Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2008
Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy.
Reliable detection of circulatory compromise threatening free-flap viability is essential for prompt surgical intervention and flap salvage. Numerous techniques have been developed to address the issue of postoperative flap monitoring but none have achieved universal acceptance. Near infrared spectroscopy (NIRS) is a noninvasive technique that allows continuous monitoring of tissue oxygenation and perfusion. It is increasingly recognised to be a reliable method for flap viability assessment. This study was designed to investigate the ability of NIRS to detect and identify microvascular thrombosis endangering flap survival. To our knowledge, this is the first clinical evaluation of NIRS used for continuous monitoring of free flaps. ⋯ Continuous NIRS monitoring can reliably detect and identify early stages of arterial and venous thrombosis, and is a credible method for noninvasive postoperative flap surveillance. Based on these findings, we advocate its use for monitoring of flaps with a cutaneous component.
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Visual images can enhance communication over a distance. In the UK, plastic surgery provides services over large distances by a 'hub and spoke' model. Telemedicine could help to increase the efficiency of service for plastic surgery patients. ⋯ We found no change in the patients being managed with telephone only advice. We found that telemedicine is a valuable method of providing useful preliminary information in the referral process for injured patients and often significantly modifies their treatment and/or management plan. This has implications for the use of Information Technology resources and potentially the delivery of healthcare in relation to the management of injured patients.
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J Plast Reconstr Aesthet Surg · Jan 2008
Case ReportsLichtenberg figures: cutaneous manifestation of phone electrocution from lightning.
Lichtenberg figures are reddish, fern-like patterns that appear on the skin when a patient is struck by lightning. These appear to be a result of an inflammatory response as current spreads out causing ionisation and heat effects and damage to the small subcutaneous capillaries. ⋯ The cutaneous manifestation of a surreptitious lightning strike through a telephone plays an important role in diagnosing the problem and is particularly significant when the patient is unconscious and unable to give a history of events or, as in this case, has retrograde amnesia. Establishing the diagnosis enables us to look for other lightning-associated injuries and to monitor the cardiac status of the patient to avoid any concomitant complications. Also, establishing the diagnosis is extremely helpful to allay patient anxiety as Lichtenberg figures on the skin can be quite dramatic, as seen in this case.
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J Plast Reconstr Aesthet Surg · Jan 2008
Ear reconstruction following severe complications of otoplasty.
Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. ⋯ While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.
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J Plast Reconstr Aesthet Surg · Jan 2008
Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.
The ability of near infrared spectroscopy (NIRS) to predict vascular compromise in vascular free flaps postoperatively has been assessed, and the extent of regional tissue oxygen saturation (rSO(2)) after fibular flap transplantation was investigated quantitatively. To validate the sensibility and precision of the technique, the following methods were used. (1) Forearm vessel obstructive tests were conducted in four healthy volunteers. (2) Measurement and analysis of bilateral rSO(2) at the mandibular body and ramus were performed in 40 healthy volunteers by NIRS in the morning and afternoon. (3) Measurement and analysis of rSO(2) in transplanted fibular flaps for 41 cases with mandibular reconstruction were performed by NIRS at postoperative days 1-6. The results were: NIRS had high sensibility and precision in monitoring rSO(2) of living tissues. ⋯ However, rSO(2) in the transplanted fibular flaps was reduced compared to the value on the control side. rSO(2) decreased gradually 4-12 hours postoperatively. After that period, rSO(2) increased gradually and approached the value of the control side at 20 h after the operation. It can be concluded that NIRS is a reliable noninvasive method for monitoring blood circulation in transplanted tissues, particularly for buried flaps.