requiring further reconstructive surgery, 4 of which were also in the group who experienced complete ADM or graft loss below. Six patients experienced complete loss of the ADM due to infection, which led to graft failure, requiring revision surgery. Of the six patients that experienced complete loss of the ADM, five were not treated with NPWT dressings. Noteworthy, is that all 45 patients who healed without any complication were treated with NPWT dressings. Biopsies that were performed on 18 patients at 2 weeks post application of the ADM, showed only granulation tissue. No evidence of residual ADM or accessory dermal structures was found in any of the samples, which were obtained from multiple loci of the ADM in situ. The mean time to closure with this method was 3 weeks and the mean hospital stay was 26 days. Two patients were lost to follow-up and were excluded from the morbidity analysis arm of the study. Discussion We found that post-operative physiotherapy, occupational therapy and splinting are extremely important in preventing morbidity in particular scar contracture when associated with wounds treated with ADMs. There was no histological evidence to suggest that the ADM remains intact after 2 weeks post application. Our data reveals that vacuum assisted closure is a vital adjunct to this method, ensuring adequate ADM and graft take. Conclusion Complex wounds in the extremities of children pose a reconstructive dilemma to the plastic surgeon. In anatomically sensitive areas where traditional plastic surgery options are unavailable or undesirable, the use of ADMs and SSGs represent a realistic alternative for the reconstruction of large wounds associated with complex soft tissue injuries in the extremities of children.
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Wessels, William Louis Fick. "Reconstruction of the lower eye lid with a rotation-advancement tarso-conjunctival cheek flap." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5441.
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Thesis (MMed (Surgical Sciences. Plastic and Reconstructive Surgery))--University of Stellenbosch, 2010.The repair of full-thickness defects of the lower eyelids poses a challenge because a graft in combination with a flap is typically used to replace either the posterior or anterior lamella. This often results in aesthetically and functional unsatisfactory outcomes. A rotation-advancement tarso-conjunctival cheek flap, which reconstructs both posterior and anterior lamella with vascularized tissue similar to the native eyelid, is described. Nine patients underwent reconstruction with a rotation-advancement tarso-conjunctival cheek flap. The indications, complications and outcomes were evaluated. The follow-up time ranged from 6 to 60 months with an average of twenty three months. The main indication for use of this flap is full-thickness defects of the lower eyelid between 25 – 75 %, typically after tumour ablation. All the patients had a functional and aesthetically satisfactory outcome. One patient underwent a revision canthoplasty. The rotation-advancement tarso-conjunctival cheek flap adheres to basic plastic surgery principles resulting in a satisfactory outcome; (a) Vascularized tissue is used to reconstruct the defect. (b)The flap composition is similar to the native eyelid i.e. replace like with like. (c) The flap makes use of tissue that is excess and therefore limits donor morbidity.
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Huss, Fredrik. "In vitro and in vivo studies of tissue engineering in reconstructive plastic surgery /." Linköping : Univ, 2005. http://www.bibl.liu.se/liupubl/disp/disp2005/med905s.pdf.
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Kleintjes, Wayne George. "The vascular anatomy of the forehead related to forehead flaps and its application in plastic and reconstructive surgery." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/1144.
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Vesely, Martin Jacob John. "The role of haem oxygenase-1 in the prevention of ischaemia-reperfusion injury in skeletal muscle." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312595.
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Fossum, Magdalena. "Urothelial cell culturing : in vitro and in vivo studies in reconstructive pediatric surgery /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-100-8/.
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Roberts, Alan Clive. "The Development of Facial Prosthetics and Adhesives in Plastic and Reconstructive Surgery. A study in the application of prosthetic materials and devices used in plastic and reconstructive surgery together with tissue adhesives as an alternative to conventional ligation." Thesis, University of Bradford, 1988. http://hdl.handle.net/10454/5065.
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Various silicone elastomers have been evaluated for use in the prosthetic reconstruction of facial defects. Their strength, texture, flexibility, hardness, ease of preparation, pigment receptivity and retention, and their resistance to cleaning were compared and the data consulted when an elastomer was chosen to restore defects, improve aesthetics and reestablish the confidence of a selection of patients. Detailed case reports are provided, together with information on the adhesives or mechanical methods available for retaining the facial prosetheses. Cyanoacrylate adhesives for use on skin surfaces and as tissue adhesives have been studied in detail. A novel n-butyl 413 cyanoacrylate has been developed with a viscosity, haemostatic property and stability to make it particularly suitable for use in skin grafting and tissue repair. It has already been used with good results on patients with severe burns. An improved formulation, containing a fluorescent dye, can be precisely applied through a specially constructed foot-controlled dispenser illuminated by a fibre-optic supplying UV-light. Cyanoacrylates are already being used as tissue adhesives in place of the conventional but potentially disfiguring suture. The availability of improved, imperceptible adhesives and a precision applicator, which can be used in a modern operating theatre, will extend their effectiveness and satisfy some of the needs of Plastic, and Oral and Maxillo-Facial Surgeons. Portable applicators have potential use in battlefield and in veterinary surgery and overcome the imprecision characteristic of earlier methods.
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Ruiz, Fernández Guillermo. "3D reconstruction for plastic surgery simulation based on statistical shape models." Doctoral thesis, Universitat Pompeu Fabra, 2018. http://hdl.handle.net/10803/667049.
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This thesis has been accomplished in Crisalix in collaboration with the Universitat Pompeu Fabra within the program of Doctorats Industrials. Crisalix has the mission of enhancing the communication between professionals of plastic surgery and patients by providing a solution to the most common question during the surgery planning process of ``How will I look after the surgery?''. The solution proposed by Crisalix is based in 3D imaging technology. This technology generates the 3D reconstruction that accurately represents the area of the patient that is going to be operated. This is followed by the possibility of creating multiple simulations of the plastic procedure, which results in the representation of the possible outcomes of the surgery.
