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  • 1.
    Abdelrahman, Islam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Olofsson, Pia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Nettelblad, Hans
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi.
    Zdolsek, Johann
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi.
    Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction2018Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 6, nr 12, artikel-id e2071Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications. Methods: All adult patients who were operated with EDB flap reconstruction of the lower limb during 1997–2017 at the Department of Hand and Plastic Surgery, Linköping University Hospital, were included in this retrospective study. Results: Of 64 patients operated, only 7 had total flap failure, and the rate of complete success was 73% (47/64). Most of the skin defects were associated with fractures or complications thereof and were located in the ankle region, the dorsum of the foot, and the distal third of tibia or even the proximal tibia. Defects in the malleolar region and coexisting cardiovascular condition were factors associated with flap loss (either partial or total). Conclusion: The pedicled EDB-flap has, in our hands, proved to be a versatile and safe reconstructive option in the reconstruction of small defects in the lower leg and foot. Long-time follow-up is, however, recommended. 

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  • 2.
    Abdelrahman, Islam
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Suez Canal University, Egypt.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Turesson, Christina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Hansson, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 1Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Dupuytren’s contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences. Methods: We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more). Results: The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02). Conclusion: Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren’s contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.

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  • 3. Bai, Lucy
    et al.
    Sandelin, Kerstin
    Wickman, Marie
    Sophiahemmet Högskola.
    Arver, Brita
    Lundström, Ola
    Johansson, Hemming
    Brandberg, Yvonne
    Patient-reported outcomes and 3-dimensional surface imaging after risk-reducing mastectomy and immediate breast reconstruction2021Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, nr 5, artikel-id e3561Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The cosmetic results after risk-reducing mastectomy (RRM) and immediate breast reconstruction (IBR) are intended to be long-lasting. Long-term follow-up of the cosmetic outcome can be evaluated subjectively by the women themselves through patient-reported outcome measures such as questionnaires, or by using data from three-dimensional surface imaging (3D-SI) to calculate the volume, shape, and symmetry of the reconstructed breasts as a more objective cosmetic evaluation. The study aim was to evaluate the correspondence between patient-reported measures and 3D-SI measurements.

    Methods: Questionnaires (EORTC QLQ-BRECON23 and BIS) were sent to women on average 13 [7-20] years after RRM and IBR. Items were preselected for comparison with 3D measurements of women imaged using the VECTRA XT 3D-imaging system at the long-term follow-up.

    Results: Questionnaire responses and 3D images of 58 women, 36 without and 22 with previous breast cancer (where 15 also received radiotherapy) before RRM and IBR, were analyzed. Median age at follow-up was 57 [41-73] years. Patient-reported satisfaction with the cosmetic outcome was positive for both groups. 3D measurements indicated more symmetrical cosmetic results for women without previous breast cancer. No statistically significant associations between patient-reported satisfaction and 3D measurements were found.

    Conclusions: Satisfaction with the long-term cosmetic outcome after RRM and IBR was, in general, positive when evaluated by the women. 3D-SI could be used as a more objective approach to assess the cosmetic outcome in terms of volume and shape-symmetry; however, it does not directly translate to the patient-reported satisfaction.

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  • 4.
    Bergkvist, Max
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Zötterman, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Henricson, Joakim
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Hudkliniken i Östergötland.
    Iredahl, Fredrik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten.
    Tesselaar, Erik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Farnebo, Simon
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Vascular Occlusion in a Porcine Flap Model: Effects on Blood Cell Concentration and Oxygenation.2017Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 5, nr 11, artikel-id e1531Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Venous congestion in skin flaps is difficult to detect. This study evaluated the ability of tissue viability imaging (TiVi) to measure changes in the concentration of red blood cells (CRBC), oxygenation, and heterogeneity during vascular provocations in a porcine fasciocutaneous flap model.

    Methods: In 5 pigs, cranial gluteal artery perforator flaps were raised (8 flaps in 5 pigs). The arterial and venous blood flow was monitored with ultrasonic flow probes. CRBC, tissue oxygenation, and heterogeneity in the skin were monitored with TiVi during baseline, 50% and 100% venous occlusion, recovery, 100% arterial occlusion and final recovery, thereby simulating venous and arterial occlusion of a free fasciocutaneous flap. A laser Doppler probe was used as a reference for microvascular perfusion in the flap.

    Results: During partial and complete venous occlusion, increases in CRBC were seen in different regions of the flap. They were more pronounced in the distal part. During complete arterial occlusion, CRBC decreased in all but the most distal parts of the flap. There were also increases in tissue oxygenation and heterogeneity during venous occlusion.

    Conclusions: TiVi measures regional changes in CRBC in the skin of the flap during arterial and venous occlusion, as well as an increase in oxygenated hemoglobin during venous occlusion that may be the result of reduced metabolism and impaired delivery of oxygen to the tissue. TiVi may provide a promising method for measuring flap viability because it is hand-held, easy to-use, and provides spatial information on venous congestion.

