Aesthetic plastic surgery
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Aesthetic plastic surgery · Jul 2003
Case ReportsAtypical pyoderma gangrenosum after breast reduction.
Although rare, pyoderma gangrenosum (PG) occurs as one of the worst local complications following plastic surgery to the breast. The early manifestations are similar to a necrotizing wound infection, so diagnosis and correct management are often delayed. Failure of response to the aggressive treatment strategies needed for necrotizing wound infections and the phenomenon of pathergy will often raise the clinical suspicion of PG. ⋯ Smaller defects are best left to heal by secondary intention, as pathergy can reactivate the syndrome and cause an even larger skin wound. Larger defects are repaired with skin grafts or flaps. We report a case of atypical (bullous) PG in a healthy 57 year-old white woman following reduction mammaplasty.
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Aesthetic plastic surgery · Mar 2003
Randomized Controlled Trial Clinical TrialComparative analysis of bupivacaine and ropivacaine for infiltration analgesia for bilateral breast surgery.
Local anesthesia infiltration has been established as a preferred method of perioperative analgesia in many cosmetic operations. In an attempt to maximize the risk-benefit ratio of local anesthesia, a study was conducted to compare efficacy of two local anaesthetic agents. Bupivacaine was compared to ropivacaine in a bilaterally symmetrical breast surgery model. ⋯ There was, however, a statistical and clinical difference in the efficacy of local anaesthetic infiltration of both agents in breast augmentation patients as compared to breast reduction patients, local anaesthetic being less effective in patients who had submuscular breast augmentation than in patients who had breast reduction. In view of these findings, it appears reasonable to recommend the use of ropivacaine in high-dose infiltration breast analgesia, as it is reported to be less cardiotoxic than bupivacaine. Serious attention needs also to be given to the adequacy of field infiltration of local anesthesia in submuscular breast augmentation.
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Many aspects of the biology and effective therapy of proliferative scars remain undefined, in part due to a lack of an accurate, practical, reproducible, and economical animal model for systematically studying hypertrophic scars. This study was designed to investigate whether hypertrophic scar formation could be induced in guinea pigs by removal of the panniculus carnosus alone, and by a combination of the removal of the panniculus carnosus with application of coal tar afterwards. Whole thickness skin excision or deep partial thickness injury was used to create the lesions on intact skin. ⋯ While hypertrophic scar development was not seen in group I and group II, scars with morphological and biochemical properties specific to hypertrophic scars developed in one third of animals in group III after healing of the wounds treated with coal tar. In conclusion, it is shown that it is possible to develop experimental hypertrophic scars in guinea pigs with morphological and biochemical properties similar to those of human proliferative scars. Therefore this model is a new, practical, and economical experimental animal model to study proliferative scars, although improvements are needed to increase yield.
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Postoperative bandaging following otoplasty is commonly used. It is also frequently perceived as cumbersome and often lost by patients. Simple splinting potentially offers a less obtrusive postoperative ear fixation. ⋯ The initial favorable experience with the ear braces is described following the otoplasty of 17 ears. It is suggested that the use of splints may improve the immediate postoperative appearance, and subsequently compliance for patients. However, the long-term effect of postoperative bandaging remains unknown.
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Aesthetic plastic surgery · Mar 2002
Case ReportsSubdermabrasion in the treatment of post-burn facial hypertrophic scars.
Hypertrophic scars cause great discomfort to the patient and pose a challenge for the reconstructive surgeon. This is particularly true in the facial area. Optimal function and aesthetic appearance are the main goals of reconstruction. ⋯ The technique consists of removal of all scarred skin from the aesthetic unit, dermabrasion of subcutaneous tissues, including the muscular surface (subdermabrasion), and a full thickness skin grafting. This technique was applied in a young patient with hypertrophic burn scars of the chin. Biopsy confirmed our basic assumption that hypertrophic scars extend into the muscular plane.