This thesis presents a framework capable to reconstruct 3D shapes of faces and breasts of plastic surgery patients from 2D images and 3D scans. The 3D reconstruction of an object is a challenging problem with many inherent ambiguities. Statistical model based methods are a powerful approach to overcome some of these ambiguities. We follow the intuition of maximizing the use of available prior information by introducing it into statistical model based methods to enhance their properties.
First, we explore Active Shape Models (ASM) which are a well known method to perform 2D shapes alignment. However, it is challenging to maintain prior information (e.g. small set of given landmarks) unchanged once the statistical model constraints are applied. We propose a new weighted regularized projection into the parameter space which allows us to obtain shapes that at the same time fulfill the imposed shape constraints and are plausible according to the statistical model.
Second, we extend this methodology to be applied to 3D Morphable Models (3DMM), which are a widespread method to perform 3D reconstruction. However, existing methods present some limitations. Some of them are based in non-linear optimizations computationally expensive that can get stuck in local minima. Another limitation is that not all the methods provide enough resolution to represent accurately the anatomy details needed for this application. Given the medical use of the application, the accuracy and robustness of the method, are important factors to take into consideration. We show how 3DMM initialization and 3DMM fitting can be improved using our weighted regularized projection.
Finally, we present a framework capable to reconstruct 3D shapes of plastic surgery patients from two possible inputs: 2D images and 3D scans. Our method is used in different stages of the 3D reconstruction pipeline: shape alignment; 3DMM initialization and 3DMM fitting. The developed methods have been integrated in the production environment of Crisalix, proving their validity.Aquesta tesi ha estat realitzada a Crisalix amb la col·laboració de la Universitat Pompeu Fabra sota el pla de Doctorats Industrials. Crisalix té com a objectiu la millora de la comunicació entre els professionals de la cirurgia plàstica i els pacients, proporcionant una solució a la pregunta que sorgeix més freqüentment durant el procés de planificació d'una operació quirúrgica ``Com em veuré després de la cirurgia?''. La solució proposada per Crisalix està basada en la tecnologia d'imatge 3D. Aquesta tecnologia genera la reconstrucció 3D de la zona del pacient operada, seguit de la possibilitat de crear múltiples simulacions obtenint la representació dels possibles resultats de la cirurgia. Aquesta tesi presenta un sistema capaç de reconstruir cares i pits de pacients de cirurgia plàstica a partir de fotos 2D i escanegis. La reconstrucció en 3D d'un objecte és un problema complicat degut a la presència d'ambigüitats. Els mètodes basats en models estadístics son adequats per mitigar-les. En aquest treball, hem seguit la intuïció de maximitzar l'ús d'informació prèvia, introduint-la al model estadístic per millorar les seves propietats. En primer lloc, explorem els Active Shape Models (ASM) que són un conegut mètode fet servir per alinear contorns d'objectes 2D. No obstant, un cop aplicades les correccions de forma del model estadístic, es difícil de mantenir informació de la que es disposava a priori (per exemple, un petit conjunt de punts donat) inalterada. Proposem una nova projecció ponderada amb un terme de regularització, que permet obtenir formes que compleixen les restriccions de forma imposades i alhora són plausibles en concordança amb el model estadístic. En segon lloc, ampliem la metodologia per aplicar-la als anomenats 3D Morphable Models (3DMM) que són un mètode extensivament utilitzat per fer reconstrucció 3D. No obstant, els mètodes de 3DMM existents presenten algunes limitacions. Alguns estan basats en optimitzacions no lineals, computacionalment costoses i que poden quedar atrapades en mínims locals. Una altra limitació, és que no tots el mètodes proporcionen la resolució adequada per representar amb precisió els detalls de l'anatomia. Donat l'ús mèdic de l'aplicació, la precisió i la robustesa són factors molt importants a tenir en compte. Mostrem com la inicialització i l'ajustament de 3DMM poden ser millorats fent servir la projecció ponderada amb regularització proposada. Finalment, es presenta un sistema capaç de reconstruir models 3D de pacients de cirurgia plàstica a partir de dos possibles tipus de dades: imatges 2D i escaneigs en 3D. El nostre mètode es fa servir en diverses etapes del procés de reconstrucció: alineament de formes en imatge, la inicialització i l'ajustament de 3DMM. Els mètodes desenvolupats han estat integrats a l'entorn de producció de Crisalix provant la seva validesa.
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Venter, J. C. "The safety and efficacy of the propofol/ Alfentanil/ Ketamine-bolus technique in midazolam pre-medicated patients undergoing office based plastic or reconstructive surgery." Thesis, University of the Western Cape, 2007. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_8596_1255685962.
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The purpose of this research project was to assess the safety and efficacy of a combination of drugs for conscious sedation in patients undergoing office-based plastic and reconstructive surgery. A pilot study was done to determine the safety of the co-administration of the drugs used in the sedation technique.
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Pickett, John Anthony. "The development of a dual wavelength spectrophotometry system and its application to the study of free flap viability in plastic and reconstructive surgery." Thesis, Queen Mary, University of London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408062.
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Schimitt, Marcelle. "Da superfície à carne : as fronteiras entre estético e reparador na formação e atuação no campo da cirurgia plástica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/168946.
