Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · May 2009
Discharge practices, readmission, and serious medical complications following primary cleft lip repair in 23 U.S. children's hospitals.
Discharge timing following primary cleft lip repair balances the desire to return patients to their home environment with the risk of serious complications occurring outside a hospital. To derive information to help estimate these risks, the authors evaluated discharge practices, readmissions, and serious medical complications following primary cleft lip repair at 23 children's hospitals in the Pediatric Health Information System over a 5-year period. ⋯ A number of factors related to the hospital, surgeon, patient, and patient's family bear consideration in deciding the timing of discharge after primary cleft lip repair. The most clinically important factor appears to be the overall preexisting medical status of the patient.
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Plast. Reconstr. Surg. · May 2009
Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia.
Occipital neuralgia is a headache syndrome characterized by paroxysmal headaches localizing to the posterior scalp. The critical diagnostic feature is symptomatic response to local anesthetic blockade of the greater or lesser occipital nerve. Further characterization is debated in the literature regarding the diagnosis and optimal management of this condition. The authors present the largest reported series of surgical neurolysis of the greater occipital nerve in the management of occipital neuralgia. ⋯ Neurolysis of the greater occipital nerve appears to provide safe, durable pain relief in the majority of selected patients with chronic headaches caused by occipital neuralgia.
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Plast. Reconstr. Surg. · Apr 2009
Predictable patterns of intracranial and cervical spine injury in craniomaxillofacial trauma: analysis of 4786 patients.
Patients presenting with traumatic craniomaxillofacial fractures often have occult concomitant injuries. This study was designed to determine whether facial fracture patterns are associated with a particular constellation of concomitant head and neck injuries. ⋯ Craniomaxillofacial fractures are commonly associated with head and cervical spine injuries that involve predictable patterns of force dispersion from the maxillofacial skeleton and transmission to the cranial vault and cervical spine. These results suggest that concomitant injuries should be investigated closely with distinct types of facial fractures.
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Plast. Reconstr. Surg. · Apr 2009
Vascularized ulnar nerve graft: 151 reconstructions for posttraumatic brachial plexus palsy.
Vascularized nerve grafts were introduced in 1976. Subsequent studies have suggested the superiority of vascularized nerve grafts. In this study, the authors present 23 years' experience with vascularized ulnar nerve graft. The factors influencing outcomes and a comparison with conventional nerve grafts are presented. ⋯ Vascularized ulnar nerve grafting is the appropriate solution for brachial plexus injuries with C8 and T1 root avulsion, with outcomes that are superior to those achieved with conventional nerve grafts. Although few changes have been made over time, the use of ulnar nerve grafts for neurotization of multiple motor targets of the median nerve from contralateral donors is under consideration.