Day 1 :
Division of Plastic Surgery, Keck School of Medicine U.S.C.
Dr. Rubayi is a fully trained plastic surgeon from the U.K. and U.S.A. During the last 36 years he is practicing reconstructive plastic surgery in burn and spinal cord injury patient presented with wounds and pressure ulcers, and hip joint involved with infection and H.O.
He published many articles and he taught this field to the plastic resident at U.S.C. and U.C.L.A. His last publication is a book “Reconstructive Plastic Surgery of Pressure Ulcers” by Springer 2015
He is a Chairman, Dept. of Surgery and Chief of Pressure Ulcer Management Program at Rancho Los Amigos National Rehabilitation Center at Downey, CA. U.S.A. and Professor of clinical surgery at U.S.C.
Heterotopic Ossification is a devastating disease in many patients with primary diagnosis of spinal injury, brain injury, and burn injury. Twenty percent of SCI patients develop this abnormal pathological calcification around their joints and muscles, which will eventually end in multiple complication to the patient, example restricted range of motion to the joints which may end in complete anklyosis, developing pressure ulcer which is secondary to abnormal fixation of the hip joints and the pelvis. To summarize the end result is tremendous changes in the quality of patient life. Nowadays the plastic surgeon involve in the management of many diseases which may involve different specialities. The advancement of reconstructive surgery has helped to apply this management of the H.O. disease. The Author will present a comprehensive presentation of the pathological manifestation and surgical management with post-operative management to prevent recurrence of the disease.
- Reconstructive Surgery | Mohs Surgery | Hand Surgery | Body Lift
Shandong Provincial Hospital, China
Fanjun Meng has his expertise in plastic and reconstructive surgery. The Modified Subcutaneous Buried Horizontal Mattress Suture he proposed in the paper is a new technique to close the tensioned wound. In vitro study and clinic practice, it is proved to be an efficient technique to reduce the tension of the wound and to prevent scarring postoperation of the large skin lesion excision.
Background: Wound tension reduction is still a challenge to surgeons. Over the years, many techniqueshave been proposed to avoid this issue. In this paper, we present a new suture technique.
Objectives: To investigate the tension-reduction effectiveness of the modified subcutaneous buried horizontal mattress suture compared with the vertical buried mattress suture technique.
Methods: Two suture techniques, the vertical buried mattress suture (group A) and the modified subcutaneous buried horizontal mattress suture (group B), were performed on paired samples of symmetrical skin flaps. An equal pulling force was applied to each paired sutured flap, and the dehiscences of the samples in the two groups were compared. Then, after the periodic mechanical pulling force was recorded, the dehiscences were compared again.
Results: The dehiscences of the vertical buried mattress suture samples(group A) were much wider than their corresponding samples. Modified subcutaneous buried horizontal mattress suture samples (group B) remained well closed with no or minimal dehiscence, under various
Taichung Veterans General Hospital, Taiwan, R.O.C
He is an attending plastic surgeon at Taichung Veterans General Hospital, Taiwan. He has more than 10 years of experience as plastic surgeon and specializes in wound treatment and reconstructive surgery. He obtained medical degree from Chung Shan Medical University. He has also authored many research publications and is an active member of many surgery societies as Taiwan Society of Plastic Surgery, Member of Taiwan Society for Surgery of the Hand, Member of Taiwan Society for Reconstructive Microsurgery
Purpose: The purpose of this study was to assess the outcomes of robotic-assisted oropharyngeal reconstruction comparison with conventional free flap reconstruction. The robotic surgical system provides a clear, magnified, 3-dimensional (3D) view as well as a precise and stable instrumental movement, which minimizes many technical difficulties that may be encountered in the surgical treatment of oropharyngeal tumors.
Materials and Methods:A retrospective review of consecutive patients who underwent reconstructive operations using free radial forearm fasciocutaneous flap for oropharyngeal defects over a 20-month period (May 2013 to December 2014). The primary predictor variable was method of reconstruction (conventional versus robot-assisted). Outcome measures were postoperative complication rates, revision rates, and postoperative functional outcomes.