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A partir de uma abordagem do fenômeno das cirurgias plásticas enquanto algo que se conforma na prática, esta dissertação versa sobre os limites entre o reparador e o estético relativos a esses procedimentos. Tendo como espinha dorsal a formação das(os) médicas(os) e a constituição dessa especialidade da medicina, tais fronteiras serão abordadas a partir do entendimento de que não apenas auxiliam na conformação das cirurgias plásticas, mas são também constituídas em relação a essas últimas. Através da participação em eventos promovidos por Ligas de Cirurgia Plástica e entrevistas realizadas com graduandas, residentes, cirurgiãs e cirurgiões plásticos, este trabalho tem como objetivo construir uma narrativa, entre tantas outras possíveis, acerca dos modos como os limites entre o estético e o reparador têm se instituído discursivo-materialmente. Antes, contudo, parte-se de uma abordagem histórica a fim de uma compreensão mais situada a respeito de como essa especialidade tem se conformado ao longo do tempo. Por meio de diferentes investimentos esta dissertação trata, em síntese, sobre como esses procedimentos assumem diferentes realidades. Assim, contingências históricas, sociais, econômicas, políticas e materiais, entre inúmeras outras, são compreendidas de maneira indissociável como atuantes na conformação das cirurgias plásticas e dos limites concernentes a elas. Por fim, sugere-se que um entendimento dessas realidades enquanto múltiplas nos auxilia na construção de uma apreensão do conhecimento médico como algo que não está dado, mas como práticas histórico-materialmente situadas. Ainda, a partir da discussão central proposta por este trabalho são estabelecidos pontos de confluência entre as cirurgias plásticas e as fronteiras relativas ao corpo e aos binômios natureza/cultura, saúde/doença, forma/função, entre outros.This dissertation addresses the limits between the cosmetic and the reconstructive surgeries from an approach of the plastic surgery phenomenon as something that conforms in practice. Having as a backbone the formation of the doctors and the constitution of this specialty of medicine, such boundaries will be approached from the understanding that they not only aid in the conformation of plastic surgeries but also are constituted of this last one. Through the participation in events promoted by Plastic Surgery Leagues and interviews with undergraduates, residents and plastic surgeons, this study aims to construct a narrative, among many others possible, about the ways in which the boundaries between the cosmetic and the reconstructive surgeries have been instituted discursive-materially. First, however, it starts with a historical approach in order to understand more about how this specialty has conformed over time. Through different investments, this dissertation deals, in short, with about how these procedures take on different realities. Thus, historical, social, economic, political, and material contingencies, among countless others, are understood as acting in the conformation of plastic surgeries and the limits concerning them. Finally, it suggests that an understanding of these realities as multiple helps us in constructing an apprehension of the medical knowledge as something that is not given but as historical-materially situated practices. Still, from the proposed discussion by this study, points of convergence between plastic surgeries and boundaries related to the body and to the binomials nature/culture, health/illness, form/function, among others, are established.
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Smith, Jessica Rose. "Developing P(MMA-co-NVP) hydrogels for use in self-inflating, anisotropic tissue expanders." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:dc1b83e1-c74a-4f28-b4a8-c7da671e3541.
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Artificial tissue expansion is required to generate new skin prior to reconstructive surgery, in order to compensate for a deficit of healthy tissue. Hydrogel tissue expanders, which expand anisotropically, show great promise in overcoming clinical limitations in the field, thus allowing the technique to be used in a wider range of surgeries. These devices consist of pellets of dry poly(methyl methacrylate-co-vinylpyrrolidone), compressed into discs through a hot compression moulding process. However, a number of significant problems still exist in these devices, and this thesis aims to address these issues. To date, there has been a lack of investigation of the factors governing the behaviour of anisotropic swelling. For this reason, a range of different compression ratios have been investigated, with particular focus on the relationship between the material flow during compression and the swelling behaviour of the resulting device. It was found that samples of the same initial size expand to the same reference swelling dimensions, regardless of compression ratio. During hot pressing, the material flow was found to be governed by slip-stick behaviour at the interface between the hot press and the device, affecting the properties and swelling behaviour of the devices. Based on these findings, devices were developed which could expand from a disc into a non-prismatic shape (dome or wedge). Such devices could reduce complication rates and allow the growth of new tissue with anisotropic resting tension. The devices were tested in a small in vivo trial, where it was shown that there were no adverse effects on the tissue produced, and that the shape of the expander (dome) was retained. As devices are being produced for medical use, understanding the effect of sterilization by γ-irradiation is essential, but to date this has been overlooked in the literature. It was found that γ-irradiation caused an increase in cross-linking in the P(MMA-co-NVP). Whilst this produced little change in swelling behaviour for isotropic devices, in the case of anisotropic devices it caused a change in the shape of expansion, reducing the area of new skin which could be generated by the device. It was found that by reducing the concentration of impurities (residual molecules from the polymer synthesis) the impact of γ-irradiation could be greatly reduced. Finally, controlling the rate of expansion is essential in order to avoid clinical complications. In order to control the rate of expansion, particularly during the initial period of swelling, semi-permeable PDMS coatings were applied to the compressed devices. Coatings of thickness greater than 0.375mm were found to effectively control the rate of swelling, for both cylindrical and non-prismatic shapes. As the coating thickness increased, the maximum swelling size decreased. However, it has been shown that change in height (the parameter which governs the area of skin produced) is affected less than the change in mass or diameter.
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Schleifenbaum, Stefan, Torsten Prietzel, Gabriela Aust, Andreas Boldt, Sebastian Fritsch, Isabel Keil, Holger Koch, et al. "Acellularization-induced changes in tensile properties are organ specific." Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-204096.
