Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Nov 2008
Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery.
The use of antimicrobial prophylaxis against surgical site infection (SSI) is widespread in plastic surgery, while results from prospective randomised controlled trials in guiding antibiotic use are lacking. The purpose of this study was to identify the incidence and risk factors for SSI in plastic surgery, and to evaluate the appropriateness of prophylactic antibiotic prescribing habits in a tertiary university centre. ⋯ This is the first study evaluating appropriateness of antimicrobial prophylaxis use by plastic surgeons. Despite widespread use of prophylactic antibiotics, significant SSI rates were still present and frequently responsible for re-hospitalisations and re-interventions. The appropriateness of administration and indications for perioperative prophylactic antibiotic use must be evaluated.
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J Plast Reconstr Aesthet Surg · Nov 2008
Long-term results after vascularised joint transfer for finger joint reconstruction.
Vascularised complete joint transfer from the finger or the second toe offers the unique possibility of reconstructing a joint defect on the thumb or fingers using autologous tissue, which fully preserves its growth potential. Indications for vascularised joint transfer on the finger in children are set because of lack of therapy options offering normal growth potential. In adults vascularised joint transfer is indicated in case of contraindication for prosthetic joint replacement or arthrodesis. ⋯ Whenever possible the 'tissue bank concept' according to CHASE should be applied in finger joint reconstruction using a vascularised joint graft from either an amputated or a redundant digit. Results of vascularised joint transfer have to be compared to those of persisting joint defect, prosthetic joint replacement, arthrodesis, or ultimately amputation of the finger involved. Patients in whom a vascularised joint transfer is anticipated should be informed about the following points: (1) The risk of failure (vascular failure, tendon adhesion, joint stiffness, etc.) is about 10%. (2) The expected active range of motion depends on aetiology, age, donor site and recipient site. Traumatic joint defects show a greater active range of motion than congenital defects. Children have more active joint motion than adults. (3) Because of minor donor site impairment and rapid recovery of normal gait the whole second ray should be amputated after harvesting of a joint graft on the second toe. (4) Hospitalisation takes 1-2 weeks. Immobilisation of the hand (palmar forearm splint) and the foot (lower leg cast) should be applied for 4 to 6 weeks. Intensive physiotherapy is necessary for at least 3 months. Additional splinting is advised for about 6 months. (5) Extensor tendolysis is necessary in a large number of cases but should not be done earlier than 6 months after transplantation.