A blinded randomized controlled trial to evaluate the use of botulinum toxin for pain control in breast reconstruction with tissue expanders.

Background: Tissue expander placement is a common means of reconstruction after mastectomy. Many patients report significant pain and discomfort with the tissue expansion process. Because placement is subpectoral, it was hypothesized that injection of the pectoralis muscle with botulinum toxin could decrease pain associated with tissue expanders.

Two cases of necrotizing fasciitis due to Acinetobacter baumannii.

Necrotizing fasciitis has conventionally been associated with the streptococci, and when it is caused by other organisms, it is most often the result of a polymicrobial infection. We report on two cases of fatal monomicrobial necrotizing fasciitis due to Acinetobacter baumannii, an unusual finding that may be an indication of enhanced virulence of the organism.

Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach.

Background: Toxic epidermal necrolysis syndrome is a devastating disease, with mortality rates ranging between 20 and 60 percent. This study evaluated an alternative treatment approach using antishear wound care and compared outcomes using the severity of illness score for toxic epidermal necrolysis syndrome (SCORTEN) system.

Methods: Records of 48 patients with a histopathologic diagnosis of toxic epidermal necrolysis syndrome treated with burn equivalent critical care and antishear wound care from September of 1985 to April of 2004 were reviewed.

The thoracoacromial trunk: alternative recipient vessels in reoperative head and neck reconstructive microsurgery.

Background: Reoperative free tissue transfer in head and neck cancer patients is often a challenging endeavor. Finding adequate recipient vessels for microvascular anastomosis can be difficult, as scar is present from previous surgery and irradiation, and the usual recipient vessels may have been damaged or sacrificed.

Methods: Seventeen consecutive cases of head and neck reconstruction with free tissue transfer using the thoracoacromial vessels as the recipient pedicle were reviewed.

Parastomal hernia repair with acellular dermal matrix.

Purpose: Treatment of parastomal hernia is often complicated by a high recurrence rate and likelihood of wound contamination. We reported an initial series of parastomal hernia repairs performed with acellular dermal matrix.

Methods: We reviewed a series of 11 patients who had parastomal hernia repairs with acellular dermal matrix and recorded the type of ostomy, previous repair, associated intestinal pathology, type of repair performed, perioperative complications, and rate of recurrence.