Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Dec 1995
Case ReportsAesthetic restoration of the severely disfigured face in burn victims: a comprehensive strategy.
Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. The strategy of modern facial restoration emphasizes enhancement of aesthetic appearance as significantly as mitigation of functional impairment. Criteria for success are (1) an undistracted "normal" look at conversational distance, (2) facial balance and symmetry, (3) distinct aesthetic units fused by inconspicuous scars, (4) "doughy" skin texture appropriate for corrective makeup, and (5) dynamic facial expression. ⋯ In all cases, facial integrity has been aesthetically restored and, in most instances, with makeup, is near normal in social settings at conversational distances. Facial animation is retained and color matches are excellent. One flap was lost early in the series.
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Plast. Reconstr. Surg. · Oct 1995
Comparative Study Clinical Trial Controlled Clinical TrialA comparison of sedation techniques for outpatient rhinoplasty: midazolam versus midazolam plus ketamine.
A total of 859 patients presenting for outpatient rhinoplasty were divided into two groups that received intravenous sedation of midazolam 0.1 mg/kg either with or without ketamine 0.4 to 0.5 mg/kg immediately prior to conduct of the local anesthetic injections and surgery. Additional midazolam was given intraoperatively as needed. No patient received narcotic either as premedication or intraoperatively. ⋯ Those who had also received ketamine had a lesser chance of remembering the local anesthetic injections (11.1 versus 19.8 percent) and a lesser likelihood of being dissatisfied with their surgical experience (3.3 versus 7.4 percent). In conclusion, the use of an opioid-free sedative technique of intravenous midazolam was highly successful in meeting the needs of both patients and surgeons. The addition of a single preblock dose of intravenous ketamine to intravenous midazolam sedation for rhinoplasty does not improve intraoperative conditions for the surgeon in terms of patient behavior.(ABSTRACT TRUNCATED AT 250 WORDS)
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Plast. Reconstr. Surg. · Aug 1995
Case ReportsPrefabricated vertical myocutaneous flap of the nose in facially burned patients.
In facially burned patients, a simple and effective technique is described for reconstruction of deformities of the lower third of the nose. The first stage consists of replacing the dorsal scarred skin with a skin graft from the buttocks or other area. The second stage is a vertical columella-based prefabricated flap that is outlined beginning near the tip of the nose and extending superiorly to the glabellar region. ⋯ This very well vascularized vertical prefabricated myocutaneous flap can cover a cartilage graft taken from the ear to reconstruct an alar rim. The donor site is closed by undermining the nasal skin laterally on each side and suturing the edges at the dorsum to leave an acceptable midline scar. In patients for whom a nasolabial flap or other technique is not suitable or is impossible, this new and simple technique may be used successfully.