This document summarizes the operative management of Achilles tendon disorders. It discusses the surgical principles and various pathologic conditions including acute and chronic ruptures, paratenonitis, and tendinosis. For acute ruptures, open repair remains the gold standard but percutaneous repairs are gaining popularity due to smaller wounds and less pain. Chronic ruptures require reconstructive options like V-Y lengthening or tendon transfers depending on the defect size. Paratenonitis is generally treated non-operatively while tendinosis may require resection of degenerated tendon and augmentation. The document emphasizes surgical pearls like avoiding tight closures to prevent hematoma and infection.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
Achilles tendon repair at the Stone Clinic is often performed percutaneously following a torn achilles tendon injury. This method has proven to be as effective as an open surgical technique while reducing recovery time.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
Achilles tendon repair at the Stone Clinic is often performed percutaneously following a torn achilles tendon injury. This method has proven to be as effective as an open surgical technique while reducing recovery time.
a summary of the pertinent elbow anatomy, mechanism of injury, primary and secondary stabilizers of the elbow, and treatment options of elbow terrible triad
# Management of Open Fractures and Pathological Fractures: An Overview #
If you have recently sustained a fracture, whether due to a traumatic injury or underlying medical condition, you may be wondering how best to manage the situation. This article will provide an overview of the management of open fractures and pathological fractures, two types of fractures that require special attention and treatment.
## What are Open Fractures and Pathological Fractures? ##
Before we delve into their management, let's first define what open fractures and pathological fractures are.
### Open Fractures ###
An open fracture, also known as a compound fracture, is a type of fracture in which the broken bone protrudes through the skin, exposing it to the outside environment. This type of fracture is considered a medical emergency because of the high risk of infection, and it requires prompt medical attention.
### Pathological Fractures ###
A pathological fracture is a type of fracture that occurs due to an underlying medical condition, such as osteoporosis or bone cancer. These fractures can occur with little to no trauma and are often a sign of an underlying health issue that requires treatment.
## Management of Open Fractures and Pathological Fractures ##
Now that we understand what open fractures and pathological fractures are, let's explore how they are managed.
### Management of Open Fractures ###
Open fractures require prompt medical attention to prevent infection and promote proper healing. The following steps are typically taken in the management of open fractures:
1. Stop any bleeding: If there is any bleeding, it should be stopped immediately to prevent excessive blood loss.
2. Clean the wound: The wound should be cleaned thoroughly with sterile saline solution or another appropriate antiseptic.
3. Stabilize the fracture: The broken bone should be stabilized to prevent further damage and promote proper healing.
4. Administer antibiotics: Antibiotics may be prescribed to prevent or treat infection.
5. Monitor for complications: Patients with open fractures should be monitored closely for signs of infection or other complications.
### Management of Pathological Fractures ###
The management of pathological fractures depends on the underlying medical condition that caused the fracture. In general, the following steps are taken:
1. Treat the underlying condition: The underlying condition that caused the fracture should be treated to prevent future fractures.