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Introduction: Though xenogeneic acellular scaffolds are frequently used for surgical reconstruction, knowledge of their mechanical properties is lacking. This study compared the mechanical, histological and ultrastructural properties of various native and acellular specimens. Materials and methods: Porcine esophagi, ureters and skin were tested mechanically in a native or acellular condition, focusing on the elastic modulus, ultimate tensile stress and maximum strain. The testing protocol for soft tissues was standardized, including the adaption of the tissue’s water content and partial plastination to minimize material slippage as well as templates for normed sample dimensions and precise cross-section measurements. The native and acellular tissues were compared at the microscopic and ultrastructural level with a focus on type I collagens. Results: Increased elastic modulus and ultimate tensile stress values were quantified in acellular esophagi and ureters compared to the native condition. In contrast, these values were strongly decreased in the skin after acellularization. Acellularization-related decreases in maximum strain were found in all tissues. Type I collagens were well-preserved in these samples; however, clotting and a loss of cross-linking type I collagens was observed ultrastructurally. Elastins and fibronectins were preserved in the esophagi and ureters. A
loss of the epidermal layer and decreased fibronectin content was present in the skin. Discussion: Acellularization induces changes in the tensile properties of soft tissues. Some of these changes appear to be organ specific. Loss of cross-linking type I collagen may indicate increased mechanical strength due to decreasing transverse forces acting upon the scaffolds, whereas fibronectin loss may be related to decreased load-bearing capacity. Potentially, the alterations in tissue mechanics are linked to organ function and to the interplay of cells and the extracellular matrix, which is different in hollow organs when compared to skin.
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Haen, Roel. "Breast cancer related lymphedema." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:c4a83ffc-790f-46ec-bde2-3ac639dd7c89.
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Improvements in the treatment of breast cancer have resulted in better survival rates and less breast cancer related morbidity. Nevertheless, a significant group of patients still experience a diminished quality of life as a result of lymphedema. In the early, often reversible, stage of lymphedema patients can experience subjective changes in the affected area. However, with the traditionally available tools the lymphedema often remains clinically undetectable and patients are denied essential care that can prevent worsening. Furthermore, most lymphedema assessment tools fail to support a clear unambiguous definition of lymphedema. This underlines the need for a sensitive objective measurement method that can assess lymphedema in a subclinical stage. In this study we demonstrated that measuring tissue dielectric constant (TDC) using the MoistureMeter-D is an effective method to detect tissue water changes and could potentially provide a cost-effective adequate tool to measure the early onset of breast cancer related lymphedema (BCRL). Secondarily, we established the correlation between the novel TDC method and the frequently used arm volume measurements and self-assessment questionnaires. A group of 20 female patients with clinically BCRL were included. TDC measurements in both arms and all quadrant of both breast were recorded along with volumetric measurements of both arms. All patients were asked to complete a self-report questionnaire. The novel TDC method detected significantly higher tissue water levels in the affected arm and breast compared to the control side. The TDC ratio between control and affected side showed significant correlation with self-reported pain and discomfort in both arm and breast. In the arm, the TDC method also showed correlation with the volume measurement method. The TDC value of the arm was correlated to age, but not to BMI. This study demonstrates that measuring TDC using the MMD is an effective method for quantifying lymphedema in arm and breast and is an important tool in detecting early TWC changes.
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Hansen, Andrew. "Perception of Differences in Lip Profile between 2-D and 3-D." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4142.
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Past studies evaluating the esthetics of orthodontic treatment have been done using 2-D images. New 3-D imaging offers an improved, real-life representation of a subject. The purpose of this study was to determine how laypeople perceived differences in lip position (flat versus ideal lip fullness) in 2-D compared to 3-D.
3dMD images of 8 Caucasian subjects were adjusted to an ideal and flat lip position in 3-D and then in 2-D from the profile view. 2 surveys were created with paired ideal and flat images on the screen, either in 2-D or 3-D, and evaluators were asked to choose which image they preferred and by how much.
Evaluators were more likely to be neutral, and were less decisive of their preference in 3-D compared to 2-D. People might be less sensitive to small differences in facial soft tissue and esthetics than previous research in 2-D has led orthodontists to believe.
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Greenhowe, Jennifer. "Stem and progenitor cells in wound healing." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:87a9a7a1-b595-458a-913f-64497174f988.
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As more patients with large body surface area burns are surviving and requiring reconstructive surgery, there is a necessity for advances in the provision of bioengineered alternatives to autologous skin cover. The aims of this Thesis are to identify feasible source tissues of Endothelial Colony Forming Cells and Mesenchymal Stem/Stromal Cells for microvascular network formation in vitro with three-dimensional dermal substitute scaffolds. The working hypothesis is that pre-vascularised dermal scaffolds will result in better quality scarring when used with split thickness skin grafts. Human umbilical cord blood, peripheral blood and adipose tissue were collected and processed with ethical approval and informed consent. Samples were cultured to form endothelial outgrowth colonies and confluent Mesenchymal Stem/Stromal Cells, which were characterised using flow cytometry and expanded in vitro. Mesenchymal Stem/Stromal Cell multipotency was confirmed with tri-lineage mesenchymal differentiation. Primary cells were tested in a two-dimensional tubule formation co-culture assay and differences assessed using a proangiogenic antibody array. Tubule formation was tested in four different acellular dermal substitute scaffolds; Integra® Dermal Regeneration Template, Matriderm®, Neuskin-F® and De-cellularised Human Cadaveric Dermis. Umbilical cord blood was the most reliable source of Endothelial Colony Forming Cells, the yield of which could be predicted from placental weight. Microvasculature dissected free from adipose tissue was a reliable source of Mesenchymal Stem/Stromal Cells which supported significantly more tubule formation than Mesenchymal Stem/Stromal Cells from whole adipose tissue. Microvasculature Mesenchymal Stem/Stromal Cells secreted significantly higher levels of the proangiogenic hormone leptin, and addition of exogenous leptin to the tubule formation assay resulted in significantly increased tubule formation. Microvasculature was cultured in all four of the scaffolds tested, but depth of penetration was limited to 100µm. The artificial oxygen carrier perfluorocarbon was shown to increase two-dimensional tubule formation and may be useful in further three-dimensional scaffolds studies to improve microvascular penetration.
