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.

The concept suggesting primary excision and immediate grafting as the definitive treatment for a thermal burn is not new (1 ). To avoid the sequelae of local and systemic sepsis, early excision of burn eschar to remove all devitalized tissue has been a widely accepted method of treatment of deep burns since 1929, when Wells performed total excision and grafting of electric burns (2). While the technique has many advantages, it is not without significant complications. Haemorrhage accompanying burn wound excision can be deceptively large, as can the metabolic stress associated with large surgical procedures performed in the post-burn period (3).

No description available.

The ACL is one of the major ligaments in the knee connecting the femur to the tibia which provides stability by resisting shear in sagittal plane. ACL tears occur in 1 out of 3000, and due to inability to heal, reconstructive surgeries are performed at a rate of 200,000/year. Final graft fixation tension during surgery has been shown to wane due to stress-relaxation which has been correlated with negative clinical outcomes. Therefore, preconditioning, which currently is an isometric load (88N), is performed to remove stress-relaxation after the final tension has been applied in vivo. Three preconditioning protocols, creep, stress relaxation, and none, were tested to show significant differences and variance in graft tension after 30 minutes. The results suggest that the current preconditioning protocol may not be efficient enough to remove stress-relaxation after final fixation, and that a creep protocol causes less variability than the other preconditions performed.

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.

The face is an integral part of one’s self-concept and unquestionably the most important attribute used to distinguish one's identity. A growing body of literature demonstrates that any condition that results in facial disfigurement can have a profound adverse impact on one's psychological and social functioning. In this respect, patients with facial disfigurements are at higher risk to experience psychosocial difficulties than others. Owing to injuries or illnesses such as cancer, patients undergo reconstructive surgeries both to recover their facial function and to reduce the adverse impact of facial disfigurements on their psychosocial functioning. However, since surgical planning and evaluation of reconstructive outcomes still relies heavily on surgeons' qualitative assessments, it is challenging to measure surgery outcomes and, therefore, difficult to improve surgical practice. Thus, this dissertation research aims to help patients suffering from facial disfigurement by developing quantitative measures that are 1) related to human perception of faces, and 2) that account for patient's internal status (i.e., psychosocial functioning). Such measures can be used to improve surgical practice and assist patients with disfigurement to be psychosocially adjusted. Specifically, this dissertation proposes quantitative measures of facial morphology and expression that are closely related to overall facial attractiveness and a patient's psychosocial functioning. Such measures will allow surgeons to quantitatively plan and evaluate reconstructive surgeries. In addition, this dissertation introduces a modeling technique to simulate disfigurement on novel faces with control on the type, location, and severity of disfigurement. This modeling technique is important since it can help patients with facial disfigurement gain a more accurate understanding of how they are viewed in society, which has a strong potential to facilitate their psychosocial adjustment. This dissertation provides a new perspective on how to help patients with facial disfigurement address challenging problems in facial reconstruction, aesthetic understanding, and psychosocial actualization. It is hoped that this work has shown that multiple benefits could be realized from future studies utilizing the modeling technique to understand human perception of facial disfigurement and thereby to develop quantitative measures that are closely associated with human perception. / text

