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BACKGROUND The latissimus dorsi myocutaneous flap is widely used in reconstructive surgery; however, primary donor-site closure remains challenging when a wide flap is harvested. METHODS A large latissimus dorsi myocutaneous flap was elevated and transferred to repair defects. Perforators adjacent to the donor site of the myocutaneous flap were explored using an ultrasound Doppler probe or a technique of extensive exploration along the margins of the donor site wound. A single or multiple perforator propeller flaps based on these perforators were used to close the donor site defect. RESULTS From June 2012 to April 2018, this method was used to restore posttraumatic and oncologic defects of the chest wall in 14 cases, upper extremity in 6 cases, and lower extremity in 1 case. The size and width of the latissimus dorsi myocutaneous flaps ranged from 16 × 11 cm to 33 × 17 cm (mean area, 335.6 cm) and 9 cm to 20 cm (mean width, 14 cm), respectively. The donor site defect was closed primarily by using a single flap in 11 cases, dual flap in 9, and triple flap in one. Donor site breakdown was not observed in any of the cases. CONCLUSIONS The perforator propeller flap could be used to reconstruct a latissimus dorsi myocutaneous flap donor site defect, ensuring not only the harvesting of a wide flap but also achieving primary donor site closure, thus greatly improving the versatility and capability of the latissimus dorsi myocutaneous flap in the reconstruction of large-sized defects.PURPOSE As one of the most common congenital craniofacial deformities, cleft lip and palate repair is a complex and much published topic. Proper treatment can require a multitude of appointments and operations and can place a significant burden on both the patients' families and the health care system itself. One proposed solution has been to combine multiple cleft procedures. However, these more complex operations have drawn concerns from institutions and providers regarding increased cost. This study provides a cost utility analysis between single-stage and staged unilateral cleft lip and palate repairs. METHODS A retrospective review was conducted via current procedural terminology code identification of all cleft-related operations performed between 2013 and 2018. Patients were screened according to diagnosis, and only analysis on unilateral cleft lip and palate patients was performed. Patients were split into 2 cohorts those that underwent a single-stage complete cleft repair, which includes palate, lip, average total postoperative cost for single-stage repairs versus staged repairs was US $19,776 and US $29,703, respectively (P less then 0.001). CONCLUSIONS This analysis suggests that single-stage PLAN repair, provides an effective, cost-efficient solution to unilateral cleft lip and palate care, reducing burden on patients' families and the health care system at large.INTRODUCTION The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit high-fidelity simulation technology to mitigate these pressures. METHODS By revisiting principles of adult learning theory, the authors created a "bootcamp-style" cleft lip curriculum that sought to (1) maximize educational impact and (2) pilot a high-fidelity procedural trainer permitting resident operative autonomy as part of that curriculum. Trainees participated in small group educational sessions comprised of a standard cleft didactic lecture, augmented by instructional video. Participants immediately processed knowledge from the lecture/video by "operating" on the simulator, allowing opportunities for questions and self-reflection, completing the learning cycle. https://www.selleckchem.com/products/WP1130.html A self-assessment survey wary into plastic surgery training using a high-fidelity simulator for deliberate practice of cleft lip repair. Further evaluation is warranted to determine whether this didactic model can accelerate the acquisition of the complex skill set required for cleft lip repair and other surgical procedures.BACKGROUND Suprazygomatic aponeurotic McLaughlin (SAM) myoplasty technique for facial reanimation is based on the classical McLauglin's lengthening temporalis myoplasty with a series of new modifications. A comprehensive review of previously described other orthodromic temporalis myoplasty techniques is also included to give a succinct comparison. METHODS Twelve adult patients of facial palsy underwent SAM myoplasty for a period of 4 years. Three had congenital facial palsy, 4 patients had facial palsy secondary to acoustic neuromas, 3 were posttraumatic, and 2 patients had Bell's palsy. RESULTS Range of modiolus excursion achieved as measured at 3 months postoperatively on reanimation in our patients was 5 mm to 20 mm with an average of 12.6 mm. With SAM myoplasty technique, we were able to achieve excellent result in 4 patients and good results in 8 patients as evaluated with May and Druker scoring system. CONCLUSIONS Suprazygomatic aponeurotic McLaughlin myoplasty for facial reanimation demonstrates a successful modification of the classical McLaughlin lengthening temporalis myoplasty, making it more customizable, simple, and predictable by taking the level of transection to the temporalis aponeurosis without the need for zygomatic osteotomy. A new classification of orthodromic temporalis myoplasty based on level of transections is also proposed for the first time. Good to excellent outcomes coupled with high patient satisfaction and low morbidity should make this technique popular among the facial reanimation surgeons.BACKGROUND Staged expander to implant breast reconstruction is associated with a high complication rate when the patient has had postmastectomy radiation. With an increasing number of American women undergoing implant-based breast reconstruction after postmastectomy radiation, surgeons may find themselves operating in a radiated field with synthetic devices. We report the performance characteristics of a novel surgical modification to the second stage expander to implant exchange after adjuvant radiation using a transaxillary approach through a prior sentinel lymph node incision, a site remote from the breast implant pocket. METHODS We performed a retrospective review of a prospectively maintained database to evaluate the surgical outcomes of serial patients undergoing second staged expander to implant exchange through the sentinel lymph node incision 6 months or more after completing whole breast radiation. A case matched cohort to age, body mass index, and comorbid status was used to compare outcomes between patients in the group of interest versus a traditional skin sparing incision on the anterior breast mound through the radiated skin envelope.
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