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  • 5.
    Breugem, Corstiaan
    et al.
    Nederländerna.
    Smit, Hans
    Nederländerna.
    Mark, Hans
    Nederländerna.
    Davies, Gareth
    Nederländerna.
    Schachner, Peter
    Österrike.
    Collard, Mechelle
    Wales.
    Sell, Debbie
    England.
    Autelitano, Luca
    Italien.
    Rezzonico, Angela
    Italien.
    Mazzoleni, Fabio
    Italien.
    Novelli, Giorgio
    Italien.
    Mossey, Peter
    Skottland.
    Persson, Martin
    Högskolan Kristianstad, Fakulteten för hälsovetenskap, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap. Högskolan Kristianstad, Fakulteten för hälsovetenskap, Forskningsmiljön PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education.
    Mehendale, Felicity
    Skottland.
    Gaggl, Alexander
    Österrike.
    van Gogh, Christine
    Nederländerna.
    Zuurbier, Petra
    Nederländerna.
    Reinart, Siegmar
    Tyskland.
    de Graaff, Feike
    Nederländerna.
    Meazzini, Costanza
    Italien.
    Prioritizing Cleft/Craniofacial Surgical Care after the COVID-19 Pandemic2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It is anticipated that in due course the burden of emergency care due to COVID-19 infected patients will reduce sufficiently to permit elective surgical procedures to recommence. Prioritizing cleft/craniofacial surgery in the already overloaded medical system will then become an issue. The European Cleft Palate Craniofacial Association, together with the European Cleft and Craniofacial Initiative for Equality in Care, performed a brief survey to capture a current snapshot during a rapidly evolving pandemic. Methods: A questionnaire was sent to the 2242 participants who attended 1 of 3 recent international cleft/craniofacial meetings. Results: The respondents indicated that children with Robin sequence who were not responding to nonsurgical options should be treated as emergency cases. Over 70% of the respondents indicated that palate repair should be performed before the age of 15 months, an additional 22% stating the same be performed by 18 months. Placement of middle ear tubes, primary cleft lip surgery, alveolar bone grafting, and velopharyngeal insufficiency surgery also need prioritization. Children with craniofacial conditions such as craniosynostosis and increased intracranial pressure need immediate care, whilst children with craniosynostosis and associated obstructive sleep apnea syndrome or proptosis need surgical care within 3 months of the typical timing. Craniosynostosis without signs of increased intracranial pressure needs correction before the age of 18 months. Conclusions: This survey indicates several areas of cleft and craniofacial conditions that need prioritization, but also certain areas where intervention is less urgent. We acknowledge that there will be differences in the post COVID-19 response according to circumstances and policies in individual countries.

  • 6.
    Ellabban, Mohamed A.
    et al.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Wyckman, Alexander
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Abdelrahman, Islam
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap2021Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, nr 1, artikel-id e3376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer. Methods: A retrospective analysis of 18 patients who had a dual coverage of complex wounds of the lumbar and the gluteal areas was conducted. Different propeller flaps were used as superior gluteal artery perforator flap (SGAP), inferior gluteal artery perforator flap (IGAP), and posterior thigh perforator flap (PTP). Results: The study included 15 men and 3 women. The mean age was 26.3 years. The causes of the defects were: pressure ulcers in 14 patients and post-traumatic in 4 patients. A total of 28 freestyle flaps was used: 11 patients had 1 flap, 4 had 2 flaps, and 3 had 3 flaps. The mean postoperative follow-up was 12.2 months. The complications registered in the medical records were venous congestion in 2 patients, partial flap necrosis in 2 patients, and wound dehiscence in 1 patient. Conclusions: A freestyle propeller perforator-based flap combined with a gluteus maximus muscle flap is a solution that provides well-padding over bony prominence with a low complication rate. However, a long-term follow-up is needed to verify these results. Published online 26 January 2021. Received for publication October 7, 2020; accepted November 23, 2020. Disclosure: The authors have no financial interest to declare in relation to the content of this article. Mohamed A. Ellabban, MSc, MRCS, MD, FEBOPRAS Plastic and Reconstructive Surgery Unit Surgery Department Faculty of Medicine Suez Canal University Ismailia, Egypt E-mail: Mohamed.ellabban@med.suez.edu.eg This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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  • 7.
    Engstrand, Thomas
    et al.
    Karolinska Univ Hosp & Karolinska Inst, Dept Mol Med & Surg, Stockholm Craniofacial Ctr, Plast Surg Sect, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp & Karolinska Inst, Dept Clin Neurosci, Neurosurg Sect, Stockholm, Sweden..
    Kihlstroem, Lars
    Karolinska Univ Hosp & Karolinska Inst, Dept Clin Neurosci, Neurosurg Sect, Stockholm, Sweden..
    Lundgren, Kalle
    Karolinska Univ Hosp & Karolinska Inst, Dept Mol Med & Surg, Stockholm Craniofacial Ctr, Plast Surg Sect, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp & Karolinska Inst, Dept Clin Neurosci, Neurosurg Sect, Stockholm, Sweden..
    Trobos, Margarita
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Biomat, Gothenburg, Sweden.;Univ Gothenburg, Vinn Excellence Ctr Biomat & Cell Therapy, Biomatcell, Gothenburg, Sweden..
    Engqvist, Håkan
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för materialvetenskap, Tillämpad materialvetenskap.
    Thomsen, Peter
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Biomat, Gothenburg, Sweden.;Univ Gothenburg, Vinn Excellence Ctr Biomat & Cell Therapy, Biomatcell, Gothenburg, Sweden..
    Bioceramic Implant Induces Bone Healing of Cranial Defects2015Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 3, nr 8, artikel-id e491Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Autologous bone or inert alloplastic materials used in cranial reconstructions are techniques that are associated with resorption, infection, and implant exposure. As an alternative, a calcium phosphate-based implant was developed and previously shown to potentially stimulate bone growth. We here uncover evidence of induced bone formation in 2 patients. Histological examination 9 months postoperatively showed multinuclear cells in the central defect zone and bone ingrowth in the bone-implant border zone. An increased expression of bone-associated markers was detected. The other patient was investigated 50 months postoperatively. Histological examination revealed ceramic materials covered by vascularized compact bone. The bone regenerative effect induced by the implant may potentially improve long-term clinical outcome compared with conventional techniques, which needs to be verified in a clinical study.

