Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Oct 2013
ReviewHigh-pressure injection injuries in the hand: current treatment concepts.
High-pressure injection injury to the hand and upper extremity is a rare but very serious clinical entity. The objective of this article was to review the current available literature and highlight important topics. ⋯ High-pressure injection injuries to the hand can result in permanent impairment. Proper diagnosis and urgent treatment are essential for a good outcome.
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Local anesthetic injection is often cited in literature as the most painful part of minor procedures. It is also very possible for all doctors to get better at giving local anesthesia with less pain for patients. The purpose of this article is to illustrate and simplify how to inject local anesthesia in an almost pain-free manner. ⋯ There are now excellent techniques for minimizing anesthetic injection pain, with supporting evidence varying from anecdotal to systematic reviews. Medical students and residents can easily learn techniques that reliably limit the pain of local anesthetic injection to the minimal discomfort of only the first fine needlestick. By combining many of these conclusions and techniques offered in the literature, tumescent local anesthetic can be administered to a substantial area such as a hand and forearm for tendon transfers or a face for rhytidectomy, with the patient feeling just the initial poke.
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After reading this article, the participant should be able to: 1. Explain the present challenges in reconstructive burn surgery. 2. Describe the most appropriate treatment methods and techniques for specific burn injury types, including skin grafts, dermal substitutes, and a variety of flap options. 3. Identify the appropriate use, advantages, and disadvantages of specific flaps in the treatment of burn injuries, including local, regional, superthin, prefabricated, prelaminated, and free flaps. ⋯ Victims of thermal burns often form heavy scars and develop contractures around joints, inhibiting movement. As burns can occur in all cutaneous areas of the body, a wide range of reconstructive options have been utilized. Each method has advantages and disadvantages that must be considered by both patients and surgeons. The authors reviewed the literature for burn reconstruction and focused their discussion on areas that have been recently developed. They reviewed the mechanism of burn injury and discussed how this relates to the pathophysiology of the burn injury. Surgeons now have a wide array of plastic surgical techniques that can be used to treat burn victims. These range from skin grafts and local flaps to free flaps, prefabricated flaps, superthin flaps, and dermal scaffolds. Recent advances in burn reconstruction provide methods to decrease scar tissue and joint contractures. In the future, the authors hope that further developments in burn treatment will foster the development of new technologies that will allow site-specific reconstruction with minimal donor-site morbidity.
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After studying this article, the participant should be able to: 1. Describe the indications and contraindications for free flap reconstruction. 2. Describe the indications, anatomy, harvest technique, and advantages and disadvantages of the workhorse free flaps. 3. Describe the indications and contraindications for extremity replantation. 4. Describe the techniques and management for extremity replantation. ⋯ Microsurgical free flap reconstruction uses a multitude of surgical flaps available to meet the needs of the recipient site. These include cutaneous, muscle, bone, fascia, or some combination of these as available options. Furthermore, sophisticated reconstruction has been enhanced by the development of perforator flaps, enabling multicomponent reconstruction to be performed with reduced donor-site morbidity. It is mandatory that proper débridement of the defect be performed before reconstruction, and that the anastomosis is performed without tension or twisting outside of the zone of injury. There are indications for both musculocutaneous and perforator flaps, and selection is dependent on recipient-site characteristics in addition to function and aesthetics of both the recipient and donor sites. Muscle flaps provide well-vascularized pliable tissue and are used for deep space obliteration, whereas fasciocutaneous flaps are used for flatter, more superficial wounds. Microsurgical replantation of an amputated extremity offers a result that is usually superior to any other type of reconstruction. However, replantation of extremities involves more than microsurgery, as repair of bony and tendon injury must be undertaken as well. This article focuses on the indications, technique, and results of free flap reconstruction and replantation.
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Plast. Reconstr. Surg. · Nov 2012
ReviewComplications of acellular dermal matrices in abdominal wall reconstruction.
Acellular dermal matrices have been increasingly used in abdominal wall reconstruction. Unique characteristics of these grafts have allowed surgeons to reconstruct increasingly complex abdominal wall defects. This has resulted in a myriad of complications related to the acellular dermal matrix with unique management strategies as compared with synthetic mesh. ⋯ Complications are frequent in abdominal wall reconstruction. Many acellular dermal matrices have properties that allow for conservative management and maintenance of reconstruction when complications occur. With traditional synthetic mesh reconstruction, complications likely result in mesh explantation and prolonged morbidity. With acellular dermal matrix reconstruction, however, more conservative treatment strategies will allow for mesh salvage.