Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Jul 2008
The vertical and extended rectus abdominis myocutaneous flap for irradiated thigh and groin defects.
Thigh and groin tumors are often treated with limb-sparing surgery and adjuvant preoperative irradiation, frequently resulting in complex soft-tissue defects and wounds. The authors evaluated outcomes after reconstruction of these difficult wounds with the vertical and extended rectus abdominis myocutaneous (RAM) flap. ⋯ The vertical and extended RAM flaps provide reliable coverage of irradiated thigh and groin oncologic wounds, with significantly improved results obtained with immediate versus delayed reconstruction.
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Plast. Reconstr. Surg. · Jul 2008
Randomized Controlled TrialA local anesthetic pump reduces postoperative pain and narcotic and antiemetic use in breast reconstruction surgery: a randomized controlled trial.
The purpose of this study was to conduct a double-blind, randomized, prospective trial evaluating the efficacy of a local anesthetic pain pump in reducing postoperative pain, narcotic use, and the incidence of postoperative nausea and vomiting in breast reduction surgery. ⋯ The results of this study support the efficacy of a postoperative local anesthetic pain pump in reducing pain, narcotic use, and postoperative nausea and vomiting in women undergoing breast reduction.
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Plast. Reconstr. Surg. · Jul 2008
Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach.
Toxic epidermal necrolysis syndrome is a devastating disease, with mortality rates ranging between 20 and 60 percent. This study evaluated an alternative treatment approach using antishear wound care and compared outcomes using the severity of illness score for toxic epidermal necrolysis syndrome (SCORTEN) system. ⋯ Transfer to a burn intensive care unit and initiation of critical care and wound protocols similar to those used for burn patients are recommended for patients with toxic epidermal necrolysis syndrome. Antishear wound care provides an effective alternative wound care approach with equivalent mortality rates.
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This study reports the experience of the plastic surgery department at Naval Medical Center San Diego in treating wounds resulting from combat during Operation Iraqi Freedom. Introduction of new technology and modification of medical treatments have emerged to provide greater success in preserving life and limb. ⋯ The authors' results reflect a higher limb salvage rate than that achieved during previous wars. They feel their success was attributable to the use of wound vacuum-assisted closure, an aggressive surgical approach, and appropriate antibiotic therapy. Wound vacuum-assisted closure is the single intervention that is new among the authors' choices of techniques for treating combat wounds.