Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Oct 2009
ReviewEvidence-based patient safety advisory: malignant hyperthermia.
As more and more routine plastic surgery procedures move from the hospital to outpatient surgery facilities, plastic surgeons must be aware of the risk factors for life-threatening events that might occur in this setting. This awareness includes recognition of the signs and symptoms and the management of a rare but life-threatening condition, malignant hyperthermia. This article reviews the current understanding of the concepts pertinent to malignant hyperthermia diagnosis and treatment in the outpatient setting and current standards and recommendations for physicians and support personnel regarding malignant hyperthermia preparedness in office-based surgery and anesthesia.
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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.
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Plast. Reconstr. Surg. · Aug 2009
Comparative StudyBiomechanical comparison of lasso, Pulvertaft weave, and side-by-side tendon repairs.
The authors' group has developed and used a lasso repair as a substitute to the Pulvertaft weave when joining two tendons for tendon grafts and transfers. This study compared the maximum load, weave time, tendon length required, and bulkiness of the lasso, Pulvertaft weave, and side-by-side repairs. ⋯ The strength of the lasso tendon repair compared well with the Pulvertaft weave and was more convenient to perform. Side-by-side repair was inferior because of its low maximum load. This study suggests that lasso repair may be an alternative to the Pulvertaft weave in tendon grafts and transfers.