Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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This is a review of 249 patients who have suffered ear trauma and who have presented for reconstruction over the last eighteen years. All were born with normal ears and had lost one or both ears or a major segment of the ear. Congenital ear problems including microtia are not included.
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J Plast Reconstr Aesthet Surg · Jan 2008
Clinical TrialAn improved alternative to vacuum-assisted closure (VAC) as a negative pressure dressing in lower limb split skin grafting: a clinical trial.
The use of negative pressure in the dressing of split skin grafts has been shown to promote healing by a variety of mechanisms, including a decrease in interstitial oedema, an increase in perfusion and a decrease in bacterial colonisation. Vacuum-assisted closure (VAC) dressings have, until now, been used as the archetype for negative pressure dressings and have been reflected as such in the literature. However, patient mobility and cost are still an issue with these dressings, and alternatives have been keenly sought. We describe an alternative method of negative pressure dressing, which we have found to be a safe and successful alternative in the setting of lower limb split skin grafts. ⋯ The use of a simple suction drain is a cheap and safe alternative to commercial VAC dressings for the treatment of lower limb split skin grafts. Length of hospital stay and cost are superior to VAC, with no diminished clinical outcome.
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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.