  • 8.
    Frostadottir, Drifa
    et al.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Chemnitz, Anette
    Skane Univ Hosp, Sweden.
    Johansson Ot, Linn J.
    Skane Univ Hosp, Sweden.
    Holst, Jan
    Skane Univ Hosp, Sweden; Skane Univ Hosp, Sweden.
    Dahlin, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Evaluation of Processed Nerve Allograft in Peripheral Nerve Surgery: A Systematic Review and Critical Appraisal2023Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, nr 6, artikel-id e5088Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Peripheral nerve injuries cause substantial problems when not treated properly. A specific problem is reconstruction of nerve defects, which can be treated in different ways. This study aimed to systematically review whether processed nerve allograft (PNA) is justified in reconstruction of a nerve defect in patients after posttraumatic or iatrogenic peripheral nerve injury and to compare PNA with other established methods. Methods:A systematic review with a focused question, PICO (patient, intervention, comparison, outcome) and constraints, was performed. A structured literature search, including several databases, was done to evaluate the existing evidence for outcomes and postoperative complications related to PNA. The certainty of evidence was classified according to Grading of Recommendations, Assessment, Development and Evaluations. Results:No conclusions, concerning differences in outcome of nerve reconstruction using PNA compared with the use of nerve autograft or conduits, could be drawn. The level of certainty for all evaluated outcomes was very low (& OPLUS;◯◯◯). Most published studies lack a control group to patients treated with PNA; being only descriptive, making it difficult to compare PNA with established methods without substantial risk of bias. For studies including a control group, the scientific evidence was of very low certainty, due to a low number of included patients, and large, undefined loss of patients during follow-up, rendering a high risk of bias. Finally, the authors often had financial disclosures. Conclusion:Properly conducted randomized controlled trial studies on the use of PNA in reconstruction of peripheral nerve injuries are needed to establish recommendations in clinical practice.

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  • 9.
    Holm, Sebastian
    et al.
    Uppsala Univ Hosp, Sweden.
    Tell, Katinka
    Uppsala Univ Hosp, Sweden.
    Karlsson, Matilda
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Huss, Fredrik
    Uppsala Univ Hosp, Sweden; Uppsala Univ, Sweden.
    Pompermaier, Laura
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Löfgren, Jenny
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden2022Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 10, nr 4, artikel-id e4246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden. Uppsala, and Linkoping, between 2010 and 2020. Method: This retrospective register-based study used hospital records from the two burn centers combined with information front Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Swedens median income. Results: The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens. Conclusions: In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.

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  • 10.
    Holm, Sebastian
    et al.
    Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, S-75185 Uppsala, Sweden..
    Tell, Katinka
    Uppsala Univ Hosp, Dept Emergency Care & Internal Med, Uppsala, Sweden..
    Karlsson, Matilda
    Linköping Univ, Dept Hand Surg Plast Surg & Burns, Linköping, Sweden..
    Huss, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, S-75185 Uppsala, Sweden..
    Pompermaier, Laura
    Linköping Univ, Dept Hand Surg Plast Surg & Burns, Linköping, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Elmasry, Moustafa
    Linköping Univ, Dept Hand Surg Plast Surg & Burns, Linköping, Sweden..
    Löfgren, Jenny
    Karolinska Inst, Dept Mol Med & Surg, Solna, Sweden.;Karolinska Univ Hosp, Dept Reconstruct Surg, Solna, Sweden..
    Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden2022Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 10, nr 4, artikel-id e4246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden. Uppsala, and Linkoping, between 2010 and 2020.

    Method: This retrospective register-based study used hospital records from the two burn centers combined with information front Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients' geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Sweden's median income.

    Results: The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens.

    Conclusions: In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.

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  • 11.
    Holm, Sebastian
    et al.
    Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Tell, Katinka
    Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Karlsson, Matilda
    Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden.
    Huss, Fredrik
    Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden.
    Pompermaier, Laura
    Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Elmasry, Moustafa
    Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden.
    Löfgren, Jenny
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden; Department of Reconstructive Surgery, Karolinska University Hospital, Sweden.
    Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden2022Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 10, nr 4, artikel-id e4246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden, Uppsala, and Linköping, between 2010 and 2020.

    Method: This retrospective register-based study used hospital records from the two burn centers combined with information from Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients' geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Sweden's median income.

    Results: The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens.

    Conclusions: In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.

  • 12.
    Kjolhede, Anders
    et al.
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden.;Linköping Univ Hosp, Dept Plast Surg Hand Surg & Burns, S-58185 Linköping, Sweden..
    Huss, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, Uppsala, Sweden..
    Kratz, Gunnar
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden.;Linköping Univ Hosp, Dept Plast Surg Hand Surg & Burns, S-58185 Linköping, Sweden..
    A Study on Symptoms of Pelvic Floor Dysfunction in Assigned Female at Birth Patients Diagnosed with Gender Dysphoria Undergoing Vaginectomy2024Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 12, nr 7, artikel-id e5950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A person diagnosed with gender dysphoria who was assigned female at birth (AFAB) may request a vaginectomy as part of gender-affirming treatment. The aim of this study was to investigate the impact of vaginectomy on symptoms of pelvic floor dysfunction (PFD).

    Methods: This is a cohort study on patient-reported symptoms of PFD in patients who were AFAB, diagnosed with gender dysphoria, and undergoing vaginectomy in a single surgical center. Patients responded to a questionnaire preoperatively and 1 year postoperatively. The questionnaire consisted of 33 questions, including a modified short-form version of the Pelvic Floor Distress Inventory (PFDI-20).

    Results: Twenty-three consecutive patients were included in the study and 20 patients (87%) completed the 1-year follow-up. The preoperative median PFDI-20 score was 24 (0-114) compared with 32 (0-168) at the 1-year follow-up (P = 0.07). Patients who had previously undergone neophallus construction with a metoidioplasty (n = 15) had no significant change between the preoperative and the 1-year postoperative PFDI-20 score [median 17.5 (0-114) and 27.5 (0-145) (P = 0.65), respectively]; whereas those with a groin flap phalloplasty (n = 5) had a significant increase in reported symptoms [median 37 (10-95) and 124 (45-168), respectively (P = 0.04)].

    Conclusions: Overall, vaginectomy could be performed without any major impact on symptoms of PFD. However, this seemed to be true mainly for patients with previous metoidioplasty, whereas patients with previous groin flap phalloplasty reported worsening of symptoms.

