Annals of plastic surgery
-
Annals of plastic surgery · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparative efficacy of ropivacaine and bupivacaine infiltrative analgesia in otoplasty.
A prospective double-blind study was conducted to compare the anesthetic efficacy of ropivacaine and bupivacaine in a bilaterally symmetrical otoplasty model. Because ropivacaine has a significantly lower toxic potential than bupivacaine, it may be established as the anesthetic agent of choice for low-dose infiltration anesthesia in routine aesthetic facial operations. ⋯ Intraoperative success rates were similar, and overall analgesia achieved at 2 hours, 6 hours, and 10 hours postoperatively was not found to be statistically different between ropivacaine and bupivacaine. The authors conclude that ropivacaine can be used as an effective alternative to bupivacaine in otoplasty.
-
Annals of plastic surgery · Apr 2005
Review Comparative StudyA comparison of combinations of titanium and resorbable plating systems for repair of isolated zygomatic fractures in the adult: a quantitative biomechanical study.
Multiple studies have sought to determine the postreduction stability of internal fixation in zygomaticomaxillary complex (ZMC) fractures. Three-point fixation with titanium miniplates is increasingly recommended to repair these injuries. Use of bioresorbable plates has been suggested to eliminate potential postoperative hardware complications. ⋯ Overall, the method of fixation significantly affected the force required for mechanical failure of ZMC fractures (P <0.0001). The presence of teeth significantly increases the force required for implant failure in ZMC fracture fixation when combinations of plates are used (P = 0.038). All combinations of titanium and resorbable plates may be sufficient to overcome the displacing forces produced by the masseter and may be used for internal fixation of isolated ZMC fractures in the adult.
-
Annals of plastic surgery · Apr 2005
Referral patterns and severity distribution of burn care: implications for burn centers and surgical training.
The purpose of this investigation was to examine burn-patient referral patterns and severity of burn distribution, as well as to determine the impact these patterns may have on the education of surgeons in training. Data from the 1998-1999 National Inpatient Sample (NIS) and the Michigan Hospital Association (MHA) were analyzed based upon burn diagnostic-related groups (DRGs; 504-511) and their referral distribution was documented. Providers were segregated into high-volume hospitals (HVHs) treating >100 patients per year, moderate-volume hospitals treating 25 to 99 patients per year, and low-volume hospitals (LVHs) treating <25 patients per year. ⋯ The most severe burns are reaching high-volume centers, but many burns continue to remain within LVHs. A wide variation in patient distribution occurs throughout the United States. Matching the patient and resident distribution is essential for effective training of surgical residents.
-
Annals of plastic surgery · Apr 2005
Hyperfibrinogenemia alone does not affect the patency of microvascular anastomosis: clinical experience and animal study.
Preventing vascular thrombosis in microsurgery is a prerequisite for a successful outcome. High plasma fibrinogen levels have been associated with thromboembolic risk in patients with cancer or cardiovascular disease. Patients with these comorbidities and associated hyperfibrinogenemia oftentimes require microsurgical reconstruction. ⋯ There were no statistical differences in the patency rates (P > 0.05) or perfusion units of femoral arteries (P = 0.84) and femoral veins (P = 0.51) after vessels division and reanastomosis, respectively. In summary, there was no correlation between experimentally induced hyperfibrinogenemia and the enhancement of thrombosis risk after microvascular surgery. This experimental data can lend support to the idea that microvascular anastomosis could be safely performed in patients with hyperfibrinogenemia alone without untoward thrombotic complications.