Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Sep 1998
Arteriovenous malformations of the head and neck: natural history and management.
This is a retrospective review of 81 patients with extracranial arteriovenous malformation of the head and neck who presented to the Vascular Anomalies Program in Boston over the last 20 years. This study focused on the natural history and effectiveness of treatment. The male to female ratio was 1:1.5. ⋯ The cure rate was 75 percent for stage I, 67 percent for stage II, and 48 percent for stage III malformations. Outcome was not affected significantly by age at treatment, sex, Schobinger stage, or treatment method. Mean follow-up was 4.6 years.
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Plast. Reconstr. Surg. · Sep 1998
Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis.
Endoscopic carpal tunnel release is a controversial procedure used in the treatment of carpal tunnel syndrome. Although endoscopic carpal tunnel release is associated with less incisional pain and faster recovery time than the open carpal tunnel release, opponents of endoscopic carpal tunnel release suggest that its benefits are outweighed by its higher complication rates from median nerve transection and transient numbness of the fingers. Because of the huge economic and social impact of carpal tunnel syndrome in this country, we performed a cost-effectiveness analysis comparing endoscopic carpal tunnel release and open carpal tunnel release using guidelines established by the Panel on Cost-Effectiveness in Health and Medicine of the U. ⋯ For endoscopic carpal tunnel release to be a cost-effective procedure, the incidence of median nerve injury must be one percentage point less for endoscopic carpal tunnel release than for open carpal tunnel release. Based on the data from the randomized-controlled trials, endoscopic carpal tunnel release seems to be a cost-effective procedure; however, before it can be recommended, greater emphasis must be given to the training of surgeons in this new technique, so that major complications such as median nerve injuries can be avoided. In addition, future studies must better define the actual incidence of nerve injuries for both endoscopic carpal tunnel release and open carpal tunnel release in the community setting.
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Tissue expanders have become a useful adjuvant in pediatric burn reconstruction. We reviewed our experience with tissue expanders from June of 1984 to July of 1995. There were 403 expanders used in 301 patients. ⋯ With regard to the nine complications in the neck, face, ear, and supraclavicular area, two-thirds were related to leakage or exposure of the expanders, resulting from the tight anatomic area causing mechanical damage of the expanders as well as ischemia to the overlying skin. Early in the study, the lower extremities proved to involve difficult or unsatisfactory areas to expand, and lower extremity expansion was abandoned throughout the remainder of the study period. The overall decrease in absolute and relative complications is likely the result of increased operative experience as well as a developed protocol for the prevention of perioperative complications relating to infection and expansion in high-risk anatomic sites.
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Plast. Reconstr. Surg. · Sep 1998
Comparative StudyEarly excision and grafting versus conservative management of burns in the elderly.
Elderly burn patients have significantly higher mortality rates than younger patients with similar burns over the total body surface area. Two theories exist regarding treatment of burns in the elderly: a traditional approach to limit physiologic stress by avoidance of operative intervention in the early post-burn stage and eschar excision and wound closure within the first week of hospitalization. We examined retrospectively the outcome in patients 70 years or older, hospitalized in the University of Kentucky Burn Unit between 1975 and 1995. ⋯ In an effort to further define the two groups, the other patient variable that contributes to burn mortality besides age and total body surface area, inhalation injury, was subtracted and the mortality rates were recalculated. Excluding patients with inhalation injury, the mortality rate was 48 percent in the first group and 27 percent in the second group (p = 0.15). We conclude that, in our unit, the management of elderly patients by early excision and grafting was of no benefit and may have resulted in a higher mortality rate.