Implantation of Acellular Nerve Allograft Using Nerve Connectors.

Background: Nerve connectors are short nerve conduits used to approximate nerve ends. Acellular nerve allografts are viable alternatives when direct repair is not possible but do not produce exudate essential for fibrin clot formation. We hypothesize that acellular nerve allograft implanted using nerve connectors must have end-to-end contact with the in situ nerve stumps to support nerve regeneration. Methods: Sixty Sprague Dawley rats underwent a 14-mm unilateral tibial nerve injury and subsequent repair using various combinations of acellular nerve grafts and nerve connectors. Proximal repairs for all groups utilized direct contact with the nerve stump within connector. Variations in distal repair methods (allograft length, nerve gap, and connector length) defined our 4 groups-group A: 14 mm allograft, no distal gap, and distal connector; group B: 11.5 mm allograft, 2.5 mm distal gap, and distal connector; group C: 9 mm allograft, 5 mm distal gap, and distal connector; group D: 14 mm allograft, no distal gap, and no distal connector. At 3 months post-repair, function and histomorphology were assessed. Results: Developed muscle force was significantly lower in group C (0.073 ± 0.077 N) compared with the other 3 groups (group A = 0.529 ± 0.312 N, group B = 0.461 ± 0.462 N, and group D = 0.409 ± 0.327 N). Axon counts were significantly lower in group C (2121 ± 389) compared with group A (6401 ± 855), group B (4710 ± 755), and group D (4450 ± 126). There was no statistically significant difference in G-ratios (myelination) between groups (P > .05). Conclusion: Nerve regeneration was significantly impaired as the gap distance between the distal end of the allograft and the distal nerve stump increased to 5 mm.

The Use of a Novel Local Flap Trainer in Plastic Surgery Education.

With the limitations of work hour restrictions and legal liability surgical resident's operative experience is declining. We sought to find other methods of training using tactile surgical simulations for plastic surgery. With the collaborative efforts of a local artist, a local flap trainer was designed to simulate the natural properties, layers, and interaction between layers of tissue. A session was held with Plastic Surgery faculty, residents, and students to review and practice local flaps using the trainer. Afterward, the participants filled out a survey evaluating the simulated skin and tissue model and the effectiveness of the class as a teaching model. The survey given had multiple questions asking the participant to provide a ranking from 1 to 10. The results show that the class utilizing the new suture pad was an effective teaching tool with an average score of 9.56. The suture pad was given a score of 6.77 for simulating realistic skin. Overall, the group rated increased understanding and confidence of local flaps after the class. Surgical skill simulations are becoming increasingly more important with the decline of resident operative experience. There are limited options for surgical simulations that provide a realistic experience. We designed a suture pad that is effective at simulating human tissue. The surveys show that using this suture pad in flap workshops provides a valuable teaching tool.

The Use of Vasopressors in Pedicled Flaps for Chest Wall Reconstruction.

INTRODUCTION: The effect of vasopressors on flaps remains controversial in the literature. Often, surgeons avoid vasopressors with the thought that vasoconstriction reduces flap perfusion resulting in flap loss. METHODS: A retrospective review was performed on patients who required chest wall reconstruction from 1998 to 2013. Patients were identified through the use of Current Procedural Terminology codes. The data collected included demographics, indications for surgery, prior debridement, preoperative albumin levels, and perioperative vasopressor use. Outcomes measures included flap survival, flap complications, reoperation rates, intensive care unit length of stay, and mortality. RESULTS: Of the 1220 patient records reviewed, 88 had chest reconstruction by a plastic surgeon. Twenty-one patient records were excluded due to incomplete data. One patient experienced complete flap loss; these data were excluded from statistical analysis. Fifty patients received perioperative vasopressors whereas 15 did not. There was no significant difference in flap survival or loss between groups who received perioperative vasopressors and those who did not receive vasopressors. Age, intensive care unit length of stay, flap complications, and reoperation rates were significantly higher in those with partial flap survival. CONCLUSIONS: Perioperative vasopressor use does not adversely affect the outcome of pedicled flaps for chest wall reconstruction. Further research is warranted to review the effects of vasopressor dose and type on pedicled flaps.

Blast Injuries Caused by Vape Devices: 2 Case Reports.

Vaporizing devices have become a popular alternative to conventional nicotine products. They are thought to be safer as they produce aerosolized nicotine powered by a lithium ion battery. Many people have used these electronic devices as a tool to quit smoking; however, the batteries can be unstable and explode.We present 2 case reports where explosions of electronic vapor devices caused significant injuries. The first patient sustained a combustion injury to the maxilla resulting in bone and anterior maxillary tooth loss requiring reconstruction. The second patient had a severe blast injury to the hand which ultimately resulted in loss of a digit. Toxicology was consulted due to concerns for systemic absorption of metals in the soft tissue of the hand. Cobalt and manganese were initially elevated but decreased after surgical debridement. The patient did not have any systemic symptoms.Currently, there is no federal regulation of electronic cigarettes or vape devices in the United States. With the increasing use of these devices and no standard regulations, we anticipate more blast injuries occurring in the future. Medical providers will need to be able to be prepared to manage the devastating clinical injuries that ensue.

Hair transplant: a basic review.

The hairline is an important aspect of beauty. Loss of the hairline can contribute to poor self-esteem. Alopecia, or hair loss, has many different causes and can have devastating outcomes to the patient. The plastic surgery team may play a role in restoring the hairline and thus improving one's image of self. This article identifies the different causes of hair loss and then reviews steps and options for hairline restoration.