Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Sep 2010
The hyperthermic effect of a distal volar forearm nerve block: a possible treatment of acute digital frostbite injuries?
The authors have observed that carpal tunnel surgery nerve blocks consisting of subfascial distal volar forearm injection of 10 cc of 1% lidocaine with epinephrine result in fingers that appear hyperemic, warm, and numb in both median and ulnar nerve distributions. The purposes of this study were to (1) determine whether forearm nerve blocks in patients undergoing carpal tunnel releases result in an objective increase in finger temperature, and (2) document the location and duration of finger anesthesia. ⋯ Forearm nerve blocks produce a chemical sympathectomy that provides a significant increase in skin temperature as a result of vasodilatation in most patients. They also provide prolonged finger numbness. This could be of clinical benefit in patients with acute finger frostbite injuries.
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Plast. Reconstr. Surg. · Sep 2010
ReviewCurrent tools for noninvasive objective assessment of skin scars.
Cutaneous scarring is affected by genetic, physiologic, and biochemical factors. These produce a continuum of scar types (i.e., keloid, hypertrophic, atrophic, contracted, and fine line) that can be symptomatic, aesthetically unsatisfactory, psychologically distressing, and functionally restrictive to the affected individual. Accurate scar assessment allows for quantification of scar evolution and management, and is key to evaluating the effectiveness of applied modulating therapies and treatments. Numerous objective instruments exist for the evaluation of different scar characteristics, but no consensus has been reached as to the most appropriate device. This review aims to explore the current range of noninvasive objective assessment tools available for cutaneous skin scarring, with specific emphasis on their application to research trials and clinical practice. ⋯ There is no overall valid and reliable noninvasive objective assessment tool for measurement of cutaneous skin scar characteristics. Further studies are warranted that compare multiple, parameter-specific instruments in a single-sample group and across a range of scar types.
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Plast. Reconstr. Surg. · Aug 2010
Randomized Controlled Trial Comparative StudyTopical silicone gel versus placebo in promoting the maturation of burn scars: a randomized controlled trial.
Silicone sheets are widely used in the treatment of hypertrophic scars, although application around joints may cause limited adherence and reduced movement. To approach these problems, a topical silicone gel was developed that can be applied easily in a thin layer, and that is nonrestrictive and less apparent. The objective of this study was to investigate the effectiveness of topical silicone gel in promoting the maturation of burn scars. ⋯ Topical silicone gel significantly improves the surface roughness of burn scars, and patients experience significantly less itching in the first half year after application.
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This narrative review provides an overview on the topic of bias as part of a series of articles in Plastic and Reconstructive Surgery on evidence-based medicine. Bias can occur in the planning, data collection, analysis, and publication phases of research. Understanding research bias allows readers to critically and independently review the scientific literature and avoid treatments that are suboptimal or potentially harmful. A thorough understanding of bias and how it affects study results is essential for the practice of evidence-based medicine.