Results:The study sample consisted of 47 subjects who underwent reconstructive operations using free radial forearm fasciocutaneous flap for oropharyngeal defects (33 conventional and 14 robot-assisted reconstructions). Complication rates between the conventional and robot-assisted groups were similar for flap failure, partial necrosis, wound infections, hematoma or seroma formation, wound dehiscence, and fistula formatiom. The revision requiring additional operation was comparable between the two cohorts. The functional outcomes postoperatively of robot-assisted reconstructions are better than conventional reconstructions as demonstrated by the Functional Intraoral Glasgow Scale scores.
Conclusion: There is no significant difference in complication and revision rates between conventional versus robot-assisted oropharyngeal reconstructions. The application of a robotic surgical system seems to be a safe option with better oral function postoperatively in the free flap reconstruction of oropharyngeal defects without lip or mandible splitting.
Shandong University, China
Dr. Chao Chen is an attending doctor in Department of Hand and Foot Surgery of Shandong Provincial Hospital affiliated to Shandong University. He graduated from Shandong University, School of Medicine and got master degree of orthopedic in 2012. He got PhD degree of Clinical Anatomy in Southern Medical University in 2015, and his major research subject during PhD’s study is microsurgical anatomy, which dramatically improve his level of microsurgery.
Dr. Chen has been a microsurgeon since he finished orthopedic training in 2014. His department is one of the most famous microsurgical center in China, and he got good microsurgical training with guide of Professor Zengtao Wang and Dr. Liwen Hao. His specialties including hand surgery, limb replantation, thumb and finger esthetic reconstruction, vascularized tissue transplantation. He can successfully anastomose small vessel with caliber of 0.2mm. He has performed over 150 super microsurgeries (including fingertip replantation and mini-flap transplantation) and has total success rate more than 90%. Of all his more than 100 vascularized tissue transplantation surgeries, only one case failed.
Dr. Chen has intense study in microvascular anatomy associated with mini flaps in hand and foot. He has extensive experience in the mini perforator flaps harvested from hand and foot, especially for primary reconstruction of composite tissue defect in finger. He has published 4 SCI articles (coauthor in 3 articles) associated with microsurgery.
Backgrouds: Composite tissue defect of the volar surfaces of fingers are frequently associated with digital vessel damage. Different reconstructive methods were used for such injuries, like digital artery flap from adjacent finger, A-A typed flow-through venous flap, or vein graft combined with a regional flap. Flow-through glabrous flaps can provide esthetic tissue coverage as well as revascularization.
Methods: Between June 2010 and April 2017, we prospectively studied the use of Microsurgical flow-through glabrous flaps to achieve simultaneously digital revascularization and soft tissue coverage in 20 fingers of 17 patients who experienced volar injuries, comprising 7 great toe fibular flaps, 4 medial plantar flaps, 2 pedismedialis flap, 3 hypothenar flaps and 4 thenar flaps. The nerve passing through the great toe fibular flap or medial plantar flap was used to repair digital nerve defects.
Results: All flaps survived completely. During a mean follow-up period of 13.6 months, the majority recovered excellent appearance and function. The flaps had the characteristics of normal finger volar skin: hairless, with similar texture and color. The sensation of finger pulp which repaired with neurovascular flap gained satiscactory recovery.
Conclusions: Glabrous flow-through flaps provide excellent reconstruction for fingers with volar injuries associated with digital vessel damage. The great toe fibular flap and the medial plantar flap are reliable and useful options for complicated finger injuries associated with digital vessel and nerve injuries.Flow-through thenar flap is our first choice if the patient denied to harvest flap from foot.
- Mohs Surgery| Cosmetic Dermatology| Breast Surgery | Burn Care/ Trauma Surgery
Federal University of Goias - Brazil
Paulo Renato de Paula has completed his Plastic Surgery training in 1995 from Prof. Pitanguy’s plastic Surgery Program; his M.Sc. at the age of 35 years from Federal University of Rio de Janeiro and his PhD at the age of 51 years from Federal University of Goias. He is an Adjunct Professor and Head Chief of Plastic Surgery Unit at School of Medicine–Federal University of Goias. He is a Supervisor of Residency Program and Internship in Plastic Surgery of the University. He has 12 book’s Chapter (including International book as author and co-author), 12 papers as an author and co-author and 32 studies in meetings as author and co-author (presented or e-poster).