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Veiga, Filho Joel [UNIFESP]. "Qualidade dos ensaios clínicos aleatórios em cirurgia plástica." Universidade Federal de São Paulo (UNIFESP), 2001. http://repositorio.unifesp.br/handle/11600/17912.
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Previous issue date: 2001Qualidade dos ensaios clinicos aleatorios em Cirurgia Plastica. Contexto. A avaliacao da qualidade dos ensaios clinicos aleatorios e importante, pois a observacao dos erros e falhas nos permite evita-los no planejamento. conducao, analise e publicacao de futuros estudos. E e fundamental para se determinar o grau de confiabilidade dos resultados dos estudos publicados. Objetivo. Avaliar a qualidade dos ensaios clinicos aleatorios em Cirurgia Plastica. A hipotese testada foi a de que os estudos sao de ma qualidade. Tipo de estudo. Estudo descritivo com a avaliacao realizada por dois pesquisadores, de maneira independente, seguida de uma reuniao de consenso. Selecao da amostra. Ensaios clinicos aleatorios em Cirurgia Plastica, com sigilo de alocacao descrito adequadamente, realizado por/ou com a participacao de pelo menos um cirurgiao plastico, foram identificados atraves da busca eletronica nas bases de dados LILACS, MEDLINE, EMBASE e CCTR. Variavel estudada. Qualidade dos ensaios clinicos aleatorios, por meio da Lista de Delphi, de uma escala de qualidade (JADAD et al., 1996) e de cinco itens complementares. Resultados. Dos 139 estudos publicados como ensaios clinicos aleatorios, 63 por cento (88/139) nao descreveram o sigilo de alocacao, em 17 por cento (23/139) o sigilo de alocacao foi inadequado e 20 por cento (28/139) descreveram o sigilo de alocacao adequadamente. Dos 28 ensaios clinicos aleatorios, com sigilo de alocacao descrito adequadamente, 25 por cento nao descreveram a geracao da sequencia de alocacao, 82 por cento nao descreveram as perdas e exclusoes, 68 por cento nao descreveram se os grupos eram comparaveis, 50 por cento nao especificaram os criterios de inclusao e exclusao, 68 por cento nao apresentaram as medidas de variabilidade e as estimativas dos pontos para a variavel primaria, 61 por cento nao apresentaram uma analise por intencao de tratar. Na pontuacao pela escala de qualidade (JADAD et al., 1996), 71 por cento (20/28) receberam dois ou menos pontos. Conclusao. Os ensaios clinicos aleatorios em Cirurgia Plastica sao de ma qualidade
Quality of randomized clinical trials in Plastic Surgery. Context. The valuation of the quality of the randomized clinical trials is important since the observation of the mistakes and failures allows us to avoid them during planning, performing, analysis and publishing of future studies. It is fundamental in order to determine the reliability degree of the results of the published studies. Objective. To evaluate the quality of randomized clinical trials in Plastic Surgery. The hypothesis tested was the one stating that the studies are low quality ones. Type of study. Descriptive study with the valuation performed by two appraisers, in an independent way, followed by a consensus meeting. Study selection. Randomized clinical trials in Plastic Surgery, with allocation concealment suitably described, performed by/or with the participation of, at least, one plastic surgeon, were identified through electronic search in the basis of LILACS, EMBASE, MEDLINE and CCTR data. Studied variable. Quality of the randomized clinical trials, through Delphi List, through a quality scale (JADAD et al., 1996) and five complementary items. Results. From 139 studies published as randomized clinical trials, 63% (88/139) didn’t describe allocation concealment, in 17% (23/139) it was unsuited and 20% described it suitably. From 28 randomized clinical trials with allocation concealment suitably described, 25% didn’t describe the formation of the allocation sequence, 82% didn’t describe the loss and exclusion, 68% didn’t describe if the groups were comparable, 50% didn’t specify the inclusion and exclusion criteria, 68% didn’t present the variability measures and the points estimation for a primary variable, 61% didn’t present an analysis for a treating intention. In the punctuation by the quality scale (JADAD et al., 1996), 71% (20/28) got two or less points. Conclusion. The randomized clinical trials in Plastic Surgery are low quality ones.
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Pedroso, Juan Carlos Montano [UNIFESP]. "Variáveis hematológicas e perfil do ferro na abdominoplastia após a cirurgia bariátrica." Universidade Federal de São Paulo (UNIFESP), 2011. http://repositorio.unifesp.br/handle/11600/9826.
