Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Apr 1995
Case ReportsSupplemental oxygen: ensuring its safe delivery during facial surgery.
Electrosurgical coagulation in the presence of blow-by oxygen is a potential source of fire in facial surgery. A case report of a patient sustaining partial-thickness facial burns secondary to such a flash fire is presented. A fiberglass facial model is then used to study the variables involved in providing supplemental oxygen when an electrosurgical unit is employed. ⋯ The properly placed nasal cannula did not ignite at any combination of oxygen flow, coagulation current level, or distance from the oxygen source. Facial cutaneous surgery in patients provided supplemental oxygen should be practiced with caution when an electrosurgical unit is used for coagulation. The oxygen delivery systems adapted for use are hazardous and should not be used until their safety has been demonstrated.
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Retrospective review of the records of 73 consecutive young children who underwent craniosynostosis surgery between 1978 and 1992 in one center was conducted to determine transfusion requirements, to document morbidity, and to identify causative variables associated with transfusion. Operative age and weight, affected suture(s), craniofacial surgeon, neurosurgeon, anesthesiologist, preoperative and postoperative hematocrit, and transfusion volumes of blood and crystalline products were recoded. Transfusion volumes were converted to percent estimated red cell mass for analysis. ⋯ Transfusions differed statistically among suture(s), neurosurgeons, and anesthesiologists. Extensive cranio-orbital surgery for synostosis in young children does not produce excessive hemorrhage or transfusion morbidity. The anesthesiologist and neurosurgeon may be equally or more important than the affected suture(s) as causal variables in transfusion.
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The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin similar in color and texture and superior to skin obtained elsewhere, thereby surpassing conventional methods. However, there still remain some problems relating to procedural details, such as the selection of tissue expanders and sites of their insertion; the design, elevation, suturing, and fixation of the expanded flap; and the management of free margins such as the lower lip and lower eyelid. In each case, some modification is required with respect to the status of the defect. The experiences encountered in a series of 23 patients are described, with illustration of several representative cases, and advantages and problems are discussed.