MedWorm: Cosmetic Surgery

A range of cosmetic medicine procedures for any age

Cosmetic Medicine / Plastic Surgery News From Medical News Today — Thu, 15 May 2008 10:00:00 +0100

BeautyforLife.com is the new interactive website where consumers can answer a few questions and receive a customized cosmetic medicine Beauty Plan. The website-a joint initiative of American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS)-is helping consumers understand and make educated choices among the full range of cosmetic medicine procedures. (Source: Cosmetic Medicine / Plastic Surgery News From Medical News Today)

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Radial forearm flap surgery—evaluation of donor site morbidity

European Journal of Plastic Surgery — Wed, 14 May 2008 06:04:17 +0100

Abstract The free radial forearm flap is an excellent method for reconstruction of defects in the head and neck region. In the literature, there is still disagreement about the best surgical treatment of the forearm defect to avoid functional and cosmetic drawbacks. There is a debate about using full-thickness skin graft or better split thickness skin graft. To evaluate our own results after radial forearm flap surgery, a follow-up examination and standardized interview of 25 patients was performed. For closure of the donor site, a full skin graft from the groin was used in 17 cases and split skin graft from the thigh in eight cases. All patients were satisfied with postoperative results and hand function for everyday use. Subjective complaints were more common in the split skin graft group, especially related to loss of sensibility. Because of severe wound healing failure with tendon exposure in one case after split skin grafting, there was the necessity for surgical revision. During the medical examination, we documented more functional impairments in the split skin graft group than in patients after full skin grafting. Only the development of hypertrophic scars dominated in the full skin graft group. According to the trend to fewer complications, we prefer full-thickness skin grafts for the closure of the donor site after radial forearm flap surgery. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00238-008-0238-yAuthors A. Thiele, Martin-Luther-University Halle-Wittenberg Department of Otorhinolaryngology, Head and Neck Surgery Magdeburger Straße 12 06112 Halle/Saale GermanyC. Wulke, Martin-Luther-University Halle-Wittenberg Department of Otorhinolaryngology, Head and Neck Surgery Magdeburger Straße 12 06112 Halle/Saale GermanyE. Roepke, Martin-Luther-University Halle-Wittenberg Department of Otorhinolaryngology, Head and Neck Surgery Magdeburger Straße 12 06112 Halle/Saale GermanyS. Knipping, Martin-Luther-University Halle-Wittenberg Department of Otorhinolaryngology, Head and Neck Surgery Magdeburger Straße 12 06112 Halle/Saale Germany Journal European Journal of Plastic SurgeryOnline ISSN 1435-0130Print ISSN 0930-343X (Source: European Journal of Plastic Surgery)

Adult burn injuries due to domestic barbeques in new south wales.

Burns : Journal of the International Society for Burn Injuries — Wed, 14 May 2008 04:00:00 +0100

Adult burn injuries due to domestic barbeques in New South Wales.

Burns. 2008 May 14;

Authors: Khalessi A, Maitz P, Haertsch P, Kennedy P

PURPOSE: Burn injuries associated with domestic barbeques were responsible for 80 admissions to Concord Hospital Burns Unit during the period from January 1998 until December 2007. In our series the number of burn injuries associated with domestic barbeques is increasing and we have reviewed the records of these patients to document their injuries and identify possible causes. METHODS: The database of the unit was reviewed for all admissions resulting from domestic barbeques from January 1998 until December 2007. Patients whose injuries resulted from bonfires, camping or other domestic fires were excluded from the study. RESULTS: The number of barbeque related burn injuries has increased as has the incidence of burns associated with gas fired barbeques. Young adult males predominate. Injuries ranged from 2 to 65% TBSA and 34% required intubation. There were 10 major complications with one death and 20% of patients required grafting. Length of stay varied from 1 to 51 days. CONCLUSIONS: In this series the number of admissions resulting from both wood fired and gas barbeques has increased. The cause of injury in open fires is associated with misuse of accelerants, whilst the cause of injury in gas barbeques is mainly due to delayed ignition of gas or incorrect use of the appliance. Distribution and severity of injuries are similar.

