Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · May 2005
Comparative StudyA biomechanical comparison of four extensor tendon repair techniques in zone IV.
This study was designed to evaluate the biomechanical parameters of four different suture techniques specifically designed for zone IV extensor tendon injuries: the double figure of eight, the double modified Kessler, the six-strand double-loop, and the modified Becker suturing techniques. Ease of repair, tendon shortening, strength to 1-mm gap, strength to 2-mm gap, ultimate strength, and mode of repair failure were evaluated. ⋯ This study shows that the modified Becker suture technique, although not easily performed, proved to be the strongest repair, with a significantly greater resistance to 1-mm and 2-mm gap and the greatest ultimate strength on maximal loading.
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Reports of a correlation between relief of migraine headaches and resection of corrugator muscles or injection of botulinum A toxin have renewed interest in finding the cause of migraine headaches and identifying the trigger sites. Four trigger sites have been described. One of these is along the course of the greater occipital nerve. Recent anatomical studies of this nerve have defined its location with respect to external landmarks, leading to new studies with gratifying results. There is a subset of patients who undergo chemodenervation or surgical release of the greater occipital nerve and note improvement or elimination of the symptoms along the greater occipital nerve course but who experience an emergence of migraine headache symptoms laterally. The authors propose the lesser occipital nerve as the source of pain in those who experience headaches laterally and involvement of the third occipital nerve in those who notice residual symptoms in the midportion of the occipital region. ⋯ This information can be used to conduct clinical trials of chemodenervation of these nerves in an attempt to eliminate migraine symptoms in the subset of patients who continue to experience residual symptoms after surgical release of the greater occipital nerve.
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Plast. Reconstr. Surg. · May 2005
Current trends in local anesthesia in cosmetic plastic surgery of the head and neck: results of a German national survey and observations on the use of ropivacaine.
The goal of this study was to evaluate at the national level the current practice in the use of local anesthetics in cosmetic head and neck surgery and to compare the results with the novel local anesthesia technique used in the authors' department over the past 2 years. ⋯ The survey showed a clear trend toward the increasing use of local anesthetics in cosmetic surgery of the head and neck. Although the use of prilocaine and lidocaine prevailed, adverse cardiovascular reactions in up to 8.1 percent seem high for cosmetic procedures. Furthermore, the need of additional intraoperative top-up infiltration adds to an uncontrolled cumulative effect and patient discomfort. On the basis of their positive 2 years of experience with ropivacaine, the authors strongly believe that ropivacaine offers significant advantages, both in efficacy and prolonged duration of analgesia, while reducing the risk for adverse side effects due to lesser toxicity. This observation deserves further investigation in an established comparative study.
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Plast. Reconstr. Surg. · May 2005
Randomized Controlled TrialRapid absorption of tumescent lidocaine above the clavicles: a prospective clinical study.
Tumescent local anesthesia has been adapted for surgery of the face and neck, but there are no data regarding drug absorption when tumescent injection is used in this region. The aim of this study was to characterize the changes in plasma lidocaine concentrations over time when a tumescent solution is injected into the subcutaneous tissue of the neck. The study was carried out in human volunteer subjects, and injection of lidocaine to the thighs provided control data. ⋯ Tumescent injection above the clavicles results in a rapid rise in plasma lidocaine concentration when compared with injection to the lower extremities. Toxic symptoms could occur much earlier than expected for lower extremity tumescent anesthesia. In addition, dangerous plasma levels could occur if tumescent anesthesia in the lower extremities is followed by tumescent injection above the clavicles, because the absorption curves would be superimposed.
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The aim of this study was to define a posterior neuromuscular compartment of the deltoid with adequate innervation and circulation for use as a local transposition flap as well as a functional flap to restore shoulder and elbow function. ⋯ A posterior neuromuscular functional compartment of the deltoid has been identified.