Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Dec 1983
The effect of topical epinephrine hydrochloride in saline on blood loss following tangential excision of burn wounds.
Burn wounds that were excised tangentially in the first 21 days after the burn were dressed immediately following excision with either saline or epinephrine hydrochloride-saline compresses (30 mg in 1030 ml normal saline) that were then left for 30 minutes while skin was harvested and banked. Thereafter, saline compresses were applied to all patients' wounds and changed every 4 hours. Banked skin grafts were applied without the need of a second general anesthetic on the first postoperative day. ⋯ Premature ventricular contractions were not observed, although 2 of 29 patients had an elevation in pulse rate of 25 beats per minute or more. No factors were identified that would reduce the blood loss following early tangential burn excision. Before embarking on tangential excision in the early postburn period, one must be prepared to replace 10 percent of the circulating blood volume for each 1 percent of the body surface to be excised.
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We studied the effect of depth of lidocaine injection into the skin, rate of injection, and temperature of the solution on pain experienced. The intervals of onset and duration of anesthesia were also evaluated. ⋯ Full anesthesia to pinprick is produced immediately with superficial injection and is present 5 to 6 minutes after deep injection. We suggest that the best method for minimizing the discomfort of inducing local anesthesia is to use a syringe fitted with a No. 30 needle and to inject the smallest amount necessary slowly into the deep dermal-subcutaneous tissue as the needle is being slowly withdrawn.
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Plast. Reconstr. Surg. · Oct 1983
Case ReportsThermal osteonecrosis complicating Steinmann pin insertion in plastic surgery.
Two typical cases of thermal osteonecrosis due to Steinmann pin insertion are presented. Using proper technique, including predrilling or the use of a hand drill, can eliminate the high morbidity problem.
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Plast. Reconstr. Surg. · Sep 1983
Case ReportsTreatment of axillary burn scar contracture using an arterialized scapular island flap.
A case of an axillary burn scar contracture treated with a scapular island flap is presented. We believe that this will be a useful addition to the treatment of burn scar contractures of the axilla.
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Plast. Reconstr. Surg. · Mar 1983
Comparative StudyReconstruction of the hand with free microneurovascular toe-to-hand transfer: experience with 54 toe transfers.
Over a period of 6 years, 54 toe-to-hand transfers were performed, 24 for thumb and 30 for finger reconstruction. Refinements in evaluation, preparation, and surgical technique are detailed. Forty-nine toes (90.7 percent) survived. ⋯ Power grip averaged 28.5 percent of the normal hand and pinch strength 26.6 percent, great toe transfer giving 35.7 percent and second toe transfer to thumb giving 15.6 percent strength compared with normal. Static two-point discrimination of less than 10 mm was present in 37.5 percent of those studied under 2 years after surgery and in 75 percent of those studied more than 2 years later. The choice of procedure for thumb reconstruction is discussed in detail, as are supplementary skin cover, vascular considerations, and the high exploration rate.