2. Stabilize the fracture: The broken bone should be stabilized to prevent further damage and promote proper healing.
3. Pain management: Pain medications may be prescribed to manage pain associated with the fracture.
4. Monitor for complications: Patients with pathological fractures should be monitored closely for signs of complications, such as infection or nerve damage.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Light House Retreats: Plant Medicine Retreat Europe
Operative Management of Achilles Tendon Disorders
1. Operative Management ofOperative Management of
Achilles TendonAchilles Tendon
DisordersDisorders
Edward G. Magur, MDEdward G. Magur, MD
Cherry Blossom SeminarCherry Blossom Seminar
April 2012April 2012
3. IntroductionIntroduction
• Largest/strongest tendon in human bodyLargest/strongest tendon in human body
• Treatment tailored to pathology andTreatment tailored to pathology and
patient demandspatient demands
• Initial treatment typically non-operativeInitial treatment typically non-operative
– Exception: rupturesException: ruptures
• Surgical intervention ranges from simpleSurgical intervention ranges from simple
to complexto complex
4. Surgical PrinciplesSurgical Principles
• Approach and soft tissue handlingApproach and soft tissue handling
• Primary repair best when possiblePrimary repair best when possible
• Reconstructive goalsReconstructive goals
– Bridge gapsBridge gaps
– Restore blood supply/healing potentialRestore blood supply/healing potential
– Provide tissue for repairProvide tissue for repair
– Augment strengthAugment strength
6. Acute Achilles RuptureAcute Achilles Rupture
• LocationLocation
– Anywhere alongAnywhere along
course of tendoncourse of tendon
– MRI when in doubtMRI when in doubt
– Very distal rupturesVery distal ruptures
and avulsions notand avulsions not
rarerare
8. Acute Achilles RuptureAcute Achilles Rupture
• Open RepairOpen Repair
– WoundWound
complicationscomplications
• Highest with openHighest with open
repairrepair
• PotentiallyPotentially
devastatingdevastating
9. Acute Achilles RuptureAcute Achilles Rupture
• PercutaneousPercutaneous
RepairRepair
– Gain in popularityGain in popularity
last 10 yearslast 10 years
– CommerciallyCommercially
available systemsavailable systems
• Easier passage ofEasier passage of
suturessutures
• Less sural nerveLess sural nerve
entrapmententrapment
11. Acute Achilles RuptureAcute Achilles Rupture
• Trends and pearlsTrends and pearls
– Small medial incisionSmall medial incision
• ““Mini-open”Mini-open”
– Full thickness flapFull thickness flap
– Range to neutralRange to neutral
– Shorter absolute immobilizationShorter absolute immobilization
• Dorsiflexion-limited ROM bootDorsiflexion-limited ROM boot
– Earlier weightbearingEarlier weightbearing
12. Chronic Achilles RuptureChronic Achilles Rupture
• 4+ weeks after injury4+ weeks after injury
• Missed ruptureMissed rupture
• ““Silent rupture”Silent rupture”
• Function based on M-T unit lengthFunction based on M-T unit length
• Operative RxOperative Rx
– Based on function and patient requirementBased on function and patient requirement
– Higher risksHigher risks
13. Chronic Achilles RuptureChronic Achilles Rupture
• Reconstructive OptionsReconstructive Options
– V-Y lengtheningV-Y lengthening
– Turndowns and local graftingTurndowns and local grafting
– Tendon transferTendon transfer
– Free graftsFree grafts
• AllograftAllograft
• AutograftAutograft
• Collagen matrix productsCollagen matrix products
14. V-Y LengtheningV-Y Lengthening
• Defects <5cmDefects <5cm
• Limbs 2x defectLimbs 2x defect
• AdvantageAdvantage
– Local tissueLocal tissue
• DisadvantageDisadvantage
– Limited to 5 cmLimited to 5 cm
– Initial weaknessInitial weakness
15. TurndownsTurndowns
• Multiple techniquesMultiple techniques
• Central thirdCentral third
• AdvantagesAdvantages
– Bridge large gapsBridge large gaps
– Local tissueLocal tissue
• DisadvantagesDisadvantages
– ““lump” at TD sitelump” at TD site
– Two anastomosesTwo anastomoses
16. TransfersTransfers
• FHL most commonFHL most common
– In phase transferIn phase transfer
– Brings blood supplyBrings blood supply
with musclewith muscle
– Minimal donorMinimal donor
morbiditymorbidity
• Exception: AthletesException: Athletes
& performing artists& performing artists
• CombinationsCombinations
24. TendinosisTendinosis
• Resect allResect all
degenerativedegenerative
tendontendon
• <50% requires<50% requires
augmentaugment
– FHL transfer mostFHL transfer most
commonlycommonly
25. Pearls and PitfallsPearls and Pitfalls
…and speaker’s biases…and speaker’s biases
- When feasible, approach off midlineWhen feasible, approach off midline
- Avoid water-tight closureAvoid water-tight closure
- Hematoma---Hematoma--- Infection and sloughInfection and slough
- Check wound early and oftenCheck wound early and often
- Don’t get surprised in ORDon’t get surprised in OR
- MRI and pre-op planningMRI and pre-op planning
- Adjunctive and multiple proceduresAdjunctive and multiple procedures
- Anchors, biotenodesis screws, allograftsAnchors, biotenodesis screws, allografts
26. Pearls and PitfallsPearls and Pitfalls
…and speaker’s biases…and speaker’s biases
- Address all pathologyAddress all pathology
- Set tension to neutralSet tension to neutral
- Trend early mobilization and WBTrend early mobilization and WB
- Largest factorLargest factor
- ““Lay the crepe”Lay the crepe”
- Big reconstructions take 12-18 monthsBig reconstructions take 12-18 months
- Risk for complications increase with bigRisk for complications increase with big
surgerysurgery