Annals of plastic surgery
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Lymphedema is a chronic, debilitating condition that has traditionally been seen as refractory or incurable. Recent years have brought new advances in the study of lymphedema pathophysiology, as well as diagnostic and therapeutic tools that are changing this perspective. ⋯ The diagnosis of lymphedema requires careful attention to patient risk factors and specific findings on physical examination. Noninvasive diagnostic tools and lymphatic imaging can be helpful to confirm the diagnosis of lymphedema or to address a challenging clinical presentation. Initial treatment with decongestive lymphatic therapy can provide significant improvement in patient symptoms and volume reduction of edematous extremities. Selected patients who are unresponsive to conservative therapy can achieve similar outcomes with surgical intervention, most promisingly suction-assisted lipectomy.
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Annals of plastic surgery · Oct 2007
Randomized Controlled TrialA liposome hydrogel with polyvinyl-pyrrolidone iodine in the local treatment of partial-thickness burn wounds.
Local treatment of burn injuries with conventional anti-infective preparations does not provide the moist environment that promotes fast wound healing. In a randomized controlled trial the effects of liposome polyvinyl-pyrrolidone-iodine (PVP-I) hydrogel, a novel formulation of PVP-I in a liposome hydrogel with high water-binding capacity, were investigated in 43 patients with partial-thickness burn wounds in an intraindividual comparison with a conventional silver-sulfadiazine cream. ⋯ Local tolerability was good; handling and change of dressing were rated as easy. Local treatment with liposome PVP-I hydrogel thus provides fast wound healing with a favorable cosmetic result.
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Annals of plastic surgery · Oct 2007
Comparative StudyActicoat versus Allevyn as a split-thickness skin graft donor-site dressing: a prospective comparative study.
The study comprises 27 operated patients with similar burns. Fifteen donor sites treated with Acticoat (Smith & Nephew) and 12 donor sites treated with Allevyn (Smith & Nephew) have been analyzed with respect to epithelization time, antibacterial effect, ease of dressing change, pain, and pharmacologic and cost-effective characteristics. All donor sites after the reepithelization were evaluated using the Vancouver Scar Scale for the assessment of scars at the fourth, eighth, and 12th weeks. ⋯ There is no considerable difference in the cost of treatment between both dressings. The results obtained determine both dressings as suitable for application on donor sites. If there is a possibility of choice, the Acticoat dressing is preferable.
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Annals of plastic surgery · Oct 2007
Case ReportsVentricular standstill: a complication of intrapleural anesthesia using bupivacaine in a patient with free transverse rectus abdominus myocutaneous flap breast reconstruction.
Transverse rectus abdominus myocutaneous (TRAM) flap is one of the commonly used techniques for breast reconstruction. Postoperative pain relief is of paramount importance following TRAM flap breast reconstruction to avoid potentially preventable complications like chest infection. Several methods of pain control are available, including intrapleural anesthesia. Here we report a case of a patient who developed ventricular standstill as a complication of intrapleural bupivacaine.