  • 13.
    McGrath, Aleksandra M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi. Department of Hand and Plastic Surgery, Norrland’s University Hospital, Umeå, Sweden.
    Lu, Johnny Chuieng-Yi
    Chang, Tommy Naj-Jen
    Fang, Frank
    Chuang, David Chwei-Chin
    Proximal versus distal nerve transfer for biceps reinnervation: a comparative study in a rat’s brachial plexus injury model2016Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 4, nr 12, artikel-id e1130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The exact role of proximal and distal nerve transfers in reconstruction strategies of brachial plexus injury remains controversial. We compared proximal with distal nerve reconstruction strategies in a rat model of brachial plexus injury.

    METHODS: In rats, the C6 spinal nerve with a nerve graft (proximal nerve transfer model, n = 30, group A) and 50% of ulnar nerve (distal nerve transfer model, n = 30, group B) were used as the donor nerves. The targets were the musculocutaneous nerve and the biceps muscle. Outcomes were recorded at 4, 8, 12, and 16 weeks postoperatively. Outcome parameters included grooming test, biceps muscle weight, compound muscle action potentials, tetanic contraction force, and axonal morphology of the donor and target nerves.

    RESULTS: The axonal morphology of the 2 donor nerves revealed no significant difference. Time interval analysis in the proximal nerve transfer group showed peak axon counts at 12 weeks and a trend of improvement in all functional and physiologic parameters across all time points with statistically significant differences for grooming test, biceps compound action potentials, tetanic muscle contraction force, and muscle weight at 16 weeks. In contrast, in the distal nerve transfer group, the only statistically significant difference was observed between the 4 and 8 week time points, followed by a plateau from 8 to 16 weeks.

    CONCLUSIONS: Outcomes of proximal nerve transfers are ultimately superior to distal nerve transfers in our experimental model. Possible explanations for the superior results include a reduced need for cortical adaptation and higher proportions of motor units in the proximal nerve transfers.

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  • 14.
    Nyman, Erika
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Dahlin, Emma
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Lund Univ, Sweden.
    Gudinge, Hanna
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden.
    Dahlin, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Surgically Treated Neuroma in Upper Extremity: Patient Characteristics and Factors Influencing Outcome of Surgery2022Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 10, nr 1, artikel-id e4076Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Neuroma formation occurs after inappropriately or untreated nerve injuries. Patients surgically treated for neuroma were characterized and factors influencing outcome evaluated. Methods: In a retrospective observational study, data from medical records of patients surgically treated for neuroma in two Swedish regions were analyzed. Results: In 115 included patients (median age at surgery 45 years [IQR 29-55]), 55% (62/115) were men and 49% (56/115) were manual laborers. Most affected nerves were in hand or lower forearm (76/115, 66%). Smoking habits, affected nerves, and cause/mechanism(s) of injury differentiated the sexes. More motor nerve injuries were observed among women and more mixed nerve injuries among men. Iatrogenic injuries, such as injury to superficial sensory radial nerve or thenar branch of median nerve, more frequently affected women (27/52, 52%). Pain, the dominant preoperative symptom, improved after surgery. Overall, surgery cured/improved 79 of 115 (69%) patients. Patients treated with repair or reconstruction (n = 62) were younger than patients given neuroma transpositions (n = 43) and sensory nerve injuries were more often treated by transposition. No difference in outcome was observed concerning patient characteristics or surgical methods. Most patients had one surgery (102/115, 89%). No specific risk factors for a re-operation could be identified, but need for re-operation(s) was associated with poor outcome, even after repeated surgery. Conclusions: Patients with a neuroma benefit from surgery with significantly reduced pain, but symptoms may remain. Surgical method does not affect outcome. Preventing neuroma formation is crucial, presently highlighted in a high frequency of iatrogenic injuries, especially among women.

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  • 15.
    Nyman, Erika
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Henricson, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.
    Ghafouri, Bijar
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Anderson, Chris D.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Hudkliniken i Östergötland.
    Kratz, Gunnar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Hyaluronic Acid Accelerates Re-epithelialization and Alters Protein Expression in a Human Wound Model2019Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 7, nr 5, artikel-id e2221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Hyaluronic acid (HA), a large glycosaminoglycan involved in proliferation, migration, and tissue repair, is suggested to be an important factor for keratinocyte activation and re-epithelialization. The experimental hypothesis of this study was that HA accelerates re-epithelialization, and we aimed to investigate the effect of exogenous intradermal HA during deep dermal, incisional wound healing in vivo in humans, the primary endpoint being re-epithelialization. Methods: A total of 8 standardized deep dermal incisional wounds (depth 1.6mm, width 1.8mm) per subject were induced in 10 healthy volunteers. Two of the wound sites per subject were pretreated with injections of HA and 2 with saline solution. At 2 time points (24 hours and 14 days), 2 biopsies for each treatment group (one for histology and one for proteomics) were taken. Skin erythema was measured at 24-hour intervals for 14 days as a surrogate measurement of inflammation. Results: At 24 hours, 8 of 9 wounds pretreated with HA showed complete re-epithelization, whereas none of the wounds pretreated with saline had re-epithelized. Wounds pretreated with HA also showed a 10-fold regulation of 8 identified proteins involved in wound healing compared to wounds treated with saline solution. No difference in inflammation, as measured as erythema, could be seen between any of the groups. Conclusions: We conclude that HA accelerates re-epithelialization and stimulates an altered protein expression in vivo in human deep dermal incisional skin wounds, but has no effect on the inflammation process as measured by erythema.