Introduction: Breast implants are often used for the reconstructive and cosmetic purpose, for pure augmentation or associated with mastopexy, demonstrating low morbidity and a reduced number of complications. These procedures demonstrated a significant improvement in the quality of life, like individual/social well-being, self-confidence, and favorable psychological consequences. The innumerable options of breast implants and their variants in the market allow us to offer more specific results for each of breast/thorax and patient wish, with a high degree of satisfaction. The most common implants used are the round or anatomical shape.
Objective: The present study aims to demonstrate a conical breast shape implant. A device model with different angle, shape, and projection and can be a great option.
Method: It is a descriptive and retrospective 10 years’ study with the use of breast implants with a conical shape, then use it and a study with patients’ satisfaction’s degree with these models.
Results: A total of 1182 implants (591 patients) were used during the study period, of which 552 implants (276 patients) were the conical shape (46,7%), all with polyurethane coating, in pre-pectoral (retroglandular/retrofascial) location in 92,2%. Inframammary access was used in 84.6%. The mean volume was 250,65 and mean age was 32 years. The follow-up time ranged from 6 to 120 months, with an average of 78.5 months. Small complications occurred in 3% (small dehiscence, asymmetry, aestrias, hypertrophic scar). Only two contractures (unilateral) cases after 5 years and no extrusion happened. A questionnaire was carried out to evaluate the degree of satisfaction. 85.3% responded and of these, 96.5% declared themselves very satisfied and satisfied with the implant profile and 3.5% were not satisfied. There was no case of dissatisfaction.
Conclusion: Cone-shaped implants are an excellent option in the surgical arsenal of breast implants according to the patient's desire and correct indication, with few complications and a high degree of satisfaction.
Taipei Medical University, Taipei, Taiwan, ROC
Trained by the National Defense Medical Center of Taiwan, Lin-Gwei Wei is the only plastic surgeon in a countryside, 690-bed, military, teaching hospital, while he also works part-time in another medical center with his mentor Prof. Hsian-Jenn Wang. The busy schedules of surgeries do not suppress Dr. Wei’s curiosity about mysteries of human body, and he tries to work out some difficult clinical challenges with researches. Currently, he participates in the complex “bank of artificial skin” development program of Prof. Wang, in a clinical trial of wound-healing enhancing gel, and in an electromyographically-controlled prosthetic limb development program. He hopes that his wide interests in burn care, acute and chronic wound care, trauma care, local- and free-flap surgeries can eventually do some good to researchers and to the people, just like what he has done in his clinical practice.
Background: Human cadaveric skin grafts are considered as the “gold standard” for temporary wound coverage because they provide a more conductive environment for natural wound healing. Lyophilization, packing, and terminal sterilization with gamma-ray can facilitate the application of cadaveric split-thickness skin grafts, but may alter the adhesion properties of the grafts. In a pilot study, we found that 500 gray (Gy) gamma-irradiation (γ-irradiation) seemed not to reduce the adherence between the grafts and wound beds.
Aim and Objectives: We conducted this experiment to compare the adherences of lyophilized, 500-Gy-γ-irradiated skin grafts to that of lyophilized, non-irradiated grafts.
Materials and Methods: Pairs of wounds were created over the backs of 12 Sprague Dawley rats. Pairs of “lyophilized, 500-Gy-γ-irradiated” and “lyophilized, non-irradiated” cadaveric split-thickness skin grafts were fixed to the wound beds. Adhesion strength between the grafts and the wound beds were measured and compared.
Results: On post-skin-graft day 7 and day 10, the adhesion strength of γ-irradiated grafts was greater than that of the non-irradiated grafts.