PMID: 18482801 [PubMed - as supplied by publisher]

(Source: Burns : Journal of the International Society for Burn Injuries)

Research findings change the way doctors perform cleft palate surgery

Cleft Palate News From Medical News Today — Tue, 13 May 2008 12:00:00 +0100

Research by Dr. Damir Matic, a scientist with Lawson Health Research Institute in London, Ontario is changing the way cleft palate surgeries are performed throughout North America and around the world. Matic has been conducting research to determine the optimal time to close the gum tissue of cleft palate patients. His research suggests that it is best to wait until the child is older. (Source: Cleft Palate News From Medical News Today)

Facial paralysis: research and future directions

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 260-267DOI: 10.1055/s-2008-1075842ABSTRACTFacial paralysis has fascinated physicians through the centuries. Management of the condition has evolved extensively over the past 50 years, relying largely upon neural repair techniques and static techniques prior to the 1940s, followed by heavy emphasis on regional muscle transfer by the 1970s. With the advent of the operating microscope and the development of microinstrumentation, in the mid-1970s free tissue transfer became technically feasible, and new techniques quickly ensued that introduced functioning muscle as a viable and valuable option in the management of the paralyzed face. These techniques have been subject to continual refinement to improve their reliability and reduce morbidity. In the modern era of evidence-based medicine, the field of facial nerve management has expanded exponentially with critical questions that will help future facial reanimation surgeons refine the approach for patients with acute and long-standing facial paralysis. This article will discuss current research areas with respect to assessment and management of the facial nerve patient, as well as future surgical outcomes. We will also present the state of both clinical research and contemporary basic science issues relevant to facial nerve disorders.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Facial rehabilitation: a neuromuscular reeducation, patient-centered approach

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 250-259DOI: 10.1055/s-2008-1075841ABSTRACTIndividuals with facial paralysis and distorted facial expressions and movements secondary to a facial neuromotor disorder experience substantial physical, psychological, and social disability. Previously, facial rehabilitation has not been widely available or considered to be of much benefit. An emerging rehabilitation science of neuromuscular reeducation and evidence for the efficacy of facial neuromuscular reeducation, a process of facilitating the return of intended facial movement patterns and eliminating unwanted patterns of facial movement and expression, may provide patients with disorders of facial paralysis or facial movement control opportunity for the recovery of facial movement and function. We provide a brief overview of the scientific rationale for facial neuromuscular reeducation in the structure and function of the facial neuromotor system, the neuropsychology of facial expression, and relations among expressions, movement, and emotion. The primary purpose is to describe principles of neuromuscular reeducation, assessment and outcome measures, approach to treatment, the process, including surface-electromyographic biofeedback as an adjunct to reeducation, and the goal of enhancing the recovery of facial expression and function in a patient-centered approach to facial rehabilitation.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

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Management of synkinesis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 242-249DOI: 10.1055/s-2008-1075840ABSTRACTFacial synkinesis is one of the most distressing consequences of facial paralysis. Synkinesis refers to the abnormal involuntary facial movement that occurs with voluntary movement of a different facial muscle group. The pathophysiologic basis of facial synkinesis is likely multifactorial although the predominant mechanism appears to be aberrant regeneration of facial nerve fibers to the facial muscle groups after facial nerve injury. Patients experience hypertonic contractures and synkinetic movements such as eye closure with volitional movement of the mouth or midfacial movement during volitional or reflexive eye closure. Synkinesis can cause functional limitation with activities such as eating, drinking, smiling, and may even lead to social isolation. Evaluation of synkinesis is primarily subjective with facial grading scales such as the Sunnybrook scale. Objective measures of synkinesis using computerized video analysis show promise although no objective techniques are currently widely used. The most common therapeutic modalities for the treatment of facial synkinesis include (1) botulinum toxin type A (BTX-A) injections for selective chemodenervation of affected muscle groups and (2) facial neuromuscular retraining. Biofeedback using mirrors or electromyography has been used both for the treatment and prevention of facial synkinesis. Other treatment options include surgical therapies, such as selective neurolysis or myectomy, although these have been rendered nearly obsolete with the advent of BTX-A.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

The evaluation and treatment of lower eyelid paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 231-241DOI: 10.1055/s-2008-1075839ABSTRACTThe lower eyelid conforms precisely across its length to the complex topography of the cornea, conjunctiva, and globe. Along with the upper eyelid, it protects the eye from foreign bodies, prevents desiccation, and helps circulate the tear film from its origin in the lacrimal gland to its drainage at the lacrimal puncta. Paralysis of the lower eyelid may result in ectropion, lid laxity, epiphora, and lagophthalmos. This article presents a structural approach to the evaluation and treatment of lower eyelid paralysis and describes the surgical procedures designed to correct the three-dimensional anatomic abnormalities underlying this disorder. These procedures are frequently performed in conjunction with upper lid procedures that are described in a previous article by Bergeron and Moe in this issue of the journal.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