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Previous issue date: 2011-05-25Introdução: O tratamento da deformidade na parede abdominal resultante do emagrecimento após a cirurgia bariátrica é a abdominoplastia, a qual pode induzir anemia pós-operatória. Além disso, a cirurgia bariátrica promove uma tendência a deficiência de ferro. Baixas reservas de ferro comprometem a eritropoese. Não há estudo avaliando o grau de anemia e sua evolução após a abdominoplastia pós-bariátrica. Objetivo: Avaliar a anemia e sua evolução após a abdominoplastia pós-bariátrica. Métodos: Os valores de hemoglobina, reticulócitos, ferro, ferritina, e índice de saturação da transferrina foram mensurados na véspera da abdominoplastia e na primeira, quarta e oitava semana de pós-operatório. A hemoglobina também foi mensurada com 48h de pós-operatório. Vinte mulheres adultas foram operadas e tiveram seus dados comparados com 12 controles. Resultados: Os níveis de hemoglobina caíram, em média, de 12,98g/dL para 10,8g/dL com 48h. Houve um aumento significante da hemoglobina no sétimo dia com correção de um terço do déficit, sem aumentos significantes posteriores. Houve um aumento dos reticulócitos na primeira semana. O ferro sérico e índice de saturação de transferrina caíram na primeira semana e mantiveram-se baixos. Os níveis de ferritina apresentaram aumento não significante na primeira semana e posteriormente caíram. Nenhuma das pacientes foi transfundida. Conclusão: Os níveis de hemoglobina caíram após a abdominoplastia e demonstraram um aumento na primeira semana de pós-operatório, com correção de um terço do déficit de hemoglobina, porém, não recuperaram por completo na oitava semana. Ao término do seguimento, 45% das pacientes desenvolveram deficiência de ferro e apresentaram déficit de hemoglobina maior que as pacientes que mantiveram estoques de ferro normais
Background: The treatment of the abdominal wall deformity resulted from weight loss after bariatric surgery is a mixed type of abdominoplasty, which can induce post-operative anemia. In addition, bariatric surgery itself promotes a tendency to iron deficiency which could compromise erythropoiesis. To our knowledge, there is no study evaluating the degree of anemia and its recovery after post-bariatric abdominoplasty. Methods: The values of hemoglobin, reticulocytes, iron, ferritin and transferrin saturation index were measured the day prior to abdominoplasty and the first, fourth and eighth weeks after surgery. Hemoglobin was measured within 48h after surgery. Twenty adult women underwent surgery and had their data compared with 12 controls. Results: Hemoglobin levels dropped significantly from 12,98g/dL to 10,8g/dL within 48h. Hemoglobin increased significantly to 11,5g/dL by day seven, with correction of one third of the deficit, without significant increases thereafter. There was an increase in reticulocytes in the first week. Serum iron and transferrin saturation index fell in the first week and remained low. Ferritin levels showed no significant increase in the first week and subsequently fell. None of the patients received blood transfusion. Conclusion: Hemoglobin levels fell from 12,98 g/dL to 10,8 g/dL after abdominoplasty and showed an increase in the first week after surgery, with correction of one third of the deficit, but did not completely recover in the eighth week. At the end of the follow-up, 45% of the patients developed an iron deficiency and had a hemoglobin deficit higher than the patients that maintained normal iron stores.
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Ishida, Luís Henrique. ""Estudo anatômico comparativo entre o retalho escapular e o retalho perfurante da artéria toracodorsal"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5158/tde-16102006-133859/.
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Desde a primeira descrição do retalho perfurante de artéria toracodorsal (TAP), sua indicação tem sido questionada por se tratar de um retalho de características semelhantes aos retalhos fasciocutâneos escapulares baseados na artéria circunflexa escapular, que são bem conhecidos e reprodutíveis. Este estudo visa comparar características anatômicas destes dois retalhos, distinguindo-os para uma melhor indicação. Adicionalmente o estudo visa estudar o posicionamento do pedículo perfurante do retalho TAP. Vinte e um pares de retalhos (TAP e escapular) foram dissecados simultaneamente em cadáveres frescos. Os músculos latíssimo do dorso e redondo maior foram seccionados e os dois retalhos foram retirados em peça única. O comprimento do pedículo, diâmetro externo da artéria e da veia, espessura da derme e espessura do tecido celular subcutâneo de ambos os retalhos foram avaliados e comparados de forma pareada. A localização dos pedículos dos retalhos foi avaliada em ambos os retalhos. Os dados obtidos foram analisados estatisticamente através do teste t de Student. O retalho TAP apresentou um pedículo com média de 16,95 cm de comprimento, sendo 50% maior que o do retalho escapular (p<0,05). A espessura média da derme foi 2,12 mm, sendo 42% mais fina do que a do retalho escapular; e a do tecido subcutâneo foi 1,37 cm, sendo 28% mais fina do que a do retalho escapular (p<0,05). O pedículo do retalho TAP apresentou artéria com diâmetro médio de 3,14 mm e veia com diâmetro médio de 3,03 mm, enquanto o pedículo do retalho escapular apresentou artéria com diâmetro médio de 3,33 mm e veia com diâmetro médio de 2,95mm, ambos sem diferenças estatísticas. Nas dissecções estudadas, todos os pedículos dos retalhos escapulares se localizavam no espaço triangular. Já a localização dos pedículos perfurantes do retalho TAP não apresentou nenhum parâmetro constante. O estudo demonstrou que, apesar de se localizarem em sítios anatômicos adjacentes, o retalho TAP possui um pedículo mais longo e sua pele é mais fina do que o retalho escapular. Por outro lado, o posicionamento do pedículo do retalho escapular é constante, enquanto o pedículo perfurante do retalho TAP possui localização variável.Indication of the thoracodorsal artery perforator (TAP) flap has been questioned because its characteristics are similar to those of scapular flaps based on the scapular circumflex artery. The scope of this study is to compare the anatomic features of these two flaps, differentiating them for a better indication. Twenty-one pairs of flaps (TAP and scapular) were dissected simultaneously in fresh cadavers. The length of the pedicles, thickness of the arteries and veins of the pedicles, and the thickness of the dermis and subcutaneous tissue of the flaps were assessed and compared. The position of the pedicles of both flaps was evaluated. The average length of the TAP flap pedicle was 16.95 cm, and it was 50% longer than the scapular flap (p<0.05). The mean thickness of the dermis was 2.12 mm and of the subcutaneous tissue 1.37 cm, respectively 42% and 28% thinner than the scapular flaps (p<0.05). No significant difference was evident between the thicknesses of the pedicles. The TAP arterial pedicle was 3.14 mm and the venous one 3.03 mm. The scapular flap demonstrated a 3.33 mm arterial pedicle and 2.95 mm for the venous one. The evaluation of the position of the pedicle of the scapular flap was constant; on the other hand, the perforator pedicle of the TAP flap did not show any constant anatomical parameter. The study revealed that although the TAP flap and the scapular flap lie in adjacent anatomical areas, the TAP flap has a longer pedicle and a thinner skin; their vascular pedicles have similar thickness; though the position of the thoracodorsal perforator pedicle is variable, when compared with the scapular flap.