Conclusion: Because lyophilized cadaveric skin grafts can be vascularized and the collagen of its dermal component can be remodeled after grafting, the superior adhesion strength of 500-Gy-γ-irradiated grafts can be explained by the collagen changes from irradiation
York Teaching Hospital, UK
I graduated from the University of Leeds, UK, with BChD in Dental Surgery. I am currently enjoying my second year as a Senior House Officer (or Core Trainee 2) in the Oral and Maxillofacial Surgery unit at York Teaching Hospital NHS FT. I am deputy editor of the Patient Safety Matters Staff Bulletin for the hospital. Prior to this I worked briefly as a Work Psychologist as I hold both a BSc and MSc in Psychology. It is my intention to compete a third SHO year before returning to university to study medicine, to embark on a career as a Maxillofacial surgeon
Introduction: A 43-year-old male presented with a 2-day history of increased pain and swelling around his right periorbital region following a small abrasion to his eyebrow. On presentation, necrotizing fasciitis was clinically diagnosed. Two-stage debridement involved the extensive sacrifice of extensive soft tissues including orbicularis oculi and levator muscles and eyelids, the globe was spared.
Reconstruction: The reconstructive challenge included separate coverage of the eyelid and minimizing bulk to the surrounding periorbital region. This case was jointly managed with the Oculoplastic Surgeons. Previously documented reconstruction with myofascial free flaps has led to unwieldy flaps with aesthetically poor results. To maximize the aesthetic result skin grafts from the upper arm were grafted to the eyelids and were then completely covered with a 10x7cm soft tissue radial forearm free flap (RFFF) utilizing cephalic venous drainage. This was anastomosed to the facial vessels. Secondary surgery was performed 8 weeks later involving division of the flap, uncovering the skin graft and debulking to provide contour.
Conclusion: In this unusual case, composite reconstructive approaches were combined to overcome a unique challenge. This is the first described case of using RFFF for reconstruction of the periorbital region following such extensive tissue loss, whilst maintaining the function of the eye following necrotizing fasciitis. The RFFF provided excellent short and long-term reconstruction. It protected the eyelid skin grafts and matched the facial contours well. Division of the flap following the establishment of the collateral blood supply was straightforward and well tolerated. We would recommend its consideration for facial defect consideration once the acute infection is cleared.
Hadassah University Medical Center, Israel
Dr. Shachar is the chief resident at Hadassah Medical center plastic and reconstructive surgery. Working under the supervision of Prof. Alexander Margulis, the department has become a reference center in Israel for pediatric plastic surgery. Our chief expertise is pediatric tissue expansion for congenital and acquired deformities. As such, we perform more than a hundred cases of reconstructions for congenital melanocytic nevi annually.
Background: Large congenital melanocytic nevi entail significant medical and cosmetic ramifications for patients and families. Reconstruction is a challenging endeavor, especially when the lesion is present on the limbs. The literature describes various methods by which a plastic surgeon can address reconstruction; yet, to date, there has been no series describing a method that provides consistent results with low complication rates.In this study, we describe our surgical technique for reconstruction of the upper extremity after excision of large circumferential cnm with a pre-expanded bi-pedicled flap, namely the “sleeve” flap.
Methods: a systematic review of our database of pediatric patients treated for large and giant nevi was performed. Patients with large and giant circumferential upper extremity nevi were retrieved, and their charts reviewed for demographics, number of procedures performed, duration of follow-up, and complications.
Results: over a course of 12 years, eight patients with large or giant circumferential nevi of the upper extremity were treated at our institution with “sleeve” flap reconstruction. Mean follow-up time was 36 months. A single complication was seen. All reconstructions achieved satisfactory results, both functionally and cosmetically discussion: we describe our surgical approach for treating upper extremity large and giant circumferential nevi with pre-expanded bi-pedicled “sleeve” flaps. When properly planned and executed, this technique enables successful treatment of large and giant nevi of the arm and the forearm. Although arduous and complex, the process yields excellent aesthetic results with low complication rates. This technique is promising as the reconstructive option of choice for these difficult lesions.