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  • 16.
    Nyman, Erika
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Nyman, Torbjörn
    Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Rubensson, Carin
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Thordstein, Magnus
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Neuroplasticity following Nerve Transfer of the Anterior Interosseous Nerve for Proximal Ulnar Nerve Injuries2021Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, nr 7, artikel-id e3684Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Injuries to the ulnar nerve at or above proximal forearm level result in poor recovery despite early microsurgical repair, especially concerning the intrinsic motor function of the hand. To augment the numbers of regenerating axons into the targeted muscles, a nerve transfer of the distal branch of the median nerve, the anterior interosseous nerve, to the ulnar motor branch has been described. Methods: Two patients with severe atrophy of the intrinsic hand muscles following an initial proximal ulnar nerve repair had surgery with an end-to-side transfer of the anterior interosseous nerve to the ulnar motor branch at the wrist level. Outcome and neuroplasticity were prospectively studied using questionnaires, clinical examinations, electroneurography, electromyography, somatosensory evoked potentials at pre nerve transfer and 3-, 12-, and 24-months post nerve transfer as well as navigated transcranial magnetic stimulation at pre nerve transfer and 3- and 12-months post nerve transfer. Results: Successively improved motor function was observed. Complete reinnervation of intrinsic hand muscles was demonstrated at 12- to 24-months follow-up by electroneurography and electromyography. At the cortical level, navigated transcranial magnetic stimulation detected a movement of the hot-spot for the abductor digiti mini muscle, originally innervated by the ulnar nerve and the size of the area from where responses could be elicited in this muscle changed over time, indicating central plastic processes. An almost complete reinnervation of the pronator quadratus muscle was also observed. Conclusion: Both central and peripheral plastic mechanisms are involved in muscle reinnervation after anterior interosseous nerve transfer for treatment of proximal ulnar nerve injuries.

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  • 17.
    Nööjd, Mari
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Wyckman, Alexander
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Flap Survival after Reconstructive Surgery for Pressure Ulcers: A Cohort Study2023Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, nr 12, s. e5451-e5451Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pressure ulcers are troublesome for patients and require considerable resources to resolve. Previous studies have focused on recurrence, whereas there are few studies on flap survival. The aim was to describe the group and to analyze possible factors for flap survival.

    Method: A descriptive retrospective analysis of all operations between 2008 and 2020 was carried out. Flap survival at 40 days was assessed. A flap was classified as a failure if a reoperation with removal or replacement was planned before, or in connection with, the first return visit. Variables of patient demographics, details of the pressure ulcers, and surgical treatment and care were analyzed with multivariable logistic regression for their effect on flap survival.

    Results: A total of 111 flaps were included [78 (70%) with random blood supply and 33 (30%) with axial or perforator-based blood supply]; 54 (49%) of the flaps were fasciocutaneous. Body mass index was 25 (IQR 22–28). Flap survival rate was 90%. Variables associated with flap failure were higher body mass index, congenital spinal cord injury, type of blood supply to the flap, and the use of methylene blue to guide debridement of the wound.

    Conclusions: The findings show factors that can be modified to improve future results, including a normalized body mass index and use of methylene blue in surgery to outline wound edges and depth, as this has been shown to protect against flap failure. Our data suggest that random flaps, such as V-Y, are preferable to axial flaps in the studied group.

  • 18.
    Olsson, Pontus
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    Nysjö, Fredrik
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    Rodríguez-Lorenzo, Andrés
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Thor, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Käkkirurgi.
    Hirsch, Jan-Michaél
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Käkkirurgi.
    Carlbom, Ingrid B.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    Haptics-assisted Virtual Planning of Bone, Soft Tissue, and Vessels in Fibula Osteocutaneous Free Flaps2015Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 3, nr 8, artikel-id e479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Virtual surgery planning has proven useful for reconstructing head and neck defects by fibula osteocutaneous free flaps (FOFF). Benefits include improved healing, function, and aesthetics, as well as cost savings. But available virtual surgery planning systems incorporating fibula in craniomaxillofacial reconstruction simulate only bone reconstruction without considering vessels and soft tissue.

    Methods: The Haptics-Assisted Surgery Planning (HASP) system incorporates bone, vessels, and soft tissue of the FOFF in craniomaxillofacial defect reconstruction. Two surgeons tested HASP on 4 cases they had previously operated on: 3 with composite mandibular defects and 1 with a composite cervical spine defect. With the HASP stereographics and haptic feedback, using patient-specific computed tomography angiogram data, the surgeons planned the 4 cases, including bone resection, fibula design, recipient vessels selection, pedicle and perforator location selection, and skin paddle configuration.

    Results: Some problems encountered during the actual surgery could have been avoided as they became evident with HASP. In one case, the fibula reconstruction was incomplete because the fibula had to be reversed and thus did not reach the temporal fossa. In another case, the fibula had to be rotated 180 degrees to correct the plate and screw placement in relation to the perforator. In the spinal case, difficulty in finding the optimal fibula shape and position required extra ischemia time.

    Conclusions: The surgeons found HASP to be an efficient planning tool for FOFF reconstructions. The testing of alternative reconstructions to arrive at an optimal FOFF solution preoperatively potentially improves patient function and aesthetics and reduces operating room time.

  • 19.
    Rodriguez-Lorenzo, Andres
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Skoog, Valdemar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Nowinski, Daniel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    The Tord Skoog Visiting Professorship2019Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 7, nr 7, artikel-id e2285Artikel i tidskrift (Övrigt vetenskapligt)
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  • 20.
    Rydberg, Mattias
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Perez, Raquel
    Lund Univ, Sweden.
    Merlo, Juan
    Lund Univ, Sweden; Reg Skane, Sweden.
    Dahlin, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden.
    Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes2024Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 12, nr 6, artikel-id e5907Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Type 2 diabetes (T2D) is a major risk factor for carpal tunnel syndrome (CTS) and trigger finger (TF), but less is known regarding the risk of developing T2D after being diagnosed with CTS or TF. CTS and TF could be early signs of preclinical T2D, and early detection of T2D is crucial to prevent complications and morbidity. Therefore, we investigate the association between CTS/TF and T2D in an adult population without previous T2D using big data registers in Sweden.Methods:Data were collected by crosslinking five nationwide Swedish registers. Individuals aged 40-85 years on December 31, 2010, without prior overt diabetes, were included (n = 3,948,517) and followed up from baseline (ie, a diagnosis of CTS or TF) or January 1, 2011, for controls, until a diagnosis of T2D, prescription of oral antidiabetics or insulin, or end of follow-up four years after baseline. Multivariate Cox regression models were created to calculate hazard ratios for T2D.Results:In total, 37,346 (0.95%) patients were diagnosed with CTS, whereof 1329 (3.46%) developed T2D. There were 17,432 (0.44%) patients who developed TF, whereof 639 (3.67%) developed T2D. Among the controls, 2.73% developed T2D. Compared with controls, there was an increased risk of developing T2D after being diagnosed with either CTS (HR 1.35; 95% confidence interval 1.28-1.43) or TF (HR 1.21; 95% confidence interval 1.12-1.31).Conclusion:Compared with controls, a diagnosis of CTS or TF was associated with 35% and 21% higher risk for later T2D, respectively, which might indicate the existence of undetected T2D in this population.

