Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Sep 2006
Case ReportsOffice surgery safety: the myths and truths behind the Florida moratoria--six years of Florida data.
Office-based surgery is an important method of health care delivery, and in 2000, the Florida Board of Medicine restricted office procedures. The objective of this study was to analyze the deaths resulting from office procedures in Florida. ⋯ There were over 600,000 operations during the study period. The fact that 11 office deaths were reported would suggest that the location in which these procedures were performed was not as much of a factor as the regulators have suggested. The most frequent cause of death after discharge was thromboembolism.
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Mallet finger deformity is a common disability that causes discomfort and inconvenience to the patient. Although numerous operative techniques have been described, surgical management remains controversial. ⋯ The pull-in technique allows accurate realignment of the tendon-bone unit without any specific instrumentation or intraoperative fluoroscopic imaging methods.
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Plast. Reconstr. Surg. · Aug 2006
Randomized Controlled Trial Comparative StudyRandomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block.
Three local anesthetics are commonly used for digital nerve block: 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine, and 0.5% bupivacaine. The authors have not identified a study that has compared these three agents in digital nerve block in a randomized fashion. The goal of this study was to determine which of the three agents provided the longest duration of digital nerve blockade. ⋯ At an average of 24.9 hours, bupivacaine (0.5%) provides a significantly longer digital anesthesia time than the average 10.4 hours achieved by 2% lidocaine with epinephrine (1:100,000), which in turn provides twice as long an anesthesia time as 2% lidocaine (average, 4.9 hours).
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Plast. Reconstr. Surg. · Aug 2006
ReviewBurn injuries inflicted on children or the elderly: a framework for clinical and forensic assessment.
After studying this article, the participant should be able to: 1. Understand the difference between battery and assault in U.S. law and the concepts of the phrase "child abuse" and "elder abuse." 2. Understand that state statutes vary and can define abuse narrowly or with great specificity, and that either definition has inherent problems for physicians treating victims of abuse and neglect. 3. Know where to find the state-specific legal criteria for child or elder abuse and neglect, along with the corresponding standards for mandatory reporting and physician accountability. 4. Understand the relevant law regarding physician-patient privilege and the repercussions of incorrect but good faith reporting and of failing to report suspected abuse or neglect of children or the elderly. 5. Understand that there are no pathognomic signs for inflicted burn injury. 6. Clinically assess burned pediatric or elderly patients within a framework that will minimize the risk of missing or inappropriately suspecting injuries that stem from abuse or neglect. ⋯ This article deals with burns inflicted on children and the elderly, two particularly vulnerable societal groups. Though inflicted burning is a relatively rare method of inflicting physical abuse, failure to diagnose it has far-reaching ramifications. These injuries pose both medical and forensic problems for physicians, along with unique ethical dilemmas. This article is a collaboration between surgeons and lawyers providing a holistic, workable approach to the management of inflicted burn injury. The authors first describe the legal considerations that must be appreciated by U.S. physicians, then they suggest a rational and balanced clinical approach to the assessment of burn injuries that may have been inflicted intentionally or negligently on children and the elderly.