Submitted by JORGE LUIS ALVAREZ GÓMEZ null (jorgeluisalgo@hotmail.com) on 2016-09-30T08:45:24Z No. of bitstreams: 1 DISERTAÇAO MESTRADO JLAG 29_09_16.docx.pdf: 14985307 bytes, checksum: 2a43232024785aafb3f29376d44310e4 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-09-30T13:41:01Z (GMT) No. of bitstreams: 1 alvarezgomez_jl_me_jabo.pdf: 14985307 bytes, checksum: 2a43232024785aafb3f29376d44310e4 (MD5) / Made available in DSpace on 2016-09-30T13:41:01Z (GMT). No. of bitstreams: 1 alvarezgomez_jl_me_jabo.pdf: 14985307 bytes, checksum: 2a43232024785aafb3f29376d44310e4 (MD5) Previous issue date: 2016-07-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Tradicionalmente um enxerto é realizado em um leito receptor coberto por tecido de granulação saudável, e na atualidade, as células tronco mesenquimais representam uma excelente alternativa para estimular a cicatrização de feridas agudas e crônicas. Sendo assim, este trabalho teve por objetivo avaliar os efeitos de células tronco mesenquimais xenógenas na cicatrização de auto-enxertos cutâneos em leito receptor sem tecido de granulação de coelhos. Foram utilizados 60 coelhos, divididos em três grupos de 20 pacientes. O primeiro grupo (GIL) e o segundo (GIV) receberam tratamento de 2 x106 células tronco , por vias intralesional e intravenosa respetivamente, enquanto o grupo controle (GC) recebeu apenas o auto-enxerto cutâneo. Na avaliação macroscópica, enxertos dos grupos GIL e GIV apresentaram melhor coloração comparado com o grupo controle, no entanto, na avaliação microscópica as variáveis inflamação, reepitelização, necrose e neovascularização não mostraram diferencia significativa entre os três grupos (p>0,05). Conclusão: a reepitelização dos auto-enxertos cutâneos em malha em leito receptor desprovido de tecido de granulação em coelhos (Oryctolagus cuniculus ) provavelmente não precisam de técnica adjuvante para estimular a cicatrização. A versatilidade da malha permite uma aderência estável ao leito receptor, e através das fendas criadas permite a eliminação da secreção inflamatória, evitando assim a presença de seroma e garantindo a nutrição e revascularização do enxerto. / Traditionally, a graft is performed in a healthy granulation tissue bed, although nowadays, the mesenchymal stem cells represent an excellent alternative to stimulate wound healing in a recipient bed without a healthy granulation tissue bed. Thus, this study aimed to evaluate the effects of mesenchymal stem cells xenogeneic at the healing of skin autografts in a recipient bed without granulation tissue in rabbits. A total of 60 rabbits were divided into three groups of 20 patients. The first (GIL) and the second group (GIV) were treated with 2x106 intralesional and intravenous stem cells respectively; meanwhile the control group (CG) received only skin autograft. At the macroscopic examination, the grafts GIL and GIV groups showed better color than the control group, however, microscopic evaluation of the variables: inflammation, re-epithelization, necrosis and angiogenese showed no significant difference among the three groups (p>0,05). Conclusion: reepithelialization of meshed skin autografts from recipient bed without granulation tissue in rabbits (Oryctolagus cuniculus) probably does not need an adjuvant technique to stimulate wound healing. The versatility of the mesh allows a stable adherence to the recipient bed, and through the created slits allows the evacuation of inflammatory secretion, avoiding the presence of seroma and providing nutrition and graft revascularization.

No description available.

Bakgrund: Trauma, tumörsjukdom, infektioner och cirkulationsrubbningar kan leda till förlust av kroppsdel. Forskning i ämnet är ofta medicinskt inriktad på smärtproblematik eller praktiska följder, medan patienters upplevelser och psykosocial påverkan hamnar i skymundan. Syfte: Syftet med den här uppsatsen är att beskriva psykosociala aspekter i upplevelsen av att leva med en förlorad kroppsdel. Metod: Litteraturstudie med kvalitativ ansats baserad på elva kvalitativa artiklar. Resultat: Att förlora en kroppsdel kan leda till påverkad självbild och psykosocial påverkan. Detta presenteras i huvudtemat att hantera en ny livssituation med underliggande teman jag är, jag ser ut, jag kan och socialt stöd. Slutsats: Vid förlust av kroppsdel oavsett etiologi kan självbilden påverkas i någon riktning. Sexuallivet såväl som vardagliga sysslor kan påverkas vilket i sin tur påverkar livskvaliteten. Att anpassa sig till en protes kan underlätta både den fysiska och den psykosociala aspekten, vilket påverkar självbilden positivt. Detta ämne har under det senaste årtiondet beforskats, men detta behöver förankras i klinisk praxis. Klinisk Betydelse: Genom att belysa de psykosociala aspekterna av att förlora en kroppsdel bidrar föreliggande uppsats till att öka förståelsen amputerade och mastektomerade patienters situation Nyckelord: amputation, mastektomi, protes, rekonstruktiv kirurgi, självbild, sexualitet / Background: Trauma, tumors, infections and vascular disease could lead to loss of limb. Research in the subject is often aimed at medical issues or practical matters, while the experiences and psychosocial aspects are being overlooked. Purpose: The purpose of this dissertation is to describe psycosocial aspects of the lived experience of living with a lost bodypart. Method: A review of qualitative approach based on eleven qualitative articles. Results: Losing a body part may affect psychosocial elements and self-image. This is being presented in the main theme to adapt to a new aspect of life and three themes: I am, I look like, I'm apt and social support. Conclusion: Loss of a bodypart of variying aetiology can lead to concerns of self- image. Sexuality and daily life activities can be affected, with a loss of quality of life as a consequence. To adapt to a prosthesis can ease both the psycosocial and physiological aspects of this transition, with im proved self-image as a result. This topic has been researched during the last decade, but the knowledge has yet to reach clinical praxis. Clinical significance: This study highlights the psycosocial aspects of losing a body part in order to give a deeper understanding of the needs of these patients. Key words: amputation, mastectomy, prosthesis, reconstructive surgery, self- image, sexuality

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.