Annals of plastic surgery
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Annals of plastic surgery · Feb 2000
The vessel loop shoelace technique for closure of fasciotomy wounds.
Compartment syndrome of the extremity may occur after severe trauma secondary to fractures, vascular ischemia, crush, or electrical injury. Treatment consists of expedient fasciotomy to avoid permanent injury to muscles or nerves. Management of the wounds postoperatively has consisted traditionally of primary closure, healing by secondary intention, or split-thickness skin grafting to cover defects. ⋯ Sporadic case reports using similar techniques have been published in the orthopedic literature with comparable results. The current series includes 37 patients, ages 9 to 48 years, who were treated for open fasciotomy. There were 11 upper extremity and 26 lower extremity wounds treated, all of which were closed within 3 weeks.
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There are numerous methods cited in the literature on the treatment of painful neuroma. Nonsurgical methods range from injections with various materials into the nerve end to desensitization of nerve pain conduction pathways. Some surgical treatments aim to alter the environment of the amputated nerve end by transposing it into muscle or bone, others have designed various flaps to protect truncated nerve ends from scar tissue, and still others try to "cap" the nerve with silicon, a nerve graft, or epineurium to prevent nerve regeneration. ⋯ The authors review the common treatments for painful neuromas. In addition, they review the preliminary results of the extended autologous venous nerve conduit as a novel technique of treating painful neuromas. They also report recent investigations into the pathophysiology of injured nerves.
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Annals of plastic surgery · Nov 1999
Skin flap survival after superficial and deep partial-thickness burn injury.
Whether a flap can be raised successfully in a body region that has been subjected to burn injury remains an issue. The aim of this study was to investigate the survival of skin flaps that were elevated after superficial and deep partial-thickness burn injury in a rat model. Sixty-five rats were divided into five groups: Group 1 (N = 15) was the control group, group 2 (N = 10) included rats with superficial partial-thickness burns that had flaps elevated on day 0, group 3 (N = 15) was comprised up of rats with superficial partial-thickness burns that had flaps elevated on day 4, group 4 (N = 10) included rats with deep partial-thickness burns that had flaps elevated on day 0, and group 5 (N = 15) was comprised of rats with deep partial-thickness burns that had flaps elevated on day 4. ⋯ The surviving portions of flaps that were elevated on day 4 in superficial partial-thickness burn zones (group 3) were similar to the surviving areas of flaps in the control group (group 1), and were larger than those of all other groups (groups 2, 4, and 5). In this rat model, flaps were elevated in superficial dermal burn zones with successful outcomes. However, raising flaps in deep dermal burn zones was not a reliable method.
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Annals of plastic surgery · Sep 1999
Comparative StudyAllogeneic cultured keratinocytes vs. cadaveric skin to cover wide-mesh autogenous split-thickness skin grafts.
Improved shock therapy has extended the limits of survival in patients with massive burns, and nowadays skin coverage has become the major problem in burn management. The use of mesh skin grafts is still the simplest technique to expand the amount of available donor skin. However, very wide-mesh skin grafts take a very long time to heal, often resulting in unaesthetic scar formation. ⋯ At long-term follow-up, clinical results and scar characteristics were not significantly different in the two compared groups. It is concluded from the results of this study that, during the early phase, epithelialization was faster with allogeneic cultured keratinocytes compared with cadaveric skin. However, taking into account the substantial difference in costs, the described use of cryopreserved allogeneic cultured keratinocytes as a double layer on meshed autogenous split-thickness skin grafts can hardly be advocated.