Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · May 2012
Perioperative antibiotic prophylaxis in plastic surgery: a prospective study of 1,100 adult patients.
Although guidelines for antibiotic prophylaxis to prevent surgical site infections (SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics. A total of 1100 patients were prospectively studied according to an evidence-based protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does increase the infection rate. ⋯ Specific guidelines are provided to encourage judicious use of antibiotics. Antibiotic prophylaxis is administered based on the type of operation and the patient's characteristics. No prophylaxis was carried out in superficial skin surgery and simple mucosal excisions. Antibiotic prophylaxis is always indicated in microsurgery, prosthetic surgery, incisional hernias, clean non-prosthetic osteoarticular surgery and clean-contaminated procedures such as oral cavity or genitourinary system. In clean surgery and rhinoplasty, antibiotic prophylaxis is only indicated when the operation lasts more than 3 h and/or the American Society of Anesthesiologists (ASA) score is 3 or more. With the protocol reported, the risk of infection can be kept very low, avoiding the negative effects of indiscriminate use of antibiotics.
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J Plast Reconstr Aesthet Surg · May 2012
Case ReportsUse of tranexamic acid to reduce bleeding in burns surgery.
We describe, for the first time, the use of topical tranexamic acid as an adjunct to traditional methods in the control of bleeding in burns surgery. We illustrate our use with a case example and continue to discuss the reasons we believe it is a useful, effective and safe means of achieving haemostasis.
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J Plast Reconstr Aesthet Surg · May 2012
Case ReportsRemoval of a titanium ring using a dental saw.
Titanium is becoming increasingly popular in the manufacture of jewellery. Titanium rings are notoriously difficult to remove in an emergency situation and there is speculation amongst the general public that amputation is sometimes necessary due to the indestructibility of this material. We present the case of removal of a titanium ring using a dental saw allowing the patient's finger to be preserved.
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J Plast Reconstr Aesthet Surg · May 2012
Case ReportsTemporary catheter first perfusion during hand replantation with prolonged warm ischaemia.
Since the first successful arm replantation reported by Malt and McKhann in 1962, developments and refinements to upper extremity replantation techniques have led to higher success rates with better functional outcomes. One of the most important determinants of a successful macroreplantation is the ischaemic time of the amputated part, as irreversible muscle necrosis begins after 6 hours of warm ischaemia. With major trauma and plastic surgery units usually covering a wide geographical area, it is often difficult to ensure patient injury to revascularization time is less than 6 hours. In 1981, Nunley et al described the temporary catheter perfusion technique in upper limb replantation surgery to reduce ischaemia time without any significant complications. When used in appropriate cases this technique can reduce complication rates in upper limb replantation surgeries. ⋯ Temporary catheter perfusion is well described in proximal upper limb replantation procedures. This case shows that it is also a useful adjunct for hand replantation, particularly when the patient presents with a critical duration of warm ischaemia.
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J Plast Reconstr Aesthet Surg · May 2012
Our experience with triceps nerve reconstruction in patients with brachial plexus injury.
Although elbow extension is facilitated by gravity, triceps muscle provides elbow joint stability; in patients with brachial plexus injuries stable elbow is necessary for obtaining useful hand function. This study presents the senior author's experience with triceps nerve reconstruction and the functional results in patients with brachial plexus injuries. Outcomes were analyzed in relation to denervation time, severity score, length of the interposition nerve graft and donor nerves used. ⋯ Intercostal nerves and the posterior division of contralateral C7 proved preferred donors for elbow extension restoration in multiple avulsions. Although it is difficult to restore strong elbow extension, triceps nerve reconstruction is suggested in brachial plexus management, since it provides elbow stability. Satisfactory elbow extension strength was restored in young patients with high severity score.