The evaluation and treatment of upper eyelid paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 220-230DOI: 10.1055/s-2008-1075838ABSTRACTPatients with upper lid paralysis suffer from a loss of the blink reflex/response in the affected eye, leaving the eye vulnerable to a host of predatory insults. Partial or total impairment of the orbicularis oculi muscle, lagophthalmos, disruption of the lacrimal apparatus, upper lid retraction, and the unopposed pull of gravity on the surrounding paralyzed tissues all contribute to increased corneal exposure and an increased risk of exposure keratitis. Management of the upper lid in these patients must therefore focus on restoration of the effects of the blink reflex/response and prevention of corneal exposure. Relevant anatomy and pathophysiology are discussed. The initial treatment is supportive, with surgery reserved for those patients that fall into two categories: those who have failed nonsurgical treatment to protect the cornea and those who have been treated effectively with conservative measures but are faced with the prospect of long-term or permanent paralysis. A variety of surgical procedures that may be classified as either or are discussed. Standard static procedures include lid loading and tarsorrhaphy, whereas the palpebral spring implant and the temporalis muscle transfer are classified as dynamic. The goal of the corrective procedures is to allow complete eye closure, thereby providing corneal protection, with minimal (1 mm or less) ptosis in the open position.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Management of the brow in facial paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 216-219DOI: 10.1055/s-2008-1075837ABSTRACTManagement of the brow remains a challenging, important, and gratifying area in the care of facial paralysis patients. Aged facial paralysis patients generally require surgical management of brow ptosis. Young facial paralysis patients occasionally require surgical management of brow ptosis. Indications for surgical management, treatment options, and surgical approach are discussed. Consideration of factors such as age, forehead furrows, skin type, duration of paralysis, and degree of visual impairment are discussed in the context of treatment planning.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Static procedures for the management of the midface and lower face

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 211-215DOI: 10.1055/s-2008-1075836ABSTRACTFacial reanimation for facial paralysis continues to be an evolving field in facial reconstruction. Static procedures in the management of mid and lower facial paralysis include the use of facial slings made from autologous tissue, freeze-dried acellular human dermis, and expanded polytetrafluoroethylene. A newly described suspension technique using a multivector suture suspension stands to expand the tools that can be used by the reconstructive surgeon. This article describes and contrasts each of these techniques.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

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Dynamic muscle transfer in facial reanimation

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 204-210DOI: 10.1055/s-2008-1075835ABSTRACTDynamic muscle transfers offer the hope of improved facial support and symmetry, with volitional movement. These are most commonly employed for reanimation of the oral commissure to produce a smile. In addition, muscle transfers have been used successfully to reestablish eye closure. Facial paralysis of long-standing duration presents challenges quite distinct from paralysis that is managed early after onset. It is in this situation, most commonly, that dynamic muscle transfers are used. In this respect, the alternative is free tissue transfer. Each of these two options have advantages and disadvantages.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Free tissue transfer for the treatment of facial paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 194-203DOI: 10.1055/s-2008-1075834ABSTRACTLong-standing facial paralysis requires the introduction of viable, innervated dynamic muscle to restore facial movement. The options include regional muscle transfer and microvascular free tissue transfer. There are advantages and disadvantages of each. Briefly, the regional muscle transfer procedures are reliable and provide immediate return of movement. However, the movement is not of a spontaneous mimetic nature. Free tissue transfer, in contrast, offers the possibility of synchronous, mimetic movement. It does, however, require a prolonged healing time in comparison with that of regional muscle transfer. The choice is made by physician and patient together, taking into account their preferences and biases. Muscle-alone free tissue transfer is our preferred option for reanimation of uncomplicated facial paralysis without skin or soft tissue deficits. Combined muscle and other tissue (most are skin flap) is another preferred option for more challenging complex facial paralysis with skin or soft tissue deficits after tumor excision. Gracilis flap is the author's first choice of muscle transplantation for both reconstructions. From 1986 to 2006, gracilis functioning free muscle transplantation (FFMT) was performed at Chang Gung Memorial Hospital for facial reanimation in 249 cases of facial paralysis. The main etiology is postoperative complication and Bell's palsy. The innervating nerve comes mostly from contralateral facial nerve branches, few from ipsilateral facial nerve due to tumor ablation, and from ipsilateral motor branch to masseter or spinal accessory nerve due to Möbius syndrome. We have evolutionally used a short nerve graft (10 to 15 cm) to cross the face in the first stage; after a 6- to 9-month waiting period, gracilis FFMT was performed for the second stage of the reconstruction. The technique of evolution has shown encouraging results to achieve the goal of rapid restoration and fewer scars on the donor leg.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Nerve transfers in facial palsy

