Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Jun 2007
Randomized Controlled Trial Comparative StudyRopivacaine versus lidocaine in digital nerve blocks: a prospective study.
Ropivacaine is a relatively new long-acting amide local anesthetic. Since its introduction in 1996, it has been used for subcutaneous infiltration; epidural, intrathecal, and peripheral nerve block surgery; and postoperative analgesia. However, it has never been used for digital blocks. This prospective, randomized, double-blind study compares the digital block results following the administration of 2.5 ml of 0.75% ropivacaine solution and 2.5 ml of 2% lidocaine solution. ⋯ Ropivacaine can be used effectively as a local anesthetic for digital nerve blocks. It can be used for prolonged operations (>1.5 hours) without additional injections and can provide long-lasting postoperative analgesia.
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Plast. Reconstr. Surg. · Jun 2007
Randomized Controlled Trial Comparative StudySedation analgesia during office-based plastic surgery procedures: comparison of two opioid regimens.
The combination of sedative and analgesic drugs is increasingly being used during minimally invasive surgery. The authors compared the clinical efficacy of two different fentanyl regimens, in combination with midazolam, for sedation analgesia in patients undergoing office-based plastic surgery procedures under local anesthesia. ⋯ Higher doses of opioid did not improve the quality of perioperative patient comfort but acted synergistically with the sedative drugs, amplifying the hemodynamic and respiratory side effects.
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Plast. Reconstr. Surg. · Jun 2007
Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps.
Microvascular free tissue transfer is a reliable method for reconstruction of complex surgical defects. However, there is still a small risk of flap compromise necessitating urgent reexploration. A comprehensive study examining the causes and methods of avoiding or treating these complications has not been performed. The purpose of this study was to review the authors' experience with a large number of microvascular complications over an 11-year period. ⋯ Microvascular free tissue transfer is a reliable reconstructive technique with low failure rates. Careful monitoring and urgent reexploration are critical for salvage of compromised flaps. The majority of venous thromboses can be salvaged. Arterial thromboses can be more problematic. An algorithm for flap exploration and salvage is presented.
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Plast. Reconstr. Surg. · Jun 2007
Differential effect of burn injury on fibroblasts from wounds and normal skin.
Although there are well-recognized fluctuations in the systemic concentration of cytokines and growth factors after burn injuries, the effect on wound-healing potential in patients is not well understood. The objective of this study was to characterize the proliferation rate and response of wound and dermal fibroblasts to cytokines in burn patients compared with normal subjects. ⋯ The data suggest that systemic mediators markedly alter the proliferation potential of dermal fibroblasts but not of wound fibroblasts. However, the wound environment substantially alters both the proliferation rate and the responsiveness of fibroblasts to cytokines. Thus, the data support the value of using wound fibroblasts during preliminary in vitro experiments to investigate wound-healing modification by cytokine manipulation.