Three-dimensional Printing in Developing Countries.

The advent of 3-dimensional (3D) printing technology has facilitated the creation of customized objects. The lack of regulation in developing countries renders conventional means of addressing various healthcare issues challenging. 3D printing may provide a venue for addressing many of these concerns in an inexpensive and easily accessible fashion. These may potentially include the production of basic medical supplies, vaccination beads, laboratory equipment, and prosthetic limbs. As this technology continues to improve and prices are reduced, 3D printing has the potential ability to promote initiatives across the entire developing world, resulting in improved surgical care and providing a higher quality of healthcare to its residents.

iPad integration in plastic surgical training: optimizing clinical efficiency, education, and compliance with the health insurance portability and accountability act.

The authors share their experience with the issuance of iPads to all residents, faculty, and physician extenders in their plastic surgical division. They found that these devices (1) optimized compliance with the Health Insurance Portability and Accountability Act by eliminating the use of paper service lists; (2) improved clinical efficiency; and (3) promoted resident education. They believe the use of these devices in residency is cost-effective when considering mitigating patient privacy risk and enriching educational value.

Management of hidradenitis suppurativa wounds with an internal vacuum-assisted closure device.

BACKGROUND: Hidradenitis suppurativa is a chronic, debilitating disease that is difficult to treat. Once medical management fails, wide local excision offers the best chance for cure. However, the resultant wound often proves too large or contaminated for immediate closure. METHODS: The authors performed a retrospective chart review of hidradenitis cases managed surgically between 2005 and 2010. Data collected included patient characteristics, management method, and outcomes. Approximately half of the patients received internal vacuum-assisted closure therapy using the vacuum-assisted closure system and delayed closure and half of the patients received immediate primary closure at the time of their excision. Delayed closure consisted of closing the majority of the wound in a linear fashion following internal vacuum-assisted closure while accepting healing by means of secondary intention for small wound areas. RESULTS: Patients managed with internal vacuum-assisted closure had wounds on average four times larger in area than patients managed without internal vacuum-assisted closure. In both groups, all wounds were eventually closed primarily. Healing times averaged 2.2 months with internal vacuum-assisted closure and 2.7 months without. At an average follow-up time of 2.3 months, all patients with internal vacuum-assisted closure had no recurrence of their local disease. CONCLUSIONS: Severe hidradenitis presents a treatment challenge, as surgical excisions are often complicated by difficult closures and unsatisfactory recurrence rates. This study demonstrates that wide local excision with reasonable outcomes can be achieved using accelerated delayed primary closure. This method uses internal vacuum-assisted closure as a bridge between excision and delayed primary closure, facilitating closure without recurrence in large, heavily contaminated wounds. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

A plastic surgery application in evolution: three-dimensional printing.

BACKGROUND: Three-dimensional printing represents an evolving technology still in its infancy. Currently, individuals and small business entities have the ability to manufacture physical objects from digital renderings, computer-aided design, and open source files. Design modifications and improvements in extrusion methods have made this technology much more affordable. This article explores the potential uses of three-dimensional printing in plastic surgery. METHODS: A review was performed detailing the known uses of three-dimensional printing in medicine. The potential applications of three-dimensional printing in plastic surgery are discussed. RESULTS: Various applications for three-dimensional printing technology have emerged in medicine, including printing organs, printing body parts, bio-printing, and computer-aided tissue engineering. In plastic surgery, these tools offer various prospective applications for surgical planning, resident education, and the development of custom prosthetics. CONCLUSIONS: Numerous applications exist in medicine, including the printing of devices, implants, tissue replacements, and even whole organs. Plastic surgeons may likely find this technology indispensable in surgical planning, education, and prosthetic device design and development in the near future.

Nanotechnology in plastic surgery.

