Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Sep 2009
Randomized Controlled TrialThe impact of topical lidocaine on pain level assessment during and after vacuum-assisted closure dressing changes: a double-blind, prospective, randomized study.
Vacuum-assisted closure dressing changes are frequently painful. The authors hypothesized that administering topical lidocaine into the vacuum-assisted closure sponge would decrease pain during dressing changes. ⋯ During the initial vacuum-assisted closure dressing change, 0.2% lidocaine administered through the suction tubing led to a reduction in pain reported by the patients in the authors' study. The duration of lidocaine administered in this fashion may be fairly short, because more patients in this group began to request small doses of opiates 30 minutes after the dressing change. Thus, lidocaine may improve patient comfort during vacuum-assisted closure therapy.
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Plast. Reconstr. Surg. · Sep 2009
A detailed analysis of the reduction mammaplasty learning curve: a statistical process model for approaching surgical performance improvement.
The increased focus on quality and efficiency improvement within academic surgery has met with variable success among plastic surgeons. Traditional surgical performance metrics, such as morbidity and mortality, are insufficient to improve the majority of today's plastic surgical procedures. In-process analyses that allow rapid feedback to the surgeon based on surrogate markers may provide a powerful method for quality improvement. ⋯ The results of this study suggest a three-phase learning curve in which complication rates, variance in operative time, and operative time all decrease with surgeon experience. In-process statistical analyses may represent the beginning of a new paradigm in academic surgical quality and efficiency improvement in low-risk surgical procedures.