  • 21.
    Strigård, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Clay, Leonard
    Stark, Birgit
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Predictive Factors in the Outcome of Surgical Repair of Abdominal Rectus Diastasis2016Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 4, nr 5, artikel-id e702Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this study was to define the indicators predicting improved abdominal wall function after surgical repair of abdominal rectus diastasis (ARD). Preoperative subjective assessment quantified by the validated Ventral Hernia Pain Questionnaire (VHPQ) was related to relative postoperative functional improvement in abdominal muscle strength.

    METHODS: Fifty-seven patients undergoing surgery for ARD completed the VHPQ before surgery. Preoperative pain assessment results were compared with the relative improvement in muscle strength measured with the BioDex system 4.

    RESULTS: There was a correlation between the relative improvement in muscle strength measured by the BioDex System 4 for flexion at 30 degrees (P = 0.046) and 60 degrees per second (P = 0.004) and the preoperative question, "Do you find it painful to sit for more than 30 minutes?" There was also a correlation between BioDex improvement for flexion at 30 degrees (P = 0.022) and for isometric work load (P = 0.038) and the preoperative question, "Has abdominal pain limited your ability to perform sports activities?" The VHPQ responses also formed a pattern with a fairly good correlation between other BioDex modalities (with the exception of extension at 60 degrees per second) and the response to the question regarding complaints when performing sports. Postoperative visual analog scale ratings of abdominal wall stability correlated to the questions regarding complaints when sitting (P = 0.040) and standing (P = 0.047). No other correlation was seen.

    CONCLUSION: VHPQ ratings concerning pain while being seated for more than 30 minutes and pain limiting the ability to perform sports are promising indicators in the identification of patients likely to benefit from surgical correction of their ARD.

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  • 22.
    Tasoulis, Marios-Konstantinos
    et al.
    Royal Marsden NHS Fdn Trust, Breast Surg Unit, Fulham Rd, London SW3 6JJ, England.
    Agusti, Ana
    Royal Marsden NHS Fdn Trust, Breast Surg Unit, Fulham Rd, London SW3 6JJ, England.
    Karakatsanis, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Royal Marsden NHS Fdn Trust, Breast Surg Unit, Fulham Rd, London SW3 6JJ, England.
    Montgomery, Catherine
    Royal Marsden NHS Fdn Trust, Breast Surg Unit, Fulham Rd, London SW3 6JJ, England.
    Marshall, Chris
    Royal Marsden NHS Fdn Trust, Dept Finance & Costing, London, England.
    Gui, Gerald
    Royal Marsden NHS Fdn Trust, Breast Surg Unit, Fulham Rd, London SW3 6JJ, England.
    The Use of Hydrodissection in Nipple- and Skin-sparing Mastectomy: A Retrospective Cohort Study2019Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 7, nr 11, artikel-id e2495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Hydrodissection (HD) is a method to create a subcutaneous and prepectoral plane during mastectomy using a mixture of crystalloid solution with local anesthetic and epinephrine. The aim of this study was to evaluate postoperative complications and surgical outcomes of this technique compared with standard mastectomy. Methods: This is a retrospective cohort study of patients who underwent bilateral risk-reducing, nipple-sparing mastectomy and immediate implant-based reconstruction through an inframammary crease incision either with standard electrocautery (control group) or HD (HD group) between January 2013 and January 2017. Patient demographics, procedural details, surgical outcomes, and complications were compared using nonparametric statistical tests and logistic regression analysis. Results: Forty-one patients (82 nipple-sparing mastectomies) were analyzed (23 patients in the HD group and 18 in the control group). Patients' demographics were similar for both groups. Surgical time was shorter with HD compared with standard mastectomy (median 168 versus 207.5 minutes, P = 0.016) with shorter median hospital stay (2 versus 2.5 days, P = 0.033). Complication rates were similar in both groups, and fewer patients in the HD group required Coleman fat transfer to improve cosmesis (12 versus 3, P = 0.003). Conclusions: HD mastectomy is a safe alternative to standard technique in selected patients. Further surgical research to explore the role of HD in a wider clinical setting is warranted.

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  • 23.
    Tee, Richard
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Odontologi & Maxillofacial kirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, Uppsala, Sweden.
    Schweizer, Riccardo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Odontologi & Maxillofacial kirurgi. Univ Zurich, Univ Hosp Zurich USZ, Dept Plast Surg & Hand Surg, Zurich, Switzerland.
    Gomez-Martinez-de-Lecea, Cristina
    Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, Uppsala, Sweden.
    Vejbrink Kildal, Villiam
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, Uppsala, Sweden.
    Thor, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Odontologi & Maxillofacial kirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, Uppsala, Sweden.
    Rodriguez-Lorenzo, Andres
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, Uppsala, Sweden.
    Early Second Free Flap is Required in Osteoradionecrosis-related Nonunion after Primary Mandible Reconstruction2023Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, nr 6, artikel-id e5024Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Osteoradionecrosis (ORN) manifested as symptomatic nonunion between primary free flap and native mandible after primary bony reconstruction of the mandible is an entity not included in current conventional ORN staging guidelines. This article reports on and proposes early management of this debilitating condition using a chimeric scapular tip free flap (STFF).

    Methods: A retrospective review was performed examining cases with bony nonunion at the junction of primary free fibula flap (FFF) and native mandible at a single center over a 10-year duration, which required a second free bone flap. Details of each case (patient demographics, oncological details, primary surgery, presentation, and secondary surgery) were documented and analyzed. Outcomes of the treatment were assessed.

