Evidence-based use of pulsed electromagnetic field therapy in clinical plastic surgery.

Background: The initial development of pulsed electromagnetic field (PEMF) therapy and its evolution over the last century for use in clinical surgery has been slow, primarily because of lack of scientifically-derived, evidence-based knowledge of the mechanism of action.

Objective: Our objective was to review the major scientific breakthroughs and current understanding of the mechanism of action of PEMF therapy, providing clinicians with a sound basis for optimal use.

Methods: A literature review was conducted, including mechanism of action and biologic and clinical studies of PEMF.

Efficacy of the pain pump catheter in immediate autologous breast reconstruction.

The purpose of the investigation was to evaluate the efficacy of a slow bupivacaine infusion at postoperative surgical sites in immediate breast reconstruction patients. This prospective study included 16 patients who underwent autologous breast reconstruction with a latissimus dorsi pedicled flap immediately after mastectomy. A two-site infusion kit with dual split-flow catheters was secured at the operative sites before skin closure.

Circumferential suction lipectomy of the trunk with anterior rectus fascia plication through a periumbilical incision: an alternative to conventional abdominoplasty.

During the past decade, many combinations of operative techniques for abdominoplasty have evolved to suit the individual requirements of the patient. The purpose of this study was to present a safe alternative to conventional abdominoplasty for appropriate patients, namely, those with minimal skin laxity, moderate fatty tissue distribution, musculofascial diastases, and no concern for abdominal stretch marks. The procedure consists of circumferential ultrasound-assisted liposuction and direct abdominal wall plication through a periumbilical incision.

Boomerang flap reconstruction for the breast.

The boomerang-shaped latissimus dorsi musculocutaneous flap for breast reconstruction offers a stable platform for breast reconstruction. It allows for maximal aesthetic results with minimal complications. The authors describe a skin paddle to obtain a larger volume than either the traditional elliptical skin paddle or the extended latissimus flap.

Use of cyanoacrylate (super glue) for the fixation and prefabrication of nasal cartilage grafts.

Background: Cartilage grafts are frequently too small to serve as dorsal grafts so that several segments must be secured together to achieve adequate dimensions. The suturing of graft segments is time-consuming and difficult.

Objective: This study examines the use of 2-octyl cyanoacrylate for the prefabrication and fixation of nasal cartilage grafts.

Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap.

Background: Currently the internal thoracic artery (ITA) is the conduit of preference for coronary artery revascularization. Although this artery offers several advantages over the saphenous vein there is a higher incidence of postoperative sternal wound infection with its use. This incidence further increases with the use of bilateral internal thoracic arteries (BITA).

Endoscopic harvest of the rectus abdominis muscle.

The rectus abdominis muscle is a versatile muscle with many applications. The use of this muscle is often limited by its considerable donor site morbidity. This study reports a minimally invasive technique to harvest the rectus abdominis muscle.

Microsurgical replantation of the lip: a multi-institutional experience.

Traumatic amputation of the lip is a rare yet devastating event affecting both form and function. Considering the available methods for reconstruction, replantation may offer a reasonable solution. We sought to characterize the variables associated with lip replantation and to assess the outcome in a retrospective review of 13 lip replantations performed in 12 institutions utilizing a form database and clinical and photographic analysis.

Split, free, jejunal transfer for pharyngoesophageal and soft-tissue reconstruction.

Pharyngoesophageal reconstruction utilizing free jejunal transfer is well established. Extensive resection or debridement for extensive tumor, infection, or radiation may necessitate additional soft-tissue coverage. The authors report a successful reconstruction using a split, free, jejunal transfer to provide simultaneous pharyngoesophageal and soft-tissue coverage.

The external rhinoplasty approach for the treatment of acromegaly.

Acromegaly produces a syndrome of physiological and physical derangements. Patients afflicted with this disease are often as concerned with the changes in their appearance as with the pituitary tumor. The external rhinoplasty approach to transphenoid hypophysectomy has recently been shown to improve visualization and to have fewer complications compared with the sublabial approach devised initially by Cushing.

The use of medicinal leeches in the salvage of flaps with venous congestion.

The use of medicinal leeches (Hirudo medicinalis) for the salvage of tissues with venous congestion has been intermittent over the last two centuries. During the last decade, interest in leech therapy has undergone a resurgence. Hirudo's tricuspid bite injects a highly potent anticoagulant.

Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation.

The purpose of this paper is to document that free-flap surgery may be applied in specific circumstances to elderly patients with extensive vascular insufficiency and wound coverage problems. Below-knee amputation may be a direct but not necessarily desirable answer to the elderly patient with these problems. The problems of increased energy of ambulation, prosthetic fit, and psychological depression are all accentuated in the elderly.

Hypothyroidism following removal of a "thyroglossal duct cyst".

This case demonstrates how a midline ectopic thyroid gland can be misdiagnosed as a thyroglossal duct cyst. Awareness of this clinical entity is critical if the diagnosis is to be made preoperatively. Thyroid function tests and a 99mTc or 123I scintiscan of the neck should be performed when evaluating a patient with a midline anterior cervical mass.

The use of microvascular free flaps for soft tissue augmentation of the face in children with hemifacial microsomia.

The extent of facial deformity from hemifacial microsomia varies considerably. Minor degrees of asymmetry may be barely perceptible. Severe defects involve deficiencies and asymmetry of bone and soft tissue.

"Apple coring" the nipple in subcutaneous mastectomy.

A simple technique is described for removing the ductal tissue from the nipple in a subcutaneous mastectomy. We believe that complete removal of all the ductal tissue is desirable in this operation, and that it will also decrease the incidence of subsequent infection. The operative technique, the problems, the advantages, and the disadvantages of the procedure are described.