Plastic and reconstructive surgery
-
Plast. Reconstr. Surg. · Jul 2002
Case ReportsUse of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures.
Free thin anterolateral thigh flaps combined with cervicoplasty were used in a series of seven patients undergoing reconstruction for previous burn injury from September of 2000 to May of 2001 at Chang Gung Memorial Hospital. This method uses a suprafascial dissection technique to provide a thin flap to improve cervical contour. Neck contractures had resulted from flame burns in six patients and from a chemical burn in one patient. ⋯ At a mean follow-up time of 5 months, the functional improvement was measured as follows: a mean increase in extension of 30 degrees (preoperatively, 95 degrees; postoperatively, 125 degrees), a mean increase in rotation of 18 degrees (preoperatively, 59 degrees; postoperatively, 77 degrees), and a mean increase in lateral flexion of 12.5 degrees (preoperatively, 26.5 degrees; postoperatively, 39 degrees). The average cervicomandibular angle was improved by 25 degrees (preoperatively, 145 degrees; postoperatively, 120 degrees). This series demonstrates that the use of free thin anterolateral thigh flaps combined with cervicoplasty provides a one-stage reconstruction with a thin, pliable flap that achieves good cervical contour with low donor-site morbidity.
-
Plast. Reconstr. Surg. · Jun 2002
Randomized Controlled Trial Clinical TrialThe prevention of emesis in plastic surgery: a randomized, prospective study.
Perhaps the most unpleasant experience following outpatient plastic surgery procedures is postoperative nausea and vomiting. Postoperative nausea and vomiting often results in delayed recovery time and unintended admission, and it can be a contributing factor to the formation of hematoma following rhytidectomy. Ondansetron (Zofran) has proven benefit in preventing postoperative nausea and vomiting if given before general anesthesia in a variety of surgical procedures. ⋯ The zero incidence of emesis in cases less than 90 minutes does not support the routine use of prophylaxis in such cases. Patient satisfaction in plastic surgery is derived from the overall subjective experience of the event as much as by the final result. By remaining attentive to patient concerns and optimizing perioperative care, we can improve the subjective experience for our patients.
-
Plast. Reconstr. Surg. · Jun 2002
Randomized Controlled Trial Clinical TrialThe use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children.
The vast majority of infants and children undergoing craniosynostosis correction receive a blood transfusion. The risks of blood transfusion include, but are not limited to, acute hemolytic reactions (approximately 1 of 250,000), human immunodeficiency virus (approximately 1 of 200,000), hepatitis B and C (approximately 1 of 30,000 each), and transfusion-related lung injuries (approximately 1 of 5000). This prospective, single-blinded, randomized study was undertaken to examine the safety and efficacy of preoperative single weekly dosing with erythropoietin (epoetin alfa) in reducing the rate of transfusion in infants and small children undergoing craniosynostosis repair. ⋯ There were no adverse effects noted among children receiving erythropoietin, nor were there any surgical complications. The authors conclude that the preoperative administration of erythropoietin significantly raised hemoglobin levels and reduced the need for a blood transfusion with craniosynostosis correction. More suggestions are made that may further reduce the need for blood transfusions, and a cost-benefit analysis is discussed.
-
Plast. Reconstr. Surg. · Jun 2002
Comparative StudyFirst-line treatment of deep sternal infection by a plastic surgical approach: superior results compared with conventional cardiac surgical orthodoxy.
A majority of cardiac surgeons manage deep sternal infection with sternal wound debridement, rewiring, and closed drainage, with or without antibiotic saline tube irrigation (the traditional approach). The authors' experience with the traditional approach was unsatisfactory; therefore, they undertook a radical change in management: an immediate plastic surgical approach. Hence, deep sternal infection was managed by immediate debridement followed by a bilateral pectoralis major myocutaneous advancement flap with greater omental transposition (PMOFR). ⋯ A predetermined plan of immediate debridement followed by treatment with PMOFR rapidly, reliably, and effectively eradicated deep sternal infection. This translated to reduced length of stay and need for additional surgery, improved survival, and excellent intermediate freedom from deep sternal infection, with minimal patient dissatisfaction. The traditional approach to managing deep sternal infection was thus abandoned.
-
Plast. Reconstr. Surg. · Jun 2002
Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.
The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used in 660 patients at Chang Gung Memorial Hospital. Four hundred eighty-four anterolateral thigh flaps were used for head and neck region recontruction in 475 patients, 58 flaps were used for upper extremity reconstruction in 58 patients, 121 flaps were used for lower extremity reconstruction in 119 patients, and nine flaps were used for trunk reconstruction in nine patients. ⋯ The anterolateral thigh flap is a reliable flap that supplies a large area of skin. This flap can be harvested irrespective of whether the skin vessels are septocutaneous or musculocutaneous. It is a versatile soft-tissue flap in which thickness and volume can be adjusted for the extent of the defect, and it can replace most soft-tissue free flaps in most clinical situations.