BACKGROUND: Nanotechnology has made inroads over time within surgery and medicine. Translational medical devices and therapies based on nanotechnology are being developed and put into practice. In plastic surgery, it is anticipated that this new technology may be instrumental in the future. Microelectromechanical systems are one form of nanotechnology that offers the ability to develop miniaturized implants for use in the treatment of numerous clinical conditions. The authors summarize their published preliminary findings regarding a microelectromechanical systems-based electrochemical stimulation method through modulation of ions around the nerve that is potentially implantable and clinically efficacious, and expand upon current and potential usages of nanotechnology in plastic surgery. METHODS: Sciatic nerves (n = 100) of 50 American bullfrogs were placed on a microfabricated planar gold electrode array and stimulated electrically. Using Ca(2+)-selective membranes, ion concentrations were modulated around the nerve environment in situ. In addition, a comprehensive review of the literature was performed to identify all available data pertaining to the use of nanotechnology in medicine. RESULTS: A 40 percent reduction of the electrical threshold value was observed using the Ca(2+) ion-selective membrane. The uses of nanotechnology specifically applicable to plastic surgery are detailed. CONCLUSIONS: Nanotechnology may likely lead to advancements in the art and science of plastic surgery. Using microelectromechanical systems nanotechnology, the authors have demonstrated a novel means of modulating the activation of nerve impulses. These findings have potentially significant implications for the design of special nano-enhanced materials that can be used to promote healing, control infection, restore function, and aid nerve regeneration and rehabilitation.

An algorithmic approach to the use of gauze-based negative-pressure wound therapy as a bridge to closure in pediatric extremity trauma.

BACKGROUND: The efficacy of negative-pressure wound therapy as a bridge to definitive closure of traumatic extremity wounds has been demonstrated in adults. Gauze-based negative-pressure wound therapy has been used to facilitate granulation tissue formation and promote closure in a number of wound types. In this study, the authors evaluated the efficacy of gauze-based negative-pressure wound therapy using the Chariker-Jeter technique for pediatric extremity wounds requiring delayed closure. METHODS: A retrospective review was conducted of 24 pediatric patients presenting with extremity injuries involving soft-tissue defects not amenable to immediate primary closure. After initial irrigation, débridement, and antibiotic therapy, negative-pressure wound therapy using the Chariker-Jeter technique was applied and dressings were changed at 48- to 72-hour intervals before secondary closure or primary closure by skin graft, local flaps, or free tissue transfer. RESULTS: Granulation tissue was noted in all wounds by day 4. The duration of vacuum therapy averaged 10 days in patients whose wounds were closed primarily (n = 19) and 17 days in patients who were allowed to heal by secondary intention (n = 5). Nine patients' wounds were closed with skin grafts and local flaps, eight were closed with local flaps only, and three were closed with free tissue transfer. There was no incidence of skin graft loss or flap failure. Follow-up evaluation of the wounds averaged 24 months, during which no complications were noted. CONCLUSIONS: As a relatively atraumatic wound care technique with few complications, gauze-based negative-pressure wound therapy with the Chariker-Jeter technique provides a highly effective option for temporary soft-tissue management of extremity trauma in pediatric patients.

Appendicitis in children less than 3 years of age: a 28-year review.

Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is rarely considered in children less than 3 years of age. The goal of this study was to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome. A 28-year experience of a single pediatric surgeon in academic practice was reviewed; 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in his series. The most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 degrees C or more (21), abdominal distension (18), Leukocytosis (<12.0 x 10(3)/mm(3)) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18. Postoperative antibiotics were administered to 17 children for an average of 6 days. Two patients underwent interval appendectomies, 1 following treatment with IV antibiotics and 1 following surgical drainage. The average time to resume oral intake was 7 days and the average hospital stay was 21 (median 15) days. Sixteen patients had 22 complications, which included 6 wound infections, 4 abscesses, 4 wound dehiscences, 3 pneumonias, 2 SBOs, 2 incisional hernias, and 1 enterocutaneous fistula. Perforated appendicitis was found in all children less than 3 years old, resulting in very high morbidity (59% complications), which may be attributed to the 3-5-day delay in diagnosis. Although appendicitis is uncommon in this age group, it should be seriously considered in the differential diagnosis of children under the age of 3 years who present with the triad of abdominal pain, tenderness, and vomiting.