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 177-193DOI: 10.1055/s-2008-1075833ABSTRACTThe facial paralysis patient suffers serious functional, cosmetic, and psychological problems with impaired ability to communicate. Despite the advances of recent years and the number of new techniques proposed in the literature, facial reanimation remains a challenge for the reconstructive surgeon. With the advent of microsurgery, reanimation of the paralyzed face took a major leap forward with the use of cross facial nerve grafts, nerve transfers, and free muscle transplantation. Today, nerve transfers represent the backbone of facial reanimation, especially in cases where reconstruction of the affected facial nerve is not feasible. The suitability of each nerve transfer is related to the type of facial palsy, time elapsed since injury, and the age and general health of the patient. The selected motor nerve must provide strong muscle contraction and allow the patient to control the facial movements. The purpose of this chapter is to present the senior author's (J.K.T.) experience in the selection of motor nerves that can function as possible donor nerves for dynamic facial reanimation. Indications and surgical technique for each procedure is also presented.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Nerve repair and cable grafting for facial paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 170-176DOI: 10.1055/s-2008-1075832ABSTRACTFacial nerve injury and facial paralysis are devastating for patients. Although imperfect, primary repair is currently the best option to restore facial nerve function. Cable, or interposition, nerve grafting is an acceptable alternative when primary repair is not possible. Several donor nerves are at the surgeon's disposal. Great auricular, sural, or medial and lateral antebrachial cutaneous nerves are all easily obtained. Both primary repair and interposition grafting typically result in better facial function than do other dynamic and static rehabilitation strategies. Proficient anastomotic technique and, when necessary, selection of an appropriate interposition graft will optimize patient outcomes. Promising research is under way that will enhance future nerve repair and grafting efforts.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Treatment considerations in facial paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 164-169DOI: 10.1055/s-2008-1075831ABSTRACTFacial nerve paralysis and its sequelae are devastating to patients. For the reconstructive surgeon, the management of the patient with facial paralysis is challenging. There is a lack of consensus regarding the initial management. Then, there is the dizzying array of treatment options for each patient, including nonoperative observation, nerve transfers, static slings, dynamic muscle transfers, and chemodenervation. The appropriate timing of any intervention is often not clear. In this article, we will briefly outline some important considerations for the facial plastic surgeon in the management of facial paralysis. This includes the relevant anatomy and the initial evaluation. An overview of treatment options, with suggestions for the appropriate use of each option, is then provided.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

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Overview of facial paralysis: current concepts

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 155-163DOI: 10.1055/s-2008-1075830ABSTRACTFacial paralysis represents the end result of a wide array of disorders and heterogeneous etiologies, including congenital, traumatic, infectious, neoplastic, and metabolic causes. Thus, facial palsy has a diverse range of presentations, from transient unilateral paresis to devastating permanent bilateral paralysis. Although not life-threatening, facial paralysis remains relatively common and can have truly severe effects on one's quality of life, with important ramifications in terms of psychological impact and physiologic burden. Prognosis and outcomes for patients with facial paralysis are highly dependent on the etiologic nature of the weakness as well as the treatment offered to the patient. Facial plastic surgeons are often asked to manage the sequelae of long-standing facial paralysis. It is important, however, for any practitioner who assists this population to have a sophisticated understanding of the common etiologies and initial management of facial paralysis. This article reviews the more common causes of facial paralysis and discusses relevant early treatment strategies.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Facial Plastic Surgery)

Facial paralysis

Facial Plastic Surgery — Sat, 10 May 2008 00:08:26 +0100

Facial plast Surg 2008; 24: 153-153DOI: 10.1055/s-2008-1075829© Thieme Medical PublishersGet connected:Table of contents | Full text (Source: Facial Plastic Surgery)

Important considerations for the burn therapist.