    Results: Four patients (two men and two women; age range, 42–73 years) out of a total of 46 primary FFF were identified. All patients presented with symptoms of low-grade ORN and radiological signs of nonunion. All cases were reconstructed with chimeric STFF. The duration of follow-up ranged from 5 to 20 months. All patients reported resolution of symptoms and radiological evidence of union. Two of four patients subsequently received osseointegrated dental implants.

    Conclusions: Institutional rate of nonunion after primary FFF requiring a second free bone flap is 8.7%. All the patients of this cohort presented with a similar clinical entity easily discounted as an infected nonunion postosseous flap reconstruction. There is no ORN grading system that currently guides the management of this cohort. Good outcomes are possible with early surgical intervention with a chimeric STFF.

  • 24. Tillman, K. K.
    et al.
    Nowinski, D.
    Höijer, J.
    Ramklint, M.
    Ekselius, L.
    Papadopoulos, F. C.
    S3-07 SESSION 3: FACIOCRANIOSYNOSTOSIS – PART I NONSYNDROMIC CRANIOSYNOSTOSIS AND INCREASED RISK FOR NEURODEVELOPMENTAL DISORDERS2019Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 7, s. 34-34Artikel i tidskrift (Refereegranskat)
  • 25.
    Truche, Paul
    et al.
    Harvard Medical School, USA.
    Moeller, Ellie
    Harvard Medical School, USA.
    Wurdeman, Taylor
    Harvard Medical School, USA.
    Zimmerman, Kathrin
    Harvard Medical School, USA.
    Cruz, Norma
    International Confederation of Plastic Surgery Societies, Utrecht, the Netherlands; University of Puerto Rico, San Juan, Puerto Rico.
    Nakarmi, Kiran
    Kirtipur Hospital, Kathmandu, Nepal.
    Rai, Shankar M.
    Kirtipur Hospital, Kathmandu, Nepal.
    Eado, Yegeremu
    ALERT Hospital and AAU, Addis Ababa, Ethiopia.
    Pompermaier, Laura
    Harvard Medical School, USA.
    Meara, John G.
    Harvard Medical School, USA.
    Corlew, D. Scott
    Harvard Medical School, USA ; International Confederation of Plastic Surgery Societies, Utrecht, the Netherlands.
    The Plastic Surgery Workforce and Its Role in Low-income Countries2021Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, nr 4, s. e3428-e3428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Plastic surgery varies in scope, especially in different settings. This study aimed to quantify the plastic surgery workforce in low-income countries (LICs), understand commonly treated conditions by plastic surgeons working in these settings, and assess the impact on reducing global disease burden.

    Methods: We queried national and international surgery societies, plastic surgery societies, and non-governmental organizations to identify surgeons living and working in LICs who provide plastic surgical care using a cross-sectional survey. Respondents reported practice setting, training experience, income sources, and perceived barriers to care. Surgeons ranked commonly treated conditions and reported which of the Disease Control Priorities-3 essential surgery procedures they perform.

    Results: An estimated 63 surgeons who consider themselves plastic surgeons were identified from 15 LICs, with no surgeons identified in the remaining 16 LICs. Responses were obtained from 43 surgeons (70.5%). The 3 most commonly reported conditions treated were burns, trauma, and cleft deformities. Of the 44 "Essential Surgical Package'' procedures, 37 were performed by respondents, with the most common being skin graft (73% of surgeons performing), cleft lip/palate repair (66%), and amputations/escharotomy (61%). The most commonly cited barrier to care was insufficient equipment. Only 9% and 5% of surgeons believed that there are enough plastic surgeons to handle the burden in their local region and country, respectively.

    Conclusions: Plastic surgery plays a significant role in the coverage of essential surgical conditions in LICs. Continued expansion of the plastic surgical workforce and accompanying infrastructure is critical to meet unmet surgical burden in low- and middle-income countries.

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  • 26.
    Unukovych, Dmytro
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Gallego, Camilo Hernandez
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Aineskog, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Rodriguez-Lorenzo, Andres
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Mani, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction2016Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 4, nr 8, artikel-id e1016Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure.

    PATIENTS AND METHODS: A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins.

    RESULTS: In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023).

    CONCLUSIONS: The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in nulliparous patients.

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  • 27.
    Vieira, Luis
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Isacson, Daniel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Dimovska, Eleonora O. F.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Rodriguez-Lorenzo, Andres
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Four Lessons Learned from Complications in Head and Neck Microvascular Reconstructions and Prevention Strategies2021Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, nr 1, artikel-id e3329Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Free flap reconstruction in the head and neck region is a complex field in which patient comorbidities, radiation therapy, tumor recurrence, and variability of clinical scenarios make some cases particularly challenging and prone to devastating complications. Despite low free flap failure rates, the impact of flap failure has enormous consequences for the patients.

    Methods: Acknowledging and predicting high risk intra- and postoperative situations and having planned strategies on how to deal with them can decrease their rate and improve the patient's reconstructive journey.

    Results: Herein, the authors present 4 examples of significant complications in complex microvascular head and neck cancer reconstruction, encountered for the last 10 years: compression and kinking of the vascular pedicle, lack of planning of external skin coverage in osteoradionecrosis, management of the vessel-depleted neck, and vascular donor site morbidity after fibula harvest.

    Conclusion: The authors reflect on the causes and propose preventative strategies in each peri-operative stage.

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  • 28.
    Vieira, Luis
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Isacson, Daniel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Dimovska, Eleonora O. F.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Rodriguez-Lorenzo, Andres
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Four Lessons Learnt from Complications in Head and Neck Microvascular Reconstructions and Prevention Strategies2021Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, nr 1, artikel-id 3329Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Free flap reconstruction in the head and neck region is a complex field in which patient comorbidities, radiation therapy, tumor recurrence, and variability of clinical scenarios make some cases particularly challenging and prone to devastating complications. Despite low free flap failure rates, the impact of flap failure has enormous consequences for the patients.

