Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Feb 2009
Case ReportsSubcutaneous emphysema of the upper extremity following penetrating blackthorn injury to the wrist.
Noninfective subcutaneous emphysema of the upper extremity, albeit rare, has to be borne in mind when treating patients with subcutaneous emphysema. The misdiagnosis of this condition as its serious infective counterpart often leads to unnecessary aggressive treatment. Noninfective subcutaneous emphysema often accompanies a patient who has no systemic symptoms of illness. ⋯ Penetrating blackthorn injury is common, especially in rural communities, and often occurs from farming or gardening activities. Blackthorn penetration can cause numerous tissue reactions once embedded under the skin and they are often contaminated with soil. Here we present, for the first time, a case where penetrating blackthorn injury to the wrist resulted in noninfective subcutaneous emphysema involving the whole upper limb and neck, and its subsequent management.
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J Plast Reconstr Aesthet Surg · Feb 2009
Randomized Controlled TrialInfluence of controlled hypotension versus normotension on amount of blood loss during breast reduction.
Controlled hypotension employed during surgical procedures results in a beneficial reduction in blood loss during the operation. Breast reduction is a common cosmetic surgical procedure. Yet, in the Netherlands, controlled hypotension is not standard during breast reduction procedures, and in fact is only occasionally employed. ⋯ A trend in favour of hypotension does suggest it may also help reduce postoperative complications. Our data indicate that a reduction in blood loss of more than 50% can be achieved by employing controlled hypotension in the first operative phase of breast reduction. A reduction in systolic pressure of 20-25% with the use of nitroprusside is sufficient to achieve this reduced blood loss.
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J Plast Reconstr Aesthet Surg · Feb 2009
Comparative StudyImproving postoperative analgesia for transverse rectus abdominis myocutaneous flap breast reconstruction; the use of a local anaesthetic infusion catheter.
Postoperative pain relief can be delivered either directly to the operative site, or systemically. When effective analgesia can be provided locally, the side effects of systemic analgesia can be avoided, reducing the morbidity of the procedure. We examined the effects of delivering local anaesthetic to the rectus sheath via a multilumen infusion catheter following transverse rectus abdominis myocutaneous (TRAM) flap surgery, and compared the outcomes with patients managed using patient-controlled analgesia (PCA). ⋯ Fourteen patients were also successful managed with just the infusion catheter and supplementary analgesia, avoiding completely the use of PCA. A 1.5-day reduction in length of hospitalisation was also found. Local anaesthetic infusion delivery to the rectus sheath significantly reduces narcotic requirements, may eliminate the need for PCA, and has an associated significant decrease in the postoperative nausea and vomiting commonly seen in TRAM breast reconstructions.
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J Plast Reconstr Aesthet Surg · Feb 2009
Case ReportsNecrotising fasciitis of the thigh secondary to a perforated rectal cancer.
We report a rare case of rectal cancer presenting with necrotising fasciitis of the posterior thigh. Perforation of a rectal cancer adjacent to the piriformis muscle provided a route for bowel contents to travel into, and contaminate, the posterior compartment of the thigh. This case highlights the need for prompt diagnosis, urgent aggressive surgical debridement and consideration of a rare underlying cause in the management of necrotising fasciitis.