Plastic Surgery

Cranioplasty is among the oldest surgical procedures. Trauma, infections, tumors and compression caused by brain edema are some of the reasons for the removal of bone. The indications for cranioplasty after resolution of the primary process that led to the bone defect were never well defined, and many were the "cosmetic" indications for cranioplasty. However, there are many theories suggesting that an underlying physiological alteration may occur which may require the correction of the bone defect; many patients improve after surgery. We discuss the physiopathological basis of the "syndrome of the trephined" and try to achieve a better understanding of the present status of cranioplasty and its possible therapeutic role.

RESUMO Introdução: Atualmente, existe uma carência de exposição à cirurgia plástica durante a graduação. A maioria dos currículos univer-sitários não possui uma forma específica de ensino em cirurgia plástica. Para reverter essa situação, algumas universidades fomentam o contato precoce com a cirurgia plástica através de cursos extracurriculares. Método: Foi desenvolvido um Curso Básico de Mi-crocirurgia para acadêmicos de Medicina com uma aula teórica e uma prática, anualmente e ao longo de 3 anos; na última edição, foi aplicado um questionário sobre o interesse na área e a importância no ensino durante a graduação. Resultados: Dentre os alunos, 65% apresentaram grande interesse pela microcirurgia, 95% relataram um aumento de interesse. Todos os alunos concordaram que os acadêmicos de Medicina devem ser mais envolvidos e treinados na área microcirúrgica durante a graduação. Conclusões: O de-senvolvimento de um curso de treinamento básico de microcirurgia para acadêmicos de Medicina é benéfico para o aprendizado dos alunos, para obtenção de informações acerca da disciplina e para o aprimoramento de habilidades. ABSTRACT Introduction: Currently there is a lack of exposure to plastic surgery during medical graduation. Most college curricula do not have a specific form of education in plastic surgery. To reverse this situation, some universities encourage early contact with plastic surgery through extracurricular courses. Methods: We developed a basic course of microsurgery for medical students with a lecture and a practical class, annually and over 3 years; in the last edition, a questionnaire on the interest in the area and the importance in education during graduation was applied. Results: Among the students, 65% showed great interest in microsurgery, and 95% reported an increase of interest. All students agreed that medical students should be more involved and trained in the microsurgical area during graduation. Conclusions: The development of a basic training course of microsurgery for medical students is beneficial for student learning, obtaining information about the discipline, and improving skills.

Defects of the dorsum of the foot can be challenging to reconstruct, none more so than the dorsum of the toe. The reverse Dorsalis Pedis Adipofascial Perforator (DPAP) flap is one possible reconstructive option for defects in this region. The aim of this study was to first demonstrate the anatomy of this flap, particularly the consistency of the perforators arising from the dorsalis pedis artery. Second, we present a clinical series based on this flap to demonstrate how it can be used. For the anatomical studies, 22 fresh cadaveric lower extremities were dissected, and injection studies were used to delineate the vascular territories. The presence of the distal perforator, distance to the first metatarso-phalangeal joint and diameter of each perforator were recorded. The cadaveric studies confirmed the presence of distal perforators to the first metatarso-phalangeal joint in 100% of limbs examined. The clinical study demonstrated the feasibility of the use of the adipofascial turn-over perforator flap for dorsal foot reconstruction. These anatomic findings provide an alternative method of reconstruction of great toe defects using the reverse DPAP flap.

