Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Aug 2009
Tissue expander infections in pediatric patients: management and outcomes.
Tissue expansion has become a well-established method for soft-tissue reconstruction in the pediatric population; however, the complication rate is still high, with infection being the most common complication. This study looks at a segment of the authors' cases over a 4-year period to document the incidence of infection, impact on completing the planned expansion, and how the treatment impacted the completion of goals. ⋯ Tissue expander infection in children does not seem to preclude further expansion and successful reconstruction.
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Striving to increase patient comfort and feasibility of performing abdominoplasties as outpatient procedures, investigators have been exploring alternative methods of anesthesia to safely avoid general anesthesia. These techniques may result in decreased narcotic administration, and decreased postoperative nausea and vomiting. The authors have added the use of preoperative local anesthesia rib blocks with sedation to replace general anesthesia in abdominoplasties. ⋯ Rib blocks placed before the start of surgery result in decreased recovery room times, pain, and postoperative nausea and vomiting, achieving increased patient comfort and feasibility of performing abdominoplasties in the outpatient setting.
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Plast. Reconstr. Surg. · Aug 2009
Pediatric dog bite injuries: a 5-year review of the experience at the Children's Hospital of Philadelphia.
The objective of this study was to characterize the nature of dog bite injuries treated over a 5-year period at a large tertiary pediatric hospital and to identify relevant parameters for public education and injury prevention. ⋯ Pediatric dog bites are preventable injuries, yet they persist as a prevalent public health problem. Evaluation of data from high-volume tertiary pediatric health care institutions identifies predictable patterns of injury with respect to patient age and gender, animal breed, provocation, and seasonality.
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After studying this article, the participant should be able to: 1. Discuss the clinical features of Marjolin's ulcer. 2. Identify the risk factors for the development of Marjolin's ulcer. 3. Develop a surgical management plan for the treatment of Marjolin's ulcer. ⋯ Marjolin's ulcer is a rare and aggressive cutaneous malignancy that arises on previously traumatized and chronically inflamed skin, especially after burns. This clinical condition was first described by Marjolin in 1828. The term "Marjolin's ulcer" has been generally accepted to refer to a long-term malignant complication of the scars resulting from burns. However, vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumor. Clinically, reports suggest that atrophic and unstable scars tend to develop into cancer. Various etiological factors have been implicated in the condition, including toxins released from damaged tissues, immunologic factors, cocarcinogens, and miscellaneous factors such as irritation, poor lymphatic regeneration, antibodies, mutations, and local toxins. The incidence of burn scars undergoing malignant transformation has been reported to be 0.77 to 2 percent. All parts of the body can be affected, but the extremities and the scalp are most frequently affected. There are two variants: acute and chronic. In the former, the carcinoma occurs within 1 year of the injury. The chronic form is more frequent and malignancy tends to develop slowly, with an average time to malignant transformation of 35 years. Although many different cell types can be seen in these lesions, the major histological type is squamous cell carcinoma. Marjolin's ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases; radical excision is the treatment of choice, but there is no consensus on lymph node dissection. Marjolin's ulcer can be insidious and often leads to a poor prognosis, and deaths from Marjolin's ulcer are not uncommon. Meticulous wound care is a crucial step in prevention of these lesions.