    Methods: Acknowledging and predicting high risk intra- and postoperative situations and having planned strategies on how to deal with them can decrease their rate and improve the patient's reconstructive journey.

    Results: Herein, the authors present 4 examples of significant complications in complex microvascular head and neck cancer reconstruction, encountered for the last 10 years: compression and kinking of the vascular pedicle, lack of planning of external skin coverage in osteoradionecrosis, management of the vessel-depleted neck, and vascular donor site morbidity after fibula harvest.

    Conclusion: The authors reflect on the causes and propose preventative strategies in each peri-operative stage.

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  • 29.
    Zimmerman, Malin
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Anker, Ilka
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Karlsson, Anna
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Arner, Marianne
    South Gen Hosp, Sweden; Soder Sjukhuset, Sweden.
    Svensson, Ann-Marie
    Ctr Registers, Sweden; Univ Gothenburg, Sweden.
    Eeg-Olofsson, Katarina
    Univ Gothenburg, Sweden.
    Nyman, Erika
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Dahlin, Lars B.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Ulnar Nerve Entrapment in Diabetes: Patient-reported Outcome after Surgery in National Quality Registries2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 4, artikel-id e2740Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Ulnar nerve entrapment at the elbow (UNE) is overrepresented in patients with diabetes, but the outcome of surgery is unknown. We aimed to evaluate patient-reported outcome in patients with and without diabetes, and to assess potential sex differences and compare surgical treatment methods. Methods: Data on patients operated for UNE (2010-2016, n = 1354) from the Swedish National Registry for Hand Surgery were linked to the Swedish National Diabetes Register. Symptoms were assessed preoperatively (n = 389), and 3 (n = 283), and at 12 months postoperatively (n = 267) by QuickDASH and HQ-8 (specific hand surgery questionnaire-8 questions). Only simple decompressions were included when comparing groups. Results: Men with diabetes reported higher postoperative QuickDASH scores than men without diabetes. Women scored their disability higher than men on all time-points in QuickDASH, but showed larger improvement between preoperative and 12 months postoperative values. Patients operated with transposition scored 10.8 points higher on QuickDASH than patients who had simple decompression at 12 months (95% confidence interval 1.98-19.6). Conclusions: Women with diabetes benefit from simple decompression for UNE to the same extent as women without diabetes. Men with diabetes risk not to benefit from simple decompression as much as women do. Ulnar nerve transposition had a higher risk of residual symptoms compared to simple decompression.

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  • 30.
    Zötterman, Johan
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Opsomer, Dries
    Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
    Farnebo, Simon
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Blondeel, Phillip
    Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
    Monstrey, Stan
    Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
    Tesselaar, Erik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Medicinsk strålningsfysik. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 1, s. e2529-e2529Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Laser speckle contrast imaging (LSCI) is a laser-based perfusion imaging technique that recently has been shown to predict ischemic necrosis in an experimental flap model and predicting healing time of scald burns. The aims were to investigate perfusion in relation to the selected perforator during deep inferior epigastric artery perforator (DIEP) flap surgery, and to evaluate LSCI in assisting of prediction of postoperative complications. METHODS: Twenty-three patients who underwent DIEP-procedures for breast reconstruction at 2 centers were included. Perfusion was measured in 4 zones at baseline, after raising, after anastomosis, and after shaping the flap. The perfusion in relation to the selected perforator and the accuracy of LSCI in predicting complications were analyzed. RESULTS: After raising the flap, zone I showed the highest perfusion (65 ± 10 perfusion units, PU), followed by zone II (58 ± 12 PU), zone III (53 ± 10 PU), and zone IV (45 ± 10 PU). The perfusion in zone I was higher than zone III (P = 0.002) and zone IV (P < 0.001). After anastomosis, zone IV had lower perfusion than zone I (P < 0.001), zone II (P = 0.01), and zone III (P = 0.02). Flaps with areas <30 PU after surgery had partial necrosis postoperatively (n = 4). CONCLUSIONS: Perfusion is highest in zone I. No perfusion difference was found between zones II and III. Perfusion <30 PU after surgery was correlated with partial necrosis. LSCI is a promising tool for measurement of flap perfusion and assessment of risk of postoperative ischemic complications.

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  • 31.
    Zötterman, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Tesselaar, Erik
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Medicinsk strålningsfysik.
    Elawa, Sherif
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Farnebo, Simon
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Correlation between Indocyanine Green Fluorescence Angiography and Laser Speckle Contrast Imaging in a Flap Model2023Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, nr 9, artikel-id e5187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Indocyanine green fluorescence angiography (ICG-FA) is used to assess tissue intraoperatively in reconstructive surgery. This requires an intra-venous dye injection for each assessment. This is not necessary in laser speckle contrast imaging (LSCI); therefore, this method may be better suited for tissue evaluation. To determine this, we compared the two methods in a porcine flap model.Methods:One random and one pedicled flap were raised on each buttock of six animals. They were assessed with LSCI at baseline, when raised (T0), at 30 minutes (T30) and with ICG-FA at T0 and T30. Regions of interest (ROI) were chosen along the flap axis. Perfusion, measured as perfusion units (PU) in the LSCI assessment and pixel-intensity for the ICG-FA video uptake, was calculated in the ROI. Correlation was calculated between PU and pixel-intensity measured as time to peak (TTP) and area under curve for 60 seconds (AUC60).Results:Correlation between LSCI and AUC60 for the ICG-FA in corresponding ROI could be seen in all flaps at all time points. The correlation was higher for T0 (r=0.7 for random flap and r=0.6 for pedicled flap) than for T30 (r=0.57 for random flap and r=0.59 for pedicled flap). Even higher correlation could be seen PU and TTP (T0: random flap r=-0.8 and pedicled flap r=0.76. T30: random flap r=-0.8 and pedicled flap r=0.71)Conclusion:There is a correlation between PU from LSCI and TTP and AUC60 for ICG-FA, indicating that LSCI could be considered for intraoperative tissue assessment.

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