Journal of plastic surgery and hand surgery
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J Plast Surg Hand Surg · Feb 2014
Combined usage of intercostal nerve block and tumescent anaesthesia: an effective anaesthesia technique for breast augmentation.
Patients are occasionally unhappy with the size, shape, and positioning of breast implants. An option to improve their satisfaction with breast augmentation includes directly involving them in the process with awake surgery done under nerve block and tumescence. This study describes the resultsof using such an awake anaesthesia technique in 35 patients. ⋯ Combined usage of the intercostal nerve block and tumescent anaesthesia effectively reduces pain during breast augmentation. Keeping patient conscious enables meeting their requests during operation, contributing to increased satisfaction. For these advantages, combined usage of the intercostal nerve block and tumescent anaesthesia is recommended as a useful anaesthetic technique for breast augmentation.
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J Plast Surg Hand Surg · Dec 2013
Review Meta AnalysisEffectiveness of local anaesthetic pain catheters for abdominal donor site analgesia in patients undergoing free lower abdominal flap breast reconstruction: A meta-analysis of comparative studies.
The use of an infusion pain pump with local wound catheters has increased among different surgical specialities. Autologous breast reconstruction with deep inferior epigastric perforator (DIEP) and transverse rectus abdominis myocutaneous (TRAM) flaps may cause severe abdominal donor site morbidity, and infusion devices delivering local anaesthetic are suggested to improve postoperative analgesia. This study performed a meta-analysis comparing pain pump use vs control to evaluate this issue. ⋯ Although not statistically significant, the pooled results showed a trend toward reduction of antiemetic medicament use (MD = -0.71, 95% CI = -2.14, 0.72, p = 0.33) and hospital stay time (MD = -0.53, 95% CI = -1.18, 0.11, p = 0.10). The use of local anaesthetic pain catheters for abdominal donor sites in microsurgical breast reconstruction might be associated with a decreased use of narcotics and antiemetic medicaments and shorter hospital stay. Further studies are needed to validate this promising treatment modality.
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J Plast Surg Hand Surg · Dec 2013
Acute paediatric bite injuries treated on inpatient basis: a 10-year retrospective study and criteria for hospital admission.
The aim of this study was to evaluate the acute bite wounds in children treated on an inpatient basis over a 10-year period and the criteria for inpatient treatment. This study comprised all acute mammalian bite injuries in relation to all paediatric bite injuries seen at the Emergency Surgical Department (ESD). Inclusion criteria were: aged between 0-18 years; acute human or animal bite injuries (presenting for the first time); and inpatient treatment. ⋯ In one case a partial distal flap necrosis occurred. Animal bite injuries treated on an inpatient basis are predominantly dog bites in young children under 10 years of age, with deep, extended, and commonly multiple injuries. Only 7% of paediatric bite injuries require inpatient treatment.
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J Plast Surg Hand Surg · Oct 2013
Comparative StudyCorrection of hyperpigmented palmar grafts with full-thickness skin grafts from the lateral aspect of the foot.
The palmar surface of the hand possesses special features when compared with the hair-bearing parts of the body. The same quality of skin has to be used in reconstruction of the palmar skin defects to restore normal function. The lateral aspect of the foot has similar features with the palmar region histologically and can be used for palmar reconstruction. ⋯ Minimal marginal scarring and scar hypertrophy occurred in four patients (24%). The skin of the lateral aspect of the foot is a good choice for palmar skin defects, because of the similarities in their characteristics. Results are acceptable in terms of minimal recurrence of scar contracture, no hyperpigmentation, adequate colour and texture match, and minimal marginal scarring and scar hypertrophy.
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J Plast Surg Hand Surg · Oct 2013
Multicenter Study Comparative StudyImmediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: a multi-institutional comparison of short-term complications.
Prosthesis-based techniques are the predominant form of breast reconstruction worldwide, with two-stage tissue expander procedures being the most popular. In the past decade, there has been increasing interest in performing single-stage implant reconstruction immediately following mastectomy as an attempt to simplify the reconstructive course and improve psychosocial morbidity. However, there is a paucity of large-scale, multi-institutional data comparing the outcomes of these two reconstructive strategies. ⋯ There was no difference in the rate of any surgical site infections (3.9% compared with 3.4%, p = 0.39), reoperation (7.5% compared with 6.9%, p = 0.40), or major medical complications (1.8% compared with 1.6%, p = 0.57). Both immediate one-stage, direct-to-implant, and two-stage tissue expander reconstructions result in low rates of morbidity. One-stage reconstruction suggests a slightly higher complication rate related to prosthesis failure.