Plastic and reconstructive surgery
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The authors present their clinical experience and surgical methods of fingertip coverage using a short-pedicle partial medial second toe pulp free flap. The surgical steps for reducing surgical time and donor-site morbidity are described. ⋯ The shorter pedicle and smaller flap can reduce the surgical time and morbidity associated with this procedure. This flap is the authors' first line of treatment for covering fingertip wounds by transferring similar pulp tissue from the toe to the finger.
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Plast. Reconstr. Surg. · Mar 2008
Randomized Controlled TrialA prospective, randomized, double-blind, controlled trial of continuous local anesthetic infusion in cosmetic breast augmentation.
Narcotic pain medications are a significant component of most postoperative pain control regimens. Although they are usually effective, they produce several untoward side effects and sometimes provide inadequate analgesia. The continuous infusion of local anesthetic agents (via pain pump) has been used to supplement narcotic analgesics after various surgical procedures. The purpose of this study was to examine the effectiveness of the pain pump after cosmetic breast augmentation. ⋯ The pain pump appears to provide breast augmentation patients marginal improvement in pain control, although this advantage did not reach statistical significance in this study. The benefit, if real, also appears to wane over the first postoperative week.
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Plast. Reconstr. Surg. · Mar 2008
The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps.
Debilitating pain following amputation surgery can seriously affect the long-term success of the operation and the patient's quality of life. Often, such patients are unable to ambulate because of pain when using a prosthesis; become grouped in the chronic pain category; and are treated with high-dose narcotics, antidepressants, or other methods to treat symptoms that may provide little or no relief. Little attention has been given to the role of peripheral nerve surgery as an early treatment option. ⋯ Peripheral nerve surgery plays a significant role in the treatment of chronic pain associated with amputation stumps. After conservative treatment methods have been exhausted, a treatment algorithm for peripheral nerve surgery is successful in improving or resolving chronic pain and the quality-of-life issues associated with amputation patients.
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Despite the reliability of microvascular free tissue transfer, flap loss remains a significant concern. To improve outcome, various pharmacologic agents have been used to prevent microvascular thrombosis. The authors review their experience with intraoperative heparin therapy, specifically addressing the risks of hematoma, pedicle thrombosis, and flap loss rate. ⋯ Intraoperative systemic heparin use has no statistically significant effect on the incidence of microvascular thrombosis. In addition, administration of a single dose of intraoperative heparin does not increase the rate of hematoma formation or prevent microvascular thrombosis. Thus, critical factors for flap survival are likely independent of the use of intraoperative anticoagulation.
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Plast. Reconstr. Surg. · Mar 2008
The importance of advanced cardiac life support certification in office-based surgery.
Safety in office-based surgery remains of paramount importance. Accordingly, many consider Advanced Cardiac Life Support training a critical component of safety preparation for office-based surgery. A survey was recently designed and distributed to assess the experience and attitudes of board-certified plastic surgeons toward Advanced Cardiac Life Support training. ⋯ Historically, Advanced Cardiac Life Support and facility accreditation were strongly recommended but often not required for office-based surgery. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have taken steps to increase patient safety, mandating that outpatient plastic surgery only be performed at accredited facilities. Many credentialing organizations are now escalating the requirements for Advanced Cardiac Life Support/Basic Life Support certification.