Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Sep 2013
Neuromusculotendinous transfer: an original surgical concept for the treatment of drop foot with long-term follow-up.
An original surgical technique for the correction of drop foot is demonstrated. ⋯ To compensate for the loss of function of the anterior muscle compartment, neuromusculotendinous transfer of the gastrocnemius muscle has proved to be highly successful. Voluntary movement of the transferred muscle and fully automatic walking was achieved in the majority of patients treated. In contrast to the commonly used treatment of tibialis posterior muscle transfer, no reeducation of the transferred muscle was needed.
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Local anesthetic injection is often cited in literature as the most painful part of minor procedures. It is also very possible for all doctors to get better at giving local anesthesia with less pain for patients. The purpose of this article is to illustrate and simplify how to inject local anesthesia in an almost pain-free manner. ⋯ There are now excellent techniques for minimizing anesthetic injection pain, with supporting evidence varying from anecdotal to systematic reviews. Medical students and residents can easily learn techniques that reliably limit the pain of local anesthetic injection to the minimal discomfort of only the first fine needlestick. By combining many of these conclusions and techniques offered in the literature, tumescent local anesthetic can be administered to a substantial area such as a hand and forearm for tendon transfers or a face for rhytidectomy, with the patient feeling just the initial poke.
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Plast. Reconstr. Surg. · Sep 2013
Comparative StudyImpact of surgical techniques, biomaterials, and patient variables on rate of nipple necrosis after nipple-sparing mastectomy.
Nipple-sparing mastectomy is appropriate for selected patients with early-stage breast cancer or high breast cancer risk. However, the postoperative rate of nipple necrosis is relatively high (10 to 30 percent). This study analyzed the impact of clinicopathologic and surgical variables on partial and total nipple necrosis rates after nipple-sparing mastectomy and compared overall complication rates between nipple-sparing and skin-sparing mastectomy. ⋯ The authors found no significant difference in the overall incidence of complications in patients who had nipple-sparing mastectomy or skin-sparing mastectomy. Exclusion of axillary lymphatic surgery in nipple-sparing mastectomy patients did not decrease the incidence of complications.
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Plast. Reconstr. Surg. · Sep 2013
Factors associated with readmission following plastic surgery: a review of 10,669 procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program data set.
This study explored factors associated with readmission following plastic surgery using a prospective, validated, national database. ⋯ The most significant predictor of readmission was postoperative complications. Patients experiencing postoperative surgical complications were six times more likely to be readmitted. These findings can assist surgeons and health systems to better tailor preoperative risk counseling, resource allocation, and postoperative discharge services.