Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Nov 2007
Case ReportsReconstruction of postburn neck contractures using free thin thoracodorsal artery perforator flaps with cervicoplasty.
Severe postburn neck contractures are devastating functional and cosmetic deformities. The ideal material for coverage of defects created by neck contracture release is thin, supple, large, well-vascularized, healthy tissue. The thoracodorsal artery perforator flap, a workhorse flap for reconstruction, allows a large dimension and free thickness control with low donor-site morbidity. The value of a free thin thoracodorsal artery perforator flap for anterior neck burn deformities has not been evaluated in a substantial series. ⋯ The free thin thoracodorsal artery perforator flap with cervicoplasty provides good functional and aesthetic results in terms of neck contour and cervicomental angle, with a reduced necessity for secondary procedures and low donor-site morbidity. This method is highly valuable for reconstruction of severe postburn neck contractures.
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Plast. Reconstr. Surg. · Nov 2007
Intravenous regional anesthesia administered by the operating plastic surgeon: is it safe and efficient? Experience of a medical center.
Intravenous regional anesthesia (Bier's block) is an effective method of providing anesthesia for extremity surgery. This technique is most suitable for short-duration, less than 60-minute surgical procedures in distal extremities. Earlier studies recommended that intravenous regional anesthesia be performed by anesthesiologists who are familiar with the technique and fully trained to treat its complications. This study was conducted to demonstrate that intravenous regional anesthesia administered by the operating plastic surgeon is safe, efficient, and simple to perform. ⋯ Despite earlier worries about the safety of intravenous regional anesthesia if not administered by anesthesiologists, the authors found that intravenous regional anesthesia represents a safe and efficient technique of anesthesia for extremity surgery when performed carefully and appropriately by the operating surgeon. The authors suggest that plastic surgeons familiarize themselves with this technique, which is simple to perform. This could probably result in lower overall costs and greater autonomy for the surgeon.
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Plast. Reconstr. Surg. · Sep 2007
Randomized Controlled TrialIntraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty.
Breast reduction is one of the most frequently performed plastic surgical procedures in the United States; more than 160,500 patients underwent the procedure in 2005. Many outpatient reduction mammaplasty patients report the greatest postoperative discomfort in the first 48 hours. The authors' investigated the effect of intraoperative topical application of the long-acting local anesthetic agent bupivacaine (Sensorcaine or Marcaine) on postoperative pain, time to postanesthesia care unit discharge, and postoperative use of narcotic medication. ⋯ This prospective, randomized, single-blind study demonstrates that a single dose of intraoperative Sensorcaine provides a safe, inexpensive, and efficacious way to significantly shorten the length of postanesthesia care unit stay and significantly decrease postoperative opioid analgesic use in patients undergoing ambulatory reduction mammaplasty.
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Plast. Reconstr. Surg. · Sep 2007
ReviewMeasuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments.
Patient-reported outcomes in cosmetic and reconstructive breast surgery are increasingly important for clinical research endeavors. Traditional surgical outcomes, centered on morbidity and mortality, remain important but are no longer sufficient on their own. Quality of life has become a crucial research topic augmenting traditional concerns focused on complications and survival. Given this, reliable and valid patient questionnaires are essential for aesthetic and reconstructive breast surgeons. ⋯ Valid, reliable, and responsive instruments to measure patient-reported outcomes in cosmetic and reconstructive breast surgery are lacking. To demonstrate the benefits of aesthetic and reconstructive breast surgery, future research to rigorously develop and validate new cosmetic and reconstructive breast surgery-specific instruments is needed.
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Plast. Reconstr. Surg. · Sep 2007
Free tissue transfer to the lower extremity distal to the zone of injury: indications and outcomes over a 25-year experience.
Microvascular free flap anastomoses performed for lower extremity reconstruction are traditionally proximal to the zone of injury. The authors assessed the feasibility and outcomes of microvascular free flaps with anastomoses performed distal to the zone of injury. ⋯ The authors' extensive 25-year experience with lower extremity reconstruction demonstrates that in appropriately selected patients, free tissue transfer to recipient vessels distal to the zone of injury is reliable and in certain cases preferable.