Annals of plastic surgery
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Annals of plastic surgery · May 2013
Logistics of building a laser practice for the treatment of hypertrophic burn scars.
Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars. ⋯ Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.
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Annals of plastic surgery · May 2013
Case Reports Clinical TrialProspective, before-after cohort study to assess the efficacy of laser therapy on hypertrophic burn scars.
Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture. Best practices for management continue to evolve. Lasers have recently been added to treatment algorithms, but indications and efficacy have not been fully defined. We studied the impact of laser therapies on hypertrophic burn scars. ⋯ Laser therapies significantly improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments.
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Annals of plastic surgery · May 2013
ReviewThe evils of nicotine: an evidence-based guide to smoking and plastic surgery.
As nearly 1 of 5 adult Americans are smokers, plastic surgeons should be familiar with the effect of smoking on perioperative risk, the importance of smoking cessation, and the tools to help patients quit. Cigarette smoke contains over 250 known toxins, including nicotine, carbon monoxide, hydrogen cyanide, and nitric oxide, which all are known to impair wound healing, through multiple mechanisms. ⋯ The ameliorating effects of cessation are supported by level 1 evidence, which suggests that the optimal duration of preoperative cessation is 4 weeks or longer. Nicotine replacement therapy and smoking cessation medications are effective aids for quitting and should be familiar to plastic surgeons.
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Annals of plastic surgery · May 2013
Case ReportsLower extremity nerve decompression in burn patients.
Generalized neuropathy after burn injury is quite common, but the diagnosis and management of peripheral nerve compression, late after injury, can be difficult. Although the release of upper extremity nerves has been reported, the indications, timing, and outcomes of lower extremity nerve decompression, after burn injury, are not known. ⋯ Lower extremity nerve decompression is effective in improving sensory and motor dysfunction, even late after burn injury, and should be considered in patients with persistent foot drop, paresthesias, and dysesthesias, given the low morbidity of this procedure and high potential for improved function.
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Annals of plastic surgery · May 2013
Case ReportsIncidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars.
Hypertrophic burn scars may generate significant morbidity, due to intense pruritus, persistent dysesthesias, and contracture. Although treatment with pulsed dye laser and fractional CO2 laser may improve symptoms, incidence of secondary wound complications is not well known. We examined the adverse event profile of laser therapies for the treatment of hypertrophic burn scars. ⋯ Despite the frequent occurrence of pain and mild blistering after laser treatment of hypertrophic burn scars, major adverse effects were exceedingly rare, with improvement noted in all patients. Patients with higher Fitzpatrick skin types must be handled with care, to avoid complications of blistering and hypopigmentation.