Plastic and reconstructive surgery
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Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. ⋯ No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.
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Plast. Reconstr. Surg. · Nov 1998
Case ReportsMicrosurgical replantation of an ear in a child without venous repair.
Ear amputation can leave a devastating deformity; the application of microsurgical replantation techniques has allowed very favorable aesthetic outcomes when successful. We report a case of ear replantation in a child in whom a venous repair was not performed; instead medicinal leeches were used to decompress the ear in the immediate postoperative setting. ⋯ A review of the literature reveals the high incidence of venous congestion requiring external decompression (57 percent) and the very high rate of salvage (80 percent) after replantation. Surgeons attempting ear replantation should be aware of the high rate of ear survival in the situation of no venous outflow (with appropriate decompression techniques) and should not abandon attempts at replantation because of the inability to establish venous outflow microsurgically.
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Plast. Reconstr. Surg. · Nov 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialThe use of silicone occlusive sheeting (Sil-K) and silicone occlusive gel (Epiderm) in the prevention of hypertrophic scar formation.
The development of hypertrophic scars and keloids is an unsolved problem in the process of wound healing. For this reason, a successful treatment to prevent excessive scar formation still has not been found. Over the last decade, however, a promising new treatment has been introduced. ⋯ Patients with an easily tanning skin, nonsmokers, and patients with an allergy showed more hypertrophic scar formation. Neither Sil-K, used in 68 patients, nor Epiderm, used in 61 patients, could prevent the formation of hypertrophic scars. If both groups were taken together, the scars treated with silicone materials even developed significantly more hypertrophy compared with the Micropore-applicated scars.
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Plast. Reconstr. Surg. · Nov 1998
Randomized Controlled Trial Clinical TrialUse of octyl-2-cyanoacrylate for skin closure in facial plastic surgery.
Octyl-2-cyanoacrylate is a long carbon chain cyanoacrylate derivative that is stronger and more pliable than its shorter chain derivatives. One hundred and eleven patients underwent elective surgical procedures by the same surgeon using either octyl-2-cyanoacrylate or sutures for skin closure at the University of Illinois at Chicago. Most patients underwent excision of benign skin lesions with a mean wound size of 112 mm3. ⋯ The lower visual analog scale score represented a superior cosmetic outcome at 1 year with the octyl-2-cyanoacrylate as compared with sutures. This difference is statistically significant at p = 0.03. Additionally, patient satisfaction was very high in the group treated with octyl-2-cyanoacrylate.
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Plast. Reconstr. Surg. · Nov 1998
Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients.
There is no agreement as to appropriate fluid resuscitation in patients undergoing liposuction. This has assumed greater significance, as surgeons have undertaken larger volume aspirations (> or = 4 liters) and the potential complications of hypovolemia and fluid overload have materialized. This prospective study of 53 consecutive healthy patients undergoing liposuction using a superwet technique served to develop general guidelines for safe perioperative fluid management, especially in regard to large-volume aspirations. ⋯ All patients have had unremarkable hospital courses. These guidelines do not replace sound clinical judgment. Good communication between the surgeon and anesthesiologist is critical to optimal patient care and safety.