Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · May 2009
Randomized Controlled TrialPostoperative analgesia and flap perfusion after pedicled TRAM flap reconstruction - continuous wound instillation with ropivacaine 0.2%. A pilot study.
Transverse rectus abdominis musculocutaneous (TRAM) flap surgery is a complex procedure characterised by an extensive wound site. We present a pilot study with 17 patients receiving continuous wound instillation with ropivacaine or isotonic saline. Patients undergoing TRAM flap surgery were included in the study and randomised to the ropi group or the control group. ⋯ Our data show a trend that continuous wound instillation of ropivacaine 0.2% increases pain relief after TRAM flap surgery with earlier bowel movement than intravenous opioid patient controlled analgesia (IV-PCA) alone. A does of 960 mg of ropivacaine daily did not result in toxic plasma concentrations. Ropivacaine 0.2% did not show a vasoconstrictor effect.
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J Plast Reconstr Aesthet Surg · May 2009
Randomized Controlled TrialEffects of high dose corticosteroids in open rhinoplasty.
Although some studies about the effects of steroids on surgical trauma in closed or combined (closed and open together) rhinoplasty have been reported in the literature, still more information is needed in order to enlighten rhinoplasty surgeons. The purpose of this study is to evaluate the anti-inflammatory activity of steroids administered in high doses to prevent and decrease periorbital ecchymosis and oedema in patients who underwent open rhinoplasty with osteotomies by the same surgeon. This is the first study in open rhinoplasty alone. ⋯ We can confidently say that high dose methylprednisolone is effective in preventing and reducing both the periorbital ecchymosis and oedema in open rhinoplasty with osteotomies and it can be used safely for this purpose.
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J Plast Reconstr Aesthet Surg · May 2009
Case ReportsPermanent scarring in a partial thickness scald burn dressed with Biobrane.
Biobrane is a biosynthetic wound dressing which has shown to be effective in partial thickness burns by improving wound healing, reducing the pain in dressing changes, and the need to use skin grafts. In addition, it has been shown to reduce both in-patient and outpatient hospital costs and incur no increase in infection rates. ⋯ Burns 2006;32:258-60]. We now report a second case of scarring with Biobrane, in which the Biobrane was left in place for a full 14 days, as recommended by the manufacturers.
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J Plast Reconstr Aesthet Surg · May 2009
Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VAC) therapy - worse or worth?
Controversy remains regarding timing in the management of complex traumatic lower extremity defects. Many authors recommend a definitive bony and soft tissue reconstruction within a critical period of 72 h, yet in many patients this may be impossible due to concomitant injuries or delayed referral. However, little data are available on the results of delayed flap reconstruction of complex traumatic extremity defects, especially using new technologies of wound coverage such as vacuum-assisted closure (VAC((R))) therapy which may reduce the disadvantages of conventional open wound therapy prior to a subsequent flap reconstruction. ⋯ According to this study, the flap reconstructions performed beyond the frequently quoted critical interval yielded similar results to those of immediate reconstruction within the first 3 days, as reported in the literature. This strategy is in accordance with the principles of 'Damage Control Orthopaedics (DCO)' and may reduce the importance of emergency reconstructions, especially in poly-traumatised patients.