Subject(s)
Evidence-Based Medicine/trends , Microsurgery/trends , Plastic Surgery Procedures/trends , Clinical Decision-Making/ethics , Clinical Decision-Making/methods , Evidence-Based Medicine/ethics , Evidence-Based Medicine/history , History, 19th Century , Humans , Microsurgery/ethics , Microsurgery/methods , Microsurgery/statistics & numerical data , Publications/statistics & numerical data , Publications/trends , Plastic Surgery Procedures/ethics , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/statistics & numerical data , Surgeons/ethics , Treatment OutcomeABSTRACT
The first successful hand transplant was performed in 1998, opening up a new possibility for patients who have suffered mutilating hand injuries. Since then, more than 60 such procedures have been performed throughout the world. This article describes the evolution of hand transplantation, outcomes of patients listed in the International Registry of Hand and Composite Tissue Transplantation, and ethical issues involved in hand transplantation. It also describes the hand transplantation program at Mayo Clinic, which was established in 2010.
Subject(s)
Amputation, Traumatic/surgery , Hand Injuries/surgery , Hand Transplantation , Microsurgery/methods , Registries , Academic Medical Centers/ethics , Ethics, Medical , Graft Rejection/etiology , Graft Rejection/psychology , Humans , Immunosuppression Therapy/ethics , Immunosuppression Therapy/methods , Microsurgery/ethics , Minnesota , Postoperative Complications/etiology , Postoperative Complications/psychology , Quality of Life/psychologyABSTRACT
BACKGROUND: The majority of breast reconstructions are performed using implant material. Implants have some major long-term disadvantages. Long-term implant-related complications and improved microsurgical techniques have led to an increased number of women requesting conversion of their implant breast reconstruction to autologous breast reconstruction. The aim of this study was to evaluate surgical and aesthetic outcome and patient satisfaction after tertiary autologous breast reconstruction. METHODS: Between 2001 and 2007, 42 women underwent 61 tertiary autologous breast reconstructions. Surgical outcome and complications were evaluated. Patient satisfaction was assessed using a study-specific questionnaire. Aesthetic result was rated by an expert panel using standardized photographs. RESULTS: Forty-seven deep inferior epigastric artery perforator, 10 mini-transverse rectus abdominis musculocutaneous, and four transverse musculocutaneous gracilis flaps were performed. Eight patients required reoperation because of complications (19 percent). Total flap loss did not occur. Nineteen patients underwent one or more additional operations to improve aesthetic outcome. Physical discomfort caused by implants and dissatisfaction with the aesthetic result were the main patient motivations to opt for autologous breast reconstruction. Reduction or disappearance of physical discomfort was noted in the vast majority of patients. Most patients were very satisfied with the aesthetic result (mean, 8 of 10), but the mean panel satisfaction score was lower (7 of 10). However, the panel noted a significant improvement of the aesthetic result after conversion to autologous breast reconstruction (from 5 of 10 to 7 of 10). CONCLUSION: Autologous breast reconstruction after failed implant reconstruction is a technically feasible and reliable procedure that leads to improved physical condition and aesthetic results and a high degree of patient satisfaction.
Subject(s)
Breast Implantation/adverse effects , Mammaplasty/methods , Microsurgery/methods , Patient Satisfaction , Rectus Abdominis/transplantation , Skin Transplantation/methods , Surgical Flaps/ethics , Adult , Breast Implantation/psychology , Female , Follow-Up Studies , Humans , Mammaplasty/ethics , Mammaplasty/psychology , Microsurgery/ethics , Middle Aged , Motivation/ethics , Rectus Abdominis/blood supply , Reoperation/ethics , Retrospective Studies , Skin Transplantation/ethics , Surgical Flaps/blood supply , Surveys and Questionnaires , Time Factors , Transplantation, Autologous , Treatment OutcomeABSTRACT
Microsurgical training is mandatory for the optimal education of modern neurosurgeons. Even though this is a widely acknowledged statement and a lot of institutions around the world practice training in laboratory, the recent literature lacks tip and tricks on how to start a laboratory from scratch, what would be a convenient anesthesia, and what kind of exercises are appropriate. We present our experience in 16 microsurgical training courses settled up at our institutions. Two hundred eleven rodents were dissected. We will describe the organization of the laboratory and of the training courses and we will discuss its practical impact on the residency program.