Background: Existing outcome studies on women seeking labiaplasty have not used a validated scale that is specific for satisfaction with genital appearance. They have also not screened for the presence of body dysmorphic disorder (BDD). There are therefore two primary aims of this study (1) to validate the Genital Appearance Satisfaction (GAS) scale in women seeking labiaplasty and (2) to modify and validate a version of the Cosmetic Procedures Screening questionnaire (COPS-L), which has previously been used to screen for BDD. Method: Two groups of women were recruited: a group desiring labiaplasty and a control group. All participants completed the GAS, the COPS-L and other general measures of mood, disgust sensitivity, sexual satisfaction and body image quality of life. Results: Both the GAS and COPS-L demonstrated good internal consistency, concurrent and convergent validity with measures of related constructs, and discriminated between women seeking labiaplasty and controls. Three factors were identified in the GAS but were not robust enough to recommend their use clinically as subscales. The COPS-L discriminated between women seeking labiaplasty with and without BDD. Discussion: We recommend that both the GAS and the COPS-L be routinely used for audit and outcome monitoring of interventions for women distressed by the appearance or function of their genitalia. The GAS has an advantage in assessing additional functional symptoms in such women. The COPS-L may be helpful in identifying women with BDD. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13 For personal use only. 48 D. Veale et al. J Psychosom Obstet Gynaecol, 2013; 34(1): 46-52 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13 For personal use only. Items in bold refer to the factors extracted which are 40.4. 50 D. Veale et al. Validation of genital appearance satisfaction scale and the cosmetic procedure 51 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13

Background: Existing outcome studies on women seeking labiaplasty have not used a validated scale that is specific for satisfaction with genital appearance. They have also not screened for the presence of body dysmorphic disorder (BDD). There are therefore two primary aims of this study (1) to validate the Genital Appearance Satisfaction (GAS) scale in women seeking labiaplasty and (2) to modify and validate a version of the Cosmetic Procedures Screening questionnaire (COPS-L), which has previously been used to screen for BDD. Method: Two groups of women were recruited: a group desiring labiaplasty and a control group. All participants completed the GAS, the COPS-L and other general measures of mood, disgust sensitivity, sexual satisfaction and body image quality of life. Results: Both the GAS and COPS-L demonstrated good internal consistency, concurrent and convergent validity with measures of related constructs, and discriminated between women seeking labiaplasty and controls. Three factors were identified in the GAS but were not robust enough to recommend their use clinically as subscales. The COPS-L discriminated between women seeking labiaplasty with and without BDD. Discussion: We recommend that both the GAS and the COPS-L be routinely used for audit and outcome monitoring of interventions for women distressed by the appearance or function of their genitalia. The GAS has an advantage in assessing additional functional symptoms in such women. The COPS-L may be helpful in identifying women with BDD. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13 For personal use only. 48 D. Veale et al. J Psychosom Obstet Gynaecol, 2013; 34(1): 46-52 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13 For personal use only. Items in bold refer to the factors extracted which are 40.4. 50 D. Veale et al. Validation of genital appearance satisfaction scale and the cosmetic procedure 51 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13

Ce manuel est destiné aux rééducateurs, aux médecins généralistes et de toutes les spécialités, ainsi qu’aux patients qui cherchent désespé-rément une solution à leur douleur.

La méthode de rééducation sensitive diminue les douleurs neuropa-thiques depuis la peau partiellement engourdie ou hypersensible au tou-cher. La peau, qui est le plus grand organe du corps humain, est fréquemment soumise à des traumatismes qui provoquent de micro lésions nerveuses avec leur cortège de symptômes : des sensations de brûlures « comme un coup de soleil » ou « comme un feu à l’intérieur », des douleurs au caractère électrique « irradiations » ou « élancements », des fourmillements, par exemples. Cette méthode est basée sur la plasticité neuronale du systême neurologique somesthé-sique – des yeux de la peau vers le cerveau – qui permet de modifier la situation, même plus de vingt mois après la lésion.

Cette méthode, qui a 15 ans, est aujourd’hui encyclopédique et de re-nommée mondiale. Les thérapeutes qui la pratiquent dans 29 pays sont organisés en un Réseau de Rééducation Sensitive de la Douleur (RRSD) neuropain.ch, qui décerne le titre de Rééducatrice/teur Sensi-tive/tif de la Douleur Certifié(e) (RSDC®).

« Ce manuel va permettre de stimuler tous les professionnels de la santé qui se consacrent à la gestion de la douleur et aux problèmes qui y sont associés. »        Ronald Melzack, McGill University, Montréal.