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Sharma, Vikram Pramod. "Genetics and pathophysiology of coronal craniosynostosis revealed by next-generation DNA sequencing." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:cf124e89-aa52-4d76-ac0f-83208afa4b3a.
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This thesis further delineates the molecular genetic basis of a relatively common craniofacial condition, coronal craniosynostosis. It used whole-exome sequencing to identify novel disease genes in patients with non-syndromic coronal synostosis and negative genetic testing. Initially, 2 patients were identified with damaging, frameshift mutations in a gene not previously linked with craniosynostosis – Transcription Factor 12 (TCF12). A further intronic mutation was identified in a third patient. This gene encodes a transcription factor that dimerises with TWIST1, mutations of which cause Saethre-Chotzen syndrome, also associated with coronal synostosis. Screening 344 undiagnosed patients identified 35 further mutations, all with coronal synostosis with 14 cases arising de novo. This work was published and testing for TCF12-related craniosynostosis was translated clinically. Significant non-penetrance (60%) was identified in mutation-positive relatives and the genetic background was investigated. Firstly, analysis of parental origins of de novo mutations identified 6 of paternal origin and helped refine haplotype assignment. Secondly, haplotype analysis of TCF12-mutation carriers revealed modest correlation with phenotypic status, but this was insufficient to be useful in clinical testing. Thirdly, TCF12 haplotypes were analysed for association with non-syndromic coronal synostosis, but no significant association was found. Further exome sequencing revealed a de novo frameshift mutation in Transcription Factor 20 (TCF20) in a patient with coronal synostosis and autism, although the mutation only correlated with the latter phenotype. Analysis of 5 trios revealed a novel variant in myosin heavy chain 4 (MYH4) in 1 family, although its role in suture development is uncertain. Reviewing pooled exome data from 19 mutation-negative patients revealed no further disease genes. In summary, this thesis describes novel gene discovery, defines a new clinical entity and investigates genetic background of penetrant and non-penetrant individuals. Further exome sequencing identified another disease gene, a de novo mutation and compiled lists of damaging variants to allow future work.
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Ishida, Luiz Carlos. ""Estudo anatômico do retalho perfurante ântero-lateral da coxa"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5158/tde-04102006-130436/.
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INTRODUÇÃO: O retalho ântero-lateral da coxa é baseado em vasos perfurantes do ramo descendente da artéria circunflexa lateral femoral. Este retalho tem características muito interessantes para a cirurgia reparadora, como a pequena espessura, pedículo longo e excelente área doadora. No entanto, existem muitas controvérsias na literatura quanto aos vasos perfurantes e ao trajeto do pedículo deste retalho. Neste trabalho procurou-se estabelecer alguns parâmetros anatômicos e esclarecer estas controvérsias. MÉTODO: Estudaram-se 100 coxas de 50 cadáveres quanto aos seguintes aspectos: 1- Número e localização de perfurantes encontrados, 2- Trajeto do pedículo perfurante, 3- Trajetória intramuscular, 4- Comprimento do trajeto intramuscular, 5- Comprimento total do pedículo, 6- Diâmetro dos vasos e 7- Espessura do retalho. RESULTADOS: 1- Encontraram-se de 0 a 4 perfurantes por coxa estudada, todas em um raio de até 6cm do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 2- Os vasos perfurantes tinham trajeto músculo-cutâneo em 75,76% das coxas e septo-cutâneo em 24,24%. 3- Dos pedículos perfurantes com trajeto músculo-cutâneo, 86,67% possuíam trajetória indireta contra 13,33% com trajetória direta. 4- O comprimento médio do trajeto intramuscular dos pedículos foi de 3,67 ± 2,01 cm. 5- O comprimento médio do pedículo total foi de 11,31 ± 3,12 cm. 6- O diâmetro médio da artéria na origem do ramo descendente da artéria circunflexa femoral foi de 2,21 ± 0,85 mm e para as veias no mesmo local de 2,66 ± 1,33 mm e 2,10 ± 1,11 mm. 7- A espessura da tela subcutânea foi de 8,98 ±6,23 mm e da pele de 1,60 ± 0,76 mm. CONCLUSÕES: 1- Existiu uma pequena possibilidade de não haver pedículos perfurantes. 2- Quando presentes, os pedículos perfurantes do ramo descendente da artéria circunflexa lateral femoral eram encontrados em numero de 1 a 4, sempre em um raio de 6 cm a partir do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 3- Os trajetos dos pedículos perfurantes eram predominantemente músculo-cutâneos. 4- A trajetória intramuscular encontrada foi predominantemente indireta. 5- O comprimento do trajeto intramuscular correspondeu a 31,69% do comprimento total do pedículo. 6- O comprimento total do pedículo se mostrou adequado tanto para transferências locais como à distancia por técnicas microcirúrgicas. 7- Os diâmetros dos vasos, tanto da artéria quanto das veias, se mostraram adequados para a realização de anastomoses microcirúrgicas. 8- A espessura do retalho encontrada foi significantemente maior nas coxas de indivíduos femininos, mas tanto nos homens quanto nas mulheres a espessura foi relativamente fina.INTRODUCTION: The anterolateral thigh flap is based on the perforator vessels of the descending branch of the lateral circumflex femoral artery. This flap has very interesting characteristics for the reconstructive surgery, like the small thickness, long pedicle and excellent donor site. On the other hand, there are many controversial data on the literature about the perforator vessels and the pedicle course of this flap. The aims of this study are to establish some anatomical parameters and clear some controversies. METHOD: A hundred thighs of 50 cadavers were studied for: 1- The number and location of the perforator vessels. 