Plastic and reconstructive surgery
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As pressure on resources increases, decision makers in health care are increasingly seeking high-quality, scientific evidence to support clinical and health policy choices. Ultimately, legislators will look to develop performance measures based on evidence, rather than on consensus or commonality of practice. ⋯ In doing so, we will challenge the common practice of basing clinical decisions solely on what we are taught, procedures we are most comfortable doing, or procedures that are most financially rewarding. These efforts will not only afford us the best opportunity to provide optimal care to patients but also allow us to demonstrate the inherent quality of our surgical specialty.
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Plast. Reconstr. Surg. · Dec 2008
Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients.
The purpose of this study was to stratify plastic surgery patients into venous thromboembolism risk categories; identify patients at highest risk for venous thromboembolism; and quantify rates of postoperative all-cause mortality, venous thromboembolism, and hematoma/bleeding on different forms of thromboprophylaxis. Furthermore, this study aimed to determine the compliance and average duration of outpatient chemoprophylaxis. ⋯ Mechanical prophylaxis plus subcutaneous heparin (unfractionated or low-molecular-weight heparin) conferred a statistically significant reduction in the rate of venous thromboembolism without a significant increase in bleeding versus mechanical prophylaxis alone. Subgroup analysis of patients placed on mechanical prophylaxis plus low-molecular-weight heparin revealed similar statistically significant findings. Outpatients placed on low-molecular-weight heparin chemoprophylaxis demonstrated excellent compliance and comfort with self-administration. Therefore, the use of mechanical prophylaxis supplemented with low-molecular-weight heparin is strongly recommended as the first-line regimen for thromboprophylaxis in plastic surgery patients at highest risk for venous thromboembolism.
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Plast. Reconstr. Surg. · Dec 2008
Superficial inferior epigastric vessels in the massive weight loss population: implications for breast reconstruction.
Breast cancer risk and reconstructive options after massive weight loss are undefined. Use of the resulting pannus for autologous reconstruction is possible, with one option being the superficial inferior epigastric artery (SIEA) flap. Large superficial inferior epigastric vessels have been observed in massive weight loss patients during abdominal contouring procedures, but their anatomical features have not been assessed. ⋯ The superficial inferior epigastric vessel system is commonly present in massive weight loss patients. Body mass index before weight loss is the strongest predictor of SIEA presence and usability. When massive weight loss patients present for breast reconstruction, careful patient selection along with weight loss history and assessment of pannus size may aid in determining the likelihood of using the SIEA flap.
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Plast. Reconstr. Surg. · Dec 2008
Low-dose propranolol improves cutaneous wound healing of burn-injured rats.
Severe burns stimulate a hypermetabolic response that causes systemic complications. Propranolol, a nonselective beta-blocker, reduces this response and increases survival. Nevertheless, few studies have shown the effects of propranolol on healing of severe burns. This study evaluated macroscopically and microscopically the effects of the administration of propranolol (low-dose) on cutaneous wound healing of burn-injured rats. ⋯ Administration of (low-dose) propranolol improves healing of burned rats, reducing the local inflammatory response and improving subsequent healing phases.