2- The course of the perforator pedicles. 3- The intramuscular course. 4- The length of the intramuscular course. 5- The total length of the vascular pedicle. 6- The diameter of the vessels. and 7- The thickness of the flap. RESULTS: 1- There were found from 0 to 4 perforators per thigh, all in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 2- The pedicles was musculocutaneous in 75,76% of the thighs and septocutaneous in 24,24%. 3- Among the musculocutaneous pedicles, 86,67% had a direct intramuscular course, and 13,33% had indirect course. 4- The mean length of the intramuscular course was 3,67 ± 2,01 cm. 5- The mean total pedicle length was 11,31 ± 3,12 cm. 6-The mean artery diameter on the origin of the descending branch of the lateral circumflex femoral artery was 2,21 ± 0,85 mm and the mean vein diameter on the same spot was 2,66 ±1,33 mm and 2,10 ± 1,11 mm. 7- The mean subcutaneous fat tissue thickness was 8,98 ± 6,23 mm and the mean skin thickness was e 1,60 ± 0,76 mm. CONCLUSIONS: 1- There was a possibility of finding no perforators of the descending branch of the lateral circumflex femoral artery. 2- When present, the perforators pedicles were found in numbers between 1 to 4, always in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 3- The perforators pedicles courses were predominantly musculocutaneous. 4- The intramuscular courses were mainly indirect. 5- The intramuscular length was responsible for 31,69% of the total length of the vascular pedicle. 6- The total length of the pedicle was adequate for either local or microsurgical transfers. 7- The arterial and venous diameters were adequate for microsurgical anastomosis. 8- The female cadavers had significantly thicker flaps, but both in the male and the female cadavers the flap was considerably thin.
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Tang, Yarong. "Computer vision-based reconstructive plastic surgery." 2003. http://purl.galileo.usg.edu/uga%5Fetd/tang%5Fyarong%5F200312%5Fms.
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Abreu, Diana Filipa Passos Dias Marques de. "Thermal characterization of flaps in plastic and reconstructive surgery." Dissertação, 2017. https://hdl.handle.net/10216/108283.
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Abreu, Diana Filipa Passos Dias Marques de. "Thermal characterization of flaps in plastic and reconstructive surgery." Master's thesis, 2017. https://hdl.handle.net/10216/108283.
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Gerós, Ana Filipa Domingues. "Capture and analysis of the trajectories of anatomical points on the face to support and evaluate reconstructive plastic surgery." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/79460.
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Gerós, Ana Filipa Domingues. "Capture and analysis of the trajectories of anatomical points on the face to support and evaluate reconstructive plastic surgery." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/79460.
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Almutairi, Khalid Mutlag. "Three Dimensional Vascular Supply to Human Skeletal Muscles: An Anatomical Analysis of Potential Donor Muscles for Segmental Muscle Transfer." 2012. http://hdl.handle.net/10222/14594.
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Sun, Clement Sung-Jay. "Shared decision-making about breast reconstruction : a decision analysis approach." 2013. http://hdl.handle.net/2152/22976.
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An ongoing objective in healthcare is the development of tools to improve patient decision-making and surgical outcomes for patients with breast cancer that have undergone or plan to undergo breast reconstruction. In keeping with the bioethical concept of autonomy, these decision models are patient-oriented and expansive, covering a range of different patient decision-makers. In pursuit of these goals, this dissertation contributes to the development of a prototype shared decision support system that will guide patients with breast cancer and their physicians in making decisions about breast reconstruction.
This dissertation applies principles in decision analysis to breast reconstruction decision-making. In this dissertation, we examine three important areas of decision-making: (1) the options available to decision-makers, (2) the validity of probabilistic information assessed from reconstructive surgeons, and (3) the feasibility of applying multiattribute utility theory. In addition, it discusses the influences of breast aesthetics and proposes a measure for quantifying such influences. The dissertation concludes with a fictional case study that demonstrates the integration of the findings and application of decision analysis in patient-oriented shared breast reconstruction decision-making.
Through the implementation of decision analysis principles, cognitive biases and emotion may be attenuated, clearing the decision-maker’s judgment, and ostensibly leading to good decisions. While good decisions cannot guarantee good outcomes at the individual level, they can be expected to improve outcomes for patients with breast cancer as a whole. And regardless of the outcome, good decisions yield clarity of action and grant the decision-maker a measure of peace in an otherwise uncertain world.text
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Krahlisch, Joelle. "Früh- und Spätergebnisse nach Latissimus-dorsi-Lappenplastiken bei sternalen Wundheilungsstörungen und Wundinfektionen." Doctoral thesis, 2020. http://hdl.handle.net/21.11130/00-1735-0000-0005-139C-6.
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